Plain English with Derek Thompson - The Omicron Variant: So, How Bad Is It?

Episode Date: November 30, 2021

Dr. Peter Hotez talks to Derek about what we know about the new COVID-19 variant (a little), what we don't know (a lot), and when we'll know more. Host: Derek Thompson Guests: Dr. Peter Hotez Producer: Devon Manze Learn more about your ad choices. Visit podcastchoices.com/adchoices

Today, I want to talk about the Amicron variant. So, on Friday, day after Thanksgiving, I was at a friend's place having leftovers, and I pulled out my phone at the dinner table, which is something you should never do. And Twitter is on fire with news of a new variant first detected and announced that of South Africa, called the Amicron variant. So first I have to learn how to say the word, Amacron. And then I get completely sucked into the vortex of doom scrolling through my phone. for the next half hour. And what immediately struck me reading all these headlines about a Frankenstein variant, a polymutant variant, was the gap between data and meaning.

Like, within hours of this thing becoming public, scientists could tell you with exquisite detail exactly what the virus looked like, exactly how it had evolved or mutated from the OG coronavirus, the original sucker. So you're just reading all this stuff, feeling overwhelmed, completely overwhelmed with new information. And I kept scrolling to the part where they said, and what does this mean for you, for the vaccines, for Christmas travel? And the answer, on every count, was, we have no idea.

Come back in two weeks. Like facts and factoids everywhere, not a drop of meaning. So in the next few days, I think a lot of people will be in exactly that state. they will be scrolling through their phones, looking at data, and not finding meaning. And so I think it's important to be clear about the only four questions that matter when it comes to this variant. Number one, is it more infectious? Number two, does it cause more severe illness? Number three, do the vaccines that we have still work against this mutant?

And number four, when will we know the answer to questions one through three? And since there's really only one guy I trust more than everybody else to answer those questions, I called him. I'm Derek Thompson. This is plain English. Dr. Peter Hotez is the dean of the National School of Tropical Medicine at Bailey University. He is the co-director of the Texas Children's Hospital Center for Vaccine Development. He is one of the rare TV figures who appears regularly on CNN and MSNBC and

Fox News. He has been throughout this pandemic, one of my top go-to sources for everything about the vaccines, the variants, everything else pandemic-related. So, Dr. Hotez, welcome to the podcast. Thanks so much for having me, and good to see you and talk with you. Good to see you, too. So when I first read the stories about Amacron, scientists were calling it a Frankenstein monster, and I am not asking you to endorse that particular description, but I was hoping we could start by having you explain what scientists saw with this mutation that caused such alarm? Yeah, I certainly wouldn't call it a Frankenstein monster, but there are some concerning elements to it.

I think one was the steep acceleration in cases that were noted in the two urban areas of South Africa, Pretoria and Johannesburg that were in the same province, and that caused people to say, hmm, what's going on here? And with it, you know, the South African virology community, is very strong in part because it really accelerated during the AIDS era and they have a lot of capacity. So molecular virology is really strong in South Africa and they were doing a very good job doing genomic sequencing and they were sequencing a number of the virus isolates and they saw two concerning trends. One was that the variant in terms of transmissibility had some mutations around what's called the 681 position,

which is known as the Fear and Cleavage site that we've seen with alpha and delta are associated with high transmissibility. And then the second, the one that more people know about is the lots of mutations in the spike protein, including the receptor binding domain of the spike protein that binds to the ACE2 receptor. So that gave people pause for concern that was kind of the worst of both worlds. One, you had an agent that could be transmissible like Alford. Delta, number one, and number two, lots of mutations that potentially could make it partially resistant to the immune responses to vaccines. And I think that was the reason why the World Health

Organization sounded the alarm. And in part, I think, because some of the international bodies have been slow in the past, and people, we wanted to give a full-on signal that this was a variant of concern. To synthesize a little bit of what you just said, the virus hooks into ourselves, primarily with the spike protein. I think of it a little bit like burs or spores that hook into a sweater.

They have these little spikes that come out of them, and they hook into the cloth of our sweater, and that's how they stick. And that's sort of how the virus sticks to ourselves and invades our bodies. And what you're saying is that... Close enough. Close enough.

Okay. Close enough for plain English, I guess. And you're saying that there are mutations in that spike protein, a large and potentially concerning number of mutations. Why are the number of mutations concerning to scientists? Well, because in the past, when we've seen some key mutations in that part of the spike protein known as the receptor binding domain, and we've seen it at least twice before, we've seen it with the beta variant that ironically came out of South Africa last year, was also known as the B-1-351, or the Lambda variant that came out of South Africa, we've seen those, we've seen how the antibodies to the vaccines are no longer as effective

at neutralizing the virus and preventing the virus from binding to the receptors, preventing the burs from binding. And now this one has not only has some of those same mutations as beta and lambda, but has considerably more mutations. So the scary situation is whether or not the antibodies to the original vaccines will be able to neutralize the Omicron variant spike protein changes at all. And I think it will. I think there will be diminished binding. But my hope is that individuals who've got really high levels of virus neutralizing antibody because they got three doses of the MRNA vaccine or because they're,

they've been infected and recovered and they got vaccinated. I'm hoping that there'll be enough crossover, or what I think Tony Fauci said today, spillover of those vaccines to still neutralize the Omicron variant adequately. And that will know over the next week or two because our lab is doing those studies with our vaccine, our recombin protein vaccine to see if the antibodies will spill over and neutralize Omicron. and I'm certain Pfizer and Medina and J&J and AstraZeneca, we're all doing the same experiments. Right.

And we're going to get to the timeline in just a second. I just want to make sure that I understand exactly what you're saying. So we built these vaccines for the original coronavirus. But the coronavirus... The strain that came out of Wuhan or Central China. Right. Exactly. And so far, that's been adequate for just about every variant.

It's cross-neutralized the alpha variant, the delta variant, the really ones of concern. Even partial cross-neutralized the beta and lambda, which never really took off but concerned a lot of people because there were a lot of mutations in the spike protein. So the history or precedent would tell us we should still be okay. But given all the extra mutations that are in Omicron, that's the concern that maybe we're going to running out of luck this time. I'm hoping not, but it's it's never been more of a possibility. Yeah, so I have a story in my head about these mutations and what they mean, and I want you to tell me if that story jives with your understanding of the science. So the founders of Beyond Tech,

which made what we call the Pfizer vaccine. I spoke to them, and they said the MRNA vaccines sort of hold up like a wanted poster of the virus to the immune system. They say this is what the bad guy looks like, and when you confront the real McCoy, you'll recognize him, stop him before he gets into the town, gets into the salon, and causes all this mayhem. But the virus, as you said, produces variants, alpha, beta, gamma, of course, delta. And I think of those variants or those mutations is a little bit like the figure in the wanted poster trying on disguises to get inside. Like, I'm anthropomorphizing here. He's not trying to, on disguises. It's just mutating because of evolution. But, you know, it's, you know, Alpha puts on the fake nose and gamma or Delta puts on the fake beard.

And what worries virologists is that Omicron has way more mutations on that critical spike protein than the other variants we've seen. It's like, it's as if the criminal pictured in the wanted poster went to the costume store and, like, grabbed every disguise in the center aisle. And now the scientists are like, we don't know. If he's got the fake nose, he's got the fake beard, he's got the wig on, we don't know if the wanted poster. that the MRNA vaccines have shown to our immune system are necessarily going to recognize this mutant the same way they have recognized all the previous mutants. To what extent, Dr. Hottes, have I completely butchered the science?

I'll run with you, or you could say, you know, before, you know, the criminal had a badly fitting fake mustache and one of those Groucher marks glasses with the fake nose and mustache, and now they've gone and gotten plastic surgery. So, yeah, I think that, That's fair enough. And whether or not we'll still be able to recognize this the Omicron variant will know pretty soon, you know, hopefully days a week or a week or so.

The problem is the same company that produces all the pseudoviruses is getting, you know, getting inundated with requests so everybody can look at it. So there's a capacity problem there too. Let's talk about the timeline here. So it seems to me there are three big questions. One, is Omicron more transmissible, more contagious than Delta? Two, does it cause more severe illness than Delta? And three, are the vaccines we're taking effective against it?

When will we know the answer to these questions? Is it a matter of days or weeks? All right. So the first thing we're going to need, we're going to try to find out is, is this virus accelerating in other places where it's popping up? I mean, we're hearing a lot of concern expressed that now it's in several European countries and Australia and Hong Kong and Canada. It's likely in the United States. But is it going to accelerate there?

And that's not a guarantee. So, you know, people are wringing their hands, the fact that it's already popped up in so many different places to which I say, you know, just about every variant that we've ever had has popped up in multiple places at the same time. And that's happened since the beginning, right? when everyone was ringing their hands about the original variant coming out of central China. We had to put in travel restrictions from China, and by that time, the virus was already in Southern Europe, and that's what ignited the terrible epidemic in New York City. So the fact that it's in multiple places per se doesn't really alarm me, but in the next week or so we'll start to see if things really accelerate with this new variant.

So that's the first piece. The second is we'll get a better sense of severity of illness. We're hearing different stories. Some are saying it's only mild illness. Others, I tend to doubt that we've so far not seen much variation in clinical presentation from variant to varying. It's been, they're all bad, right? So I doubt we're going to see much difference there. Then the third is we'll get collect information about whether it has the capacity to actually out-compete Delta.

and that's the big question everybody needs to know is because that's the way this has worked. We had the original lineage, and despite all these different variants, there was one dominant one that took over, and that was alpha that arose out of an unvaccinated population in the UK in 2020, swept across the world, and then Delta came along,

and that was even more transmissible and swept across the world and out-competed Alpha. The question people will want to know is whether OMAC, is out competing delta. That's a pretty high bar because delta is highly transmissible. I'd be surprised if it does, but it's not impossible. And then the last thing we want to know is do the virus neutralizing antibodies recognize this new bandit, right? Does it have the ability to cross-neutralize or spillover to recognize the omicron variant? And that will know over the next week or to. So that's why, you know, when people ask me about international travel plans, what should we do now,

and this, I say, look, if you can hold off big decisions for the next couple of weeks, we'll know a lot more. And so just to jump in here, we're going to know more soon. But in the meantime, Christmas is four weeks away. Hanukkah is literally right now. Holiday travel is already underway. If people are concerned, what should they do right now? One, if you've only gotten two doses of the mRNA vaccine, it's more than six months, get that third immunization. That'll give you a 30 to 40-fold rise in your virus-neutralizing antibodies. Second, vaccinate your kids if they're not vaccinated yet. And he went over the age of five. And third, if you've been infected and recovered, we now have studies coming out of Rockefeller University in Yale and elsewhere showing that if you get vaccinated on top of that, it not only

will elevate your virus-neutralizing antibodies, but it gives you this phenomenon of what's called epitope broadening to make you more resilient against the variance. So rather than ring your hands, talk to your loved ones and make certain everybody is taking advantage of this very impressive luxury that we have here in the United States, which is a widespread availability of vaccines. Epitope broadening basically meaning that our immune system recognizes a wide variety of potential COVID mutations. So to go back to the first metaphor, it's like the guy in the wanted poster can't trick us with fake mustaches anymore because we're recognizing him in all of his disguises. I want to summarize for myself what I take to be your timeline, because, again, timeline is so

important. We're getting more information about case growth every day, which means we will have a sense of its transmissibility pretty soon. On severe illness, it might take a little bit longer, as we wait to hear about hospital reports and places like South Africa. And then on vaccine effectiveness, it could take a week or two. Is that right? Well, at least in the test tube, though, the antibody studies against the variants, if you have all the reagents, it can move pretty quickly. I mean, all the companies and we have our antibodies, it's a matter of how quickly they get the pseudovirus into their lab. And they'll get some early indication within a few days. And that's not the same as vaccine effectiveness studies, but it'll kind of give you an indication of what this is looking like. So we might get some of that vaccine information sooner. soon as well. What scares you more right now? Is it the potential risk of Omicron, or is it the potential for another deadly winter surge from Delta? My biggest worry is this next Delta waves coming, and we still have too many unvaccinated Americans, and the numbers are horrific. Since June 1,

we've lost a hundred and fifty this year 150,000 unvaccinated Americans who needlessly threw their lives away

because they refused to get vaccinated and that was the consequence of this delta wave over the summer across the south into Texas

and the southern states into Florida and now it's going to happen again. It's going to happen now it's going to start starting up in the upper Midwest

in Michigan, Wisconsin, Minnesota, New Mexico, and this virus, Delta, is going to pick off all the unvaccinated. And now the under-vaccinated, those who are too far out from their second dose and are not getting their third dose, they're also vulnerable. And people are infected and recovered who think they have great immunity. They don't. They have inconsistent immunity.

So that's my, that's overwhelmingly my biggest worry. And Omicron, yeah, that's a concern too. But we're putting in the infrastructure, not a look at it. But right now, we're about to get slammed yet again by another big wave this winter with Delta. And so you think that people should get – anybody who's available or eligible for the booster shot should get boosted. Not only if they're over 65, not only if they're immunocompromised, you would encourage everybody more than six months away from their last shot to get the third shot. Why is that the case? And what's the most compelling evidence that you see that boosters really are that valuable?

Well, the compelling evidence is based on studies out of Israel, showing that there's a substantially, once you get boosted, and you not only have a 30 to 40-fold rise in your virus-neutralizing antibodies, but you're 10 times less likely to be hospitalized and to get symptomatic illness and to get infection. And I think that's the piece that not a lot of people talk about. You know, you were hearing some of my colleagues saying, well, do you only vaccinate to protect against hospital is, and death. And I'm saying, no, because you don't want to get COVID. We now know that a significant percentage of people get long COVID symptoms lasting 15 months. And why did I get my third immunization? I got it. Well, when I didn't want to go to the hospital or go to the ICU, but I didn't want to get COVID. I didn't want to get gray matter brain degeneration and have an

MRI that looks like somebody 20 years older than I am. And to, you know, to, you know, have cognitive decline. And I think that's the other piece that we're not talking enough about. That's another compelling reason to vaccinate. Yeah. So right now, the Biden administration is currently restricting travel from Southern African countries. I wonder what you think about this travel ban strategy, which, to be fair, is not only the Biden administration, there's a lot of governments in Europe that are doing the same thing. It seems a little bit strange. to me to specifically single out Southern Africa, considering that, as you said, I think,

just maybe 10 minutes ago, we know that this virus has likely already spread all over the world to Canada. It's almost certainly already here, if it's in Canada. It's almost certainly all over Europe. What is the deal with this travel ban? And do you think it's a smart policy? I've never understood travel bans. As I say, from the beginning, they haven't worked. You know, when we first implemented travel bans from China and this virus came in from Southern Europe to Igniter, New York epidemic, they've not worked. Maybe some exceptions or some of the island nations, New Zealand, Australia, but overwhelmingly for North America, South America and Europe, they've not worked. And this virus just spreads too quickly.

sneaks into countries very quick. So I don't really understand the logic. I think part of it may be optics that, you know, that global leaders want to show that they're doing something and that they're looking out after their populations. I think ultimately it's self-defeating because it's counterproductive. It makes it harder to work with affected countries and it's expensive. And it drains resources from organizations to implement the travel bank. when what we really should be doing is helping the affected countries where potentially

omacron originated and and help Botswana get vaccinated, help South Africa, help Mozambique, and Malawi and Namibia and Tanzania. And that's far more productive use of our, of our energies. So if travel bans are bad policy, what does good policy look like? Let's say you're Joe Biden, or even better perhaps, you have the ear of Joe Biden. He calls you tonight and says, Dr. Hotes, what should I do? What do you tell you?

Here's what needs to be done. We now know that the alpha variant arose out of an unvaccinated population in the UK in 2020. Delta arose out of an unvaccinated population in India in 2021. What did they think was going to happen when you left the entire African continent unvaccinated or 6% vaccinated, which basically rounds off to zero.

What did you think was going to happen? So, of course, the next big worrisome pandemic threat variant arose out of Africa. This was both predicted and predictable. And this is, you know, overall, I think the Biden administration has done a good job in terms of vaccine policy for the U.S., but we're just not seeing that ownership of doing something globally, right? I mean, you even heard it today. You know, the president said, well, we've sent 275 million doses to 110 countries more than any other country. I mean, that's true.

But what he didn't say was we've got a billion people in sub-Saharan Africa. We've got 600, 700 million people in Latin America. We have, you know, hundreds of millions of people in the Middle East and the Middle East and smaller, low-income Southeast Asian countries, we need to vaccinate 3 billion people, and not by 2023 now. That means we need 9 billion doses. Where's the 9 billion doses coming from? And that's what we need. And the problem is there was never a plan to make 9 billion doses of anything. We certainly can't do it with MRNA, and at least at the beginning, with any brand-new technology, as any engineer would tell you, you can't go to zero.

to 9 billion. So by design, we knew we were going to screw over the Southern Hemisphere. That was the plan. That was always the plan. We were going to leave the Southern Hemisphere unvaccinated. And I said, no, I don't think we need to do that. So that's why we made our simple, you know, recombinant protein vaccine. Same technology used to make the Hepatitis B vaccine. That's been around for 40 years that works really well. I think maybe as good as MRI vaccines. and is made locally in Brazil, in India, and Indonesia, and Bangladesh, and many other places,

that's what we need to do. And nobody would buy into that. So we've been left on our own the whole time. I'm doing it now. We've now transferred the technology to India first. Hopefully it'll be releasing for emergency use authorization. But had we gotten a fraction of the support that Moderna got or Pfizer,

I think we could have had the world vaccinated by now. And even now, there's still no plan to vaccinate the world. There's no ideas being really put forward of how we're going to make and deliver 9 billion doses now. And then, you know, we heard the president say, we need the other countries to step up. But who's going to lead? I mean, we're not seeing that leadership, right? I mean, who's supposed to lead this?

Putin, she? I mean, some nameless bureaucrat from the European Commission. I mean, no, it's got to be the President of the United States. And you might say, well, that's not fair to always make America do it. And that's life in the big city. That's always been for the last hundred years, that if the U.S. doesn't lead the big picture, it doesn't get done. And the same as now. I want to ask you about vaccine hesitancy. You and I have talked quite a bit about vaccine hesitancy. and vaccine denial in the United States, but it's not a purely American phenomenon. It is a global phenomenon.

Just a week ago, there was a headline in Bloomberg that South Africa was asking Johnson-Johnson-Fizor to stop sending vaccines to that country because they couldn't administer as many doses as they were receiving. They were hitting the vaccine hesitancy or vaccine denial ceiling after only inoculating about 35% of their adult population.

So how do we combat not only the vaccine supply problem, which you just mentioned, but also the vaccine demand problem? It's not just a purely American phenomenon. It really does appear to be similarly global. Yeah, no, but it's an American-led initiative, unfortunately, the anti-vaccine movement, and it's got three moving pieces. And again, there's not been the appetite to really take this on.

So what are the three moving pieces? Well, right now in the United States, the number one force, of course, is the aggression coming from the far right. And the statements from members of the U.S. Congress who've declared vaccines as political instruments of control or have said, first they're going to vaccinate you and then they're going to take away your guns and your Bibles. And as ridiculous as that sounds to us, we've got a quarter of the U.S. population that believes it. And so trying to find a way to yank the anti-science out of far-right extremism in the U.S. and unfortunately it started all in Texas is, I think, been one of the real challenges. And so far, nobody's shown much appetite to take it on. But there are other things we can do.

The other piece to this is what the Center for Connery Digital Hate, and it's amazing we have to have an organization called the Center for Connering Digital Hate calls the disinformation dozen. These are a dozen non-governmental organizations. that are responsible for a lot of the content and and that includes for instance these fake documentary that's a documentary they call it that shows you know people of color getting their fiser biotech vaccine and then it switches over to images of tuskegee experimentation and you know makes the statement that the african people are being experimented on and and nobody has

an appetite to de-platform those disinformation does and that has to be done and then the third Third is the Putin government, who has had this systematic program of what's being called weaponized health communication, which includes discrediting Western vaccines, in some cases in favor of Sputnik v. So that's caused a lot of problems. And so the problem is it goes beyond the health sector to know how to dismantle the anti-vaccine empire. And I've said both to the Biden administration and the UN agencies, you know, you can't leave it to the health sector. They don't know what to do. But there are people who do, the same people who fight global terrorism or nuclear proliferation

or cyber attacks. We need to bring them in to create an interagency task force in the U.S. government to see how you look at that from State Department, Homeland Security, and Commerce and Justice Department. Because I don't know how to do it. None of my colleagues in the health sector do either. And, you know, you've heard the Surgeon General talk about Facebook and the social media companies, yeah, they're disseminating a lot of the stuff, but they're not, they didn't create the content. So going after the groups that create the content, I think is something

that we really need to look at seriously. Yeah. My last question is about the future of vaccine innovation. I know that Medina right now is working on a multivariant booster. Beyond Tech is also working on a shot specifically for Omicron, but is also looking at the possibility of developing a shot that could take on all of the variants and we're doing that as well. What is the timeline on that? On your progress and on the progress you understand other pharmaceutical companies are having with this sort of silver bullet. I think if it's necessary, just say if it's necessary, it may not be to make the Omicron

equivalent of what we've already made. I think that's not going to be a big deal. I think that's doable within months. to make a true universal coronavirus vaccine, where there are a lot of different suggested approaches. We're taking one to look for some consensus sequence and other approaches. I think that'll be a bit longer.

I think the other thing to think about moving forward is trying to build capacity in low and middle income countries to make vaccines. And again, it should not be all in MRNA because there are limits to the technology. and to keep in play a variety of technologies, including ones that we use like recombin protein vaccines. I mean, if you remember at the beginning of this pandemic,

many of us thought, you know, if you said I couldn't pick our vaccine as who was going to be the winner, I would have said the VESV technology that Merck and company did for the Ebola vaccine that was so successful, and I think even stabilized the African continent. That looks really good. It was a single dose.

But it tanked for COVID-19. If you said, well, what about MRNA or nucleic acid vaccines? I always said, well, those have been around for a couple of decades. They haven't really moved anywhere. I think the lesson learned is for any new pathogen, you don't know to you know. So we're going to have to keep a lot of different technologies in play. Great. Dr. Hottes, thank you so, so much for talking us through this confusing moment.

And I will see you and speak to you soon. Thanks so much. Appreciate the opportunity. That's all we have for today. Plain English with Derek Thompson is produced by Devin Manzi. We will be back in your podcast feed on Friday this week. Talk to you soon.