>> WELCOME TO THE 21st YEAR
OF THE NIH COURSE IN DEMYSTIFING
MEDICINE.
THE GOAL OF THIS COURSE IS TO
BRIDGE EXCITING DEVELOPMENTS IN
BIOLOGIC AND ENGINEERING
SCIENCES AND BRIDGE THAT WITH
MEDICINE.
THE LOGO IS THE BROOKLYN BRIDGE
AND WE'RE LIKE THE TWO
INDIVIDUALS ON THE BRIDGE TO
COMMUNICATE.
TODAY WE'RE GOING TO DISCUSS THE
MAJOR HEALTH PROBLEM CONFRONTING
US AND THE WORLD.
THE COVID-19 PANDEMIC.
WHICH HAS TAKEN OVER 5 MILLION
CAUSED 5 MILLION DEATHS
WORLDWIDE AND OVER 800,000 IN
THE UNITED STATES ALONE AND HAS
CHANGED LIFE FOR EVERYONE.
WE'VE SEEN DURING THE PAST TWO
YEARS EXTRAORDINARY ADVANCES IN
SCIENCE, AT THE SAME TIME
INEQUALITIES IN NATIONAL AND
GLOBAL HEALTH SYSTEMS,
EXTRAORDINARY COOPERATION AND
EXAMPLES OF OUTSTANDING
LEADERSHIP.
OUR SPEAKERS TODAY ARE IN THAT
GROUP.
DR. ANTHONY FAUCI TRULY NEEDS NO
INTRODUCTION TO US.
HE HAS BEEN THE PUBLIC FACE OF
THE COVID PANDEMIC RESPONSE
SINCE JANUARY OF 2020.
AND IS CURRENTLY THE CHIEF
ADVISER TO THE PRESIDENT OF THE
UNITED STATES.
AND A LEAD MEMBER OF THE NIH
COVID-19 RESPONSE TEAM.
TONY WILL SPEAK FIRST AND HIS
LECTURE IS ENTITLED COVID THEN,
NOW AND THE FUTURE.
OUR SECOND SPEAKER DR. ROGER
GLASS IS THE DIRECTOR OF THE NIH
FOGARTY INTERNATIONAL CENTER FOR
GLOBAL HEALTH.
HIS WORK HAS SPURRED
INTERNATIONAL COOPERATION IN
VACCINE DEVELOPMENT AND
DISTRIBUTION AS WELL AS TRACING
THE EPIDEMIOLOGY AND
TRANSMISSION DYNAMICS OF THE
PANDEMIC ON A GLOBAL SCALE AND
ROGER WILL SPEAK ON THE GLOBAL
CHALLENGE COVID-19 AND FUTURE
PANDEMICS.
TO BOTH OF YOU, WE THANK YOU
ENORMOUSLY FOR YOUR
PARTICIPATION IN THE DEMYSTIFING
MEDICINE PRESENTATION TODAY AND
FOR YOUR VALUABLE TIME AND
CONTRIBUTIONS.
OUR FIRST SPEAKER IS
DR. ANTHONY FAUCI AND THANK YOU
TONY FOR BEING WITH US.
>> THANK YOU VERY MUCH.
IT'S A GREAT PLEASURE TO JOIN
YOU AGAIN FOR THIS IMPORTANT
SERIES OF LECTURES.
AS I MENTIONED IN YOUR
INTRODUCTION I WILL BE TALKING
ABOUT COVID-19 THEN, NOW AND IN
THE FUTURE.
SO LET'S GET RIGHT TO IT.
AS WE KNOW NOW WITHOUT ANY DOUBT
THIS IS ONE OF THE MOST
IMPORTANT AND HISTORIC PANDEMICS
IN HISTORY CERTAINLY THE MOST
SEVERE OF ANY RESPIRATORY
ILLNESS OF A PANDEMIC NATURE
THAT WE'VE SEEN IN OVER 100
YEARS.
THE GLOBAL PANDEMIC IF YOU LOOK
AT IT GLOBALLY IS ALMOST
300 MILLION CASES AND AS WAS
MENTIONED OVER 5 MILLION DEATHS
GLOBALLY.
IF YOU LOOK AT THE CONFIRMED
CASES WORLDWIDE ONE CAN SEE THE
SEVEN DAY ROLLING AVERAGE FROM
THE LEFT TO THE RIGHT OF THE
VARIOUS SURGES THAT DIFFERENT
COUNTRIES HAVE EXPERIENCED TO
VARYING DEGREES OVER THE LAST
TWO YEARS.
BUT NOTE THAT EXTRAORDINARY
VERTICAL SPIKE THAT WE'RE NOW
CURRENTLY EXPERIENCING WITH
OMICRON WHICH I WILL GET BACK TO
IN A MOMENT.
UNFORTUNATELY FOR US HERE IN THE
UNITED STATES WE'VE BEEN ONE OF
THE WORST HIT COUNTRIES IN THE
WORLD.
WITH OVER 50 MILLION CASES AND
NOW EXCEEDING 820,000 DEATHS.
THE DISTRIBUTION OF CASES PER
100,000 ARE MARKED BY THE
DENSITY AND DARKNESS OF THE BLUE
SHADE ON THIS SLIDE.
CHILDREN ARE NOT SPARED FROM
THIS.
IF YOU LOOK AT IN THE UNITED
STATES THERE HAVE BEEN ALMOST
7 MILLION CASES IN CHILDREN WITH
ABOUT 76,000 HOSPITALIZATIONS.
SEVERAL HOUSE OF WHICH HAVE
EXPERIENCED MULTI-SYSTEM
INFLAMMATORY SYSTEM AND OVER
1,000 DEATHS THUS FAR AMONG
CHILDREN.
THIS IS THE PATTERN THAT WE'VE
ALL PAINFULLY EXPERIENCED OVER
THE LAST TWO YEARS.
AS YOU CAN SEE THE VARIOUS
SPIKES IN THE SPRING OF 2020 THE
SUMMER OF 2020 AND THEN THE FALL
WINTER OF JUST THIS PAST YEAR
WITH ANOTHER SURGE IN THE SUMMER
WHICH WAS.
COMING DOWN NICELY BUT THEN WE
WERE HIT WITH YET AGAIN ANOTHER
SURPRISE IF YOU WANT TO CALL IT
THAT BUT WE'RE GETTING USED TO
THEM NOW THAT THEY ARE NO LONGER
SURPRISES.
IS AN ALMOST VERTICAL SPIKE
REFERRED TO BY SOME AS AN ICE
PICK OF CASE THAT'S WE'RE SEEING
RIGHT NOW IN THE UNITED STATES.
OF NOTE AND I'LL GET BACK TO
THIS IN A MOMENT THAT THE SPIKE
IN CASES -- THERE HAS NOT BEEN A
COMMENSURATE INCREASE IN
HOSPITALIZATIONS OR DEATHS BUT
REMEMBER BOTH OF THOSE ARE LATE
LAGGING INDICATORS AND ALTHOUGH
WE CAN TALK ABOUT THAT IN A FEW
MINUTES WHEN I GET TO THAT
NONETHELESS THIS IS SOMEWHAT
COMFORTING NEWS ABOUT THE
DISPARITY NOW BETWEEN CASES,
HOSPITALIZATIONS AND DEATHS.
LET'S TALK ABOUT SOME OF THE
IMPORTANT ELEMENTS OF THIS
HISTORIC OUTBREAK.
FIRST THE VIE LOCAL GEE.
THE HISTORY * IS VERY IMPORTANT
TO OUR UNDERSTANDING.
THE FONT IN RED ARE THE HUMAN
CORONAVIRUS.
THE HIGHLIGHTED YELLOW ARE THE
PRECOVID SARS CO-V1 OUTBREAK IN
2002.
THESE ARE THE COMMON COLD
VIRUSES THAT ACCOUNT FROM 5-30%
DEPENDING ON WHERE YOU ARE OF
THE COMMON COLD A USUALLY
RELATIVELY BENIGN DECIDES.
AND THEN THIS MAY HAVE HAPPENED
-- WHICH ANTIDATED THE COMMON
COLD.
WE HAD A PANDEMIC OUTBREAK OF A
CORONAVIRUS WITH THE FIRST SARS
CO-V1.
10 YEARS LATER THE SECOND NOT AS
NEARLY AS IMPACTFUL AS SARS
CO-V1 BUT THE MIDDLE-EAST
RESPIRATORY SYNDROME.
NOW WE'RE TALKING ABOUT NEW
PANDEMIC VIRUSES THAT AS I
MENTIONED BEGAN FROM 2002 AND
2012.
WHERE ARE WE NOW TODAY?
THE THIRD PANDEMIC OUTBREAK.
THIS ONE FAR SUPERSEDING ALL OF
THE OTHERS.
BEGINNING WITH A PATTERN OF AN
OUTBREAK IN A MARKET, A SEAFOOD
WET MARKET IN THE WUHAN DISTRICT
OF CENTRAL CHINA.
A FEW DAYS LATER THE PUBLICATION
OF THE SEQUENCE ON A PUBLIC
DATABASE TELLING US ALL WHAT WE
ACTUALLY SUSPECTED THAT THIS WAS
A CORONAVIRUS.
BUT AN UNUSUAL CORONAVIRUS.
ONE THAT IS VERY CLOSELY RELATED
ON THE TREE TO SEVERAL BAT
VIRUSES THAT CIRCULATE IN THE
ENVIRONMENT.
MAKING IT CLEAR THAT THIS VERY
LIKELY THOUGH NOT PROVEN YET WAS
A NATURAL OUTBREAK FROM AN
ANIMAL MODEL TO A HUMAN.
SO A CLOSER LOOK AT THE
VIROLOGY.
AS I MENTIONED SOME BAT
CORONAVIRUSES AND AN RNA VIRUS
WITH A LARGE GENOME.
AND THE SPIKE PROTEIN WITH THE
RECEPTOR BINDING DOMAIN THAT
BINDS TO THE ACE 2 RECEPTORS
THAT ARE DISTRIBUTED IN THE
UPPER AIRWAY AND OTHER CELLS AND
OTHER ORGAN SYSTEMS THROUGHOUT
THE BODY.
THE TRANSMISSION NOW IS VERY
WELL CHARACTERIZED.
EXPOSURE TO RESPIRATORY FLUIDS.
FINE RESPIRATORY DROPLETS BUT
VERY, VERY CLEAR NOW ALTHOUGH
THIS WAS SOMEWHAT IN DOUBT EARLY
ON THAT THIS IS AN AEROSOL
SPREAD VIRUS.
WITH DEPOSITION OF AEROSOL OR
DROPLETS ON THE MEMBRANES.
EARLIER THEY THOUGHT MAYBE THERE
WAS TRANSMISSION WITH CONTACT
WITH CONTAMINATED SURFACES.
IF THIS OCCURS IT IS EXTREMELY
RARE.
THE RISK IS GREATEST IN POOR
VENTILATED AREAS BUT WITH
CERTAIN ACTIVITIES HENCE
EXERCISE.
SUCH AS IN CHOIRS OR CHORUSES.
SOME RATHER UNIQUE ASPECTS OF
THIS VIRUS THAT A VIRUS THAT HAS
ALREADY KILLED 820,000 AMERICANS
AT LEAST A THIRD OF PEOPLE HAVE
ABSOLUTELY NO SYMPTOMS AND NEVER
DEVELOP SYMPTOMS.
ANOTHER UNUSUAL ASPECT THAT WE
DID NOT FULLY APPRECIATE UNTIL A
FEW MONTHS INTO THE OUTBREAK IN
THE UNITED STATES THAT ALMOST
60% OF ALL TRANSMISSION RELATE
FROM SOMEONE WHO HAS NO
SYMPTOMS.
EITHER SOMEONE WHO NEVER
DEVELOPED A SYMPTOM OR SOMEONE
IN THE PRESYSTEMATIC STAGE.
PREVENTION IS MULTI-FACETED.
THE HALLMARK IS VACCINATION WITH
A BOOST BUT AS SHOWN ON THIS
SLIDE OTHER MEANS IMPORTANTLY
THE WEARING OF MASKS AND TESTING
AND ACTINGS ON RESULTS, PHYSICAL
DISTANCING.
HAND HYGIENE.
STAYING OUT OF SAME IF YOU'RE
SICK.
CLINICAL COURSE: AS I MENTIONED
MANY PEOPLE NEVER GET SYMPTOMS.
FOR THOSE WHO DO PRESENT VERY
MUCH LIKE A FLU-LIKE SYMPTOM
WITH ONE EXCEPTION, A LOSS OF
SMELL AND TASTE AND MIGHT LINGER
FOLLOWING THE ACUTE PHASE.
AGAIN FOR THOSE WHO DEVELOP
SYMPTOMS ABOUT 80% ARE MILD TO
MODERATE.
ABOUT 15% TO 20% ARE SEVERE OR
CRITICAL LEADING TO A WIDE RANGE
OF CASE FATALITIES.
UP TO 20% IN THOSE REQUIRING
HOSPITAL VENTILATION I MEAN
MECHANICAL VENTILATION.
THOSE WHO GET SEVERE DISEASE
FALL INTO A COUPLE OF CATEGORIES
BASED ON THEIR INCREASE.
OBVIOUSLY OLDER ADULTS, THE
RATHER EXTREME ELDE EX-- EXTREME ELDERLY.
THE MANIFESTATIONS ARE DOMINATED
BY THE ACUTE RESPIRATORY
DISTRESS SYNDROME.
HOWEVER AS MORE EXPERIENCE
ACCRUES WE KNOW THERE ARE
NEUROLOGICAL, CARDIAC, ACUTE
KIDNEY DISORDERS.
PATHOGENIC EVENTS IN MULTIPLE
ORGAN SYMPTOMS AND HYPER
INFLAMMATION ALMOST AND HYPER
INFLAMMATORY RESPONSE.
AND I ALREADY MENTIONED THE
MULTI-INFLAMMATORY SYSTEM IN
CHILDREN.
THERE ARE POST COVID CONDITIONS.
SOME ARE READILY EXPLAINABLE.
IF SOMEONE HAS A GREAT DEGREE OF
ORGAN SYSTEM DYSFUNCTION
REQUIRING PROLONGED
HOSPITALIZATION.
OFTEN ORGAN SYSTEM DAMAGE
EXPLAINS A DIMINISHED PULMONARY
FUNCTION.
HOWEVER THERE ARE A CONSIDERABLE
NUMBER OF PATIENTS WHO HAVE
SIGNS AND SYMPTOMS THAT YOU
CANNOT COMPLETELY EXPLAIN BY A
READILY APPARENT PATHO BEGINIC
PROCESS.
THIS IS REFERRED TO AS LONG *
COVID.
THESE ARE SOME OF THE SYMPTOMS
AND SIGNS OF LONG COVID.
DOMINATED BY EXTREME FATIGUE,
MUSCLE ACHES, LIGHT HEADEDNESS,
AUTONOMIC DISTURBANCES SUCH AS
TEMPERATURE REGULATION, MOOD
CHANGES, SLEEP DISORDERS AND
BRAIN FOG OR COGNITIVE
IMPAIRMENT PARTICULARLY THE
INABILITY TO FOCUS OR
CONCENTRATE.
THE MEDICAL MANAGEMENT THE
CONTROL OF SYMPTOMS SUCH AS WITH
ANTIINFLAMMATORY.
MOST PEOPLE WHO STAY AT HOME
WITH FEVER OR ACHES ARE WELL
CONTROLLED ON THIS.
THOSE WHO HAVE MILD SYMPTOMS NOT
REQUIRING END ORGAN SUPPORT
WHICH MUST BE GIVEN IN THE
HOSPITAL.
USUALLY THINGS LIKE MECHANICAL
VENTILATION, DIALYSIS AND OTHER
SUPPORT OF ORGAN SYSTEMS THAT
ARE FAILING.
NOW WE'RE GOING TO FOCUS ON ONE
OF THE THERAPIES APPROACHES.
ANTIVIRALS.
ONE CAN THINK OF THERAPY IN TWO
MAJOR PILLARS.
ONE, TARGETING THE VIRUS ITSELF.
WE NOW HAVE A NUMBER OF APPROVED
LIKE REMDESIVIR FULLY APPROVED
BY THE FDA.
RECENTLY PAXLOVID AND SEVERAL
MONOCLONAL ANTIBODIES THAT HAVE
BEEN USED SUCCESSFULLY AT LEAST
WITH THE DELTA VARIENT.
I'M GOING TO GET BACK TO OMICRON
IN A MOMENT.
BUT WITH PEOPLE WITH ADVANCED
DISEASE OFTEN YOU HAVE TO
MODERATE THE RESPONSE.
SUCH AS WITH DEXAMETHASONE OR
OTHER BLOCKERS OF PROCESSES SUCH
AS -.
NOW THE HALLMARK OF THE
SUCCESSFUL RESPONSE.
NAMELY VACCINES.
RIGHT NOW IT'S VERY, VERY CLEAR
WITH GOOD JUSTIFICATION THAT THE
DEVELOPMENT OF VACCINES FOR SARS
CO-V2 ARE THE MOST IMPORTANT
BREAKTHROUGH OF THE YEAR OF
2020.
WHICH IS THE REASON WHY SCIENCE
MAGAZINE DEEMED IT AS SUCH.
IT WAS A COMBINATION OF MANY
YEARS OF BASIC RESEARCH IN
DEVELOPING PLATFORM TECHNOLOGIES
SUCH AS THE mRNA TECHNOLOGY AS
WELL AS DESIGN GETTING THE
PROPER CONFIRMATION OF THE
PREFUSION SPIKE PROTEIN TO ALLOW
FOR A HIGH DEGREE.
AND SO NOW IN THIS COUNTRY AND
MORE WORLDWIDE WE NOW HAVE THREE
SEPARATE PLATFORMS, FIVE OF THE
SIX IMOGENS USE THE PROGRAM
DEVELOPED BY BARNEY GRAHAM AND
JOHN AND OTHERS IN THE VRC.
THE DEVELOPERS ARE SHOWN INTO
THE COLUMN NEXT TO THE LEFT AND
THE STATUS AS YOU KNOW THE BIOIN
TECH FULLY APPROVED WITH THE
BLA.
MODENA AND J & AJ AND OTHERS.
ON THEIR WAY TO APPLYING FOR AN
EUA.
LET'S TAKE A LOOK AT THE HISTORY
OF THESE VACCINES.
FIRST THE EFFICACY IN CLINICAL
TRIALS.
THESE ARE THE ORIGINAL PAPERS.
THE RATHER STRIKING AND VERY
WELCOMED RESULTS OF THE
MULTI-THOUSAND CLINICAL TRIALS
DONE ON THE mRNAs WITH 95%
AND 94% EFFICACY.
J&J HAD A DIFFERENT PROFILE.
DONE IN MANY DIFFERENT COUNTRIES
AND SHOWED A 72% EFFICACY
OVER-ALL VERSUS MODERATE TO
SEVERE DISEASE IN COVID-19 WITH
AN 85% EFFICACY IN ALL REGIONS
OF THE WORLD STUDIED.
THE THIN THAT IS MOST GRATIFYING
ABOUT ALL OF THIS IS THE
EXTRAORDINARY REAL WORLD
EFFICACY WHICH REALLY IS NOW
DEFINED AS EFFECTIVENESS NAMELY
WHEN YOU DO A CLINICAL TRIAL
OFTEN THE RESULTS OF THE TRIAL
ARE ALWAYS BETTER AT WHAT
HAPPENS IN THE WHEEL WORLD.
BUT WE'RE * SEEING REAL WORLD
EFFICACY THAT IS STRIKING.
I CAN GIVE YOU PAPER AND PAPER
BUT IT'S BEST SAID THAT IF YOU
LOOK IN OCTOBER OF 2021 AND THE
COMPARISON BETWEEN UNVACCINATED
PEOPLE IN THE UNITED STATES
COMPARED TO FULLY VACCINATED
PEOPLE IS A 5 TIME INCREASE RISK
OF TESTING POSITIVE.
12 TIME INCREASED RISK OF BEING
HOSPITALIZED AND 14 TIMES
INCREASED RISK OF DYING IF
YOU'RE UNVACCINATED COMPARED TO
A FULLY VACCINATED PERSON.
NOW WE'RE ALL AWARE OF THE
IMPORTANCE OF BOOSTER SHOTS.
WHY IS THAT THE CASE.
IF YOU LOOK AT THE HIGH DEGREE
OF EFFECTIVENESS IN THE
COMMUNITY WHICH I JUST MENTIONED
IN ALL THREE OF THE APPROVED OR
AT LEAST EMERGENCY AUTHORIZED
VACCINES IN THE UNITED STATES
THE EFFICACY OR EFFECTIVENESS
WANES OVER TIME.
IT GOES DOWN FROM 88 TO 48%.
AND AGAINST DEATH IT GOES DOWN
ALSO.
IT IS BETTER PROTECTIVE AGAINST
SEVERE DISEASE BUT CLEARLY FIRST
NOTICED IN ISRAEL AND NOW VERY
CLEAR IN THE UNITED STATES THAT
AS HIGH AS THE EFFECTIVENESS IS
WE NEED A BOOST.
NOW, LET'S TAKE A LOOK AT THE
DATA OF BOOSTING.
THERE ARE TWO THINGS THAT YOU
MEASURE.
ONE IS THE NEUTRALIZING ANTIBODY
TIGHTERS AGAINST THE VACCINE
MEASURED BY PSEUDO VIRUS ASSAYS
OR WHOLE LIVE VIRUS ASSAYS OR
THE CLINICAL PRESENTATIONS AND
THE CLINICAL EFFECT.
LET'S TAKE A LOOK AT THE INVITRO
ANTIBODY STUDIES.
THIS IS A SLIDE THAT LOOKS AT
WHAT THE PREBOOSTER LEVEL OF
ANTIBODIES ARE AGAINST DELTA.
WHICH IS THE VARIENT THAT IS
CAUSED THE MAJOR PROBLEM
IMMEDIATELY PRIOR TO OMICRON.
IT IS AT 55 IN THE YOUNGER
INDIVIDUALS AND GOES WELL ABOVE
800 -- 28 DAYS AFTER THE THIRD
SHOT BOOST OF THE MODENA
PRODUCT.
IF YOU LOOK AT THE ELDERLY IT
GOES UP FROM 32 TO 706.
CLEARLY A MAJOR RECONSTITUTION.
LET'S TAKE A LOOK AT THE PFIZER
-- IN THE GREEN -- FOCUS ON
B1617 WHICH IS ACTUALLY DELTA.
AGAIN IN YOUNGER INDIVIDUALS 241
ONE MONTH AFTER DOSE TWO WHICH
SHOULD BE THE PEEK OF THEIR
RESPONSE -- * IN THE ELDERLY
AGAIN IN THE BLUE BARS IT GOES
GREAT 123 TO 1479.
NOW LET'S TAKE A LOOK AT SOME OF
THE CLINICAL STUDIES THAT
INDICATE THAT BOOSTER SHOTS
RECONSTITUTE THE DIMINISHED
PROTECTION AGAINST SYSTE SYSTEMATIC
INFECTION, SEVERE DISEASE AND
DEATH.
THESE ARE REPRESENTATIVE SLIDES
THAT ARE CLEARLY BEING REPEATED
IN ANY COUNTRY THAT USES
BOOSTER.
IF YOU LOOK AT THE CALM LAIVE
INCIDENTS * OF HOSPITALIZATIONS,
SEVERE COVID AND DEATH LOOKING
AT THE PINK TO RED IS WHAT YOU
SEE AFTER TWO DOSES OF AN mRNA
IN THIS CASE THE PFIZER.
LOOK AT THE BLUISH LINES WHICH
ARE AFTER THREE DOSES NAMELY A
BOOST.
IF YOU LOOK AGAIN HERE IN THIS
STUDY THAT COMES FROM MULTIPLE
DIFFERENT COUNTRIES AND IS
CUMULATIVE INCIDENTS IT SAYS
PLACEBO BUT THAT MEANS TWO DOSES
AND A PLACEBO VERSUS TWO DOSES
AND THEN THE THIRD BOOST OF AN
mRNA.
A STRIKING DIFFERENCE IN THE
CUMULATIVE INCIDENCE OF
INFECTION.
FOR THAT REASON THE CDC IS NOW
EXPANDED THE RECOMMENDATION FOR
BOOSTERS WE'LL CROSS VIRTUALLY
EVERYONE NOW THAT HAS BEEN GIVEN
THE PRIMARY WITH SOME RECENT
DECISIONS BY THE FDA TO EXPAND
THAT EVEN TO YOUNGER
INDIVIDUALS.
OKAY.
NOW WE HAVE THE CHALLENGE OF
THESE VARIANTS WHICH REALLY
RELATE A LITTLE BIT TO WHAT I
SHOWED YOU ABOUT DELTA A MOMENT
AGO.
THESE ARE SOME OF THE VARIANTS
THAT WE HAVE FACED.
BETA THAT STARTED OFF IN SUB
SAHARAN AFRICA AND THEN WE GOT
DELTA.
DELTA TOOK OVER BECAUSE ITS HIGH
DEGREE OF ABILITY TO SPREAD FROM
PERSON TO PERSON.
IT WAS TWICE AS GREAT AS ALPHA
WHICH IT BUMPED OFF THE TABLE
AND THE VIRAL LOADS WERE UP TO A
THOUSAND TIMES GREATER THAN
ALPHA.
LEADING TO ITS CLEAR-CUT
INCREASED TRANSMISSION.
IT RAPIDLY TOOK OVER THE WORLD.
SEEN IN OVER 155 COUNTRIES.
AND IT WENT WAY UP TO 99% OF ALL
THE VARIANTS IN THE COUNTRY WERE
DELTA.
BUT NOW IF YOU LOOK FROM
DECEMBER 4 THROUGH DECEMBER 25
JUST A FEW WEEKS IT TELLS YOU
WHAT WE ALL KNOW THAT IT IS
BEING REPLACED BY OMICRON AND
THAT IS THE VARIENT THAT WE'RE
DEALING WITH NOW WHICH HAS SOME
DIFFERENT CHARACTERISTICS.
-- WHY
IS OMICRON DIFFERENT?
IF YOU LOOK AT THE SPIKE PROTEIN
ON THE LEFT THE OMICRON ON THE
RIGHT YOU SEE RIGHT OFF THAT
THOSE LITTLE LINES THAT ARE
COMING OUT ARE AMINO ACID
SUBSTITUTIONS RESULTING FROM
MUTATIONS.
THERE ARE MANY MORE WITH
OMICRON.
50 IN TOTAL.
30 IN THE SPIKE PROTEIN AND 10
IN THE RECEPTOR BINDING DOMAIN
WHICH LEADS TO DIFFERENCES IN
TRANSMISSIBILITY, SEVERITY,
VACCINE EVASION OF IMMUNITY AND
POTENTIAL IMPACT ON
THERAPEUTICS.
LET'S TAKE A LOOK.
THESE SLIDES SPEAK FOR
THEMSELVES.
IN EVERY COUNTRY THERE HAS BEEN
A SHARP VERTICAL SPIKE AS SHOWN
IN THE RED LINE WHICH IS OMICRON
COMPARED TO THE BLUE LINE WHICH
IS DELTA.
NOTE SOUTH AFRICA SEEMS TO HAVE
ALREADY PEAKED AND IS ON ITS WAY
DOWN.
HOPEFULLY THAT IS WHAT WE'LL SEE
IN THE NEXT FEW WEEKS IN THIS
COUNTRY.
IT'S VERY CLEAR NOW FIRST HINTED
AT IN SOUTH AFRICA BUT NOW
CLEARLY IN THE UK AND ALREADY
EVIDENCE IN THIS COUNTRY.
BETA BLUE, DELL DO RED, OMICRON
YELLOW AND COMPARE TO PORTION OF
PEOPLE ADMITTED.
ON OXYGEN.
WITH SEVERE DISEASE.
THE PROPORTION THAT DIED.
THIS IS A LESS SEVERE VIRUS.
LIKELY DUE TO A COMBINATION OF
UNDERLYING IMMUNITY DUE TO
INFECTION OR VACCINATION AS WELL
AS A POSSIBLE DIMINUTION OF
PATHOGENS OF THE VIRUS ITSELF.
IT'S ALREADY SEEN IN THE UK, IN
SCOTLAND, IN LONDON WHICH
INTERESTINGLY WE HEARD TODAY
THAT LONDON SEEMS TO HAVE
ALREADY PEAKED WITH ITS VERTICAL
SPIKE.
THERE ARE EARLY SIGNALS THAT
WE'RE SEEING THIS IN THE UPS
FROM A STUDY IN HOUSTON.
NOW IMPORTANTLY BACKING UP THE
SUGGESTION THAT I MADE A LITTLE
BIT AGO THAT THERE MAY BE
ACTUALLY AN INHERENT LOWERING OF
VIRALMENTS -- THAT WHEN YOU
INFECT THEM THAT THE PATHOGENS
IS MUCH DIFFERENT.
OMICRON SEEMS TO REPLICATE VERY
WELL IN THE UPPER AIRWAY AND
BROWN SKY BUT * POORLY IN THE
LUNG WHICH AGAIN ALTHOUGH YOU
HAVE TO PUT THE CAVEATS THAT YOU
HAVE WITH AN ANIMAL STUDY THIS
IS PERFECTLY COMPATIBLE WITH A
VERY HIGH DEGREE OF
TRANSMISSIBILITY AND A LOWER
DEGREE OF PATHOGENESIS.
DOES IT EVADE IMMUNITY?
WITHOUT A DOUBT.
IF YOU LOOK AT THE OMICRON WAVE
THE EFFECTIVENESS AGAINST SARCO
V2 INFECTION GOES DOWN TO 33% UP
FROM 80% PREOMICRON.
IF YOU LOOK AT HOSPITALIZATIONS
IT GOES DOWN STILL A DEGREE OF
PROTECTION.
70 IS NOT BAD BUT CLEARLY IT
GOES DOWN WHEN YOU TALK ABOUT
HOSPITALIZATION.
FORTUNATELY FOR US LOOK AT WHAT
HAPPENS WHEN YOU GIVE A THIRD
SHOT BOOST OF AN mRNA
VACCINATION WHERE YOU HAVE THE
LOWER -- AND THEN IT GOES UP BY
38 FOLD WITH THE BOOSTER.
AGAIN A VERY, VERY STRONG
ARGUMENT FOR BOOSTING
INDIVIDUALS WHO HAVE BEEN FULLY
VACCINATED.
AGAIN A STUDY FROM UK HEALTH
SECURITY AGENCY IN ENGLAND A
REDUCTION IN THE RISK OF
HOSPITALIZATION OF 81% FOLLOWING
THE THIRD SHOT AND REDUCTION
AGAINST HOSPITALIZATION IN
ANOTHER STUDY OF 88%.
SO WHAT IS THE BOTTOM LINE WITH
OMICRON.
THE VARIANT COMPROMISES THE
EFFECTS OF THE TWO DOSE RNA FOR
SURE AND REDUCES OVER-ALL
PROTECTION.
EVEN THOUGH AS I SHOWED YOU THIS
CONSIDERABLE PROTECTION STILL
REMAINING AGAINST SEVERE
DISEASE.
EARLY STUDIES INDICATE THAT
BOOSTERS RECONSTITUTE ANTI
BODIES AND ENHANCE PROTECTION
AGAINST OMICRON.
SO OUR REGIMENS APPEAR TO BE
WORKING AND RIGHT NOW ALTHOUGH
WE'RE MAKING A SPECIFIC BOOSTER
IT APPEARS THAT BOOSTER AGAINST
STRAINS CAN BRING UP THE
PROTECTION EVEN AGAINST OMICRON.
WHAT ABOUT THE POTENTIAL IMPACT
ON THERAPEUTICS? SOME BAD NEWS
AND SOME GOOD NEWS
THE BAD NEWS IS THAT THE LILY
AND REGENERON MONOCLONAL
ANTIBODIES THAT WAS SO EFFECTIVE
AGAINST DELTA DO NOT APPEAR TO
BE EFFECTIVE AGAINST OMICRON.
THE NEW ANTIBODY FROM GSK
APPEARS TO BE QUITE EFFECTIVE
AGAINST OMICRON AND
AstraZeneca MONOCLONAL FOR
PEOPLE WHO ARE IMMUNO
COMPROMISED LOOKS GOOD AGAINST
OMICRON.
LUCKILY SOME OF THE VIRALS --
REMDESIVIR SEEM TO BE QUITE GOOD
AGAINST THIS AT LEAST IN AN
INVITRO SITUATION.
WHAT ABOUT THE FUTURE?
AGAIN WHAT IS THE END AGAIN FOR
2022 AND BEYOND?
WHEN YOU THINK ABOUT OUTBREAKS
THERE IS A PANDEMIC PHASE.
A DECLINE IN ACCELERATION.
THERE IS CONTROL.
ELIMINATION AND ERADICATION.
LET'S LOOK AT HISTORY.
WE'VE ONLY ERADICATED ONE
PARTICULAR PATHOGEN AND THAT IS
SMALL POX.
WE'VE ELIMINATED NAMELY DIDN'T
WIPE IT OFF THE PHASE OF THE
EARTH SEVERAL IMPORTANT
PATHOGENS.
BACK VACCINATION.
POLIO, MEASLES.
EXCEPT FOR SMALL POCKETS OF
COMMUNITIES THAT ARE UNDER
VACCINATED.
SO WHAT ARE WE LOOKING AT?
IT'S ONLY ASPIRATIONAL TO THINK
THAT WE'RE GOING TO ELIMINATE
SARS CO-V2 SO WE'RE GOING TO
LIVE WITH IT AND THAT MEANS
CONTROL.
SO WHAT LEVEL OF CONTROL DO WE
HAVE?
CERTAINLY 90,000
HOSPITALIZATIONS THAT WE HAVE AS
OF YESTERDAY IN THE HOSPITAL.
1300 DEATHS AND 400,000 CASES IS
NOT ADEQUATE CONTROL.
WE'VE GOT TO GET IT DOWN TO A
LOW LEVEL WITH THE
HOSPITALIZATIONS AND DEATHS ARE
SO LOW THAT IT DOESN'T INSTILL
FEAR IN SOCIETY AND DISRUPT
EVERYTHING THAT WE DO AND GETS
TO THE POINT WHERE WE HAVE
ENOUGH PEOPLE PROTECTED WITH
VACCINATION AND ARE PRIOR
INFECTION THAT * WE HAVE A VIRUS
THAT WILL ASSUME A MUCH LOWER
LEVEL.
I'LL STOP THERE AND I'M HAPPY TO
ANSWER QUESTIONS
>> THANK YOU VERY MUCH, TONY.
ONE OF THE QUESTIONS THAT HAS
POPPED UP IS -- IS THERE ANY WAY
OF PREDICTING WHO IS LIKELY TO
DEVELOP CHRONIC FORMS OF COVID
INFECTION?
EITHER GENDER, GENOME OR IS
THERE ANY EVIDENCE THAT PROVIDES
SOME OF THAT INFORMATION?
>> THE ANSWER RIGHT NOW I WOULD
NOT SAY CHRONIC FORM OF
INFECTION.
I WOULD SAY LONG COVID SYSTEM
TOLOGY FOLLOWING THE CLEARANCE
OF INFECTION.
THERE ARE SOME STUDIES ONGOING
RIGHT NOW.
THERE DOESN'T APPEAR TO BE
ANYTHING STRIKING.
THERE ARE SOME PRELIMINARY
EVIDENCE THAT MAYBE WOMEN ARE
MORE INFECT WITH LONG COVID THAN
MEN BUT IT'S GOING TO REQUIRE
MUCH, MUCH LARGER STUDIES.
>> AND ALSO CONSIDERABLE
INTEREST -- HOW DO WE GO ABOUT
DETERMINING WHETHER NEW VARIANTS
APPEAR AND TO WHAT EXTENT HAS
THE SYSTEM FOR THEIR DETECTION
BEEN REVVED UP OR AMPLIFIED?
>> A YEAR AGO, TWO YEARS AGO
WHEN IT WAS TERRIBLE IN THE
SENSE THAT WE REALLY DIDN'T HAVE
ADEQUATE ENOUGH GENOMIC
SURVEILLANCE TO BE ABLE TO DO
SOMETHING.
THE CDC HAS GREATLY IMPROVED
THEIR ABILITY NOW TO SEQUENCE A
SUBSTANTIAL PROPORTION OF
ISOLATES TO GIVE A GOOD FEEL FOR
WHAT IS OUT THERE IN THE
COMMUNITY.
WHICH IS THE REASON WHY WE NOW
KNOW THAT ACTUALLY DELTA STARTED
OFF AT 1% OR 2% AND HAD A
DOUBLING TIME SO THAT WE WERE UP
TO 90%.
RIGHT NOW THE DOUBLING TIME OF
OMICRON IS ABOUT TWO DAYS AND
THE CDC IS SHOWING NOW THAT EVEN
THOUGH IT'S ABOUT 70 PLUS
PERCENT THROUGHOUT THE COUNTRY
THERE ARE MANY REGIONS THAT HAVE
WELL OVER 90% AND THAT IS DUE TO
THE SURVEILLANCE THAT WE'RE
TALKING ABOUT.
>> IT'S ALSO BEEN AN INTEREST IN
HOW DO WE KNOW WHEN A -- WHAT IS
THE END OF A PANDEMIC LOOK LIKE?
OR WHAT ARE THE DETERMINANTS
THAT LEAD TO IDENTIFYING THE END
OF THE PANDEMIC?
>> WHEN I TRY TO -- THE ANSWER
IS WE DON'T KNOW WHAT IT'S GOING
TO BE.
WE'LL KNOW IT WHEN IT HAPPENS.
THAT DOESN'T SEEM LIKE A VERY
SCIENTIFIC APPROACH BUT I TRY TO
BREAK IT DOWN TO THE AUDIENCE BY
GOING THROUGH WHAT WE KNOW
HISTORICALLY ABOUTY
RATIFICATION, ELIMINATION,
CONTROL.
IT'S SOMEWHERE IN THE CONTROL
BOX BUT WHAT LEVEL OF CONTROL?
I THINK IT WOULD HAVE TO BE
WHERE IT DOESN'T DISRUPT
SOCIETY.
WE'RE GOING IS TO START AND
YOU'LL PROBABLY HEAR ABOUT THIS
REASONABLY SOON.
PARTICULARLY WHEN YOU HAVE A
VIRUS LIKE OMICRON WHICH HAS
MUCH LESS SEVERITY THAN DELTA
THAT WE'RE GOING TO BE FOCUSING
MUCH OR ON HOSPITALIZATIONS AND
DEATHS AS OPPOSED TO HOW MANY
PEOPLE GET INFECTED.
LIKE WE DON'T USUALLY COUNT THE
NUMBER OF PEOPLE WHO GET A COLD
THAT GET A PARA FLU.
A RHINO VIRUS.
BUT WE'RE GOING TO BE FOCUSING
ON HOW MANY PEOPLE ARE SEVERELY
IMPACTED.
AND WHEN THAT NUMBER GETS TO A
LOW LEVEL THAT THERE IS NO
STRAIN ON THE HOSPITAL SYSTEM.
NO STRAIN ON SOCIETY.
THERE IS NOT A PERVASIVE FEAR
THAT IF YOU'RE 80 YEARS OLD THAT
YOU'RE GOING TO DIE IF YOU GET
INFECTED THEN WE WILL BE ABLE TO
LIVE WITH IT
>> THERE ARE RECORDS IN ISRAEL
THAT THEY ARE CONTEMPLATING OR
HAVE BEGUN A SECOND ROUND OF
BOOSTERS OR VACCINATION.
I'M NOT SURE.
WHICH.
WELL IT'S A BOOSTER TO THE
VACCINATION.
IS THERE ANY EVIDENCE AS TO THE
EFFECTIVENESS OF THAT.
WOULD YOU ANTICIPATE SOMETHING
LIKE THAT HAPPENING GLOBALLY?
>> THE ISRAELIS ARE TALKING
ABOUT A FOURTH SHOT ABOVE THE
THIRD SHOT BOOST OF AN mRNA.
THEY US ALMOST EXCLUSIVELY
PFIZER.
WITHOUT THE DURABILITY OF
PROTECTION OF THE THIRD SHOT
BEFORE WE START THINKING ABOUT
THE FOURTH SHOT.
WE MAY HAVE TO GET YET AGAIN
ANOTHER SHOT.
WE'RE USING THE TERMINOLOGY NOW
KEEPING YOUR VACCINATIONS
UP-TO-DATE RATHER THAN WHAT
FULLY VACCINATED MEANS.
OPTIMAL PROTECTION IS WITH A
THIRD SHOT OF mRNA OR A SECOND
SHOT OF A J&J.
>> THERE IS INTEREST IN -- WHAT
IS THE RELATIVE SENSITIVITY OF
THE HOME KITS THAT ARE BEING
USED FOR DETECTION OF THE
ANTIGEN VERSUS THE PCR?
AT ONE POINT IF SOMEONE HAS SOME
SYMPTOMS THAT ARE SUGGESTIVE AND
HAS A NEGATIVE ANTIGEN TEST IN
ONE OF THE HOME KITS SHOULD THEY
HAVE A PCR?
>> IT DEPENDS ON WHAT YOU ARE
USING THE TEST FOR.
SO LET ME SEE IFIC LAY THIS OUT
BECAUSE THERE IS ALWAYS
UNDERSTANDABLY WHEN A LOT OF
CONFUSION ABOUT THAT.
WITHOUT A DOUBT THE PCR IS A
HIGHLY SENSITIVE TEST.
SO IF YOU REALLY WANT TO KNOW IF
YOU'RE INFECTED THE PCR IS THE
WAY TO GO.
THAT IS USUALLY FOR SOMEONE WHO
HAS SYMPTOMS AND NEEDS TO KNOW
AM I INFECTED YOU WANT TO GET A
PCR.
IF YOU GO TO THE HOSPITAL AND
YOU'RE COMING IN WITH SYMPTOMS
THEY ARE GOING TO DO A PCR ON
YOU.
WHEN YOU RECOVER IT CAN STILL
REMAIN POSITIVE BECAUSE IT PICKS
UP FRAGMENTS OF THE VIRUS THAT
MIGHT NOT BE REPLICATION
COMPETENT.
THEN THE ANTIGEN TEST.
THERE ARE NOW 8 AND WILL SOON BE
9 AND 10 APPROVED TESTS.
THEIR SENSITIVITY IN GENERAL IS
LESS THAN THE PCR.
HOWEVER, IF YOU FOR EXAMPLE DO
THE BAR NEXT NOW TEST IT IS
DEPENDING UPON WHETHER YOU DO IT
PROPERLY OR WHAT STAGE YOU'RE IN
EARLY OR MID-INFECTION IT'S
ABOUT 80 SOME ODD PERCENT
SENSITIVE.
IF YOU DO TWO OR THREE OF THEM
SEQUENTIALLY IT BECOMES AS
SENSITIVE AS THE PCR AND THAT IS
WORK THAT HAS COME OUT FROM A
NUMBER OF GROUPS.
HOWEVER, IF YOU GET A POSITIVE
ANTIGEN TEST IT MEANS THAT URINE
AFFECTED.
THERE ARE VERY FEW FALSE
POSITIVES.
AND NO TEST IS 100%.
BUT IT IS MORE INDICATIVE IF
IT'S POSITIVE YOU KNOW IT'S
POSITIVE.
IF IT'S NEGATIVE IT MAY NOT BE
SENSITIVE ENOUGH TO PICK UP YOUR
INFECTION.
DOES THAT MAKE SENSE?
>> THAT IS VERY HOPEFUL.
I'M SURE THERE IS SOME
CONSIDERABLE CONFUSION.
QUESTIONS ABOUT INDIVIDUALS WHO
HAVE BEEN FULLY VACCINATED AND
WHO HAVE SEVERE DISEASE OR DIE
IN THE FATE A CASES THAT DIE DID
THEY HAVE SOME IMMUNO
DEFICIENCY.
>> WELL YOU KNOW * AS WE'VE
OFTEN SAID ALL OF LIFE IS A BELL
SHAPED CURVE.
IF YOU COMPARE THE UNVACCINATED
TO THE VACCINATED THE DEATHS AND
THE HOSPITALIZATIONS ARE OVER
OVERWHELMINGLY MORE IN THE
UNVACCINATED.
IT'S VERY HEAVILY WEIGHTED
TOWARD THE ELDERLY AND THOSE
WITH UNDERLYING CONDITIONS THAT.
DOES NOT MEAN THAT A 45-YEAR-OLD
HEALTHY VACCINATED AND BOOSTED
PERSON IS NOT GOING TO WIND UP
IN THE HOSPITAL AND DIE BUT IT
WOULD BE EXTREMELY UNUSUAL AS
OPPOSED TO A 95-YEAR-OLD PERSON
WHO IS VACCINATED AND BOOSTED.
SO, ITS HEAVILY WEIGHTED TO THE
ELDERLY AND THOSE WITH
UNDERLYING CONDITIONS.
>> WHAT DO YOU THINK ARE THE
MAJOR PROBLEMS IN TRYING TO TAKE
THE ADVANCES OF SCIENCE AND THE
ANNUAL BODIES AND VACCINES TO
THE PUBLIC AT LARGE TO HAVE A
GREATER RESPONSE AND
ACCESSIBILITY? WOULD YOU LIKE
TO COMMENT ABOUT THAT?
THERE IS A DIFFERENCE BETWEEN
ACCESSIBILITY AND RESPONSE.
BECAUSE THE VACCINES ARE
OVERWHELMINGLY ACCESSIBLE IN
THIS COUNTRY.
AND YET WE HAVE ABOUT 34 MILLION
PEOPLE WHO ARE ELIGIBLE TO BE
VACCINATED WHO ARE NOT GETTING
VACCINATED.
THAT IS A BIG, BIG PROBLEM.
AND THAT HAS TO DO WITH ANTIVAX
WITH MAKING DECISIONS ABOUT
PUBLIC HEALTH BASED ON POLITICAL
IDEOLOGY.
THAT IS IN MY MIND ONE OF THE
GREATEST STUMBLING BLOCKS TO AN
ADEQUATE RESPONSE IN THIS
COUNTRY.
IS THAT THERE IS A DEGREE OF
POLITICAL DIVISIVENESS THAT HAS
ENTERED INTO THE EQUATION OF
ADEQUATE INTERVENTIONS AND THE
PROPER UTILIZATION OF HIGHLY
EFFECTIVE TOOLS.
THAT IS A REAL PROBLEM.
THAT IS GOING TO KEEP THIS
LINGERING LONGER THAN IT NEEDS
TO.
>> ALL RIGHT.
I WANT TO THANK YOU ON BEHALF OF
ALL OF US VERY MUCH.
YOU'RE A VERY BUSY MAN AND WE
APPRECIATE YOU PROVIDING THIS
VALUABLE INFORMATION.
THANK YOU AGAIN.
>> THANK YOU.
IT'S ALWAYS A PLEASURE TO BE
WITH YOU.
>> YOU'RE WELCOMED.
NOW OUR SECOND SPEAKER IS ROGER
GLASS.
THE TITLE OF HIS TALK IS THE
GLOBAL CHALLENGE OF COVID AND
FUTURE EPIDEMICS.
>> THANK YOU.
AND LET ME START BY THANKING
TONY WHO HAS BEEN SO TERRIFIC
BOTH IN THE PRESENTATION AND IN
HIS LEADERSHIP AND SPEAKING
TRUTH TO POWER AND DELIVERING ON
THE SCIENCE AND REALLY
REPRESENTING US SO WELL, TONY.
WE OWE YOU A GREAT DEBT OF
THANKS.
LET ME GENUINE.
I'LBEGIN -- WIN.
>> I WANT TO TALK ABOUT THE
FUTURE.
THANKS TO TONY THE RIGHT MAN AT
THE RIGHT TIME WHO HAS HELPED US
ALL.
I ALSO WANT TO STATE THAT
DR. MYSELF AND DR. -- VOGEL HAVE
NO CONFLICTS OF INTEREST.
AND MY TALK WILL BE OUTLINED
FIRST TO DISCUSS THE IMPACT OF
COVID-19 PANDEMIC ON SOCIETY.
HOW THE SCIENTIFIC ENTERPRISE
HAS CHANGED.
THE IMPORTANCE OF BUILDING
RESEARCH CAPACITY AND GLOBAL
PARTNERSHIPS TO IMPROVE PANDEMIC
RESPONSES IN THE FUTURE.
AND FINALLY, A SPECIAL SECTION
ON THE VALUE OF MODELING.
AND WHAT DOES THE FUTURE HOLD
FOR BIOMEDICAL SEARCH.
IT'S BEEN OVER A HUNDRED YEARS
SINCE THE GREAT INFLUENZA.
WHAT HAVE WE LEARNED SINCE?
I FOUND IT INTERESTING THAT THE
PANDEMIC WAS TRULY HISTORIC BUT
OUR BASIC CONDITIONS AND CONTROL
MEASURES HAVE NOT CHANGED FOR A
HUNDRED YEARS.
MASKING.
SOCIAL DISTANCING.
NOT COUGHING AND SNEEZING IN
SOMEONE'S FACE.
IT'S AMAZING HOW LITTLE HAS
CHANGED EXCEPT FOR SOME OF THE
NEW SCIENCE.
THIS PANDEMIC MORE DEATHS THAN
THE SPANISH FLU.
ALTHOUGH A LOWER FATALITY RATE.
WE'VE SEEN ALL KINDS OF PROBLEMS
WITH IT IT'S BEEN HISTORIC.
OVER 5 MILLION DEATHS.
THE UNIVERSITY OF WASHINGTON HAS
SUBJECTED THAT THAT IS ONLY HALF
OF THE NUMBER OF DEATHS DUE TO
THIS.
AND ALSO STRIKING IS THE FACT
THAT THERE HAVE BEEN OVER
9 BILLION VACCINE DOSES
ADMINISTERED IN A LITTLE OVER A
YEAR.
REALLY A QUITE REMARKABLE
ACHIEVEMENT.
SO THE PANDEMIC HAS AFFECTED US
ALL.
WE'VE ALL LIVED THROUGH THIS.
THE SHUT DOWN OF TRAVEL.
BUSINESS LOCKDOWNS.
MENTAL HEALTH.
STRESS AND SCHOOLS AND
ENTERTAINMENT.
OUR LIVES HAVE ALL BEEN IMPACTED
AND AFTER TWO YEARS AS YOU CAN
SEE WITH OMICRON WE'RE STILL
LEARNING ABOUT THE VIRUS AND THE
CONSEQUENCES AND THINKING ABOUT
THE FUTURE.
LARRY AND DAVID AT HARVARD
ESTIMATED THE IMPACT IN ECONOMIC
TERMS AND FOR THE UNITED STATES
AND FELT THAT THE VACCINE WAS A
$16 TRILLION VIRUS.
ALSO THE COMMENT THAT SARS
PANDEMIC IS THE GREATEST THREAT
TO PROSPERITY AND WELL-BEING THE
U.S. HAS ENCOUNTERED SINCE THE
GREAT DEPRESSION.
THAT IS SOMETHING IMPORTANT.
DESPITE THE FACT THAT WE'VE USED
THAT 9.2 BILLION DOSES OF
VACCINE WHEN YOU LOOK AT THE
DISTRIBUTION OF THOSE IN THE
WORLD YOU CAN SEE IN AFRICA ONLY
8% OF ALL OF THESE VACCINES HAVE
REACHED THE AFRICAN CONTINENT.
A TROUBLING ISSUE ABOUT VACCINE
EQUITY.
AND SOMETHING THAT I WANT TO
DISCUSS IN THIS TALK.
AND THE PANDEMIC WE SEE AS A
WAKE-UP CALL.
A TEACHING MOMENT.
THE AFRICAN UNION HAS FOR A LONG
TIME ENCOURAGED CONSTITUENT
COUNTRIES 55 TO INVEST IN HEALTH
RESEARCH.
BUT VERY FEW HAVE PUT THE
INVESTMENTS IN AND NOW THEY ARE
IN A SITUATION WHERE ALL OF THE
COUNTRIES HAVE BEEN IMPACTED.
ALL PRESIDENTS IN AFRICA ARE
ENGAGED.
SOME VERY STRONGLY INVESTED IN
RESEARCH AND THE LIKE.
ALL ECONOMIES HAVE SUFFERED.
ALL PEOPLE'S HEALTH AND WELFARE
HAS BEEN IMPACTED.
THESE COUNTRIES HAVE FOUND
THEMSELVES NOW DEPENDENT UPON
THE INTERNATIONAL COMMUNITY FOR
ITS DIAGNOSTICS, DRUGS AND
VACCINES AND PPE.
QUITE REMARKABLE.
WELL I JUST CAME BACK IN
DECEMBER FROM RWANDA WHERE
THINGS SEEM QUITE DIFFERENT.
I HAD TO BE SCREENED BEFORE I
GOT ON THE AIRPLANE GOING IN AND
GOING OUT AND QUARANTINED FOR
TWO DAYS UNTIL I WAS COVID
NEGATIVE.
THEY VACCINATED OVER 90% OF
THEIR POPULATION WITH TWO DOSES
AND THEY ARE IN THE PROCESS OF
VACCINATING EVERYONE IN THE
RURAL AREAS AND THEY ARE MASKING
PER WHERE EVEN IN PERSONAL
VEHICLES AND THEY ARE PLANNING
AN mRNA FACILITY IN THE
COUNTRY.
WORKING ON GRANTS FOR GENOMICS.
THEY HAVE AN ENGINEERING
INSTITUTE AND THEY ARE DOING
AMAZING THINGS.
SO I WAS HEARTENED TO SEE THE
RATES WERE LOWER THAN IN MOST
PLACES IN THE UNITED STATES.
KNOWLEDGE OF THE PANDEMIC IS
SPREAD IN EVOLUTION IMPACT HAS
COME FROM GLOBAL PARTNERSHIPS.
WE HAVE NOT DONE THIS ONLY ON
THE U.S. CONTINENT.
THE SURVEILLANCE MAPS AND THE
DATA ARE FROM AROUND THE WORLD.
THE CLINICAL TRIALS OF DRUGS AND
VACCINES HAVE BEEN UNIVERSE 58.
THEY'VE BEEN FROM ALL OVER.
*.
CLINICAL TRIAL SITES.
VACCINES HAVE BEEN PROVIDED FOR
MANY COUNTRIES AND MANUFACTURERS
INCLUDING THE SHY NIECE,
RUSSIANS AND INDIANS HAVE BEEN
STRIKING.
INDUSTRY AND FINANCIAL
INSTITUTIONS HAVE BEEN INVOLVED
TO SEE WHAT THEY COULD DO AND
INTERNATIONAL ORGANIZATIONS AND
ACADEMIC INSTITUTIONS ARE ALL
INVOLVED.
THEY ALL HAVE A ROLE TO PLAY.
THIS IS A PANDEMIC THAT IS
MOBILIZED EVERYONE.
BECAUSE WE'RE ALL IN THIS
TOGETHER AND THE PANDEMIC WON'T
GO AWAY ANYWHERE UNTIL IT'S
CONTROLLED EVERYWHERE.
WELL I HAD THE PLEASURE OF
SPENDING TIME WITH JOHN, THE
DIRECTOR OF THE AFRICAN CDC IN
RWANDA.
HE IS EXTRAORDINARY AND HE HAS
BEEN PUSHING PROGRAMS FOR FIVE
YEARS INCLUDING THIS PROGRAM.
THE PARTNERSHIP FOR VACCINE
MANUFACTURER IN AFRICA.
AND HE HAS WRITTEN RECENTLY THAT
TWO YEARS IN COVID LESSONS OF
THE WORLD AND NATURE AND HE
ARGUES THAT AFRICA NEEDS TO
GUARANTEE ITS OWN HEALTH
SECURITY.
FINDING AN AFRICAN SOLUTION TO
AN AFRICAN GLOBAL PROBLEM.
HE ALONG WITH CHRISTIAN HAPPY
HAVE COME UP WITH FIVE CRITICAL
ELEMENTS.
INVESTING IN HEALTH AND DISEASE.
BUILDING REGIONAL CONTROL AND
CAPABILITIES.
ACCELERATING TRANSLATIONAL
RESEARCH AND DEVELOPMENT.
THOSE DIAGNOSTICS AND VACCINES
AND DRUGS THAT NEED TO BE
TRANSLATED AND RESEARCHED IN
COUNTRY.
INVESTING IN SURVEILLANCE.
SO HE HAS BEEN VERY CLEAR.
AND I JUST WANT TO NOTE THAT
CHRISTIAN HAPPY AND JOHN ARE
BOTH INVOLVED WITH NIH.
CHRISTIAN HAPPY IS A RECIPIENT
OF THE AWARD WHO MADE THE FIRST
SEQUENCE OF A COVID STRAIN IN
NIGERIA WITHIN A FEW DAYS OF ITS --
ITS EY IDENTIFICATION.
SO THEY BOTH HAVE STRONG
LEADERSHIP QUALITIES.
BORN LEADERS.
AS TONY MENTIONED THE OUTBREAK
BEGAN IN CHINA SO WE HAVE TO
THANK THE CHINESE FOR PUTTING
THE SEQUENCE EARLY ON AS A
PUBLICATION WHICH WAS THE
BLUEPRINT FOR MOST VACCINES SO
THAT TYPE OF INTERNATIONAL
COLLABORATION IS KEY.
THOSE SEQUENCES HAVE NOW BEEN
FOLLOWED AND ARE BEING LOOKED AT
AROUND THE WORLD AND TONY
MENTIONED HOW THAT HAS HAPPENED
BUT WHAT IS INTERESTING IN
AFRICA IS THAT AT THE BEGINNING
OF THE PANDEMIC ONLY THREE
COUNTRIES IN AFRICA ONLY THREE
SITES COULD SEQUENCE STRAINS IN
THE FIRST WEEKS.
SOMETHING THAT REALLY HAS TO BE
REMEDIED AS WE GO FORWARD AND
THINKING ABOUT GLOBAL
SURVEILLANCE.
AS AN EXAMPLE WE HAD A FELLOW
JESSICA MANNING AT FOGARTY HAS
MOVED TO NIAID AND IS ASSIGNED
TO THE NATIONAL CAMBODIAN
NATIONAL LAB.
SHE AND HER GROUP SEQUENCED THE
FIRST STRAINS OF COVID CAMBODIA.
SO EXTENDING THAT GLOBAL
NETWORK.
WHEN OMICRON EMERGED IN NOVEMBER
YOU CAN SEE HERE THE NUMBER OF
STRAINS AND THEIR MIGRATION
AROUND THE WORLD.
QUITE IMPRESSIVE AND THIS ALSO
HAS A LINK TO FOGARTY WHERE YOU
CAN SEE THE IN INVESTOR * WAS IN
TRAINING IN OUR AIDS PROGRAM
BEFORE AND IS NOW THE LABORATORY
DIRECTOR IN BOTSWANA.
THIS BEGAN AND THE IDEA OF
GETTING LEADERSHIP IN THE FIELD
IN AFRICA AND BUILDING AROUND
THOSE LEADERS IS ABSOLUTELY
ESSENTIAL GOING FORWARD.
THE ABILITY TO DO THE SEQUENCES
HAS BEEN A RAPID ADVANCE OF
TECHNOLOGIES THAT BECOME LESS
COSTLY.
PORTABLE.
SMALL SCALE AND ACCESSIBLE TO
ALL AND WITH THAT AT FOGARTY
ALONG WITH MANY PARTNERS JOHNS
HOPKINS AND THE AFRICAN CDC
WORKING TO TRAIN PEOPLE IN
SEQUENCES SO THEY WOULD BE
PREPARED FOR THE NEXT PANDEMIC
OR FROM WATCHING THIS PANDEMIC
AS IT GOES ON.
WE'VE DEVELOPED THIS AS A COURSE
WHICH HAVE BEEN USED THROUGHOUT
AFTER AT DEVELOPING WORLD AND
WHERE EVER IT IS NEEDED WITH
PACKAGES AND SOFTWARE TOGETHER
WITH JOHNS HOPKINS AND YOU CAN
SEE SOME OF THE INVESTIGATORS IN
PROVIDING SUPPORT FOR THIS.
THIS IS SOMETHING THAT WILL BE
AN ESSENTIAL TOOL IN PUBLIC
HEALTH LABORATORIES HENCEFORTH.
I WANT TO NOW BECAUSE THIS
SURVEILLANCE HAS BEEN SO
INTERESTING MODELING IN THIS
PANDEMIC HAS BECOME A NICHE
FIELD IN THE PAST.
AND CECILE LEADS A GROUP AND I
WILL GIVE HER A FEW MINUTES TO
DESCRIBE THE IMPORTANCE OF
MODELING AND HOW THIS COULD HELP
ANY COUNTRY IN ACCESSING THE
BURDEN OF THE DISEASE.
>> THANK YOU.
GO BACK.
PERFECT.
THANKS.
SO OUR CENTER HAS MAINTAINED A
GLOBAL NETWORK ON INFLUENZA AND
RESPIRATORY VIRUSES FOR TWO
DECADES NOW.
AND WE'VE USED THIS RELATIONSHIP
BUILT IN PEACETIME TO STUDY THE
COVID-19 PANDEMIC.
SO I WILL SHOW YOU A LITTLE BIT
OF OUR WORK WITH COLLEAGUES IN
SOUTH AFRICA AND CHINA TODAY.
SO VERY EARLY ON THERE WAS VERY
LITTLE DATA ON THE PATIENT LEVEL
ON COVID-19.
SO WE RELIED ON DIGITAL
SURVEILLANCE WHICH IS AN
APPROACH -- SUCH AS THE WEB OR
SOCIAL NETWORK TO MONITOR
INFECTIOUS DISEASE.
-- -- USED THE CHINESE SOCIAL
MEDIA WHICH IS TARGETED AT
MEDICAL PROFESSIONALS AND
AGGREGATES LOCAL NEWS FROM
[ INDISCERNIBLE ]
BUT ALSO LOCAL DOCTORS TO CREATE
A DATABASE OF PATIENT DATA. SO
WE HAD AT THE TIME IN
JANUARY 2020 A FEW HUNDRED CASES
BUT YOU COULD ALSO SEE
INTERESTING INFORMATION.
YOU CAN SEE THE AGE DISTRIBUTION
OF THESE CASES WITH THE BLUE
CURVE OF PRESENTING THE RELATED
RISK OF BEING DISEASESSED BY AGE
AND INCREASING IN OLDER AGE
GROUP WHICH IS A DEFINING ISSUE.
AND ON THE RIGHT-HAND SIDE YOU
CAN SEE HOW THE SOCIAL MEDIA
BASED DATA IN LIGHT BLUE
CORRESPONDS TO GROUND TROOP DATA
THAT WAS RELEASED BY THE CHINESE
CDC.
WE MADE THIS DATABASE.
IT WAS ONE OF THE FIRST TO BE
AVAILABLE TO THE PUBLIC AND
WE'VE NOW EXPANDED ON THE
DIGITAL SURVEILLANCE IDEAS WITH
COLLABORATORS WHERE WE'RE
LOOKING AT BOTH COVID-19 BUT
ALSO SOME OF THE DISEASES SUCH
AS MEASLES.
THROUGHOUT THE PANDEMIC WE'VE
BEEN WORKING CLOSELY WITH CHINA
AND PARTICULARLY WITH OUR
LONG-TERM COLLABORATOR ON FLU.
IT HAS MANY LABORS OF
INTERVENTION.
AND ONE OF THE INTERESTING
STUDIES WAS TO MONITOR CONTACTS
CLOSELY.
SO YOU SEE A CONTACTS BETWEEN
DIFFERENT AGE GROUPS.
WITH RED REPRESENTING HIGH
INTENSITY OF CONTACTS.
ON BASELINE YOU CAN SEE FREQUENT
CONTACTS BETWEEN CHILDREN IN
SCHOOLS AS WELL AS BETWEEN
ADULTS AND THEIR CHILDREN AND
THEN THE SQUARE IN THE MIDDLE
REPRESENTS CONTACTS AT WORK.
AND THE MIDDLE GRAPH YOU SEE
CONTACTS DURING THE LOCKDOWN
PERIOD WHICH WAS VERY STRICT IN
CHINA AND YOU CAN SEE A LOT OF
CONTACTS THAT HAVE DISAPPEARED
THAT YOU CAN SEE ON THE
RIGHT-HAND SIDE.
THE CHANGES IN CONTACTS --
[ INDISCERNIBLE ]
AS MONITORED BY GPS PHONES WHICH
IS ONE OF THE INDICATORS OF
CONTACTS AND PREVENTION USE FOR
OTHER PANDEMICS.
WE COULD USE THEM TO -- MODELS
AND LOOK AT THE DIFFERENT IMPACT
OF TRANSMISSION.
WE SEE AN UNCONTROLLED
EPIDEMILOGICA--EPIDEMIC IN RED.
WE DO NOT INTERRUPT TRANSMISSION
AND ALSO THE TOTAL SIZE OF THE
OUTBREAK IS
[ INDISCERNIBLE ]
SO CLOSING SCHOOL IS NOT ENOUGH.
SO WITH CHINA STILL WITH --
WE'VE BEEN ABLE TO LOOK AT
DETAILED CONTACT TRACING DATA
THAT THEY HAD FROM WUHAN
PROVINCE AND THIS WAS AT THE
VERY BEGINNING OF THE OUT BLACK.
THE NETWORK ON THE RIGHT
PRESENTED TRANSMISSION OF
COVID-19 CASES FROM ABOUT 1100
COVID-19 INFECTIONS.
THE DIFFERENT COLORS
REPRESENTING DIFFERENT CITIES
WITHIN THE PROVINCE.
AND YOU CAN SEE A HISTOGRAM.
YOU CAN SEE THAT ABOUT 70% OF
CASES -- -- SECONDARY INFECTION.
THERE WAS STRICT CONTACT TRACING
AND QUARANTINE AS WELL AS SOCIAL
DISTANCING BUT SOME CASES
[ INDISCERNIBLE ]
SO A LOT OF PE -- PET HETEROGENEITY.
WE ALSO SEE THAT CASES WITH
FEVER ARE COMING FROM WUHAN WAS
THE EPICENTER OF THE OUTBREAK.
THEY WERE SUSPECTINGS THEY HAD
COVID AND ALSO A LOT OF
TRANSMISSION OF THE HOUSEHOLD
AND THE FAMILY OF OVER 80% IS IN
THAT SETTING BECAUSE -- SO NOT
MUCH CONTACT IS HAPPENING
OUTSIDE OF THE FAMILY.
SO WE CAN ALSO USE THIS DATA ON
CONTACTS AND TRANSMISSION.
HERE WE WERE INTERESTED IN DOING
JUST CASE BASED INTERVENTION
WHICH WE SEE ON THE LEFT AND
THAT MEANS DETECTING CASES
ISOLATING THEM AND QUARANTINING
CONTACTS AND THEN ON THE
RIGHT-HAND SIDE WE LAYER CASE
INTERVENTIONS WITH SOME LEVEL OF
SOCIAL DISTANCING AND WE CAN SEE
THAT BECAUSE THERE IS A HIGHER
RATE OF TRANSMISSION BUT ALSO A
LOT OF OF THE TRANSMISSION IS IN
THE PRESYSTEMATIC PHASE IT'S
VERY DIFFICULT.
SO YOU WANT TO BE IN THE BLUE
AREA WHICH IS WHERE THE
REPRODUCTION NUMBER IS BELOW ONE
AND YOU'RE NOT ABLE TO SUSTAIN A
PANDEMIC.
IF YOU LOOK ON THE RIGHT -- AND
LAYER IT WITH SOCIAL DISTANCING
-- YOU THEN ARE BETTER ABLE TO
REALLY INTERRUPT TRANSMISSION
AND THIS IS A STRATEGY THAT A
NUMBER OF COUNTRIES HAVE TRIED
TO ADOPT.
SO WE'VE BEEN WORKING WITH
COLLEAGUES IN SOUTH AFRICA AND
AT THE NATIONAL INSTITUTE OF
COMMUNICABLE DISEASE.
AND WHAT IS INTERESTING ABOUT
SOUTH AFRICA IS THAT MOST OF THE
EPIDEMIC HAS BEEN DRIVEN BY
NATURAL INFECTION.
THE VACCINE HAS BEEN LATE
COMING.
BUT IT'S VERY INTERESTING TO TRY
TO UNDERSTAND NATURAL IMMUNITY.
SO TO HAVE A STRONG COHORT --
FOLLOWING PARTICIPANTS FOR OVER
A YEAR THROUGH THREE DIFFERENT
WAYS OF INFECTION WHICH YOU CAN
SEE HERE IN GRAY.
AND THEN PEOPLE ARE PCR'D EVERY
THREE DAYS AND THEN TESTED EVERY
THREE MONTHS.
AND YOU CAN SEE THAT AT THE END
OF THE DELTA WAVE MAY OF 2021 WE
SEE ABOUT 60% OF PARTICIPANTS
HAD BEEN NATURALLY INFECTED AND
MODELING THE RISK WE SEE THAT
PRIOR INFECTION IS 85% PROTECTED
BY ANY VARIENT.
IT WOULD BE QUITE DIFFERENT WITH
OMICRON.
AND WE ALSO SEE --
[ INDISCERNIBLE ]
SIMILAR TO WHAT WE SEE OF
VACCINATION.
SO WE CAN USE THIS CAREFUL
LEHMAN TOWARD COHORT TO MAKE
PROJECTIONING OF WHAT WILL
HAPPEN NEXT.
*.
WE'RE MAKING PROJECTION OF THE
OMICRON WAVE.
AND THE RELATED TRANSMISSIBILITY
TRANSMISSIBILITY.
THEN WE'RE LOOKING AT THE
PROJECTED ATTACK RATE IN SOUTH
AFRICA WHICH WE PROTECT TO BE
AROUND 70%.
THE FOURTH GRAPH PRESENTS THE
OUTBREAK AND ON THE RIGHT-HAND
SIDE THE PORTION OF INFECTIONS.
[ INDISCERNIBLE ]
SO IN ADDITION TO DOING THIS
SHELTER IN PROTECTION OF OMICRON
WE CAN USE THIS DATA TO THINK
ABOUT THE LONGER TERM
CONSEQUENCES.
WHAT COULD BE THE CONSEQUENCES
OF IMPRINTING WHICH IS THE IDEA
6 WHAT HAVE WHAT YOU'VE SEEN IN
THE PAST WILL DRIVE THE FUTURE
VARIANTS.
*.
SO WE'VE ALSO BEEN ABLE TO LOOK
AT SOUTH AFRICA DATA TO
UNDERSTAND THE IN DIRECT
CONSEQUENCES OF THE PANDEMIC AND
THAT IS THE CONSEQUENCES ON A
RANGE OF CHRONIC INFECTION.
THIS IS A TOPIC THAT IS STUDIED
A LOT.
BUT WE RELIED ON THE
SURVEILLANCE FROM THE PRIVATE
HEALTH CARE SYSTEM WHICH IS
CALLED MED CARE.
AND WE SEE THOSE AT THE BOTTOM
GRAPHS HERE.
WHAT IS GOOD IS THEY HAVE
HISTORICAL DATA BEFORE COVID-19
WHICH IS IN BLUE WHICH ALLOWS US
TO CREATE A BASELINE LEVEL OF
HOSPITALIZATION MIRRORING WHAT
COULD HAVE HAPPENED IF COVID-19
WAS NOT CIRCULATING.
AND THE DIFFERENCE BETWEEN THE
BLUE LINE VERSUS THE BLACK WHICH
IS WHAT HAPPENED WE CAN SEE THE
IMPACT OF THE PANDEMIC.
SO HERE WE'RE LOOKING AT THE
IMPACT OF RESPIRATORY
ADMISSIONS.
AND WITH CHILDREN WE'RE SEEING
FEWER HOSPITALIZATION THAN IN
NORMAL YEARS.
HOWEVER IN ADULTS WE'RE SEEING
MORE HOSPITALIZATIONS THAN IN
NORMAL YEARS DUE TO COVID-19 AND
WE THINK SOME OF THE CHANGES
THAT ARE EXPLAINED.
IN BLUE WE HAVE THE VIRUSES AND
IN ORANGE WE HAVE THE COVID-19.
SO THIS WAS COVID-19 BUT THE
INTEREST WAS TO LOOK AT OTHER
CONDITIONS NOT RELATED TO
COVID-19.
WE'RE LOOKING AT 19 DIFFERENT
CONDITIONS THAT LEAD PEOPLE TO
THE HOSPITAL.
SOME ACUTE.
SOME CHRONIC.
WE'LL FOCUS ON THE TOP LEFT FOR
A SECOND.
THIS IS FOR NONCOVID-19
PNEUMONIA AND INFLUENZA
HOSPITALIZATIONS.
PRELOCKDOWN IS THE REFERENCE
BEFORE COVID-19 AND ON THE Y
AXIS WE HAVE DIFFERENT PHASES
LINED UP CHRONOLOGICALLY.
AND YOU CAN SEE THAT FOR
PNEUMONIA AND INFLUENZA WE SEE A
SUBSTANTIAL DECREASE MORE THAN
50% FOR SOME OF THE PERIOD
RELATED TO PAST YEARS.
BECAUSE WE THINK THERE HAVE BEEN
FEWER RESPIRATORY VI VIRUSES BEYOND
COVID-19.
BUT WE ALSO SEE SOME OF THE
CHANGES FOR A RANGE OF
CARDIOVASCULAR CONDITIONS AND
CANCERS AND INJURY.
THOSE CHANGES ARE BECAUSE PEOPLE
AVERTED THE HEALTH CARE SYSTEM
DURING LOCKDOWN AND PERHAPS
13469 CONDITIONS ARE BEING
MISDIAGNOSISSED OR MISTREATED
BECAUSE PEOPLE DIDN'T REALLY
CARE FOR IT AND THAT MIGHT
TRANSLATE INTO --
[ INDISCERNIBLE ]
IN THOSE CONDITIONS AFTER
COVID-19.
THIS IS MY LAST SLIDE.
I HOPE TO GIVE YOU AN OVERVIEW
OF WHAT MODELING HAS BECOME AS A
TOOL.
TO HELP US ANTICIPATE THE
PROGRESSION OF THE PANDEMIC AND
ALSO THE CONSEQUENCES OF THE
PANDEMIC ON A RANGE OF
CONDITIONS AND WE THINK IT'S
VERY IMPORTANT IN BUILDING SO
THAT PEOPLE CAN LOOK AND
UNDERSTAND THE DATA AND MONITOR
THE PROGRESS OF THE PANDEMIC.
THANK YOU ROGER AND BACK TO YOU.
>> THANK YOU VER CECIL.
WE THINK DATA SCIENCE IS
IMPORTANT FOR ALL KINDS OF
HEALTH INTERVENTIONS AND ALL
KINDS OF RESEARCH.
IT'S ESSENTIAL TO GO ALONG WITH
INNOVATION.
THIS IS LAUNCHED.
$5 MILLION TO 12 AFRICAN
COUNTRIES WITH 15 OTHER
INSTITUTES BESIDES THE FOUR OF
US.
OTHER CHANGES THAT HAVE OCCURRED
THROUGH SCIENCE.
THE FACT THAT ALL OF THE
RESEARCH THAT IS GOING ON NOW
MUCH OF THE RESEARCH IS FOUND IN
PREPRINTS AS OPPOSED TO THE PEER
REVIEW LITERATURE WHICH HAS THE
ADVANTAGE OF GETTING SEEN
RAPIDLY WHEN IT'S VALUABLE AND
ALSO THAT NONPEER REVIEWED
THINGS CAN BE SEEN.
BUT IT'S THE SPEEDED UP REVIEW
THAT CAN BE VIEWED QUICKLY.
THE EMERGENCY USE AUTHORIZATION
THAT WAS PIONEERED IN THE UNITED
STATES HAS GONE THROUGHOUT THE
WORLD AND MANY COUNTRIES NOW
LIKE INDIA HAVE GIVEN EMERGENCY
USE AUTHORIZATIONS TO NEW
VACCINES BEFORE THE FULL-TIME TO
MONITOR FOR SEVERAL YEARS TO SEE
VACCINE LONG-TERM ADVERSE
CONSEQUENCES OF VACCINE.
WE'VE SEEN IN THE U.S. ELEVATION
OF SCIENCE IN THE U.S.
GOVERNMENT.
ERIC LANDER IN THE CABINET AND
TONY AS THE CHIEF MEDICAL
ADVISOR WE WOULD LOVE TO SEE
CABINET MINISTERS IN AFRICAN
COUNTRIES WHO ARE CONCERNED
ABOUT SCIENCE, RESEARCH AND
HEALTH.
BUT SCIENCE AND RESEARCH AND
SPECIFICALLY.
THIS WOULD CHANGE THE WAY WE
VIEW THINGS.
THIS IS SO IMPORTANT.
THE PANDEMIC AND DEALING WITH
THE EQUITY ISSUES THAT THE G-7
SPECIFICALLY GOT TOGETHER JUST
RECENTLY AND DECIDED THAT
SEVERAL INTERVENTIONS WERE
CLEARLY IMPORTANT
TRYING TO GET GLOBAL
SURVEILLANCE AND DETECTION OF
NEW OUTBREAKS BY A SURVEILLANCE
NETWORK THAT COULD IDENTIFY
OUTBREAKS WITHIN A WEEK.
DEVELOPING NEW VACCINES WITH A
TARGET OF LESS THAN 100 DAYS.
CONSTRUCTING VACCINE CONSTRUCTS
FOR 20 FAMILIES OF VIRUSES SO WE
CAN TAKE THEM OFF THE SHELF WHEN
A NEW PANDEMIC OCCURS.
THIS WOULD PROTECT THE PLANET
AND EMBRACE THE FUTURE.
BEYOND THAT WE'VE HAD AN ISSUE
OF DISINFORMATION AND I WAS
STRUCK IN ROWS WANDA HOW LITTLE
VACCINE HESITANCY THERE WAS.
PEOPLE WERE EXCITED TO GET THE
VACCINE.
THEY WERE PREPARED TO RECEIVE IT
WHEN IT WA IT WAS THERE.
SOMETHING THAT NEEDS TO BE
STUDIED.
VACCINE MANDATES ARE BEING USED
IN SOME COUNTRIES AND NOT
OTHERS.
SOMETHING THAT WE'RE CONSIDERING
HERE BUT WOULD LOVE TO SEE HOW
THE OTHER COUNTRIES RESPOND TO
THIS.
HAS COVID TAUGHT US ANYTHING
ABOUT PANDEMIC PREPAREDNESS.
WE HAVE TO STUDY THIS CAREFULLY
BECAUSE WE HAVE TO KNOW HOW TO
DO THINGS BETTER NEXT TIME.
MY SON IS A MEDICAL STUDENT.
HE SPENT TWO YEARS IN VIRTUAL
LEARNING SO I HOPE THAT VIRTUAL
LEARNING IS AS QUALITY AS THE
REAL THING.
MAYBE IT'S BETTER.
BUT THAT IS SOMETHING THAT WE'RE
GOING TO SEE MORE OF.
BUT IT'S CERTAINLY PORTABLE TO
OTHER COUNTRIES.
THE GLOBAL RESPONSE OF THE
PANDEMIC HAS BEEN EXTRAORDINARY.
EVERYONE IS INVOLVED IN TRYING
TO HELP BRING ABOUT AN END TO
THIS PANDEMIC BECAUSE WE'RE ALL
IN THIS TOGETHER.
PHO -- THE GLOBAL ALLIANCE FOR
VACCINES.
THE AFRICAN UNION.
PRIVATE SECTOR, INDUSTRY ARE ALL
LOOKING IN INVESTING IN AFRICA
IN DIFFERENT WAYS.
AFRICAN GOVERNMENTS ARE ALL
ON-BOARD.
THE G-7.
THE ACADEMIC CENTER.
WHAT CAN WE DO?
THE TWO OF THINGS THAT WE CAN
PROVIDE IN THIS SETTING ARE
TRAINING AND RESEARCH AND I
THINK THE EXPANSION OF THESE IN
AFRICA AS WE'VE DONE WITH AIDS
AND HAS BEEN SO EFFECTIVE IN THE
PAST 30 YEARS.
PETER MY DEPUTY AND I MADE A
COMMENTARY WHICH STATES THAT
[ INDISCERNIBLE ]
OF HEALTH RESEARCH CAPACITY AS
AN ESSENTIAL ELEMENT OF PANDEMIC
PREPAREDNESS.
WHEN WE LOOK AT THE LEADERS IN
AFRICA AND BEYOND JOHN LEADING
THE AFRICAN CDC, LINDA GRAY IS
HEAD OF THE SOUTH AFRICAN
MEDICAL RESEARCH COUNCIL WORKING
TO GET VACCINE MANUFACTURERS IN
AFRICA.
SLIM -- -- WORKING TO GET
DIAGNOSTICS WITH THE AFRICAN
UNION.
JEAN NACHEGA WORKING ON SIM POSE
YAM US JUST LIKE THIS ONE.
AND DR. WU.
THOSE FOREIGN LEADERS TRAIN
THROUGH NIH AND FOGARTY PROGRAMS
ARE REALLY OUR LINK TO THE WORLD
TO BUILD BACK THE FUTURE.
CHALLENGES GOING FORWARD.
BUILDING THAT EPIDEMIC
SURVEILLANCE SYSTEM TO IDENTIFY
NEW OUTBREAKS.
ESTABLISHING CENTERS TO MAKE
VACCINES, DRUG SUPPLIES AND
DEVICES LOCALLY.
MULTIPLE PROVIDERS OF KEY
INGREDIENTS THAT ARE AVAILABLE.
ACCELERATE RESEARCH UNDER
VACCINE GROUPS.
ACCESSING COLLATERAL DAMAGE.
CAN WE GRANT BIOSECURITY.
THE SAME PRIORITY AS MILITARY
SECURITY.
SO HOW DO WE PREPARE FOR THE
NEXT PANDEMIC?
WELL FIRST WE HAVE TO RECOGNIZE
THAT WE WON'T BE SAFE UNTIL WE
ALL ARE SAFE AND THIS INCLUDES
PEOPLE IN LOW AND MIDDLE INCOME
COUNTRIES WHO DON'T YET HAVE
ACCESS TO VACCINES AND
DIAGNOSTICS AND DRUGS AND THAT
WILL BEGIN WITH SETTING UP THE
GLOBAL SURVEILLANCE AND MODELING
SUPPORT.
WE HAVE TO GET THE AFRICAN
LEADERS AND UNION WHO ARE NOW
MOTIVATED TO RESPOND TO BUILD ON
THEIR PLAN THROUGH THE AFRICAN
CDC AND DEFINITELY A BIOTECH
INDUSTRY WHICH SOME OF THE
COUNTRIES HAVE JUST BEGUN TO DO.
PEOPLE ARE INTUNE TO DO THINGS.
THE GLOBAL COMMUNITY IS TRYING
TO HELP IN ALL SORTS OF WAYS.
NOT ALWAYS WELL COORDINATED BUT
THE SPIRIT IS THERE.
AND ULTIMATELY GLOBAL
COLLABORATIONS HAVE DEMONSTRATED
AS WITH HIV THAT THESE
DISCOVERIES IN SCIENCE CAN LEAD
TO INDUSTRY AND FUNDING
PARTNERSHIPS THAT HAVE TURNED
THAT PANDEMIC OF HIV INTO A
CHRONIC DISEASE.
WE HAVE A WAYS TO GO WITH COVID
BUT THIS IS SOMETHING THAT WE
MUST PURSUE TODAY.
I WANT TO GIVE A BIG SHOUT OUT
TO WIN -- WHO HAS DEVELOPED THIS
INCREDIBLE PROGRAM.
AND DAN KASTNER.
YOU'VE DONE A GREAT SERVICE TO
THE MEDICAL COMMUNITY AND THE
WORLD TO PUT THESE ON THE WEB
AND ARCHIVE THEM.
AND DAN YOU HAVE BIG SHOES TO
FILL.
THANK YOU SO MUCH FOR LETTING ME
SPEAK TO YOU TODAY.
>> THANK YOU, THANK YOU VERY
MUCH ROGER.
.-- IT'S EXCITING TO SEE HOW THIS
TRULY IS BEING TRANSLATED INTO A
PLAN OF GLOBAL ACTION RATHER
THAN JUST GLOBAL RECOGNITION
WHICH BECAME APPARENT DURING THE
EPIDEMIC.
WE HAD A GLITCH IN THE
SUBMITTING OF QUESTIONS.
SO NOT ALL OF THE QUESTIONS THAT
WERE SUBMITTED WAS IT POSSIBLE
TO PRESENT TO HIM WHILE HE WAS
WITH US BUT WE'LL FORWARD THEM
TO HIM.
WE APOLOGIZE.
WITH SPECIFICALLY ROGER WHAT DO
YOU THINK -- WHY DO YOU THINK
THE PEAK OF INFECTION IS
DECREASING SO RAPIDLY IN SOUTH
AFRICA?
WHAT DO YOU BELIEVE -- WHAT ARE
THE MECHANISMS THAT COULD BE
RESPONSIBLE FOR THAT AND IS PART
OF THAT DUE TO VAC NATION?
AND THE * PUBLIC HEALTH
RESPONSE.
>> THAT IS A QUESTION FOR THE
MODELER.
IT IS SO BIG THAT IT'S GOING TO
COME QUICKLY AND GO QUICKLY.
CECIL CAN YOU COMMENT ON THAT?
>> YEAH.
BUT YOU ANSWERED IT WONFULLY,
ROGER.
* WE DON'T THINK IT'S
INTERVENTIONS OR VACCINATION.
BECAUSE WHAT WE HEAR ON THE
GROUND IS NOTHING REALLY
HAPPENED IN TERMS OF
INTERVENTION AND THE VACCINE
ROLLOUT IS STILL RELATIVELY
SLOW.
WITH THE HIGH TRANSMISSION RATE
YOU WOULD EXPECT IT TO BE SPIKEY
AND BURN ITSELF OUT QUICKLY
WHICH IT HAS.
>> CAN WE BELIEVE THAT WE'RE
GOING TO BE BETTER IN THE U.S.
BY FEBRUARY OR MARCH?
THAT IS A QUESTION FOR TONY?
>> YES.
WE HOPE SO.
>> DO YOU THINK IT WILL BE GOING
AWAY IN THE U.S. BY FEBRUARY OR
MARCH, CECIL.
WHAT ANSWERS DO THEY PROVIDE?
>> WE'RE RUNNING PREDICTIONS
COMBINING RESULTS FROM DIFFERENT
MODELS IN THE U.S. WHICH
PREDICTIONS IS WHAT WAS RELEASED
TODAY AND OUR PREDICTION IS THE
PEAK OF THE EPIDEMIC WILL BE
REACHED WITHIN ONE TO THREE
WEEKS.
VERY SOON.
DEFINITELY BY JANUARY.
ALIGNING WITH TONY'S
PROJECTSESES IT WILL BE MUCH
BETTER BY FEBRUARY.
BUT THE SEVERITY OF THE DISEASE
--
[ INDISCERNIBLE ]
AND THAT WILL LEAD TO
HOSPITALIZATIONS IN UNVACCINATED
PEOPLE.
>> THANK YOU.
>> THE QUESTION IS -- THE USE OF
MODELING IS DEPENDENT UPON THE
RELIABILITY ACCURACY OF THE
INFORMATION THAT IS PROVIDED FOR
THE MODELING SYSTEM.
TO WHAT EXTENT, ARE THERE
PROBLEMS IN ACCESSING THAT KIND
OF INFORMATION PARTICULARLY IN
MANY OF THE COUNTRIES IN AFRICA
THAT YOU REFERRED TO?
>> SO YES AND NO.
HAVING WORKED ON A LOT OF DATA I
WILL SAY THAT THE U.S. IS
ACTUALLY A DATA POOL COUNTRY
COMPARED TO WHAT WE SEE IN
EUROPE.
VERY DETAILED DATA AND THE
ABILITY TO RUN THESE COHORTS OF
FIFA THAT ARE FOLLOWED CLOSELY.
PERHAPS SOMEHOW WE DON'T SEEM TO
HAVE IN THE U.S.
IT'S A COMPLICATED SYSTEM IN THE
U.S.
BUT WE CAN FIND VERY DETAILED
AND GOOD DAT DATE -- DATA
[ INDISCERNIBLE ]
WHERE DATA IS MUCH FASTER AND
THE WAY TO TRY TO USE THIS IS TO
USE MODELS FROM NEIGHBORING
COUNTRY OR TO DO SCENARIOS.
IF MY PARAMETER IS THIS OR THAT
WOULD THAT CHANGE MY
PROJECITONSES?
THERE IS A WAY TO HANDLE THE
UNCERTAINTY OF THE DATA
>> A QUESTION ROGER, WHAT IS THE
INVOLVEMENT OF FOGARTY WITH
RESPECT TO THE COVID PROBLEM IN
LATIN AMERICA?
>> LATIN AMERICA HAS BEEN IN
SOME WAYS SPECIAL.
BECAUSE THEIR HIGH RATES OF
VACCINATION.
FOR COVID.
SO WE HAVE HAD LIMITED
INVOLVEMENT IN LATIN AMERICA
BECAUSE THE SETTING IN AFRICA IS
SO MUCH DIFFERENT AND SO MUCH
UNDER RESOURCED.
SO I CANNOT GIVE YOU A FULL
UPDATE WITHOUT GOING TO OUR
RECORDS.
WE HAVE GRANTS IN LATIN AMERICA
BUT NOT AS MANY AS WE HAVE IN
AFRICA AND LOW-INCOME COUNTRIES.
7
>> SO IS THAT TRUE FOR MEXICO AS
WELL?
>> MEXICO HAS DONE NICE WORK
WITH AND HAS GOOD EPIDEMIOLOGY.
AND HAS DONE NICE WORK WITH
COVID IN COLLABORATION WITH
CECIL'S GROUP IN MODELING.
78
>> WHAT IS THE CURRENT STATUS OF
PET FAR.
IS IT STILL ACTIVE IN AFRICA OR
IS ITS FUNDING CONTINUING?
>> FUNDING IS CONTINUING.
THE PRISON IS NOT YET A SIGNED A
NEW DIRECTOR BUT JOHN THE HEAD
OF THE AFRICAN CDC HAS BEEN
OFFERED THE POSITION BUT IT
REQUIRES SENATE CLEARANCE.
SO, THAT IS UP IN THE AIR RIGHT
NOW.
THERE IS A POSITION THAT WILL BE
FILLED AND THE PROGRAM WILL BE
CONTINUING.
THE ADDITIONAL QUESTION IS
WHETHER THERE WILL BE A
BROADENING OF MANDATE TO INCLUDE
COVID ACTIVITIES AS WELL AS HIV.
AND IT'S REMARKABLE TO US THAT
HAVING INVESTED FOR SO LONG IN
HIV RESEARCH IN MANY COUNTRIES
THAT THOSE PEOPLE WHO HAVE THAT
EXPERIENCE IN TRAINING AND
HISTORY IN RESEARCH HAVE BEEN SO
READY TO ADAPT TO WORKING NOW
WITH ANOTHER PANDEMIC AND TO
ASSUME THOSE LEADERSHIP
POSITIONS.
ANYTHING THAT WE DO IN CAPACITY
BUILDING FOR COVID WILL HAVE
RETURNS IN THE FUTURE.
>> VALERIE ASKED WOULD YOU SAY
THAT THE UNITED STATES HAS THE
RESPONSIBILITY OF SHARING
VACCINE PATENTS AND INCREASING
ACCESSIBILITY OF VACCINATIONS
UNTIL AFRICA IS UP AND RUNNING
ON ITS OWN?
>> THAT IS A QUESTION THAT IS
CURRENTLY UNDER DISCUSSION.
I THINK BIG PHARMA FEELS THAT
THEY CAN TURN UP THE NOTCH AND
PRODUCE MORE VACCINES.
THE EVIDENCE IS THAT SO FAR VERY
FEW AS YOU SAW LESS THAN 8% OF
THE VACCINES PRODUCED HAVE GONE
TO AFRICA.
AND EVEN COMPANIES LIKE MODENA
HAVE BEEN SLOW TO EMBRACE A
GLOBAL AGENDA.
SO THAT IS ONE OF THE REASONS
WHY AFRICANS WANT TO DEVELOP A
MANUFACTURING CAPACITY.
SOME OF THAT WILL BE WITH DECK
TRANSFER.
THERE IS DISCUSSION UNDERWAY.
FOR RESEARCH INSTITUTE THAT CAN
WORK WITH NEW VACCINES THAT
MIGHT BE OF PARTICULAR INTEREST
IN AFRICA SO I THINK WE HAVE A
LONG WAY TO GO THERE BUT
SHORT-TERM THE FACT THAT WE'VE
GOTTEN 9 BILLION DOSES OF
VACCINE OUT IN THE PAST YEAR
WITH NEW PRODUCTION COMING
ON-BOARD IN INDIA AND IN THE
UNITED STATES AND THAT MEANS
THERE WILL BE A GOOD SUPPLY OF
VACCINES FOR THE NEXT TWO OR
THREE YEARS.
>> CHRIS ASKED HOW ARE THE
CROWDED POOR CITIES SUCH AS
THOSE IN INDIA, PAKISTAN
RELATIVELY SPARED WHEN THEY HAVE
NO VACCINES?
I KNOW THERE HAVE BEEN BAD DAYS
IN INDIA BUT WHY IS THE DEATH
RATE IN THE UNITED STATES WITH
ITS 70% VACCINATION HIGHER THAN
IN COUNTRIES WITH 5% TO 10%
VACCINATION?
>> AT LEAST I DON'T KNOW IN
INDIA EXACTLY BUT IN AFRICA THE
AGE DISTRIBUTION IS SUCH THAT
THERE ARE FEWER OLDER PEOPLE AND
THOSE ARE THE PEOPLE MOST LIKELY
TO DIE FROM COVID.
SO THE YOUNGER THE HEALTHIER YOU
ARE THE LESS LIKELY YOU ARE OF
DYING.
SO THAT MAY EXPLAIN SOME OF IT.
ALSO THE INDIANS HAVE BEEN
EXTRAORDINARY WHILE THEY MISSED
THE FIRST PANDEMIC OR THE% PEAK
THE SECOND PEAK WAS TERRIBLE.
DESPITE THE FACT THAT THEY MADE
LOTS OF VACCINES.
MODI REQUEST THAT THE VACCINE
COMPANIES IN INDIA NOT EXPORT
THEIR VACCINES UNTIL THE INDIAN
POPULATION WAS IMMUNIZED AND
THAT CHANGED IMMUNIZATION
COVERAGE.
INDIA WAS A DARKER PINK BUT NOT
A RED SO THE COVERAGE IS -- THEY
ARE IMMUNIZING SEVERAL MILLION
PEOPLE A DAY.
IT IS EXTRAORDINARY.
>> DAN ASKS WHETHER THERE IS
SOME CONJECTURE REGARDING THE
POSSIBLE EVOLUTION OF COVID-19
IN THE SETTING OF INDIVIDUALS
WITH INCOMPLETELY TREATED HIV AS
IS SEEN IN SOME AREAS OF SUB
SAHARAN AFRICA HAS THE MODELING
PROVIDED ANY INSIGHTS ON THESE
RELATIONSHIPS?
>> LET ME START WITH THAT AND
THEN I ASK CECIL.
WHAT IS INTERESTING IN THIS
OMICRON STRAIN IS IT WAS FIRST
SEEN QUITE A WHILE AGO AND THEN
THERE IS NO EVOLUTION OF THIS
STRAIN UNTIL JUST RECENTLY UNTIL
NOVEMBER.
A FLAT LINE.
SO YOU HAVE A VIRUS THAT HAS NOT
CHANGED FOR A YEAR AND A HALF.
HOW COULD THAT BE?
WHERE CAN IT HIDE?
AND ONE OF THE HYPOTHESIS IS
SOMEONE WHO WAS IMMUNO
COMPROMISED WHO CARRIED THAT
TRAIN FOR THE DURATION.
IT IS AN INTERESTING
SPECULATION.
ANY OTHER INSIGHTS TO THIS,
CECIL?
>> THAT IS THE PRIMARY -- THERE
IS ALSO A SECOND -- PRESUMABLY
OF THAT SAME PATIENT.
[ INDISCERNIBLE ]
AND THE MODELING THAT ALLOWS YOU
TO UNDERSTAND THE RELATIONSHIP.
IT'S NOT THE TRANSMISSION THAT
WE TALKED ABOUT TODAY.
THERE IS SOME EVOLUTIONARY WORK
BEING DONE AT THE UNIVERSITY OF
WASHINGTON ON THIS AND THIS IS
ALSO SOMETHING THAT WE SEE IN
THE FLU WHERE PEOPLE WHO ARE
IMMUNO COMPROMISED GENERATE
STRAINS THAT ARE SEEN IN THE
POPULATION.
[ INDISCERNIBLE ]
>> THE QUESTION ASKED BY -- HOW
DO YOU JUSTIFY THE WIDE
AVAILABILITY OF BOOSTERS IN THE
UNITED STATES WHILE LOW AND
MIDDLE INCOME COUNTRIES HAVE
VERY LOW VACCINATION COVERAGE
DUE TO LACK OF SUPPLY?
YOU WANT TO COMMENT ABOUT THE
QUESTION OF SUPPLY AND
AVAILABILITY?
REGARDING BOOSTERS PARTICULARLY
IN AFRICA?
OR LATIN AMERICA.
>> THAT IS REALLY WHERE THE
ISSUE OF EQUITY IN VACCINE
DISTRIBUTION COMES ABOUT.
AND I THINK MOST RECENTLY AS
SUPPLY HAS GOTTEN GREATER WE CAN
BE MORE GENEROUS IN THE SUPPLIES
PRESENTED TO THE CO-VAX
FACILITY.
THE GROUP THAT IS RECEIVING
VACCINES AND DONATIONS FROM
MULTIPLE COUNTRIES WITH THE IDEA
THAT THIS WOULD GO OUT TO AFRICA
AND LOW-INCOME COUNTRIES TO
TARGET 20% OF THE POPULATION WHO
ARE AT HIGHEST RISK.
THE ELDERLY AND HEALTH CARE
WORKERS.
THAT HAS NOT HAPPENED YET.
COUNTRIES MAY MAKE VACCINE ARE
HARD PReSED TO GIVE UP THEIR
VACCINES UNTIL THEIR OWN
POPULATIONS HAVE BEEN FULLY
IMMUNIZED BUT NOW THAT WE HAVE A
SURPLUS IN THE U.S. WE'RE
CONTRIBUTING MORE TO THE
CONTINENT.
ONE OF THE PROBLEMS IS THE
INABILITY TO HAVE THE
REFRIGERATION FOR THE LOW
TEMPERATURE PFIZER VACCINE.
VACCINES THAT ARE SUITABLE AT
REFRIGERATED TEMPERATURES ARE
MUCH MORE SUCCESSFUL AND SINGLE
DOSE VACCINES WOULD BE OPTIMAL
IF THEY DIDN'T NEED TO BE
BOOSTED.
>> WE HAVE AN IMPORTANT QUESTION
FROM A PRIMARY CARE PHYSICIAN.
HOW DO I DECIDE WHETHER TO
RECOMMEND ANTIVIRAL VERSUS
MONOCLONAL THERAPY IN THIS TIME
OF OMICRON.
WOULD A STANDARD PCR
DIFFERENTIATE OMICRON FROM
DELTA?
CAN YOU COMMENT ABOUT THAT?
>> THE -- RIGHT NOW THAT IS A
DIFFICULT DECISION.
IF SOMEONE HAS AN INFECTION AND
THEY AR IMMUNO COMPROMISED --
WHETHER THERE IS A SUITABLE
MONOCLONAL FOR THAT STRAIN OR
WHETHER REMDESIVIR AND THE
OTHERS ARE MORE APPROPRIATE BUT
I'M NOT A CLINICIAN.
>> WE'LL FORWARD THAT TO TONY
AND HAVE HIM RESPOND.
>> AMELIA ASKS THAT YOU
PREDICTED 34 DAYS OF OMICRON
OUTBREAK IN SOUTH AFRICA THE
PEAK HAS PASSED.
DOES IT APPEAR THAT YOUR
PREDICTIONS WERE VERY CLOSE?
>> YES.
THE EPIDEMIC IS IS NOT OVER YET.
IT IS ON ITS WAY DOWN AS HAS
BEEN MENTIONED BUT I THINK WE'RE
GOING TO BE CLOSE.
>> OKAY.
SO WE ANXIOUSLY WILL SEE AND
HOPE THAT THINGS WILL
FOLLOW-THROUGH.
A COUPLE OF INQUIRIES AS TO
WHETHER THERE IS -- WHETHER
FOGARTY -- HOW DOES FOGARTY
APPROACH VACCINE EQUITY ISSUES?
AND YOUR PROGRAMS.
IS THERE A SPECIAL APPROACH TO
THAT IMPORTANT PROBLEM?
OR I IS THIS IS A LOCAL PROBLEM
>> EQUITY IS QUITE SPECIFIC.
WE'RE INTERESTED IN TRAINING
LOCAL PEOPLE.
TO PROVIDE LOCAL ANSWERS AND TO
MAKE LOCAL DECISIONS.
SO WE'VE TRAINED PEOPLE FOR
INSTANCE LIKE -- SLIM WHO'S HEAD
OF THE COVID ADVISORY COMMITTEE
FOR THE MINISTRY OF HEALTH IN
SOUTH AFRICA.
THIS IS A DECISION THAT THEY
HAVE TO MAKE FOR THEIR OWN
PEOPLE.
-- BUT OUR CONTRIBUTION IS TO
HELP TRAIN LEADERS TO ADDRESS
THESE.
SOMETHING THAT WE'RE ALL
CONCERNED WITH WHEN WE SEE THE
INEQUITY AND HOW WE CAN ADDRESS
THAT.
AN ISSUE THAT WE HAVE AT HOME AS
WELL.
GETTING VACCINES TO THE POOREST
COMMUNITIES.
>> ROGER IN YOUR OPINION WHAT
COUNTRY OR COUNTRIES HAVE HAD
THE MOST EFFECTIVE PUBLIC HEALTH
RESPONSE AGAINST THE COVID
PANDEMIC AND WHAT LESSONS COULD
WE LEARN AS A GLOBAL
COMMUNITY-BASED UPON THOSE
INDIVIDUAL COUNTRY EXPERIENCES?
>> WELL FOR HIGH INCOME
COUNTRIES I WAS ON THE PHONE
YESTERDAY WITH A SENIOR
VIROLOGIST IN AUSTRALIA WHO SAID
THEY'VE DONE WELL IN CONTROLLING
THE PANDEMIC.
THEY HAVE HIGH LEVELS OF
IMMUNIZATION.
THEY HAVE VERY FEW DEATHS SO
THEY'VE DONE ALL OF THE RIGHT
THINGS.
AND I MUST SAY I WAS IMPRESSED
IN RWANDA.
A POOR COUNTRY WITH HOW MUCH
THEY'VE DONE FROM THE ONSET TO
NOT LET FOREIGNERS
>>> THE COUNTRY WITHOUT BEING
SCREENED AT THE BORDERS.
PUTTING MESS CA -- MASKING IN AND
SHUTTING DOWN SOCIAL DISTANCING.
7 AND WHEN THEY PREPARED TO HAVE
VACCINES THEY WENT RIGHT INTO
THE -- POPULATIONS AND THEY
COULD ABSORB AND USE THEM
IMMEDIATELY.
IT WAS QUITE A UNIQUE SITUATION
AND WITH A COUNTRY THAT IS
HIGHLY COMMITTED TO ITS PUBLIC
HEALTH SYSTEM.
>> IN AUSTRALIA I BELIEVE THAT
INDIVIDUALS HAVE BEEN PREVENTED
FROM MOVING FROM ONE STATE AREA
TO ANOTHER.
WHICH IN THE FACE OF LOW
INFECTION RATES LOW CLINICAL
INFECTION RATES AND DIFFERENT
COMMUNITIES IT CAN CAUSE QUITE
AN UPROAR.
THE AUSTRAILIAN PUBLIC -- DO YOU
HAVE ANY COMMENTS ABOUT HOW
POLICIES, HOW DO YOU BALANCE
WHAT INDIVIDUALS WANT TO DO AND
WHAT REGULATIONS REQUIRE THEM TO
DO?
IS IT POSSIBLE TO GO TOO FAR
WITH REGULATIONS?
>> WHEN WE'RE HAVING THE SAME
PROBLEM IN THE UNITED STATES OF
WHAT CAN WE MANDATE?
WE CAN MANDATE FEDERAL EMPLOYEES
AND EMPLOYEES OF COMPANIES MORE
THAN 100 TO BE IMMUNIZED AND TO
BE TAKEN CARE OF BUT WE CANNOT
MANDATE EVERYONE.
THAT IS A REAL CONTROVERSY.
IF WE HAD OUR WAY AS PUBLIC
HEALTH PHYSICIANS WE WOULD SAY
EVERYONE SHOULD WANT TO BE
VACCINATED SO WE WOULDN'T HAVE
TO MANDATE.
PEOPLE ARE HESITANT AND
UNCERTAIN AND IF YOU MANDATE IT
WILL ONLY THE BELIEF IS THAT IT
WILL ONLY LEAD TO A NEGATIVE
RESPONSE.
A RESPONSE THAT WE REALLY DON'T
WANT.
SITES HOW YOU LOOK AT PRIVATE
RIGHTS OR INDIVIDUAL RIGHTS AND
THAT IS ONE THAT WE HAVE NOT
SOLVED HERE IN THE UNITED
STATES.
>> WHEN DID THAT DEVELOP
HISTORICALLY IN THE UNITED
STATES?
I SEEM TO RECALL THAT THE PUBLIC
HEALTH RESPONSE FOR EXAMPLE TO
TYPHOID IF SOMEONE WAS A CARRIER
THEY COULD BE LITERALLY PUT AWAY
IN ISOLATION.
I BELIEVE DURING THE POLIO
EPIDEMIC THERE WERE MANDATES
WITHIN -- I'M NOT SURE IF THEY
WERE FEDERAL OR NOT.
BUT CHILDREN COULD NOT GO TO
SCHOOL IF THEY WERE NOT
VACCINATED.
ALL OF THAT.
WHEN DID IT CHANGE?
>> ONE THING THAT CHANGED WAS IN
THE CARTER ERA THE MANDATE TO BE
IMMUNIZED BEFORE CHILDREN WENT
TO SCHOOL WAS PUT IN PLACE.
THAT YOU USED TO BE ABLE TO OPT
OUT.
YOU WERE IN UNTIL YOU PROTESTED
BUT THAT LAW REALLY ALLOWED FOR
CONTROL OF MEASLES IN THE UNITED
STATES.
IT WAS FLUF -- INFLUENCAL AND
SUCCESSFUL.
NOW WE'RE ALL IMMUNIZED AGAINST
POLIO EXCEPT FOR A FEW.
AND WE'VE PERIODICALLY HAVE HAD
TINY OUTBREAKS.
I HAVE NOT HEARD OF ANY IN THE
RECENT PAST BUT THEY STILL WERE
A PROBLEM.
>> SO IF YOU WOULD ENGAGE IN A
LITTLE PERHAPS SPECULATION
CERTAINLY OPINION -- IN TODAY'S
MEDICAL POSSIBILITIES WE CAN
VACCINATE TO BASICALLY PREVENT
HELP -- HEPATITIS B VIRUS.
WE CAN TREAT HEPATITIS "C." WE
HAVE DRUGS THAT CONVERT HIV INTO
A CHRONIC LIVABLE DISEASE AND
WITH COVID WE SEEM TO HAVE
EVERYTHING IN THE WAY OF
PREVENTION, TREATMENT AND SO
FORTH.
BUT IN YOUR VIEW HOW DO WE GET
TO THE POINT WHERE ALL OF THESE
THINGS BECOME AVAILABLE TO
POPULATIONS RICH AND POOR AROUND
THE WORLD.
TO WHAT OBSERVES -- EXTENT DOES
THE SCIENTIFIC COMMUNITY HAVE TO
WORK WITH THE POLITICAL
REALITIES.
WHAT IS YOUR PERSONAL VIEW AS TO
WHAT DO YOU THINK THE FUTURE IS
GOING TO HOLD FOR MAKING THESE
THERAPIES TRULY AVAILABLE TO
EVERYBODY AT A COST THAT CAN BE
HANDLED?
IS THIS A DREAM OR IS THERE
REALLY A REASONABLE POSSIBILITY?
>> GREAT QUESTION.
WHEN YOU LOOK AT THE HIV
EXPERIENCE THOSE DRUGS THAT WERE
TENS OF THOUSANDS OF DOLLARS IN
THE U.S. 25 YEARS AGO ARE NOW
INEXPENSIVE, THEY ARE MADE IN
INDIA AT LOW COST AND NOT FOR
REIMPORTATION TO THE UNITED
STATES.
THERE HAS BEEN A SHARING OF
INTELLECTUAL PROPERTY SO THEY
COULD BE MADE OFFSHORE AT LOW
COST FOR THE DEVELOPING WORLD
AND THEY ARE SUPPLIED THROUGH
PET FAR FOR EXAMPLE.
WE DON'T UNDERSTAND THE
BEHAVIORAL -- THE BEHAVIOR OF
PEOPLE TAKING DRUGS.
PETER SMALL SAID THE BIGGEST
PROBLEM IN MEDICINE OF DRUG
ABUSE IS PEOPLE FAILING TO TAKE
THEIR DRUGS.
IF SOMEONE WERE TO TAKE THEIR
DRUGS ROUTINELY FOR HIV THEY
WOULD HAVE A CHRONIC DISEASE AND
LIVE AN ALMOST NORMAL LIFE.
YET SO MANY PEOPLE FOR REASONS
OF DEPRESSION, MENTAL HEALTH
PROBLEMS STOP TAKING THEIR DRUGS
AT DIFFERENT TIMES AND SET
THEMSELVES UP.
THERE IS A WHOLE AREA OF
BEHAVIORAL RESEARCH ABOUT TAKING
DRUGS.
WITH HEPATITIS "C" THERE ARE
COUNTRIES NOW THAT ARE IN THE
PROCESS OF TRYING TO HAVE A
ROLLOUT A SCREENING AND
TREATMENT.
AND THAT IS AVAILABLE NOW IN
MANY COUNTRIES OF THE ANTIVIRALS
OF DIFFERENT BRANDS ARE
AVAILABLE AT A LOW COST IN SOME
COUNTRIES AND THERE ARE NATIONAL
ROLLOUTS WITH SCREENING AND
TREATMENT.
SO I THINK THAT WE ALWAYS START
HERE IN THE UNITED STATES WITH
HIGH COST VACCINES AND DRUGS.
AND AFTER WE'VE SATURATED OUR
MARKET THERE IS A REAL EFFORT TO
MOVE ON.
I THINK THAT IS WHERE WHO HAS
DEVELOPED THIS INTERNATIONAL
PATENTS POOL TO ADDRESS THAT.
THERE ARE ECONOMIC ISSUES AND
BEHAVIORAL ISSUE ABOUT TAKING
THE DRUGS AND VACCINES WHEN YOU
HAVE THEM.
IT JUST TAKES TIME.
AND THAT IS A REAL CHALLENGE IN
GLOBAL HEALTH.
HOW DO WE DEAL WITH EXACTLY
THOSE ISSUES.
>> ALL RIGHT.
I WANT TO THANK YOU ON BEHALF OF
ALL OF THOSE LISTENING AROUND
THE WORLD FOR YOUR PRESENTATION
TO YOU AND YOUR COLLEAGUE AND
ALSO
[ INDISCERNIBLE ]
>> THANK YOU VERY MUCH.
THIS HAS BEEN A REAL -- PLEASURE
>> BEFORE WE GO OFF THE AIR NEXT
TUESDAY WE HAVE WHAT IS AN
EXTRAORDINARY OPPORTUNITY TO
DISCUSS ONE OF THE MOST EXCITING
DISCOVERIES IN MEDICINE PROBABLY
IN THE LAST 50 YEARS OR MORE.
AND IS THAT WAS THE DISCOVERY OF
HILOCOBACTOR AS THE AGENT IN
PEPTIC ULCER DISEASE.
SPEAKER WILL BE WITH US FROM
PERTH, AUSTRALIA AND MARTIN
BLAZER WHO HAS WORKED FURTHER ON
THE RELATIONSHIP BETWEEN
ORGANISMS LIKE THIS AND THE HOST
AND THE DEVELOPMENT OF CHRONIC
DISEASE INCLUDING CANCER WILL BE
WITH US TO BE THE SECOND
SPEAKER.
AND THE OFFICIAL TITLE IS THE
SPLIT PERSONALITY OF
HELEOBACTOR-PYORLI.
THANK YOU ALL AND WE'LL SEE
YOU NEXT WEEK.