Vaccine Expert: Once COVID-19 Vaccine Is Available, 'Don't Overthink It. Don't Wait'

Nov 24, 2020
Originally published on December 4, 2020 4:08 pm

As coronavirus cases continue to surge both in the U.S. and around the world, there's promising news on the vaccine front. Pharmaceutical companies Pfizer, Moderna and, more recently, AstraZeneca have all announced that their vaccines have shown better-than-expected results.

Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children's Hospital, says that a vaccine release could begin for selected populations by the middle of December — and that a broader vaccination effort could soon follow.

"By the early part of next year, we're going to move pretty quickly, I think, in vaccinating a significant percentage of the [U.S.] population," Hotez says.

Hotez says that at present, all the vaccines in development work similarly, by inducing an immune response to the spike protein of the virus.

"One of the questions that I'm asked all the time is, 'Hey, doc, which vaccine are you waiting for?' And the answer is ... I'm going to take any of those vaccines that's made available to me that's authorized by the U.S. Food and Drug Administration," he says. "Don't overthink it. Don't wait. Get what vaccine you can."

Dr. Peter Hotez is co-director of the Center for Vaccine Development at Texas Children's Hospital. Some people in the global health sector call him "Bono with a bow tie."
Katie Hayes Luke for NPR

For two decades, Hotez and his team have worked to develop low-cost global health vaccines. Now, with COVID-19, they're working on developing a vaccine that he hopes could be produced locally, so low- and middle-income countries aren't reliant on the U.S. or Europe for production.

"We signed an agreement with Biological E., based in India, in Hyderabad, and they are now scaling this up to 1.2 billion doses, testing it across India," Hotez says. "It's very exciting for us to make a contribution. We've never made a billion of anything before — so that's pretty exciting also."

Despite this good news, Hotez urges people to continue physical distancing and wearing masks.

"Don't be lax with it now, especially with the holidays," he says. "It's especially tragic if one of your loved one loses their life or has permanent, long-lasting injury during this period because it's just a matter of staying disciplined for the next couple of months and getting them to the other side."

Hotez's forthcoming book is Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-Science.


Interview highlights

On his advice for the holidays: telling loved ones that visiting isn't safe this year

It's not worth that short-term event, getting family together, in order to put them at risk and put yourselves at risk. Vaccines are coming. - Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children's Hospital

Remember, this is a true gesture of love — telling people not to come — because right now ... COVID-19 [is] accelerating across the United States at this screaming-high level of approaching 200,000 confirmed cases per day, which really means about probably at least half a million new cases a day. Any airport right now, any bus terminal, any train station has lots of COVID-infected people in those venues. It's not worth it. It's not worth that short-term event, getting family together, in order to put them at risk and put yourselves at risk. Vaccines are coming. It's just a matter of recognizing we have to get everybody through to the other side.

On the U.S. pulling out of the World Health Organization and how vaccines have become nationalized

I think the scientists are still sharing information and communicating at an international level, so I don't think that's been too affected. The thing that I worry about now is people have tied national identities to vaccines. In fact, there's a new term that's been coined called "vaccinationalism." We talk about the Chinese vaccine, the Russian vaccine, the British vaccine, the American vaccine. We've never had that before. I think it's counterproductive. And so by the U.S. pulling out of the World Health Organization and refusing to be a part of the COVAX sharing facility, which is our new mechanism that's been put in place to provide global equity for vaccines, I think this has been counterproductive and could hold us back.

We also now have this unfortunate situation where countries that don't have full access to vaccines are now making one-off deals with the Russians, the Chinese, and [it] has kind of a Cold War smell to it. We have to fix that as well. I've been devoted my whole life to this concept of vaccine diplomacy, sharing vaccine development practices between countries. And I served that role as U.S. science envoy in the Obama administration. I think we have to get back to that.

On the vaccine development he's working on and why he hopes it will reach low- and middle-income countries

Medical staff along with volunteers from the Hindu hard-line group Rashtriya Swayamsevak Sangh walk through a market for a door-to-door medical screening in Mumbai, India, on June 17.
Indranil Mukherjee / AFP via Getty Images

This is a very traditional technology. The same technology used to make the recombinant hepatitis B vaccine used all over the world. And that's important for two reasons. One, many countries have the ability to make their own hepatitis B vaccine — that includes Brazil and Cuba and Bangladesh and India and Indonesia — so that potentially our vaccine could be made locally. It doesn't depend on it being made in Europe or the U.S. and then filtering to the low- and middle-income countries. And it could be made pretty inexpensively, we think. So the hepatitis B vaccine, in many cases, is made for under a dollar a dose, so we think our vaccine could come along in a similar cost structure. So we're looking potentially at using this to help fill the gaps where low- and middle-income countries don't have access to COVID-19 vaccines, and possibly even a strategy for the U.S. and Europe.

On the lack of communication among Operation Warp Speed, the pharmaceutical companies and the American public

I would have liked to see more of ... a communication strategy coming out of Operation Warp Speed. The communication has been very much left to the pharma CEOs, and I think overall they've not done a good job communicating to the American people. First of all, too much reliance on press releases that over this past year have been sometimes hard to decipher or understand. Too many leaked phone calls, too much weirdness about the stock trading and options. And I think that has undermined some confidence.

I would have liked to have seen government scientists out there communicating on a frequent, regular basis about Operation Warp Speed, very much like the way [New York Gov.] Andrew Cuomo did in March and April. It doesn't have to be every day, but on a regular basis. I've done what I can to fill in those gaps, being on the various cable news networks and podcasts, but at the end of the day, I'm not a government scientist.

On how 95% mask-wearing could prevent hundreds of thousands of deaths

We have new estimates now from the Institute for Health Metrics and Evaluation at the University of Washington, really looking at the number of deaths that are going to be projected to result from COVID-19. And they're pretty chilling numbers. And that says that unless we can get to 95% mask-wearing, we're looking at another 150,000 Americans who will lose their lives between now and a week or two after the inauguration. So we have the stunning number in a terrible way of 400,000 Americans losing their lives ... by a week or so after the inauguration. That's basically the number of American GIs who died in World War II. We're looking at those kinds of numbers.

For me, the tragedy is none of those people have to die if we adhere to 95% mask-wearing — No.1. No. 2: social distancing, especially in times when there's a threat of a big surge on intensive care units, because, remember, that's when the mortality figures go way up. We saw this in New York in March and April. We saw it in southern Europe and Italy and Spain in March and April. The death rates really accelerate as ICU staff starts to get overwhelmed. And that's already starting to happen now in the northern Midwest and in Lubbock and El Paso here in Texas. So just by those straightforward measures, social distancing, being responsible, wearing masks, we can save tens of thousands of American lives between now and the time of the inauguration. And that has to be our big emphasis.

On the importance of a coordinated federal government response to the pandemic

What we saw all this year in the Trump administration was putting the states in the lead and the U.S. government would be responsible for backup supply-chain management and FEMA support and manufacturing ventilators and that sort of thing. And it didn't work. And this is why the U.S. has led the world in terms of COVID-19 deaths. And the reason it didn't work is the states never had the epidemiologic horsepower to even know how to conduct COVID control measures. And they also needed the political cover of the federal government to deflect from the attacks that they were getting from their own internal political opposition. I think having the federally coordinated response, which the Biden administration seems committed to, will make a big difference.

On the difficulty of achieving herd immunity when so many people believe anti-vaccine conspiracies

If we're going to really achieve that 70% herd immunity, which is what our estimates that we came up with, together with our colleagues at City University of New York ... we need to figure out ways to better communicate about vaccines and the importance of vaccines and really start doing something about this very aggressive anti-vaccine movement that's now morphed into a wide-scale anti-science machine or empire or confederacy that really dominates the Internet and dominates American life right now. We've got to figure out a way to begin dismantling that.

On going back to "normal" life

It's not going to be a light switch. It's going to be an evolving process. We will be in a much better place by the spring, and then by the summer we'll even be in a better place, and by a year from now, life, I don't know that will entirely return to normal, but it's going to be much better than it is now. - Peter Hotez

It's not going to be a light switch. It's going to be an evolving process. We will be in a much better place by the spring, and then by the summer we'll even be in a better place, and by a year from now, life, I don't know that will entirely return to normal, but it's going to be much better than it is now. And the reason I say [life] may not entirely return to normal is we don't exactly know the performance of these vaccines in terms of reducing the amount of virus shed from our nose and mouth. ... So there still could be a fair bit of virus circulating. And that means there could be still some need for masks and social distancing and contact tracing. But, no question, life will be so much better in the next few months than it is right now.

Lauren Krenzel and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Marc Silver adapted it for the Web.

Copyright 2020 Fresh Air. To see more, visit Fresh Air.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. The new coronavirus vaccines are giving us hope that we can get the virus under control. Pfizer and Moderna have announced that their vaccines are showing very promising results. And this week, a third company, AstraZeneca, announced that the vaccine it's developed had good results in its late-stage clinical trials. But for the vaccines to work, people have to be willing to get vaccinated.

My guest, Dr. Peter Hotez, is an expert in vaccines. He's working on the development of one for COVID-19. And he's very well acquainted with the anti-vaxxer movement. Dr. Hotez is the co-director of the Center for Vaccine Development at Texas Children's Hospital and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Much of his career has been devoted to developing vaccines for neglected, poverty-related tropical diseases. Texas, where he lives, is the epicenter of rare tropical diseases in the U.S. He's the author of the forthcoming book "Preventing The Next Pandemic: Vaccine Diplomacy In A Time Of Anti-Science."

His daughter, Rachel, was diagnosed with autism in 1994 when she was 19 months old. When a research study came out that was later discredited connecting vaccines to autism, galvanizing the anti-vaxxer movement, he tried to debunk it. That made him a target of the movement. He wrote about that in his earlier book, "Vaccines Did Not Cause Rachel's Autism: My Journey As A Vaccine Scientist, Pediatrician, And Autism Dad."

Dr. Peter Hotez, welcome to FRESH AIR. So now there's three vaccines in the works that are - they sound like they're all pretty close to actual production. You're working on one that you're hopeful about. So is this good news that we have three vaccines that are close? You're working on one that you're hoping would be ready sometime when?

PETER HOTEZ: Well, we're - it's in clinical trials now, and we hope by early middle next year.

GROSS: OK. So does this mean that we're going to have to be like good consumers and decide which vaccine we want, or are we not going to have a choice which of the ones in the works now we end up taking?

HOTEZ: No. I think at least in the beginning, we're not going to have much choice, but that's OK because they all work pretty much by the same pathway. They all work by inducing an immune response to the spike protein of the virus. And they're just different technology approaches to achieving that.

One of the questions, Terry, that I'm asked all the time is, hey, Doc, which vaccine are you waiting for? And the answer is I'm not. They all work by inducing virus-neutralizing antibodies to the spike protein. That's the best way we know to prevent us from, if we're exposed to the virus, from going into the hospital or the ICU. I'm going to take any of those vaccines that's made available to me that's authorized by the U.S. Food and Drug Administration.

Later on, if it turns out that the length of protection is not so long or if there's - better vaccines are coming along, it's OK. We can always get a boost later on. But don't overthink it. Don't wait. Get what vaccine you can because they all work by inducing virus-neutralizing antibodies into your system.

GROSS: I don't really understand how the new vaccines can predict their effectiveness. For example, in the studies, the way I understand it, for AstraZeneca and Pfizer, they gave people the vaccines. There was a control group that didn't get vaccines. And then everybody's told, basically, go about your business, live like you've been living, and then we'll see who gets the virus and whether the virus is severe when you get it.

But each person - I mean, you can't very well intentionally expose them to COVID. That would not only be unethical; it would be incredibly dangerous. You'd be risking the lives of everybody in the study. But if you're telling people just, like, live your life and we'll see what happens, well, everybody is exposed to different things in their life, so there isn't consistency. There isn't, like, a control of, like, what you were exposed to. So how can you really tell how effective the vaccine is?

HOTEZ: Well, the thinking behind these large clinical trials, and we've had a lot of experience with this, is these are really big. So the Pfizer vaccine is being tested on 44,000 individuals. It's almost like a small city, so that, yes, some people will change their behavior because they either got the vaccine or placebo. They don't know which one they got. Others won't. But it kind of evens out ultimately.

And what happens is - my understanding is this is looking at symptomatic infection so that if you start developing symptoms that you think could be COVID, you get tested, and that then counts for a case. And it wasn't subtle. It looked like - that these vaccines provide a very high level of protections, a 90% decrease or more in the cases. And that's really exciting.

GROSS: So you're working on a vaccine. What does that mean exactly? What is the work that you're doing on it?

HOTEZ: Well, at our Texas Children's Center for Vaccine Development at Baylor College of Medicine, we've been doing this now for two decades, developing low-cost global health vaccines, mostly focused around disease targets that no one else wants to take on because, one, they're complicated, often, but second, they're diseases that generally affect only the poorest of the poor. And we've made some progress in terms of shaping vaccines and getting them to clinical trials.

But then about a decade ago, we recognized coronaviruses were going to be of enormous pandemic potential. And at that time, nobody was really very interested in coronavirus vaccines. So we adopted it. We started partnering with the New York Blood Center, together with the Galveston National Laboratory and Walter Reed. And we wrote an NIH grant that was funded, and we wound up developing vaccines for the first coronavirus of pandemic potential, SARS or SARS-1 in 2003 that emerged out of southern China, then Middle Eastern Respiratory Syndrome, MERS, so that when we saw the sequence of the SARS-2 coronavirus that causes COVID-19 and the Chinese scientists that put this up on a preprint server known as bioRxiv, we realized that we could move pretty fast in terms of developing a third coronavirus vaccine for COVID-19.

And our scientists worked under incredibly difficult circumstances. And this is a group that's co-led by my science partner of 20 years, Dr. Maria Elena Bottazzi. And they worked day and night under difficult circumstances because, as you remember - if you remember back in the spring, they weren't allowing many businesses to be open. We had special permission because we were working on COVID-19. They worked in record time and building on all of the experiences, the successes and failures that we had with previous coronavirus vaccines to move pretty quickly.

And now this is - we signed an agreement with BioE or Biological E., based in India and Hyderabad, and they are now scaling this up to 1.2 billion doses, testing it across India. So it's very exciting for us to make a contribution. We've never made a billion of anything before, so that's pretty exciting, also.

But the point is this is a very traditional technology, the same technology used to make the recombinant hepatitis B vaccine used all over the world. And that's important for two reasons. One, many countries have the ability to make their own hepatitis B vaccine, so that potentially our vaccine could be made locally. It doesn't depend on it being made in Europe or the U.S. and then filtering to the low- and middle-income countries. And it could be made pretty inexpensively, we think. So the hepatitis B vaccine, in many cases, is made for under a dollar a dose. So we think our vaccine could come along in the similar cost structure.

GROSS: President Trump is taking credit for project Warp Speed and for fast-tracking the vaccine research, and I'm wondering how much credit you give him directly, as opposed to the career scientists at the CDC, NIH, NIAID. And maybe you can mention one or two of the things that you think he's done wrong and done right.

HOTEZ: Well, no question, none of this would've happened without carefully thought-out infrastructure by the National Institutes of Health and our fantastic research universities and institutes. That made all of this possible.

I will - exactly how Operation Warp Speed was assembled, I don't have a lot of details about that. I will say the individuals chosen - Moncef Slaoui and General Gus Perna - looks like have done a very good job. Moncef I've known for a while. He came out of GlaxoSmithKline vaccines. He's been in our laboratory. He's a very smart vaccine guy and has done what looks like a really good job so far in leading that.

The only piece that I would say that has not happened that I would've liked to see more of is more of a communication strategy coming out of Operation Warp Speed. The communications has been very much left to the pharma CEOs, and I think overall, they've not done a good job communicating to the American people.

First of all, too much reliance on press releases that over this past year have been sometimes hard to decipher or understand, too many leaked phone calls, too many weird - too much weirdness about the stock trading and options. And I think that has undermined some confidence.

I would have liked to have seen government scientists out there communicating on a frequent, regular basis about Operation Warp Speed, very much like the way Andrew Cuomo did in March and April - doesn't have to be every day, but on a regular basis. I mean, I've done what I can to fill in those gaps, being on the various cable news networks and podcasts. But, you know, at the end of the day, I'm not a government scientist, so I - you know, I'm a medical school professor and call it as I see it. But I don't have the accountability of being a government scientist. So I think it's - that's been a weakness.

GROSS: So you've spoken about how scientists from competing pharmaceutical companies and your own group are cooperating with each other, at least to some degree, sharing information for the greater good.

President Trump, on the other hand, has been calling the virus the China virus, which is not in the spirit of cooperation. He's pulled out of the World Health Organization - also not in the spirit of that kind of cooperation that you're talking about. Do you think that that has limited in any way what we or other countries are able to do in the development of a vaccine? Like, what are the problems that may have been caused by, for instance, pulling out of the World Health Organization?

HOTEZ: Well, I think the science - the scientists are still sharing information and communicating at an international level, so I don't think that's been too affected. The thing that I worry about now is people have tied national identities to vaccines. In fact, there's a new term that's been coined called vaccinationalism. We talk about the Chinese vaccine, the Russian vaccine, the British vaccine, the American vaccine. We've never had that before. And I think it's counterproductive.

And so by the U.S. pulling out of the World Health Organization and refusing to be a part of the COVAX sharing facility, which is our new mechanism that's been put in place to provide global equity for vaccines, I think this has been counterproductive and could hold us back.

We also now have this unfortunate situation where countries that don't have full access to vaccines are now making one-off deals with the Russians, the Chinese, and it has kind of a Cold War smell to it. And we have to fix that as well. I've been devoted my whole life to this concept of vaccine diplomacy, sharing vaccine development practices between countries. And I served that role as U.S. science envoy in the Obama administration. I think we have to get back to that.

GROSS: Let me reintroduce you. If you're just joining us, my guest is Dr. Peter Hotez. He's the co-director of the Center for Vaccine Development at Texas Children's Hospital and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. We'll talk more after a break. This is FRESH AIR.

(SOUNDBITE OF TODD SICKAFOOSE'S "TINY RESISTORS")

GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Peter Hotez. He's the co-director of the Center for Vaccine Development at Texas Children's Hospital and author of the forthcoming book "Preventing The Next Pandemic: Vaccine Diplomacy In A Time Of Anti-Science." It's expected to be published early next year. He's working on the development of a COVID-19 vaccine.

The CDC recently released new suggestions about mask-wearing. We had been told that wearing masks protects other people from you spreading the disease, from the mask-wearer spreading the disease, but now we're being told that it's effective - not terribly effective, but somewhat effective - in protecting the person wearing the mask from other people who might be spreading the disease. What's your understanding about how much wearing a mask can protect you against getting COVID?

HOTEZ: Well, we have new estimates now from the Institute for Health Metrics and Evaluation at the University of Washington really looking at the number of deaths that are going to be projected to result from COVID-19. And they're pretty chilling numbers. And it says that unless we can get to 95% mask-wearing, we're looking at another 150,000 Americans who will lose their lives between now and a week or two after the inauguration. So we have this stunning number in a terrible way of 400,000 Americans losing their lives between - by a week or so after the inauguration. You know, that's basically the number of American GIs who died in World War II. We're looking at those kinds of numbers.

And, you know, for me, the tragedy is none of those people have to die if we, you know, adhere to 95% mask-wearing, No. 1 - No. 2, social distancing, especially in times when there's a threat of a big surge on intensive care units because, remember; that's when the mortality figures go way up. We saw this in New York in March and April. We saw it in Southern Europe in Italy and Spain in March and April. The death rates really accelerate as ICU staff starts to get overwhelmed. And that's already starting to happen now in the northern Midwest and in Lubbock and El Paso here in Texas. So just by those straightforward measures - social distancing, being responsible, wearing masks - we can save tens of thousands of American lives between now and the time of the inauguration. And that has to be our big emphasis.

One of the things that I've been trying to explain to general audiences is, look; in the past, when I've asked people to wear masks and do the social distancing, prevent the ICU surges, I never had a bracket on the right-hand side. I was never able to say that, look - in the past, I've said, please do this, and we'll figure out something later. Now we have something very concrete to say. I can say, we have good vaccines coming. If you can keep your mother, your father, your brother or sister alive for the next - just for the next two, three months, we can start getting them vaccinated, and they will live a normal life span.

This is not a time to be reckless or careless or defiant or tying political allegiance to protesting COVID prevention measures. This is a time to save the lives of your loved ones. And it's been really exasperating when we're seeing so many refuse to understand that straightforward point.

GROSS: How soon do you think a vaccine will be available? I've been hearing different estimates. What's your understanding?

HOTEZ: Well, the - Pfizer is now applying for emergency use authorization. It'll take two or three weeks for the FDA and the affiliated committees to review that information. And I think vaccine could possibly be - we could start releasing vaccine to selected populations by the middle of December. And then, remember; other vaccines are coming along. We'll have, following the Pfizer vaccine, the Moderna, the AstraZeneca-Oxford vaccine in the U.S. We'll have the J&J vaccine - so that by the early part of next year, we're going to move pretty quickly, I think, in vaccinating a significant percentage of the population.

Over the weekend, Moncef Slaoui, who heads Operation Warp Speed, felt that we could reach herd immunity, meaning 70% of the U.S. population, through vaccines by as early as the spring. I think that's a bit aspirational. I don't think we'll quite get there. But you get the idea. I think we're going to move pretty quickly now in vaccinating a significant percentage of the U.S. population, provided all of the three or four stars that we need to align actually align.

GROSS: And so your advice is don't see this as an opportunity to take risks 'cause what you want to do is make sure you survive long enough to get the vaccine. It's a reason to protect yourself until the vaccine is ready.

HOTEZ: That's right. It's especially tragic if one of - your loved one loses their life or has permanent, long-lasting injury during this period because it's just a matter of staying disciplined for the next couple of months and getting them to the other side. And we get them vaccinated. They can live a normal life. This is not a time to be defiant. This is not a time to be reckless. This is a time to take this virus seriously and realize that now we have an end to this through vaccination.

GROSS: And this is especially important advice during the holidays. Do you think people should, like, not go visit family and friends during Thanksgiving and Christmas, much as they want to?

HOTEZ: Yeah, we have - we all have to make some tough decisions. I know we like to be together. Families like to be together over the holidays - Thanksgiving and Christmas and other holidays. This may not be the year to do it with this much virus circulating in the country right now.

Remember; the U.S. is the epicenter of the COVID-19 pandemic in terms of new cases. And not only that - it's even more defined than that. Right now, it's the middle part of the country, especially in the upper Midwest and in Texas. These are the highest COVID transmission rates in the world. And what that means, practically speaking, is anytime you have a large gathering of people, whether it's in airports or bus stations or train stations, any public venue, there's going to be lots of COVID-infected individuals there. This is not a time to travel. This is a time to prepare for future Thanksgivings and Christmases ahead by protecting your loved ones.

GROSS: Let me reintroduce you here. If you're just joining us, my guest is Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children's Hospital. He's working on the development of a COVID-19 vaccine. And he's the author of the forthcoming book "Preventing The Next Pandemic: Vaccine Diplomacy In A Time Of Anti-Science." That's expected to be published early next year. We'll be back after we take a short break. I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF SO PERCUSSION AND STEVE REICH'S "STEVE REICH: MALLET QUARTET III. FAST")

GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Dr. Peter Hotez. We recorded it Monday. He's working on developing a vaccine for COVID-19. He's the co-director of the Center for Vaccine Development at Texas Children's Hospital and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Much of his career has been devoted to developing vaccines for neglected, poverty-related tropical diseases. He's the author of the forthcoming book "Preventing The Next Pandemic: Vaccine Diplomacy In A Time of Anti-Science." It's expected to be published early next year.

What are some of the things you're hoping the Biden administration will do? And I know that you think federal guidance to states, to governors, is very important. It's not something President Trump chose to do. Why is that federal guidance important? And what kind of guidance are you hoping the Biden administration provides?

HOTEZ: I think one of the most important is actually leading a federally coordinated response. I think what we saw all this year in the Trump administration was putting the states in the lead. And the U.S. government would be responsible for backup supply chain management and FEMA support and manufacturing ventilators and that sort of thing. And it didn't work. And this is why the U.S. has led the world in terms of COVID-19 deaths. And the reason it didn't work is the states never had the epidemiologic horsepower to even know how to conduct COVID control measures. And they also needed the political cover of the federal government to deflect from the attacks that they were getting from their own internal political opposition.

So this - I think having a federally coordinated response, which the Biden administration seems committed to, will make a big difference. The other thing that I've recommended is, given how disastrous the White House coronavirus task force has been, particularly on - with Scott Atlas leading things and leading that aggressive disinformation campaign, claiming that COVID-19 deaths were not due to COVID-19 but other causes or discrediting masks or fake concepts of herd immunity - I would say the response - the leadership of the response needs to be taken out of Washington and put firmly in control of the U.S. Centers for Disease Control and Prevention. Move it to Atlanta. This is why the American people pay $11 billion a year in taxes to the CDC. Put them firmly in charge.

There may be some internal deficiencies that have to be corrected because we did see mistakes in 2020 - missing the virus entry from Europe into New York and the problem with the testing. Fix that component, but put the CDC firmly in charge, I think, is going to be really important.

And finally, if we're going to really achieve that 70% herd immunity, which is what our estimates that we came up with together with our colleagues at City University of New York, led by Bruce Lee, who's a friend and colleague that we've worked with for years, we need to figure out ways to better communicate about vaccines and the importance of vaccines and really start doing something about this very aggressive anti-vaccine movement that's now morphed into a wide-scale, anti-science machine or empire or confederacy that really dominates the Internet and dominates our American life right now. We've got to figure out a way to begin dismantling that as well.

GROSS: Any suggestions of how to do that? You've been trying to debunk the claims of the anti-vaxxers for years. You haven't succeeded yet (laughter). I mean, that movement is, like, stronger than it ever was, probably.

HOTEZ: That's right. It began - it really took its modern form in 2015 under this - fake slogans of health freedom, medical freedom. And then it expanded out of Texas, became a national movement headed by Robert F. Kennedy Jr., who now publicly labels me the OG villain because I wrote a book called "Vaccines Did Not Cause Rachel's Autism" explaining why vaccines don't cause autism. But then, that national anti-vaccine movement then took on new components to it. It not only now protests against vaccines, but in 2020, it now protests against masks and social distancing and contact tracing.

So it's done a lot of damage in terms of preventing COVID-19 prevention measures, especially in the middle part of the country. And we've even seen now it export to western Europe. So we've had now rallies in Berlin and London and Paris. RFK Jr. spoke at the rally in Berlin. And CBS News and other news outlets reported it was linked to QAnon and neo-Nazi groups.

So it's taken on this very dark turn. And, as I say, it dominates the Internet with more than 480 fake anti-vaccine sites all revved up on social media and e-commerce platforms. We've got to - have to figure out a way to confront this. It's not enough just to fine tune our message or promote pro-vaccine messages. I say it'll get us about 30 to 40% of the way there because those messages are messages in bottles floating in the Atlantic Ocean. We have to do something about the Atlantic Ocean and begin taking down the anti-vaccine empire and confederacy.

GROSS: Yeah. You know, the rally in Berlin that you mentioned that Robert Kennedy Jr. spoke at, that was a rally of, like, 18,000 people protesting COVID restrictions, including mask wearing. And apparently, very few people in that 18,000-large rally, very few people were wearing masks. I know at one time that Kennedy opposed early vaccinations, believing that they were linked to autism. But I had no idea he'd become, like, an anti-masker, anti-COVID restrictions leader.

HOTEZ: Well, here's the interesting part about the anti-vaccine movement. You know, when you saw COVID-19 emerged, my first thought was, well, maybe, finally, this is what puts the anti-vaccine groups sort of into retreat or somehow sets them back. But - and I think that happened for about two weeks. And then they came out and really re-energized and then took on all anti-COVID-19 measures, like social distancing, again, under this fake banner of health freedom or medical freedom, and really revved it up and piled on the conspiracies as well.

You had, you know, Bill Gates is trying to implant chips into people through vaccinations and links with 5G - that I still don't understand - of course, really going after the OG villain - meaning, me - and going after Dr. Fauci. It's - so it's - and that's the other scary element of this is the targeting of scientists. So this is yet another dimension. It's - and then you have the fact that the Russians are using what's sometimes called weaponized health communication and filling our Internet with bots and trolls and lots of anti-COVID prevention measures and anti-vaccine messages.

And this has been reported on by U.S. and British intelligence. So that's a big concern. And the problem is, how do you talk about this in a way where you sound rational? Because, you know, as I hear myself speaking now and in the past when I've spoken about this, you know, you start talking about neo-Nazi and QAnon and Russia, you sound like one of those people that throws things at the TV. And trying to explain it in a way that is convincing...

GROSS: Right. The word doesn't sound like you're the victim of - like, you're buying into conspiracy theories by saying Russia and bots and neo-Nazis (laughter). Yeah. I see the problem.

HOTEZ: Exactly. Yeah. So - but I think it's real. And we're going to have to figure out a way - and I think we've let it go so big, because I think the attitude of - in the U.S. of the HHS agencies - health and services agencies - has been because I've had calls where they - you know, I've been - I said, you know, Peter, why are you, you know, writing about the anti-vaccine movement? You're just going to give this oxygen and amplify their message. And I've said, look; that horse has left the barn. That ship has sailed. It's - this is out there. And it's dominating the Internet, as I say, 480 anti - fake, anti-vaccine websites.

If you go to amazon.com and you put books up at the top, as everyone has done, press return, you'll get a scroll-down menu at the left that says health, fitness and dieting. You click that. And then you get another scroll-down menu that allows you to select vaccinations. You click that, it's all fake, anti-vaccine books - and now anti-COVID prevention books calling COVID a hoax.

GROSS: Let me reintroduce you here. If you're just joining us, my guest is Dr. Peter Hotez. He's the co-director of the Center for Vaccine Development at Texas Children's Hospital and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. We'll be right back after a short break. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Peter Hotez that we recorded Monday. He's the co-director of the Center for Vaccine Development at Texas Children's Hospital and author of the forthcoming book "Preventing The Next Pandemic: Vaccine Diplomacy In A Time of Anti-Science." He's also working on the development of a COVID-19 vaccine.

Is there, like, a hidden agenda behind the anti-vaxxer movement? I mean, in a lot of movements, there's money behind it. And the people with the money have a vested interest in promoting this cause for corporate reasons, for political reasons, for whatever reasons. So is this, like, a funded movement? Is this a movement being led by people with some kind of motive that goes beyond COVID-19?

HOTEZ: Yeah. I don't know the anti-vaccine movement all speaks with one voice. That's why I call it more of a confederacy than anything else. And where exactly the money comes from, there's a lot of money behind it, an organization as well. You know, I don't know. It really needs a good investigative journalist to really push hard on this. But clearly, in some cases, it's coming from the extreme political right and traditional sources of funding for the political right, especially under this health freedom, medical freedom banner. I think that's a big piece to this. I think the other is, clearly, you know, the Russian government's doing a piece of this.

The health and wellness industry and all the supplements - and in some cases, the fake autism cures - I think they're helping to fund this as well. But it really needs to be more carefully looked at. And unfortunately, I don't have the time or the energy to take that on with all the other things we have to do....

GROSS: No, of course. Of course.

HOTEZ: ...But I think this is going to be really important. And also, I think, if the U.S. government's going to want to do something about this, it's - now it's gotten to the point where it's going to have to go beyond the health and human services agencies. We're going to need an inter-government task force to really look at this. And the problem is no one really wants to take it on because - and I don't know the reasons why they don't want to take it on. I think, clearly, they see how I get beat up for it. And, you know, nobody wants to step into that too quickly. And it's complicated. And it's a lot - it's a hard slog. And there are other priorities, I think, people feel. But I think it's going to be very important.

GROSS: So you've been a target, basically, ever since the anti-vax movement started because your daughter was diagnosed with autism. Was it 1994?

HOTEZ: Right.

GROSS: And there was a research study that was debunked that said that childhood vaccines or infant vaccines could lead to autism. That - like I said, that study was debunked but the belief lingered on that there was a connection. You tried to debunk that belief, which made you a target of the anti-vaxxer movement. Have the threats changed? Because you've been a target of threats since the early days. Have the threats and the number of threats changed recently because of COVID?

HOTEZ: Well, I think they've changed because of COVID, but also, you know, because I've been working on coronavirus vaccines for 10 years. I have a much higher media profile on the cable news networks than I've had before. So that's made the - that's revved up the intensity in terms of the emails and the stuff you see on Twitter and other forms of social media. But it - so probably the volume and the amplitude has definitely accelerated over the last year. And they've - and these groups have been targeting several scientists as well as, you know, people like Dr. Fauci and Bill Gates. It's - this has been one of the dark sides of what's been going on.

GROSS: Oh, it's really dark. I mean, to think that scientists like you and Dr. Fauci are being the targets of threats, it's just horrifying. It's so - it's just so wrong and so shocking that that would be happening. But we all know that it's happening. So you got involved with this because your daughter was diagnosed with autism when she was 19 months old. Why didn't you believe the theory that vaccines caused autism?

HOTEZ: Well, you know, just seeing Rachel and her behavior and her developmental delays and - you know, it's such a pervasive situation in terms of her capabilities.

And, in fact, they used to call it pervasive developmental disorder, which, you know, was an appropriate term, I thought, for many forms of autism, that it just - I couldn't imagine a plausible mechanism, you know, as MD-Ph.D. physician scientist, pediatrician scientist, I just couldn't envision a plausible mechanism, by inducing an immune response to a virus, that that could account for how global the deficits and other things that happen with something like pervasive developmental disorder or autism. It just didn't make any sense to me. So it always sounded odd from the beginning.

And then what you saw was the anti-vaccine people kept on moving the goal posts as the scientific community debunked the link. So the first link to be debunked was the links between MMR vaccine and autism. And that was the original assertion from Andrew Wakefield and his colleagues in London, that it was the MMR vaccine.

GROSS: This measles, mumps, rubella vaccine.

HOTEZ: Right. That's right, the measles, mumps, rubella vaccine. And then they pivoted. They said, OK, it's not the MMR vaccine, but it's the thimerosal preservative that used to be in vaccines. And then it pivoted again to spacing vaccines too close together, and then it was aluminum in vaccines. And you realize that there was no science here. It was all a different type of agenda to try and stay relevant, and that still continues today.

And now you're even - I think - you know, I'd like to think I've done a pretty good job debunking the autism vaccine links, that now you're starting to see them even move away from autism. Now they're calling it unspecified chronic illnesses. So that's - and how do you start going after that? So there's clearly other - there's agendas other than trying to - beyond genuine scientific inquiry.

GROSS: Let me reintroduce you here. If you're just joining us, my guest is Dr. Peter Hotez. He's the co-director of the Center for Vaccine Development at Texas Children's Hospital and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. We'll talk more after a break. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Dr. Peter Hotez. He co-directs the Center for Vaccine Development at Texas Children's Hospital. He's the author of the forthcoming book "Preventing The Next Pandemic: Vaccine Diplomacy In A Time Of Anti-Science." And he's working on the development of a COVID-19 vaccine.

Now that we have several vaccines in the work for COVID, do you feel like you can see an end in sight to the pandemic? Like, when you look ahead, what do you see, say, in the next year?

HOTEZ: I think in the next year, we're going to have at least maybe half-a-dozen vaccines, maybe more. I hope ours is one of them. And we'll certainly do - we'll be well on our way to vaccinating the U.S. population and Europe and Japan. I don't know about the low- and middle-income countries, how successful we'll be. And that's why we're trying to come in with our low-cost vaccine. But, clearly, we will make a big dent in this particular pandemic, although it may take us a couple of years to vaccinate our way out of it.

The other problem that I see is this will not be the last coronavirus. We've now had SARS in 2003. We've had MERS in 2012. Now we have COVID-19. It's just a matter of time before we have COVID-26 or COVID-29 or COVID-32. And this is going to be a regular occurrence. So now we're looking at the prospect of developing a universal coronavirus vaccine because I think there's going to be an important need there.

GROSS: But what do you see when you look ahead in terms of our ability to resume something more closely resembling normal life?

HOTEZ: You know, it's not going to be a light switch. It's going to be an evolving process. We will be in a much better place by the spring, and then by the summer, we'll even be in a better place. And by the - a year from now, life - I don't know that we'll entirely return to normal, but it's going to be much better than it is now.

And the reason I say may not entirely return to normal is we don't exactly know the performance of these vaccines in terms of reducing the amount of virus shed from our nose and mouth. So some of the vaccines in clinical trials prevented death, prevented virus infection in the lungs, but some of the nonhuman primates and other animals tested still could shed a lot of virus in their upper airway and mouth. So there still could be a fair bit of virus circulating, and that means there could be still some need for masks and social distancing and contact tracing. But, no question, life will be so much better in the next few months than it is right now.

GROSS: With several vaccines likely to come out within a brief time of each other, do you think that one of those vaccines will be, like, the winner and the others will be the losers? Or should we be grateful that there are so many at the same time because they all have advantages and disadvantages and, you know, some of them might be better for certain populations in certain areas of the world and others better for others?

HOTEZ: Well, remember - ultimately, we have to vaccinate the world's human population, billions of people, and even the U.S. population is going to be pretty daunting. And there's no one organization that has the ability to make all that vaccine for the world. So we're going to need multiple different vaccines, and the advantages of having different technologies, even though they all target the spike protein of the virus, is that some may work better over the long run in terms of length of protection or other issues. So it's a tremendous advantage having all of these different technologies, all these different shots on goal.

GROSS: How is your Thanksgiving going to be different from normal years, so-called normal years?

HOTEZ: Well, ordinarily, I'd have all my four adult children together. That would be - that's the aspirational goal. But two of them - one, my daughter, lives in Los Angeles. She's a research scientist at UCLA. And I have a son who's a musician in Tucson, Ariz. They're both married. And it would have been nice to see them, but I had to tell them not to come because it would require traveling through dangerous parts of the country in terms of where COVID-19 is really accelerating, especially in New Mexico and El Paso.

So that was very sad for my wife and I to ask them not to come this year, knowing that they could get COVID or they could give us COVID. So everything is very small and modest. But remember - this is not forever. This is just for a few months.

GROSS: I think some people are afraid to say I'm not going to come or don't come because they don't want to offend family members or dear friends. What advice would you have for them?

HOTEZ: Remember - this is a true gesture of love, telling people not to come, because right now with COVID-19 accelerating across the United States at this screaming high level of approaching 200,000 confirmed cases per day - which really means about probably at least half-a-million new cases a day - at any airport right now, any bus terminal, any train station has lots of COVID-infected people in those venues. And it's not worth it. It's not worth that short-term event, getting family together, in order to put them at risk and put yourselves at risk. Vaccines are coming. It's just a matter of recognizing we have to get everybody through to the other side.

GROSS: Dr. Hotez, thank you so much for talking with us. I wish you and everybody dear to you good health. And I wish you a good Thanksgiving in spite of the fact that you won't be able to see your family as you hoped you would. But I appreciate your advice, that it's just too risky to do that.

HOTEZ: Well, thank you, Terry. It's a real honor to speak with you today. And we're going to have a tough few months ahead of us, but there is some good news coming.

GROSS: That is really good to hear. So let's all hang on and be safe until then.

Dr. Peter Hotez is the co-director of the Center for Vaccine Development at Texas Children's Hospital, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and author of the forthcoming book "Preventing The Next Pandemic: Vaccine Diplomacy In A Time Of Anti-Science."

Tomorrow on FRESH AIR, my guest will be David Chang - chef, restaurateur and host of the Netflix series "Ugly Delicious." He's had to close some of his restaurants because of the pandemic. Although his early restaurants were influenced by Korean food - his parents are from North Korea - when he was growing up, he was embarrassed by the food they ate and how their kitchen smelled. He has bipolar disorder and thinks cooking and opening restaurants saved his life. I hope you'll join us.

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GROSS: FRESH AIR's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Roberta Shorrock, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Ann Marie Baldonado, Thea Chaloner and Kayla Lattimore. Our associate producer of digital media is Molly Seavy-Nesper. Seth Kelley directed today's show. I'm Terry Gross.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.