This article is part of an ongoing collaboration between the Colorado School of Public Health, the Denver Museum of Nature & Science, and the Institute for Science & Policy. Watch the full recording of this session and find all of our previous COVID-19 webinars and recaps here.

The race for a COVID-19 vaccine has commanded international focus since the pandemic began, so where do things stand now that autumn is approaching? A number of vaccine candidates, including some from the federal government’s Operation Warp Speed initiative, have begun clinical trials. Experts have not ruled out the possibility of FDA approval in record time and mass distribution by early 2021. But as research proceeds at a breakneck pace and vaccines become a political hot button in the lead up to the November election, scientists must delicately balance speed, efficacy, and safety. What will the first “successful” vaccine look like, and which criteria should be used to make that determination?

The Institute’s Senior Policy Advisor Kristan Uhlenbrock spoke with Dr. Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, about the latest developments and he shared some of his key takeaways.

The whole landscape of poverty related diseases has shifted.
When we think of our global health, we're very focused on developed versus developing countries. That's kind of the paradigm. But that has changed quite a bit over the last couple of decades in part because what we're seeing is a steady rise in the global economy up until a few months ago. And with that, it's leaving behind a bottom segment of society…Overwhelmingly, these poverty related diseases are in the richest 20 countries. And you might say, well, that doesn't make any sense because those are the 20 wealthiest economies, how could it be that poverty will be found there? Well, it turns out it's the poor living among the wealthy that now account for most of these illnesses. And I gave it a new name called Blue Marble health, to distinguish it from traditional norms of global health. It's not an idea that has widely caught on yet. But it has a lot of policy implications because it says if we pay greater attention to our own poor and vulnerable populations in the G20 nations, including the United States, we can make a huge impact

COVID-19 appears to be poverty related disease
The Houston health department publishes the COVID-19 deaths daily and they don't provide the names, but they provide the age, race, and ethnicity…More often than not, it’s the essential workers living in our low income neighborhoods across Houston. They're individuals who can't make a living via Skype and Zoom and are denied that opportunity. They're working in family businesses, such as dry cleaners and restaurants and bakeries and construction sites. They are really getting hit very hard.

I'm pretty confident we'll be able to have multiple COVID-19 vaccines
I say that because the scientific hurdle to develop COVID-19 vaccines is actually not that high. It's what I call an old school problem in biology. By now everybody's seen a cartoon of the COVID-19 virus, and they recognize that donut with the RNA stuff inside and then spikes emanating out and these spikes are what are used to bind to our host receptor…And it turns out if you make an immune response to the spike protein, both by inducing high levels of virus neutralizing antibody, as well as T cell responses, you'll make a vaccine and the point is, there are many different ways to do that.

One of the exciting things about Operation Warp Speed is the exploration of new technologies and innovation.
So you've been hearing quite a bit in the last few weeks and months about DNA and RNA vaccines. Rather than administering the protein or a component of the virus, what you do is introduce a piece of RNA, which then gets taken up by the host cell and is used the host cell machinery to produce some of that protein and that's what gets presented to the immune system. And this is how the Moderna and the Pfizer vaccine work. And there's a lot of technology around the packaging used to get that RNA taken up by the cell. We're now going to be looking at at least seven or eight Operation Warp Speed vaccines over the next year. We’re trying to get multiple shots on goal.

Having said that, there are some potential disadvantages.
Some of these technologies have never resulted in a licensed vaccine before. So we don't have a lot of experience with those and some have criticized the program saying we need some more of the traditional old school technology such as inactivated viruses or recombinant proteins produced by fermentation. Another potential disadvantage is that it’s quite expensive. It's a big demand on American taxpayers. We haven't had a communication plan coming down. And I think that that's going to be a mistake. From my standpoint, the biggest mistake that Operation Warp Speed has made is that they've not put in any type of communication plan for leading CEOs of companies. And we've seen so many missteps, from the stock dumping by Moderna to what we saw with AstraZeneca and the actual case of transverse myelitis.

The US is very much going it alone on this.
It's operating in a bit of a silo, without much interaction with other countries. I'm not happy about that because we've always relied on what I call “vaccine diplomacy” to accelerate global health. When Albert Sabin developed the polio vaccine, it was done jointly with Soviet scientists. It was scaled up first in Russia and tested 10 million Soviet schoolchildren and showed to be safe and effective - during the Cold War. That's what led to the licensing of the polio vaccine. So, that type of thing where countries put aside differences to work together.

I'm especially worried about what's going to happen as this virus races through the big urban areas of low and middle income countries.
We've already seen it earlier this summer in Mexico, in Ecuador, in the Brazilian town of Fortaleza. We're starting to see the virus move through the big crowded urban areas of the big cities in India and Lagos in Nigeria. How do you do social distancing under the circumstances? You can't. And as bad as things are, they're only going to get worse as the virus races through the big cities of the Southern Hemisphere and Africa, Asia, and America.

We're starting to see this interesting organization called the Developing Country Vaccine Manufacturers Network step up and produce their own vaccines.
And they tend to be more traditional technologies, but I think there's a good chance they could work. For instance, China is collaborating with Brazil to accelerate an inactivated virus. Our friends at AstraZeneca Oxford are collaborating with the Oswaldo Cruz Foundation to scale up production. China's collaborating with Indonesia. We're seeing several of the large vaccine manufacturers in India, accelerate vaccines. So the idea is that these vaccines will be found at lower costs than the Operation Warp Speed vaccines and may actually work just as well or even better.

Vaccine misinformation is higher than ever.
While we're trying to produce and scale COVID-19 vaccines, we’re being confronted by a pretty aggressive anti-vaccine push. It started out claiming that vaccines cause autism and I pushed hard against that because I'm not only a vaccine scientist, I’m also the parent of four kids including Rachel, who has autism and intellectual disabilities. I wrote this book a few years back which goes into details of the science. The anti vaccine movement claims that vaccines are rushed or not adequately tested for safety, that there's a conspiratorial relationship between the pharma companies and the US government. And now we're at the point where a couple of surveys out of the Associated Press and Reuters find that some Americans won't accept COVID-19 vaccines, even if they're made available. I'm really worried we're going to be in this big conflagration trying to develop vaccines. We're headed towards a bit of an epic struggle here.

Herd immunity remains a question
The way you typically calculate herd immunity is a very simple equation. It's 1 minus one over the reproductive number of the virus. So for instance, measles has a reproductive number of between 12 and 18 on average, so one minus one over 18 is around point nine five. And so the point is to achieve herd immunity for measles is 95% of the population has to be immune. The SARS-coV-2 virus has a reproductive numbers anywhere between two and three. So you do one minus one over two or one minus one over three, you get between about 50 to 70% of population required to be infected and rendered immune before you get herd immunity.

However, it's been noted that nowhere in the world so far has the population exposed  hasn't gotten anywhere close to 50 or 70%, the highest so far is New York at 22%. So the question is, is there something going on? And there are papers now suggesting maybe there's differential susceptibilities. And so that herd immunity is probably less than 50 or 60%. But we don't know if it's 20 or 30%. I don't actually find that number very helpful one way or the other. Because as an individual or someone concerned about your family, it doesn't really guide you very much. You're not going to change your behavior.

If there are several vaccines out there, how will people know what to choose and how will public health officials decide which ones to use? I don’t know yet.
There's no communication strategy coming out of Operation Warp Speed and they're tone deaf to the fact that this is a huge issue…What I think is likely going to happen is different states and different communities may have access to one vaccine or the other. So you may not have a lot of choice in at least early on. Any vaccine that's licensed r has a level of approval with transparency and CDC data, I'm going to take and I'm going to recommend for my family, knowing that the vaccine you first have available may not be the best one. There may be better ones down the line, and you may be able to get a booster through a different vaccine later on.Remember, this is not entirely unusual.

If you have the ability to get a vaccine, take it.
Even if it may not be your first choice for which one you want, because at least you can get some neutralizing antibodies in you and reduce your likelihood of contracting COVID-19. As more vaccines become more widely accessible, then you can look at possibility of getting a booster, but I'm not recommending anyone wait for new and approved vaccines.

Building trust is key to fighting misinformation.
When I visit with families or health care practitioners, what I have found is most parents are willing to vaccinate their kids provided they understand the correct information. The problem is they're so inundated with misinformation that they don't know what to believe, but if you take the time to talk with parents, they will vaccinate their kids. It's just that it does take time because there is this pervasive misinformation movement out there and it's not getting better, it's getting worse….And that is one of the reasons why the US has been the epicenter of this pandemic almost since the beginning and. We will have 200,000 American deaths by the end of this month. It didn't have to be this way. Canada just celebrated zero deaths in a 24 hour period and that’s a country of 40 million people. So it goes to show you what a country can do with leadership and adequate communication.