It took an extraordinary combination of government and the pharmaceutical industry to come up with COVID vaccines so fast. Our guest was Deputy Assistant Secretary for Health Policy at Health and Human Services during the Clinton administration. Now he chairs the health policy and management department at Emory University’s Rollins School of Public Health. Federal Drive with Tom Temin welcomed Dr. Ken Thorpe.
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Tom Temin: Dr. Thorpe, good to have you on.
Dr. Ken Thorpe: Thanks for having me on.
Tom Temin: And I did a little research and it was nearly 50 years between the discovery of the polio virus and the advent of a vaccine. And that’s kind of in some ways, a much more rocky rollout than these vaccines have had. What happened here that we need to kind of bottle for the next time?
Dr. Ken Thorpe: I think having this public private partnership was the real key where the federal government basically upfront pre-purchased hundreds of millions of doses of a vaccine to be developed that provided the economic foundation to allow the drug companies to do the basic research quickly. So having that commitment to buy hundreds of millions of doses of vaccine upfront really accelerated the development of this vaccine. Clinical trial process is very time consuming. And so by allowing them to sort of buy in quickly into a network of people to do the clinical trials also shaved off a tremendous amount of time of developing these drugs.
Tom Temin: So, not to get into the politics of it. But the term warp speed then wasn’t really a bad term for what occurred?
Dr. Ken Thorpe: No, not at all. I mean, it’s incredibly fast compared to other types of vaccines which take, as you talked about, years and years and years to develop. I mean, getting this done, basically, within a year was just absolutely remarkable. And so kudos to me go out to the researchers at Pfizer, and Moderna and Johnson and Johnson that develop this in really record speed.
Tom Temin: Who paid for it in past rounds of development of vaccines,? The government underwrote it this time, but somebody’s got to pay for them eventually. So how did that speed it up relative to other developments?
Dr. Ken Thorpe: Well, that’s been the dilemma. I mean, it’s the private sector who’s funded this. And for a lot of vaccines, the population, not in this case, there’s a lot of people affected by COVID. But for different types of vaccines, the population is oftentimes very limited. And so you have a low reimbursement rate, limited population. So the incentives to innovate are very limited, because it’s just the private sector upfront doing the investment. So this model of having it pre funded by the government really allowed the private sector to do its magic and innovate very, very quickly.
Tom Temin: And were there developments in the science of developing vaccines itself that might have also sped it up even with some other funding type of model?
Dr. Ken Thorpe: Well, sure. I mean, they had experience in dealing with coronavirus in the past, this is different to SARS-CoV-2, it’s a different variation of it. But certainly the science was there to have some some basic framework of how to develop it. But really, it’s a combination of having the upfront funding, getting the clinical trial process set up faster. Those were two of the big keys.
Tom Temin: And what about the idea of the FDA having kind of a fast track approval because even now, when you go for the shot, there’s a warning or they hand out literature in my case, it’s through CVS that says this is not an approved vaccine, we just say technically it has not yet gone through the full FDA vetting?
Dr. Ken Thorpe: Right. Well, that process, that emergency use authorization process is critically important. So they’re still doing research, obviously, in terms of the impact of the vaccine has on longevity, different populations. Technically, you’re right. It’s not completely, quote unquote, fully approved. But there’s emergency use authorization process, again, just procedurally allows us to get the vaccine to market much, much faster.
Tom Temin: Just speaking from your background, there’s no danger that this vaccine could suddenly rise up and kill people five years from now?
Dr. Ken Thorpe: No, I don’t think so. I mean, again, we have experience with similar vaccines, they have been doing research on side effects, they are continuing to do research on side effects and track that down. Today, we don’t see much evidence at all, and some people have some mild reactions to it that are short term, and last maybe a day or two, but they’re really pretty limited in terms of the side effects.
Tom Temin: And what’s your sense of what the HHS role might have been in this case, other than standing by and just shoving the money at these companies?
Dr. Ken Thorpe: Well, again, I think they set up the framework, the thought process of actually developing this public-private partnership. I can think about it we’ve had sort of two good examples of public-private partnership that has resulted in incredible innovation and incredible medical importance. This is one — funding the Human Genome Project. Another basic science of mapping the genetic composition of individuals to 23 chromosomes has really resulted in a whole new set of medicine that really better matches pharmaceutical treatments to people based on their genetic composition, because people respond differently to different types of medications. So this is a really good model going forward, we have other challenges and bacteria is a growing problem, those infections have doubled over the last decade. The dilemma there is a lot of people, but it’s still a limited number of individuals, 3 or 4 million individuals. So the incentives to innovate is just really not there, the economics don’t work out. So that’d be another model where the public sector could step in and pre-fund buying some of the doses that would allow the private sector to go ahead and innovate. There really hasn’t been any innovation in that space in years, despite the fact that it’s a problem as long standing.
Tom Temin: Sure. And should the COVID to become something like the flu shot every year where you need a new variation, and this is something we’re just gonna have to live with forever and getting a shot. What are the economics, what might they be going forward, when everyone will just get a shot now> My employer pays for a flu shot, I’m presuming they cost pennies at this point. What do we know about the possible future economics of a yearly COVID vaccine? And can this be something now that can be in the private sector?
Dr. Ken Thorpe: Well, yeah, I think going forward, it would probably be largely privately financed. But I think that’s where the research needs to keep going. We don’t really have a complete understanding of the longevity of the vaccine and whether or not if you take it to twice with the Pfizer vaccine, for example, whether that sort of provides immunity for a very long period of time. The key here is to get large numbers of people vaccinated. Plus, we’ll have some people exposed to it that have built up antigens. And hopefully at that point, the transmission rates are virtually eliminated. And so that will be the key is eliminating the transmission of the virus from person to person.
Tom Temin: And from your standpoint as running a Health Policy and Management Department in a public health school, what have you seen among the students in terms of what this might engender in interest in the whole public health question? Because now it’s something that everybody feels like they’re involved with.
Dr. Ken Thorpe: Well, it’s, it’s really interesting. The number of applications that we’ve had to the school of public health overall, in our department, Health Policy Management at Emory, has skyrocket, we’ve had huge increase in interest in applications in public health, which is really to me encouraging that we have a large number of potential students interested in this topic. There’s so much going on in public health policy right now, that is a great area for any undergraduates to come in and really explore the future of policy in this area.
Tom Temin: And there’s a whole new team coming into HHS now under the Biden administration. What should they do first to kind of, as we said in the beginning, bottle the learnings here, even though they might have been initiated in the prior administration, but that’s politics? But among those that really care about the details of this, there’s probably not so much politics — doctors, succeeding other doctors and so on – what should be their first priorities now?
Dr. Ken Thorpe: Well, I think taking away some lessons on how to do a better job, perhaps on the next pandemic, whether it’s at bats, influenza, heaven forbid something like smallpox. I mean, there’s going to be something downstream that it’s likely to happen. And I think there’s a bunch of takeaways. One is messaging, having sort of a uniform message from the federal, state and local governments about the nature of the problem and the severity of the problem. Stockpiling supplies, and it might be real simple. But if you think back on the earlier a year ago, our ability to get sort of N-95 masks, just basic personal protection equipment was limited because we were importing it. So that was not under control. We need to figure out how to stockpile this and have it regionally distributed and available so that for the next pandemic that happens that we have already made ability with personal protection equipment to quickly distribute. So there’s some really good takeaways to think through.
Tom Temin: So hope for the best but prepare for the worst.
Dr. Ken Thorpe: Exactly. We need to be more agile to right now anticipate the next version of this and have the supplies we need either in place or have a production and distribution network domestically in place that we can really move quickly be more agile and responding to whatever the virus may be.
Tom Temin: Dr. Ken Thorpe is chairman of the Department of Health Policy and Management in the Rollins School of Public Health at Emory University. Thanks so much for joining me.
Dr. Ken Thorpe: Well thanks for having me on. Really enjoyed it.