Sex, Drugs, and Public Health

The party was invitation only and had a theme. When everyone was comfortably seated and served beverages, the hostess passed around an ornate ceramic china bowl. Each guest took one of the small flat discs to eat.

Not mints. Not bon-bons.

These were scabs from a Smallpox victim. The Renaissance-era guests were attempting to immunize themselves from that disease with its 20 to 30 percent mortality rate. (I apologize if you’re eating dinner). This story appears in some Medical History books, but not in others, so the details may be apocryphal. But in China during the 15th century , they performed “nasal insufflation,” inhaling dried, aged, powered scabs. And in Africa, a mother would visit the house where a child was ill with the disease and tie a cloth over the child’s arm. She would return home to tie the cloth on her own child’s arm.

Such processes, called “variolation” (named for the Smallpox disease) all show that people had observed how someone who experienced a mild case would be protected later from the severe form of one of mankind’s most devastating plagues.

The name of the process changed when a physician in the late 1700’s observed that milkmaids who became ill with cowpox were protected from developing Smallpox. He scratched liquid from cowpox lesions into the arms of people, found them to be subsequently protected, and called the process “vaccination” in a nod of gratitude to the cows.

“Vaccination” worked so well over the decades that World Health Organization officials decided to attempt something historic. I saw evidence of it in South America in the early 1970’s. Even in the most remote towns of Bolivia and Paraguay, there were posters offering cash rewards for reporting a case of Smallpox. The efforts to chase down every case and vaccinate those around them was the final stage of Smallpox eradication.
For the first time in history, humans had exterminated a deadly disease.

GOOD VACCINES: following the Smallpox example, we created vaccines against viruses. Some contained killed viruses, others used attenuated (damaged) viruses. With these, we had good results against Polio, Rabies, Measles and Yellow Fever among others.

SO – SO VACCINES: due to the biology of the pathogens and of human immune systems, some vaccines only protect for a while. The Tetanus shot – a vaccine against neither viruses nor bacteria, but against the toxin that this bacteria produces – requires periodic re-vaccination. And with Flu, the virus changes so much each year that we need a new vaccine every Autumn.

DIDN’T-WORK-OUT VACCINES: over the course of six years, a friend of mine worked with Jonas Salk trying to create a vaccine for AIDS. But that never panned out. The test to see if someone is infected with HIV is detection of antibodies. Thus, the antibodies produced by the immune system just don’t kill that particular virus.

So not all vaccines are the “Silver Bullets” we hope for in Medicine.

The HIGHLY UNUSUAL RACE FOR A COVID VACCINE:
Have you ever seen a movie of the Oklahoma Land Rush? Hundreds of hopeful candidates (on horse or wagon) line up; a gunshot; people screaming, horses galloping, great billowing clouds of dust. That’s the vision that plays when I hear the term “Operation Warp Speed.” As many as twelve pharmaceutical companies are rushing to bring to market some of the more than 100 candidate vaccines being developed word-wide.

There are two masked riders galloping among them: Excitement and Skepticism.

EXCITEMENT: there’s some new technology going into this vaccine race. Let’s sort out the different approaches. You really need to know this.

1. WHOLE VIRUS: as with the historic viral vaccines, the technique is to use either attenuated live virus (none of the Covid candidates are doing this) or killed virus (the Chinese are using this).

2. SPIKE PROTEIN: the “corona” (crown) on this virus is composed of protein spikes which attach to human cells and gain entry. The virus then uses the human cell’s machinery to make babies (new viruses). Several labs are working to make vaccine from this spike protein or pieces of it, priming the immune system to attack that part on the virus as it tries to attach to a cell.

3. VIRAL VECTOR: this is interesting. Labs take a common Cold virus (Adenovirus) and splice in the genes for manufacturing the Spike protein. This “vector” virus is injected, enters human cells as it usually does, but makes coronavirus Spike protein because of the modified genetic material. The immune system then builds antibodies against the Spike. Companies using this approach include Merck, Oxford and some Chinese companies.

4. RNA / DNA VACCINES: even interestinger. The virus’ genetic material which produces the Spike protein is synthesized, then injected. No need for a vector virus. Human cells take up the genetic material and produce Spike protein for a while (until the body rejects the foreign genetic strands). Immune system responds. Names of labs using these two approaches (either DNA or RNA) you may recognize are Moderna, Pfizer and Inovio. Here are some interesting points about this new technology of vaccine manufacture:
• This avoids any accidental infection with whole virus
• The RNA vaccine requires two injections
• The RNA vaccine requires special shipping and handling
• Early results show good production of antibodies
• There have been significant side effects reported
• No RNA vaccine has yet been licensed for humans

IN GALLOPS THE SKEPTICAL RIDER:

• Antibody production from some of these (all are still in development or testing) varies from 60% to 90%. None, so far, approach 100%. Unless that changes, not everyone who gets vaccinated will be protected.

• Covid is still new. We don’t know if antibodies will, in fact, neutralize the virus and protect humans. Remember the lesson of the HIV / AIDS vaccine attempt. And if it does protect, we don’t know for how long.

• Politics # 1: China has offered a one billion dollar loan to Latin American nations to purchase and use their vaccine.

• Politics # 2: Pharmaceutical companies see an opportunity to sell their product to a large majority of the world’s population. Billions of dollars to be made. They usually want to rush such a profitable product to market. In the U.S., we have a system to protect the Public from un-safe and/or in-effective vaccines and drugs. The F.D.A. requires rigorous proof that a pharma product meets these goals. That process slows the rush to profit, protecting the Public.

But with this Covid Pandemic, those tables have turned. There has been political pressure (including pressure on the FDA) to speed up the vaccine as the election process gets underway. This is, unfortunately, undermining public confidence. Surveys report that only half the U.S. population currently states they would take the vaccine. Not enuf to attain “herd immunity” and slow the disease. In an unprecedented move on September 8, several CEO’s of Big Pharma signed a very public pledge to meet every standard before releasing a vaccine. That’s usually the FDA’s role.

• Herd Immunity: in Public Health this means a large enuf percentage of a population is immune – from either recovering from the illness or from vaccination – that the virus has a hard time finding susceptible victims and the pandemic becomes controllable. Experts estimate that this number is about 5.6 billion worldwide, 200 million in the U.S. and that manufacturing enuf vaccine, educating the public, and distribution could take years.

TAKE AWAY MESSAGE: vaccines have saved millions of lives over the centuries. We have a mechanism in place to assure safety and effectiveness (the FDA). The technology of vaccine creation is evolving with the development of Coronavirus vaccine. You need to keep a sharp eye on how this progresses to understand how to balance the value against the risk when vaccine is finally ready.
Trust the Scientists. Ignore the politicians.

QUESTIONS and ANSWERS

Q: Will a vaccine prevent me from getting infected?
A: No. The antibodies are inside you. They go to work AFTER you ge infected. Hopefully, they keep you from getting very ill.

Q: Is there anything that will prevent me from getting infected?
A: Yes. Adhering to Distancing and Face Covering guidance has been proven to work. Continue this, even after you get vaccinated. If the vaccine is 75 to 80% effective, you could be in the unlucky 20% group.

Q: How many people would die if three fully loaded 747’s crashed?
A: About the same number of people who die of Covid each day in the U.S.

Q: Where is Covid surging in the U.S?
A: Rural locations – the Dakotas, Utah, Oklahoma, Arkansas, Texas, Florida.

San Francisco has one of the lowest case rates and the
absolute lowest death rate among large American cities.