With new COVID variants looming, Dr. Peter Hotez says Biden will have to step up his vaccine game

At the beginning of the U.S. outbreak, he was carefully nonpartisan, appearing on both Fox News and MSNBC. But as his horror grew about the lack of a national response to the pandemic, he sharply criticized the Trump administration.

Now, it’s the Biden administration’s turn. In a Tuesday op-ed in the Washington Post, Hotez explained why new variants of SARS-COV-2 require Biden to radically step up his vaccine game.

Here Hotez explains how we could do that — and what he believes the U.S. must do to get vaccine into more arms.

What’s going on with COVID-19 right now? Could you give us an overview?

The number of new cases is starting to decline. When we last spoke, the U.S. was at this awful level of 250,000 new confirmed cases a day. Since the count of confirmed cases is an underestimate times 4, that was really a million new cases a day.

Now we’re down to around 160,000 to 180,000 new cases a day. If six months ago you’d told me we’d be at that level, I’d have been horrified. I remember when Dr. Fauci predicted that we could get to 100,000 new cases a day: We thought that was shocking. So the fact that we feel relief at going down to 165 is a weird, new normal.

But the rate of new cases is going down a little bit, for reasons I don’t think we really know. Some say it’s because the post-holiday surge is over — the surge that follows Thanksgiving, Christmas and New Year’s. There may also be a component of seasonality to the virus that people like Marc Lipsitch, at Harvard School of Public Health have been modeling. Maybe people are finally socially distancing and mask-wearing to a greater extent. Or it could be some combination of all those three things. I don’t think we really know.

But it’s going down: That’s the good news.

The terrible news is, these new variants are turning out to be a much bigger factor than a number of us thought they would be. The Centers for Disease Control said recently that the new UK variant, which seems to be more transmissible, may become the dominant virus type in the U.S. by March. On top of that, Tony Fauci has said the evidence is increasingly clear that what the Brits say is true: that the mortality rate may also be higher by as much as a significant percentage. I had thought that was because the UK health system was just being overwhelmed — that people were on gurneys in the hospital hallways — and that may still be true as well. But there seems to be something else.

That makes me worried that this downturn we’re seeing is not much more than in the eye of the hurricane — there’s a metaphor that Houstonians will appreciate — and that we may still be in for the next big hit.

That makes me rethink U.S. vaccination strategy. It’s been good that the Biden administration has a vaccine plan. The previous administration really didn’t, beyond dropping off the vaccines on the doorsteps of the states.

But now, what are we going to do about vaccinating the American people? Here’s where I’m starting to have differences with what we’re hearing from the Biden administration. They’re laying out a plan that will get us through vaccinating the American people by the fall. President Biden himself announced Tuesday that we’re going to have maybe enough additional doses of the mRNA vaccines to fully vaccinate 300 million Americans by the end of summer or fall.

I’m saying, “Well, no, that’s that’s not gonna work.” Telling us “by the fall” is like telling us “when the glaciers are gonna come back down from Quebec.” I mean, that’s not adequate.

We’re going to have to figure out a way to vaccinate the American people by late spring. That’s a tall order. To beat back the virus we need to give two doses to three-quarters of the population, to 246 million Americans. That’s half a billion immunizations. To get there, we’d need a rate of immunizations two or three times higher than what’s proposed.

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The other interesting experience I’m having now is what it means to not sort of contradict, but question the the Biden administration and make a recommendation that’s different from the party line that’s Chris’s new dynamic that I hadn’t, that I didn’t think would ever be a problem, but is maybe starting to be a problem. So that maybe we’ll explore it.

Is it strange for you, being critical now of the Biden administration? At the beginning of the pandemic, you tried hard to be nonpartisan, to speak both on Fox News and CNN, but over time you came to criticize the Trump White House sharply.

I went to war with the White House Coronavirus Task Force starting in late spring or early summer summer. They implemented a deliberate disinformation campaign that downplayed the epidemic, discredited masks, and said COVID-19 deaths were due to other causes. They said that high hospital admissions were due to catching up on elective surgery, and were spectacularizing hydroxychloroquine.

In my circles, no one seemed to have a problem with my pushing back against the White House then. But now it’s different.

I’m not attacking the Biden White House. I’ve been very complimentary. I’ve said they’re going to tough route ahead, and that I would do things differently. But even that modest variation from the White House plan has been met with a strong reaction.

Who’s reacting that way?

Many people — people who are so upset about what happened last year, and what happened with the Trump administration, and they see the Biden administration as some type of salvation.

I’m the first to say, “Look, now we have a national response. And we have an evidence-based, scientifically driven team that’s not going to launch a disinformation campaign.” That’s a low bar to clear, but it’s a huge improvement. I’m very supportive. I know a lot of people in the Biden administration and have access to them.

But there are things about the White House plan that need to be adjusted. As a scientist, my focus has been on saving lives, and I do whatever that takes. I mean, I launched that war against the disinformation campaign, but not because I wanted to go to war with the Trump White House. I’m not politically ideological. I wanted to save lives and to get people to wear masks and social distance.

It’s the same thing with the Biden administration. I worry that people are already used to that 600,000 number — 600,000 deaths by May — that they think it’s sort of a fait accompli, and I’m saying no, hell no.

Somebody once said to me, “There’s the short answer and the long answer, The short answer is no. The long answer is, ‘hell no’.” So I’m giving the long answer: Hell no.

Hell no, we’re not going to get the 600,000 deaths! There are things we can do now.

And I’m making suggestions. And I wrote that piece in The Washington Post that kind of spelled it out. And again, it wasn’t throwing darts. I was very positive about what’s happening now, but we’re gonna need some adjustments.

This week in a Washington Post op-ed, you stated strongly that the U.S. needs to speed up vaccinations, moving twice as fast as Biden has proposed. Could you talk about that?

If we’re going to get to 100 million immunizations a month, first, we have to expand the vaccination hubs. I think everyone’s in agreement with that. Clearly the Houston area’s local leadership — the mayor and the county judge — is committed to that.

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The pharmacy chains are doing a good job — H-E-B has a great website — and the hospital system is doing a great job too. But even with those, we need additional sites, especially in low-income neighborhoods, which are pharmacy deserts. I think everybody agrees with that.

I think the guidelines are still too confusing and fussy. We need to streamline that: I’d like to see vaccinations offered to everyone who wants one.

But the U.S. doesn’t have nearly enough vaccine to do that now.

Right. The response from the Biden administration was, we’re gonna get more mRNA vaccine by the fall.

And I said no. We need vaccinations now.

The suggestion I made is not to rely only on the mRNA vaccines. I’m confident this is not a new idea to the Biden administration. They certainly must be looking at every possibility.

But things have been slowed down with the AstraZeneca-Oxford adenovirus vaccine. My understanding is that the FDA insisted that they conduct a full-scale Phase Three trial in the U.S., and we won’t have results for that until April. Meanwhile, the European Medicines Agency, the EMA, is going to make a ruling on the AstraZeneca Oxford vaccine on Friday based on studies done in Europe and also probably on data from Brazil and South Africa.

Those are large, reliable studies?

Yeah. And most people think the EMA will likely rule in favor of releasing that vaccine to the European Union through emergency use authorization. I suppose there is a possibility that something of concern will come up and cause additional delays. But I’m assuming that they get approval.

Because of these new variants, there’s great urgency here in the U.S. So I’m saying that sometimes we have to do things that take us out of our comfort zone in order to save lives. That means, rather than focusing only on the new study that we’re doing in the U.S., we also look at the dossier presented to the EMA.

As a regulatory agency the EMA is up there with our U.S. FDA. They’re the two best regulatory agencies in the world. So if they sign off, I think we should say, “Look, let’s do it. Let’s use that vaccine.”

We’ve already bought 300 million doses of the AstraZeneca-Oxford vaccine. We’ve paid for it — over a billion dollars — so let’s use it.

Now is the time. We need to get ahead of the variant.

One of the interesting features about the AstraZeneca vaccine is that, from some of the data I’ve seen, it’s not as effective in older individuals. So you might say, “Well, then what good is it?”

Let’s say we use that vaccine for the 20- to 50-year-olds, or the 20- to 45-year-olds. I know we have some of that vaccine stockpiled. Let’s use that to start vaccinating those younger people now. That would help slow virus transmission, so it would reduce the likelihood that the new variants will emerge.

Besides the AstraZeneca-Oxford vaccine, there’s also the Johnson & Johnson vaccine, which I think will get up.

And there’s also the recombinant protein vaccine our lab has developed at Baylor College of Medicine and Texas Children’s Hospital. In India they’re scaling that up to a billion doses. Nobody from the White House has approached us to say, “Hey, Peter, what can we do to bring that vaccine in.”

There seem to be blinders: All they can see is getting the mRNA vaccines. I don’t quite know what’s driving that. We have to figure out a way to bring the other ones on board.

And soon! We’re in the eye of the hurricane. When you’re in the eye of the hurricane, you don’t say, “We’re going to buy a better house in the fall.”

What makes you so nervous about these variants?

It’s how quickly they become the dominant lineage in a community — that shows that they have a higher ability to spread. So with individuals who so far have dodged this bullet and not gotten infected, we’re going to see a much higher rate of infection. That could overwhelm our hospital systems, like we’re seeing in the UK.

It’s amazing how, between September and November, one strain went from being a rare variant in England to accounting for at least half of all the virus isolates in southeastern England and then parts of London. That’s how quickly this thing moves.

And that’s not even the only variant. We’ve got the South African one and the Brazilian one. There’s one from Denmark circulating in California.

It’s not so much that the vaccines aren’t going to work against them: They may have some reduction. But it’s the fact that the variant is going to spread so quickly, and the deaths are going to start to accelerate again.

GOT QUESTIONS: Ask us your COVID questions here.

Remember President Trump said he didn’t want to get to a million deaths? Well, guess what: I don’t want to get to a million deaths either.

Because I’m saying these things, some people who’ve been on my side for a long time — when I was really concerned about what the Trump administration was doing — some of them now see what I’m saying as a betrayal of sorts. It’s really odd.

I haven’t changed. My focus is on saving lives and I’ll say or do whatever it takes to save lives. That’s what I’ve been doing for over a year now — waking up at 4 or 5 a.m. every day, and working late into the night on Zoom calls, trying to get our lab’s vaccine up, and explaining the science of all of this to the nation through the media.

I’ve tried to remain consistent: I try to reach people anywhere I can. Most people are seeing me on CNN or MSNBC now. I was on Fox for a while and still get on there now and then, and I’m reaching out to conservative news outlets. I did NewsMax and the Daily Caller not long ago.

A month ago I wouldn’t have guessed that you’d appear in those places.

Well, you know, they have a different view of the world. But I don’t have a problem with that.

So as you talk about science, you’re trying to reach anybody you can?

This is one of the cool things about Texas, right? For all the terrible things people in other parts of the country say about Texas, the truth is, it’s one of the most diverse places in the world. We’ve always had tolerance for different views.

I find people in Houston to be some of the most intellectually curious people I’ve ever met — in part because nobody’s from here, right? Everybody’s coming from somewhere else. People here have an open-mindedness. They like to hear different points of view.

So I love going on conservative news outlets. And then I also go on a number of African American radio stations, because African Americans are the other big group hesitant about the vaccines.

We did a study with a group at Texas A&M led by Tim Callaghan — he’s a social scientist; I’m a lab person, not a social scientist — and we found that the two most vaccine-hesitant groups were Trump voters and African Americans. That was almost identical to what the Kaiser Family Foundation found. So those are the two groups that I think we have to reach, and that’s what I’ve been doing.

Can you imagine two groups further apart? Except they’re connected by vaccine hesitancy. So it’s interesting: How do you get a message to those two groups? What are the words you select? How can I say the right things to get people to accept vaccines?

You’ve been fighting the anti-vaccine movement for years, and you’ve said that it’s grown into an anti-science movement. Are you seeing more of that lately?

Yeah. It’s scary. In the past it was mostly thought of as a fringe element. Now it’s become mainstream, and it dominates the internet.

I have a paper out this week that takes a step back and looks at that. This has become a major activity of mine — trying to understand anti-science movements and how to combat them. I’m glad PLOS Biology, one of the top basic science journals, was willing to take it.

The paper traces some of the anti-science movement back to Stalinist Russia in the great purge of the 1930s. It’s really interesting how much anti-science has a historical thread that runs through the USSR and now Russia. It started with Stalin, continued with Khrushchev, went through the Cold War. Now Putin has picked it up in a big way, and is really amplifying it through his program of what now called “weaponized health communication.” It’s causing a lot of damage.

So it’s not only our homegrown anti-vaccine groups, like Texans for Vaccine choice and Oklahomans for Vaccine Choice, but there’s also a big component coming out of the Russian government. That makes it very complicated to fight.

At the federal level, the U.S. needs to create some kind of interagency task force to fight anti-science — not only include the Health and Human Services agencies, but also Homeland Security, Commerce, the Justice Department, and State Department. That has to be an important activity for the U.S. government.

How does that Russian involvement work? I know lots of real, live Americans who have major reservations about vaccines. I get lots of email from them. So how does Russia influence that?

Well, before we go too far, let’s face it: There’s not been a good communication program coming out of Operation Warp Speed. There’s been a non-communication program, except for the pharma CEOs. Now Biden’s trying to correct that, which is good.

It was reasonable for people to say, “Hey, what’s going on here? What are these vaccines?” But the problem is, we’ve now got groups that are dominating the internet on social media and e-commerce sites. They’re peddling a lot of fake information — anti-vaccine books and COVID conspiracy books.

Both U.S. and British intelligence say that a lot of this is coming from the Russians. They’re piling on through bots and trolls, dominating the internet with these anti-vaccine messages.

Why would they want to do that? From what I understand, they’re trying to destabilize democracies, to show the world that their model of governance is the best of all, compared to what we do in the U.S. and Western Europe.

Unfortunately, that’s having some impact and effect. We need to figure out a way to counteract that. Someone’s got to stand up to Putin and say, “We’re not playing this anymore.”

We haven’t been able to do that for the last four years. So this is going to be an important priority.

What else is on your mind these days?

I’m worried for the nation. Everyone’s exhausted and and now people are really upset that they’re not getting vaccine. I’m getting heartfelt emails from people who are desperate — calling around to pharmacies, trying to get on their websites.

The American people don’t feel the government’s taking care of them. They’re calling around to Sam’s Club and Walmart and all the other pharmacy chains, and no one’s not getting anywhere. We should not underestimate how destabilizing that’s going to be for the country.

We need vaccine now. It’s not going to take much to erode goodwill with this administration. We usually meet a new administration with this spirit of hope and excitement, and that’s not there. This is a worried nation.

That’s unfair to the Biden administration — but so what? It was also unfair that when FDR passed away, and Truman had to take on the whole war with Japan. The reality is that the new administration has inherited a mess.

But that’s also the reason why people voted for Biden, right? It’s not because these are the most charismatic people on the planet. Americans did it because this administration would be made of people that have spent a lot of time in government. They’re not going to spend two weeks figuring out how to work the White House microwave. They’re able to hit the ground running.

lisa.gray@chron.com

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