NatHealth, as part of its Thought & Leadership series, presented a riveting session on the Future of BioTech and the evolving Global COVID Vaccine Landscape on January 21, 2021. Moderated by Dr. Sudarshan Ballal, Chairman, Manipal Hospitals, opening remarks by Preetha Reddy, President Nathealth, Vice Chair, Apollo Hospitals, closing remarks by Mr Siddhartha Bhattacharya, Secretary General at NatHealth and special remarks by Dr. William A. Haseltine, President, Access Health International, the session centred around the novel-coronavirus Covid-19, its impact and ways to tackle it. It provided a holistic and well-rounded approach to the topic at hand. In addition to discussing the ongoing pandemic, the panel also significantly focused on the way forward and spoke about the various vaccines, their types and consequences.
Preetha Reddy, President at Nathealth and Vice Chair at Apollo Hospitals, she said, “The past 10 months significantly have been tumultuous for us Indians and humanity at large. Genomics has been the key word lately and has made a huge difference with vaccines. Bill Gates said that what we have done in two months could have taken two decades to achieve. We look forward to Dr. Haseltine telling us what would be the right thing to do, whether in the space of innovation, research, genomics or biotech. We can look forward to various solutions for healthcare. We should give credit to the hours of research, hard work, thought which had gone into producing the vaccines and predicting the future”.
Congratulating everyone at Nathealth for organising the leadership series,Chairman at Manipal Hospitals Dr Ballal further talked about how 2020 has been the worst year for us, everything went spiralling down and how we were battered by Covid. He then welcomed Dr. William Haseltine for his comments.
Dr. Haseltine, President at Access Health International, said, “We know this is a new virus, which probably started circulating as early as October of 2019. It manifested as an outbreak in the Chinese city, Wuhan in a demonstrable way in December. Once it was recognised, the Chinese authorities took very strong measures to control the spread. In a few months’ time, it was controlled because of instituting standard public health measures, which is a tribute for the Chinese government as they had sent people for 10 years to Harvard School of Public Health to understand how to control a pandemic. They understood that SARS not only destroyed lives but had the potential to destroy economies. So, they had studied in great detail about what to do and they implemented almost a textbook case of what to do and it worked in a spectacular way. China is the only country, apart from a few island countries, that instituted that kind of control and they managed to quarantine 11 million people. That should’ve taught the world a lesson but it did not. This virus could be controlled by public health measures alone, without the benefit of all the science. We are still minimising the danger. Taking India as an example, you reach the peak and see the cases decline, eventually leading to population immunity. I have argued since the beginning that this is a poor concept for coronaviruses. As a virologist, I’ve learned to look at what actually happens and what we think should happen. The lesson from SARS and MERS is that viruses are out there and can adapt to humans. We need to be careful because we dropped the ball globally, we didn’t do our research on those viruses and we weren’t prepared for the next one that came along. Scientists got everything done, the vaccines ready but the money wasn’t there. Another thing we should’ve paid more attention to is that coronaviruses aren’t new to us and each of us has it every year, we call it a common cold. They keep coming back, like the flu, which is why I said that don’t count on population immunity because it doesn’t exist for these coronaviruses.
He added, “As far as countries are concerned, I would say, if you’re afraid for your economy, you took some action. Chinese and East Asian countries knew that SARS could’ve destroyed their economy and they took rapid action after studying what to do. Other countries, western countries, India didn’t have this problem so they didn’t take the same kind of action. Countries, this is for the future, if we’re going to deal with pandemics, we need good political leadership, good governance and Heath system for communities and social solidarity, which is true for the whole world”.
Speaking about the path to the early development of the vaccine and the role of innovation and technology in its development, Dr. Haseltine opined, “I have different views from most people. Everyone is celebrating how great science is, how we’ve solved this but we haven’t. We dropped the ball in many ways- we didn’t need high science, if we had taken a simple route and not a complex one, as it is more convenient. These kinds of vaccines work and it still works today, for polio. Our emphasis on high science instead of blocking and tackling that needs to be done in healthcare, has led to some problems. For America, it has been a disaster to not rely on public health but high science. Same goes for diagnostics, we felt that we needed fancy ones whereas lateral flow anagen diagnostics work far better and the world still doesn’t have access to tests like we need. That was a fundamental mistake made earlier on but these vaccines are wonderful to have”.
Elaborating on how he felt that the testing for coronavirus could’ve been different, Professor Haseltine expressed, “In the early days of detection, the CDC tests didn’t work, they were PCR based tests. Once the virus was understood, what could’ve been done was to develop simple antigen tests, measuring the concentration of protein in saliva, nasal fluids. In a pandemic, during the diagnosis, you want to know if they’re infectious or contagious and take action. We relied on a test which broke down and is very expensive compared to other tests. Antigen tests are very simple and cheap to do yet, nowhere in the world do you have free, simple tests which can be self- administered and know who’s contagious. This should then be followed by making sure those people are isolated but this is difficult as people avoid this due to lack of economic support. I believe if the tests are done, you pay people to stay home and have a realistic policy. Simple tests, simple solutions. Pay people to stay home or ensure that the country’s social system works for everybody”.
Giving an overview of the types of vaccines, their safety, efficacy and which one he would choose if given a choice, Professor Haseltine said, “I would take the simplest one, the killed vaccine, because one, it has a huge safety record. Second, it’s a whole virus ,which changes when it’s trying to escape and how the body reacts. Like the mRNA vaccines are unreliable and we don’t know the full story and adverse reactions. If you have a chance to take any vaccine, take it, that’s the message I want to give. After this, I would prefer subunit vaccines, where you produce a piece of the virus and use it as the antigen. Indian companies make such vaccines at a large scale, like Hepatitis B vaccine. The vaccine I would not prefer is, the adenovirus vaccine and the reason is that it’s usable only once”.
Talking about the logistics, production and distribution across the globe, as well as maintaining the extreme cold chain which the mRNA vaccines require, Dr. Haseltine said, “We know that in the global vaccine business, a cold chain is a problem. The two problems are- cold chains and multiple doses, that limit it. We’ve almost eliminated polio and smallpox, in that process we learnt the two big barriers to global vaccination were these two problems. Another important component is whether you can get it to every community and to work with community leaders who are trusted. If this lacks then people will be afraid to take it and so the whole process is important”.
When asked whether vaccines should be recommended for children, Dr. Haseltine said that it is not known yet and is being tested. He does hope that it will protect children because some news strains are popping up more in children.
Talking about the mutation of the virus, Dr. Haseltine said, “One thing we learned is that the cold coronaviruses come back every year, like flu. The two reasons you can get infected every year, one, the immunity drops and the second is that, the virus changes. In Covid, we knew that the immunity dropped but we didn’t know the virus changes and now both thus are going on. Natural immunity doesn’t last long for these viruses, especially mucosal immunity, the type which stops things from getting into you and you passing it on, that doesn’t last long. The Chinese were lucky because they got the weakest version of this virus, by February it mutated and transferred across the world. Over the summer, it changed again in different ways to become more transmissible. The mutations are escaping our immunity and becoming more infectious. Another lesson from is virus is, think of it as flu, more deadly so vaccines will have to adapt and vaccine companies are rushing to understand it. The vaccine is like a tree with branches, to deal with it, cut down the tree at the root with public health. This is a lesson we need to push pretty hard if don’t want to get hit again and again with this tricky virus”.
On being asked about the equitable distribution of the vaccine between the haves and have-nots of the world, Professor Haseltine said, “This is very important. Our world is connected like never before, the lesson of all these viruses is that, if don’t eliminate it everywhere, we don’t eliminate it anywhere. We cannot isolate ourselves from these diseases and have to help everybody and that’s what we need to do for this. India has a history of supplying these vaccines to the world because of heat stability, safety, cheapness. Vaccines can be as cheap as a rupee, it won’t be profitable but it could be subsidised. The world has now become small and we’re all connected but more people are required to help each other out and restrict their freedom to help others.”
Speaking on when we’ll be able to breathe easy, literally and figuratively, Dr. Haseltine said, “It’s going to be very spotty. I have teams of people in China who’re travelling, enjoying life but they can’t leave the country. Life in China got back within 5 months, other countries can do that but they don’t, because they’re not willing to put in the effort to control the pandemic through public health measures. Unless countries do that, they won’t get back to normal in the foreseeable future because the vaccine will not do it, there’ll be other variants which will do it over again. Medicine can help the problem but not solve it. To cut it off from the root, we need to combine public health with other measures so it doesn’t exist on the planet anymore, not just one country. We’re entering a period of vaccine euphoria, thinking it over but next year it’ll be back like the flu. We need to be vigilant and cut it off from the root, another lesson is to pay attention when nature warns us and not push it to the side. We’ll move from pandemic to endemic, something that will live with us. To get back to normal life, we need to do our best to take the institutions, our leadership, our governance, our social solidarity and science to tune them to their maximum efficiencies in order to have a normal life. Humanity will prevail, but let’s hope we’re happy while that happens”.
In his closing remarks, Dr. Haseltine told citizens across the globe, “Care for one another. The Bible says ‘Treat you brother as yourself’. If we take precautions, we protect ourselves, our family and everyone around you. This is a message at a country level, to make sure your country is disease free and help other countries who have advantages. India can now help other countries, which it does, so we need to join as a community and help our neighbors”.