You’re listening to a press conference from the Harvard School of Public Health with Michael Mina, assistant professor of epidemiology. This call was recorded at 11 a.m. Eastern Time on Friday, January 15th.
Transcript
MODERATOR: All right. Dr. Mina, do you have any opening remarks?
MICHAEL MINA: No, I’m happy to take questions.
MODERATOR: All right, great. First question.
Q: Hi, thanks for doing this. We heard governors and health care leaders expressing concern about health care workers not taking the COVID vaccine. Do you have any thoughts on why this appears to be an issue? What could potentially be done about it to inspire confidence? And are you worried about this potentially sending a message to the general public?
MICHAEL MINA: Well, it’s a great question. It’s not directly in my domain of expertise to comment on why there’s sort of a large group of people who are refusing. But what I would say is I think especially for young people, there is probably some reluctance to get a vaccine, I don’t know, I think some people might be doing it because they are concerned about safety profiles or something like that. But I think a lot of people are refusing to get a vaccine right now because they’re seeing themselves as young and healthy and potentially sort of hopping in front of a of some elderly or more vulnerable person that they perceive would otherwise get the vaccine. So I think that both of those two are at play for health care workers. They’re put in an interesting position of being first in line, which comes with some levels of potential guilt, I suppose. So I don’t know that I’m too concerned about it sending the wrong message. I think at the end of the day, people are going to likely get vaccinated. You know, we’re going to see lots and lots of people end up getting vaccinated. So I think we can anticipate things will continue moving forward.
Q: Thank you.
MODERATOR: Next question.
Q: Morning, Dr. Mina. I assume we’ll probably get to talking about rapid tests, but I was hoping you could speak to the many variants out there. And specifically, I’m curious, I’ve seen some talk of this, I don’t know if to be expected is the right way to put it, but as the pandemic continues, as you have more and more infections and more and more time, perhaps that helps explain why we’re seeing more now. And I’m curious which ones might be concerning you the most?
MICHAEL MINA: I think that from my perspective, this was essentially, a definite that we would start to see this occur so they shouldn’t be taking anyone by surprise. I like to think of viruses like software and new viruses like software version 1.0. It would be extremely naive if we thought that for some reason this virus was going to come out and be virus 1.0 of itself and not have any real way to improve itself, that just isn’t how viruses work. So in that sense, these mutations are expected. What exactly happens now with them is that the world is the oyster for this virus, if you will. It has a lot of room to grow. It’s showing us how plastic it spike protein is. It can continue to mutate in ways that hopefully we can identify, and we can predict. But viruses have a tricky way of finding new ways to mutate that we won’t be able to predict. The South Africa variant, for example, I will say that there’s two. For me, it’s not what each of these individual variants represent, or it’s not what they are that is most concerning. It’s really what they represent. They represent that there are more variants to come and potentially strains that can start evading immunity once we really start bottlenecking this virus. I would say that the UK variant that did come about, that is concerning because it’s speeding through populations so much quicker, even without increasing any sort of pathogenicity, it will kill more people because it’s going to infect more people. The South Africa variant is showing some ability to evade neutralizing antibodies to a certain extent. And so if we continue to see variants like that, that would be very, very damaging, potentially, of course. So this brings us to sort of we need to do everything we can now to get ourselves ready to get transmission as low as we possibly can for this virus. The best way to prevent mutant strains from emerging is to slow transmission and to do that without the vaccine, through other measures. So I’ve, of course, talked about testing very much. I think President elect Biden will be really pushing for testing as a means to control this virus in a way that we haven’t seen yet. And we’ll also continue seeing all of the other public health approaches continue. And I hope that we can just get transmission down as much as possible and reduce the likelihood of a bad mutant.
Q: Thank you.
MODERATOR: Next question.
Q: Hi, thanks very much. I do have a question about the variants. I’m wondering, specifically, if you think that the travel restrictions that are being imposed on the U.K. impose some restrictions against Portugal and Latin America over the Brazil variant that has emerged. Do travel restrictions in this context have any benefit?
MICHAEL MINA: This is like déja vu. You know, it’s too little, too late, I suppose. My feeling is the variant, it’s already spreading. It can have some small benefit at this point. But, you know, maybe we end up getting small numbers of people from abroad who are contributing to the pool, if you will. But at the end of the day, these variants are already most likely in the United States. And if they’re not in the United States, then we’re a country with some of the highest rates of infections in the world. So we can breed our own variants that are just as bad or worse. So I think, you know, travel restrictions might be useful for just mitigating spread overall. But if it’s in an attempt to really stop one of these strains from spreading into the United States or outside, I think the ship has sailed already.
Q: Thank you so much.
MODERATOR: Next question.
Q: Good morning, Doctor. My question has to do with the distribution of the vaccine and especially the wildly differential rates between states. West Virginia is leading the country and in distribution of the vaccine. And I’m wondering if you have any thoughts as to why that might be happening and what other states can learn from West Virginia?
MICHAEL MINA: Unfortunately, I haven’t been following each individual state closely enough to really be able to comment much on what they’re doing. You know, a common theme in this pandemic has been regulating ourselves into the ground and trying to do things so not by the book but trying to follow every little guideline so much that we lose track of why the guidelines are even there. And we start actually doing damage to our ability to know whether it’s to get tests out or get vaccines out. So I think sometimes you just have to put systems in place that will accelerate vaccines just to get them out to as many people as possible with some priority list. But make sure that you’re just kind of not overthinking it, I suppose. And I don’t know if West Virginia is doing something that’s just very aggressive and using the right kinds of minds, whether it’s generals in the army or something to really organize. But I would say that I think we have overthought too many aspects of this to our own peril. And we can’t overthink this one. We just have to do it.
Q: I know one thing they’ve been doing there is they created their own distribution network using their own pharmacies instead of relying on CBS and Walgreens. What do you make of that?
MICHAEL MINA: If it’s working, I think it’s great. I mean, CVS and Walgreens have an amazing reach and so there are good sort of one stop shop, if you will, to talk to a few people and get a vaccine distributed to the whole country or within a state, to the whole state. But if you have a more malleable system, for example, because it’s a smaller chain, but it’s across the whole state or multiple pharmacies, by all means, I think that we should be using grassroots efforts, if you will. We should be using big chains. We should be using whatever is fastest, whatever is going to be the nimblest and where we will get people who are dedicated to just helping with this cause of keeping the population safe.
Q: Thank you.
MODERATOR: Next question.
Q: I have a question regarding the debate about whether or not it is advisable to follow the UK approach in postponing the second dose of the vaccines. There has been a lot of talk about possible risk of promoting vaccine resistant mutations this way and I sort of wonder, what do you think about that, because this now seems to be the most effective argument against the British strategy. I think what I’m specifically wondering the most about is if you have any thoughts about the way the increased natural infections. If we do not do it this way, it may also elevate the general risk of mutations. So I was wondering if you have any thoughts about the way these concern against each other?
MICHAEL MINA: You know, this is a great question. I would say that whether or not a single dose, you know, there’s been this idea of partial immunity that’s been kicked around. And I think that this is largely an error to assume to really put so much weight on this. And the reason it’s being utilized as a talking point or as a comment is a comparison of this to antibiotics. And people know, for example, that if you don’t take your whole course of antibiotics, you have a chance of breeding a mutant strain that can resist your antibiotics. Immunity is different because the denominator with immunity is everyone who doesn’t have any immunity or who doesn’t have sterilizing immunity. So we can’t forget that if you are unvaccinated, if you don’t have any vaccines yet, you are going to also have to pass through a period of partial immunity. And so the question then is, does starting with some boost or some partial immunity, if you will, and lower affinity antibodies from a single dose, when you actually do get the infection, are you able to tackle the virus so much faster that that outweighs any risk of putting the virus into an environment where low affinity antibodies already exist? If you haven’t had any vaccines yet, you’re going to also have to go through this whole period of low affinity antibody maturation. But the benefit is that you’ll do it in the context of innate immunity and interferons and other antibodies that might be helping out. So it’s really a balance. And I would say that we just don’t have the right models built to understand which is going to be more dangerous. But I think that what has been missing from the conversation is this idea that everyone who is naive, who has zero vaccines, will still have to go through the same process and they’ll be going through this partial immunity the whole time that they’re tackling the virus versus somebody who’s got one vaccine, they might be able to tackle the virus very quickly. We already saw, for example, that efficacy rose to over 90 percent by the time people were getting were just about to get the second dose. So we saw just how powerful a single dose can be. And there’s been a lot of misinformation out there in the media talking about 50 percent efficacy before dose two. That number should have never been put out by the pharmacies, by those papers. You have to look at the first dose efficacy after 12 days or so. And if you look after that, it’s about 92 percent efficacy before dose two. How long that lasts is unclear. But if you can stretch it out, the twenty-one- and twenty-eight-day window was only chosen for the most part to accelerate the trials, it wasn’t a biological property, it wasn’t because that was necessarily going to be the best timing. It was because they wanted to get the trials over and done with and not waiting an extra two months for the results to come in. So I think the UK is taking a strategy that makes sense. It’s not going to be the strategy for everyone. They’re banking on the idea that there’s going to be more supply. And that’s an OK decision, because if there’s not more supply, then we’re all in a much worse place than we thought. So I think it’s OK to assume that the supply will be there and we just have to get as many vaccines as possible. There’s no reason to have vaccines at the moment sitting in freezers, not going out if you can get them out to people.
Q: Thank you. I don’t know if the upcoming results from the Johnson and Johnson study. That’s a one dose vaccine candidate. I don’t know if that could possibly shed some light on the matter, at least when it comes to the AstraZeneca vaccine, that is built on the same technology.
MICHAEL MINA: Yeah, it will be interesting to see. I mean, they are different. Some critics will say that, and rightly so, that the mRNA vaccines may be more than an adenovector vaccine required boost. But, you know, it’s very unclear to me. For example, the mRNA vaccines are doing so well, the two-dose regimen of AstraZeneca was much lower efficacy than even the single dose appeared to be from the mRNA vaccines. My one recommendation to policymakers and others is to keep our eye on the ball and make sure we are optimizing at every step for public health and not getting lost in the weeds of trying to optimize individual immune responses at the expense of stopping this pandemic. I think we just need to remember that.
MODERATOR: Next question.
Q: Hey, Michael, thanks for doing this every week as you do. My question actually kind of follows up with what John just asked, I guess is more specific to the US. Recently, Health and Human Services Secretary Alex Azar told states to use up their second dose or the reserve of second doses to speed up vaccination and relying on manufacturing to fill in those second doses later once they’re available. The federal government, as we learned today, I’m not sure if you saw this, but The Washington Post published that the federal government is not holding reserve. I guess they’ve already given them to the states. So what do you think of states going ahead and doing this? Just using up their entire reserve, relying on manufacturing and the logistical infrastructure to send them their new allocations as soon as they can to fill in people who have gotten that first dose? And I guess given our current infrastructure, would that even be possible to achieve logistically if we just gave out everything and try to find people later? Are there any risks associated with that?
MICHAEL MINA: I would say that ideally what will happen is we will go through the reserves sort of in real time, and you know, if somebody is slated to come back at day twenty-eight, then they will do that. They’ll come back at day twenty-eight and there will be a dose for them. Now, if there’s really no dose for them, because they’ve been given out, that might sound bad for the person who isn’t getting their second dose. But again, these trials, while they looked at only days twenty-one and twenty-eight, that doesn’t mean that those were the optimal time points. The optimal time points very well could be two or three months delayed. Most vaccine schedules are much more separated. Unfortunately, once again, regulation and sort of driving policy and public health decision making rather than the other way around, we should be using everything we know about immunology, everything we know from the past about vaccines to say, look, let’s be real for a moment. We know that immunity isn’t going to go up to 90 percent before dose two and then just drop off. It’s going to probably keep going up and it’s going to level off for a while and then maybe it will wane over a couple of months or more. And so I think the logistics challenge is the most important one that you bring up. I’m not concerned about the biology here. I think people’s immune systems will still boost just fine if they get it at eight weeks or even twelve weeks. But making sure that people know how to get it and making sure that if somebody comes in for a vaccine at day twenty-eight and it’s not there, that there is a messaging system of some sort to let communities at a local level know if you received your first dose sign up again, we got a new million doses. And yesterday we will be supporting the rollout of those two second dose people this week. I think we just have to ensure that those pieces are in place. Unfortunately, there wasn’t a lot of thought by our current administration put into the public health aspect of vaccines. There was a lot of thought put into the biology and the medicine and the trials. And then once again, when it came to the public health part, the boots on the ground distribution, it just wasn’t well thought out. And so now it’s up to the states to really try to be malleable and try to be nimble and adaptable and figure out how to do this quickly. We have to do it. I hope maybe we can take lessons from West Virginia, maybe we can take lessons from Israel. There are places on Earth that have now really been good at getting vaccines out sufficiently. And I think that this is an OK approach, but we do have to be careful to make sure that people understand how to get a second dose if they’re dose sort of that they were expecting isn’t available on time.
Q: So I guess my follow up to that would be, would you know if people come back and the second dose isn’t there? I mean, would you be worried that they might lose faith in the system, they’d be like, oh, you know, I tried to come back, and the second dose wasn’t there, so why would I try again or something?
MICHAEL MINA: You know, I keep hearing people say this especially the same kind of people who said if masks are perfect, you know, people are going to lose trust. If tests are perfect, people are going to lose trust. We keep saying this argument. It’s like it’s this weird straw man argument that everyone likes to put up. I don’t understand it. The American public is plenty smart. You know, if you tell them, sorry, your vaccine will be in next week, they can get that. I think that we’re better than this as a country. We can understand the public is not a bunch of one-and-a-half-year old’s. The public can understand these pieces. And so I think this is the ideas that you bring up which has been raised, as you say, by many public health people and physicians and others and policy people, but it fits in line with this persistent assumption that Americans will just throw their hands up and put their nose up at a second dose if it’s not there right on time when they need it. I think that we are better than that. We can use messaging. We can get radio ads placed in TV ads and, you know, Twitter, whatever it might be, to let people know in a targeted fashion, hey, your community has done an exceptional job at getting first doses of vaccines out. You’re all safer and better for it. What it means is that you will get your second dose two weeks later. And we just we put those in in the newspapers. We get people to understand what’s going on. I think a lot of people already do understand that. So these are the kind of barriers that frustrate me, maybe more than anything else, because these are person issues. We can deal with these. We just have to get the right people to help. This isn’t something that an epidemiologist should be dealing with or even commenting on, you know, not that it was bad that you asked the question, but, you know, this is something that I want to get a major marketing agency on board and say, hey, they’re the people who know how to talk to the public and we should be bringing these marketing agencies on in every step throughout this pandemic to help bring in the real experts who have a lot of experience changing the hearts and minds of Americans. We continue to not use that very powerful tool, probably because it doesn’t look like a public health tool. It’s not somebody with a Ph.D. and somebody who’s been in marketing their whole life. But that’s the way we should be communicating with the American public. We should have real partnerships built here. And I think we can get over these types of issues.
Q: I don’t want to take up too much time from the other journalists on this call, but, you know, I wanted to ask if there are any dangers to not trying this plan. You know, if we move too slowly with the vaccine rollout and too cautiously, is there a danger that the virus might mutate away from the vaccine because we’re seeing this selective pressure on it and then end up having to start over? And, of course, I mean, obviously, you might cost lives.
MICHAEL MINA: Certainly, I would say that that in all of this, you know, a failure to act quickly and aggressively with this virus is causing lives. It’s been causing lives from day one in the US and elsewhere. I believe pretty firmly that we should be doing everything we can to optimize the vaccine rollout as much as possible. If we sit around and try to get every individual the best immune response, we can at the expense of most people having zero, that’s going to be a problem. I mean, the math is really simple here. And this just gets so much like this antigen testing that the testing problem that I’ve been talking about in this case, the math is simple that you either get if you have two people, you could vaccinate both of them, but you’re holding one vaccine back for this person to get two vaccines and this person gets zero scale that up to a hundred people or a thousand people. At that point, the maximum efficacy of the population level you can have the absolute maximum is 50 percent efficacy. Now, if you give each of them one dose, maybe your maximum efficacy averaged across all those people is 90 percent, maybe it’s 85. But it’s probably going to be a lot better than 50. So these are the ways that we need to start thinking about all of this, whether it’s testing, whether it’s masks or whether it’s vaccines through a population lens and through what I call, I want to create a new field called Public Health Engineering. It’s a way to start thinking about public health, not through this medical lens, but through engineering lens to optimize systems. And so I do think part of this to get to your question is if we act slowly, if we try to do this too methodically, if we focus too much on optimizing every individual immune response and doing a perfect twenty-eight days, that’s not how we win a pandemic that’s killing four thousand people every single day in the United States.
Q: Thank you.
MODERATOR: Next question.
Q: Hi, thank you so much for doing this. I know you’ve touched on vaccine rollout a little bit. Here in Florida where I am, we have six or seven different counties each have a dozen different rules on how to roll it out. You have churches, Publix, CVS, Walgreens, health departments, hospitals. There’s no one plan to insure everyone is going to get a shot. Multiply that by 50, some would say the vaccine rollout in the US is quite a mess right now. Now you have President elect Joe Biden who’s saying we have to federalize this and his new plan that came out last night and make it simpler. How important is that to get more people vaccinated?
MICHAEL MINA: Well, I think it’s extremely important. At the end of the day, to get a shot into somebody’s arm, though, you need people to do it. You know, you can’t send one message from the White House, but what has been lacking in an extraordinary fashion, this entire pandemic has been federal leadership. This virus doesn’t care about borders, really doesn’t care about borders at all. And to tackle it, we need coordinated action, just like in a war. If you have a whole bunch of soldiers doing random movements, you’re never going to win. That war needs to be coordinated and just small amounts of coordination go a really long way. So I think that what President Biden is really getting at here is we need federal oversight or we need federal sort of plans. We need plans so that we’re not asking every county or even every state to come up with their own plans and reinvent the wheel. We need to, you know, create a central plan that takes a lot of pieces into account, that takes the national supply of these vaccines into account and the timetables for that each state will be able to get them not only can be answered at the federal level and really pushes for a national federal policy to make it all work. Eventually it will have to rely on the states to really carry it out independently or individually, rather, but not independently of the federal government.
Q: Thank you.
MODERATOR: Next question.
Q: OK, can you hear me?
MICHAEL MINA: Yes.
Q: All right. Sorry about that. You’ve already gotten a couple of questions about the different vaccine rollout rates between the states and we as reporters, we like to focus on a horse race whenever we can. Are we right to do so in this case? If my state’s trailing West Virginia, does it really matter if my state’s a few weeks or a few months behind another state in terms of saving lives and stopping the pandemic? You’ve said faster is better, but why is faster better?
MICHAEL MINA: Well, faster is better in this case because the quicker we can get people vaccinated, the quicker we can start to have heard effects. We have huge numbers of people dying, and so if we can, I don’t have a feeling one way or the other, if the media should be following one state versus the next and treating it like a race. But if that helps states to put more effort in and do it more quickly, great. I think most states probably have plenty of reason to go as fast as they can at the moment, economically anyway. But certainly, just getting vaccines out faster means that fewer people will die. If I could snap my fingers right now and say that I want half of America to be vaccinated, then I would absolutely do that because that would generally stop the spread of the virus at the moment. So the quicker we can do this, the quicker we will start to see cases decrease. Every person that’s vaccinated who hasn’t been infected yet, as one is one less person to potentially die from this virus.
Q: And I want to just follow up on something you mentioned about the second dose timing, you said in the trials that were done, the timing was set mainly by the pharmaceutical companies to get the trials done faster. And if I understand you correctly, we might get to 90 plus immunity with just one dose. If we wait long enough, how will we know if that second dose is really necessary? Since I think Pfizer and the other companies have decided to drop the double-blind studies, will we really know if that second dose is necessary?
MICHAEL MINA: So I think there are some correlates of immunity that we can look at to say, look, we know that if you get a second dose, you boost your antibodies even more. And that’s generally thought to be good. But this is exactly a number of weeks ago, I wrote an op-ed in The New York Times specifically calling for these studies. Had we started the day we wrote that op-ed, and we could have we still can, we would be a couple of months away from knowing a lot more than we currently do. And these don’t have to be super expensive studies. I wish that we would start them today. What we should be doing is we should get people who have had a single dose already, maybe a month ago and are about to go get a second dose, have them volunteer to not get their second dose, have them volunteer to participate in a trial. We can do this utilizing the current roll out of the vaccine as our study. Maybe it’s people like me in pathology where we don’t really see patients very frequently, but we have gotten vaccines. I didn’t get my vaccine, but that’s only because I never go into the hospital these days. I’m always here, you might not be surprised by that, but you could take people like me who don’t see patients who have access to a vaccine, many who have already gotten their first vaccine and ask them to just forego getting their second. Now, we could do that. We could then test their antibodies on a regular basis after month one, and then we could give them a boost, say, a month, two or month three and look to see, do their antibodies boost in the way that somebody at day twenty-one or twenty-eight boosts? If we did that with just a small number of people, just one hundred people, we would get a much, much better idea. But we’re not even doing the smallest studies to understand the ramifications. This again goes towards this whole problem where we have no ability to optimize the right things and, in this case, optimizing public health. If we wanted to optimize it, we would be doing these studies because the ramifications of taking a bit of time right now in a small number of resources and doing a study of ten thousand people or one hundred people depend on the study design, could potentially mean billions more people get vaccinated this year. I mean, that’s not an exaggeration. But we just aren’t doing it, and I think that it’s a travesty that we’re not running these trials, that we didn’t run them from the beginning. We should have. We should at the moment. We saw that efficacy was staying high for dose one before people got dose two, or was getting high anyway, not necessarily staying. We don’t know the durability, but that’s why we need the trial. And if we’re not doing it, there’s no good argument to be made to not do that trial. It’s sheer lack of will and laziness.
Q: Thank you very much, I appreciate that.
MODERATOR: Next question.
Q: Morning. Hope you’re doing OK. I’m going to ask the obvious question, which is what do you think about the Biden administration and their plans? Are they going to fix all of these problems you just articulated and you’re testing issues?
MICHAEL MINA: I think that I feel very, very positive about what I’ve been seeing so far from Biden’s administration or incoming administration. I’ve personally had the opportunity to speak on a fairly frequent basis with some folks and in the external task force, and I think that he has built a team that is based around science. We are going to see a whole different era of tackling this virus when this new administration comes on board. I think they are showing clear signals that they want to be aggressive. They recognize that this pandemic is absolutely priority number one. And it’s holistic. It’s getting money into people’s pockets who don’t have income because of this virus. It’s putting the right amounts of money where it needs to be. One of the major pieces he put out yesterday was 50 billion dollars for testing, specifically calling out the need for rapid testing and to scale up rapid testing and get it out to America. I’ve spoken at length about how useful rapid testing, when done appropriately, can be. And the Biden administration is just overtly putting it in their plan that this is going to be a priority. The testing we’ve been doing hasn’t worked. They are now recognizing that the testing we need are rapid tests. They are tests that will give people answers in moments, not days, and can be distributed and sold very cheap and inexpensive, made in the tens of millions a day. We’ll see companies like this company that’s providing tests for the UK and NOVA. They are scaling to literally tens of millions that just one company will produce in a single day, every day moving forward. So the scaling is getting there. And I think the Bush administration is recognizing that this is a powerful tool and they’re taking a reasoned scientific approach to thinking through what are going to be their first steps when they get into office and into power here, how will they be able to really make a differentiating impact on this pandemic? And I feel very positively that this is the right administration to try to tackle this virus.
Q: Great. Definitely thought of you and I read that in the Biden plan. There’s another study or another fact that we don’t know yet, but I was wondering about transmission. I know there was one study that wasn’t funded to help understand transmission. What do you think can be done once vaccinated to understand whether we can still transmit this virus?
MICHAEL MINA: This is another thing we should have been doing this all along. It’s a travesty that we didn’t. For anyone who hasn’t followed this, the reason we need to know if a vaccine inhibits or stops people from transmitting because it makes all the difference in the world towards our efforts to utilize vaccines to achieve herd immunity. If the vaccine prevents us from getting severe disease, but still, the virus can grow in our nose and mouth and be able to spread, then we are going to have to vaccinate many, many more people before we reach herd immunity. My full expectation is that this virus keeps saying that this vaccine will elicit reductions in transmission, but we don’t know how much we’ve seen in monkey models and things like that that people have lower viral loads. And we know that lower viral loads generally reflect lower transmissibility for obvious reasons. But will that last? My biggest concern, I have a number of concerns, but my biggest concern is that we have only studied these vaccines in terms of our formal trials up through a few months to three months after dose two. But there’s reason to believe that after two or three months, all of your plasma blasts that you have, all of these cells that are producing a lot of antibodies, they sort of have to die off. They are temporary cells, and so although the vaccines have been doing a very good job at stopping infection as symptomatic disease, they hopefully, during that period of time, are stopping transmission that we do not look at it closely. One question is, will they continue stopping transmission at month three and four and five and six after all of your front-line cells, if you will, that are spewing out tons of antibodies die off and we just don’t know. So I think we should be doing those studies as well. And again, it doesn’t need to be this quarter of a billion-dollar studies. We could just be taking people today saying, hey, you’ve got a vaccine, let’s start swabbing you daily, you know, and keep the swabs in your freezer and every three weeks mail them into this company will run PCR tests on them. You know, whatever it might be. We can do this very cheap and inexpensive and nimble and quick and put us in a much better position to know what we’re dealing with in the future. That it’s not being supported widely in the US is unfortunate. But my guess is other countries will step in and do these trials.
Q: If it’s not too greedy, I have one more question, which is how long do we give the Biden administration to work? What do you think is the time frame now to expect a difference?
MICHAEL MINA: Well, I think we have to be very clear about what the expectations are. I think we can’t expect a major shift on day one. That’s just not going to happen. But I do think that there is a lot that can be done over the first couple of months. Presidents like to say what they’re going to do in their first hundred days in office. I think it’s always ambitious. It’s always accelerated. But in this case, with this pandemic, I think that there is a tremendous amount that this president can do. And the full administration is coming on board with 100 days in office in that first window of time. I think that they can, if I was advising the president right now directly, I would say, you know, step number one is taking some of that 50 billion that is just set aside, essentially designated for testing, get it to these companies to scale up as quickly as possible. They’re doing a good job on their own. But if the government helps them to scale, that also encourages them to keep their costs low later on. So that will put us in a good position to negotiate good prices with these companies, so we’re not spending 20 dollars per test. We could be spending two dollars. As soon as scaling is getting going, we know that we have a lot of these tests available already. We need to convene the CDC and the Biden administration. They need to come on board, and they need to develop a plan for how exactly these tests will be used. Something akin to the vaccine plans. How are they going to be allocated to states? Is it just going to be money, or these tests are actually going to be allocated and the federal government buys them? That plan needs to put in place very, very early with specifics on how people should use them at home, at work, at school, etc. And then after, that first piece should take weeks and then we should just start seeing these tests get out to the public, get out to the masses. And if the president does that, you know, they can only accelerate vaccines so much. You can’t really do much more with masks. You can’t do much more with shutting down. I mean, unless we really shut down. But with distancing, these tests are something that Biden can stand up on day one and say, this is our plan. We’re going to scale testing. We’re going to create the policy. We’re going to get test to every American household in the next five weeks. And we if we start seeing these tests actually reach into American households in a short order, which they can, we can start seeing cases plummet. We can start seeing whole communities achieving herd affects not herd immunity, but herd effects through the frequent use of these tests and so forth. And so one of the reasons I like this approach of these tests so much is because they can be scaled and distributed so much easier than any other tool we have. They can be shipped through USPS and Amazon and FedEx and UPS to the households of people. Again, we can get messaging in place with big media agencies, with news anchors, everyone else to tell Americans what these tests are about. And if we can do that, we can start to see cases come down dramatically across the country within weeks in a way that vaccines could never do in this first hundred days. So I hope that there is a major investment by the administration to push a plan like this, and I’ll write it for them if they want, but I don’t think it’s that hard. It’s not easy. But a lot of good people have put a lot of thought into this over the last year. And I think that there are plans that can be put into place very quickly.
MODERATOR: OK, I’m going to kind of piggyback you back on that really quickly. If that 50 billion dollars for rapid tests, is that what you’ve been hoping for?
MICHAEL MINA: Yes, we have been really pushing for this for a long time. I don’t think all of that will go directly into rapid tests, but certainly an initial upfront number of dollars that go directly towards scaling. And then absolutely putting aside a decent amount of maybe it’s 20 billion dollars, maybe it’s 10, whatever it might be to get these tests into the homes of all Americans. If we can put numbers like that, you know, ideally, it’s something on the order of 20 billion could make a major, massive difference. So this is exactly what I’ve been pushing for. I’ve tried to push for it through Congress, try to push for it through interactions with senators and current administration. And I think that what we’re seeing is this administration, I know, knows of this, has heard about it directly and indirectly, and I like to believe that some of our efforts are paying off to raise awareness around these crucial tools to create the science that needs to underlie the utilization of them. And now we finally have a president who is about to be become president that is willing to look at the science and look at things rationally and say that this is the right way to go.
MODERATOR: Thank you. Next question.
Q: Thank you for taking my question. So I’d like to address the same question that I asked also other scientist at MIT, which obviously questions about the balance between the US and the importance of Big Pharma. So you are insisting on the need to boost vaccine production to make sure that everyone that gets a first and second dose of vaccine. So one option would be obliging the pharmaceutical companies to provide US licenses, compulsory licensing to the manufacturers. So that actually would increase the overall production capacity. Actually, it was a proposal put forward by the WHO through the technology access pool, which was actually inviting pharmaceutical companies to basically donate voluntarily technology and intellectual property rights in the form of Big Pharma and basically committed to these projects. I would like to know your opinion about that and the debate on this issue, the Defense Production Act to try to adopt these compulsory licensing on the pharmaceutical companies for these vaccines?
MICHAEL MINA: Absolutely, I think so. You know where we are, if it means we could improve manufacturing. Now the nice thing about the DPA, the Defense Production Act, is that it’s not just stealing things away from companies. There’s usually a fair market price that’s paid. And if we can utilize ideally, the companies would do it on their own. But sometimes they need a bit of a push. And it’s oftentimes that the marketplace does not necessarily align with public health. That’s no surprise to anyone, I think. So this is an approach if we could have increased manufacturing capacity, if it’s possible to do which it’s not fully clear. But I believe that it would be possible to do quite readily. This is the kind of approach that we should be taking. We should be getting the license in such a way that there’s temporary licensure, there’s royalties that are paid, whatever it needs to be, to ensure that we can prioritize public health. At the end of the day, the American public has largely funded huge portions of these vaccines, the R&D for them, whether that’s before COVID through NIH grants and taxpayer dollars, which people oftentimes forget, how much of the research that led to these vaccines and the basic infrastructure and development of them, is it actually taxpayer funded, going back years. And so there’s a lot of reason for Americans and for the government to feel OK about doing this and really forcing the hand of some of these companies. And I think that anything we can do to stop people from dying, it’s worthwhile. Nobody’s paycheck should come ahead of anyone’s life.
Q: Thanks a lot. And the second technical question, so the governments from Western countries, put a lot of emphasis on these new fashionable mRNA vaccines, which I understand they can basically speed up the production or the development of much more than they have access. But, I mean, the drawback then is the logistics because of the cost storage requirements and also because this kind of new technology cannot be easily transferred to the middle- and low-income countries. So I was wondering if you had a view to as to whether this strategy basically aims to provide the global access and to actually vaccinate the entire population because the South African variant, show that even though we vaccinate Americans, Europeans, we are not safe against the vaccine. I was wondering if the committee should also try to increase funding to traditional vaccine like subunit vaccines, which are, as I understand it, the only the vaccine technology which actually wrote to the market, the actual vaccines against the Polio etc. So all these vaccines were completely forgotten by Western countries. I know that Australia is negotiating with Novavax. India is investing in this vaccine. Do you think also the Western countries should do that?
MICHAEL MINA: Absolutely, I think we are taking an extraordinarily shortsighted view of our vaccine approach. We’ve created four vaccines that are nearly identical to each other in terms of the proteins that people are recognizing in this case, the spiked protein and again, this is the spike protein from version 1.0 of this virus. It takes one virus somewhere out there in the world in the quadrillions of replicating viruses right now, happening every day to potentially escape vaccine derived immunity in just the right way to set off a whole new pandemic of mutants that are generally immune to vaccine derived immunity or can escape. And so for that reason alone, from a selfish reason, I think Western countries and wealthy countries that are focused so much on the four vaccines that were producing spike protein vaccines, we should be absolutely trying to find other approaches and scaling up and accelerating trials for multiple protein vaccines, subunit vaccines, live attenuated vaccines. We need an armamentarium of vaccines that are not simply the same protein in case this virus does escape, we need to have a backstop. And it also goes into why I have been so adamant about testing, because these tests, if we had rapid tests out across all of the United States, we could start and stop them with a text message if a new variant comes up and an outbreak starts with a variant that is immune to or that can escape immunity from the vaccine, then the best thing we can do is immediately start to curb the spread of that. And rapid testing is one way to do that. If the country is already conditioned on how to use them and how to use them fast. So I think everything we can do right now to assume that we are going to see new viruses develop that are able to evade immunity, we can hope they won’t, but assume they will. You know, the global economy and global markets are on the line here, not just lives from the viral infections, but a true trust ability of humans. So we should be absolutely doing everything we can to prepare for this.
Q: So basically, you mentioned some variants of the virus to escape mRNA vaccines, but could be still neutralized by subunit or traditional vaccines?
MICHAEL MINA: Yeah, we can create other vaccines that will elicit slightly different proteins to bind to whole parts of the virus that are in the spike protein. We can design them in a new, newer and better ways, given what we now know of the virus.
Q: OK, thank you.
MODERATOR: Next question.
Q: All right, thank you. So we have a situation where the staff, the nurses at one county health department say that they will not give the vaccine because, as they put it, it’s only been tested on a couple dozen people. And the manufacturers of the vaccine will not be legally liable if anything goes wrong with it. So the county health department is contracting with nurses outside of the department to give the vaccine. I wonder, what is your message regarding a situation like this, and concerns that some people have that this vaccine isn’t safe?
MICHAEL MINA: We have vaccinated a lot of people at this point, millions and millions of people have now been vaccinated. We have seen essentially no serious side effects, no serious adverse effects for the most part. I would say that from a safety perspective, as much due diligence has now been done for this vaccine as has been done for measles vaccines and anything else, these vaccines are safe. I think people should know that the safety profiles look very good. Unfortunately, things like rare allergic responses make headlines these days. But in general, the vaccines are as safe as we could ask for.
Q: Thank you.
MICHAEL MINA: I can stay on for one more moment, if you have a question.
Q: I’m sorry, one more question, just to follow up what you were saying about the other vaccines. What do you think about others globally? I mean, the U.S. obviously is leading, but we’re not the only ones with vaccines. What about from China, the Russian ones? There’s one in India?
MICHAEL MINA: Yeah. So it’s a little bit hard, given what we know, given the data that’s been put out there. But some of them have shown various results, I think, it’s a fairly poor efficacy, but that’s still needing to be explored more to understand. Don’t quote me that. I can’t recall exactly what it was. And so I think there are a lot of vaccines that are getting pushed out. You know, same time, it could be that our vaccines, once we start getting these out into the world, that it could be that our vaccines don’t work as well as we are hoping in terms of this 95 percent efficacy. And so we need to take all of it one day at a time in terms of really being willing to look at data in real time and adopt as necessary. I think that certainly there’s going to be as good or better vaccines that are produced internationally, and we should be absolutely keeping our eye on all of those, making sure that we’re up to with the best the best science and the best knowledge of what vaccines are doing well, especially as it pertains to some of these other variants that might, may or may not ultimately escape some level of immunity. So this is not a time for American exceptionalism to take priority. We need to recognize that there are many, many countries out there doing great work. The US is just one of them. And in many ways, our response has been abysmal compared to many of them. So I would say that we have a lot to learn from other countries and we should really keep our eye out and not sweep aside the results coming from many of these other countries in terms of new vaccines that aren’t American made or supported. There might be a day in the very near future where we are begging China and Russia for doses of their vaccines if a vaccine does end up escaping immunity through this fake protein. So we have to we have to keep all doors open, I think.
Q: Thank you so much. Have a good day, guys.
MODERATOR: Thank you. Dr. Mina, do you have any final thoughts for us?
MICHAEL MINA: No, I think that’s it for now. Thanks, everyone, for coming.
This concludes the January 15th press conference.