Trump says coronavirus therapy drugs 'more important' than vaccine despite $1.6bn investment to inoculate

[Mary Wilson]

John T Bennett Washington Bureau Chief @BennettJohnT

Donald Trump on Tuesday called therapeutic drugs to treat coronavirus "more important" than a vaccine just hours after his administration cut a $1.6bn deal to give taxpayer funds to a Maryland company that has never brought a product to market to develop 100m does of a vaccine.

Therapeutic medicines "get you better," he said after his administration struck its largest deal yet towards vaccine development, this time with an unproven company, Novavax. He ignored the fact that a proven vaccine would make Americans immune from catching and spreading the disease.

https://www.independent.co.uk/news/world/americas/us-politics/donald-trump-latest-coronavirus-vaccine-therapy-drugs-inoculate-a9606881.html

[Emily]

Novavax has been getting hundreds of millions from BARDA since the 2009 swine flu days. I prefer the idea of treatment drugs for diseases like this, too, but pharma companies don't. There is a lot more liability for a treatment drug so they have to be really careful about safety. Vaccine makers are judgement proof.

https://www.thepharmaletter.com/article/barda-continues-novavax-influenza-vaccine-programs-following-in-process-review

[JJackson]

He ignored the fact that a proven vaccine would make Americans immune from catching and spreading the disease.

If we get a working vaccine there is no guarantee that it would prevent infection, it is more likely to reduce severity which would be a win anyway.

[Pathfinder]

Remarks by President Trump on Safely Reopening America’s Schools

EDUCATION

Issued on: July 7, 2020
East Room

3:12 P.M. EDT

THE PRESIDENT:
...
You know, our mortality rate is, right now, at a level that people don’t talk about, but it’s down tenfold.
...
We’ve pioneered new treatments that are dramatically improving the health outcomes. Vaccines are doing very well. Therapeutics are doing very well. The therapeutic research has been incredible. And I think you’re going to have a lot of big things happening long before the end of the year, on both vaccines and therapeutics. Therapeutics is, I guess, a little bit of a word we can use for “on the way to a cure.” But they make you better. I mean, to me, the therapeutic is even more important than the vaccine at this point because people will get better.
...
SECRETARY AZAR:
...
When we think about kids and schools, the school for our children is a center of so much of their life. It is where they get healthcare, it is where they get mental healthcare, it is where they can — many of them get nutrition. It is — it is where mandatory reporting of child abuse and sexual abuse happens most often because of the nature of mandatory reporting requirements, in addition to the social, physical, intellectual development that the kids needs from a physical setting in schools.

We’re at a very different place now than we were two or three months ago. We have the world’s most robust testing system, with close to 40 million tests having been done. We have health system capacity and personal protective equipment to enable us to work through these outbreaks that we’ve got.

We’re advancing on therapeutics, as the President said. We now have remdesivir for hospitalized patients, steroids for lung illness. We have convalescent plasma to treat individuals. And just this morning, the President made a major half-billion-dollar investment in a monoclonal antibody that will be a treatment that could, if approved — if successful and if approved, could deliver hundreds of thousands of doses as early as late summer, early fall.

We have three vaccine candidates, and just this morning, invested $1.6 billion in a fourth vaccine candidate that could deliver hundreds of millions of doses this fall and into early next year.

So it’s just a very different circumstance than we ever had before. We know more about this virus. The fatality rate is going down because we’re better at taking care of patients with the virus. Our fatality case rate in the United States is among the lowest, if not the lowest, in the developed world right now.

And we can reopen our school safely with what we know. And it’s really simple practices of common sense. It’s social distancing. It’s wearing face coverings when you’re in a setting that you can’t social distance. And it’s practicing good, personal hygiene. The tools are there to bring our kids back safely, to protect our teachers and our staff, and it’s time to do it now.

THE PRESIDENT: Thank you, Alex. And good luck with all of the therapeutics. I know you’re getting very close. Very close. That would be incredible. What are your chances early, like in September?

SECRETARY AZAR: So, Regeneron, which is the one that we funded at almost half a billion dollars this morning, they are one of the most advanced. We have several very advanced monoclonal antibody products. This basically takes that convalescent plasma that recovered patients would donate, and bio-engineers that in, effectively, unlimited supply that we can do. And so it’s a cocktail of multiple antibodies to give your immune system an immediate defense. And we’re studying it both for preventing disease, as well as stopping the progression of the disease. So it’s really very exciting.
...
THE PRESIDENT: Do you have tests right now that says — say, “It does work”?

SECRETARY AZAR: Well, you’ve got the initial trial work that Regeneron did, and that’s why we’re investing in the late-stage development of it. But then we have these other three therapies that, thanks to your leadership, we now — we have so many more tools than we had three months ago in terms of therapeutics.

So we don’t want anyone to get sick, but we have much better ways to take care of individuals now than we did three months ago.
...

https://www.whitehouse.gov/briefings-statements/remarks-president-trump-safely-reopening-americas-schools/

[Mary Wilson]

“But if thought corrupts language, language can also corrupt thought.”
― George Orwell, 1984

[Emily]

And we could say that when the world is in a state of mass psychosis, the truth is hard to see. A watershed moment for me is when I heard our governor Inslee admit recently that he knew only one person who died of COVID. That was a nearly hundred year old activist he met a few times. When a politician with vast social and professional contacts (barely) knows only one person who died and that was at a very advanced age, this is no extinction event virus that should destroy the future of a generation.

[Emily]

I think a vaccine for this virus that does not give sterilizing immunity could be very dangerous. In the short term unvaccinated hosts or those who were vaccinated but had no repsonse would be at risk from 'hot strains' that evolve in imperfectly vaccinated hosts. In the long term, you could have the evolution of a far worse virus that could affect the whole human population.

https://www.asm.org/Podcasts/MTM/Episodes/095-The-Evolution-of-Virulence-with-Andrew-Read

Meet the Microbiologist The Evolution of Virulence with Andrew Read
Episode Summary

In the early 2000s, Andrew Read predicted that non-sterilizing vaccines would lead to more virulent disease. He was able to test his hypothesis with the real-world example of Marek’s disease, a disease of chickens. Read tells the story of his discovery, and talks about his work on myxoma virus.

Chickens do not get sterilizing immunity from the Marek’s disease vaccine; they can be infected by the wild-type virus, but the vaccine prevents infected animals from having disease symptoms. These asymptomatically infected animals can still shed the virus. Contrast this to human immunity from many of our vaccines, such as measles or smallpox vaccines, in which our immune response stops the virus from entering our cells and therefore blocks virus replication.

Vaccination inhibits strains with lower virulence more than strains with higher virulence. This fact, combined with asymptomatic infection, means that although the infected birds don’t show disease symptoms, they are more likely to be shedding more virulent (or ‘hot’) strains. This generates selection for these hot strains that wouldn’t normally be successful. Without vaccination, host strains kill the host too quickly to allow viral replication and transmission to occur; Vaccines allow these hot strains to propagate.

Vaccine resistance is much more rare than antibiotic or antimicrobial resistance. This is due to a number of factors, including the diversity of microbial population being acted upon (small with initial infection, large when treated with antimicrobial drugs). Vaccines are much more evolution-proof for these reasons.

Purposeful release of myxoma virus during the 1950s in Australia killed between 10 and 100 million animals, or 99.9% of the rabbit population. Frank Fenner followed the virus and surviving rabbit populations and discovered that myxoma viruses that were too virulent were less likely to be transmitted, because they killed the host too quickly. He also showed that the small surviving number of rabbits were more resistant to viral infection. The arms race between the two has generated a virus so immunosuppressive that Read’s group has found the currently circulating myxoma virus has changed the way it kills its host: the virus disables the rabbit immune system and allows the rabbit’s own microbiome to cause invasive bacterial disease.

https://www.the-scientist.com/features/do-pathogens-gain-virulence-as-hosts-become-more-resistant-30219

Do Pathogens Gain Virulence as Hosts Become More Resistant?
Emerging infections provide clues about how pathogens might evolve when farm animals are protected from infection.
Andrew F. Read and Peter J. Kerr
Sep 30, 2017
...
We can’t help but wonder if something similar is happening in other poultry diseases. Highly pathogenic strains of several viruses—most notably, those that cause infectious bursal disease, avian influenza, and Newcastle disease—arise from circulating strains that are less virulent. The resulting outbreaks can be economically devastating. In all those cases, vaccines are available and often widely used. But none of the vaccines generate sterilizing immunity. We think it should be a top priority to determine whether, by reducing bird fatalities and hence the death rates of hypervirulent strains, vaccines are actually increasing the risk of outbreaks of highly pathogenic avian influenza in birds.
....
PUBLIC HEALTH

Could the widespread use of human vaccines lead to the evolution of pathogens that would be more harmful to the unvaccinated? Most of the human vaccines that have been in use for decades generate sterilizing immunity and so would not be expected to promote pathogen evolution. But next-generation vaccines might be less effective. Clearly, we all hope for malaria or HIV vaccines that completely prevent transmission, but in the absence of fundamental breakthroughs, it seems likely that our current list of vaccine-preventable diseases will soon be joined by a list of vaccine-ameliorable diseases, in which symptoms are alleviated but infection and onward transmission continue. In those cases, it will be critical to understand the possible evolutionary trajectories those target pathogens might take once they evolve in populations that can, just like resistant Australian rabbits, control pathogen titers and sickness, but not prevent infection...

[JJackson]

Emily I have a few issues with this. I do not know what they mean by hot strains but in Flu's case there is no evidence, that I know of, that vaccines promote virulence. What they do do, which is also a problem, is take out that section of the quasi-species that is most closesly matched to the vaccine. If you sequenced all of millions of virions within one chicken you would get a distribution curve about a peak, if you target the middle of the peak then you go from one hump to two with a dip where the vaccine has taken a bite out of those it was best adapted to. As these spread you now have two targets to aim at with not much left that the vaccine works on. The genetic makeup of these humps will probably make them less efficient (the original peak was where it was because that was the best solution the virus had come up with) but how it effects virulence, or anything else, is random.
The article also talks about vaccinated poultry which sometimes become highly pathogenic. I do not know about Newcastle or bursal but for flu the switch from LP (low path.) to HP (high path.) occurs naturally from time to time and has not been linked to vaccine usage - to the best of my knowledge. An LP strain of H5Nx or H7Nx will get into a poultry shed and cause mild disease, usually a drop in egg production, a random change adding basic amino acids at the cleavage site allows a greater range of host protease to cleave the HA. This poly-basic cleavage site makes it HP and most of the chickens die. It is difficult to envisage a cause and effect that would allow this to be vaccine driven.
The MMR vaccines are for viremic viruses which tend to give long lasting sterilising immunity. Respiratory pathogens which are largely contained in the lungs are less likely to. There are 6 human corona viruses and we have not managed to make a working vaccine against any of them, although we have never tried this hard, but immunity, after natural infection, wanes fairly quickly

[Emily]

JJackson, I think Read is using the term hot virus to describe a virulent strain of a common virus. Normally it would immobilize the host so the host couldn't spread the strain widely. But with imperfect vaccine immunity, the host could be low or asymptomatic and quickly spread the virulent disease to others with no immunity. This happened with the new Men B vaccine. They used it at one college to stop an outbreak and that college had a mixer with another college. A vaccinated boy was carrying the disease, passed it to an unvaccinated girl at the second college and she died. We have a thread about that here somewhere.

In that case the disease merited a vaccine. Bacterial meningitis is deadly, (no further vaccine driven evolution needed), to many young healthy people and the conservative use of the vaccine at the outbreak college would have been great if they had quarantined the recipients until they were sure they weren't infectious.

In this case COVID is not nearly as deadly to most of the population as meningitis. The risk/benefit ratio is different. It is not influenza, either, even if influenza is similar as far as the vaccine not giving complete immunity. Even if influenza vaccine has not driven virulence as far as we know, vaccinated people can be infectious without symptoms. That would spread COVID even more and there is a lot of fear about case numbers. It’s really a big unknown as far as whether virulence could increase due to vaccine use. Read talks about it more here:

https://pdfs.semanticscholar.org/a402/c0c3bdcfc69581dc779073429635829ef7d1.pdf

[Shiloh]

"While companies and governments around the world race to develop a safe and effective vaccine against COVID-19, a survey designed by a group at Tufts University found that just 57 percent of Americans said they would get a COVID-19 vaccine if one were available today.": https://www.heraldnews.com/news/2020...e-if-available

In light of the above, one hopes we have better treatment options.

[Emily]

The numbers were down at 49-50% vaccine enthusiam a few weeks ago, so have risen quite a bit. The Seattle woman who was the first to get the mRNA Moderna vaccine 16 weeks ago was interviewed. https://komonews.com/news/coronaviru...eels-fantastic

She's wearing a mask all the time which is a good idea. Sounds like they are still safety testing so avoidance is best for now. Once I started wearing a mask and very quickly fleeing an area where someone was coughing, I never got sick again.