- Could you please briefly introduce the International Vaccine Institute? What are the institute’s main missions and goals?
(00:10 – 00:45)
Yes, the International Vaccine Institute was founded in 1997 as an initiative of the United Nations Development Programme. Korea won a request for proposals that included many major countries in Asia.And with an offer of providing 30% of the support for the Institute and the donation of a building and the land. The Korean government won the bid and IVI was sited in Korea. It’s the first International Organization, actually, to be headquartered in Korea.
- What do you think is the reason that has caused this pandemic?
(00:46 – 01:48)
So, I think viruses have a very interesting relationship with humans. And, you know, we’ve had a number of viruses jumped from animals to humans. We call those zoonotic diseases. You know, we talked about the Black Death, Bubonic Plague, that actually, you know, that’s a transmission from a flea from a rat to humans. HIV originated in monkeys. Transition to chimpanzees and then made a jump from chimpanzees to human, MERS, from bats to camels to humans. So, viruses have a way of jumping from one species to another. And this most recent COVID-19 outbreak was another one of those viruses that makes its way from animals to humans. I think these events occur all the time the greater the interaction between humans and animals either as domestic livestock, or in the wild, or as food, the more likely these occurrences of transmission will be.
- How long do you think the pandemic situation will last?
(01:49 – 04:42)
How long will it last? (Yes) So, I think that, you know, we’re probably getting close to hearing about the success or failure of the first round of vaccines. And if those vaccines are shown to protect and to be safe, then probably in the middle of next year. Countries around the world, particularly, the high-income countries will probably have access to vaccines that are safe and effective. We won’t have all the data by then. We’ll have evidence that it works. We’ll have short-term safety data, but given the pressure that many countries are under now because of the pandemic, it’s likely that there will be use of the new vaccines. But a vaccine is not the key. It is not a cure. It’s not that, you know, once you have a vaccine, the disease doesn’t stop. We actually really have to go out and vaccinate maybe 8 billion people. And most of the vaccines are two doses. So, you can imagine: we need 16 billion doses of vaccine. And there is no vaccine that we make in that quantity currently. So, we would not only have to make it but we’d have to distribute it around the world and it’s not as easy as, you know, putting something in a Federal Express Box and going to post office and dropping it off. I mean, these are vaccines that have to be kept at a certain temperature, and that temperature has to be maintained all the way to the point of delivery. Otherwise, the vaccine loses its potency. It may not protect as it is supposed to. So, you know, like up a bottle of soda that has to be kept cold, a vaccine has to be kept cold from the time it is made and all the way to the time it is delivered. So, for instance, if the vaccine is made in Korea and is going to be used in Ethiopia, the vaccine has to make it at 2 to 8 degrees refrigerator temperature from Korea through the shipping process to Ethiopia. And when you think you may have to have hundreds of millions of doses at that temperature, you’re talking about a lot of transport and a lot of attention, very careful attention to temperature and details. So that stage is going to be very difficult. And then of course, you know, we are pretty good at giving vaccines to children. We are less good at giving them teenagers. And we’re not really good at giving them to adults. And in the case of COVID-19 we have to vaccinate everybody. So, that includes the elderly, working adults, teenagers, and children. So, it’s a significant problem. From a vaccine delivery-perspective, and from a vaccine manufacturing-perspective. So, just having the vaccine is an amazing accomplishment, but we still have a lot of work ahead.
- What is the unique contribution of international organizations like IVI for overcoming and surviving this pandemic crisis, as distinguished from those of state and local governments?
(04:43 – 7:00)
So, IVI does a lot of things. We have a laboratory where we can actually make vaccines, ah, where we discover vaccines. We have another laboratory that gets the vaccines to the point where the vaccine manufacturers can make it. And then we transfer the vaccines over to those manufacturers. We have another laboratory that supports manufacturers. So, when the manufacturer says, okay, we have a lot of vaccine and we need to test it in humans, the Ministry of Food and Drug Safety in Korea or the FDA in the United States have very, very strict requirements about the way we do those lab tests, because these are information that are going to be used to make judgments about whether the vaccine is safe or is working in humans. So, we have to follow this very strict procedure. And so, our laboratory at IVI can do that so we can help smaller companies that don’t necessarily have big laboratories available to them. and then we can help companies by testing vaccines. So, if SK BioScience, or if Sanofi Pasteur came to us and said, can you help us test this vaccine in India or Nepal or Bangladesh? We could. Because we work in those parts of the world that other companies don’t necessarily have work. And then finally, when it comes time to actually getting the vaccine approved, we don’t. IVI doesn’t submit the proposal to the Ministry of Food and Drug Safety or to the WHO for approval. We can support companies to help the companies obtain approval. And in order to be used globally, a company’s vaccine not only has to be approved locally that is in Korea or in the United States or in Europe, but it also has to go through a second level of review and approval at the World Health Organization. And only then can it be purchased by the big organizations that buy vaccines for global health, like UNICEF.
So, you know, IVI can help at all those steps and then finally in the end, we can deliver vaccines. So, actually, one of the big questions that we have now is the tests that are being done and you’ve heard that there are tens of thousands of people involved in these vaccine trials all over the world. Those trials are actually designed to look to see how the vaccine protects an individual. So, if you are in the trial and you got the vaccine, how does the vaccine compare to person who doesn’t have the vaccine? Does it protect YOU against infection? The bigger question the government has is not about protecting individual people but protecting society. So, we need to know how the vaccine works when it’s given to a hundred thousand, two hundred thousand, or in the case Korea: 51 million people. Will it actually lower the burden of disease, decrease hospitalization, decrease deaths? And that’s information that we don’t get from these, what we call, phase-3 trial and that’s actually very important information, and IVI helps countries to develop that. That helps countries to understand the cost of vaccination and then to measure the benefit of vaccinations that’s actually really important for governments.
- Please tell us what is your opinion on ‘vaccine nationalism’.
(07:48 – 10:42)
So, you know, we’re an international organization, and we really believe in a multilateral approach. Now, when you look around the world today, the high-income countries and actually some middle-income countries like India, and, sorry, like India and Brazil, have actually purchased about 8 billion doses of vaccine. The low and low-and-middle-income countries haven’t made much in the way of a pre-approved purchases for pre-orders. So, the big concern is how is this vaccine going to get to the billions of people around the world who need it but whose countries can’t afford it? So, we think the vaccine nationalism is actually impeding progress towards vaccinating the world and that it holds a tremendous potential for increased deaths. So, there’s been a study funded by The Gates Foundation that says, if the high-income countries take the first 2 billion doses, without there being any equity in distribution, then we could double the number of COVID-19 deaths worldwide, which would really be a disaster. I mean, you know, the extent of the pandemic really being able to allocate vaccine fairly is something that only international organizations can do. So, we need to support an organization called COVAX. COVAX is an effort put together by GAVI, The Vaccine Alliance by the World Health Organization and by CEPI, Coalition for Epidemic Preparedness Innovation. And the goal of COVAX, and Korea has agreed to participate in COVAX, is to provide 20% of the necessary doses worldwide for all the countries, hundred and ninety countries that have signed up. That will allow a country to vaccinate the elderly and healthcare workers. So, it allows them to prioritize the highest-risk populations. So, that would be great. But COVAX still needs to be fully funded in order to make the bulk purchases. And also, we need to start thinking beyond 20%. We need to think about vaccinating 60, 70, 80% of the population. And that’s going to require international cooperation. Therefore, it is completely opposed to vaccine nationalism where, you know, the needs of the country come first. So, you know, I guess there’s a game-theory problem, the prisoner dilemma. And it turns out that these two prisoners. These who have to make a decision about how things will benefit them or the group. Typically, the best solution is cooperation. And we think that that’s the solution for COVID-19 and the use of vaccine. The best solution for the world lies in cooperation.
- As a health professional, how do you think each individuals should respond to this pandemic situation?
(10:43 – 11:45)
So, it always comes down to individuals. And I think that, you know, the most important things are going to be, and, even after we have a vaccine, is going to be a a comprehensive approach to prevention. So, you know, as soon as we have the vaccine, we can’t say to people okay, take your masks off, and, you know, it’s okay to go to church. It’s okay to go to the movie theater. We’re going to, we will have a vaccine and that will be important. But we’re going to still need to wear masks, keep distance, maintain good hygiene until enough of the population is vaccinated so that the burden of infections, or the number of new infections, is significantly decreased. When will we know when that is? You will have to look at the information because, again, the information that we’re collecting from these phase 3 trials doesn’t necessarily tell us how much a society needs to vaccinate in order to protect itself, to be protected against COVID-19. And that’s actually one of the key scientific questions that has to be answered the day after we have a vaccine in our hand.