Healthy You: Surviving a Pandemic - William Moss Transcript
SESNO: I hear it again and again. The lengths some people are going to to get a vaccine shot. Going online the instant the system opens up, dropping to the bottom of the list of vaccine sites first to maybe leapfrog the signup crowd, making an appointment in an adjacent state and then showing up hoping for the best. While we're properly obsessed with COVID vaccines, there are others though that we shouldn't forget while we're at it, other vaccines that are lifesavers, but have also been victims of this pandemic. Hi, everybody. Welcome to Healthy You: Surviving a Pandemic. I'm Frank Sesno, host of this podcast series, which is 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 talking with pretty amazing people who are confronting this pandemic and helping us survive it. Dr. William Moss is executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health. He's a pediatrician with special training in infectious diseases, worked around the world from Ethiopia to Kenya, India, to South Africa. Dr. Moss, hi, how you doing?
MOSS: Great. Thanks for having me, Frank. I'm glad to be with you.
SESNO: Well, I'm really interested to hear what you've got to say because I know so much of your work is so relevant to the whole vaccine conversation, and some of it COVID and these other vaccines. Let's start with COVID. Now, we got Johnson and Johnson - three vaccines. The bottom line for you on all that?
MOSS: Yeah, I think the bottom line Frank is I think we're in a really remarkable place. I mean, it's worth pausing and just reflecting on the fact that you know, a little over a year into this pandemic here in the United States, we have three highly effective vaccines against SARS Coronavirus, two that have received emergency use authorization, and that are or will be rolling out in the coming days. That said, we've also faced a lot of challenges in rolling out these vaccines. We're getting better. The systems and processes are getting better, but there remain a number of challenges.
SESNO: There's some really interesting things going on here. I mean, yes, on the one hand, this is gigantically encouraging, and clearly it's moving us in the right direction. Meanwhile though, we've got the variants. Meanwhile, some of the states are relaxing restrictions and people in your line of work, some of them are saying, ooh, not so fast, be really careful, because we really got to keep our foot on the brake here to make sure we don't suddenly pick up speed in the wrong direction. And then there's this business about the Johnson and Johnson vaccine, and perceptions and particulars about whether it's as effective and how that plays out in the public domain.
MOSS: Yes, you're exactly right. And I think the messaging around the Johnson and Johnson vaccine is going to be a little tricky. It was studied as a single-dose vaccine. It's an adenoviral vectored vaccine, different than the Pfizer and Moderna vaccines, which are messenger RNA vaccines. There are a number of advantages of the Johnson and Johnson vaccine, and I think where it's going to have a particular impact is more globally. It was studied as a single-dose vaccine, and that's going to make it easier in places where it can be difficult or communities where it can be difficult to get a second dose of vaccine.
SESNO: Well, it doesn't need the hyper-refrigeration and it doesn't need two doses, and it doesn't need all that. But if one of your patients, Dr. Moss said to you, "hey, is this as good as the other ones? Because I I saw that they're like 94-95% effective," what would you say?
MOSS: Yeah, it's a complex question. And you know, the first thing is that the Johnson and Johnson vaccine was 85-86% effective against severe disease, 100% effective against preventing death. And so our first goal and getting people vaccinated is to prevent hospitalizations and deaths, you know, severe disease. And so it had very high protective efficacy against those severe outcomes. But it's true, the efficacy was lower with the single dose of the Johnson and Johnson vaccine then we saw in the phase three trials with the Pfizer and Moderna vaccines.
SESNO: So I'm one of your persistent patients, and I say, "hey, Dr. Moss, I hear about this, I'm glad if I get this vaccine, I'm not gonna die, maybe. But I still might get sick. I still might pass it on. Shouldn't I really steered toward the Pfizer or the Moderna?" What would you tell me?
MOSS: Yeah, I would say, you know, during really high community transmission, people should be getting the vaccine that's available to them as soon as possible. Once, you know, community transmission goes down - we're heading in that direction - a little bit of a plateau right now, but we hope that community transmission continues to go down. I think people will have the opportunity to choose and the choice will be kind of a balance of that efficacy against perhaps the convenience of have a single dose. But I think right now when community transmission is really high, and waiting a couple weeks or a month, months to get the vaccine of choice, I think people are putting themselves at risk.
SESNO: Let me ask you this. When I was reading a news story this morning about the panel that proved this thing, and they were hearing from different people, they heard from a college president, who said that the single shot vaccine, the Johnson and Johnson, should be used on younger people between 18 and 29 years of age. This was a college president who was saying that so he knows what he's talking about, right? And he said, you know, they make up some of the biggest spreaders of this virus because they're living together. They're working together, they're in dorms, or apartments and sharing spaces. What do you think about that? Should the Johnson Johnson or any effort start to target younger people more aggressively?
MOSS: Yeah, I think that's a very reasonable argument. Obviously, we don't have that recommendation right now from the CDC. But I think that's a reasonable argument. And as we get more and more vaccines, and there'll be more coming. Well, I anticipate we'll have an emergency use authorization for the AstraZeneca and emergency use authorization for the Novavax's. I think it's very reasonable to think about whether there are certain population, subpopulations, that are better served by a particular vaccine. And given the lower efficacy of the Johnson and Johnson vaccine against moderate disease - 72% we saw here in the United States. I think it's a it I think it's a reasonable proposal to say that perhaps that vaccine, that single dose vaccine, be used in people who are at lower risk of severe disease, hospitalization, and death. I think that's a worthy consideration.
SESNO: And how about getting all of these vaccines more effectively, to communities at risk - rural communities, communities of color? What more can we be doing about that? What more can the public health community do to message and deliver around that? Do you think?
MOSS: Yeah, no, these are really important issues. And I'll just say, you know, we don't want the perception that the Johnson and Johnson vaccine is kind of a second class vaccine, because that really can disrupt kind of our public health messaging. But no doubt, we need to do more to get vaccines to underserved areas, hard to reach areas, communities of color. And so I think there are two things - there one, you know, bringing the vaccine to people, increasing the access, mobile vans. And that has to be combined with public health messaging, and we need the community leaders, the community influencers within these communities, to be advocates and proponents for vaccines. So it's a two pronged approach. It's increasing the demand through the public health messaging, and increasing access by bringing the vaccine into communities.
SESNO: I want to ask you one more time about the messaging around the Johnson and Johnson, because there's a lot of concern that in these underserved communities, if, as you say, people think they're getting the second class vaccine, the leftover, the less effective, that it just perpetuates the concerns that these communities have had, that they are, in fact, underserved. How, in sort of a real world real language way, can people talk to their members of the community, to their friends, perhaps. A friend of mine was telling me not too long ago, an African American friend, about his 83 year old father getting the vaccine and then going out and talking to people in his circle, in his church and elsewhere, urging them to get the vaccine. What language should people be using to make it really clear that if in fact this isn't a second class vaccine, it isn't a second class vaccine, right?
MOSS: And, you know, I think the messaging there first has to be around the fact that the Johnson and Johnson vaccine prevents severe disease almost as well as the Pfizer and Moderna vaccine.
SESNO: So maybe you say something like look, this vaccine will keep you out of the hospital and you won't die if you take this.
MOSS: Exactly, exactly. I think that's the main message. And then you could couple that or that could be coupled with messaging around the fact that it is a single dose. There's some suggestion that the side effects are less. So there is this kind of convenience, we know that there are some people who are concerned about the second dose of a Pfizer maternal vaccine because they've had reactions with the first dose that have laid them low for a day or two. And so I think it's that messaging but it is really critical that people not have the perception that it is a second class vaccine that's going into hard to reach communities.
SESNO: Okay, let's talk about consequences of all of this, which is another part of your work. Across the healthcare system, other parts of our health have suffered because of this, and whether it's going into get a regular checkup or people have to get cancer screening or whatever, and they've stayed away. That also applies, as I understand it, to other childhood vaccinations that are so important for our kids' health. You have focused a lot around the world on some of these vaccinations in particular measles. What's happening there?
MOSS: Yeah, this is a really important question, Frank. And it's really important that we stay focused on routine immunizations as we're rolling out and scaling up COVID-19 vaccines. There are a number of reasons why routine immunizations, so obviously, particularly for children, that's who we largely target, have decreased both here in the United States and in other countries around the world.
SESNO: So the childhood vaccinations, measles, have gone down as a result of the COVID pandemic.
MOSS: Yes, and that's through two broad mechanisms. One is, you know, through what we call routine childhood immunizations, where children are taken to a clinic, a health facility, where they receive vaccinations, but alsom and this is more important globally than the United States, but through delays or postponements of mass vaccination campaigns that are really critical for the global control of a number of routine childhood infections, particularly measles, rubella, and polio. Many countries rely on these mass vaccination campaigns to keep up that level of population immunity and reduce the disease burden. It's also been these mass vaccination campaigns have been key to the global polio eradication initiative. And so one thing that we've seen is that countries have been unable to really conduct these mass vaccination campaigns, so they've postponed them. Some countries have been able to pull them off and through practicing safe immunization practices that include, you know, masking and distancing. But there have been delays and that leaves millions, they're estimated up to you know, 80 million children globally have been affected by this. The other disruptions are to routine immunization services, and this results from a number of factors - healthcare workers are diverted to the covid 19 pandemic, health care workers are afraid to go to work because they may get COVID-19, supplies have been disrupted because of borders being closed, and lastly, you know, some parents have been reluctant to bring their child to health care facilities because they're afraid of getting exposed to the virus there.
SESNO: So you've described some of these decreases in childhood vaccines in the United States, and abroad as a potential "time bomb," your words. Can you explain that? What do you mean by time bomb? That's a serious thing.
MOSS: Yeah, so it's really interesting. And I'm going to use measles as an example, because measles is so highly contagious. It can just explode, and obviously, it can be a major killer of children globally. So in 2019, we had more measles cases reported globally and in the United States since the mid 1990s. It was a big year. 2019 was really the year of measles. We also had over 200,000 deaths, estimated globally due to measles in 2019. That was up from 100,000. It was doubled over the past few years. Now, what's happened is we've seen measles cases go down in 2020 to lower levels that we've never seen before, in low levels. And, you know, this is probably due to a couple factors. One is when we have had increased number of people infected in 2019, there may be just fewer people susceptible to measles in 2020. But I don't think that's the whole thing. Part of it is the interventions that were put in place for COVID-19. The reduced travel, the social distancing, the masking - all of those practices actually have had a large impact on respiratory diseases. Here in the United States, we're seeing record low numbers of influenza cases, record low numbers of respiratory syncytial virus, and record low numbers of measles cases.
SESNO: That's because so many fewer people are interacting with one another, right, and we're all wearing masks and all the rest.
MOSS: Exactly. But we've also globally had an impact on surveillance systems. So we think that there may be underreporting. We know in some countries like Brazil or the Democratic Republic of the Congo, that there have been ongoing measles outbreaks during 2020, during the pandemic. But here's the here's the time bomb. We've had these disruptions to immunizations to vaccinations of children around the world. That means that there are now more children susceptible to measles, and measles hasn't gone away. It hasn't been eradicated. And so what we're really concerned about is that once these public health interventions that we've done for COVID-19 start relaxing, people start traveling, people start gathering together, the masks come off, as we kind of work our way out of this pandemic, what we're afraid of is that there could be an explosion of measles cases here in the United States and globally.
SESNO: An explosion of measles cases. Gosh, people are so COVID fatigued, you know, to kind of be ready and stay up for that, it's exhausting. So, you know, what should the health community be doing about this? What should parents be doing about this? What should public health be doing about this to not get that time bomb going off under it?
MOSS: Yeah, in some ways, frankly, you know, the answer is easy. We need to do catch up vaccinations. We need to make sure that children who missed their measles vaccines and other routine childhood vaccines during the course of this pandemic, get vaccinated as soon as they can.
SESNO: Who's the "we" in that? Who gets that done? Is that the pediatrician? Is that public health? Is that parents? Grandparents? I mean, how do we how do we make sure that happens?
MOSS: Yeah, so it that falls on a number of people. First, parents need to recognize that if they've delayed their child's vaccinations that they should be looking to ways to get their children vaccinated. It's on the pediatricians and primary care providers to make sure that they are providing all the opportunities they can for children who missed vaccines to be vaccinated. And it's part of our you know, public health response, public health community response, to do the messaging. You know, as we're promoting COVID-19 vaccines, we need to have public health messages, again, you know, community influencers, community leaders out there saying, now is the time to get your children vaccinated and make up any last vaccines that have happened as a consequence of the pandemic.
SESNO: Dr. Moss we've been through so much in this past year. We've experienced so much. We've lost so much. There's been so much pain, so much stress, for people on the frontlines of this in the health care profession, public health workers and frontline workers in so many places. We've also learned so much. As you think about what has largely been your life's work, these childhood immunizations that can make so much of a difference in this country and around the world. What are the lessons do you think that we can most productively put to use to continue to make progress with these very important vaccinations and health care?
MOSS: Yeah, I think there are a number of lessons out of this pandemic, you know, and and we're gonna face additional pandemics. We may see resurgences have some childhood diseases. I hope we don't, like measles or polio. I think some of the lessons are that we can't politicize infectious diseases. We can't politicize pandemics. We need to come together as communities, both within a country like the United States and globally. I think a second lesson is that we need to recognize that pandemics such as this are global, and that countries like the United States need to be leaders globally. We need to make sure that the rest of the world is vaccinated not only against measles, but against COVID-19. I think one lesson, a really important lesson, is we've learned about new vaccine platforms, new vaccine technologies. Prior to this pandemic and prior to a couple months ago, we've never had an mRNA vaccine. And we've seen these types of vaccines are highly efficacious, and safe. And you know, I think we may see more that see that type of vaccine platform used for other infectious diseases, maybe for diseases for which we already have vaccines, but also for new and emerging infections. And then lastly, I think we've learned during this pandemic that we need to listen to communities and listen to people and address the mistrust or skepticism around vaccines.
SESNO: Very important lessons. Yeah, I think that's really an interesting and thorough take on things. Imagine if we had gone into this pandemic, less politicized, better listening, more inclusive across the board. It wouldn't have made it go away by itself, but maybe some of the obstacles would have been would have been reduced. Alright, last question to you is a little bit different level, you know, you've traveled the world for your work, and I get you know, I get the impression you love your work and you like to travel. When are you gonna be able to travel again? When are you going to start booking your tickets back to around the world, the world you love?
MOSS: Yes, Frank, this is a really important question to me. And you're right, I spend much of my career traveling and had the great fortune to visit and work with colleagues in many countries and have not been able to do that. It's been just about a year since I made my last trip to Zambia. I'm hoping that by summer or early fall, we'll be able to safely travel again. I have not yet been vaccinated because I'm not yet in a priority group, but that I will be vaccinated by then and we're gonna have increasing number of doses of vaccines here in the United States in the coming months. But I also want my colleagues in other countries and the communities that we work with to be protected as well. So I'm hopeful that summer, early fall, but we've still got a ways to go to get ourselves out of this pandemic.
SESNO: You book your plane ticket the day after you get your vaccine?
MOSS: I may do that.
SESNO: Dr. Moss, thank you so much for all that you're doing and for all your work both on COVID and on these childhood vaccines.
MOSS: Thank you, Frank, it was a pleasure speaking with you.
SESNO: Pleasure speaking with you. This has been Healthy You: Surviving a Pandemic, 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, thanks for listening. Stay healthy.