A 90% Effective Vaccine! (with Eric Topol)

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Description

Could this be a light at the end of the tunnel? Andy evaluates the remarkable news that Pfizer’s COVID-19 vaccine proved more than 90% effective with physician, scientist and author Eric Topol. How excited should you be? What do we know and what don’t we know? What’s the timing and what comes next? Plus, a look at President-Elect Biden’s COVID-19 task force.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Eric Topol on Twitter @EricTopol.

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Transcript

SPEAKERS

Andy Slavitt, Eric Topol, Joe Biden

Joe Biden  00:00 

Folks, our work begins with getting COVID under control. We cannot repair the economy restore vitality, or relish life’s most precious moments, or grandchildren, our children are birthdays, weddings, graduations, all the moments that matter most to us until we get it under control. On Monday, I will name a group of leading scientists and experts as transition advisors to help take the Biden-Harris code planning converted into an action blueprint that will start on January the 20th 2021. That plan will be built on bedrock science. It will be constructed out of compassion, empathy and concern. I will spare no effort, none or any commitment to turn around this pandemic.

Andy Slavitt 

Welcome IN THE BUBBLE. This is Andy Slavitt. That was Joe Biden, President-Elect Joe Biden, at least according to most people. Wow. What a show we have. Where to start? Where do we start? We have potentially a very good vaccine that’s about to hit the US possibly within a couple of months. The data from this vaccine, as people probably know, from Pfizer, and a German company, Bio & Tech is incredibly promising. And we happen to have the ideal guest to talk about it today. Because we planned it, because we knew the producers on this show, Kryssy and Alex knew that we would have a vaccine with outstanding results. They said, let’s have Eric Topol, who is a friend. He’s a Doctor. He’s a scientist. He’s an author. I think of him as a renaissance man for healthcare because he’s very tech savvy. He has this translational Institute called Scripps Research Center, which I wish we’d had more time to talk about because he does phenomenal things there. 

02:19

He is in a beautiful La Jolla, California. He is editor-in-chief of a something called Medscape. He is just the perfect person. And I want you to hear his reaction to this vaccine. Because this is a guy who I think you can trust his reaction. So I’m not gonna say any more about it. I just want you to wait in with me, as we listen. And we talked to him. Now what else happened? some other stuff happened this week. What is it? What is it? Oh, Georgia, Georgia, Georgia elected a democrat? How about that? Nevada, Pennsylvania, Michigan, Wisconsin, Arizona, Joe Biden, Kamala Harris. So let’s talk about that for a second. I expect you you’re gonna expect me to be happy about that. And I am. I am. I’m happy about that. Why am I happy about that? Well, first of all, we’re all allowed to have a preference, a political preference. I am not Walter Cronkite; I do have a preference. I do think he’s; he was a better candidate. I do think it was a really telling election. 

There’s a lot of lessons to learn from it. I don’t think that being happy about it is the same as gloating about it. Because I think there are two parties of this country that are quite different. Now, I’m happy about it. Largely because I think beside wants to bring the country together. I think he wants to be a transformational figure in the sense that he helps us capture the things that we think about ourselves on our best days. And, you know, I tell you there you know, I know him a little bit. I don’t know him a ton. But I’ll tell you, my impression is he can’t fake anything. That’s my impression of Joe Biden. He is who he is. He just has been through enough. He’s just got raw emotion. He is not a politician in the sense that, you know, he gives a great windup speech. When he speaks with passion. He’s passionate. When you tell jokes, he’s jokey. You know, that’s just the guy. He is in a moment like this. Where the country needs to be brought together. The country needs competence and the country needs compassion. I think he’s  the right guy. So that’s half the equation. Well, that’s a third of the equation. What’s the second third equation Kamala Harris, Kamala Harris.

04:55

If you didn’t know she’s a woman and I can’t tell you how long I’ve heard that will never happen. And it happened. And you know, I don’t even think people paid that much attention to it. Because we were caught up in so many other elements of this election in this story. But that is profound picture, Kamala Harris, a woman of color. Child of immigrants in the White House, in that beautiful Naval Observatory, which is where the Vice President lives. Jewish husband, I’m just saying. I’d be second gentlemen. For those of you who met Lana, you could say yes. Anyway, I could go on but I won’t want to tell you is, those are great things, and not for nothing. The person who would not manage the pandemic, even in his own quarters, is going to be exiting the building. And I’ll tell you, that’s a different outlook. Skies a different color. The grass is a different color. I’m better looking. I’m thinner. I’m smarter. I’m younger. You’re better looking. You’re thinner, you’re younger. We all are. Okay. Speaking of good looking thin and young, let’s get to Eric Topol. You’re gonna like this interview. It’s a good day.

Eric Topol  06:28

Hello, there. Hey, Andy.

Andy Slavitt 

How are you? 

Eric Topol 

I’m all right. Good to see you. 

Andy Slavitt 

What a day to be doing this show, huh?

Eric Topol

Wow. Good timing. You’re amazing. You know how to schedule things.

Andy Slavitt 

You know, there’s something cosmetic. I don’t know what it is about having you on today of all days.

Eric Topol 

It’s a big day, the best day of the pandemic, I think right here today.

Andy Slavitt 

Yeah. So there’s a lot of things to be excited about. But for those who don’t know, we’re talking about news this morning, out of Pfizer, and a German company that I think is called Bio and Tech. How excited were you this morning when you hear it? First of all, tell us what the news is? And then tell us what you felt like when you heard the news?

Eric Topol 

Well, I woke up this morning, it was about 5am. And I’m looking at my emails and I’m saying oh my gosh, Pfizer is announcing 90% at least 90% of a say whoa. As you know, Andy, we’re looking at, they were looking at 60% we’d be happy even met 60%. So the fact that it was 90 plus the fact that it was 94 events rather than 32, which was going to be their first interim. It was enthralling. It was definitely the kind of news we need right now. Because things are overall looking so bleak. And this is the beginning of the turnaround. This is a day of inflection.

Andy Slavitt 

I will give you your background in a second and I did the trope, but your perspective from start to finish. I mean, let’s say that this that the vaccine is somewhere close to as promising as it is these results that they’ve added to showing indicate from when this thing started. To get to the point we are now just give us a sense of the that scientific accomplishment.

Eric Topol  08:18

You know, I don’t know anything like this, the virus was sequenced in January, within five days they were developing templates. mRNA templates like this one in Moderna. They started trials in July phase three trials completed in terms of getting the enrollment in September and October. So Pfizer and Moderna have led the pace. But to have that by year end to have vaccination programs started in December the same year that the virus was sequenced and basically landed in most of the world is amazing. I mean that’s compressing at least five to seven years, at least five to seven years into one year, which is astounding. It’s a stunning accomplishment of science of medical research, lots of which I don’t know, it’s unimaginable how great it is.

Andy Slavitt 

It’s a great story and a few things probably went our way and maybe we can come you can identify with some of those things are but we started we had it we had a little bit of a head start we had some things that were that were kind of they were kind of ready in the barrel but to think about the fact that you know we don’t have a vaccine for HIV we don’t have a vaccine for cold which is a Coronavirus. Your there’s a lot of reason to think that despite all the optimism, that there was also reason for skepticism.

Eric Topol 

Oh, no, this could have been a dud this, these vaccines could all gone down. You know, just like or it could have been like flu. You know, which is like 50% at best. The problem was we didn’t know where would land and now it’s kind of in a special group like you know, measles and tetanus and HPV, you know, it’s in the good group of kind of towards the super human vaccine where the vaccine induces a response better than the human response. And that’s what we’re looking at here.

Andy Slavitt  10:10

Do you think it could be that that high?

Eric Topol 

Yeah, I mean, good. We knew that the neutralizing antibodies that were coming out of these trials in the phase two, phase one too look awfully good. And we still don’t know the duration. Andy, I mean, you know, this may not be, this could be a six- or 12-month story. We don’t know how long it’ll last. But, you know, as you mentioned, you know, we never have had a coronavirus, cold, common cold with a vaccine, flu vaccines are, you know, shaky, this looks, you know, 90% or, or more is as good as we could get, you know, it’s beyond what we could have expected. So, the fact that it’s with a new type of vaccine, and mRNA has never been at scale, is also really interesting, because Moderna is similar. And so that speaks that we’re going to see other vaccines of high efficacy. And even if when the trials done at final 164 events, it shouldn’t drop down that much, you know, maybe 80% 85, it’s still superb.

Andy Slavitt 

Wow, wow. So on a scale of 1 to 10. But there’s a lot of people out there that are that have grown skeptical about following the bouncing ball, with vaccines and the FDA and some of the politics and so forth. And you’re not all of us are professional scientists. So if you’re listening to this, and you know, you know, a little bit, you know, on a scale of 1 to 10, how excited should people be?

Eric Topol 

Well, I put it at, you know, somewhere on 12. Wow. You know, because we haven’t had any good news here. I mean, you know, we everything has been so bleak. I mean, we’re in the midst of this horrendous surge, you know, we’re gonna keep going up before this gets, you know, probably up to 200,000 cases a day. I mean, so, you know, this is a triumph of science, we had the worst public health response. And it’s almost the reciprocal, or the, you know, the converse whereby we have the best science, it’s actually kind of amazing. Now, there’s still some unknowns. Obviously, we don’t know the admixture of where they were some severe and moderate infections in that, which would add to the strength of the signal. We don’t know all the data; we want to know about safety. I mean, yeah, we don’t want to go too overboard. But assuming things hold up, which I think they will. This is, you know, fantastic news. And the good part about this high efficacy, Andy is we’ll get to the population immunity, heard story so much more quickly. We don’t need to have 80% of the population to be immunized or vaccinated. So it’s really another positive step is the speed with which our exit ramp we can write off this thing.

Andy Slavitt  12:57

You started to enumerate what we do don’t we don’t know. And maybe that would just be helpful to get everybody to what, what are the things we think we know based upon the data? What are the things we’re not sure of? And what are the things we just don’t know yet?

Eric Topol 

Well, the most important thing is that we know these vaccines, all of them produce good levels of the neutralization antibody IgG. But we didn’t know if they work if they prevent infections. Now, Pfizer had the lowest threshold for that endpoint, you could accept PCR positive virus test plus like anything sore throat headache, you know, they took almost anything, some of the other vaccine trials were more stringent. The good part about being more stringent is its strength of the efficacy signal. Now, what happened in October was that FDA tightened the guidelines for an emergency authorization, and they said, you’re going to have to have some severe infections in there to warrant an emergency approval. So we know that Pfizer intends to file that emergency approval in the next couple of weeks, just to finish up the safety window, also part of the tighten guidelines, that would tell us that some of those infections that they protected against were all more severe as well. So you know, the indirects that we’re getting here with the timeline. So safety is still out there. But you know, the fact that they’re finishing that up to two months median safety, you know, we’re getting close on that. I’d say the biggest unknown is just the duration of the vaccine protection. There’s one other big unknown, and that is sterilization immunity. So that means, so when we give the vaccine, what we’re hoping, of course, is to prevent pneumonia and all these other untoward parts of the COVID illness. But what we don’t know is does it protect the nose, the nasal mucosa and the upper respiratory tract, that is could you be protected your body from getting ill, but you could be harboring the virus to be a carrier to others, which is essentially you got to wear a mask. Because you don’t know it. 

Andy Slavitt 

So that changes the herd immunity equation if that’s the case.

Eric Topol 

Yes, exactly.

Andy Slavitt 

So in other words, there’s possibility you could feel okay, but still be able to be contagious.

Eric Topol 

Exactly. You could be protected the vaccine working great, but you’re a carrier because you got the virus in your nasal upper and upper respiratory tract. Now, why is it important? Well, when the vaccine programs went forward, we didn’t know if they’re capable of sterilization immunity, that requires IGA antibody, you know, the mucosal antibody. And that’s not especially what these vaccines are known for. So we have to, we have to consider and this is, you know, 2021 is a year of mask, we’re going to be wearing masks, because we don’t know that yet. And so that’s a big unknown, and nobody talks about that. But that’s awfully important. The other reason why you wear a mask is, you know, most people develop neutralizing antibodies. potent, but not everybody. So you don’t know if you’re in that category. So these are the uncertainties, you know.

Andy Slavitt  16:15

Will there be a test to see whether you’ve got you have the antibodies? If so, let’s say I take a vaccine, and my wife takes the vaccine, will we be able to take some sort of test to see, Hey, you got the antibodies. I don’t.

Eric Topol

Yeah, that’s a really important question. Because right now, the antibody tests are pretty primitive, rudimentary, they don’t really tell you your neutralization level. And  that antibody test is what we really need is not just you have IgG because it could be an antibody directed to remnant, not to the spike protein, not to the business part of the virus. So, you know, that’s what we have now, most of the antibody tests that are available commercially are not good enough to know whether you got the real deal 

Andy Slavitt

I see it, can you speak do we know if this affects T-cells, and explain whether that matters. And that’s also something that we don’t get, I believe, have a test for.

Eric Topol 

That’s right. And we’re not going to have any tests for that. It’s only kind of a research lab story. And there are two types of T-cells that are really important. The CD4 the memory B cells and the CD8, which are the cytotoxic T-cells, these vaccines have a very, they have a whole array of response on T-cells. And that’s what may ultimately account for differences in the follow up. That is, maybe the vaccines that have this bonus factor of the CD8 T-cell response gives you better long-term protection, we just don’t know that yet. There are stocks that it’s not essential for a vaccine to work. But it may be tied into durability of the response.

Andy Slavitt 

Got it. So we may actually beat Scott Atlas to the punch here with we can actually be able to get people immune before he gets people sick.

Eric Topol  18:08

I hope so because the rate things are going. It’s ripping across this country. I mean, like it’s a horror show, really.

Andy Slavitt 

So there’s other vaccine candidates, let’s just make sure there are at least three more that we see in the next couple of months. One of the implications of what we’re seeing here for those vaccines and the ones that you may mention others, but the Moderna, the AstraZeneca, one that was held at Oxford, the Johnson and Johnson vaccine, what does this tell us anything is good news about those two?

Eric Topol 

Yeah, they’re the one that’s closest, in terms of the vaccine would be Moderna, and not just in time, is they’re just right behind Pfizer in time, but to read out their results, but also because it’s an RNA vaccine. So it works very similarly, you know, the RNA, producing the response against the spike protein. So that one is expected to be very similar. The other vaccines probably is it turns out this virus is kind of like a flashing sign. You can get me if you have quick vaccine. This is not an elusive vaccine at virus. So I think what we’ll see is, next up will be the AstraZeneca Oxford. We’ll also see J&J pretty quickly, and Novavax, those five. And likely they’re all going to be at least 80%, 90% is the guess. And they differ also with respect to practical aspects, J&J is a single dose. The others are two doses. They do have different refrigeration features. I mean, Pfizer and Moderna require Deep Freeze.

Andy Slavitt  

Below 75.

Eric Topol 

Yeah, and so that makes it more logistically challenging. Whereas, you know, J&J is a single dose and you know, some don’t have as much refrigeration can just be, you know, cold but not deep freeze. So, you know, these are some of the they turn out. If you have efficacy of 90% across the board then you start getting into these other details.

Andy Slavitt  20:12

These sound like good problems to have, don’t they?

Eric Topol 

And by the way, as you know, Andy, we need all these freakin vaccines to work. We need them all. Because we have 300 million people we got to get or you know, whatever. 200 we have to pay them back. 

Andy Slavitt 

7 billion. 

Eric Topol  

Yeah. And at least 7 billion plus we don’t know, another uncertainty. We have no data for pregnant women. We have no data for young children and old, old people, you know, we’re missing these people.

Andy Slavitt  

How old did this go up to?

Eric Topol 

They got up to 85. But you know, the number of people in 80 and above is not so large. And you know, they’re the frail

Andy Slavitt 

People over 85 lies about their age, though. So I think they’ll be able to get it. And I think that’s how it works. That’s my, that’s my scientific read. And on this, my birthday is next week, I’m gonna start lying about my age too. So I know problems people lying about their age of makes you feel better. So Wow, it’s it really could be a new day.

Eric Topol  

It’s the best news. I you know, I’m really floored. I raked over Pfizer, you know, I gave him hell firstly didn’t produce their protocol. Then I had this, you know, conference, zoom with Katherine Jansen and the whole team. And they were kind of, you know, somewhat disdainful. We had a real confrontation. I didn’t expect him to pull this thing off. And, and I know the other companies are going to file a suit. And this is better than we could have ever anticipated.

Andy Slavitt 

And now for something we like to call advertising.

So I’m going to take a quick step back, and I introduced you and I don’t know if you’ll agree with this introduction. But the introduction I called you one of healthcare’s great renaissance men. Because you are, you’ve got this Research Institute, which I’d like you to describe in San Diego at Scripps. Your cardiologist, you’re an author, you’re an editor, you’re a scientist, you do pretty mean Twitter. You’re a technologist. So tell us how I think about you besides a guy who’s just got every tool in the chest,

Eric Topol  22:33

You’re very kind, Danny, maybe a lunatic would be a better term. You know, I kind of shifted gears back in and early in the year, February, March to devote a lot of energy to this knowing it was going to be bad news. And, you know, I think to watch what has happened here, you know, it’s momentous. So our whole team, it’s good research we work on, we try to do things that are transformative, and we have been very heavy into digital genomics. So we have the second largest genomics of the virus in the country, where they’re under our team, Christian Anderson, and he is just amazing. We also have the first and only validated app for detecting COVID from the risks that is.. 

Andy Slavitt  

Tell us about that. 

Eric Topol  

Elevated heart rate resting with decreasing steps. And if the data are in there for sleep, more sleep, that triad or the two, the two metrics, those steps in an elevated heart rate at rest. We just published in Nature Medicine last week, is a very crisp signal on top of whatever symptoms which are easily missed, unless you have loss of smell, for picking up coverage. So now we are on a path to try and prevent a COVID-19 outbreak. So what we need to do, we’re only at about 45,000 people that are actively streaming their data, we need to get to hundreds of thousands. And if we do that we should be able to along with other parts of a national real time dashboard, which Biden’s Coronavirus Taskforce has called for but they don’t really have any granularity of how to get there. Nor on the team, which is a great team, but there’s no one in there. That’s kind of a digital aficionado type or you know, real supportive. In fact, Zeke, and.. 

Andy Slavitt  24:24

I think their teams just getting started.

Eric Topol  

Zeke has been an anti-digital throughout his years and I hope he’ll be enlightened. 

Andy Slavitt  

I’ll take care of him. 

Eric Topol  

I talked to Murthy and I know he can be persuaded and Atul and some of the others in the taskforce. I think it’s great we have a taskforce. Can you believe we didn’t have anybody for all this time

Andy Slavitt  

Actual qualified clinicians, scientists, the task force is a great signal, but as you know, and wonderful people that you mentioned several, Atul Gawande and (UNCLEAR). You know, people that You and I are longtime friends with, but they’re, they’re thinkers, and they’re brilliant people, they’re likely not going to be the doers of the people who are going to operate, I think there’s going to be a structure next to underneath whatever the task force is going to gonna contain. I think a lot of a lot of that stuff. But of course, Ron Klain, who knows nothing about operating thing or two.

Eric Topol  

(UNCLEAR) I mean, having him on there is really great. And, you know, there are many good people on that group. And I think that’s going to help us it’s gonna, as you say, they may not be the doers, but they have, if you look at the initial plans, they’re really solid. I mean, we want to get this rapid home testing moving as quickly as possible. We, you know, and I think this real time national dashboard is essential. We have so many layers of data that we haven’t been looking at, like, you know, wastewater, like this wrist, like smartphone data, you know, just searches. I mean, so many things that we can do to get our arms around this.

Andy Slavitt  26:04

Right. If I’m not mistaken, it was the British that figured out that Dexamethasone was probably the most effective treatment. I mean, I should say, therapy and putting aside, you know, proning, and, and other kinds of other kinds of things we’ve learned. But I would have thought a few to said, you know, where will we be right now, where we’ve made progress, you know, in a well-functioning system, with linked electronic medical records and shared information, you think that those kinds of discoveries from because we’ve had so many patients, that we would be making those discoveries, that mean, I mean the CDC that should be leading the way? How should that really work in an optimal setting?

Eric Topol  

Well, you know, the sad part is we haven’t done nearly as well and doing clinical trials in this country. And we’ve relied on the recovery group out of Oxford, and then to another extent, the solidarity group of WHO also connected with Oxford. So, you know, our largest journals are still very small, the remdesivir trial was actually, you know, just over 1000 people, whereas the trials that have Oxford and WHO supported have been, you know, many thousands, the Dexamethasone is the only proven drug to reduce mortality, likely the Monoclonal will get us there, but we don’t have a large enough trial to prove it yet. It looks promising. But other than that, you know, all these repurposed drugs, were too much work with, you know, trying to work on Hydroxychloroquine. And, you know, so many others have failed. So repurposing drugs, you know, so far are shots on goal there have been one, Dexamethasone.

Andy Slavitt  

And well, just to finish the vaccines conversation. We talked about some production by the end of this year. And then we talked about larger amounts of production over the course of 2021. And, of course, that’s just the Pfizer vaccine, there are several others. But if I’m sitting here, and you know, I want to plan a wedding, or I want to start thinking about because, you know, the despite our best efforts, we can’t help but try to think ahead to when can we get back to normal. And I try to discourage people from thinking that way, because I think it you know, first of all, getting leads to disappointment. Second of all, you can live your life now, in the very rich ways. And we try to talk about that on this podcast, that even with sacrifice and struggle, there’s a tremendous amount of meaning. So kind of putting off and hoping for the future and all that isn’t necessarily their way. But, you know, still there are things that people love to do, hug their parents get around the Thanksgiving table. Can we credibly say that over the course of 2021, people are going to start to get vaccinated, and very likely, some of those things are going to return to us?

Eric Topol 

I really think that’s possible, you know, if we have better modeling in this country with respect to the importance of mass and distancing and patience, instead of China force things and rush things, and we get a buy in from a reasonable portion of the population about getting vaccinated. And unless there’s some new bumps in the road on anticipating, we could be in very good shape by you know, middle of the year, we got to wear masks, and probably throughout most of 2021, because of those uncertainties about how long the vaccines are going to last and this sterilization, immunity and protection of any given individual. But assuming we get through a good part of next year, like this time next year, by Thanksgiving 2021. I’d be very surprised if we have not gotten to the point where the virus is having a really hard time finding people to infect. that’s where we want to be. If we get to that point, then you know, it’s all about probabilities. As you know, this virus is going to be around is going to be endemic for years to come. But if it has a really hard time finding people, that’s all we need. That’s gets us from where we are today, which is like 120,000 cases a day to maybe, you know, 100 or 50. That’s where we want to be.

Andy Slavitt  30:09

Right, little tiny sparks, not giant forest fires. And that’s right. And I think the math here is profound, because just as it grows exponentially when you have this decay, when it spreads to people, now everyone in the world is probably familiar with what an R-Naught is. So we won’t have to completely explain it. But if you’re spreading the virus to less than a half a person per person, it’s very hard for the virus to find a place to go. And so just as hard as it is now, that place your advantage and an exponential, an exponentially growing virus, because the scale tips over the other way. Now, that dependent on one variable that we should talk about trust, trust the vaccine, and with a 90%, or something close to it. As you said, you know, you don’t need 100% of people to take it. But what percentage of people at a minimum would you say, just 60% of people need to take the vaccine does 70% of people need to take the vaccine?

Eric Topol 

Yeah, I mean, I think the calculations were, you know, at least 70 to 80, when we thought we were dealing with an efficacy of 50 to 60%. That dropped down. And I don’t know if it dropped down as low as 50. But it certainly is lower than you know that 70% need, you know, it looks like we could achieve, you know, you brought up, you know how many vaccines will be available, we got so many people to vaccinate, but when the distribution that looks like it’s planned out really well, with Operation Warp Speed, I mean, they got every dose tracked, the day that emergency authorization is granted, they’re ready to ship and all over the country, every health center. So, you know, I think it’s possible through that organized, getting the military involved, I mean, who would ever think but you know, that that may help us get to that mid-year point of 50% to 60% of the population immunized. And the virus is really on a hunt to find people. So, you know, I think it’s possible by, you know, summer, next year, we should be in good shape. But I wouldn’t have guessed that if we had 50% 60% efficacy. 

Andy Slavitt  32:22

Right, we’re gonna have an episode a couple weeks with CVS and some others, and you’re talking about vaccine distribution. And you know, with the Pfizer vaccine, you won’t be able to get it in your doctor’s office, you’d be able to get it at your local hospital, probably, you’ll be able to get it into major centers. But you know, we’re gonna have to find places that have the ability to start now, Pfizer did some interesting things, right? They created, maybe you can, you can explain it better than I can. But some kind of box, or packs, that’s sort of a self-contained storage, as I understand it, so we can get shipped with lots of doses in it. So they plan ahead a little bit.

Eric Topol 

Yes, those are good. And now, you know, these are the details that are really important is that idea of, you know, trying to scale this in such a large population. And so, you know, dispersed throughout this big country. That’s so out of control at the moment. So, you know, and there’s a couple other things we don’t know much about, like, for example, in the trial, they only had about 1% of people who turned out to be antibody positive when they looked after they got into the trial. So you know, a lot of people that are going to line up to get vaccines are people who already had COVID, whether they knew it or not, and that’s going to be interesting to see what happens in that group. But no, they did a really good job. I think actually, all these companies have thought about the scaling aspect and how to get it into 10s or hundred million people around the world. Hundreds.

Andy Slavitt 

They did a nice job. I will say Ivanka Trump told a fib, if you want to believe it or not by she credited Warp Speed with Pfizer’s success. Maybe she didn’t know.

Eric Topol  34:02

Well, you know, I think that was actually pretty bad because both Mike Pence and she and perhaps others did that this morning. And that was uncalled for. Pfizer did roll on their own, they have not been part of Operation Warp Speed, their engagement only is at the time of distribution of vaccines. They’re going to be part of that. But otherwise, they were running solo. The other companies did participate in OWS. So for them to claim that, you know, this has anything to do with the current administration is really not right.

Andy Slavitt  

I need an opportunity to say this is a potential win for humankind. 

Eric Topol  

Yeah.

Andy Slavitt 

It’s Democratic win, Republican win. 

Eric Topol  34:41

That’s right. 

Andy Slavitt  

You know, Biden and the team. They believe that the vaccine was more important than the election. Joe Biden believed that people’s lives here were more important than the election. And so, you know, I really think in his heart, that’s what Joe believes and if there was if this vaccine, were ready a week ago or two weeks ago, or three weeks ago, and there was the right level of sign off from independent scientists, I don’t think you’d be anybody happier in the world than Joe Biden about that. I hope we can all use this as an opportunity to rejoice in these scientists celebrate them, get the rest of the way there because we’re not done. And there’s plenty of credits to go around. But you know, it’s the trust and the politics just is what people are so tired of, I think in this country. 

Andy Slavitt  

Don’t go anywhere, we’ve got to go earn some money to donate to charity.

Andy Slavitt  

Just think about a new administration. And you think about besides this obvious big news, but it would be different. If you think about what kind of changes, we should expect to see where we’d like to see in the FDA, and in the CDC, and look, to be clear, and I you know, if we’ve said this on the show before, these are private institutions, these are some of our greatest assets, not just as a country, but as a world, they’re not perfect. The people in them are human, but they’re the best there is at this if you let them do their jobs, still, the CDC and the FDA had some bad moments during their response. So when you look at those agencies, what kind of reforms would you like to see you put more broadly?

Eric Topol  36:28

Right. Well, you know, it’s unfortunate, because we got into big trouble with the CDC just because they didn’t have a test ready. And that’s one thing we really can’t blame the administration on per se, that was a CDC responsibility. And they it was an abject failure. And they actually have never Redfield is never really owned up to that. That’s what put us in the hole for almost two months that we had no testing capacity. And it was just spreading viruses going all over the place. Now, besides that though, there are some phenomenal career scientists at CDC. And their work is laudable and I hope that that reputation of CDC can get back to where it was, which is, you know, as good as it gets in the world, a highly respected and, you know, a model, we need that we don’t have enough dedication of public health resources though, and we haven’t, and it’s been gutted over the years. 

On the FDA side, we had a serious problem. Steve Hahn, who had good intentions, comes in in December walks into a pandemic is bullied by a president who doesn’t believe in anything except to enhance his re-election, orders him to get an EUA on Hydroxychloroquine order soon for EUA on Convalescent Plasma. I mean, things were looking really bad as if the FDA was just a sieve, you know, like a tool for the President. Fortunately, he developed a spy. And back in October, he stood up to Trump, change the EUA guidelines for vaccines. And he’s helping to restore the trust and confidence in FDA going forward, we’re going to have a different Commissioner, obviously, but I don’t think we’ll ever have a situation, I hope ever again, when a president and an administration, basically just manhandles the public health agencies like this one has.

Andy Slavitt  38:18

So you have an interview with Steven Hahn, and we’re gonna put a link to that interview in our notes for people to watch it. I really thought it was such a human and compassionate and really important conversation. Because you know, sparks fly in these situations. Hahn, made a mistake, whether it’s because he got over his head, whether he was trying to please a President, whether he outright knew he was lying, whether he said something he shouldn’t have, you know, he tweeted against, it’s quite intimidating, to be honest. I mean, he’ll have it President tweet again, you know, get to and he did not come to the agency, as people know, to read it, you know, he sort of stepped into that role, but took a lot of grief, including for me, including from you, including the people. And you had a conversation with him, which I thought was very cathartic and very human and very important. Because when this is all said and done, we’re gonna have to heal together.

Eric Topol 

Yes. Yeah, I think where I saw and have so much respect for Steve Hahn is when he said, I don’t care, I’m fired, I’m going to do the right thing. I’m going to stand up to this bully. And I’m not no more. He’s not going to get away with it. And we needed that. We haven’t seen it with the CDC director, you know, but we are going to heal. I mean, when you have a President and administration that embraces science, when you have a triumph of science, like we’re seeing with the vaccine, and we’ll see what the monoclonals is and other things along the way, people will believe in that people will understand the importance and also just the no frill, low tech things like mask and distancing and things like that. So I think we are now, you know gonna have a whole bunch better path. If we had the leadership that is soon to take hold back in January, the pandemic would never gotten out of control as it has. The other point just to make Andy is patience. I’m the most impatient person, you know, I don’t know anybody as bad as me, right? 

40:20

But if we were patient, instead of forcing, reopening, forcing schools forcing everything before its time, in certain parts of the country, good things we’re going to come vaccine to, we’re going to be here and better than expected. So people are going to survive now that might have died earlier, you know, that’s the difference, or might have gotten really sick. All you had to take was some weeks or a couple months. So this whole idea of, you know, groundhog day, every day, and we’re like stuck in a cave. And you know, it’s bad. But if you just sit tight, you know, good things are going to happen.

Andy Slavitt 

You know, I just I don’t know if you know, I just finished a manuscript, book’s coming out March 16th. It’s called Preventable. It’s about our COVID response. But the reason I bring it up is because I have a chapter, I’m sure I’m guessing you’re familiar with this famous experiment called Trump ate the marshmallow?

Eric Topol

Oh, it’s good. Oh, I can’t wait to read this.

Andy Slavitt 

He just walked right in the room. popped it in his mouth. Yeah. Well, it’s great to be with you in the daylight today. And it’s great to have an episode that’s about really nothing but promising news. We’re not out of the woods, there’s a light at the end of the tunnel. And I think the message that I want to give people is, you know what, with that light at the end of the tunnel, use it to not make this Thanksgiving something that makes things worse. Use it. I know, I know, we want to be with our kids and our parents, I know, we want to get everybody around the table. I know we miss socializing with our neighbors, but we have not yet skipped a holiday. And every time we don’t skip holiday, we’re accelerating. We’re just being a better host to the virus. We could have 100 and 30 million hotspots, if we are not careful this Thanksgiving. And maybe use the fact that as Eric said, you know, sometime over the next year, things are likely to be looking a lot better clouds are likely to lift. Let’s be alive for next year’s Thanksgiving. Let’s have our loved ones alive. Let’s have our neighbors alive.

Eric Topol  42:38

You’re absolutely right. sitting tight. being patient is such an important message. You know, just before wrapping up, it’s exhilarating to be with you today, Andy especially, I’m so thankful for that. You’ve been such a leader, great communicator throughout this pandemic, and you have not only captured the happenings, but the emotions, and you know, you’ve just been a phenom. So to share this experience together is pretty special for me. I really thank for the opportunity to have this conversation. And it’s the best day we’ve had in 2020 with respect to the pandemic, for sure. And hopefully, as you say, it is the light, the light we’ve been needing, and it’s better, stronger light than we had expected.

Andy Slavitt  

Right back at ya, I would only wish we could cheer to drink today and celebrate.

Eric Topol 

I look forward to that. Someday we will hopefully not so such distant future. Thanks so much, Andy.

Andy Slavitt 

Thank you, Eric. 

Andy Slavitt  

When I asked Eric, if he thought on a scale of 1 to 10 I plan that question, you know, what do you think this is good news on a scale of 1 to 10 because I wanted to give myself and the rest of us something to react to. Like how do you gauge, how excited we should be about this news. And I thought he was gonna say, eight or nine because he’s a scientist. You know, it’s gonna hedge a little bit. He said 12. Now maybe he thought I was out of 1 to 20 I don’t know. So I can’t over interpret it. But I tell you the look at his face, you got to watch some of the video that we’ll put out on social media. This was someone who was just extraordinarily happy at what happened. He’s a wonderful guy. Very, very, very good person. We are going to have more people on the next few episodes that we are going to give them to in exact order. But we’re going to put Inglesby on he is one of the world’s premier epidemiologists. He’s at Johns Hopkins. We’re going to have an episode on the transition. We’re still planning that, that’s likely to be the next one. But sometimes producers like to surprise me in the order of things. And then vaccine distribution. We’re going to have a big episode on how to get it, where to get it, when to get it, why to get it, all that stuff. All right enough good news. I’m sure you’re tired of all the good news, over and out. 

CREDITS

Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media, Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and they executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at Lemonada Media. And you can find me at @aslavitt on Twitter or at @andyslavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, but still tell them at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome

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