expert explainer

Why Talk of a Fall Vaccine Is ‘Irresponsible’

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This week, the U.K.’s Pediatric Intensive Care Society sent out a warning about a rise in the number of children showing “overlapping features of toxic syndrome and atypical Kawasaki disease with blood parameters.” Any alert emanating from pediatric-intensive-care specialists is alarming, but according to Dr. Peter Hotez, co-director of Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, it’s unlikely this is evidence that the virus is changing its behavior. Intelligencer spoke to Hotez about the alert, hopes of a vaccine in the coming months, and his fear that the coronavirus will become even more politicized.

I want to ask you about this National Institute of Health alert in the U.K. about the number of critically ill children with a COVID-19-related inflammatory syndrome.  
In addition to being a vaccine scientist, I’m also trained in pediatric infectious diseases — I used to be on the pediatric-infectious-disease faculty at Yale. A few things come to mind. Kawasaki disease has been a mystery vasculitis forever. Its origin has always puzzled us as clinicians. There was a suggestion that it was caused by an infectious agent, but we could never quite pin that down. It clearly is a vasculitis —you get the inflammation of blood vessels, you get a rash, you get a big increase in the number of platelets. Interestingly, there is a whole body of literature looking at upper-respiratory coronaviruses as a potential cause, including a coronavirus known as NL63, which binds to the ACE2 receptor, just like COVID-19.

The studies were never conclusive. For every study that links it to coronaviruses, you can find a study refuting it. It always went back and forth. So the first thing that came to my mind was, ‘Oh my God, maybe this is further evidence that coronaviruses can cause Kawasaki-like syndromes.’ The second thing I was thinking about was, ‘Why didn’t we see this before?’ You would have thought this might have come up in all of the cases in China. It could be that everything is so concentrated in the U.K., everything is hyperendemic right now, so maybe that’s why they’re seeing a few cases. The other question is, ‘Are we seeing it here in the U.S.?’ I’ve spoken to a couple of colleagues at Yale Department of Pediatrics, and they said they haven’t seen anything quite like that. The only adolescents they’re seeing in the pediatric ICU are overweight or morbidly obese, which would go along with everything that we’ve seen. So, how common is this going to be? I don’t think we know. But it does connect some dots.

I think for laypeople, like me, seeing this sort of news can be scary. It’s reported in such a way that it seems like a mutation — because why else would this be reported only now? 
I don’t think we need to invoke a mutation. Of the 3 million confirmed cases globally, a third of them are now in the U.S. Of those, half are in New York City and a significant number are in the U.K. They are the epicenter of this epidemic. So if you’re going to see uncommon syndromes linked to COVID-19, that’s where you’re going to see them.

A top scientist in China said that we really need to be prepared to live with this disease for a long time, years and years. Should we be wary of talking about a vaccine as if it’s inevitable at this point?
I think we will have a vaccine; I just don’t think it’s a matter of weeks or months. It will take time. We’re going to need plan A and plan B. Plan A is what life looks like as vaccines come online — it will be multiple vaccines. Plan B will be what life will look like if we don’t have a vaccine in the coming months and years. That plan will need to look at some of the models coming out of Harvard, showing that we may see some seasonal spikes every winter, and be prepared to re-implement social distancing if that’s needed. I think that might be a very realistic scenario.

What else are you thinking about on the vaccine front — including about recent stories suggesting we could have one by fall?
I’m very concerned about those statements. One, we are not going to have a licensed vaccine by the fall. Two, I think it’s irresponsible of the biotech, pharma, and other groups, because it causes a lot of damage. I’m not only a vaccine scientist and pediatrician, I’m the parent of an adult daughter with autism. I wrote a book called Vaccines Did Not Cause Rachel’s Autism, which put me up against the anti-vaccine movement. Because of that, I became one of the lead public defenders of vaccines in the United States. Nobody else was willing to stand up to the anti-vaccine lobby. The anti-vaccine lobby is reenergized by COVID-19 in part because of these statements coming out by the biotechs and pharma companies and others saying how quickly they’re going to have a vaccine. One of the central tenets of anti-vaxxers is the claim that vaccines are not adequately tested for safety, they’re rushed through. For years, I’ve been explaining, ‘No, vaccines are the most thoroughly tested pharmaceutical we have; it’s a well-vetted process monitored by the Food and Drug Administration.’ Now these guys come along and say, ‘We’re going to have a licensed vaccine in a few weeks.’ It’s causing us to lose a lot of ground. We have spent years defending vaccines and going up against the anti-vaccine movement. This is making things much more complicated for people like me and pediatricians across the United States. I understand why they’re doing it, for shareholders or investors. But when they put this stuff out in public, they’re so oblivious to the damage it is doing. 

Everybody was so hungry for a COVID-19 vaccine, I thought we could gain some ground with the anti-vaxxers, but not anymore. Remember the anti-vaccine movement back at the end of 2018 reorganized under RFK Jr. and his organization Children’s Health Defense? It gave them tremendous strength, momentum, and funding. They specifically targeted me through a series of fake postings on Instagram and a fair bit of cyberbullying. I’ve been pushing back ever since and gaining a lot of ground. But then this thing comes along and I’m like, ‘Oh dear God, I’m going to have to fight this battle all over again.’

Some states, like Colorado, South Carolina, and Georgia, are opening up already for business. What do you make of that decision?
This is something I’m concerned about. In many parts of the country, the Institute for Health Metrics and Evaluation models say we shouldn’t be doing this until the early part of June, so we’re opening up a month early. That could lead to a resurgence of COVID-19. There’s two parts to that. I get that the economy can’t take that prolonged a hit by waiting until early June. That’s why you’re seeing governors in many states creating economic recovery teams composed of some of the leading business leaders in the state. That’s great, but the problem is that it’s not being adequately linked to public health. There seems to be this lack of realization that unless we put in place a public health response that’s commensurate to the economic response, that economic response is not going to be sustainable. We’re seeing detailed plans for economic recovery but not for how we’re going to be doing employee testing at work, how we’re going to hire contact tracers, how we’re going to put a system in place for syndromic surveillance. That gives me a lot of worry. Now, if you look at Children’s Hospital of Philadelphia’s website, they’ve put a team together to look at the rebound that we can expect this summer and fall. In places like New York, Boston, and Philadelphia, it looks pretty scary. There seems to be this misunderstanding that it’s all over now, we can fix the economy. It’s just not going to work that way.

Down here in Texas, the oil and gas industry is really hurting badly. There are genuine reasons for reopening the economy. I understand that rationale. What I don’t understand is why people think it’s no longer necessary to build in that public-health infrastructure. Why aren’t we seeing more involvement from the CDC leadership instructing the city and county health departments how to do this? There’s a huge piece missing that I don’t quite understand.

Are we going to live in a world where hospitals are going to have permanent COVID-19 units? 
Yeah, but the more important point is to try to take steps to limit how extensive this rebound is. That’s not really being given adequate consideration at this point.

One other point: First, I see a perfect storm of forces brewing. First, COVID-19 returns this summer and fall because we didn’t build a public-health response commensurate with the economic plan. Second, this happens right before the fall presidential election and this then creates extreme political instability, the polls go down for the president, he lashes out and causes a lot of political unrest and instability so that we could even start seeing political riots. I’m worried about something that looks like the 1968 Democratic Convention. I’m not a political scientist, but I just see a lot of troubled waters ahead.

Expert Explainer: Talk of a Fall Vaccine Is ‘Irresponsible’