Dr. Paul Anderson breaks down COVID therapeutics from vaccines to hospital drugs. He reviews approved treatments like remdesivir and dexamethasone, explains why most others remain experimental, and surveys roughly 60 candidates grouped by how they work. He cautions against self-medication and notes mRNA vaccines are fast but their long-term safety is unknown.
Chapters
If you're listening live, it's November 2020, and we still have this thing called coronavirus, COVID-19, going on. And I've been getting just a ton of questions about a phrase that has become— well, it's been being used in the news for a long time, but it's become used more and more as they start talking about, well, what's the future with COVID and coronavirus responses. And are we, you know, like on the West Coast here where I am, we're back on a limited service. There's no, you know, no indoor restaurants, no indoor— a lot of things. They went through and did that, and all 3 West Coast states have agreed to do the same thing. I just returned last week. I was down in Los Angeles. And I was at a recording studio recording the new book, which is Cancer: The Journey from Diagnosis to Empowerment. And so if you haven't checked that book out, you can, but I was recording the audio version for all the audio platforms. But because of the rules, I was able to fly down. Of course, you wear a mask on the plane and in the airport, but I had to get a COVID test there in Los Angeles County. I couldn't do it here in Seattle, so I had to do that, and then I had to quarantine in my hotel until we got the results back. And once I, you know, could prove a negative test from somewhere in LA County, then I could go into the studio. So, you know, it's a lot of these sort of things going on, and it's, you know, you could kind of look at it as that's sort of the cost of doing business nowadays. But one of the things I think, you know, probably amplified by the recent election and a lot of talk around, well, what's going to change around, you know, COVID and coronavirus response, is this phrase COVID therapeutics. And so you've got people, you know, on the news and people who are commentators, etc., and they're saying things like, well, there's going to be COVID therapeutics, and when we get more COVID therapeutics, we'll have less restrictions on everybody, and you'll be able to, you know, get up and move about the country again, etc. Well, a lot of times, as a matter of fact, with only one or two exceptions where they were going a little deeper into this idea of COVID therapeutics, most of the time with those few exceptions, I have not seen anybody really talk about what does that mean? What does COVID therapeutics mean? And if you're listening to it kind of quickly, you might think, well, what, yeah, I mean, what does that mean? Does it mean that we're going to have like one thing that we take and protects us from COVID Or is it just about the vaccines that are in development? Or, you know, or is it something if I have to go to the hospital that I get? And so I wanted to break down today the actual ideas behind COVID therapeutics, the ones that are approved, the ones that are in the pipeline, including the different types of vaccines that are being developed and what they really do and maybe don't mean for the rest of us, as far as being able to, you know, help out. Because as we've talked about before on a number of the programs where we've talked about COVID-19 coronavirus and the way it's going in 2020. We don't have the statistics to know where it's going. We know that coronaviruses as a family usually go in cycles and they eventually burn themselves out, which is usually a good thing. But we still have a fair number of people both, you know, on the, you know, becoming infected side as well as becoming ill with the disease. And so— there's a lot of confusion around what to do. And so largely the response has not been, has not been specifically medical. Of course, if you've had to go to the hospital, you get, you know, whatever the standard of care is at the moment. We'll talk a little bit about that, but the response has really more been, you know, public health oriented things like social distancing and masks and other stuff of that nature. Now, we did have whole programs on some things that we're not gonna really get into today, which are around what I would call hygienic or natural measures that you can employ, things like diet and nutrition and lifestyle and therapeutic use of vitamins and minerals and herbal medicines and things of that nature. We've also talked a bit here because it's related to some of my research, the use of intravenous vitamin C in people. So, Really, all in all, all of those things, you know, we may do some more updates on those, but those are not generally what are talked about as far as COVID therapeutics. Now, there's a lot of people that I see online, and they'll post, and legitimately so, you know, we should be, you know, if we're going to talk about, you know, environmental measures like distancing and masks, you know, things of that nature, why aren't we talking more about immune health with respect to how we treat our bodies and what we feed our bodies and the nutrients we give our bodies and things of that nature. And I think that makes total sense, but generally speaking, although that's sort of a footnote right now, all those natural and hygienic interventions, most of what's going on is more on the public health side. So now they're saying, well, you know, as the— it's November already, so the year's almost over, but as the year is ending and into the new year, we'll have COVID therapeutics. Well, what in the world do they mean by that? And how are those things going to help? Well, we'll start with the big picture, and then we'll sort of boil it down to ones you're going to be hearing more and more about on the news and talk about, you know, what do those things do? Or maybe you've already heard about some of them on the news. We'll talk about what those things do. But here's the kind of the big picture. COVID therapeutics, when they talk about them and they refer to that, you know, sort of phrase, are a spectrum of things that could be anywhere from a reported preventive effect drug or intervention, meaning something like, let's say you had a vaccine that worked, that would be considered a preventive. You could have a few other kind of gambits, medically speaking, that would be preventive. Then you would have targets that are Early treatment targets. These would be things to try and keep you out of the hospital. So you get, you start to develop symptoms, you get tested, it's positive. You know, you do these early treatment measures to try and keep your body from kind of going off the rails and becoming sicker and sicker and sicker. And then there are interventions that would be either directly pre-hospital or in the hospital inpatient type treatment, or maybe even in the follow-up period. After the hospital. So you have the spectrum from true prevention, which could include a number of things, to prehospital, to let's say in the hospital or after. So that's what therapeutics are. So you might say, well, what are the things that are approved? Well, the things that are approved are not very many. If you look at something like dexamethasone, which is a steroid, and we've talked a bit in the past about steroids, and so steroids are used to try and mitigate the inflammatory response. We hear a lot about the infamous, you know, cytokine storm or cytokine response syndrome, and that can actually kill you if it goes bad enough. Steroids are there to help with that. It's an approved drug everywhere, but it's approved for COVID-19 in the UK and in Japan, not here. There's an antiviral drug called favilavir that's approved in Russia, China, and Italy, but not here currently. One you've heard about probably because it's been in the news, remdesivir, Another antiviral drug is approved in Japan, the US, and Australia. Then there is under emergency use approval. So this is sort of a, you know, we've got a big problem. And so the government is going to have an emergency use approval pathway to get a procedure or a drug or something to you faster than the normal process would be. And so under emergency use approval, we have 2 things in the US. One is called convalescence. convalescent plasma. We'll talk about that. And then there's another one that's a monoclonal antibody, which we'll talk about what that means, but it's balmanivumab, and it's a single antibody. We'll talk about how it's made, that is there to try and help out with, essentially help out with your body's response. And that's basically it. There's no currently approved vaccines. There are no other really approved therapies. Now, you might say, which would be very logical, well, you know, I went to the hospital with COVID or a family member or friend did, and they did all sorts of medicines and therapies and other stuff. Does that mean those were all not approved? Well, no. When you go to the hospital, what happens— and this has evolved in every country, you know, that's had to deal with COVID which is all of them— but you are being treated with the standard of care for what your presentation is. So whether you go to the hospital with respiratory distress because you have influenza or you have COVID or you have some other problem, you're going to have a core set of treatments for your respiratory problems that are going to be very similar or the same. Specific treatments might be added or subtracted because they know that you tested, say, COVID positive, as opposed to, you know, having another type of pneumonia or some other problem. So you're gonna be given, you know, usually FDA-approved drugs in a particular protocol while you're there. This is why people are sometimes not on ventilators, sometimes they are on ventilators. Sometimes they're given heparin, sometimes they're not given heparin. There are a lot of other options as they go along, depends on how that particular facility treats the problem. So there's treatments for you if you need to go to the hospital. The issue that's going on is we would like to be able to improve the hospital treatment output, meaning less people die and people get healthier faster. We would also like to Make more robust the pre-hospital treatment so that hopefully not as many people need to go to the hospital and they can deal with the problem as an outpatient. Because if you can get through and deal with the problem as an outpatient, and it's putting no danger on your life to do that, you're actually in a lot better position than going into a hospital. As soon as you get to the hospital, that might be very necessary for you medically speaking. But you might wind up having a higher risk for other complications. Obviously, once you get to the hospital, you've already got some big problems going on. So when we talk about COVID therapeutics and they throw that term around in the news, it's sort of a, you know, a blue sky in the future kind of an idea saying, we hope that of these, you know, hundreds of things that are being tested out in the pipeline, we come up with a group of them that will work work in the spectrum from prevention through treatment of all types, and we'll have more than what we have now. We can prevent more disease and we can treat more disease early and keep more people out of the hospital. So that's what they really mean. They don't really, because it would be inappropriate, they don't have a list where they're going to say, well, it's going to be these 4 things for sure. Okay. Because then you have to step back and look, and even within the US, what we call Operation Warp Speed, where they're pushing things through the system as fast as they possibly can, which has, of course, both good and bad things to it. You push anything through a system faster than normal, you cut out a lot of red tape and a lot of other stuff, but you can potentially engender some, you know, issues that may be sorted out with a longer process. So it's not that that's all good or all bad, this Operation Warp Speed, but the idea is to try and get usable worthwhile treatments to the public as quickly as possible. The understanding in the scientific and regulatory community being that might mean that we put some things into the public domain that are not as safe as they would otherwise be. Now, one, you know, not really caveat, I suppose, but one just a bit of reality I'd like to interject there is that Having had a, you know, little tiny role in the world of medical research, what I would say is there are things that take forever and ever to get approved, long time, and they still wind up having unintended consequences and safety issues and all kinds of other stuff. So the fact that it's doing faster and you might get more, you know, untoward things that you don't want. You know, it's not probably as big of a deal as you might think. Yes, it's something we have to be careful with, but I've seen things that have gone through a very long process and still wound up creating a lot of trouble. So let's talk about some of the things that are in the pipeline and either available under emergency use or probably really close. So the first thing is just a terminology difference, and I think this is really important because we hear that names, they have partly the same name, and it sounds like they might all be the same thing, and that could be true or could not be true. So the 2 that I get the most questions about, and are they the same thing, and is this what I heard about, you know, so-and-so getting on the news, one is a monoclonal antibody, and then the other is an antibody cocktail. Okay. Now, the addition of the word cocktail doesn't sound terribly scientific or medical, but usually when that's spoken about with respect to drugs and procedures, it just means that it's a mixture of either approved or somewhat approved procedures or drugs. So the difference is there's a lot of monoclonal antibodies in the pipeline to help with the treatment of COVID and they all do different things. But a monoclonal antibody is not a group of antibodies. It's literally, when they say monoclonal, it means that they all look exactly the same. Now, why would that be helpful to have a cloned antibody that's, you know, there's a billion of them, they're all the same thing? If the purpose of that antibody is to go out and land on one receptor type or trigger one type of cellular reaction, and not others, then you want it to be monoclonal. And that's something that we've been developing in, you know, pharma— pharmacy science for years and years. There are a lot of biologic drugs that are monoclonal antibodies, both for cancer and autoimmunity and a few other indications as well. So monoclonal technology is out there. It's a thing that can be done. Now, if you look at the list of Candidate drugs. There's a large number of candidate drugs. You know, if you pull up these lists online and you look at where they are, there's a group of candidate drugs that I was studying for this to try and wrap my head around what people are using. There's about almost 60 of them. Many of them are monoclonal antibodies that already exist, so they're already a monoclonal antibody that was going to be used for an autoimmune condition or maybe cancer or something. something else. And the people who developed it said, well, wait a minute, we have this problem with SARS-CoV-2 or COVID-19 disease. And it would appear this monoclonal antibody we developed for this other disease might shut off part of the COVID disease process. So that's why you see these on there. So there's a lot of what we call biologic drugs on here. Many, many of them are monoclonal antibodies. So whenever you hear clonal, if it's monoclonal antibody and they They all end in MAB, M-A-B, so that you can remember that. But when you hear about monoclonal antibodies, they're engineered to all look exactly the same and reportedly go and do the same job in the body. And like I said, that could be binding to a receptor type, turning on a cellular process, et cetera, but they're supposed to be targeted. This is when you hear about targeted therapies. Now, what's the difference between a monoclonal antibody that is a targeted therapy and then something like an antibody Antibody cocktail. Well, an antibody cocktail, or its relative, what we've heard about a lot of people using in some places called convalescent plasma, although the word antibody is not in there. When you look at things like convalescent plasma or antibody cocktails that are administered to people, those are pre-made antibodies. And one, the antibody cocktail generally are lab-made, and convalescent plasma are actually extracted from people who have had SARS-CoV-2 infection, and then the antibodies are extracted from their plasma, hence convalescent plasma. So either from a laboratory or a base or a human base, an antibody not to go and turn on a process in your body like a monoclonal antibody would do, or turn it off like a monoclonal antibody would do, but an antibody that's actually against the SARS-CoV-2 virus, COVID-19 agent, is put into your body to go in and block it up. Now, why would that be useful, and have we ever seen that in medicine before? Well, if you look at, there's a few cases where those things are used. We don't really call it an antibody cocktail, but you can get a pre-made gamma globulin, an immunoglobulin, which is an antibody. And if you have, say, hepatitis A, you get a shot of gamma globulin. Well, that's a shot of an antibody protein that has been sequenced and synthesized so that it goes and blocks the hepatitis A virus. So it's the same kind of technology as giving someone either the antibody cocktail or even the convalescent plasma type treatment. So in that case, what you're doing is giving a grafted immunity, meaning you, the patient, have this viral infection and the antibody cocktail of one type or another is put into you, and then it goes around and starts to block up the virus, because that's what antibodies do when they're used by the immune system. Right. Initially, the B cells help make them, and then they block up the virus. Now you might say, well, would I like have to keep getting that? Or you know what's the deal there? Well, with infections, and especially certain types of viruses, it's a numbers game. It's a time game. So if you have a virus that has this huge variety like SARS-CoV-2 does, so you get people that get COVID-19 and they have minor symptoms. and then they're fine. You get other people get COVID-19 and they get big symptoms and then they have a lot of problems afterwards. And then you get people that get COVID-19, they're in the hospital and maybe they even die. This giant, giant variety. So when you're treating people, you're treating for the worst possible outcome. And it's a time— there's a time-sensitive factor. So if I can go to you and give you some kind of antibody mixture, whether it's from something like convalescent plasma plasma or an antibody cocktail or something of that nature, it will go and it will decrease the amount of virus that's available, but it will also then stimulate your immune system to say, oh, we're binding these viri up, these particles up, or whatever the antibody is targeted to, and then that will trigger more of your own B cell and T cell activity to go on. Now, if you, if you want a little deeper dive into this, 2 sides of the immune system, the B and the T cells, there's a previous program that I did all about that, that's just about 8 weeks ago, and it's about COVID and the immune system. But so those are very promising, and they've been used experimentally in people. I believe that the US president when he went to the hospital, had the antibody cocktail and a few other things. So those, those show some promise. Okay, then there's things that are like antivirals, like remdesivir. Remdesivir is an antiviral that reportedly, you know, will help, which has been used actually in a few countries and is around. And if you go to the, you know, this big list of things in the pipeline, of course it is, it is in there too. And there's a number of ways that that can kind of, you know, be of use. Now, when you get to these antiviral drugs and then things like the monoclonal antibodies and stuff, things that aren't the antibody cocktail or convalescent plasma approach, There's some targets that you're trying to do. So one target is to increase your immune response, increase an immune reaction that is at the, at the virus, hopefully. Another target is to actually block the virus from replicating, because the way the virus gets a foothold in your body is it gets in your cells, and it replicates in the cell, and then it goes out and replicates in more cells. Okay, so if you can block the virus, that's great. And there's another target which is more on the let's not have you get real sick and die end of the disease, and that is blocking something in the inflammatory process, trying to shut down the cytokine storms, all of that. And then there's an extension of that which is trying to target the disease-induced dangers that come along. That would be things like like the overall inflammation, clotting, decreases in oxygen saturation in your body, and all of this stuff. So there's a lot of other targets. So when you go through this list of, you know, almost 60 drugs that are in the pipeline, if you subtract out the antibody cocktail type things, most of the rest of them are targeted at one of these areas. So for example, you'll see things like Over-the-counter, you know, things we would consider as like an antacid, like an H2-blocking drug, histamine subtype 2-blocking drug. And you start to think about it and you think, well, why would I be taking Pepcid, you know, for my COVID? Well, the Pepcid, that literally is one of the things that's in phase 3 because it's already widely used. It blocks a type of histamine receptor. And basically, if you look at their rationale for putting it forward as a COVID drug, it's not because it helps with the virus or viral replication, but it helps with one of the other categories, which is to diminish the inflammatory effect as things go downstream. So then you've got The antibody cocktail Regeneron, you've heard of that one that's been in the news a lot. Again, we talked about antibody cocktails. Then you've got a ton of monoclonal antibodies and kinase-manipulating drugs. These are all in that biologic category, and most of them are designed to modulate the immune inflammatory response. Now, some do different stuff, but most are there. So they're not really there to trigger your immune system to do something. In most cases, they're there to try and level out the disease response. And so you think, well, then I've already got the disease and the drug isn't doing anything to help me with the disease. Many of those drugs are there to try and manipulate and modulate the inflammatory response so that you don't get sicker and die from the disease. So they are— the target there is your— the horse is already gotten out of the barn and you're chasing the horse down to try and get it back in the barn. You've already got the disease. They're trying to minimize the damage downstream by most of those drugs. And if you look at all, you know, all 55 or 60 or whatever's on here, most of them are disease modifiers. A few are viral replication inhibitor blockades or viral blockers. And then the rest are going to be antibody-oriented, not monoclonal antibody, but actual antiviral antibody-oriented. And you'll also see on here, they have an extremely old drug, aspirin is on here, it's being studied, and it's in trials. And again, you know, aspirin has been around for a long, long time, but its purpose, much like the H2-blocking drugs, is to look at muting the cytokine response, muting the inflammatory response, etc. And if you, if you watch You know, the one of the things I've said on the programs all through our experience here with SARS-CoV-2 COVID-19 disease is you'll see science and the news reports about science do this ping pong thing where initially they'll say, "Oh, might be good to take aspirin." Then it's like, "Oh, it's really bad to take aspirin." Oh no, it's good to take this. This those things will go on a long time, and that's actually one of the problems with rushing. the drugs to market to you and I is the reason that science ping-pongs back and forth on drugs a lot is that we get a drug, we get it approved, and we know what we know at that moment about the people we tried it out on. And then what happens if we release it to a large population and let's say 100,000 or half a million or millions of people use the drug, the chance of you Discovering side effects or discovering patterns is a lot higher when you put more people into it. We'll talk about that with the vaccine discussion coming up. Oh yes, you thought I forgot about vaccines. They're, they're coming up very soon here. But, um, so the other thing is things that are inflammatory manipulators, like aspirin's a simple one. Turns out There are times when the dosage of something like aspirin makes a very critical difference. And so a dosage that is normally too low for its normal purpose might be an appropriate dose, whereas a higher dose might do too much of a good thing. It's sort of the same as the steroid discussion. We've seen this go back and forth with steroids. It's the same to a degree with heparin, the, the blood thinner, so to speak. Those things can be used very, very well. And we've gotten a lot better at them to keep you, you know, from dying once you're in the hospital, but you don't want to overdo them. Because while in the hospital, especially, we don't want you to become so inflamed that you have clots and you can't move air and all that stuff anymore. But we also don't want to have so much anti-inflammatory effect that we shut your immune system off. So it's a really, really tight balance. And there's nothing easy about that. You know, there's a lot of people that will, you know, kind of slam the medical system or whatever about, oh, well, you know, this, like, you know, like the medical system is trying to do this wrong. But when you get something that's got a new, and what we call novel virus, it's got a new way of doing things. You know, even though it's in the SARS family, SARS-MERS family, it's still got some different tricks. So you develop your drug protocols based on what works, and you find out when you go too far one way or the other, and you modify And that's what's been happening. So the goals and the targets of the drugs that are in the pipeline, like I say, are either direct grafted immunity, such as the antibody cocktails, convalescent plasma, that sort of thing. Or they are viral blockers, replication or other blockade of the virus once it's in you. Or they are there to try and mitigate a problem that will happen that could harm or kill you, such as the cytokine response syndrome, extra inflammation, clotting, heart, lung, brain problems, all of the things we hear about. So the drugs, if you look at them, are targeted to all of those areas. So that's a good thing. Now, we only, as I said, we only have in the United States, we have remdesivir, the antiviral drug that's approved. We have convalescent plasma and one of the monoclonal antibodies approved under emergency use, so you can use them under, you know, some tight controls. And then you might say, well, you know, didn't I hear that you know, the president got Regeneron, which is experimental and it's not approved. How did you know that happened? Well, the president can get pretty much anything that their doctors want to give them. And so that's why the president got Regeneron as well as some other stuff. So along the way, there's a couple others I think that deserve some honorable mention. One of them, which I was just talking to a doctor yesterday, they called me and they, they were asking some questions about COVID And I said, well, the, you know, the other thing that you might want to look at is this, the drug. It's a, it's an anti-worm drug that's used a lot in veterinary medicine, a little bit in people, which already sounds weird to use a parasite worm drug with a virus, but it's called ivermectin. And it's been in the news. Ivermectin is one of those drugs where It's used a lot with large farm animals because they get a lot of, you know, worms and things of that nature. It is used with people. It's been studied around the world. We actually use it experimentally in cancer patients. And it's also now been used experimentally in, in SARS-CoV-2 COVID-19 disease. And you think, well, what in the world is giving someone a parasite or a worm treatment doing for a viral problem? Well, it turns out that ivermectin actually has a viral replication blocking capability. So just like in cancer, when we use it experimentally, it's not really used for its anti, you know, worm effect or parasite effect. It's actually used for its immunologic effect. And with viruses, kind of the same thing. Now, one thing I want to make clear is I am educationally talking about all of these therapies. I'm talking about a lot of things because that's the purpose of today's podcast, is talking about a lot of things that aren't approved yet. So by no means is any of this medical advice for you. So, you know, I don't want you to go in and ask for Regeneron or ivermectin or whatever. I'm just kind of telling you the lay of the landscape of what they mean when they say COVID therapies. therapeutics are coming, that's what it means. It's this collage of medications, some of which will be approved, some won't. And there'll be more tools for the doctor to use all the way from prevention to, you know, bad treatment in the hospital. So that's all that is. Don't, don't take any of this and try and treat yourself or any of, any of that. And there's a bunch of other drugs we could look at and talk about, but they basically, you know, kind of fall into those Areas now, in the last portion of today, I want to talk about the vaccine proposition that we're seeing. We're seeing more and more vaccine talk in the news. We're seeing now some statistics again. If you're listening live, it's November 2020, and so if you're listening in the future, the statistics and everything I'm about to say about vaccines could be totally different, and and maybe none of it will apply at all. But As of right now, if you look, you've got about a total of around 50, maybe a little more vaccines around the world being tested. There are phases when they say it's in phase 1 trial or phase 2 or phase 3. Phase 1 is usually about safety and maybe dosings and Then if it passes phase 1, it goes to phase 2. It's about more safety. And phase 3 is larger scale, looking at did it work once we figured out it was safe. And then it goes into early approval. Right now, of all of them, there are none that are fully approved because we've not had the virus around that long. And even at the very best that modern science can do, the development of a vaccine takes some time. So yes, there are a bunch of these vaccines around there, but none are approved. Now, are some of them on the list to be approved? Yes. So if you look at things that are in the pipeline, okay, I got my numbers close, 48 vaccines are candidates for clinical evaluation, meaning that they're already in the phase 1, 2, 3 process. of them, but if you look at the total, there are right now 164, 164 different vaccines in preclinical evaluation, meaning that they are being looked at with respect to the science that creates however you make that vaccine. They are being looked at with respect to What, what the vaccine potentially can do to cells, and then the next step in the preclinical evaluation would be we've looked at it in cells, now we look at it in animals, and then it goes into the world of phase 1, 2, and 3, which would be putting it into people. Okay, so that's where we're at. We've got a lot of vaccines there now. Obviously, there's, you know, you think, well, what's, what's driving all of that? Well, you have a novel virus that's affecting a lot of people around the world. One thing is just scientific development of things that may help. The other is, of course, there's a large potential profit that might be made as well. So, you know, these things are generally not done for free. So there's a little bit of all of them that are possible there. So when we think about vaccines and all of that, we want to talk about some unique things around vaccines with respect to coronavirus, SARS-CoV-2, COVID-19, all talking about the same thing. Now many of us have had a vaccine for something or a lot of vaccines for something. I don't know if you ever see those things about, well, if you know, if you're born in this year, You know, you had like 1 or 2 vaccines like me. If you're born 10 years later, you know, you had 12, and 20, 30 years later you had, you know, 20 of them. Vaccines change over time, the way they're done changes over time. But if you think about, say, you know, getting a tetanus shot, so tetanus toxoid was for a long time the type of tetanus vaccination so that you wouldn't get a spore-forming bacteria from a cut outside or something, Clostridium tetani, and then, you know, get tetanus, lockjaw, and maybe die from it, something unpleasant like that. So most of us kind of think of vaccines in that respect. Well, then you get over into the world of things that, you know, are a little more dicey, a little more tricky, and that certainly explains something like a SARS virus. So the SARS-MERS family There never was a vaccine developed for SARS-1, SARS-CoV-1, or MERS. There just wasn't. Now there's different explanations for that. Some is it's hard to do, some is they kind of burned out, they're not a big deal around the world. Remember I was saying earlier the coronavirus family, if you get a bad bad one, you know, like the SARS-MERS family, they tend to peter out eventually anyway, which is true. So there's that as well. And then the other thing is, there's just a numbers game of, well, if the infection rate has gone down because it's kind of burned out in the world, and we may not see that virus again, or it might be a long time before we see that virus again, Is it really worth, you know, going through the process of making a vaccine? So regardless, there's no vaccine for anything in the family right now. Okay, so that's the first roadblock. Now you've heard probably about a few of the ones I'm going to mention now. Obviously, there's 48 in current human clinical work and 160-whatever in preclinical work. We're not gonna talk about all of those, but I wanna talk about a couple of the big, what I call the big ones, because they're the ones you're hearing about and they're the most likely vaccines to come to a market near you and be maybe offered to you. Now, what's the upside of a vaccine? The upside of vaccine is if it works, And you're vaccinated, you have an acquired natural immunity. Now, what's the normal way we acquire natural immunity? If I go and I get SARS-CoV-2, COVID-19, and I live through it, I generally have acquired immunity to that because my immune system makes memory recognition. And I said in the previous one, you look at the COVID-19 immunity podcast. You can go back and look at that. COVID-19 appears to be a little bit unique in the way that it does that with people, but it does happen. So that's natural acquired immunity. A vaccine is coming to you, giving you a shot, and putting something in your body that would trigger this natural immunity to occur. So it's not really natural immunity, although your body is doing a lot of the work. So, okay, that's fine, that's what the vaccine is supposed to do. What's so different about this particular type of virus and doing a vaccination for that virus? Well, there's a few things. One of them is when you make some something, a vaccine against something, you're usually taking one of two avenues towards it. You either have a virus that is dead, okay, or you have a virus that's what's called attenuated, so it's sort of like it kind of works, kind of doesn't. You put it into the person and they build up an immunity against So if you look at the polio vaccine, the Jonas Salk, there are 2 versions. The Jonas Salk version, if you got that, you had to have a shot for it. That is a dead virus, okay? Can't get polio from that. You look at the Sabin version, which is the oral polio vaccine, that one's attenuated, and that actually potentially can cause polio. So attenuated vaccines, if it's, you know, partly live virus, are always a little bit dicey in that respect. The other thing is, because there's so much cross-reactivity with the coronavirus family, you have to have something that's specific enough so that it will actually make your body have an immune response against the particular SARS-CoV-2 in this case. Now, and I admittedly try not to watch too much news because I think that aside from knowing, you know, what's going on. And, you know, if there's any big things coming down the pike, a lot of the news, if you overdo it, is pretty toxic, is an influence mentally. But as I watch, because I try and keep up with what people are saying, especially around COVID therapeutics and stuff, one of the ones we hear a lot about is the Moderna version of the vaccine that is coming. It's in phase 3 trials right now, which means that if it's approved at the phase 3 It can be start— it can start to be released to broader groups of people. That's why you're hearing about this one. This is the one that has 2 doses. So you have— you may have had a vaccine in the past where you had to get a booster dose. If you have a hepatitis B vaccine, it's usually 2 booster doses. It's, it's like that. But the Moderna version is one of those that we hear a lot about called an mRNA. Or a messenger RNA vaccine, and the idea is that you inject into you, instead of injecting an attenuated or a slowed-down virus or a dead virus to make you make immune activity, mRNA is injecting you with a code, okay, RNA is a code to replicate different things, so messenger helps with that. You get injected with messenger RNA. The Moderna one is there to make your body produce these viral spike proteins. So coronavirus, corona means crown in Latin, and it makes your body make these spike proteins, and then you develop an immune response against those. The idea being, if then our friend SARS-CoV-2 comes along, it has spikes too, And your immune system will say we don't like those, and it will block it and go after it and try and inactivate it, take it out. Now this one is you know the controversy around the mRNA ones are first we've never had a human mRNA vaccine, just never had one. It's been used in primates, and it has worked in primates to some degree, but we've never had a human. So that's one thing. So it's not like we're using like old technology, we're using new technology. The upside that people will tell you, you hear this on the news all the time, is these are very fast to produce, which is true. Okay, so we got that. Recently, like in the last week, you hear, oh, well, it's got a 95% success rate. Well, that's a little bit— now, okay, numerically, that's true. But you want to be thoughtful about this when you hear it and think, well, gosh, so if I give it to a million people and I had a 95% success rate, that's going to protect, you know, most of the million people. Well, here's the problem with talking about 95%. It was 95 people, okay? And out of them, 95 people who got either the placebo or the real injection, 95 people got COVID. Wow. So of the 95 people who got COVID, 90 out of the 95 had, um, the placebo, so they didn't have the real vaccine, and 5 did. So they're saying, well, it's about 95%, uh, effective then, because if that many got it and only 5 of the people actually had the vaccine, it must have worked pretty well. Yes, those numbers do work. out. The problem is, if we take that, and if it was any other normal time to make a vaccine, we would do that then in a larger and larger and larger group. What's being talked about is jumping that now to bigger groups very rapidly. The trouble with the mRNA vaccines is, and this is in every paper that critically assesses them in the peer-reviewed literature, the trouble that we see with the mRNA vaccines is You can trigger some things such as autoimmunity and other reactions. So one of the things that you need to really be careful with is if you have other diseases, before you rush and get an mRNA vaccine, you really want to speak to your provider. If you have, say, MS or another autoimmune condition, or if you are prone to autoimmune problems, you want to talk to your provider about Also, this whole thing about 90-95% success, yes, but we don't know if that's going to last when you get to big numbers of people. Maybe, maybe not. There's also the Pfizer, and it's another company, but the Pfizer one, which is an mRNA, it's also a 2-dose one. It triggers things a little bit differently, and they're saying 95% success rate. And again, that's about in 164 people, so still pretty tiny number. Yeah. Then there is a Zytus DNA vaccine. This is a skin patch vaccine. This one is not an mRNA vaccine. This is using a type of DNA that's usually a free piece of DNA that's in our bodies outside the nucleus of the cell called a plasmid, and it is there to try and create an immune response, and it's coded to create immune response against the coronavirus. This is a little easier to give out. It doesn't require freezing and refrigeration and all that other stuff. So that's kind of the big thing, and there's no needles. It's a patch. Then there's one that's talked about a lot, but it's not really, I don't think, out of phase 2 trials from Imperial College in London, and this is what's called a self-amplifying RNA vaccine. So mRNA is, is usually stable amplification, meaning we give you a certain amount, it goes in, makes these spike proteins that you develop immunity against, and it's done its job. mRNA is fairly fragile in that respect, so that's often why there's 2 doses. In a self-amplifying RNA, it goes in, and in the case of the London one, the Imperial College of London one, it's an RNA that goes in and causes itself to multiply essentially its effect. So it doesn't— it's not a one-to-one effect like the Moderna one. It goes in and it, it actually shotguns and it goes to your muscle cells, and it makes your muscle cells make these spike proteins. Okay. There's A self-amplifying RNA vaccine has a benefit, so-called, over an mRNA vaccine in that you need a lower dose because it's going to get in you and do more work. Now, those are the main competitive vaccines that are going on right now. Are they good? Are they bad? I will leave that to you to decide. The thing that you need to be cautious with and thoughtful around is these are being pushed through a system that is used to taking very long times to judge safety, and we still don't get it right with very long times. We've not ever had mRNA or, or self-amplifying RNA vaccines, or even really any SARS family vaccines So we have to be a little bit thoughtful about we're making something and we're basing our 95% success rate on a few people. Is that going to carry over when we put it into 100,000 or a million people or millions of people? We don't know. Okay. So we just have to move forward closely and watch. If you have autoimmune issues or if you have immunologic issues or if you're on drugs that manipulate your immune system, please talk to the doctor who manages your care before you do these or enroll as one of the first people out of the gate. But we are now— I'm going to get the electronic hook. We are now out of time. And I wanted to talk to you about COVID therapeutics that they're saying in the news. We'll have COVID therapeutics, and then that'll help us all get our move around the country and everything. We'll see, we'll see how that all turns out. Today's hour has just been a little review of what they really mean and the pluses and minuses of all of that stuff. But I'm Dr. Paul Anderson, Medicine and Health with Dr. Paul, and I'm gonna sign off for today and see you next week.
