Healthy You: Surviving a Pandemic - Jon Andrus Transcript

SESNO: Well, how about a little geography? The United Kingdom, South Africa, Brazil? Been to any of those places know what they have in common? Unfortunately, they're the countries where new strains of the COVID-19 virus were discovered. And with the development and distribution of COVID vaccines, there's some places where we ask some tough questions. What about countries that don't have access to vaccines? Does that increase the chances that those places become incubators for various strains of the virus, whether the virus will be resistant to the vaccines. A phrase that rings true now more than ever - COVID anywhere is COVID everywhere. And this global pandemic requires global solutions. Lest we forget that. Hi, everybody. Welcome to Healthy You: Surviving a Pandemic. I'm Frank Sesno, host of this podcast series. It's a co-production of the George Washington University's Milken Institute School of Public Health, and the School of Media and Public Affairs where I hang out. We're hearing from frontline folks who are dealing with the pandemic and the very tumultuous world it has created. Today, I'm pleased to welcome back to the podcast Dr. John Andrus, a leading expert in vaccinology, with extensive experience doing strategic planning to contain and address emerging infectious diseases around the world. He's an adjunct professor of global health at the Milken Institute School of Public Health, and director of vaccine and immunizations with the Center for Global Health at the Colorado School of Public Health. He's a former Deputy Director for the Pan American Health Organization. Dr. Andrus, glad to have you back. I hope you're well.

ANDRUS: Yes, thank you. Thanks for asking me back.

SESNO: Well, we're glad you're here. As I mentioned before, this vaccine really has marked such a turning point. And it's, you know, so good to see the various vaccines on the market. And maybe Johnson & Johnson some new ones soon. We've got multiple vaccines. But what about the UK, South Africa, Brazil, where there have been variants discovered and more that yet may emerge? What threat do these variants pose against the vaccines we've got with this pandemic?

ANDRUS: That's a great question. They are emerging at a rate that's concerning and may lead to a virus that is dissimilar, or at least reduces the vaccine efficacy of those vaccines we have in hand so far. Based on the information we have, the vaccines that we have in hand aren't having great drops in their ability to protect, but that is conceivable, and it's a concern that we should keep track of. You very eloquently said at the beginning, that infection anywhere is infection everywhere so it is a global problem that requires a global solution.

SESNO: But how does that affect then the race to get these shots and these vaccines in arms? And whether and how that actually protects us ultimately gets us to herd immunity? I mean, is this a lost cause? We know these variants are already in this country. We just don't know how extensive.

ANDRUS: Yes, what it does is underly the priority of urgency of rapid deployment as fast as we can get those shots in the arms. The longer we wait, the longer it takes to roll it out, the more time this virus has a chance to mutate. It also points to the fact these viruses are coming from countries where they've had great difficulty in making any impact on transmission. And it gives the virus that perfect storm to go person to person, have the time to mutate and emerge. So just protecting the US population won't do it. We'll have to reach out to these countries and be sure that they're also being protected and diminish and mitigate the risk of these emerging infections.

SESNO: Let's talk about the UK, South Africa, Brazil, but throw in Cameroon or Honduras or you know any other place while we're at it. I mean, the UK is in a completely different place because it's rapidly vaccinating people. South Africa, Brazil, these other countries have less access to some of these vaccines, though some of them have signed up for Sputnik, the Russian vaccine or the Chinese vaccine. What do we know about how well these other countries that have already been, you know, that have sort of led to the variant are doing with the vaccine themselves?

ANDRUS: Well, they've got one hand behind their back. The good thing is though, these same countries have eradicated polio, measles, rubella, and introduce new vaccines so they have a track record of getting it right. So we have to build on that kind of experience. Imagine a poor population like Lagos having Ebola. That would have been a disaster, but the polio team there, responded and stopped transmission. So my point is: build on what's out there, because they have a proven track record. Having mentioned that last year, in 2020, polio used 25% of its assets to respond to COVID in developing countries. So if the cost of polio eradication is about $1 billion a year, that's what people estimate, they then contributed about a quarter of a billion dollars. That's a significant contribution in these poor countries. So that's my message - build on what we have and let's not reinvent the wheel. There are lessons to be learned.

SESNO: There's something you said a moment ago that I'd like to consider and dive into a little bit deeper for a moment. Certainly, people in the United States are seeing such a challenge to get the shots and arms, right? And we consider ourselves a very developed country. You're familiar with these other countries because you've been involved in these global health crises in the past, and let's talk about that, you know. What is the infrastructure in some of these countries? They've dealt with Ebola or HIV AIDS or malaria, there's a public health network that exists. How quickly as the vaccines are more available, will they be able to distribute them and get them into arms so that they can get to 10, 20, 30, 70, 80 percent of their populations inoculated?

ANDRUS: Well, first of all, in terms of the supply and allocation, there's the COVAX facility created by the coalition of epidemic preparedness and GAVI Alliance, WHO, UNICEF, that's going to be a mechanism for purchasing vaccines to be able to supply to developing countries and their goal is to have about 2 billion doses this year, in order to cover about 20% of the population of each of these countries. That would provide a huge impact. It's a great starting point, and it would be unprecedented in a pandemic as such. What's happening right now is this COVAX is trying to secure vaccines, but what we're seeing is that the affluent countries that represent only 16% of the world's population are already procuring vaccines, they're called pre-production contracts. Before the vaccine is even off the assembly line, they have purchased the vaccine, up to 75% of the supply of the top leading five manufacturers. That's a huge siphon of vaccines that could go to these countries that are struggling, where the variants are going to emerge from. Now to counterbalance that, there are emerging manufacturers from what you mentioned, the Russias, the Indias, and the Chinas. Hopefully, they'll ramp up their supply to ensure that the COVAX can meet that intermediate target.

SESNO: Well, and also that will, you know, you can distribute it in ways that it can actually be used that you don't have vaccines going to waste or spoiling or whatever. But, you know, listening to you, it just sort of, it really makes me think about the whole conversation that we've got in this country about equity. I live in Washington, DC, and in Washington DC, in a, you know, in the nation's capital, right, that's a fairly small, relatively manageable population. It's got its act together, I have to say, for the most part, but there's been great inequity in the disparities between who's getting the vaccine when, with white populations, wealthier populations, getting before some of the more vulnerable populations and people of color. When I apply that I think that on a global scale, it's almost overwhelming. How do you see sort of getting equity into the global response? And who even addresses that and oversees that?

ANDRUS: Well, I think the US government, academia, our government institutions, like the CDC, we can be a part of this COVAX initiative. So the WHO, with this GAVI, with this, UNICEF, at the global level, are putting forth tremendous efforts to tackle equity, which one needs to be translated at the national level. And that's where I think we can build on those lessons learned. Even though these countries are struggling that DRCs, you know, the Congos, the Brazils of the world. They have the experience. They've done this successfully in the past.

SESNO: You know, there's a term that's been thrown around and it concerns all of us, I suppose, which is vaccine diplomacy, know the Russians crowing about their vaccine, but also using it strategically to lock down deals and establish themselves in different parts of world. The Chinese doing the same, maybe the Indians in their own way. What do you make of that? Are you concerned about vaccine diplomacy?

ANDRUS: The term vaccine diplomacy in the real sense, is really countries coming together to tackle global challenges with an understanding of their cultural differences, but that their action will mitigate the risk of a problem growing bigger and getting out of control.

SESNO: Sounds like you're saying get over it. The more vaccine the better wherever it comes from.

ANDRUS: Yes, but the point is vaccine diplomacy with values - that were targeting these disproportionately affected populations. We're not targeting Sri Lanka because we want it under our sphere of influence, even though they have a low incidence. Maybe Mia Mar Bangladesh needs the vaccine more than Sri Lanka. So let's use the vaccine diplomacy as we did in Asunción, Paraguay to stop yellow fever, urban outbreak in its tracks. You know, have the Brazils, have Germany, have Bolivia, Cuba, anybody that has extra yellow fever vaccine supply, target that outbreak stop it so it doesn't run rampant in the rest of the hemisphere.

SESNO: Why COVAX is so important. It's why WHO is so important. It has to be globally coordinated. There is vaccine diplomacy, it's going to happen. Countries pursue their self-interests. They ingratiate themselves with populations. But in a case like this, as you say, we've got to get the vaccine out there. Before we wrap up here, I just have to ask you this. You know, you're a vaccinologist,  you're a doctor. Somebody bumps into you on the streets of Cape Town, or Rio, or Lincoln, Nebraska, and they say to you, "Dr. Andrus, I'm thrilled. I've got my two shots now.
What difference does that make in my life? There's plenty of disease still out there. There are the variants out there. But I got my two shots. So what?" What do you tell them?

ANDRUS: I think that's great. I'm glad that you've accepted this public health tool. That's amazing. That will help keep you out of the ICU when you get infected. The two shots, however, we still don't know if that prevents infection. So as someone that's had two shots, you could still conceivably get infection. We won't know this until we collect more data. And so to be respectful, to your neighbors, to the community, to the grandparents that live with you at home, you'd still want to wear masks, you still want to be careful. That's the point.

SESNO: So does that mean I would you say don't go to a restaurant? Would you say don't hug your grandchild? Would you say don't hug your grandma?

ANDRUS: I wouldn't say those things in that manner. I would say even go to the restaurant but maintain the mask, maintain the social distancing. I mean, the bottom line is you're trying not to breathe somebody else's air, even though you're vaccinated, because you could conceivably get the infection, spread it to somebody else. That's what we want to try to stop. Now, they're opening schools, so they're doing so in the correct manner in the way I'm describing it, you know, still having a level of caution, a level of concern that would mitigate the risk. So will we ever go back to normalcy? That's a common question. I don't think so. I recall, when I used to work in India on polio eradication during the 1990s, we'd see Japanese tourists and see them in Bangladesh, and Nepal, all over Southeast Asia where I was working. And they always they many of them wore masks at that time. I thought, gosh, that's overkill, you know that they were trying to prevent themselves from getting the common cold or influenza. We're going to go forward, I won't be shy about after my second dose wearing a mask, because for reasons I just mentioned, but you know, I haven't had a common cold this last year. And the reason is because I'm quarantined at home. I'm not being exposed. And you know what, I feel healthy. I haven't had the influenza, I get the early shot, but occasionally I get sick. Could be another virus, but it does diminish infectious diseases. So it's a difficult question. If the certainly the response isn't easy.

SESNO: Yeah, it's one we're gonna really be struggling with for a long time. Because we want people to get these shots. We want them to feel that it's responsible for themselves for their own health and for everybody else's health in their circle and beyond it. But it's also not going to give people a get out of jail or get out of the hospital free card because we don't know.

ANDRUS: Yeah

SESNO: And so people are still going to need to maintain their distance and be smart and be responsible. But we got to get back to life. I mean, you know, this can't go
like this forever, so we're gonna have to find that space. That's what we'll be kicking around with. Dr. Andrus, thanks so much for all you do and for your knowledge and insight here.

ANDRUS: Thank you, Frank. Appreciate it.

SESNO: This has been Healthy You: Surviving a Pandemic. It's a co-production of the George Washington University's Milken Institute School of Public Health and the School of Media and Public Affairs. I'm Frank SESNO. I thank you for listening. Please stay healthy. We'll see you next time.