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Description

COVID-19 vaccines are no longer blocking infections like they used to. Nasal vaccines could help patch up the holes where the new variants like BA.5 are getting in. Andy talks to physician and scientist Eric Topol about the promising trials underway, when we could see a nasal vaccine hit the market, and why it could transform our pandemic response by providing mucosal immunity.

Keep up with Andy on Twitter @ASlavitt.

Follow Eric Topol on Twitter @EricTopol.

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Check out these resources from today’s episode: 

• Read Eric and Akiko Iwasaki’s piece about how nasal vaccines could achieve mucosal immunity against Omicron: https://www.science.org/doi/10.1126/sciimmunol.add9947
• Find vaccines, masks, testing, treatments, and other resources in your community: https://www.covid.gov/
• Order Andy’s book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response”: https://us.macmillan.com/books/9781250770165

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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Eric Topol

Andy Slavitt  00:01

Welcome IN THE BUBBLE. It’s Andy Slavitt. Is my voice such that it is, it is August 1st. First, I want to thank Steph who substituted on Friday for a great show. Monkeypox. I really thought it was an amazing show. It’s probably the first time I was able to listen to IN THE BUBBLE completely objectively. And I’m like, hey, this is a good podcast. And I thought you did a great job. I thought the guests treated the topic both with appropriate amount of seriousness realism, a little bit of even, I don’t know, I don’t want to say humor because, but they were funny, while they were trying to be clear about some of the points that they were making. And they were very real, I thought it was a great show. So thank you Steph. And I am back with an episode that continues our conversation with Eric Topol, which you learned last Wednesday. And if you haven’t listened to it, I really recommend that you do. It lays out what we’re going through with BA5 and lays out the complexities that our current vaccines are having with BA5, then it talks a little bit about why some of us are more likely to get COVID than others. So it’s a really interesting show. And I really wanted to save the second piece for today, which is something that Eric has been working on. And the country has been working on, although not to the extent that it needs to be which Eric believes is one of the most important solutions. And that is the creation of a nasal vaccine, and nasal vaccine that has the promise of keeping the virus from spreading in the first place. And from us catching it. By working in a different part of the body, the nose, there are some complexities, but there are 12 drugs in trial. And three or four of them are now in stage three. Before we get to that interview, I want to give you two updates. One, I think a quite a serious update. And one, a more personal update. The quite serious update has to do with something going on in Washington. And that is you all may be aware, I’m sure you’re aware right now that there is a bill that is a gap agreement, potentially enough votes to pass that would do the following things it would reduce the cost of prescription drugs for seniors. It would continue subsidies for the Affordable Care Act for people who are getting insurance now for the first time. And it would invest about $370 billion, maybe most importantly, in a new set of climate initiatives, that would create much more solar opportunity, electric battery opportunity, wind powered nuclear. And it does it in a way that continues to not abandon fossil fuels immediately, but keeps us stable on fossil fuels until such time as those new forms of renewables can kick in. It is the biggest investment in climate ever and had been done by the US there’s good evidence that it will do two things. It will get us 80% of the way towards our climate goal from a place where if we don’t pass this, we hear really nowhere there. And it will spark the world in the upcoming meetings that are about to take place to respond in kind. So, I think it’s really important. On top of all that, this bill would reduce the deficit by $300 billion. And according to most every economist, would take a big bite out of inflation. So let me review, good for the planet. Good for seniors, reduces prescription drug costs, good for people’s healthcare, good for inflation. Here’s what serious about it. There are a handful of reasons why it might not happen. And I think you should know about them. One of them to state the obvious is that there are 50 Republican votes in the Senate against the bill. We can’t forget that. And that also means that if this doesn’t pass now, and the House or the Senate flips into Republican hands in November, it won’t pass. So this is the window if you want to pass it. The other reason is that a bunch of money, a bunch of lobbyists, some from traditional conservative causes, some from corporate causes, like private equity, and probably most powerfully from the pharma industry, are spending a lot of money to lobby against it.

Andy Slavitt  06:29

And I just think it should be known that the pharma industry and look, we’ve had pharmaceutical CEOs on the show, we have acknowledged where we think the pharmaceutical industry is right, and where we think they’re wrong. And certainly the development of vaccines, acknowledge the good work, but to protect their own financial self-interest, which by the way, cost both taxpayers and seniors lots of money, to keep drugs that are really lookalike drugs, from being reasonably priced, and risking our climate future. To do this, to me, is just an unconscionable act, and one that needs to be understood, and for those who disagree with it, to be countered. So let’s be very clear. This is not done despite the agreement we have. It is a very good piece of legislation. It is one of the most important pieces of legislation we have. And the most powerful lobby. In the Congress, which is not the NRA, it’s the pharma lobby is on the attack, and they could be successful. They’re running ads and all of the battleground states. So that’s the serious thing I wanted to talk to you about. One other quick update was that my own health, my own status, I thought you’d want to know you’re aware, perhaps, if you’d listened to the last couple of episodes that I came down with COVID just give you an update. First of all, I don’t know where I got COVID from, I have been going through all of my steps like that childhood book where the kid drops his lunch money, and then has to go back and figure out where he dropped it. You know, we haven’t been less careful over the last few months, if anything, would BA5. Lana and I have been even more prone to wear masks indoors and test frequently. But it’s also true that we’ve been on airplanes wearing masks, we’ve went to an outdoor dinner party, where everybody who had to test prior to coming that in an office setting where everybody was tested, a bit in the hotel rooms. So there’s no obvious single culprit, but BA5 can find plenty of potential holes in my story. So know that. And look, I knew the risks and understand the risks. We went to visit our sons in New York, we went to see our friends. And even when I thought was being careful, I have to take responsibility for my own health and my own actions. So you live with the results, you know, you’re taking some slight risks. You know, the bigger issue for me is being responsible for others getting COVID because that is something that nobody signed up for. So we contacted everybody that I’ve been in contact with. Doesn’t seem like there are other exposures so far. And that’s a relief. And at least as of this airing, a lot of it’s still negative. And look, I know how fortunate we are to be in a place where I can safely quarantine. You know, we’re empty nesters. She’s got Zach’s bedroom. Yes, that’s right. And she left me, our bedroom and she went to Zach’s bedroom. Probably a good move on her part.

Andy Slavitt  09:58

Everything I tell you is like it Interesting experience with treatment. You know, the first line of treatment that is recommended for people that are moderate to high risk is Paxlovid. And I’m not eligible for Paxlovid. But I have had four vaccine shots, didn’t feel in danger. But I wanted to do a couple things. I wanted to get the monoclonal antibody because it wasn’t feeling great. But I also wanted to go get my positive test results reported officially because I only had it on a home test and I wanted to go to a treatment center where they would take the PCR tests report it, even though my physician said it wasn’t necessary to get the monoclonal antibody, I wanted to check it out. And, lo and behold, I went there, and had a chest X-ray determined that I have pneumonia, as well as COVID. So the monoclonal turned out to be the right move. The clinic was interesting, they specialize in COVID patients. And they gave me five prescriptions to take with me. And I went and researched each of those five of them, asked other people I know asked my own doctor asked, Bob Wachter, looked at clinical studies. And it turned out that four of the five things that they gave me, were at best, unnecessary, and one of them in studies was plenty harmful. And that was a steroid. And I understand why they gave me the steroid, because it’s probably helpful with pneumonia, but it prevents your immune system from responding. So I just thought that was interesting that, you know, we feel like we’ve been at this a long time. But the truth is, you know, at this early date, we’re still at a stage where the studies can be read multiple ways. Most people don’t even read them. And we expect our doctors to read them, when they read them, they reach their own conclusions and have varying degrees of confidence. Or they’re just not at all, because there’s so many, and there’s such low numbers. So, it is still not a lot of settled science when someone has a case. Thankfully, you know, I’m on the mend. I don’t think I’m gonna miss any more shows. Pretty confident of that. But continue to monitor things, you could tell my voice is not perfect. Mostly, I’d say my story is a story about fortune and privilege to be frank, living in a country where I’m vaccinated and twice boosted. Living in a place where I can quarantine with ease. You’ll have multiple clinical options available based on great research. And even though there’s been some disputes, we’ve got options today. And it’s all covered by insurance or by the government in the form of buying these vaccines and buying these therapies for us. And I wish it was that way every time we got sick. All right. Now we’re gonna get to Eric Topol and we’re gonna talk about how we get out of this messy situation we’re in Eric’s got some great ideas. Thanks.

Andy Slavitt  13:20

Eric, welcome back.

Eric Topol  13:21

Andy.

Andy Slavitt  13:23

You’re on last week, you can’t blame people for feeling a bit of concerned, depressed, etc, for feeling like we’re in a rut on COVID. Maybe we just spent a second summarizing what we covered last week about BA5, and kind of the pattern of variants, and kind of how they’re sort of overtaking the ability of either vaccines or prior immunity.

Eric Topol  13:49

Yeah, I mean, I think we should take notice that this virus has ways to continue to evolve in a non-accelerated and formidable way. And, you know, it’s just so efficient at finding people to infect, or encore infections. And so we have got to do much better, because BA5 is not the end of the line here. And we have caught unprepared, we just haven’t taken the aggressive initiative ever since the pandemic began to get ahead of it.

Andy Slavitt  14:23

And so it looks like it’s has landed major blows against this virus specifically, clearly prevented me at the 10s of millions of people from dying. And you could argue it’s the most important blow, yet, I think, as I listened to you, and as anybody listens to this conversation, they get the impression that you know, as of today, in terms of the micro battles, the virus is winning, it’s just moving faster, it’s evading faster, and you can’t create vaccines quickly enough to prevent people from getting infected. So, you have recently called for major action in the area of nasal vaccines. Tell us why that’s the answer?

Eric Topol  15:03

Well, I mean, I think to highlight the important points you just made Andy, we know that in 2021, just that year, we had already saved 20 million at least lives, and more every day. All right. But that’s not enough. And we’re still, you know, our deaths have actually are increasing with BA5. And so, but we are paying much too much attention to that endpoint, or hospitalizations and you know, not about what infections can do and predictably to induce chronic illness and long Covid, it’s just a sickness, as you said. And you know, that can be scary. And it can take you out of your life and your work and whatnot. So, what we have now is, the vaccines are the most extraordinary advance in biomedicine, I think ever, to have that done so fast. In the first year of the pandemic, in 10 months, from the secret, unbelievable. 95% efficacy, 10 months rolling out to you know, millions of people. There’s nothing ever like it in the history of medicine. You were on the show the day we learned about it. Oh, I know. I’ll never forget that. That was the most exhilarating moment of the pandemic was that day, then when 95% I was just blown away. I said, we got this, you know, we’re going to prevail. And why did we get it? That’s the most important thing. Why did we get it because we went after it. We said the only way we’re gonna get out of this pandemic is a vaccine and the government worked with industry and put $10 billion investment to de-risk the vaccines in case they click, who would have ever thought they’d be 95%? against infections? Hospitalizations? Deaths? And by the way, if they’re 95%, effective against infections, you don’t see a lot of long Covid there either. Okay. That’s where we were. And the problem is, we’ve lost that. Vaccines are no longer blocking infections and spread like they used to. We were great through Delta. But when Omicron appeared, we lost that. And yeah, there’s some protection from the boosters, vaccine, but it’s very temporally limited. And it’s also, you know, low, it’s not 90 some percent, it may be, you know, short term 30% or 20%. I mean, it’s just pitiful, big plummeting drop. So why is that? Well, if you look at why we lost the protection from infections and transmission, it’s because there’s several papers about nasal vaccines or mucosal vaccines. But remember, that’s where the virus gets in. That’s the patch that we need, to patch up the leak of the vaccines. Because once it gets in through our nasal mucosa, or our oral mucosa, upper airway. That’s game over infection.

Andy Slavitt  18:02

All right after the break, if a nasal vaccine hit the market, we’re going to talk about how often it would be used and what that would look like.

Andy Slavitt  20:09

So you take a nasal vaccine as something that you spray in your nostrils and it becomes preventative, prophylactically. Is that the idea?

Eric Topol  20:58

Exactly. Yeah, exactly. And, you know, I think the paper that came out from University of Virginia last week, is actually extraordinary, because they were able to get, you know, about 30 some people to do bronchial alveolar lavage, put it to down your throat in your lungs to get the fluid of your lungs to see if you had mucosal immunity to the lower respiratory tract, right? And what they found, mRNA vaccines, no mucosal immunity Omicron, none, or so little it was worthless. So that tells you that we’re susceptible. And what does a nasal vaccine do? Well, we have in all these now 12 clinical trials that are ongoing, four of them are in late stage. But in this particular UVA study, you can’t do bronchial alveolar lavage and 1000s of people, but they did it in mice. So they did the same thing in humans they did in mice, and then he gave him a nasal vaccine on top of the mRNA vaccine. And there you saw it, you know, great neutralizing antibodies in the bronchial alveolar fluid.

Andy Slavitt  22:13

What’s the marker of protection, since you can’t, you’re not really measuring, if I’m not mistaken, antibody titer to the blood, you’re measuring something in the nose, right/.

Eric Topol  22:23

Alright. So up until now, most of the work we had on mucosal immunity was from nasal washings or oral Washington’s it didn’t get down to the lungs to see what was going on there. And tissue level mucosal immunity is really important, right? So you want to know that you have great neutralizing antibodies and IGA antibodies, which are, you know, tied into this mucosal immunity, which is, that’s the seal, you know, you don’t want to pierce through that. Because once you pierce through that, then you get organ damage potential, right? Infection directly into the lungs, or other organs of the body. So if you can get a Teflon coated mucosa of your nose and your upper airway, that’s what you call preventive. Now, we had that inadvertently from shots, but that’s not the best way to get it, the best way to get is to do something, to induce the mucosal mini right at the upper airway with either nasal or oral vaccines. Oral vaccines would work too, but they’re not nearly as far along as a nasal vaccine. So yeah, the spray would do this. And the fact that Omicron is what really pierce through was really notable in the UVA study, because it wasn’t the case with the prior variants. This happened from the time of Omicron. So, I think that study helped take this over the brink of how desperate we need nasal vaccine, mucosal immunity to be induced because the virus has outstripped any mucosal immunity, essentially. And we have a patch up, waited to recover that.

Andy Slavitt  24:06

So when you use a nasal vaccine, is it used kind of with frequency, you know, when people feel like they’re gonna get exposed, or maybe they did get an exposure? And then they use it to sort of protect you prophylactically or upon exposure?

Eric Topol  24:21

Yeah, it was a really important question, because the only commercially available nasal vaccine we have is FluMist. And it’s not that potent, but no influenza vaccine is, right? And that’s just taken preventatively instead of for certain people, like you know, younger than age 50 and not pregnant and not immunocompromised, those people can get FluMist instead of a shot. And it’s basically substituting for the once a year shot. But we don’t have a lot of experience to answer your question, though. The idea is that since it’s such an innocuous thing, I mean, it could have side effects. There has been at least one vaccine that was implicated of years ago with Bell’s palsy inducing that. So, you know, it isn’t like it’s very has to be free of side effects. But hopefully it would be, we don’t know, if it’s going to be, you know, every four months, once a year, you know, assuming that one of the all we need is one of these, Andy, you don’t need to 12, you know, the problem we have is that we’re not prepared for one of them to click. We have no operation warp speed, like initiative, which was the real reason why we were able to, you know, triumph in that first year, the pandemic, we basically said, okay, we got this great vaccines, 95% efficacy, that should do it. But instead of saying, hey, you know what, this warp speed thing is pretty damn good. Let’s do a couple more of these. Let’s do one for, you know, a nasal vaccine, let’s do one for a pain remover, let’s get ahead of this pandemic, in case the virus evolves, you know, it’s a problem. We never did that. But now we need to do it real badly. And we have basically, all these trials that are ongoing. One of them is I think, now complete, three others are in the next weeks or month or two. And we don’t have any manufacturing. So let’s say we have a really effective nasal vaccine. We have no public private partnership, these are relatively small companies, they can make millions of doses of nasal vaccine, and your questions are unanswered? Should we use it only when to exposure? Should we take it every four to six months, once a year? We don’t know any of that stuff. All we know is that we’ve had really good promising data, that that’s how they got to phase three, because they had promising phase two data. And hopefully, my goodness, hopefully, at least one of these is going to be a safe and efficacious vaccine. I also would just preface it; we shouldn’t think just because flu miss is a weak hitter. That, you know, influenza is the precursor to that same here, because influenza is a much more formidable virus to fight against. Look at Tamiflu, we kill her drug compared to Paxlovid. We can triumph over this virus, I’m confident that and I do think that’s why the nasal vaccines look so alluring. Because this virus is a very ideal target for a nasal vaccine, we just haven’t gotten after it. Except for you know, these various companies that are on their own, have been on the hunt.

Andy Slavitt  27:25

You give me a bunch of really bad flashbacks, right? Because on the one hand, what I’m hearing you say is, look, if one of these dozen drugs that are at trial, and I think you said three that are in phase three, which is, you know, they’re in people, people are trying them in some amount of scale. You know, if one of them hits, we’ll have that moment of euphoria. And then we’ll go hey, wait a minute. Because the pharmaceutical companies have spent all the money in doing the R&D, they can charge whatever they want for it. And because the government doesn’t really have it funded, because it’s not being done in partnership, and because they haven’t built any manufacturing scale capacity. We could be sitting here looking at this watching people die before our eyes; say we have an answer. And guess who’s gonna get that answer? Wealthy connected people at first. And the whole process that we went through when we had the initial mRNA vaccines? So it’s this failure to plan, and plan for success. And I think you’re really pointing to what would you like to see the government do? Is it NIH? What would you like to see happen?

Eric Topol  28:32

Yeah, I think, you know, Tony Fauci is supportive. And there are some people in the White House COVID Response Team, your teammates that are supportive, all I understand. And, you know, I think Akiko Iwasaki and I, when we wrote this operation nasal vaccine, we’re trying to help get that level of support to very high. But the problem really isn’t with the administration, I think Ashish Jha and others do want to do an operation work speed, type to address manufacturing, distribution, planning, regulatory guidance, and all the things that we need to be ready, like we were for the vaccines. But the problem we have is to do this. We have right now, we have small scale funding at NIH for research labs, we have none of these other unmet needs, you know, grappled with. So the idea is we got to get money allocated, and we can’t even get any money from Congress, because there are people in Congress that don’t think that there’s a pandemic. Or don’t think that, you know, you know, that it’s some kind of a made up problem that doesn’t need any resources. I mean, it’s really extraordinary. How, what are we going to do, Andy, when we get to December, January, and we’re in even in a worse storm than we are right now. And so it’s always like, we better go after those nasal vaccines, or the universal vaccine. I mean, We’ve been looking at these staring at these opportunities to get ahead of the virus since the pandemic began. I mean, mucosal immunity has been known to be a powerful intervention and prevention, no less the pan Coronavirus vaccines. We have 35-40 of these that have been discovered in academic labs like Scripps Research and many others throughout the US and the world and we don’t have a real pan Coronavirus vaccine in the clinic. You need both by the way. If you just do nasal vaccines, you get the patch up in the upper airway. But you have to also have variant proof vaccines because we know this is going to have more evolution. You can’t just do one or the other. Because that’s short sighted. So, right now we’re in this zone of we know what we should do the science is fully supportive. We’re on the brink of having successful nasal vaccines. We’re not as far along with Pan Coronavirus is because of the companies not taking the risk and not being supported. But, you know, we could be like that pilot on the plane. It says, you know, we’re gonna we’re leaving many hours late, but we’re gonna try to catch up. We should be doing that right now. Let’s catch up we can get, we know that the science is there to get ahead of the virus on the variant side on the mucosal immunity side, we’re just not doing it. And when are we going to actually wake up? When are we going to get Congress to say, you know, $10 billion that was put in to the initial operation warp speed, that’s nothing with the trillions of dollars that are being lost. Just look at the hospitalizations that the United States pays for with Covid. How many of those do you need to support these two initiatives of nasal and pan Coronavirus? So the economics are there, the science is there. But we have the people that are in charge of dispersing funds and making it a priority are a real obstacle.

Andy Slavitt  31:56

So, you’re saying it would be nice to have a pro science Congress and well maybe a pro-democracy Congress wouldn’t be bad a pro understanding of the climate science.

Eric Topol  32:10

We’re in a multi-dimensional denialism. I’ve never seen in my life, Andy, you touch on climate, on banning abortion, or not banning assault weapons, on not supporting whatever we can do to advance our science in the pandemic. And the list goes on from there. I mean, I just, it’s unfathomable to me that we’re in this state. And it’s not just a pandemic, the pandemic exemplifies the problem, but you see common threads in everything through our health and our environmental threat.

Andy Slavitt  32:46

Okay, after the break, let’s finish up we’re going to talk about when we can expect a nasal vaccine to come to the market to be available to you and I presuming all goes well.

Andy Slavitt  33:27

You’ve got a track record with Operation Warp Speed. We know how to do it. And put even aside all the other issues we just mentioned, this is one where there is a leapfrog needed in the type of you’re calling for a leapfrog and the kind of vaccines needed. Because the virus leapfrog from where it was, if we were still dealing with wild type virus, fine. We wouldn’t need any more money. But the fact is, it’s like dealing with China, when China escalates. It’s policies, you know, you have to escalate to and I think that’s really interesting. By the way, speaking of foreign governments, I read somewhere that Russia claims that it has a nasal vaccine, and that Putin took it, have you read this?

Eric Topol  36:18

Oh, I didn’t know about Putin taking it. But yeah, Russia’s Sputnik has made a lot of claims that haven’t been I think evidence based. There are nasal vaccines, you know, being developed in India and Russia, you know, and China. And, of course, many of those 12, clinical trial companies, several are in the US, right. So, this, the world has recognized the need for these, but none of them have gotten a priority. I mean, they all been working on their own. And if we learned anything from this pandemic, from the most momentous advance of the vaccines, we learned how public private partnerships can be such great accelerators of innovation to take out the risk, and do the proper planning. And the head in the sand, which we have couldn’t be the more wrong approach. And we’ve known that, you know, when, late in 2021, when Omicron hit, we’ve known that we had a deep problem. And if anytime, we should have pulled out all the stuff that was you know, well before then, but it’s not going to get better. And we keep relying on prayers and hope is not going to help get us out of this pandemic. And people can call it an endemic and a pandemic. But when you have, you know, hundreds of 1000s of people dying just in this country, each year still around no less around the world and you have more and more people getting long Covid and all these other sequela I mean, it doesn’t matter what it’s something has to be done to get ahead of the frickin virus. And I’m amazed that we have to work so hard to get buy in to the importance of this.

Andy Slavitt  38:00

Well, especially given the caliber of scientists that exist both in the public and private sector that are people that you know, better than I but they do remarkable things when we let them in when we would set the right goal. Speaking rubbish by the way, if you talked with our friend, Rob Califf for those who don’t remember Rob’s the head of the FDA, a good mutual friend of Eric and mine, […] see the promise here.

Eric Topol  38:27

Yeah, I think so. I mean, I think he understands the FDA is not in the way here. You know, this is really beyond what FDA can do. I mean, they don’t have the budget. I think they would very much support. What’s nice about the pan Coronavirus vaccines is that we have a template called you know, the immunologic bridge where you don’t have to do trials of 10,000-40,000 people you can do smaller trials like for the variant specific VA one or VA five vaccines. So we have an FDA template that Peter Marks and Rob Califf have overseen and it’s very favorable for a pan Coronavirus vaccine. The problem with the pan Coronavirus vaccine, Andy is we’ll never know if it’s truly pan Coronavirus until it’s out there for a couple of years. Right? You know, you have to go in there with good science. So I think FDA is supportive with respect to the nasal vaccines. They haven’t issued guidance for what would be the criteria for approval of a nasal vaccine? I think that would should come readily once they have an application. They haven’t received one because they’ve trials phase three trials are not yet complete. But that’s imminent.

Andy Slavitt  39:36

It’s to remind us with a little bit of luck and success, how long it will take roughly before people can expect a nasal vaccine would be available. Either in this country. There’s a lot of variables, certainly but it occurred in speed without this sort of operation that you’re talking about. What would be your expectation of how long would it take before a nasal vaccine if the ones that are currently in stage three panned out hit the market?

Eric Topol  40:06

Well, it’s a big difference between treating one person versus treating millions. Right. And that’s, I think we’re talking about years to scale up production. If we de risked that, yep. If we went through this inventory of the four that are in full eight trials, or even a few that are not far behind in phase two, we could direct that get the manufacturing up, get distribution plans, we could be ready by the beginning of next year or late this year, even if we really went after this aggressively. But that’s assuming that, you know, we have very clear cut safety, efficacy. And the production shouldn’t be the problem, the limiting feature here. I mean, we know FluMist. You know, we learned from MedImmune years ago, that’s not hard to make. And then they redesign their Quadrivalent vaccine and make it even better. But no, I don’t think that the manufacturing itself, it’s just that these companies are not capable of making the kind of dosages that we were going to need, assuming they’re, they meet the expectations of efficacy and safety. So, we’re talking about difference between months and years here, unfortunately.

Andy Slavitt  41:14

Final question for you on this topic, is a really promising exciting area. It just in terms of lessons learned to what we didn’t do well, last time, you would strike me. And this is tricky. That the difference between this being available if it’s successful, to some, and it being available broadly around the world, in a low cost way, is a big difference. And one of the things that seems nice about a nasal vaccine is you don’t need a doctor. You don’t need cold storage. You don’t need a bunch of the things that inhibit people. And by the way, there’s a whole bunch of people, I’m convinced that are needle phobic. Maybe 10 to 20% of the population has some severe needle phobia. I’m related, happened to be related to two of them. So you know, this has a lot of advantages. But with the way the IP works, you’re getting this vaccine around the world so that we actually are slowing the spread. And so that we don’t have new mutations, new variants, to the degree we do feels like the difference between this being kind of a niche product, and something that really is a game changer.

Eric Topol  42:30

Yeah, well, you, I think touched on some of the extraordinary advantages that this can be given in any pharmacy, potentially even you know, may out at some point, but certainly, it can be easily given getting away from needle phobia would be you know, phenomenal. And also, you know, planning, one of our biggest problems, as you got to about lack of vaccine equity, hopefully we learn from that, hopefully, we can get the costs here are very low, and that the […] is not holding things back. But the imperative of nasal vaccine equity is clear. So I do think that we have missed out, we should have had nasal vaccines last year, they should have been ready to go. If we had them before. Omicron just think, I mean, we we’d be in such great position. But I do think we can rev it up and think about the lessons not just from not having operation warp speed, but not having global equity, having all these issues that prevented global equity. And so hope we can do a better job there too.

Andy Slavitt  43:44

Well, Eric, thanks for coming out and educating us about this is a hugely promising area. And I just think about something you said both in this episode and the one you’re in last week, which is there’s just maybe too many people who feel like 500 people dying a day or whatever the number is in the US and far more around the world just isn’t something to worry about and invest in any longer. And we got to get over that hump. But if we do, we unleash our scientists. It feels like we can make really significant progress.

Eric Topol  44:13

Absolutely. I remain optimistic that we will and can do far better than where we are right now. And hopefully we’ll see that.

Andy Slavitt  44:21

Thanks for all you do, Eric.

Eric Topol  44:22

Thanks Andy.

Andy Slavitt  44:36

Okay, thanks, folks. Let me tell you what we have coming up this week. Wednesday, are we in a recession? What’s gonna happen with inflation? Justin Wolfers, great guy, former Obama administration official. He’s a professor at the University of Michigan. Friday is our conversation on climate and whether or not this bill should be getting passed what difference it will make, and then we’ve got a bunch of great shows in the following week. And weeks ahead. Patton Oswald, the comedian, we’re gonna have a show on the crash in crypto. And we’re gonna have Tony Fauci coming up. And Congressman Raskin from Maryland who’s on the January 6 committee, so lots of good shows coming up. Remember, we will keep covering everything going out to be a five and Omicron. As it comes up. I would also remind you go back to our prior shows, and listen, because we have really good, very current information in these recently recorded shows that I think if you’ve missed a few, you’ll want to catch up on and thank you again to Steph for doing the great job as a guest host on Friday. So appreciate it. Talk soon, everybody.

Andy Slavitt  45:58

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.