Physician-scientist Peter Hotez, MD, PhD, joined leaders from Indiana University School of Medicine, IU Center for Global Health and the AMPATH development board to discuss current COVID-19 vaccine development and deployment and issues of health equity related to the pandemic and beyond.
IU School of Medicine Dean Jay Hess welcomed Dr. Hotez to IU stating that his work on coronaviruses over the last 10 years has made the development of our current COVID-19 vaccines possible. “We’ve relied on experts like Dr. Hotez to provide reliable information on how we move forward,” said Dean Hess. He also introduced IU School of Medicine faculty members Patricia Treadwell, Adrian Gardner and Chandy John to participate in a question and answer session with Dr. Hotez.
Dr. Hotez is dean of the National School of Tropical Medicine and professor of pediatrics and molecular virology and microbiology at the Baylor College of Medicine, where he is also the co-director of the Texas Children's Center for Vaccine Development and Texas Children's Hospital endowed chair of tropical pediatrics. Additionally, he is a health policy fellow at the Baylor Center for Medical Ethics and Health Policy. As head of the Texas Children's Center for Vaccine Development, he leads a team developing new vaccines for hookworm, leishmaniosis, Chagas disease, schistosomiasis, and SARS and MERS infections that affect hundreds of millions of people worldwide. Most recently, he has been addressing COVID-19 vaccine hesitancy and giving particular attention to the concerns of African-Americans.
Dr. Hotez began his remarks by outlining the concern over variants throughout the world and in the United States creating a second version of the pandemic that involves larger numbers of young adults. “The good news is we are making a lot of progress in vaccinating the American people. Now, 41 percent of the country has gotten at least a single dose of vaccine,” he said. “If we can get upwards of 80 percent of the population vaccinated, and that could happen by July, I think what that potentially could mean is we get back to something that looks close to normalcy,” he continued. However, with 20 percent of the U.S. population under 12 years old and a vaccine for this age group unlikely to be approved soon, Dr. Hotez said this would mean nearly all adults would need to be vaccinated to reach this goal.
Globally, the challenge is even bigger. “We really have not addressed the problem of vaccine equity globally,” said Dr. Hotez. He added that Africa, Latin America, parts of the Middle East and the low-income countries of Asia have low levels of vaccination. “That's a daunting task because that's about 2.5 billion people times two doses, that's 5 billion doses. And we don't really have an answer of where that supply is going to come from,” he continued.
Dr. Hotez explained that he and his colleagues have been working on developing low-cost vaccines for a variety of diseases for 20 years. They are currently working on a COVID-19 vaccine using recombinant protein technology that has been available for 40 years. The vaccine is finishing phase 2 clinical trials in India. “The hope is thatvaccine will be released through emergency use authorization in India by the summer and then go through WHO pre-qualification by late summer or fall. And hopefully that can make a big contribution because it can be made for $1.50 a dose,” he said.
Dr. Hotez concluded his introductory remarks saying that there was “a lot of optimism for the U.S. especially by the summer, but a lot of pessimism for the world's low- and middle-income countries unless we can turn things around. And pessimism about our unwillingness, so far, to fight what's become an anti-science globalized empire.”
Adrian Gardner, MD, MPH, director of the IU Center for Global Health, asked Dr. Hotez what we could or should do better globally in response to the pandemic. Dr. Hotez said we learn something after every pandemic and praised the policymakers who came together quickly to create the COVAX initiative. “The problem is the vaccines aren't there. The problem from my point of view was upstream. We were so focused on innovation that nobody really thought whether those vaccines could be scaled to 5 billion doses quickly,” he said. “If you look at the rate of vaccinations in Africa right now, it's 40 times lower than in North America.”
“This is the crunch time. COVID-19 is accelerating globally,” Dr. Hotez added.
Dr. Gardner further asked Dr. Hotez what academic health centers could be doing through their global health partnerships, such as the IU’s AMPATH partnership in Kenya, to ensure more equitable vaccine distribution or to contribute more generally to global health. Dr. Hotez pointed to operational research on how the vaccines are used as well as the impact of COVID-19 on vaccine health systems. “I think there's going to be a need for a lot of social science around vaccine acceptance. We understand that better in the U.S. and in Europe. We don't really have a good understanding of it globally.”
Dr. Hotez added that the pandemic has set back gains in childhood immunizations, worldwide poverty reduction and diseases such as malaria, HIV and neglected tropical diseases. “I worry that we may have lost five years of progress because of COVID-19,” he said. He added that the impact of COVID-19 on co-morbidities such as diabetes, hypertension and obesity around the world also needs to be studied. Mental health challenges, both as a result of social disruption and as a COVID-19 long-haul symptom, are going to have a huge impact globally, he continued. “The long-lasting effects are going to affect medical practice globally for a long time.”
Dr. Patricia Treadwell, special advisor to the dean and chief diversity officer at IU School of Medicine asked what the pandemic has taught us about health inequities in the United States and what investments in our public health infrastructure and medical system are necessary to address. Dr. Hotez said he had seen the decimation in Hispanic communities in his home state of Texas. “In Black and Brown communities, about a third of the deaths are under the age of 65--so it's moms and dads, brothers and sisters in their 40s and 50s. That was huge and devastating. We still really haven't told that story yet about how a generation of African-American, Hispanic, Native American kids lost their parents and their uncles and aunts in this epidemic,” said Dr. Hotez.
“I think while vaccine hesitancy has come down a lot, and that's no longer the major problem, there is still a major problem with access and ensuring we can vaccinate in low-income neighborhoods,” he continued. “You see how vaccination rates in Black and Brown communities seem to still lag in many, many parts of the country.”
Dr. Treadwell also asked if we are doing enough to reach people with reliable vaccine information. Dr. Hotez responded that the right messaging is important but “disinformation is just drowning everything out.” He thinks we need to be more aggressive in countering the anti-vaccine movement and has also recommended creating an interagency task force to tackle anti-science information from Russia.
Dr. Chandy John, director of the Ryan White Center for Pediatric Infectious Disease and Global Health at the IU School of Medicine, asked Dr. Hotez what is driving the acute global health crisis related to the pandemic in India. “It matters to me as a global health expert and also as someone who has a lot of family in India,” he said.
“My understanding is much of that is due to this new variant, the Maharashtra variant, which is the state where Mumbai is located,” said Dr. Hotez. “It looks like it's much more transmissible and I think that has a lot to do with it. It also coincides with a number of important Hindu festivals where people are congregating in large amounts. There's a lot of elections now going on and so people are congregating there and people are holding these big political rallies,” he continued. Dr. Hotez said that the good news is that India has many vaccine manufacturers. That is tempered by the bad news that much of the rest of the world was counting on vaccines from Indian manufacturers that are now not available.
“I'm extremely worried. Now I understand that it's spilling over into Pakistan and Bangladesh as well, which makes sense. So this is going to destabilize all of South Asia,” Dr.Hotez continued. “This is what I feared, that the big mega-cities were going to get hit hard.”
Dr. John concluded by asking about the future of vaccines for children. Dr. Hotez thinks that the existence of multisystem inflammatory syndrome in children (MIS-C) will slow the clinical trials down in younger children.
An audience member asked if lifting intellectual property rights would make a difference in vaccine distribution. Dr. Hotez said that the vaccine he is working on is not patented and available in the public domain with a small licensing fee. However, he sees the barriers to increasing production as more than just lifting the patents, but also developing the human capacity to be able to make the more complex vaccines.
“I think the other piece to this is we do need to build capacity. As I say, no vaccines are made on the African continent, almost none in South America, Latin America. For the next pandemic, I think that could be really important because that way we can get vaccines for diseases of regional importance,” he added.
Dr. Hotez concluded, “What you're doing in Indiana University Medical Center is extraordinary. Thank you for all the great work that you're doing. I know this has been a horrible, horrible 14 months. The good news is it's going to get better.”