Dr. Eric Topol: The CDC Was a “No-Show for the Pandemic”

CHRISTIANE AMANPOUR: And now, we turn to some tentative good news as new COVID-19 cases and deaths are falling on both sides of the Atlantic, in the United States and the U.K., which are two of worst affective countries. Still, the variants mean that people are being told to still keep up their guards. Dr. Eric Topol is a professor of molecular medicine and the director of Scripps Research Translational Institute as of the — as one of America’s top medical researchers, he has studied the coronavirus closely obviously. And here he is talking to our Walter Isaacson about vaccines, variants and what to expect going forward.

WALTER ISAACSON: Thank you, Christiane. And Dr. Eric Topol, welcome to the show.

DR. ERIC TOPOL, FOUNDER AND DIRECTOR, SCRIPPS RESEARCH TRANSLATIONAL INSTITUTE: Great to be with you, Walter.

ISAACSON: Hey, it looks like new things are getting better in terms of COVID. New cases are down, I think almost 40 percent from a couple of weeks ago. To what extent — is that the vaccine kicking in or herd immunity or better social distancing or what just other factors that cause an epidemic to wax and wane?

TOPOL: Right. Well, it’s gratifying to see finally this reduction in the third monster surge, and it appearing to be mostly the distancing and the masking because the vaccination hasn’t yet reached a level where it could have a real dent as we have learned from Israel where most of the aggressive vaccination is finally taking big hold. But it gets, you know, three or four time as much as we have done so far. The only major obstacle though, Walter, that we have to face is looming beast of a variant, the so-called B117 that — what was first seen in the U.K. That one is starting to be spread in Florida and here in California and some other places, and it could really take off fast because it’s really like a super spreader variant. So, it would be good if we put on all of the pressure now to get containment, because we’re in for one hopeful final tough round.

ISAACSON: The variation in that British mutation doesn’t affect the exact part of the spike protein that’s encoded in the two RNA vaccines. Is that right? Those vaccines are still pretty in the effective?

TOPOL: Yes, the good thing — there’s only one good thing about that variant, even though it is a super spreader and it has been linked to a higher hospitalization and death rate, but it’s immensity (ph) that is the resistance of a vaccine appears to be, if anything, modest relative to the South African variant that we have seen where it is actually quite formidable as far as some resistance. So, you know, this is a really tough one because it is spread so easily. But fortunately, the vaccines, as again, we have learned from Israel where it is all B117, that they basically had to confront that very big surge with that variant, and the vaccines have basically conquered it in most respects. So, that’s the good piece of news.

ISAACSON: And you are talking about, of course, the Pfizer vaccine and the Moderna vaccines. It seems, but correct me if I’m wrong, that the AstraZeneca one developed at Oxford may not be as good against some of these variants. Why would that be?

TOPOL: Well, it’s a really good question and we’re going to learn more in the U.S. trial of the AstraZeneca in Oxford which is due out in the weeks ahead. The real issue about dosing is uncertain with that vaccine. And the one major paper they published was really hodgepodge of multiple different dosing schedules. But you’re absolutely right, Walter, when that was tested in South Africa, in thousands is of relatively low risk young people, there was no effect of the vaccine. Basically, the infections, these mild moderate infections weren’t suppressed. So, that’s the only vaccine that’s been in South Africa with that tough variant they have as opposed to Novavax and Johnson & Johnson, which also have been tested there and worked reasonably well. Not as well as U.S. or other countries. So, there is something soft about that vaccine. We need to learn more. It might just be dose but we will learn more in weeks ahead.

ISAACSON: You are talking about the Johnson & Johnson vaccine that turns out to be pretty effective against some of these variants that we have now, and it is awaiting FDA approval. And now, you have been very strict in saying you should never push the FDA to go faster than their guidelines allow, but, man, it seems like we’re in pretty hefty race is here. Is there a possibility we could speed up the Johnson & Johnson vaccine?

TOPOL: Well, I’m with you, Walter, as far as speeding up everything we can because this is the time to get our vaccination rate as high as we can go, especially that first dose which gives people a real edge. The second dose doesn’t have to be necessarily at three or four weeks if we prioritize first dose. The J&J, the first vaccine that would be a single dose is very attractive, but they are not really ready anyway as far as scaling up manufacturing. So, even if that FDA meeting was the day when they present — the results were presented by press release, no less they haven’t yet been published, it still wouldn’t change our vaccine supply. So, I actually do think that waiting — there’s a standard three-week time from the first submission of this (INAUDIBLE) authorization at FDA to the convening this so-called Virbac external advisory group. That’s what was honored for Pfizer and Moderna. It’s being kept the same for J&J. I understand this is a national emergency. I’m not sure it would change things really. But I have no problem if it was done in one week or two weeks actually. We know enough about the vaccine review for this COVID story that we could go somewhat faster.

ISAACSON: And what about other vaccines are you hopeful for? You mentioned Novavax. There’s some being used overseas, some China and Russia?

TOPOL: Well, the Novavax looks pretty much as good as the mRNA vaccines. You know, it’s a protein. It is a very novel platform in that regard. It had — in the U.K., where it was tested, it had 96 percent efficacy just like the mRNA vaccines. It dropped down some in South Africa, but it was preserved. So, I think that one is going to look in the same category as the mRNA vaccines. That gives us three very powerful ones. There was a drop down in efficacy for J&J, but there’s a tradeoff there. They are testing the two doses which could bring it back up and that’s also a viral vector, adenoviral virus vector like AstraZeneca. The Sputnik V out of Russia was a surprise. That had 91 percent efficacy and it’s now been fully published better than we would have expected. And that, like the AstraZeneca and the J&J, is also an adenoviral vector vaccine. So, the list of options is expanding. There’s several vaccines out there, we need them all to be successful because we have 7 plus billion people we need to get vaccinated and we really can’t fully rest until we get the majority of more population protected.

ISAACSON: We talk about the variations and mutations that have come out of Britain, South Africa, a few other places, but I assume since it’s a coronavirus, there must be 10,000 or so mutations of it floating around saying which one will be more effective. Do the vaccines by targeting the spike protein in theory, would they protect against almost any mutation and variation to some extent?

TOPOL: Right. Well, this a really important point you’re bringing up. The spike protein was an easy target, it’s like the side of the barn. And the fact that these vaccines all worked against the side of the barn and it worked so well is amazing, because, you know, you could get at this virus lots of other ways. You know, it has many other target points. So, it is true that when we make antibodies to an infection, or when we get the vaccine to mimic an infection, we make, you know, really tons of these clones, different clones of antibodies. What’s interesting particularly, Walter, is the super human response to the vaccines, because a level of these neutralizing antibodies that take down the virus and activate it are so much greater than natural infections. And this is a rare virus vaccine that is super human, which, of course, helps people who even had COVID infection to take them to a higher order level of protection. The problem is that as the mutations have been occurring, you know, there’s 30,000 bases in this virus and any one of them can change, most of those are innocent, the adage is the variants are innocent until proven guilty and it took over 10 months of the pandemic to find a guilty variant. The problem we have now is they are starting to see, particularly the South African and Brazil, some immunisty (ph), meaning that the combinations of these mutations is making it harder for those neutralizing antibodies to truly inactivate the virus. It’s not complete. It’s partial. But what we can anticipate is, as we go months forward, perhaps a year or more, there’ll be more of this so-called antigenic drift of the virus, more and more mutations, and we will need to find other targets besides just the spike protein. And what is exciting here is, we can take down this entire family with a pancoronavirus vaccine, and that’s what we should be doing right now, because we can’t just chase one variant after another. Yes, there will be boosters later this year if the need arises, but what about with the next variant and the next one occurs, which inevitably is what we’re going to be facing.

ISAACSON: Bow, when you are vaccinated there’s some unsettled issues about whether you can still catch and transmit a COVID. What is your opinion? Are you still infectious if you have been vaccinated?

TOPOL: Well, that is something that we don’t know for sure, but my guess is that the more potent the vaccine, the more likely it will achieve this block of so-called asymptomatic transmission. Basically, you become a carrier. You don’t get ill, but the virus has established residence in your nasal lining, mucosa. And so, if the vaccine is really potent and you have strong neutralizing antibodies that last many, many months, it is more likely — and we have initial data from Moderna to support that, that you will achieve near complete or certainly high level of blocking this carrier state of asymptomatic transmission. The problem we don’t know is how long does that hold up? Because when the shots were never meant to achieve so-called sterilization or mucosal immunity, they were meant to prevent illness. So, if we get sterilization immunity, even if we get it for months, that’s like a bonus factor. We can’t really count on it. So, that’s why we need to wear masks because we don’t know how long and how good it is. But also, there’s probably a gradient. We discussed early that some of the vaccines are, you know, really high performance, efficacy 95 percent. Those that are in the 60 and 70 percent are more likely to allow for this carrier state. So, that why the more effective vaccines, the better. And who would have guessed that we would have had vaccines at this extraordinary level.

ISAACSON: The CEO of Johnson & Johnson said that the coronavirus vaccine may become an annual thing like the flu shot. Do you think that’s true or do you think we might be able to just beat COVID and its coronavirus?

TOPOL: Yes. I think the false strategy, unfortunately, Water, will be this booster shot and it could be every year or every couple of year, but a far better one would be to go after this pancoronavirus vaccine. It is do-able. We could get that without worry of having to have renewal shots. So, if we can put our minds to that rather than just this so-called put in the South African called bivalent vaccine where we put some of that in and put some of the original strain or we put in the Brazil strain, you know, there’s better way to do that. And so, my hope is that we won’t have to — look at what we are going through right now for people to get vaccinated. And so, if we have to go through that repeatedly, that would be really unfortunate. We have to be thinking bigger, and I do think that we will achieve that and I actually think we can get to that point if really have a concerted effort, make it a priority, scientifically, even by the end of the year.

ISAACSON: How do you think the Centers for Disease Control have done in the past year?

TOPOL: Well, unfortunately, the CDC, which has been a time revered institution around the world was a no show for the pandemic. It was subjugated by the Trump administration, HHS and the director never stood up. And basically, it was put aside and all of the things it should have been done throughout the pandemic, we lost so much with the testing in the first two months that we were flying blind, the bad recommendations with the respect to masks, opening up schools and the economy, that it just was played patsy with the interests of the administrations. So, it’s really a shame. Now, we have a new leader with Rochelle Walensky and I think it’s starting to get rebooted and started to get back to where it ought to be. But unfortunately, you know, we got so far behind in this country. And instead of being an exemplar, we became like the worst-case scenario, and the CDC, unfortunately, played a role in that.

ISAACSON: How would you rate the FDA?

TOPOL: Well, you know, that is really interesting. I was ready to just give up on the FDA back in August though when I took on the commission, Stephen Hahn, Dr. Hahn, about his approval in this — if you remember, this very historic breakthrough press conference with Trump and czar. And I said that there were no data, Dr. Hahn, to do this, and you called it and others a historic breakthrough and all of the survival benefits. So, interestingly, he did respond to me days later, and we actually became friends and spoke frequently, and I admire him because he had a very marked turnaround from being basically passive and accepting anything like hydroxychloroquine or the plasma or whatever it took, if Trump wanted to get it done, he did it for him. But now, he had developed this new look, which was, we’re only going to stick by the science and we’re not going to be trampled or bullied by the administration, and he took them on, both the HHS, the czar and Trump, and he then, with the vaccine manufacturers, tightened the criteria. They could have, theoretically, delivered this so-called October surprise that Trump wanted the vaccine in October before the election, he prevented that because he wanted to get the trials done rather than to half assed with a very limited number of participants to so-called interim analysis. And he did that and he did it in a way that is really extraordinary laudatory. So, I give him a lot of credit. He left, I think, proud, and he should be. So, the FDA, interestingly, was the one agency that stood up to the Trump administration when it counted with the vaccines.

ISAACSON: Dr. Eric Topol, thank you so much for being with us and thanks for all you’ve been on this story.

TOPOL: Oh, I really appreciate the chance to visit with you, Walter. Thanks so much.