We welcome you to this primetime edition of the washington journal. With the senate back in session today, we will talk to a leading vaccine expert from newton, massachusetts. Later, we will examine some of the new side effects from this virus. We hope you join in on the conversation. Our phone lines are open. If you live in the eastern or central time zone. For those of you out west if you are a medical professional, we would love to hear from you. Good monday evening. Thank you for being with us. Lookgin as we always do, at the numbers from Johns Hopkins university. Now around the world, the number of coronavirus cases approaching 3. 6 million in 187 countries and regions. The death toll has exceeded 251,000 around the globe. Joining us from massachusetts is dr. Mark poznansky, director of the vaccine and Immunotherapy Center at mass general hospital. I want to begin with the headline today from the new york times. As states moved to reopen, at least one model predicting the u. S. Death rate could double. As you see that headline and follow the story today, what is your reaction . A. Poznansky well, its tragic inevitability of the fact we are facing a pandemic virus infection where there is no native immunity. No ones naturally protected against this virus. Therefore, the most vulnerable in the population the elderly, those with preexisting conditions are at the mercy of that virus. Best will in the world to social distance and contain the virus, there is still the tragic lossoflife because of the severity of the illness by those severely affected by it. Host with the death toll that could top 3000 a day from a report inside the trump white house. Dr. Poznansky yes. A goes with the territory of pandemic that spreads in this way. As states open little by little, it increases the risks that people will be in contact with each other. The virus will spread to some controlled degree, but those people who are vulnerable to the infection will become infected serious cases will end up being hospitalized with the infection. I think the only thing i can say is working in the hospital is that the Health Care Workers are getting more and more experienced in dealing with this new disease. There are new developments emerging in terms of treatment. New ideas about handling cases in the intensive care unit. The issues of having patie nts lie flat to improve oxidization of their lungs. This has happened in real time as we have seen the severity of this infection in hospitals. There is the sort of battle in terms of numbers, but the actual active battle going on in hospitals to continuously improve care. I think the Biggest Issue as these numbers increase is that they shouldnt, as best as we can do with social distancing and the controls at which we are doing, overwhelm the healthcare services. Therethose circumstances, is a tragic needless deaths of people waiting to come to hospitals. The in adequate numbers of ventilators. Infectedhe numbers of under some sort of control by social distancing advances the goal to avoid overwhelming healthcare services, as we saw in new york city which is now resting back control. Or as we see in boston, we do have experience, a sustained level of control over the pandemic through social distancing here in the city. Also our guest is associate professor at harvard medical school. Tomorrow, dr. George daley, the dean, will be joining us tuesday evening at 8 00 eastern time. I want to get your reaction to what the president said last night in a fox news town hall meeting on where we stand for the vaccine. Pres. Ttrump we are very confident we will have a vaccine by the end of the year. By the end of this year . Pres. Trump we think we are going to have a vaccine by the end of the year. We dont even have the final vaccine. Johnson johnson, if you look at Johnson Johnson is doing it. We have Many Companies are, i think, close. I meet with the heads of them and i find it a very interesting subject because it is so important. I think we will have a vaccine by the end of the year. Host as you hear that from the president , is he on target . Dr. Poznansky people who know me know im an optimist. The optimistic things are the more than 70 vaccines at play in the moment. We have his great advantage of multiple shots on goal which gives us a chance to find a wsay through here with an effective vaccine. The issue here is time to develop a safe and effective vaccine. Two elements of time anof that which is related to the mechanics of making a vaccine and the biology itself. On the mechanics, it takes time to actually assemble a vaccine, test it, make sure it is safe, make sure it is actually effective. Uncaused there are not effects of the vaccine. That takes time. Dr. Fauci has talked about 12 to 18 months. Secondly, there is one part of this that is the fundamental biology of the virus. We dont yet completely understand what consists of socalled protective immunity. What is the immune system doing and people get infected with this virus actually protect them . That biology remains unknown at this time. In some ways, were laying the track for a vaccine while building the train that is moving along that track at the same time. Unknown answers to very significant questions that make prediction of shortterm Vaccine Development really, really tough to make. There are a number of known unknowns, as they are called, which we have to know in order to develop an effective vaccine and those remain unknown at this time. Host which is what you outline in a recent piece at thehill. Com, entitled changing america. You said we are still many months away from final testing of the vaccine. From your standpoint, what is your biggest unknown . Your biggest question . Dr. Poznansky my biggest question is truly this question i raised about what constitutes protective immunity . In other words, if you are infected with the virus, you recover, what are the elements in your body that are defending you effectively against a subsequent infection . Because that detail of the immune system that a vaccine absent that infection will have to bring about in your body. That question, once that is answered, will speak on the development of vaccines. We will actually know what the target is. 70 or am optimistic about more vaccine platforms targeting covid19 at the moment is simply whether it isnce, the oxford team for the johnson our team team for ou or at mass general, there is a chance we are able to invoke the immune response that will protect people against infection with the covid19 virus. At the moment, that question remains to be unanswered and consequently, we are moving on vaccines forward as we are laying the tracks towards that understanding. Host you are working on what is being described as a selfassembling vaccine. What is that . Dr. Poznansky it is the sort of interesting biological construct which consists of one component which is a protein that activates your immune system generally to get ready to fight a virus. Is onen the second part that actually targets that response to the specific virus. This is actually funded by darpa, the department of defense over eight or nine years ago as part of a Pandemic Preparedness Program that they launched. The selfassembling piece you attach one part of the belco molecule to one part of that vaccine, and the other piece of velcro so the other part of the molecule. They come together straightforwardly to make the whole vaccine. It is an extremely stable construct. That velcro component are naturally occurring proteins that can be added to both sections of the vaccine. Then, they come together when you mix those in a test to. It is stable, it is longlasting and suitable for distribution in large quantities, manufacturing, stockpiling large quantities which was the stipulations of a pandemic preparedness type of approach in making a vaccine. Is dr. Poznansky from mass general. Our phone lines are open. We have a line set aside for medical professionals at 202 7488002. If you are a doctor, nurse, emt, we were left to hear from you. Pat is on the phone from new jersey. Caller even if by some miracle we got a vaccine by the end of this year, wont this virus still be existing in the population for years to come . How long is it going to take to vaccinate every Single Person in the world . Thank you. Dr. Poznansky that is another enormously important question, which is once you have made a vaccine, how do you then deploy it across the globe to eradicate a virus . We have some models of this in history, the eradication of polio, the eradication of smallpox. Absolutely right. It takes a long time. That does not mean we cannot get significant strides to this effective vaccine. We would vaccinate those at most risk. The frontline workers. The individuals who have high risk of severe disease. The elderly. Those with coexisting medical complaints like diabetes and Chronic Airways disease and so forth. We can make a very Significant Impact on the severity of the disease in the population as one of the first metrics. But pats right, this is a major global undertaking as it was with smallpox, as it was with polio. To go after the global population, deploy effective vaccines and get to everybody effectively on the planet to protect them against this disease, because the alternative hangingthe virus starts around on the globe, infecting andets of patients individuals even when there is an effective vaccine for it. Host you mentioned vaccines in development. Some confirmed, some not confirmed. When you get to phase one of a vaccine, what does that mean . Dr. Poznansky phase one is the principal test you are doing is safety. That is that you dont see adverse reaction to the actual vaccine itself. We are talking about serious adverse reactions, including skin rashes, upset symptoms that are related to the vaccine itself. It first at phase one. You can at that stage have a readout of efficacy as well as a second refinding based on the fact of the context of the vaccine that those people you are testing within the trial might themselves be challenged with the virus, just hanging around on the planet, being exposed to it. You cant see whether in phase one, if there is some indication of efficacy, you can in more withoped settings work out generating those who got the trial vaccine are generating an immune response to the virus that looks like it should, at least in theory, challenge the virus. Host lets go to stephen joining us from brooklyn, new york. Forer thank you, doctor, everything you have been doing during this crazy pandemic. What are some risks and challenges you have been facing during this development of the vaccine . Im wondering when the next update for dr. Poznansky the things we face challenging the first one delivered us on a plate. Our vaccine platform, six month before the pandemic, was actually licensed to a company that was interested in it initially as a cancer vaccine platform. But once the pandemic arose, they realized it could turn on a dime and be ineffective pandemic pandemican effective virus vaccine which it was initially designed for. Why they said it was a hurdle that was almost instantaneously overcome is as we develop vaccines, especially in academia, we must have partners in industry who will take this on and drive them into being a product. This thing of academic universities dont make medical products, Companies Make products, that kind of partnering early on is incredibly important component of what we do. Those challenges we would have otherwise faced melted away in conjunction with therapeutics that came together to provide the expertise to take on a new further towards full development and testing and provided the Financial Support to make that possible. That all happened in the space of two or three weeks. Certainly in the history of academia, that is a very short period of time, i can tell you. Host james is next from shreveport, louisiana. Good evening. James, go ahead. I will ask you to turn the volume down on your set, otherwise we have to move on. James, are you with us . Let me go back to that development of remdesivir which is a new treatment for covid19 patients. How significant is that in terms of the timeline and in terms of what its potential means . Dr. Poznansky the key thing as one of the first barriers to this awful virus is a drug that change severe disease into moderate disease, moderate disease into mild disease. Tamiflu equivalent. That we have the flu, but the tamiflu equivalent of covid19. We saw the first glimmers. Again, im an optimistic person. It is an intravenous drug that can be given to severe patients which shortens the duration of their symptoms. It didmportant to note not release the preliminary reporting on the Clinical Trials theificantly impact instance of mortality or death as a result of covid19 disappointingh is to doctors like myself because we like to have it all and see it succeed in every possible way at this time. It is certainly significantly reduced the duration and severity of the disease which is a major advance for us. And could have a potential impact in the icu to reduce the length of the state in icu. The quicker the patients get out of the icu into the general ward, the better. The only caveat i would say im a pragmatist is that the positions of the scientists, we await the full report of the trial so we can understand the details of how it was executed and what the devils of the detail were about the trial itself. That is imminent and we are obviously all excited to see that. There may be more positive data to be yielded through scrutiny of that data. Host dr. Poznansky joining us from his home in newton, massachusetts. He is the director of the vaccine and Immunotherapy Center at massachusetts general hospital. Raju is joining us from houston, texas. A medical student. Could evening. What are you studying . Caller im actually planning to go to medical school in the next few years. Im currently a biotechnology student. Ive taken classes related to virology and things like that. In regards to covid, a lot of the talk has been about in terms of side effects or other types of viruses that have the ability to mutate, because if you try a vaccine, the virus will heal itself and things like that. Has there been any trouble with regards to vaccine trials, the virus mutating or shielding or things like that . Or is it more in regards to the side effects and the clinical endpoint you guys are trying to reach . Host thank you for the question. Dr. Poznansky i encourage you to go into medicine. We need all the help we can possibly get. The mutationo rate of the virus, it has been low, but there have been sequences of the virus that have different versions genetically. Ologistsin are very aware of this. Canave a platform that newly change the targeting vehicle of the vaccine to adapt to the specific changes in the virus. A vaccine for covid19 to a vaccine for covid19a, for example, if we need to. The other important point to stay about viruses changing it can change genetically but it may not have a major consequence in terms of either their immunology or biology. It is an area very close monitoring, like with a lot of viruses, how they are changing genetically. But there are vaccines out there which are watching that and ready to move and adapt according to the way the virus changes. Host gary, you are next. Good evening. Caller evening. Interested in knowing whether there have been any reported of influenza in covid19. If not, what are your thoughts about that occurring . Host what is your background . Caller im a family physician. Dr. Poznansky that is a deep medical question. I have not personally seen cases of combined infection with flu and covid19. I have seen patients who had flu and thought they had covid19. Also, as one of the areas of Infectious Diseases specialty, i work in an area where we are treating patients who are immunocompromised. We certainly see coinfections or two or three different infections affecting the same individual when their immune system is impaired by medications like steroids and agents like in cancer, patients of cancer. Conceptually, it is certainly possible that a patient with an immune defect could actually be coinfected with both viruses. It is just i have not personally read about it or seen it for myself. Host lansing, michigan. You are on the air. Caller i have a question. How is it possible somebody gets the disease and recovers and not be immune . Contradictory that if you develop immunity by injection or given an injection of sort to create the immunity from scratch. Host thank you for the question. Dr. Poznansky another great question. It does relate to what i said earlier about not knowing exactly what protective immunity means in the context of covid19. So, until there is more understanding of that, we wont know what constitutes it. Again, in the hospital so far, i havent personally seen patients who have had recurrent covid19 infection. Said, it isr. Fauci much more likely that once you have been exposed to this virus, just like other viruses, you end up being immune to that virus. The thing thats holding us up is understanding what immune to that virus actually means. That takes time and science to work out. Is exactly what i gave the analogy of laying the tracks while moving the train along it. That we are heading into Vaccine Development without a clear idea of that, but we have enough shots on goal and enough experience with the science of Vaccine Development to make certain of subs assumptions we e moving that train along to an effective vaccine, that we will get to effective immunity based on the number of different vaccine platforms being tested du. Host how do you make sure that train reaches the destination . In other words, how do you test the vaccine to know it is working and what are some of the stumbling blocks along the way . Dr. Poznansky the key stumbling blocks actually, the biggest tumbling block is the industrial interest in taking the vaccine all the way to the end. We know the financial component of Vaccine Development where the product, each unit has to be under one dollar and cost and it is going to be a global product. Theres going to be all sorts of economic ramifications. Companies will have to swallow that to drive this forward. The second one is simply that vaccines have moved along the Railroad Track towards phase ii and phase three have ultimately failed on safety. That issue of safety actually magnifies if you move along the path. The reason why is as these trials move from phase one to phase two to phase three, you get to see the effect of the vaccine on more and more patients. From hundre