He is a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development.
His lab has developed a vaccine to protect against SARS, a deadly strain of coronavirus, but in 2016 was unable to get the money to test it in humans. Now they’re rushing to create a vaccine to protect themselves from the new coronavirus that is wreaking havoc around the world.
Earlier this week, on Twitter, he wrote:
“There is a misunderstanding there that America has been hiding for a year, and then a #vaccine magically appears, and everyone goes out for a good picnic on the National Mall. It would be nice, it is not impossible, our laboratory operates 24/7, but I think it is a low probability scenario. “
This interview has been edited for clarity and length.
Could you tell us about these tweets and the expectation that we will have a coronavirus vaccine in the next year at 18 months?
This is certainly the ambitious goal. It was the responsibility of Dr. Anthony Fauci, who advises the President. And that’s what we’re all working towards. Our scientists are in the lab day and night to get there and speed it up, but that is a difficult goal.
Sometimes people forget how long it really takes to make a vaccine. Dr. Fauci knows this as well as anyone: he has dedicated his life to the HIV / AIDS vaccine – which took 30 years to develop and which matters.
Most vaccines take 10 to 25 years. That’s the delay. My colleague Paul Offi points out that the record is probably four years from start to finish in terms of development license. It was for the mumps vaccine.
The time horizons are immense for vaccines. So you say, “Okay, well, how do you compare to a year to 18 months?”
It will be very hard. We are clearly investing a lot of resources in it. Many intelligent people are thinking in an innovative way about how we could do more things in parallel. But we also need to set realistic expectations that we may not have this vaccine in a year or 18 months – and maybe not for two, three or four years.
So how do we manage it? How do we manage expectations and what does our country look like during this period?
Do you have any idea where this goal from one year to 18 months comes from?
I do not know. There is a new international organization called CEPI, the Coalition for Epidemic Preparedness Innovation, which has been tasked with setting the long timelines for vaccines and finding new ways to speed them up. And there are theoretical reasons to say that we can do more things in parallel. Regulators are all studying the issue.
So we’re all going to try, but history says it’s not a high probability. I listen to some of the cable news networks that say, “Well, we just stopped for a year and then we got the vaccine.”
It is not a wise strategy. Or maybe we can have this as one strategy, but don’t put all of our eggs in this basket. Let’s have another strategy with a more realistic schedule for vaccines.
This disease can occur in waves, such as the 1918 flu pandemic. It occurred in several waves between the beginning of 1918 and the end of 1920. It was a three-year pandemic, and it is a possibility for so do we.
Developing a plan for the country in case we don’t have a vaccine is going to be very important to us. Some people are not happy to have said this because it sounds so pessimistic. It is not.
I think we will have other technologies coming out. We are already recovering from antibody therapy. We have new drugs that will go online.
But let’s also consider a realistic schedule, in case the vaccines haven’t come out, and determine if this virus was coming in waves.
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What would it look like to encourage people to return to work? How would we handle this? This includes the mental health aspects. Will people have PTSD in terms of return to work?
We will also have governors of some states unwilling to return to social distancing once we get out of this first hook. Even this month, when things are so dire in the country, you have about a third of the governors who are pushing back against aggressive social distancing.
What will happen in a year if we move away from social distance, then we have to go back?
And who organizes it? Who organizes the response? Who is drawing up the plan for us?
How can we understand this as a nation? How do we look at all the models and say, what is a realistic model? And if this virus shows a rapid and decreasing evolution, how can we cope with it, by working with governments, by working with companies and by working with health systems? It will be a very complicated situation.
Right now, we’re going mostly state by state, and looking at things like closing state borders – or at least the auto-quarantine requirement for people traveling to Texas from Louisiana. How do you think it works?
This does not reflect the reality of the situation. COVID-19 is present in all states of the country.
The travel restrictions seem attractive because they give the impression, “Well, it’s over. We just closed this trip, and that will prevent the virus from entering. The president said he had slowed things down by closing trips to China. But we now have reports, based on the genetic sequence of the virus, that the virus in New York came from Europe.
At this point, we have to recognize that the virus is probably everywhere. There is a diminishing return at this stage in the reduction of interstate traffic.
I’ve seen estimates that we may be two weeks from the summit here in Houston – or maybe I should say, our first summit.
It’s based on the Washington University’s IHME model.
So what should Houstonians do right now?
Now is the critical moment. This is the time when you are most at risk of getting the virus from being in the crowd or being with people outside your home. We are trying to do our best to minimize the number of people who need to be brought to the hospital and who need ICUS.
It is really important now that we aggressively seek social distancing, especially to avoid a push to the Texas Medical Center. Even though TMC leaders meet daily, we must do our part as citizens of Houston to minimize the number of people entering the hospital.
It’s easier for some than others. We have already talked about Houston’s poor neighborhoods and how social distancing is more complicated in areas of poverty and overcrowding, or for families where many people live in a house or apartment.
It’s one thing to say, “Okay, everyone has to distance themselves socially now. I don’t know how easily this is done in Fifth Ward or Acres Home or northeast of Houston.
I know the mayor is concerned about it, as is the county judge and our congressional delegation from Texas. Everyone is trying to think seriously about how to solve this problem.
Currently, without a vaccine, unfortunately we have to use a 14th century approach. It’s quarantine.
Assuming it takes a long time to get a vaccine, what kinds of things do you see happening? Amidst the waves of the virus, could we begin to relax restrictions and kick-start the economy?
The models indicate that, during the month of May, the number of transmissions will decrease considerably. Maybe at this point we could start to open things up.
But I do not know. When do we risk the disease coming back immediately if we do? We are starting to hear that from Singapore and elsewhere.
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We’re going to need outside help here in Houston for advice on this. Hopefully the federal government will provide some support.
Then assume that transmission levels continue to drop over the next few months. What are the predictions of return of this virus? Is it fall of this year? Is it January next year? April of next year? Getting advice on this will be really helpful.
Other questions are: who returns to the job market? Is it only people who have been infected and have antibodies that make them resistant to infection? Or is it or is it everyone?
I certainly don’t have the answers to that. We will have to have meaningful dialogue and bring together some of the best minds in the country. I suggested on CNN that bringing in the National Academy of Sciences, or a similar organization, would be very helpful. We need some of the best scientists in the country around the table, examining the models and drawing a path.
What adds to the problem is that we are in an election year. Things will be so politically animated that decisions made on both the Republican and Democratic sides can put political expediency on public health. How do you handle this?
It’s really difficult. I hear people looking at the relatively small number of people hospitalized in Houston, or the small number of deaths here. They ask whether the cost of social isolation is worth it and whether we should continue to stay at home. What would you say to them?
First of all, I don’t know if we really know the number of people in ICUS or deaths. And remember, we still have two weeks to reach our peak. So we certainly haven’t come out of the woods.
If it turns out that the data is not as high as we thought, the question still arises: did it happen because of what we did? Or despite what we have done?
We have already discussed Zika. I met with the mayor of Houston and I strongly recommended cleaning the tires that raise Aedes Aegypti mosquitoes in places like the Fifth Ward. He did it.
Then we didn’t have Zika. Is it because of my recommendation? We have no idea. You cannot prove a negative.
But from the experience we see elsewhere, we know that social isolation is really important for the next few weeks.
What do you think of other things these days? What are you looking at?
I’m really scratching my head to know what the next two and three years will look like. It’s a big problem.
We’ve also heard a lot now about health, COVID-19 as a health disparity among African American and Hispanic communities in the southern United States. I put that out there ago almost three weeks: concern. And that turns out to be the case, unfortunately. Fighting this in Houston is going to be very important.
How are you personally?
Oh, we hang in there. I spend a lot of time writing documents and documents related to getting our vaccine started, and also writing reflective papers on the ideal characteristics of the vaccine and how we are advancing the vaccine for global health .
I’m also trying to raise funds to get there. Vaccine developments are costly.
And I’m also talking to people like you, to spread the word, so that we get a good, accurate scientific message. I go to CNN or MSNBC and Fox News, and sometimes I don’t tell people good news.
I get a little perspective from people I have known for years, people who are not happy not to paint a very rosy picture of things.
It took me a while to figure out how to say real information without alarming people. I turn a little too much on pink. Sometimes I turn a little too much on the dark side. The best critic of all is my wife, who let me know.
How is she?
I think so. She sees how stressed I am.
It’s not just me – it’s our whole group, and Dr. Maria Elena Bottazzi, my scientific partner for 20 years. I’ll text her at 4 a.m. when I wake up and find out that she’s already texted me at 3:30 a.m. when she wakes up. It’s crazy. I will wake up in the middle of the night and send an SMS, without waiting for an answer the next morning, and she will answer immediately.
We are all sleepless.
[email protected], @LisaGray_HouTX