GHC3 Talks

“We have a huge commitment to get our vaccine — and I consider it the best of the best — to the poorest of the world.”

Dr. Gregory Glen, President of Research & Development at Novavax joins the podcast to talk about their COVID-19 vaccine. Like those used for decades to protect against viral infections, such as shingles and hepatitis, Novavax’s COVID-19 vaccine is protein-based. It presents a genuine alternative for those keen to be protected but wary of the newer vaccine technologies, like mRNA.

In this episode, Dr. Glen describes Novavax’s innovative methods, immunity stimulating adjuvant Matrix-M™, and how their vaccine differs from the others available. He reveals the hurdles faced conducting Novavax’s two gold-standard clinical trials amidst the challenging landscape of evolving variants and shares the encouraging data produced.

Currently authorized for use in countries throughout Europe and Asia, and pending emergency use authorization in the United States, Novavax has partnered with the Serum Institute of India to ramp up production. Together they have pledged 1.1 billion COVID-19 vaccine doses to the neediest parts of the world. A move that could, with hope, help accelerate our path out of this pandemic.

Takeaways:

• 01:33 — Elegant and effective: Just what makes the Novovax COVID-19 vaccine unique?
• 05:43 — Conducting clinical trials amidst the challenging landscape of evolving variants.
• 11:05 —Strain change strategy: developing a vaccine especially for Omicron.
• 14:42 — Key partnerships to pledge 1.1 billion doses to the neediest parts of the world.
• 18:54 — Diversity in gold-standard clinical trials.
• 21:28 — More than COVID – collaborating to vaccinate against malaria.
• 25:27 — What is Matrix-M™ adjuvant technology?

Special guest:
Dr. Gregory Glen, President of Research & Development at Novavax 

“It’s a lesson from Bangladesh and research in global health that’s helped almost every American family. I learned we can learn a lot from developing countries.”

Public health security requires a global approach. It’s a fact currently underscored by the COVID-19 pandemic, but one that Dr. Roger Glass, Global Health Expert and Director of the Fogarty Center at NIH has known for some time. In this episode, he talks with our hosts, Dr. Rob Breiman and Ken Berta, about the bidirectional benefits of investing in global health, the role the private sector can play, and the mission and achievements of the Fogarty Center.

Takeaways:

• 02:10 — Lessons for the developed world from the developing world
• 06:00 — Fogarty invests in people and global health security
• 09:30 — How AIDs prepared us to tackle COVID-19
• 12:00 — Private sector’s key role in global health
• 18:30 — Scoping a research agenda to tackle climate change
• 23:06 — Medicine is only good for you if you take it
• 32:15 — A physician’s dream tool

To hear more on global health work listen to our podcast with Dr. Rebecca Martin, “Global Investments, Domestic Dividends.”

Special guest:
Dr. Roger Glass, Global Health Expert and Director of the Fogarty Center at the National Institutes of Health (NIH)

““Imposing a travel ban on a handful of countries in Southern Africa does not reduce your chances of importing the virus … There is absolutely no scientific basis to close your borders to a handful of countries and still keep it open to others.”

In this episode of GHC3 Talks, Professor Shabir Madhi of the University of the Witwatersrand in Johannesburg, South Africa discusses what we know about the Omicron variant so far. He explains that Omicron is more transmissible than Delta and more antibody evasive, but it will be a couple of weeks before we know if it is more virulent.

He goes on to talk about the vaccination challenge in South Africa. While the country has secured supply, vaccination rates have stagnated at 55% of the over-50s and 20% of younger age groups. He cites multiple barriers to vaccination including electronic registration, apathy, misinformation, and mistrust of government.

Finally, Professor Madhi highlights the damage caused to low-income countries by WHO failing to update recommendations in real time and by irrational travel bans from high-income countries.

Takeaways:

• 03:30 — Omicron – what we know, what we don’t know, and how long we’ll have to wait for answers.
• 13:00 — Access and acceptance of COVID-19 vaccines in South Africa:  Supply is secure but uptake is disappointing for a number of reasons.
• 21:04 — South Africa’s previous harsh lockdowns achieved little and will have long-reaching negative impacts.
• 24:16 — WHO failed to update lockdown recommendations in real time based on data. That came at a high cost for low-income countries.
• 28:50 — The travel ban is futile. Closing your borders to a handful of countries does not reduce your risk of importing the virus
• 30:15 — The contempt of high-income countries for countries in the south of Africa is obvious. They congratulate the expert and transparent science but are happy to destroy economies and livelihoods.
• 34:00 — Mutations may be occurring in the immunocompromised.
• 36:20 — How can we move away from a colonial approach to global health?

Spike and Surge are back!

After an extended summer break filled with new adventures for them both, they return to the show to share their news. Joined by old friend and CHRISTUS St. Francis Cabrini Hospital CEO and President, Monte Wilson, they discuss the unintended consequences of COVID-19 for healthcare and what the future could hold.

Takeaways:

• 02:30 — The return of travel and the beginning of a long-postponed research project in Uganda to detect emerging zoonotic diseases and enhanced prevention and control.
• 07:15 — A new job for Surge in Healthcare and Life Sciences technology.
• 11:05 — No reason to be wary: collection of healthcare data is well protected and could lead to precision, personalized medicine.
• 17:34 — Monte Wilson of CHRISTUS Health discusses the challenges COVID-19 and climate change have brought to Louisiana healthcare systems.
• 19:56 — Consequences beyond COVID-19: Few ICU beds, nursing staff shortages and low vaccination rates have had lethal impacts for patients with diseases other than COVID-19.
• 25:00 — Why are vaccination rates in Louisiana so low? A deadly mix of fear, suspicion, politics and religion.
• 33:32 — Finding creative approaches, including technology, to address the shortage of nursing staff – a problem exacerbated not assisted by staffing agencies.
• 39:15 — Success through telehealth and virtual care, but how do we retain the most important and human elements of care?
• 42:26 — Collaboration is a differentiator.

Special guest:
Monte Wilson, President and CEO, CHRISTUS St. Francis Cabrini Hospital

References:
CHRISTUS St. Frances Cabrini Hospital (christushealth.org)
Dr. David Holcombe, Public Health Medical Director for Alexandria
Cutting for Stone by Abraham Verghese
Center for Forecasting and Outbreak Analytics, CDC

Against the backdrop of India’s punishing second wave of COVID-19, Dr. Raches Ella of Bharat Biotech joins the podcast to talk about the company’s pioneering work in vaccines. He discusses their own COVID-19 vaccine, Covaxin, the challenges India faces right now in administering vaccine to such a large population, and Bharat's innovative work in developing a respiratory vaccine to fight a respiratory virus.

Takeaways:

• 04:07 — When the virus hit, Bharat Biotech were well placed to respond. The result is Covaxin.
• 09:58 — Just how effective are the vaccines against the COVID-19 variants of concern?
• 15:30 — 20 million doses of Covaxin have been administered in India. While all production is currently mandated for domestic use, the only way out of the pandemic is equitable distribution of vaccine globally.
• 18:36 — India leveraged its childhood vaccination program to roll out the COVID-19 vaccine.
• 20:15 — As a country with high levels of infectious diseases, vaccine hesitancy is not really an issue in India.
• 22:53 — Respiratory vaccine for a respiratory virus: Bharat Biotech have partnered with Washington University in St. Louis to develop an intranasal vaccine. Currently in trials and hoping for release by the end of this year.
• 26:12 — What can the world do right now to help India? A great start would be standardized protocols for treating and managing COVID-19 from the WHO.
• 31:10 — Beyond COVID-19: Bharat Biotech are also working on vaccines for polio, cholera and chikungunya.

Special guest:
Raches Ella, MBBS, MS, Head of Business Development & Advocacy and Project Lead for Sars COV2 vaccine 

As India battles a catastrophic second COVID-19 surge. Dr. Venkat Narayan, Professor of Global Health and Epidemiology and Professor of Medicine at Emory University joins our podcast. He talks about how this pandemic has shown the world the importance of responsible, ethical leadership, strong science, open data, preparedness, and collaboration across borders.

Takeaways:

• 06:10 — The three factors that made COVID-19 the perfect example of a syndemic.
• 08:28 — India looked like it was weathering the COVID storm. What went wrong?
• 15:00 — The pandemic has shown the need for responsible, ethical leadership, strong science, open data, and preparedness.
• 15:31 — India’s vaccination challenge. India manufactures 60-70% of the world’s vaccines. Yet only 2% of India’s population is fully COVID vaccinated. With a population of 1.4 billion, reaching herd immunity will require 10-15 million vaccinations daily.
• 24:05 — India has the infrastructure to manage this – from vaccine manufacturers to a civil service and rail network but this effort will need very skilled collaboration, coalitions and coordination.
• 30:00 — India needs a central vaccine communication center – vaccine reluctance can be combatted with sensitive, consistent messaging.
• 32:15 — The healthcare system is stretched to its limits. The lesson to learn here is listen to the data: it provides a window to prepare and plan.
•  44:20 — This virus does not respect societal biases. It infects all, regardless of age, gender, race, or religion. 

Special guest:
K. M. Venkat Narayan, MD, MSc, MBA | EGDRC | Emory University 

Dr. Rob Breiman and Ken Berta are joined by Professor Dame Sally Davies, the U.K.’s Special Envoy for Antimicrobial Resistance, and Andrew Staunton, HM Consul General in Atlanta, to talk about the urgent public health challenge posed by antimicrobial resistance (AMR). With the use of antibiotics and deaths from drug-resistant infections rising, Dame Sally and Andrew discuss the essential steps that need to be taken to highlight and arrest this silent pandemic.

Takeaways:

• 06:00 — Without action, the death rate from drug resistant infections per year is predicted to reach 10 million by 2050.
• 07:00  — As low- and middle-income countries are disproportionately affected by AMR, a sharp focus on investment and development is crucial.
• 09:24  — Antibiotic effluence contaminates the environment, and fish farming is one of the biggest culprits.
• 13:23  — AMR is a silent and creeping pandemic. We must communicate more effectively and broadly about the dangers.
• 14:57 — To combat antimicrobial resistance, we need to begin with surveillance, better drug stewardship, examination of the food chain, and promotion of pharmaceutical innovation.
• 18:57 — The impact of COVID-19 on AMR.
• 22:18 — In a world of urbanization, global warming, climate change and COVID-19, why should people worry about antimicrobial resistance?
• 26:29 — The private sector has a critical role to play.
• 34:25 — Communication, education and engagement on AMR at the community level.
• 38:38 — Finding the access versus excess balance.

Special Guests:
Professor Dame Sally Davies, U.K. Special Envoy on Antimicrobial Resistance and Master of Trinity College, Cambridge
Andrew Staunton, HM Consul General in Atlanta

References:
The Trinity Challenge
Investor Action on AMR
The Fleming Fund
Jim O’Neill, Economist

Dr. Rebecca Martin, Director of CDC’s Center for Global Health (CGH), joins this episode to discuss their recently published Outbreaks Report and the important work CGH is doing around the world. She highlights several of the Center’s programs, including the Field Epidemiology Training Program which has taught over 18,000 Disease Detectives to lead prevention, detection and response in more than 90 countries. Now the most experienced of those countries have begun to mentor others through crises.

Dr. Martin goes on to talk about the impact of COVID-19 on the Center’s programs, especially critical initiatives like measles and polio vaccination. She describes the Center’s mission as “working globally to domestically.” The symbiotic nature of that mission has become increasingly apparent during this pandemic, as the lessons learned abroad are now helping to inform the response to COVID-19 at home.

Takeaways:
03:39 —The Center for Global Health’s history, mission and 10-year anniversary successes.

06:46 — Disease detectives: over 18,000 health professionals in 90 countries trained to lead prevention, detection and response.

11:49 — How CGH programs have adapted and innovated in the face of COVID-19.

18:15 — The impact of suspending programs due to COVID-19. The collateral damage from program suspension could have been greater than the virus itself.

22:37 — What the next ten years holds for the Center for Global Health.

24:51 — Three key examples of how investing in public health overseas has taught the U.S. valuable lessons that can be implemented at home.

31:40 — Partnerships are key. This work cannot be completed alone.

38:04 — Has the pandemic taught us to value equity?

References:
CDC - Global Health
CDC 2021 Outbreak Report 

Towards the end of last year, our co-host Ken Berta (aka Surge) contracted COVID-19. Determined to add to our pool of knowledge on the virus and provide a resource for others, he kept a diary of his experience. In this episode, he talks candidly to fellow host, Dr. Rob Breiman (aka Spike) about his battle with COVID-19.

Takeaways:

• 02:00 — Keeping a COVID diary. To document this disease, sharing our COVID experiences is critical. We all want to know what is going to happen next and what we should do when.
• 05:09 — Day One - The first symptoms and self-isolation: fatigue, muscle aches, and joint pain.
• 09:22 — Tests – not so easy to take and tough to sit through.
• 12:35 — Round two of symptoms: cough, migraine, nausea, low oxygen levels, chest constriction, and finally, the fever.
• 16:00 — Mitigation methods or how to stay out of hospital.
• 17:33 — Day Five - The symptoms compound and worsen, the delirium begins, but worst of all is not knowing what to do or whom to turn to for advice.
• 20:50 — Day Seven – loss of taste and smell
• 22:00 — Retracing the steps to exposure.
• 24:00 — The virus spreads to other family members.
• 27:20 — Eli Lilly monoclonal antibody trial.
• 33:00 — Lessons learned? Isolate, drink fluids, try to stay mobile, do breathing exercises, know where to go to get tested.

References
What is bamlanivimab | Antibody Drug | Lilly COVID-19 Treatment

Regeneron’s COVID-19 Response Efforts

Having received several queries and questions from our listeners, in this episode Dr. Rob Breiman and Ken Berta, aka Spike and Surge, set out to provide some answers. They discuss trust in vaccines, COVID virus mutation, safely reopening schools and businesses, and the mitigations we’ll need to keep as the vaccine rolls out.

References:
Different COVID-19 Vaccines | CDC
U.S. Food and Drug Administration (fda.gov)
WHO | World Health Organization
Gavi, the Vaccine Alliance
U.S. Health Resources & Services Administration | (hrsa.gov)
When to Test - COVID-19 Testing Impact Calculator
Home· Starter Portal (globalhealthc3.org)
Global Health Crisis Coordination Center - Vaccine Tracker (globalhealthc3.org)
Global Health Crisis Coordination Center - Back 2 Work (globalhealthc3.org)
Global Health Crisis Coordination Center - Back 2 School (globalhealthc3.org)