S2E2 | Vaccines, for COVID and cancer: What patients need to know
S2E2 | Vaccines, for COVID and cancer: What patients need to know
Mashiul Chowdhury, MDInfectious Disease Specialist, CTCA COVID-19 Incident Command
Dr. Pat Basu: Hi, I'm Dr. Pat Basu, president and CEO of Cancer Treatment Centers of America and the host of Focus on Cancer. Incredibly excited for today's show, where we talk about a topic that could not be more important and more timely, and that is the COVID- 19 vaccine. The vaccine has been with us here and people have been getting it now for a couple of months. It's on everybody's minds. Hopefully, more and more it'll be in people's bodies and we can really beat this disease back. To help us in today's show and really take us through everything you want to know about the vaccine, we're joined by a renowned infectious disease specialist, who is also the leader of the Infectious Disease COVID- 19 Task Force at Cancer Treatment Centers of America, Dr. Chowdhury. Thank you for being here.
Dr. Chowdhury: Thanks Dr. Basu. I'm happy to be here.
Dr. Pat Basu: Well, we're lucky to have you here because this is a topic that's on everybody's mind. COVID- 19, it is not hyperbole to say, literally changed our lives and every aspect of our lives, coming up on almost a year ago now. It's hard to believe. For some people probably seems like a decade ago, for some people maybe it seems like just yesterday but 11 months ago, in March of 2020, people began to hear about this novel coronavirus, this COVID- 19 pandemic and it has changed our lives in every single way. And always begin with people. For you and I as physicians, our motto at CTCA is really, it's only and always about the patient and sadly, the numbers have just become staggering. We're talking about more than two million people worldwide who have been killed by this virus. Just here at home in the United States alone, 400, 000. Something that we must use medicine and science, collaboration and cooperation, the best of humanity frankly to beat this virus back, we have the Pfizer and the Moderna vaccines that thankfully millions have begun to receive since December and hopefully tens of millions will get going forward. You and I now have gotten it. But lots of questions on people's minds. Let's really jump into it. Why don't we start by you telling us a bit about these two vaccines, the Pfizer vaccine and the Moderna vaccine? How are they? What type of vaccines are they? How are they produced? What makes them different?
Dr. Chowdhury: This is an extraordinary time that we are passing through. And first of all, my heart goes out to thousands of families who lost their family members, loved ones and I lost my good friends from COVID- 19. And unfortunately, we are still seeing that a lot of cases like you said, and hospitalization and death. This is the worst pandemic in 100 years and we are suffering, our families are suffering, our cancer patients are suffering and cancer cannot wait. So basically, the vaccine that we have right now from Pfizer and Moderna, those are really extraordinary. What I mean by that is actually a vaccine traditionally and conventionally, we use either live virus, we kill them or make them weak or take the antigen or protein of a particular pathogen and then inject to our body so our body can actually teach our immunity to fight against the virus or bacteria. But in this case, this is a very new technology. In this case, they're using call this messenger RNA. And this messenger RNA is actually is synthesized in the laboratory. What it does is actually, in the beginning we know that this, every pathogen a virus has a unique property and unique protein and in this case in COVID- 19, there is a protein called a spike protein which is on the surface and it integrated into our cell and then cause all this problems. So the scientists actually sequenced that code of that protein, spike protein, and then synthesize like I said, in the laboratory and then packaged it in a lipid nanoparticle and then inject to our cell. Once we inject into our cell, we instruct our cell to make that the spike-like protein, once it is in the cell, it doesn't really go to the nucleus and it doesn't get into embedded in our DNA. That is important to realize because it is in the cytoplasm so it gets disintegrated eventually, but by the time it actually teaches our immunity so we can make the antibody. So once we make the antibody then in future if people get infection we are safe. Now the Pfizer and BioNTech that the vaccine that we see right now is ready to, and is enrolling and getting to people's arm. They actually have done their study and it's published in peer- reviewed journal. And we know the data and the data looks really fantastic. It is 90 to 95% effective and with the very low side effect. Now you remember that we said that if the vaccine is more than 50% effective, we are pretty good. So this is kind of unexpected result. And it is just because that I think it is a new technology and then we have did a lot of advancement in the science and this is the product of our advancement of science and knowledge. And we are very lucky that we have these two vaccines and enrolling this vaccine to our population. So eventually if we can get this vaccination done in our population, then we can actually completely eradicate this virus from our community.
Dr. Pat Basu: Fantastic. You're right. We absolutely are fortunate to have, not just one but multiple vaccines now. So just kind of rewinding for a second there, we on the show have tried to make some everyday analogies to what we're describing. And so sometimes I've used the analogy of an infection or a virus being a sort of like a criminal or a foreign invader, if you will. And our immune system oftentimes just can't recognize or recognize it fast enough to replicate. So in some cases a vaccine, I've used the metaphor is sort of like taking a photograph and producing a bunch of mugshots so that our defenses can react to it. Or when you have sort of a piece of clothing from the criminal, you give it to the dog and the dog can go smell it. And so what you're saying is very important here because there are a lot of myths around vaccines and there's been a lot of changes in them but to be clear you're saying a couple of things, number one, that this is a synthetically manufactured vaccine. So just to be very clear for our listeners, it is not as if we're taking a live strain of COVID and injecting it into the people, obviously I know you know this but I think it's important in this day and age when there's a lot of misinformation out there. So number one, it's a synthetic, you mentioned mRNA, messenger RNA that's been manufactured. Number two, you mentioned that it's nonintegrated, so it doesn't get integrated into the nucleus of the cell. I think that's really important just to illustrate for people why this is so safe. It's not as if somebody is going to take this and then get COVID, there's a 0% chance of that happening because of exactly what you described. You mentioned efficacy, 95% efficacious which is tremendous. You mentioned even about 50% would be good. Just give us a sense of what does that exactly mean to the average human being. Does that mean that out of 100 people who get the vaccine, 95 will get immune? Can you just tell us what those numbers actually mean in terms of 95% efficacy.
Dr. Chowdhury: This is like you said, that we teaches our immune system to recognize the foreign invaders, so we can be safe if we get a real infection. If you look at this two vaccines trial is, actually they have recruited about 75,000 volunteers and 75, 000 volunteers is pretty good number actually. And when they did it, they did it across the board in many countries and different ethnicity and different comorbidities and different populations. And data shows that when you are giving the vaccine to a group and not giving the vaccine in other group and in the vaccinated group, we have a very, very few people actually get infection. And in the nonvaccinated group, there's a significant number of people who got infection. This vaccine, when you look at the hospitalization and death, which is, we call it severe disease from COVID-19, these vaccines are almost 100% effective to prevent the death and hospitalization from COVID- 19. We not only seeing that it is preventing the mild infection, it is almost 100% effective for people who are most vulnerable and most have bad outcome they can get actually from COVID- 19. We can actually conclude that this is very efficacious and beyond that we expected from a vaccine trial, and this is also very safe.
Dr. Pat Basu: So without a doubt, just a remarkable success in terms of its safety, in terms of efficacy but let's just examine for a moment because again, these are interesting times that we live in. Science is one of the most important disciplines in humankind and yet difficult to understand sometimes. And in this day and age, I think where I sometimes say," A lie gets halfway around the world before the truth gets out of bed." And in the day of social media a lie probably gets six times around the world before the truth gets out of bed, a lot of mystery still around vaccines, a lot of myths, even going back to some things a couple of decades ago that were proven to be totally false that led people to not believe in vaccines. How is it possible that this got developed not just with such efficacy but with such speed in just under a year? Can you talk about what led to that success and why?
Dr. Chowdhury: Very good question. Actually, we are so lucky that we got this vaccine while the pandemic is actually going on. So when we get things so fast and easy actually I think people have... It's reasonable to have a doubt actually. But one thing I wanted to emphasize that this happened because of the advancement in science, like I mentioned in the beginning, the technology is different. For example, if you are actually developing a flu vaccine for example, every year they have to go through this cell technology, cell biology then you have to go through a lot of regulatory agencies and oversight so that takes months. This technology actually bypass that technology, the cell biology. You can see that there is no really red tape and bypass the regulatory agency because it's not touching that technology but at the same time I wanted to say that it did not cut the corner. Before we actually develop our manufacturing company, develop any vaccine. Number one priority, again number one priority is the safety. So you are injecting something a foreign materials to a healthy individual, you don't want to make that healthy individual sick. So that actually in our mind all the time, so vaccine can be less efficacious but that vaccine has to be very safe. So that is the number one priority. So what happened is actually, even though we got it less than a year, this vaccine went through every single, the stages of the phase that is required. And we look at the efficacy and the safety data. And the safety data actually is not done by or is not looked at by the pharmaceutical company who make the vaccine. We have an independent body actually who oversight the safety data. So it is the independent group who look at this data, who look at the safety and then approve for the, and then submit that to FDA and FDA gives the emergency authorization. So if we go through the process, if we go through all the rigorous process that is required for any drug or vaccine, you can be assured that it touched everything and we feel very confident that it is efficacious and safe.
Dr. Pat Basu: Absolutely. The risk- benefit analysis at the end of the day is a basic tenant of science, it's a basic tenant of leadership, it's a basic tenant frankly of decision- making, is what is the risk and what is the benefit? And that very simple framework has frankly been missing in a lot of really important discussions. But what you're talking about here with respect to the vaccine is this, at a population level, you have millions of deaths and massive, massive disruption of life due to this virus versus getting the vaccine. Those are your choices. You can get the vaccine and we can help return life to a better sense of normalcy with openness and activities and schools and restaurants or we can not get the vaccine and continue to live in what has been a very chaotic and challenging year. The risk- benefits certainly screams in favor of getting the vaccine to as many people as fast as possible. I think you've laid out a tremendous case for the safety. The idea that we have gone through massive phases of clinical trials. And now we have millions of people who have actually gotten these vaccines and the data from them continue to show that this is incredibly safe. I'd be remiss if I didn't point out that the CDC has apps such as the V- safe app, where if you have received the vaccine you can report any side effects that might've occurred. And it continues to be just a fast way for us to give people certainty around the safety of this vaccine. Just briefly, I think it's important to cover, in terms of revving up the immune system, why would somebody get an allergic reaction? Even though small, let's just say, as you mentioned one in a million, what is going on? And can you sort of explain to our listeners is that, isn't the notion of your immune system sort of just getting hyperactivated? Why would one get an allergic reaction to a vaccine?
Dr. Chowdhury: Yes. So let me just clarify this. When we get a vaccine, the vaccine is actually packaged in like I said, lipid nanoparticle and then for the stabilizing of the vaccine-
Dr. Pat Basu: What by the way, just for our listeners so essentially, a lipid nanoparticle essentially means a sort of a very small, fat surrounding molecule that basically-
Dr. Chowdhury: Correct.
Dr. Pat Basu: Encases it, is just for the sake of our listeners. Sorry to interrupt you.
Dr. Chowdhury: Yeah, right. Sure. And then we need to stabilize the vaccine. Messenger RNA, one disadvantage of messenger RNA is actually is very unstable. So over the years, scientists actually made sure that it is stable and for that stability they use some components, we call it polyethylene glycol that probably people are listening to this component and it was not used before. So some people can be allergic to this components of like, we call it stabilizer of the vaccine. So this is something that if someone is allergic to the component they didn't know, they can have this allergic reaction. And this polyethylene glycol is commonly used in several products for example, tooth paste to MiraLax and some other materials that we use on a daily basis. So if someone has this allergic reaction that they didn't know, they might get into some sort of, we call it a serious to mild allergic reaction from itching to hives to like feeling of dizziness, doom and things like that. That's usually happen within half an hour to four hours. So that's why we actually are very, very careful because when we are giving this vaccination, we advise people to stay like at least 15 minutes to 30 minutes around so we can actually observe them. When we actually inject the vaccine our body start to produce the antibody. So it is happening locally on the site and also in a systemic basis. So if someone actually getting as local pain, a soreness and redness and some fever and chills that means that we are actually fighting, were actually making the antibody. So in the study shows that the older we are, we are actually showing the least reactogenicity and younger we are, we are showing more reactogenicity. So I rather use reactogenicity than side effect, but which is actually expected from any vaccinations.
Dr. Pat Basu: Terrific. Well, wonderful segue into where I want to go next. But yeah, the idea of reactogenicity is the notion that it's working, right. Your body is responding, we want the body to respond. If I use this sort of, we're printing out a bunch of mugshots example, the printer's getting, it's getting hot, there's a lot of pictures getting printed there and so we want that to happen. I'm glad that you're making that distinction and I'm also glad that you're pointing out this idea of packaging so that the vaccine itself has to be delivered in the human body, frankly it's something that we work on with any therapeutic, any medication as you develop the medication but how do you get it into a mechanism that your body can use it and frankly not destroy it before it can do what we want it to do. In the rare occurrence that there is an allergic reaction that a human being has, it's usually to that packaging of the vaccine that we use and that packaging sometimes as components that the body can be allergic to. That being said, our cancer patients have unique regiments that they're on and drugs that they're taking and immune systems in their body. What should cancer patients know specifically about the vaccine? How they might respond to it differently, I gone forward?
Dr. Chowdhury: Very good question. As I said, that it is very safe and there is no actually correlation between the allergic reaction or side effect of the vaccine and what they get in terms of the cancer directed therapy. But one thing we need to realize that the cancer patient who actually get active chemotherapy or radiation therapy or immunotherapy, they may not mount as much immunity or antibody as other people, like they may not have as robust antibody response. So what we typically do and it is true for all vaccines not only COVID-19 vaccine that if we can, we like to wait two weeks, why two weeks? Any vaccine, it takes about 10 to 14 days to develop adequate immunity antibody. So if it's possible, the cancer patients should take the vaccine at least two weeks after the chemotherapy or two weeks before the chemotherapy. I would say that please talk to your oncologist or infectious disease consultant and see what is the best time for you to take the vaccine. So again, there is no correlation between the allergic reaction and the chemotherapy or immunotherapy, there is no correlation between what the cancer directed therapy are getting and the side effect, but it is true that the risk of COVID- 19 and also bad outcome from COVID- 19 is way higher than any kind of side effect or reactogenicity that you expect from the vaccines.
Dr. Pat Basu: Very, very helpful. I know we get these questions a lot from our cancer patients, in addition to when will they be able to access the vaccine and all sorts of questions, but just sticking with kind of this clinical realm. Number one, no evidence of any, what you've described where the allergic reactions can come from which is that envelope or that sort of a casing that we put the vaccine into, nothing specifically about a cancer patient that would make them more allergic, nothing specifically to suggest that there's an adverse interaction between an oncology drug that they may be taking. And then ultimately going back to your risk- benefit analysis, what you've laid out is that the risk of COVID being greater to a cancer patient but the risk of a vaccine being tiny and equal across the board would lend itself towards saying, the cancer patients indeed should be among the top of the list getting vaccinated. Would you agree with that statement?
Dr. Chowdhury: Oh, absolutely. I think the category right now that we see, that one see which is very, very high in terms of the priority of the vaccines. And again, the priority of the vaccine actually done because we don't get the 200 million doses at the same time. So we are getting the batches of vaccines and that's why we need to prioritize population because we can't get vaccinate every single Americans at the same time. So who are the vulnerable? Vulnerable again, older individuals more than 60, 65, people who have cancer, who are getting the immunosuppression and then other morbidities like diabetes and high blood pressure. So they are the one who are actually more vulnerable to get the bad outcome of the COVID- 19. And as we know that the most of the time, if you're healthy, otherwise, if you are younger, otherwise then COVID- 19 actually in 80% cases it is pretty mild. Only that 10 to 15% cases we can actually see that hospitalization and then other bad outcome. And it's not only me that I'm actually talking about. We know that American Society of Clinical Oncology, they also recommend that the cancer patients should get the vaccination as soon as possible.
Dr. Pat Basu: As you said at the beginning, cancer does not wait for COVID. We have spoken a lot about this concept of the shadow curve. Literally, tens of thousands, hundreds of thousands of patients perhaps that I've had their cancer diagnosis delayed or missed because of COVID. And you've really laid out a case as have every intelligent body out there from, you mentioned the ASCO, the American Society of Clinical Oncology and a whole bunch of other really professional organizations saying that cancer patients should really be in that first line of patients to get vaccinated. I'm an optimistic realist or a realistic optimist, either way that being said, I think there's tremendous hope on the horizon here. This vaccine is the single greatest help for us to put COVID-19 back in kind of into our history rather than into our present and future. Let's talk about what that's going to take at a population level. Dr. Fauci predicted that if we can get 70 to 85% of the public vaccine by the end of the summer, that should be enough to really cause an exponential decline in the spread of this virus. Where are we right now in terms of population that's been vaccinated? Where do we need to get to really reach a tissue tipping point where the population at large will be safer from COVID-19?
Dr. Chowdhury: When we wanted to eradicate a virus or infection from a community, the pandemic, we need at least 70 to 80% population either immune by disease are immune by the vaccines. So immune by the disease is like the natural immunity, we call it and then immunity by the vaccine is the backward immunity. We are trying to vaccinate 100 million population in 100 days. So if that can be done, then we can actually see that in a couple of months, if I would like to be very, very optimistic we can get it done because we are getting not only these two vaccines, we are getting other vaccines too in our pipeline and also they are done with the clinical study. So every single day a week actually we are getting very nice data and efficacy wise and there are many different vaccines available. I think if we have that leadership and if we have that enthusiasm and optimism and the innovation of giving the vaccines to population that we need, I think it can be done.
Dr. Pat Basu: Yeah. I agree with you. And oftentimes when I'm speaking to friends or people on this topic I say," Collectively speaking, we as a people, as a country, as a society really need to band together and learn the facts, learn that you're protecting not only yourself but you're protecting your loved ones, you're protect your community in doing so." To those listening to this show today and in the future, what would you tell them about getting a vaccine and the importance of getting a vaccine as it becomes available to them in the weeks ahead?
Dr. Chowdhury: As you mentioned in the beginning that this is probably one of the best thing that humankind actually did, the vaccination. We actually looked at the history and we know that the world was devastated with the very dangerous diseases like smallpox, polio and measles and so on. And we kind of eradicated. The smallpox eradicated couple of decades ago. There are only a handful of cases of polio every year, so we can do it. We can do it. We are in a age where the science has done tremendous advancement. Just think about if I can put this in a perspective, like when we had Spanish flu like 100 years ago, that time it went through world like three years and kill millions and millions of people all over the world. We did not even know what is the organism was causing it. We know about the virus about 10, 15 years later and forget about the vaccine, vaccine came about 20 to 30 years later. If I compare that now, when the first case was diagnosed of COVID- 19 in last week of December of 2019 by two weeks, we not only know the virus, we know the sequence of the virus and what is actually how we can diagnose by PCR and how we can actually teach people what to do prevention wise. So it was done so quickly and believe it or not as soon as we know the sequence of the virus, we got the vaccine in couple of weeks. Of course, either way it had to go through the phases and the clinical trial. So we are living in extraordinary time that things are very, very fast. We're getting the thing that we need actually to save the population. We cannot let this pandemic take and win so we need to fight, we need to fight very hard. And if we actually vaccinate, if I vaccinate myself I'm actually helping others, I'm helping the community, I'm helping the country and I'm helping eventually the world. We are very fortunate, take the advantage of the science and try to stay safe and be safe and we can win it.
Dr. Pat Basu: Well, fantastic. And I should mention that you've gotten the vaccine, I've gotten the vaccine and you hit the nail on the head. This is literally the shot that we've been waiting for, for over a year. So you've done an incredible job of laying out how the vaccine works, why specifically it is so safe and so efficacious in terms of the signs and the data that you've laid out. And most importantly that it is imperative for patients and people, everybody to get this vaccine as soon as they can to protect themselves and their loved ones. So thank you for just sharing your knowledge and your expertise. Thank you Dr. Chowdhury for all you do, for keeping cancer patients safe and thank you for taking time away from that busy job that you have to join us there on the show. I Appreciate it and will talk to you soon.
Dr. Chowdhury: Thank you for inviting me. Thank you.