Authors:
Javier Casellas, M.D., Ph.D.
Enrique Chacon-Cruz, M.D.
Felicitas Colombo, MPA
Summer hit the United States Congress and it’s inferno hot in public health. Coincidentally, we had the privilege to have a candid conversation with Prof. Peter Hotez, M.D., Ph.D., a pediatrician-scientist and Dean of the National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine and Co-director of the Texas Children’s Hospital Center for Vaccine Development, who shared his perspectives on many important health issues.
Prof. Hotez is deeply immersed in the intersection of science, politics, and public health, particularly in the realm of vaccine development and defense against anti-science movements. His career and advocacy highlight several critical themes and challenges facing global health and science policy today.
Partisan Science & Polarization
Science and politics are extremely complex ecosystems. An intricate spiderweb of actors and players that influence health policy with multidimensional repercussions. Trying to make sense of it is as difficult as making vaccines. Physicians and scientists struggle to discuss the attacks on biomedicine because they are trained not to talk about politics.
Prof. Hotez notes that attacks on science often align along partisan lines, impacting health policy decisions and public trust in scientific consensus. This polarization complicates efforts to combat diseases and promote evidence-based policies.
“All our training says we’re not supposed to talk about Republicans and Democrats and liberals or conservatives or red states and blue states, but clearly the attacks are along a partisan divide, both against biomedicine and climate science. So, the fact that it now reaches the highest level of the United States Congress, that’s a big concern,” expressed Prof. Hotez, author of The Deadly Rise of Anti-Science.
An internationally recognized physician-scientist in neglected tropical diseases and vaccine development also a stalwart voice at the helm of the difficult journey to protect science, Prof. Hotez has received several attacks throughout his career, which spans over four decades. Keen to see more government protections to scientists from the White House Office of Science & Technology Policy and scientific societies, among other institutions, he finds solace in his work and achievements.
“I mean, I’m often asked, well, why aren’t you suing all these people for defamation? And I say, yeah, I could, or I could make vaccines to save the world,” shared Prof. Hotez during our conversation.
Science above all
As both a vaccine scientist and autism parent, Prof. Hotez began his journey to defend vaccines more than two decades ago and now serves as a passionate advocate against the growing ‘antivax’ activism. Becoming these groups’ target gave him ample visibility to contest the dangerous and pervasive anti-vaccine rhetoric.
The world is currently experiencing strong pushbacks against vaccine mandates through aggressive anti-vaccine activists that discredit the effectiveness and safety of vaccination. In the zeal to push back against mandates, they’re also weaponizing the health and science communication. Prof. Hotez is concerned this could be reversing all the gains of the last 20 years through the Gavi Alliance and latest World Health Organization (WHO) data confirms that childhood immunization rates have stalled.
With so much information available, combating disinformation is not an easy task. Improving science communications is key to successful health policy. Protecting scientists, Prof. Hotez claims, is at the center of this conflict because the attacks are not only against science but also portraying scientists as public enemies or enemies of the state.
“Even worse, sometimes it’s the silence of the friends is almost as bad as the words of the enemy,” he concluded.
Yet, as he openly explains, there are many factors driving the emergence of diseases, and anti-science forces are only one of them. Others include climate change, urbanization and poverty.
The Next Pandemic
Scientists are seeing a cadence of regular pandemics. Whether it’s SARS and MERS, COVID and Ebola, H1N1, or H5N1 currently and hopefully not accelerating, Prof. Hotez believes we are at high risk for a major zoonotic flu pandemic, either from pigs or from birds.
What he is referring to is the Center for Disease Control’s (CDC) One Health surveillance program. A collaborative, multisectoral, and transdisciplinary approach working at different government levels with the goal of achieving optimal health outcomes through monitoring and controlling public health threats. Through the collaboration of all relevant disciplines and sectors, it aims to learn about how diseases spread among people, animals, plants, and the environment.
“I think we’re just not prepared yet to really take that on, and that’s got to be a priority. One of the things that COVID taught us was, yes, there was a public health impact, but it was so much more than that, right? It affected the global economy and global security, and it will happen again with the zoonotic flu. And so, we’ve got to get out of this mindset of doing everything on the cheap,” explains Prof. Hotez, who highlights that the need for surveillance efforts in areas of biodiversity extends throughout the world, especially in low- and middle-income countries.
During the COVID-19 pandemic, mRNA, particle and adenovirus vaccines were developed quickly. The issue when relying on a brand-new technology, is that there is a learning curve before going from zero to the 15 billion doses needed to vaccinate the world. These initial doses quickly were bought up by the U.S., Canada and Western European countries, leaving the low- and middle-income countries vulnerable.
“The question is how do you do this in an equitable form? How do you also encourage technologies that could be scaled up locally by vaccine producers in low- and middle-income countries?” questions Prof. Hotez, who was nominated for the Nobel Peace Prize for his work to develop and distribute a low cost (recombinant protein) COVID vaccine for the developing world by transferring previously researched technology with no patent, minimizing strings attached to vaccine producers.
Through this initiative, by 2022, 100 million people got vaccinated in India and Indonesia. A testimony that not only big pharma can do big things. Nevertheless, vaccines for low- and middle-income countries doesn’t seem to be anybody’s priority.
Pre-qualification mechanisms at WHO are still putting a velvet rope around big pharma, making their path much more straightforward and easier. A procedure Prof. Hotez is confident WHO is committed to fixing.
Currently, to get rapid approval and dissemination of a vaccine, you either have to go through the WHO’s pre-qualification mechanism or one of the so-called ‘stringent regulatory authorities’, and then it gets concurrence by WHO. One way Prof. Hotez believes getting the world vaccinated could move a lot faster would be to provide the biggest producers of vaccines in the world, such as India, Indonesia or Brazil, ‘stringent regulatory’ status.
“Our technical ability to make vaccines has outpaced the political, social and financial instruments that we have to ensure their equitable distribution. So that turns out to be as complicated as the science itself,” vehemently expressed Prof. Hotez.
The challenges & opportunities ahead
“Preventing the Next Pandemic”, a book Prof. Hotez wrote in 2021, looks at how all these forces are converging. He explains it is this constellation of 21st century forces, of which climate change is a big aspect because so many of these viruses derive from bats, and bats are migrating in different patterns in search of new habitats and food sources because of climate change. Deforestation, urbanization, in addition to political instability and anti-science are indeed important as well.
The convergence of these and other forces is contributing to these illnesses appearing at an alarming rate. Not only are we seeing an increased frequency in the cadence of pandemic threats such as Ebola and Coronavirus infections, as well as zoonotic influenzas, but there’s also a notable increase in neglected tropical diseases, including places where we haven’t seen them before. Hence, it’s not only the pandemic threats, but also parasitic and neglected tropical diseases, which include arbovirus infections (dengue, Zika, chikungunya, and yellow fever) tick-borne illnesses, and parasitic infections (Chagas disease and hookworm anemia).
Technology is advancing at an exceedingly fast rate and there currently are many options for new vaccine technologies, whether it’s mRNA, particle vaccines, or traditional yeast-based recombinant protein vaccines. Prof. Hotez believes another challenge is going to be to discern what the best technology will be for any given vaccine.
“And then realizing that making the vaccine may not be the hardest part anymore because you’ve got to, one, get people to accept new vaccines,” continued Prof. Hotez.
He worries that the recent vaccine refusal, or fatigue, is going to extend to other new vaccines being introduced. The question is, what is the upper limit of new vaccines people will accept and how to bring them into the system in combination, as a way to streamline the process so it fits into the health system.
“I think my big worry is that we are seeing, whatever metaphor you want to use, a tear in the matrix or some gaps now on our global vaccination ecosystem,” concluded Prof. Hotez.
Looking ahead, Prof. Hotez calls for sustained global cooperation and financial commitments to address neglected tropical diseases, pandemic threats, and broader health challenges. He emphasizes the critical need to acknowledge the risks posed by politically motivated anti-vaccine and anti-science movements, which are increasingly spreading beyond the United States to become global issues. He continues to emphasize the importance of scientific integrity, public engagement, and equitable health policies.
In summary, Prof. Hotez’s work and advocacy underscore the complexities of navigating science within political landscapes, the imperative of global health equity, and the urgency of preparing for future pandemics. His insights and initiatives highlight the ongoing need for collaborative efforts and innovative solutions to safeguard public health on a global scale.
