Why Are We Scaling Back Bird Flu Vaccine Development?

Ashish Jha: 00:00:08

Hey everybody. Ashish Jha, here back with another episode of a moment in health from Providence, Rhode Island. Hey, thanks so much for joining us. This is the podcast where we talk about one data point, discuss one study and then answer a question. And today's answering a question will be a little bit of an odd format. We'll get to that in a few minutes. But let's talk about one data point, and the data point I want to throw out at all of you is 70% 70% seven out of every 10. What is the 70% I'm thinking about today? It's the proportion of the world that got at least one dose of a COVID vaccine. 70% of the world has gotten a COVID vaccine. Now, the reason I bring that up is because COVID vaccines have been in the news. The Secretary has of Health and Human Services, the United States has limited who will be have, who will be able to have access to COVID vaccines going forward, saying that young people, healthy people, pregnant women, people who are non elderly, will not be routinely recommended to get a COVID vaccine, which means that they will likely not have access to COVID vaccines. In terms of getting their vaccines covered, 70% is about 5.6 billion people in the world got a COVID vaccine. And if you think about all the bad information you hear out there about how these vaccines are terrible and they're killing people, if these vaccines were actually a problem, we would see it at that scale. And yet, we have not seen substantial health problems. Look nothing in the world is perfectly safe. We know there are some side effects of everything, including COVID vaccines, but these vaccines, when you look at it in retrospect, I think, have turned out to be exceedingly safe, safer than almost any medical treatment that we have, safer than many other vaccines, just very, very safe. And we know that because literally, seven out of 10 people in the whole world got at least one shot. In fact, they were protected from COVID getting seriously ill from

Ashish Jha: 00:02:05

COVID because of the vaccines. And let's be honest, the COVID vaccines helped bring the pandemic to an end. So that's your number, 70%

Ashish Jha: 00:02:17

okay, I'm going to move on now to talking about our one study of the week. And the study of the week comes from the May 30 issue of Jama Health Forum. And the study is entitled projected outcomes of removing fluoride from US public water systems. The study is done by Sung Yoon Choi and Lisa Simon, and here's what the study did. They basically did an analysis of what would happen if we removed fluoride from public water across the country. They used a National Health and Nutrition Examination Survey, and they looked at data from states that had banned fluoride compared to states that had not. And basically what they estimate is that over five years, about 7.5% of children, about one in 14, one in 13 children, zero 19 would get cavities. Compared to if we had not banned fluoride, it would cost the country about $10 billion of additional spending. You're not going to be surprised to hear this, but the increased tooth decay would disproportionately affect poor kids, those on Medicaid and those who are uninsured, and basically they make the case that this is going to lead to a lot more dental caries, a lot more dental health problems, and is really just not a very good policy idea. Now, a little bit about fluoride. There is stuff out there about, could fluoride be harmful to you? No question about it. At high levels, fluoride can be harmful, by the way. That is just a truism in life. Almost everything at high levels can be dangerous. They estimate that about 40% of kids in the United States live in areas that have optimal fluoride levels. About 45% of kids live in areas that have less than optimal and about 2% of kids live in areas where fluoride levels are at an excessive level, where they're probably more dangerous than they are helpful. Many more kids live in either suboptimal or no fluoride communities, and removing fluoride, if we were to do that nationally, would cost us about $10 billion and a lot more cavities. Okay, so that is your study of

Ashish Jha: 00:04:27

the week, projected outcomes of removing fluoride from US public water systems in this week's Jama Health Forum.

Ashish Jha: 00:04:39

All right, question of the week, and usually I have a guest, and today I decided I'm going to answer the question, because I have been getting asked this question over and over again over the last few days, and I have been answering it, and I thought I would use this podcast to answer the question. And the question that I have been getting asked over and over again is, you might have heard that the Department of Health and Human Services can. Insult a moderna mRNA vaccine contract for bird flu. And people have been asking, what is this? Why should we care? Why should we care? So let me, let's talk about why we should care. And I'm going to first start off by talking a little bit about bird flu. A highly pathogenic avian influenza is another way we often talk about it, h5, n1, is the influenza strain. And bird flu has been, you know, it's been around for a long time. We have tracked it in the public health community for a long time. You know, at any time in the last 20 years, if you asked a public health expert, what is the thing that scares you the most in terms of a potential global pandemic, almost everybody would say bird flu. Why is that? Because over the last 30 years, as we have seen, bird flu spread in different bird species, whenever it has jumped to humans, it has been incredibly deadly. The literature suggests that its case fatality rate, proportion of people who are known to been infected who then die. The case fatality rate is over 50% now, none of us actually believe that the true infection fatality rate is over 50% we think that a lot of cases go a lot of infections go undetected. But if you ask me, my best estimate of what the infection fatality rate is, if of all the people who actually have been infected, my best guess, this is just a guess, is probably in the five 7% range. By the way, just to be clear, that would be about 10 times worse than COVID was when it first landed on our shores. So it's a very deadly virus. It has largely stayed

Ashish Jha: 00:06:39

just among birds. And then over the last few years, we have seen the virus evolve to start affecting mammals, sea lions, tigers and bears, and obviously, in the last couple of years dairy dairy cows. And what we have not seen, thankfully, is sustained human to human transmission. And I think a lot of us worry excessively, or quite substantially, I wouldn't say excessively quite substantially, that if it starts spreading among humans, it could end up being a very, very deadly pandemic. So inside the Biden administration, the last administration, there was a decision made that we needed to start working on building better vaccines against this. Now this is on the backdrop of the fact that h5 n1 or bird flu, has been on the radar of policy makers for a long time, as I said, for at least 20 years, and President George W Bush and his administration actually did a lot of work in this space, including requiring that we have a small number of vaccines available in the national stockpile, which we do, five to 10 million doses. Those are old vaccines, and none of us are sure that they're going to work super well, compared to where the virus has evolved to now. So the Biden administration gave a contract to moderna and said, figure out how to build a vaccine, build a high quality h5, n1, bird flu vaccine using the mRNA platform. And the reason that's important is because it actually takes a lot of scientific work to figure out exactly how best to design the vaccine, and that's what moderna had been working on under the contract, until very recently, when HHS, under President Trump, under Robert F Kennedy Jr, decided to cancel the contract. No word on are they going to give it to somebody else? Are they going to even try to work on building a bird flu vaccine that's likely to be more effective, or what their strategy is? Last thing I want to talk about on this is they mention that one of their concerns is, quote, unquote, the mRNA platform that has not

Ashish Jha: 00:08:38

been adequately tested. So let's talk about that. Is the mRNA vaccine platform under tested, I would argue Absolutely not. It is actually, even though it's been around and used, obviously, and has gained prominence, really, since the pandemic, it has been very thoroughly tested. The two big clinical trials that Pfizer and moderna ran had 10s of 1000s of patients in those trials. Those are bigger trials, and we usually see for almost any drug that's approved out there, bigger than most vaccine trials that have been out there. So these are large trials that were done. And then what I like to remind people who say, well, we don't really know how well these work and whether they're really safe or not, is my best estimate is that somewhere between 1.5 and 2 billion doses of mRNA vaccines were given to people during the pandemic. We know just between US and Europe, it was about 1.5 billion doses were administered to about 700 million people. And when I was in the Biden administration, we sent out about 650 million doses to low and middle income countries. And if you just do the math, that's probably over 2 billion doses that were put into people's arms. If there was gonna be a problem with this platform, we would know it. We would see it. Given the vast number of people who've gotten an mRNA vaccine, we have not seen that data. Obviously, we know a little bit about myocarditis that can happen if you give two doses in short order to especially the young healthy men. But at a at a larger scale, we have not seen any real health problems from mRNA vaccines. I. I think they are exceedingly safe. And so this whole concern about mRNA vaccines is, I think, way, way, way overstated. All right, so that is the question. Why should we care about this? Because bird flu could be quite dangerous. We need to be working on building the next generation of vaccines. MRNA are great platform. If the administration doesn't want to use the mRNA platform, which they, of

Ashish Jha: 00:10:37

course, should, then they need to think about what other platform but the idea that we're just going to try to wing it and hope that we don't get a bird flu pandemic is a very bad idea, and I hope the administration reconsiders its strategy. All right, there you have it another episode of a moment in health where we talked about one data point 70% of the world has gotten at least one COVID vaccine, and that's about 5.6 billion people over 13 point 7 billion doses. These are very, very large numbers. It's hard for me to think of anything that has been given to more people as safely as it has. One study we talked about the study of what would happen if we really removed fluoride from US public water systems across the country about $10 billion a year in extra spending and lots and lots of extra cavities. And then we talked about one question, why we need to be working on a bird flu vaccine. The Time is Now if the virus starts spreading, it will take us months, if not much longer, maybe even years, to build adequate vaccines. That is not time we will have. So working on it now will be critical. Thanks so much for joining us on this episode of a moment of health. I'll be back again next week to talk about one data point, to discuss one study, and to answer a question, probably with a guest. Have a great week, everybody.