T202. COVID Work

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Project Save the World Podcast / Talk Show Episode Number: 202
Panelists: Ronald St. John and Jon Cohen
Host: Metta Spencer

Date Aired: 10 March 2021
Date Transcribed: 19 March 2021
Transcription: Otter.ai
Transcription Review and Edits: Adam Wynne

 

Metta Spencer

Hi, I’m Metta Spencer. If you’re thinking of either getting COVID or getting a vaccination, you’ve come to the right place, because today we’re going to talk about COVID vaccination and all things connected with the equitable handling of this pandemic. I have with me two very knowledgeable people. Jon Cohen is a staff writer on Science Magazine, who covers epidemics. And it looks like he’s been doing it a long time and knows his way around a few viruses. And he’s, I guess, where are you, Jon?

Jon Cohen

I’m based in San Diego.

Metta Spencer

Oh, good. All right. I’m a Californian by upbringing.

Jon Cohen

I’m half Canadian also.

Metta Spencer

All right. And in Ottawa, a friend of mine, Dr. Ronald St. John, is ready to talk to us about his experience as an epidemiologist. He spent a number of years with the World Health Organization, especially the Pan American end of things or side of things, and then was with Canada’s Public Health Service, and was in charge of SARS and Canada’s response to SARS. So I think he and Jon Cohen have things to say to each other. I’m going to let them mostly tell us what they’re up to. But let’s start with Jon, because I believe you said yesterday you had an article you wrote about the pending surplus of vaccines. Can you tell us what you have in mind on this issue?

Jon Cohen

I did a story with Kai Kupferschmidt, our correspondent in Berlin, that looked at the contract agreements that the wealthy countries of the world have made for acquisition of COVID-19 vaccine. It seems preposterous right now to talk about surplus given that everyone’s scrambling to get vaccines, even in wealthy countries. But the reality is that UNICEF catalogues how many people could be vaccinated by the purchase agreements that the wealthier countries of the world have made that far exceed their own needs. So, for example, the United States and Canada both have agreements to have over 500% of their populations vaccinated. Which leads to a whole lot of people who could be vaccinated if those purchase agreements actually lead to product and purchased product. In the United States, which would be the largest over purchase, we could vaccinate – with what we have committed to buy – 1.5 billion more people. That’s a lot of people. Right now, there’s something called the COVAX facility that was set up by World Health Organization and its partners to ensure that there would be access and equity to vaccines around the world for COVID-19, unlike what happened with pandemic influenza in 2009, which was a fiasco where the wealthy world hoarded vaccine. So COVAX is a great mechanism, it is a fantastic idea. But to date, it only has committed to rolling out enough vaccine for 247 million doses of two-dose vaccines. You can do the math, cut it in half, for the world, for the poor countries of the world. And the US, in contrast, by the end of May anticipates vaccinating all adults, which is about 200 million people. And by the vaccine that we have purchased already here in the United States, come the end of July, we could have 200 million more people vaccinated. What are we going to do with that vaccine? The US may well donate it, and it may well donate it to COVAX, and COVAX is encouraging countries to donate through the facility. But there has been no formal discussion and plan about how to do it. I quote Nicole Lurie in my story, who was a top official at the Obama administration during 2009 flu epidemic, saying that when the US went to give away that vaccine, there were a gazillion obstacles that surfaced, including the need to fumigate a pallet of vaccine before it could be sent to the Philippines, which delayed that shipment by two weeks. So you have to have these discussions now, to figure out how to do that very positive thing later. It can’t just happen with a snap of the fingers. And if you look at Canada and the United States and about a dozen other countries that have fairly large populations over 25 million people. I calculated with Kai that there are nearly three billion people who could be vaccinated with those surplus vaccines. It’s huge.

Ronald St. John

I agree, Jon. it’s amazing to me that Canada had reserved contracts for vaccinating three times its population roughly. And then reserve two million doses out of COVAX. We have no need to withdraw any vaccine from COVAX, but we did reserve two million doses, which astounded me and I do not understand the rationale for that. But it’s a little bit like so many things in the world, where we have countries and have not countries. And our inability to distribute things equitable across the divide between the have and the have nots is an ongoing problem.

Jon Cohen

There’s a wrinkle to this and it’s that the United States is the hardest hit country in the world by COVID. And so, the United States has a desperate need for a vaccine that some countries don’t share. So, there is a reason for vaccine nationalism in the United States. We’ve had more death than anywhere else. We have suffered tremendously. And you can understand from a politician’s point of view, why they cannot discuss donating vaccine right now, when there are still people here in California where I live, who are terrified of becoming infected, who cannot access a vaccine, and who even meet the criteria that have been established here for being vaccinated. It is a mess in this country if you want to get vaccinated. I became vaccinated. I’m 62. Because I volunteered at a superstation that vaccinates thousands of people a day. So, I’m considered a medical volunteer. And indeed, my working at that superstation puts me at great risk, because I’m in close contact with huge numbers of people. But that’s an exceptional way to get vaccinated. And I’m not, by the criteria that exists, otherwise eligible. So, I understand why countries… as one person said to me about the United States, you cannot say no to governors, and yes to other presidents. That is political suicide and maybe even foolish, at the same time. We’re moving at such a rapid pace that I think people are blinded by the surplus that’s going to happen. We’re going to be awash in vaccine way before people realize.

Metta Spencer

How soon? When do you think that might happen?

Jon Cohen

Given that the United States is the largest purchaser and that Biden has committed to vaccinating all adult Americans by the end of May. We will have a surplus in the United States, I predict, certainly by the end of July. Because that’s when we have delivery commitments of Moderna, Johnson and Johnson, and Pfizer for far more product than we can possibly use. Then there will become a question of: do we want to vaccinate children in the United States? Do we need booster shots for people to combat the variants that are circulating and might require stronger immunity? Is there a durability issue that requires booster shots? Those are all real and salient reasons to reserve some vaccine and not give everything away. But this is a dynamic, and you need the top people sitting down regularly to discuss how to adjust. And that’s what this whole pandemic has been about – adjusting. There is no certainty here. And that’s the big fallacy that I think keeps tripping up countries is that they keep pretending that they know what’s going to happen tomorrow. They don’t. We don’t.

Ronald St. John

Jon, there’s an interesting phenomenon and I’d be interested in your comment. And that’s when there is an emergency situation – like COVID – and when there is a certain ingredient or measure that needs to be used, like having a vaccine or getting a vaccine or some commodity that becomes in short supply – the international markets collapse and countries start to scramble under nationalism to get a hold of that commodity at all costs. And globalization sort of goes out the window. How can we deal with this in the future? Just let me give you a personal anecdote: During the anthrax letters scare in the early ’80s, early ’20s (2000s), there was a need in Canada to purchase some antibiotics for a national emergency stockpile. When I went onto our standard suppliers of antibiotics, within an hour, I was told that I had 40 minutes to make a decision about purchasing X, Y, or Z, because there were 4 or 5 other countries in line. And recently Canada actually ended up with a shortage of vaccine, of COVID vaccine, because we were dependent on the production facility in Belgium. So, this whole thing collapses in like lightning speed. And I’m curious about how you think we can deal with this.

Jon Cohen

Yeah, I think that, you know, you raise a really important point that we are defined by how we behave during a crisis, not how we behave during, you know, simpler times – – and we behave badly during crises typically. The COVAX facility is new, and it’s a clever idea to address this. But we see its limitations already, given that there are over 100 countries in the world that have not vaccinated anyone. So ideally, the world would say, as a Kumbaya world, hey, the priority is health care workers, frontline responses, responders everywhere. And once you as a wealthy country have covered your most vulnerable health care workers, start sharing at that moment. And there are people who argue that’s a huge mistake we’re making. France has donated 5% of its vaccine right now. And Norway says it’s going to do a 1-to-1 donation of its vaccine. But Norway has 4, 4 and a half million people France has only vaccinated 5 million of its own, of course 6 million today. It’s nothing it’s a drop in the bucket. So I think what we need to do is create more COVAX-like facilities for these responses that address things other than just vaccines, PPEs for example, our you know, a classic thing where we run out of masks and gloves. Why don’t we have a global facility that is set up to address… there will be more pandemics, Ron, you know that and I know that we’re not out of this, it’s not like we’re gonna emerge here and somehow have taken care of the pandemic problem. (dog barks in background) My boss is yelling at me, I’m gonna let her out of the office in a moment. But I think you’re spot on that we have to come up with mechanisms that say in the future, this will happen again. And history will repeat itself, there will be hoarding, and there will be, it’s a natural inclination to take care of your own. And what you’re seeing here as well is China squashed it’s epidemic against COVID without biomedical interventions. So, China has been using vaccine as a diplomatic tool. And so, then you enter in this other realm of geopolitics, where commodities become tools to establish economic relationships or political advantages. And that in itself, creates dilemmas. You know, Russia is doing the same thing with its Sputnik vaccine, which it’s selling, but it’s inexpensive, and it’s aggressively marketing it and saying to the world, we are good neighbors, we are good people. Now that well, that well may be true. I’m not arguing that what they’re doing is bad. But it creates geopolitical dynamics that ultimately shouldn’t exist. You know, we don’t really want that. I’m gonna let her [the dog] out. But I can hear you.

Ronald St. John

Right.

Jon Cohen

Jon, I’ve often thought that there was an argument, there is an argument, that from a country’s perspective, that what is over there in the other world can be in my backyard in no time, Therefore, we should help solve the problem over there, because it’s in our own in our own self-interest, to deal with things, but that doesn’t seem to gather a whole lot of, of credibility or, you know, force, when you get up against something like COVID somehow.

Metta Spencer

Yeah, I think that the whole spirit of globalization should be enhanced by the experience of being in a pandemic, but it’s so clear that germs do not respect borders, and that people travel across borders. And I would have thought that we would be, you know, exactly singing Kumbaya by now. But if anything, it looks to me like it’s gone the other direction that there’s more nationalism, you know, borders, harder borders than then before. Is that your impression or do we have something hopeful to look forward to in those?

Jon Cohen

Oh, I think I there’s been more scientific collaboration and openness than ever before, I do see progress. And I see scientists communicating. You know, one of the, I hate to say this, because we’re all so sick of Zoom. But what Zoom has done is it has put groups of people from different countries in the same room, having discussions day in and day out, where they don’t have to get on airplanes and fly to places or even have bad telephone connections. We are communicating information more aggressively with more openness than ever before. So, I do you see progress. But what we’re talking about the goal we’re talking about runs up against, I don’t know if you know, the old-world health organization, or Mata declaration that health care is a right, and the notion that we all are in this together, the reality is that poor people do not have the access to medical care that rich people have. That’s a reality. And it’s true in every country. And it’s true between countries. And we’re not going to erase that problem. Just as we’re not going to give everyone in the world screens on their windows and air conditioners, and cars that don’t break, there are there are always going to be divisions of wealth, and your access, Metta, to healthcare is going to be better than someone else in Canada who doesn’t have your resources. That’s just reality. And your connections to doctors and nurses is going to give you better care than other people. And that’s just reality. So, I think we have to find some sweet spot in the middle, where we say, Okay, we have a universal base that we are going to adhere to. And then if you’re wealthier, yes, you get better, you get more, but there is a base that is agreed upon. And that’s what COVAX is attempting to do, can we achieve it? Well, I think we need leadership from the G20. And from the wealthier countries of the world to really put money into this, and not just talk. And that’s a big ask. And you know, politically, you don’t get that far with your own people, unless you’re some small Scandinavian country. And that’s why we see all these great issues coming to the fore in these small Scandinavian countries, because they have buy-in in from their populations of 5 million people. My country is 328 million people. We are incredibly divisive and divided and heterogeneous. And look what happened in our last election. We had people attack our own capital. We’re a very, very split place. And so to get buy in in the United States, is tough. And it’s not a politically attractive thing for a president to say, you know, we’re going to lead the way here, but that’s the kind of leadership we need.

Metta Spencer

How far do you think Biden is going to go with his progressiveness?

Jon Cohen

I don’t know. I mean, we’re, we’re in a very uncertain time politically in this country. We did just see a $1.9 trillion passage of a of a bill that will address COVID more aggressively than it’s been addressed, but it was completely along party lines.

Metta Spencer

Does it cover this COVAX thing too?

Jon Cohen

Well, that that occurred earlier, Biden committed to COVAX actually, the Trump administration in December, the Congress, not the Trump Administration, the US Congress wanted to back COVID. And when Biden was still not president, but the elect, he backed this, and he has put money on the barrelhead. So yes, the Biden Administration is strongly backing COVID. And the Biden administration importantly, rejoined the World Health Organization. I mean, remember, Donald Trump’s Administration pulled out of WHO during a pandemic, which to the world that I live in, was, are you kidding?

Ronald St. John

I was gonna also talk a little bit about internal I mean, within country equity. We know that different segments of our populations have are currently having differential access to the vaccine, even when they’re on the list of desired people to be vaccinated simply because of perhaps access issues, or I’d be interested in how we can address the internal inequity within a country.

Jon Cohen

Yeah, enormous, enormous challenge.

Ronald St. John

You’ve touched on it a little bit because you’ve noticed that there is there is inequity built in, within societies, but this is particularly disturbing to me because we just need to get everybody possible vaccinated.

Jon Cohen

Yeah, in the United States, we have disproportionate burden of disease in African American communities in particular and in Latino communities. And there has been a great effort by people running the vaccine, steering the vaccine ship, to try to have leaders from those communities talk publicly about being vaccinated and to make it something that’s desired. There’s been a lot of vaccine hesitancy in African American communities in particular. But I think it’s also important to note that the Pew Foundation did a survey that found that the most hesitant people are White Republicans. Not that it divides politically more than it divides by racial or ethnic groups. The efforts have to make it simpler to get a vaccine. And it is so terrifically difficult to get a vaccine in the United States. That communities that aren’t as connected to the healthcare system to begin with, which we know is the central problem for African American and Latino communities are going to be left out. And you know, your first Americans are, what do you call it Canadian?

Ronald St. John

You’re our Aboriginal population, our Indigenous people. We have the same kinds of situations here, slightly different ethnic groups. But we do have the same problem.

Jon Cohen

 And it’s a disconnect from healthcare, isn’t it? I mean, isn’t that the central problem?

Ronald St. John

Yes.

Jon Cohen

That’s a systemic problem.

Ronald St. John

And, and also some ethnic profiling that takes place. I mean, the Asian Canadians have been, I’ve had some difficulties with discriminatory remarks, and so forth, during the COVID situation here in Canada.

Jon Cohen

I think what we need to do is learn from others successes. And we know, for example, with HIV, that one of the great advances in terms of antiretroviral treatment was bringing testing to the community to find who was infected in a community, and then bringing drugs to the community in a way that was simpler. That didn’t require getting on a bus and riding for an hour to get your drugs. But instead, people would come to you maybe, and we did this with tuberculosis and the direct observed therapy where you go door to door and make sure people are swallowing their pills. I think we have to get aggressive about it and target communities that want vaccine that can’t easily access them, maybe by having mobile clinics that go out and do it, or by setting up…

Metta Spencer

About those people who are hesitant though … I really don’t understand the logic or what their rationale is. But to what extent is it possible to push them? You are even I think I’ve heard some employers can require it of their employees. And I guess there’s a legal question of whether or not that is violating their rights. Help me get clarity about what the rules are, and should be, about insisting that people take the vaccine.

Ronald St. John

I’m going to jump in right here for because what you’re opening also, Metta, is the doorway to the whole notion of a passport or certificate for the vaccinated against the unvaccinated. And I’m, I’m really quite concerned about how the ethics and the law is going to play out, are going to play out over that.

Jon Cohen

They’re very tricky questions.

Ronald St. John

Jon, have you been thinking about passports?

Jon Cohen

Yeah, a great deal. And I think Israel is far ahead of everyone because they vaccinated such a huge percentage of the population. And Israel has been criticized for requiring people to show vaccine documentation to go to a shopping mall, for example. And what Israel says in reply is, “Hey, you know, you don’t have to go to a shopping mall. And if you don’t want to get vaccinated, don’t go shopping, don’t go to the shopping mall.” And they’re using it something as something of an incentive for people. I think there is a very troubling aspect to passports in terms of people who cannot access vaccines, right? And then you have an equity issue because they can’t go places other people can go at no fault of their own. So that a serious consideration. But the flip side is that we’ve used yellow fever vaccine immunization cards for as long as I’ve been on airplanes. And you know, I have my yellow fever vaccine card with me whenever I travel. And I accept that that helps slow the spread of yellow fever, the same thing was done for a time with smallpox, when that was a problem. There was an immunization card that you needed to show. So, I don’t think that the idea itself is a bad idea. But with yellow fever, anyone who wants the vaccine can get the vaccine. And the same was true with smallpox. So, the access and equitable distribution of product wasn’t at the center of the dilemma. I think it’s ultimately a matter of timing a year from now, when everyone can get a vaccine anywhere. I hope that’s true a year from now, the passport idea takes on a different sheen than it does today. I’m going to start traveling because I’m fully immunized at the end of this month. And I’m going to be traveling with my immunization card. And it is going to benefit me in some locales to have that card. And I think that’s wise, I think it should, because I think there is a different immune status in my body, that should be taken into consideration in terms of the risks that I pose to others, although we don’t really know how much transmission occurs yet, through vaccinated people. And certainly, vaccinated people can become infected. But I would anticipate that their viral loads would be far lower, and they’d be far less likely to transmit, we have to see the data. But that is logical. Right?

Ronald St. John

Right. Right. It’s beginning to look like that’s true.

Jon Cohen

I think I think there’s data building that that’s true. But the getting it the vaccine hesitancy question, I, I’ve studied vaccine hesitancy in great depth. It goes back to the first vaccine that Edward Jenner made against smallpox. And the England reaction to that vaccine led to the Luddite movement, which oppose sewing machines and industrialization, creating an anti-vaccine movement in the 1800s. And that movement has ebbed and flowed ever since. And there was a Supreme Court case in the United States in the early 1900s, about the smallpox vaccine. And the issue is ultimately about the fact that healthy people don’t want to stick needles into their bodies. And they ask, why are you going to… I mean, think about how we use needles, right? Who gets needles? Well, people have diabetes, for insulin; people who inject drugs that we think are dangerous, opiates, in particular; and most of us have never injected ourselves with anything – all of us have taken pills. And if a vaccine is a pill, it alters the hesitancy equation to some degree, but the idea of an injection into a healthy person into my perfect baby, you’re going to do this to my baby, that in and of itself, it’s a logical, rational concern, to not want to cause harm to some human body that seems perfectly healthy. But, you know, it’s the whole question of what is prevention? And how do we understand and think about prevention. And we are very bad at that as humans. And the way to address vaccine hesitancy is not to simply flood people with facts, because it’s an emotional response. In many ways. It is not factually based. And part of what leads people to change their minds about hesitancy is seeing others who benefit from the intervention. And I watched HIV denialism very closely where people didn’t believe HIV caused AIDS that evaporated, why did it go away? It went away, because very good antiretroviral drugs came out. And as they became accessible, people everywhere, saw their dying neighbor, get up out of bed and go back to work. So, anyone who was living with HIV who didn’t believe the virus was harmful, directly saw the benefit. We are now directly seeing the benefit of COVID-19 vaccines. We’re seeing deaths plummeting in settings, like nursing homes where they’re widely used, and we’re seeing Israel with its early data. And as those data show us, the benefit, hesitancy is diminishing, and that will continue and it will become more dramatic. As people who are hesitant in high-risk situations die. Unfortunately, that will happen. There will be nurses and doctors and people in nursing homes, who refuse vaccines, and everyone in their setting will be fine. And they will be put on a ventilator and die a horrible death. And people will see that and that will diminish hesitancy I’m sorry to put it that starkly, but I do think that’s what’s going to happen.

Ronald St. John

If I may just add this, I appreciate the way you’re putting the whole issue, Jon, because in public health we have such a tendency to try to explain to people what the statistics are. So, we are just reading a study with healthcare workers in the UK. On the frequency of anaphylactic shock following the Pfizer vaccine. And it was 0.25%. Well, you know, what does a person understand about point 0.25%? And you say, oh, well, that’s, that’s 2.5 people per 10,000. You know, I understand that. But the average person I just stated, doesn’t.

Jon Cohen

It doesn’t mean anything. “And if it’s me, if it’s me, it’s me, if I’m that person, it’s me.”

Ronald St. John

Exactly. I often said that, people I remember back in HIV days, people would ask me, what’s my risk of getting HIV and I would say, 0 or 100. For you, as a person, because either you get it or you don’t. As a as a population, it’s different. But I find it very interesting that I think in public health, we just don’t present things quite as clearly as we need to for the average person.

Metta Spencer

But Jon, if I can ask why the Republican, what is it? White male Republicans, is that the people that you say are resisting it most? Why would they be any more hesitant than anybody else if it has something to do with the experience of seeing people get well or die?

Jon Cohen

Well, the narrative that came out of the Trump White House began in February of 2020. With “this is not a big deal, it’s going to go away. Hey, it doesn’t really cause harm.” And that then be mutated into this a scamdemic. It’s not real. It’s a political tool being used by Democrats to get rid of Donald Trump. And let’s not bother wearing masks, and the President refused to wear a mask for a very long time. And, hey, you know, this just is like the flu. And it’s just something that’s just gonna come and go, and by springtime, it will be gone. All of that created a false narrative about the dangers. And in the Republican Party, it also became a rallying cry to try and win an election. And so, there’s residue left over from that. The hesitancy that now exists in Republicans, I predict will plummet as data… not just as data emerges, but as people witness reality. Reality is a really, really strong medicine. It just, you know, when you see, if you ride a motorcycle, you’re taking a risk. And if you see somebody in a motorcycle accident, and you see how horrific it is, it makes you rethink your risk taking I ride waves. I surf and I surf large waves, but I don’t serve the kind of giant waves the people who surf giant wave surf. And in part, that’s because I have been humbled so many times in the water, where I’ve reached my limits, and I’ve nearly drowned. And I’ve seen other people drown. And it changes how I approach that risky behavior. I still surf. And I still love it. And but I’m much more calculating about how I make decisions. And I think that’s true for all of us. We, the experiences we see that are frightening, lead us to modify our behaviors, and the experiences we have of things that are positive, that we see, really great things happen to communities. Like my mom plays Mahjong, she’s 91. She’s from Winnipeg. And yesterday, my mom and 3 of her friends who are all doubly vaccinated, had a Mahjong game without their masks on. And she sent me a video and it was just beautiful. And as people share things like that, of their relatives, that will lead to hesitancy diminishing because they see the joy that the vaccine has brought to people, they love. And they’re going to see grandparents hugging grandchildren, they haven’t hugged in a year, that’s happening all over the place, and it’s going to happen more and mor. And children will return to schools. And the joy that comes from this, from the protection of the teachers in the school through vaccination will have an impact. I’m certain of that I think we are driven tremendously by hope. I think that’s what humans are made of. And when we see hope in action, it changes us. So that’s my pollyannish view of it that my cynical skeptical side kicks in and I think there’s some people who are anti-vaccination. It doesn’t matter. They don’t believe in vaccines. They’re a minority. And there was a study done that I wrote about some years ago, in I think it was Michigan, where they said to parents who didn’t want to vaccinate their children, okay? You just have to come to the public health department and have a meeting for 30 minutes to discuss your concerns and then we’ll give you a waiver. Vaccination rates, steeply climbed, and hardly anyone went to the meeting. They couldn’t be bothered to drive down town and pay for parking and go listen to somebody. They weren’t anti-vaccine, they were hesitant. And if you created the slightest obstacle, they said, “Oh, to hell with it, I’m gonna vaccinate my kid.” So, I think that’s another clever way to address some of this and to separate anti-vaccine from hesitancy because they’re extremely different things. And most people are not anti-vaccine, they’re hesitant. And that’s different.

Ronald St. John

I think you’re right. I think if this passport thing, if you if people find out, you just cannot get on an airplane and go anywhere to visit your uncle, or to go to Miami or whatever, without evidence that you have been vaccinated, I think that may persuade a lot of people to get the vaccine.

Jon Cohen

I do too. And I think there’s a concept also that we haven’t talked about, and it’s about risk reduction and harm reduction. You know, in the HIV field, it became very clear that if you provided clean syringes to people who shoot heroin, that they don’t spread HIV amongst themselves, the heroin doesn’t cause HIV transmission. It’s the dirty syringe and needle. And people politically said, Oh, no, don’t do that you’re encouraging heroin use” and other people said “No, we’re reducing the risk of harm. They’re still going to be harmed by shooting opiates, but we’re reducing their risks because they won’t get HIV” and that had been hugely successful. We have to think about COVID-19 vaccination in terms of harm reduction. It doesn’t eliminate risk. That’s not what it does. It vastly reduces your risk of becoming severely ill, it may well eliminate your risk of being hospitalized and dying, for a period of time. And it may well vastly reduce your risk of transmitting the virus to others. That’s what it does. It’s not eliminating anything right now that we know of other than hospitalization and death, which do seem to be eliminated by the initial responses to these vaccines. That might wane over time, it likely will. But right now, I can say with great certainty that nine vaccines have presented efficacy data, and no one who has received any one of these vaccines – and we’re now talking about millions of people – no one has developed, has died.

Ronald St. John

Yeah, you’re absolutely right. I was asked a question. I was asked: “Well, there are now four vaccines approved here in Canada, and they’re not quite all the same. Should I wait and choose my vaccine?” I said, you take the next vaccine that comes along. Because they all stop death.

Jon Cohen

You know, Ron, we know what the virus does. So, you want to calculate precisely what a vaccine does? Give me a break? Right. You know.

Metta Spencer

I have the one question that I haven’t heard a definitive answer to though. And I don’t know whether you have the answer. To what extent are the existing vaccines good against the variants? I mean, if you take a vaccine, what is left for you as a risk of one of the South African or other variants?

Jon Cohen

Well, the best data we have come from the Johnson and Johnson study, which was in partially in South Africa, and no one who received a single dose of that vaccine ended up being hospitalized or dying. Even though 85 to 90% of the people who became infected and who are becoming infected in South Africa are becoming infected by a variant that can dodge antibody responses. The antibody responses are but one arm of the immune system, and everyone’s gauging the power of the variants based on their ability to escape from the antibody. But we have a whole other arm of the immune system that behaves in an entirely different way. Antibodies, for the most part, prevent viruses from infecting a cell by glomming on to them and blocking their ability to dock onto a cell. But when cells become infected, we have a whole other arm of the immune system that our T-cells orchestrate that targets and clears infected cells. And these variants are not getting around T-cell immunity as far as we can tell, to any significant degree. And that’s likely why people are doing well, even in situations where the variants that are most concerning are predominant. So, the variants are real, they’re a concern, they do weaken the ability of vaccines to prevent mild disease, they probably lead to more transmission. But in terms of what we really care about, let’s remember we got into this lockdown situation, because hospitals were overwhelmed. ICUs were overflowing in Wuhan in northern Italy, in Spain, in Iran, in New York City, in Seattle. Hospitals were collapsing, because they couldn’t handle it. Vaccines prevent that.

Metta Spencer

 Yeah.

Jon Cohen

So, you know, smell the coffee here.

Metta Spencer

You don’t have to convince me about the vaccine. We’re not quite as far advanced in in Canada as the US is, we’re a couple of months behind I think in our ability to make the vaccine available. But I’m certainly I’m on board with that.

Ronald St. John

That matter was due predominantly to the supply interruption issue. When the production… since we get our vaccine from Belgium, and the production vaccine, the Pfizer production capacity in Belgium was halted for a while because they wanted to expand their production, you have to stop the assembly line to do that. We had a shortfall of weeks with very limited supply. And now we’re in a catch-up phase.

Metta Spencer

So, you think we will get caught up?

Ronald St. John

I think it’s it seems to be accelerating right now at a pretty good pace. And we may, you know, the Prime Minister promised everybody would be vaccinated by the end of September, which is a great goal. Now people are talking beginning and talk about being able to meet that goal a couple months earlier. Let’s hope so.

Jon Cohen

There’s something else to keep in mind here and probably is true in Canada as well as the United States. We do not do mass vaccination of adults as a routine thing. We do flu vaccine, but you go to your local pharmacy and get a flu vaccine here in the United States. And there’s no signup process. There’s nothing or the Shingrix vaccine for shingles. There was a shortage of that vaccine, I had to get on a waiting list. But it wasn’t a sense of urgency about shingles. Because shingles is not a seasonal thing. It’s like shingles is in my body. I don’t want to get that virus. So, we don’t have a history of mass vaccination campaigns of adults. We do have children, pediatricians routinely, you know, vaccinate. That’s one of their main jobs. And in the United States, it’s a birth cohort of 4 million a year. And we figured that out. We’ve got that down. But our systems have to figure out the kinks of mass vaccination campaigns for adults. And as we figure out those kinks, it happens in a couple of months’ time. Everything speeds up.

Ronald St. John

Yeah, yeah, no, you’re absolutely right. I don’t think there’s ever been, certainly in this nation’s history, a mass campaign to vaccinate adults. We had mass campaigns for polio and kids.

Jon Cohen

Right.

Ronald St. John

But I think that was the last time we had mass campaigns. Now we vaccinate kids as they’re born. But to do everybody, to vaccinate adults of all ages, all occupations is a huge undertaking,

Jon Cohen

Especially with a priority scheme. If you just opened up the doors and said anyone can get a vaccine who wants one, it’s much easier. But when you start prioritizing health care workers. “Now okay, now we’re going to include nursing homes. Okay, now we’re going to include over 75, over 65.” It creates massive confusion here in California right now, you can get a vaccine if you are a food and agricultural worker or if you work in a grocery store. Okay, how do you prove that? Well, you know, you show up with your pay stub and do people take advantage of that system? Of course, they do. They forge documents, and the vaccine superstation where I’m a volunteer. My job last Friday night was being the first screen of people who showed up with documentation and wanted vaccine. And I had to turn away a lot of people. And it was almost comical the way people lie. And the way you know, and it was almost comical that I’m telling people, they can’t have a vaccine. I want them to have the vaccine. Who wants to turn someone away? So that’s part of the dilemmas that we’re prioritizing because we’re rationing. We’re doing a ration system. Yeah. Because of a shortage.

Ronald St. John

Yeah, absolutely.

Metta Spencer

So, it’s something about barcodes or, you know, there’s little things that you know, that they stamp on things. Apparently, they’re going to be using those and I noticed, I think today’s papers said that Canada is not set up with enough of those readers. Cell phones can do it. But the Government of Canada can’t.

Jon Cohen

Well, man, I was just speaking this morning with a researcher in India. And in India, they have very organized electronic medical record system for 1.2 billion people. And they sell smartphones for as little as $10. And basically, they’re not struggling with these issues the way we are. There are privacy concerns, certainly. And then you start to think about China and the way China uses smartphones to track people. But when it comes to public health mass campaign, this thing right here is a phenomenal tool that we haven’t figured out how to properly use and India has, and China has, and Israel has. You know, Israel has for HMOs for the entire population, it’s only 9 million people. Everyone has an electronic medical record. Every COVID-19 test you take is in your record, every vaccine dose you’ve received as in your record, every hospital visit you have for anything is in the record. If they want to figure out what’s happening with a vaccination campaign, they punch buttons on a keyboard, and they get answers. We can’t do that in the United States. We’re so fractured here that, you know, I there, there are four major hospital systems in San Diego alone, where I live. And they don’t talk to each other. And if you go from one hospital system to the other, you don’t just press a button and move your records. Oh, you file all sorts of confidentiality agreements, and you wait three weeks and you pay some money. And then maybe the records get there, and maybe they don’t, it’s a mess.

Metta Spencer

Okay, there’s one final thing I’d like to ask you to consider. And that is the question of actions that will try to stop the spread of pandemics in the future by early warning systems. And I particularly want Ron to describe the GPHIN system. Because when you were working for the Canadian government, you were in charge of this outfit, which you can, I’m going to let you describe and see whether or not… I know that the history of it has gone bad. But is there a prospect of being able to revive it or even expand on that kind of thing? Tell us about GPHIN, Ron.

Ronald St. John

Well, GPHIN stands for Global Public Health Intelligence System. And is the product of something here that we started, we created about the late 90s, when we realized that, given global mobility, infectious disease could be on our shores within 24 hours from anywhere in the world. And we needed we thought we should… we had a couple of incidents, that pushed us to develop a system that would monitor media worldwide, for outbreaks of disease. And so, we could anticipate – and that’s the key word anticipate -that we might have a problem here in Canada. So, we created this system, it was the first ever computer-based monitoring system. The World Health Organization bought in, so did CDC, and we’re still going today. But in 2019, early 2019 – and before that – the government sort of felt that, well, there’s not much happening in the world right now. So why are we spending money on this early warning system? Why shouldn’t it be diverted to other priorities? And they said, well stop issuing international alerts, because we just don’t need those. There’s nothing happening in the world. That was in May of 2019, which was about seven months before COVID came. So, our early warning system got muzzled. And it has become a big issue with now a panel of inquiry looking into what happened, why, and so forth. There are lots of reasons, it’s complex. But the… we feel strongly, I feel strongly that we need the early warning systems, not just based on media, but looking at other innovative ways of finding out things like Twitter’s and social, some people talk in on their social networks and we may be there’s a lot of noise there but sometimes there might be some important information. We need to know how to tap into that and other systems as well. To enhance our capacity to detect something that we say uh-oh we need to anticipate this might become bigger.

Metta Spencer

Well, shouldn’t this also be global in scope.

Ronald St. John

It is global, Metta. Now. It has been global for some time, and it has been linked into the WHO, the World Health Organization. And it is now part of something called Epidemic Intelligence from Other Sources. EIOS Programme at WHO and GPHIN contributes about 20% of the information. Now, there are lots of different like systems: PROMED and Health Map and you name it. I mean, there are lots now. And they’re all being they’re trying to consolidate this information in WHO with some difficulty, because the systems are not compatible and there’s a lot of noise in the systems. But GPHIN i contributing about 20% of the information that WHO has at the present time. But GPHIN has not been updated or modernized, especially with its IT in some time. So, there’s a big issue now about what to do with GPHIN and how to how to get it back on track. Here in Canada and with WHO and the rest of the world.

Jon Cohen

And upstream of that we need more aggressive surveillance of animals that potentially have pathogens that can jump into humans. There is surveillance that takes place of bats and pigs and chickens. And it is useful, but it’s not done aggressively enough. And the US had a program called predict that in a similar timeframe was defunded right before the pandemic. That was a global collaborative effort to do animal surveillance to try to look out for potential, what are called zoonotic events, the jumping from one species into us. And if we can identify, let’s say, a pig farm that has an influenza virus that has never been in humans, but could grow in human cells, we could potentially, for example, vaccinate those pigs or take some other measures to protect the workers there from becoming infected by those pigs. And that’s where we’re failing upstream, is we’re not aggressively enough doing the surveillance and acting upon what we find to prevent zoonotic events, like the one that likely is behind the pandemic we’re experiencing right now.

Ronald St. John

Yeah, I mentioned there is this movement called One Health. And the basic principle is that our health is inextricably linked to our animal’s health, and vice versa. And the fact that we’re all here on one planet. It’s all linked. And there’s there is a movement to do exactly as you say, Jon increased surveillance and… Go ahead.

Jon Cohen

I was just gonna say the One Health movement is tremendous. Several years ago, they held a meeting in Mongolia for the One Health Conference and they held it there because more humans live with animals in Mongolia, it turns out than anywhere else.

Metta Spencer

Really? Horses, they ride horses. I have pictures of them doing it. What else do they do?

Jon Cohen

 Well, they have horses, cows, pigs, chickens. I mean, the way that farming and agriculturally based communities live with animals creates a lot of opportunity for viruses and other pathogens to jump around.

Metta Spencer

Yes, but they tell me that the contact is increasing. Now that I don’t understand. Because you know, yes, we are tearing, building houses in jungles and you know, tearing down habitat. So somehow that seems to be exposing people to pathogens more than even in the days when we were all farmers. I don’t know. And I don’t understand it. But that’s what they claim.

Jon Cohen

There has been a lot of opportunity for pathogens because of habitat destruction. That certainly is taking place. But the primary way … just look at influenza. What happens? Why do we have changing vaccines every year for flu? What is that about? Well, that’s about the fact that chickens and pigs get infected and other wild fowl, for example, get infected with influenza viruses that jump into us. And then they mix with viruses that are already in us and create new variants that we have to deal with. If that happens with SARS COVID-2 watch out. The variants we’ve discussed so far are variants of SARS COVID-2. If you get a mix of a new coronavirus and SARS COVID-2 we are screwed. That’s what worries me.

Ronald St. John

I’m really thankful that this coronavirus COVID-19 has not behaved like MERS coronavirus where the mortality rate is as high as 35%. That would be unthinkable.

Jon Cohen

Ron, imagine if this coronavirus hit children the way it hits adults and we had ICUs filled with dying five-year-olds. We have been so spared of that horror. And I think we have to be grateful that this virus is as wimpy as it is.

Ronald St. John

I agree 100%. As wimpy as it is, it’s a good way to put it.

Metta Spencer

Well, we’ve covered the waterfront. I think that this is very enlightening. I hope you don’t mind if I put some clips from it into Peace Magazine. I’m working on the next issue now. And I think it’s important to share as much of it as I can. So, it’s very kind of you, Jon, to be with us. And Ron, too. I see Ron more often.

Jon Cohen

Well, it’s my pleasure. I really enjoyed the conversation. Thank you. Thank you both.

Ronald St. John

Thank you, Jon. Enjoyed it very much.

Jon Cohen

Let’s stay in touch.

Ronald St. John

Take care.

Metta Spencer

Bye.

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