Peter Hotez: Scientists divided on what recent COVID decline means for Houston, U.S.

Since 2020, when the word “coronavirus” entered the average American’s vocabulary, bow-tied vaccine researcher Peter Hotez has become one of the country’s — and Houston’s — most visible explainers of science. He’s dean of the National School of Tropical Medicine at Baylor College of Medicine. And at Texas Children’s Hospital Center for Vaccine Development, he and his team have created a COVID-19 vaccine that can be produced in large quantities for a low cost — a global vaccine for a global pandemic. Let’s start the way we usually start: What’s the COVID situation in Houston right now? What we’re seeing across Texas is bad. The only possible silver lining is that the number of new cases seems to have hit a bit of a plateau. That’s actually true in many parts of the South. And in some places, like Florida, it’s even going down now. But I don’t think we really know what that means. If you remember, the United Kingdom was about a month ahead of us with the delta variant. Their terrible delta wave went from 5,000 new cases a day to 40,000 new cases, then it went down to 20,000 new cases a day. People thought, “Well, that’s it.” That was what had happened in India: It had a long tail, but it dropped. But then in the U.K. it stuck at 20,000 for quite a long time, and now it’s going back up to 30,000. So I don’t think we really know. The scientific community is a bit divided. Some people feel things will now continue to go down in Texas and elsewhere in the South, maybe with a long tail. But a lot of us think it’s not going to go down nearly enough. That’s because our schools opened. We’re seeing a lot of transmission in the schools, and a lot of kids getting sick — in some cases from each other, in some cases from their parents. We even had that tragic case from the recent Centers for Disease Control and Prevention report: Kids were infected by an unvaccinated teacher. So I don’t know what’s going to happen here for the next few weeks. I think best case scenario, it slowly goes down. Worst case scenario, the graph forms this small hill, it goes down a little bit, and then it remains almost level for the rest of 2021. On HoustonChronicle.com: What you need to know about the COVID mu variant, WHO's latest 'variant of interest' That’s possible because we’re still underachieving in terms of vaccination. If you look at the vaccination rates in Harris County, it’s not so terrible. In Fort Bend, it’s pretty good. But when you get up to Liberty County or Waller County or move into East Texas, it’s terrible. In Shelby County, only 25 percent of the county’s vaccinated, so what’s to stop this virus from just plowing through it? East Texas is one of the worst affected places in the country right now. That was predicted and predictable. And preventable! Predicted, predictable and preventable! That’s what’s so tragic. I think we’re still in for a very rough period here in Texas as we move into the fall. Are there theories about why it plateaued and then went back up in the U.K.? I don’t think we really understand it. They did a better job vaccinating the country than we did, but it still wasn’t enough. With this delta variant, the bar has become super high because it is so transmissible — two or three times as transmissible as the original COVID-19 virus. The more transmissible a virus agent is, the more people you need to vaccinate to stop the virus from spreading. The best example of that is measles, which is so highly transmissible. The reason we see measles outbreaks in this country now more frequently than we used to is that vaccination coverage went down below 90 percent. That’s all it took. With delta, we may need to get the 85 percent vaccination coverage in the U.S. to shut it down. That’s 85 percent of the total population, not just the people who are eligible? That’s 85 percent of everyone, everybody. Since children aren’t eligible, that basically means all the adults and all the adolescents. You might say that’s not possible. Well, of course it is! We do it for measles, Massachusetts and Vermont are getting there. That’s why COVID transmission is so low there now. That has the collateral benefit of protecting their little kids. Here, little kids are often getting it from their unvaccinated parents. Plus, those are also the states that have mandates and even vaccination requirements. All those things work together to protect kids. Here in Texas, unfortunately, many school districts have no mask mandates, and certainly no COVID vaccine mandates. Having the mandates is not even part of the culture. Now we’re seeing what happens: The schools can’t sustain in-person learning, and they go back to virtual learning. We talked about this last time: You can’t just stamp your feet and say, “We’ve got to have our kids do in-person classes.” We all get the importance of in-person classes. But then nobody wanted to put the policies in place to make that doable. MORE Q&A WITH LISA GRAY: The pandemic's next stage is endemic COVID. Here's what that would look like. To make in-person classes safe, you’d have to require that everybody who walks into a school, whether it’s a bus driver or teacher or student, has a mask on. The possible exception would be the special needs kids who can’t do it. And also, everybody would have to be vaccinated. If we had done that, we wouldn’t have so many kids getting sick. This weekend, Texas set a record for pediatric hospitalizations. We had over 300 hospitalized kids in Texas every day this week. The policy makers operated as though this is the old-fashioned COVID that that we did pretty well with over the last year. Despite warnings from the scientific community, they were not able to adjust their thinking to the delta variant. Do scientists still believe that delta is not targeting kids relative to grownups? They think that so many kids are getting sick simply because there’s so much virus loose in the state? It may turn out to be that kids are disproportionately infected, but it doesn’t look that way so far. I think it’s just that delta is so highly transmissible, and it’s sweeping through unvaccinated populations. What’s interesting is the effect of vaccination rates on pediatric hospitalizations and pediatric cases: Pediatric hospitalizations are much lower in areas with this high vaccine coverage. It’s a collateral benefit of the vaccine. Even though the little kids aren’t vaccinated, if you’re a little kid in Vermont, or Massachusetts, you have a far lower risk of getting sick or being hospitalized. Does the high transmission rate that we’re seeing in Texas mean that we could be a breeding ground for new variants? It could. But look, right now, delta is pretty much your nightmare variant already. It is so highly transmissible, and now it looks like it’s spreading in the face of waning immunity. There may be some partial resistance to the vaccine in terms of lower virus neutralizing antibodies, but I think the combination of delta and waning immunity is why we’re in this really difficult situation. Addressing that waning immunity requires another dose. Now, to be fully vaccinated, we’re talking three doses of the Pfizer BioNTech vaccine, or three doses of the Moderna vaccine, or two doses of the J&J vaccine. That was also predicted: We’ve spoken about this before. When we rolled the vaccines out in December and January, we did it with a three- to four-week interval between doses — three weeks for Pfizer BioNTech, four weeks for Moderna. We did that because we were in a hurry to fully vaccinate the American people — especially that first round, to protect nursing home residents, who were being picked off by the virus, and our health care providers. That was a good decision and saved a lot of lives. But if you were designing a vaccine schedule to give long-lasting, durable protection, you would never think about a three- to four-week interval between doses. The interval would be longer. So that pretty much guaranteed it was going to be a three-dose vaccine, with a third dose given six months to a year later. There’s a lot of precedent for that. If you look at the pediatric vaccines our kids get — like diphtheria, pertussis, tetanus, influenza type B or the inactivated polio vaccine — we give three or four immunizations in quick succession. That’s our primary immunization. Then we wait. Six months to a year later, we give the boost. That’s what gives you the durable protection. The mRNA vaccine is going by the same playbook — as predicted. Its effectiveness appears to wane. There’s new data from Israel showing that with the Pfizer vaccine, the decline in protection went from over 90 percent down to 40 or 50 percent, primarily with breakthrough infections being mild or asymptomatic. It looks like boosting restored that protection. That’s preliminary data. One of the problems is we don’t have access to much data regarding waning immunity — very little is published — and we don’t know how reliable the data is in the places it’s popping up. For example, some of it is coming from the website of the Ministry of Health of Israel. You assume that’s quality data, but it’s hard to really know. Or the data is coming from preprint servers, or it’s coming from a PowerPoint slide from a Pfizer shareholders’ meeting, or it’s coming from a press release. That’s the reason why the FDA is so important. Its VRBPAC — the Vaccines and Related Biological Products Advisory Committee — will require access to the data, and then we’ll be able to see it. The other thing that’s going on in the scientific community is, there’s an old guard that’s saying, “Well, we really shouldn’t give a booster until we know that there are breakthrough hospitalizations or deaths in significant numbers. That’s the time we give the boost.” But with the lag in our data reporting system, if we wait for that, that’s going to create an enormous amount of instability. On HoustonChronicle.com: Good news: Houston's COVID transmission rates are down. Bad news: Maybe not for long. The other piece of that argument is, we’re getting vaccinated not just because we want to stay out of the hospital or not lose our lives. We also want to interrupt transmission in the community. That’s an important reason. We’ve also learned a lot about long COVID in breakthrough cases — that it affects even vaccinated individuals. A terrible report from the UK, Oxford’s brain research group, showed gray matter brain degeneration in brain scans. What their National Health System did is quite extraordinary. They collected 40,000 MRI brain scans, and they were able to bring back a lot of those people for new scans after they got COVID. So it’s a perfectly controlled study to look at before and after. It shows gray-matter brain degeneration. To this very expert group, which works on Alzheimer’s, it looks like the cognitive decline that you would expect in a much older individual. So who wants to get that? I think that’s why we need the third boost. As adults, we don’t only get vaccinated to prevent hospitalization or death. I mean, why did I get my Shingrix — my shingles vaccine? I wasn’t gonna die of shingles. I got it because I didn’t want to get shingles. I think that the FDA committee, VRBPAC, meets on the 17th, to consider all those booster issues. They’ll consider the Pfizer BioNTech vaccine. Moderna is also applying and presumably J&J. If the U.S. can ramp up our vaccination coverage and have the population fully vaccinated, I think we’ll be in a much better position. What about other countries? We have to deal with the global equity issue. The U.S. needs to do a better job — to make a commitment that for every third dose that we give our citizens, we at least purchase and donate one dose to other countries. That’s the right thing to do. We’ve got to take greater leadership in vaccinating the world. There are 6 billion people in low- and middle-income countries. Our lab has been pushing very hard. Our Texas Children’s and Baylor College of Medicine vaccine hopefully will be released for emergency use relatively soon in India. Our partners, Biological-E, are scaling up to make 100 million doses a month. That’s exciting. Did you say 100 million a month? Yeah, that’s their capacity. Because our vaccine is based on an older technology, you don’t have the kind of production limits that you have with a brand-new technology, whether it’s mRNA or adenovirus. As any engineer will tell you, with any new process, you can make a little bit of it in the beginning, and then there’s a learning curve as you figure out how to produce billions of the thing. That’s the problem with being so reliant on the mRNA and adenovirus vector vaccines: It takes time to learn how to make billions of doses. They will figure it out eventually, but not now. Whereas with ours, we already have that knowledge, and we can move pretty quickly. Our group, which is co-led by Maria Elena Bottazzi, my science partner for the last 20 years, has now licensed this to Biofarma in Indonesia. They’re going to make a halal version as well for Muslim-majority countries. We’re really thrilled. But we’re disappointed that we’re not getting more help from the U.S. government. As I often like to say, Texas is doing more to vaccinate the world than the whole U.S. government right now. Because so much of your vaccine’s backing has come from private entities in this state? A lot of the philanthropy, right? From the Kleberg Foundation, and Tito’s Vodka, the Dunn Foundation, MD Anderson Foundation. We’ve had some support from outside of Texas, like the JPB Foundation in New York and others. But Texas has been a game changer. People need to know that. Texas often has a bad reputation back in the northeast. But people should know that it’s a Texas institution that’s vaccinating the world. Let’s go back to the U.S. Why is the FDA considering Pfizer first? Is it just that Pfizer is ready to be considered for the third dose? Yeah, they put the package together sooner. A lot of it is, I think, because the Israelis collected the data. Pfizer is the major vaccine used in Israel. Israeli academics and the Israeli government have been really out in front collecting the data. Part of the reason we don’t have that data for the J&J or Moderna is because those vaccines are not used in Israel or in the U.K. Unfortunately, the U.S. winds up being dependent on Israel and the U.K. to provide our vaccine effectiveness data. Our CDC has come up small, unfortunately, in terms of collecting vaccine effectiveness data. Is the CDC doing anything to improve its data collection? Yeah, they are. Things are better than they were. But they’ve got to modernize. Eric Lander who’s from the Broad Institute at Harvard and MIT is now the White House Science Adviser. He’s come out and said that he wants to create a Mission Control for pandemic preparedness, presumably in Washington with the National Security Council or some arrangement within the White House. I think it’s great to create a Mission Control for pandemic preparedness, but don’t put it in Washington. Last year we saw how easily things can get manipulated. On HoustonChronicle.com: They survived COVID, but unseen brain damage is leaving them foggy and forgetful Also, essentially you’d be building a shadow CDC, which is not right. What we’ve got to do is fix the CDC and modernize it. By creating a parallel infrastructure, you’re basically telling the American people, “Here’s another reason why you should lose confidence in the CDC.” We’ve got to fix the CDC. Let that Mission Control Center run out of Atlanta. And if there’s a problem, then let’s really understand what needs to be done. Maybe the CDC has to be an organization that doesn’t have to be everything to everybody. Let’s focus on a few good things. Change management is probably the hardest thing a CEO has to do, right? Now think of doing change management in a federal agency that’s been around for decades. I wouldn’t want to be the one having to do that. That may be the reason why they said, it’s too complicated, too hard. Let’s just build a new entity. That’s easier in the short term. But in the end, I think it’ll just create more chaos. How are you feeling about the mu variant? I’m asked a lot about. Look, let’s get through delta right now. When you actually look at them, mu is still a very minor variant. It popped up for a while in Florida and then went down again. I think delta is going to be so dominant for the next few weeks or months. That’s where we need to focus. Delta already has a lot of nightmare qualities — transmissibility, and I think we’ll see worsening illness as well. Is it possible to be over-vaccinated? Does the risk of side effects grow with each dose? Another thing the VRBPAC has to review is the serious rare side effects with all of the vaccines. For the two mRNA vaccines, there was that very rare myocarditis side effect, especially in younger people who got two doses. It was like 300 cases out of 20 million, so one in 70,000. When it was higher with the second dose, does it go up exponentially with the third dose? I don’t think so. I doubt it. But we want to confirm that. The same with the J&J vaccine: Does a second dose increase the risk of that rare cerebral thrombotic event? Again, I don’t think so. But this is why we need to have all that data in front of us. Is disinformation picking up, dropping down, or about the same now? It’s pervasive. Just yesterday a member of the U.S. Congress — not from Texas, thank goodness — said vaccine mandates are not American. That’s patently false: We’ve been doing vaccine mandates since the 1800s, especially in schools. But those disinformation wheels keep turning, and they’re doing so much damage. I mean, look at the numbers. By April, 550,000 Americans had lost their lives to COVID. I thought that was going to be it because we were gonna vaccinate our way out of it. But because of defiance, 80 million Americans who are eligible to get vaccinated are not taking their vaccines. And of those, now 100,000 more have died. On HoustonChronicle.com: COVID patient dies at Memorial Hermann during family's legal push for ivermectin treatment That’s 100,000 Americans who did not have to die, who died because of disinformation — death by anti-science. This is one of the things that I’m working so hard to fight. It’s why I spend so much time writing and speaking about anti-science and how destructive it is. Anti-science has killed more Americans than global terrorism, nuclear proliferation and cyber attacks combined. Yet we don’t build an infrastructure to fight it. What else is on your mind these days? The big piece that I’m thinking about is our lab’s vaccine, trying to do something by the end of 2021 so we can stop all the loss of life globally. That’s a big priority. Actually getting it into people’s arms by the end of the year? Yeah, that’s the aspirational goal. We think we can do that. The other thing on my mind is, how do we convince more people in the U.S. to get vaccinated? We’ve just got to do a better job at that if we hope to end our epidemic. The only way I see ending it is to vaccinate our way through it. It’s a high bar, but it’s doable. Somehow we have to bring the country together for that purpose. This epidemic is accelerating still. It may be going down now a little bit in Florida and elsewhere in the South, but it’s picking up, spreading north, going into South Carolina, going into West Virginia, Ohio and Pennsylvania. I think it may stop in New England and the mid-Atlantic states because the vaccination rates there are high. It’s not the Mason-Dixon Line anymore. It’s the Vaccination Line. That’s the new name. Then there’s that second node. After the Sturgis motorcycle rally, it started in western South Dakota. It’s been in Wyoming and now is going into Idaho and Utah. I think that’s going to be another big problem this fall. You may see confluence of it all. Except for the Northeast, and maybe Michigan, Minnesota and some of the West Coast states, I think we’re going to see a lot more COVID. That’s one problem. The other problem is, I worry about the exhaustion of hospital staffs. Calling it burnout trivializes it. I think a lot of hospital staff, nurses, staff, doctors are demoralized because they’re seeing so many the sick and dying patients who didn’t have to be there, people who were defiant about the vaccines. Then the medical workers go out into stores, doing their shopping, and they’ll see that nobody has a mask on. That’s very discouraging. A lot of health care providers are leaving the profession now. I think that’s going to continue to pick up steam, and it’s going to make things harder. So I see this fall as a turbulent time. Then of course, you’ve got the unvaccinated. In the face of more employer vaccine mandates, they’re continuing to remain defiant. Are they going to become unemployed? Is this going to create a cadre of 30 million very angry Americans? I see some instability there. And I worry about political violence in this country. There’s a lot to be concerned about. This interview has been edited for clarity, length and flow. lisa.gray@chron.com, twitter.com/LisaGray_HouTX - COVID Help Desk: Which vaccine offers the best protection against omicron? - Despite COVID-19 surge, Texans scheduled to play Sunday - NHL to withdraw from Olympics after COVID surge - Bus operators among 28 Metro employees to recently test positive for COVID

Peter Hotez: Scientists divided on what recent COVID decline means for Houston, U.S.

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