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With a 'return to normal' from the pandemic practically hinging on COVID-19 vaccines, how do you overcome those who are vaccine hesitant? How does vaccination history impact perception and what role do medical professionals have in explaining the science? To learn more we chatted with 番茄社区 Editorial Board member Peter Hotez, MD, PhD, Co-Director of the Center for Vaccine Development at Texas Children's Hospital and Dean of the National School of Tropical Medicine at Baylor College of Medicine.
The following is an abridged transcript of his interview with "Track the Vax" host Serena Marshall:
Marshall: Dr. Hotez, thank you so much for joining us here at Track the Vax.
Hotez: Thanks so much for having me.
Marshall: You're an inventor of an out-licensed COVID-19 vaccine technology. You've also invented multiple other vaccine technologies previously and authored a few books, a couple of those on hesitancy and vaccines. And we want to dive into that question of vaccine hesitancy. And one of the big questions people are going to have when they look at these vaccines, and as they become available to them, is was I represented in the data? Because if I wasn't, maybe it's not for me. So what can you tell us about the people that these vaccines were tested on, the manufacturers, who they included in these clinical trials?
Hotez: I got involved somewhat in this because I'm part of the NIH active vaccine working group to help provide advice and input on the trials. And one of the impressive things about the trials is there was a real commitment to being inclusive of the entire U.S. population. So that meant getting a high percentage of representation from the African American, Hispanic, and Native American community, that was a priority, looking at older Americans who are at risk, those with comorbidities. We really got a good slice of the American population in these vaccine trials.
The only ones we don't know yet are adolescents and kids, because we haven't done those step-down studies yet, but those will follow.
Marshall: And so speaking of adolescents and kids, a lot of parents do want to know when their children would be able to receive this vaccine.
Hotez: Well, you know, this is all going pretty quickly. So I think the focus was initially on the adult population, because they have the highest mortality rates, especially those who are older with underlying comorbidities. But another reason this could be really important to include adolescents and children is we had done some studies with a group at City University of New York led by Bruce Lee, we found that to achieve interruption of transmission or so called herd immunity, we're going to need about 75% to 80% of the U.S. population vaccinated. So it's a pretty high bar, even with a good vaccine, like these are, and that's going to mean, we're going to have to vaccinate adolescents and children.
Marshall: Operation Warp Speed, the title, the overarching theme of what we've been seeing this past year. In health communication, we know language is everything. When you hear this phrase "warp speed," is this the right way to frame the mission of bringing a vaccine to the public.
Hotez: A terrible name. And that was a terrible name because -- you know, I've spent years going up against the anti-vaccine lobby, I'm their number one lead target, because I wrote a book called "Vaccines Did Not Cause Rachel's Autism" about my daughter. So I know what the anti vaccine lobby is like more than any one person should know. And among their fake assertions is that vaccines are rushed and not adequately tested for safety. Well, that's not true for any licensed vaccine. It's not true for the Operation Warp Speed vaccines. These are carefully done, clinical studies, part of the reason we're able to move relatively quickly is there's such a high attack rate of the virus, there's so much COVID-19 transmission, we're able to move quickly. And the warp speed part was really around manufacturing in parallel. But the name was out there. And it was a gift to the anti-vaccine movement, it's going to cause some damage. So I wish they had not chosen that title.
Marshall: But it's not just right, the anti-vaxxers that we're talking about here, vaccine hesitancy, which is a different level than anti-vaxxers. It's coming even from some folks in the medical community, what would you say to those individuals who believe in vaccines, but are still concerned about how fast it's moved?
Hotez: That's a very fair question. The politicization of the vaccines this summer and the worry that it would be rushed ahead of the election, that did cause a lot of damage. And so even people who ordinarily are big enthusiasts, or are supporters of vaccines, are concerned. My friend and colleague Anne Rimoin, who's a professor of epidemiology at UCLA, a couple of weeks ago came out with a study on medRxiv showing that there's even significant amount of concern among healthcare providers, especially nurses. So there's going to be a lot of damage control, and it's going to be critical because we're not going to reach that 75% threshold unless we can do this.
Marshall: Do you think part of that hesitancy, though, also comes from these are two groups -- the federal government and the pharmaceutical industry -- that have teamed up and those are two groups that are notoriously receiving low marks and trustworthiness?
Hotez: Well, you have the politicization from the White House, not just the vaccines, but all of COVID in downplaying the severity, the epidemic, they're saying it's a hoax or contributing deaths to other causes or discredit masks -- problem number one. Problem number two, there was no communication strategy designed by Operation Warp Speed, the plan was to let the pharma companies take the lead and the CEOs did a pretty terrible job of communicating. You have the concerns about the stock trading from one company to another CEO, leaking a phone call with JP Morgan investors about a clinical hold, so it's just one gaffe after another in communication. So that was a problem. And then you have the anti-vaccine movement. So there was that gap and strategy, that vacuum was filled by things that caused people to be concerned about vaccines. So we've got to figure out the way to take this back and put up a communication strategy where we have government scientists out there on a regular basis, communicating to the public.
Marshall: Now outside of anti-vaxxers, though, I mean, does the public have some right to be a little bit skeptical? There are a few, not a lot, but a few instances in the past of vaccine development errors that have played into some of those fears?
Hotez: Well, yes, and no, I mean, there there have been vaccines that have been removed from the market. But the way I look at it is that's actually a sign that we've got a very robust monitoring system in place. So for instance, the RotaShield, the Wyeth rotavirus vaccine was voluntarily removed by Wyeth, because even though it didn't show up in the phase III trials -- because it was a rare event -- after licensure there were a few cases of intussusception, which is a serious condition where one part of the bowel telescopes on the other in infants and could be a severe condition. But that was picked up by our monitoring system. So we do have one of the most extraordinary systems of vaccine safety monitoring and pharmacovigilance anywhere in the world. And the American people need to take some comfort in that as well. And so it's not only the review of the phase III dossier of data, but also what's going to happen after these vaccines are released to the public, in terms of their monitoring.
Marshall: You like to see that monitoring set up in order to tamp down fears that people might have that there isn't enough monitoring in place?
Hotez: Well, there are established monitoring initiatives. So there's the Vaccine Adverse Event Reporting System, there's Vaccine Safety Datalink, there's PRISM, if that gets up, and a couple of others. That's not so much the issue. The issue is how you communicate. And given the complexity of Operation Warp Speed, the concern that the public has, the attention that it's getting -- and you may remember, in the absence of a federal strategy to contain COVID-19, that the Trump administration refused to do, we put all our eggs in the biotechnology basket. We're now relying exclusively on vaccines to control this, it's importance. We need to really up our game in terms of communicating on a regular frequent basis with the public. What I've been pushing for, we'll see if it happens, is to have respected government scientists who are knowledgeable about vaccines, on the cable news networks and on podcasts on a regular and maybe not daily basis, but close to it. And without that this will not go well, because otherwise every time there's an adverse event after people are getting vaccinated, you know what's going to happen -- that's going to be in tabloid news, the anti-vaccine forces will pile on, the cable news networks will interview the families, the family of someone who had an adverse event, whether or not it was related to the vaccine. And I make the point that the vaccine ecosystem is extremely fragile. It doesn't take much for a vaccine to get voted off the island, even if it's a good vaccine. I mean, for example, the GSK Lyme disease vaccine, which was an excellent vaccine, but you know, there was a very aggressive Lyme disease lobby out there, and combined with the anti-vaxxers, to discredit it, and it was dead in the water, even though it was a good vaccine. And the same will happen with the Operation Warp Speed vaccines, unless we really can put on a strong program of health communications and do it in a sophisticated way. We're really going to have to get people that are scientists who have an in-depth understanding of vaccines, and are able to really explain issues as they arise to the American people.
Marshall: Now the Reagan-Udall researchers have been looking at vaccine hesitancy, and one of the themes that emerged whether it be concern amongst certain populations based on past experiences, one of the people polled said, "I firmly believe that this is another Tuskegee experiment," and that "we are not going to be guinea pigs again." Another commenter said, The more they study me, the more they know how to get rid of me. How do you overcome those lasting effects of community trauma?
Hotez: Everyone's talking about that as community trauma and historic racism. And there's no question that's a component of it. But the other piece that people aren't talking about, which I think is very important, is that the anti-vaccine groups are deliberately targeting specific ethnic groups. So this is not an accident. This was deliberate targeting, predatory targeting, of specific ethnic groups. They did it with the Orthodox Jewish community, they used inflammatory language, comparing vaccines to the Holocaust, that caused the Orthodox Jewish community in New York to stop vaccinating their kids -- landed 18 kids in the ICU. So again, until we can figure out a way to dismantle these kinds of activities, it's going to continue. Now mind you it's not going to go away at all, there are forces that go beyond the deliberate targeting of the anti-vaccine movement, but I think that's an important start.
Marshall: What about building trust among those people, when they take the vaccine, we've heard that the side effects from some of these are not going to be pleasant, they might be a little bit longer in terms of having a fever than simply a sore arm. How do you ensure that those people come back for the second vaccine?
Hotez: Yeah, and it's absolutely important, right, because the phase I studies clearly show that a single dose of the vaccine does not induce virus neutralizing antibodies, or at least a significant titer of them. The individual vaccine recipients are going to have to have some situational awareness, and to be educated to make sure they know that. But in addition -- in Texas, for instance, Texas Department of State Health Services is providing cards to individuals to remind them about the second dose. And again, some are saying the side effects in terms of fever and malaise or fatigue and aches and pains are more for the second dose than the first dose. But again, once you start vaccinating millions of people, there's going to be all sorts of variations on that. So that's going to be really important to provide that as a health education message.
Marshall: And to that point, what role do community doctors, family practice, pediatricians have in ensuring that their patients get vaccinated and answering the question, what would you tell those doctors when it comes to overcoming that community trauma, building trust in those trials and increasing uptake?
Hotez: Well, one of the things that I'm doing is to try to educate physicians in detail, especially primary care providers about vaccines. The specialty of pediatrics is pretty good about educating physicians about vaccines. If you do a pediatric residency, you get a lot of information about vaccines, some of the other specialties maybe not so much. A lot of the physicians are not deeply knowledgeable about vaccines. They're going to have to make the effort to want to learn this. And by the way, we did this before -- we had a similar problem with HIV/AIDS -- that there were a lot of physicians who, especially those that had been in practice for a while, didn't really understand all the nuance of the natural history and management and treatment and prevention of HIV/AIDS, but eventually things geared up. In the case of Washington D.C., where I used to be I used to be chair of microbiology at GW and kept my medical license there, they actually required a certain number of CME hours in HIV/AIDS education, to maintain your licensure, and maybe that would be something that we do for COVID-19.
Marshall: Speaking of types of communication, we saw it in with the polio vaccine that at the time, Elvis became the poster celebrity of getting the polio vaccine. There are photo ops, and they used him in order to encourage uptake in that vaccine program. Will we see that kind of a celebrity persona to come in and encourage people to take the vaccine? We've already heard a couple of the presidents say that they will get behind and do photos getting the vaccine, what role would that play?
Hotez: Yeah, I think that's perfectly fine, particularly for the African American community that has that vaccine hesitancy, or other groups, I think it would be totally reasonable to, you know, bring on key celebrities on this. I don't see a downside. What I do see a downside of is the high profile people that campaign against vaccines, that could be extremely damaging. And I'm hoping that doesn't happen too often.
Marshall: What happens if you have a celebrity or president who's outside of those specific groups that it is approved for? Could that play into a negative feeling that it's only being provided to the rich and famous?
Hotez: I don't think so. I can't imagine there's a downside -- it may not be very impactful, but I don't see that so much being a problem. But again, if we can get prominent individuals in the African American, Hispanic, also the Native American community, they really are getting hit hard.... We're gonna have to work extra hard for those groups that are especially vulnerable.
Marshall: Okay, so what role will social media play when it comes to countering misinformation and when it comes to providing factual information with COVID-19 vaccines?
Hotez: Well, right now, the anti-vaccine groups dominate social media, on Twitter, on Facebook, on Instagram.... And then you have the phenomenon that we now know that the Russian government is putting out a systematic program of what called weaponized health communication with bots and trolls with anti-vaccine disinformation. So that's a formidable force and figuring out how to mount a counter offensive will include amplifying our message, but it's still very tough to do. The pro-vaccine groups tend to be outgunned, and the Health and Human Services presence on social media is still relatively modest. And so I think the answer is we're gonna have to start taking down the empire. And I tend to be kind of alone on this, you know, when I go on various Zoom meetings with pro-vaccine groups, the whole conversation focuses around fine tuning the message, getting the message out. And then I say, look, all this is fine and good. And we'll get you about 30% to 40% of the way there and unless, because your message, just a little message in a bottle in the Atlantic Ocean, unless you can figure out a way to drain the ocean and take down some of the anti-vaccine content, that's just not going to be heard.
Marshall: Can scientists win this war in social media? Or should they be focusing more on those offline community efforts?
Hotez: It's important for scientists to be out there, we need a robust program of science communication coming from the scientists themselves. A part of the problem is scientists are not trained to do it there. You know, we don't provide training and public engagement and science communications in our doctoral and postdoctoral training. But unfortunately, universities and academic health centers are not very encouraging of scientists and physicians to speak about social issues or to take on anti-science groups there, they tend to be quite risk averse, and only want to focus on protecting the institution and not really delving into these spaces. But I think it's going to be really important that we change this whole ecosystem to make especially young scientists and physicians comfortable speaking out on social media, writing op-eds, writing commentary pieces, being out on TV and radio, it's going to be absolutely important to reshape this entire new ecosystem.
Marshall: I can see it now, a new class for you to teach.
Hotez: The young physicians and scientists there I mean, every time I talked about this back before the apocalypse, I was doing it in person, I'd have a small line of -- either after grand rounds -- young physicians or scientists. "Hey Dr. Hotez, I'm all in, how do we do it? And the problem is it's just not set up to make this easy at this point. But if we can make that change, it would be a game changer.
Marshall: Dr. Hotez we like to ask every one of our guests one final question, when a vaccine is available to your specific group. Do you plan to take it?
Hotez: Oh, absolutely. I will take any FDA authorized vaccine that's made available to me or my family. We'd take our own vaccine, but you'd have to go to Hyderabad, India now, and it might not be so easy, but absolutely and one of the things I say is, they all work by the same mechanism. They all work by inducing virus neutralizing antibodies. Don't over think it, don't wait, don't try to cherry pick which vaccine you're going to take, take whatever's offered because they all work by the same mechanism. The only thing we don't know is length or durability of protection. So it's possible that whatever vaccine you get, may last only 3 months, or it may last 3 years or 30 years, we're not going to know till we know. But it's okay, because later on, if that turns out to be the case that it's short-lived protection, you can get boosted even after your two doses with a third dose, either with the same vaccine or a different vaccine. But the best way to keep yourself and your family out of the hospital and intensive care unit is to get those virus neutralizing antibodies in your system and get vaccinated. So I will absolutely get whatever vaccine is offered to me as soon as I can get it.
Thank you so much, Dr. Hotez. We really appreciate your time here at Track the Vax.
Hotez: Thank you so much.