The first time TheStreet spoke with veteran infectious disease expert Dr. Otto O. Yang was in September, as the Trump administration was promising new shots for COVID-19 in a surreal time frame. Many were skeptical of the former president’s willingness to inject politics into public health, and some were worried that views of the vaccines would be tainted by the promises and presidential pressures.
But here we are now with three relatively safe and effective vaccines available -- and possibly a fourth on the way -- to virtually every American teen and adult who wants one. At the same time, not even half of the nation is fully vaccinated and yet nearly everyone seems ready to ditch their masks and get back to normal.
“Obviously it’s fantastic that we have vaccines that are so safe and effective. I think what it partially points out is how inefficient the usual process is, and how quickly things can get done well and safely in terms of Food and Drug Administration evaluations and getting vaccinations started, if we have the will to do it,” said Yang in a phone interview.
But Yang, who is a medical doctor at the David Geffen School of Medicine at UCLA, is also concerned about our rush to reopen. He also has a nuanced view of the vaccines and many other aspects of the pandemic and federal policies around it.
And Yang has the credentials to weigh in. In addition to his other roles, he specializes in clinical infectious diseases, and his laboratory focuses on T-cell immunology in HIV infection, as it relates to developingan immune therapies and vaccines for HIV and other diseases and infections.
Here TheStreet talks with Yang about the vaccines, possible side effects such as myocarditis, why some people are dying after getting vaccinated and how animals, including our pets, could remain a possible reservoir for the virus that causes COVID-19.
The following has been edited for clarity and brevity.
TheStreet: What do you think of these issues with clotting with the Johnson & Johnson (JNJ) - Get Report vaccine and the possible link between heart inflammation in younger men and the shots by Moderna (MRNA) - Get Report and Pfizer (PFE) - Get Report?
Yang: To some extent, we don’t know if these cases (of inflammation) that have been seen after vaccination are actually higher than what one would expect without vaccination or not. We don’t have a clear denominator to know whether there really is an association with vaccination, or whether these are cases that are being picked up because we’re looking for them.
That said, at least what I’ve seen so far, the cases are mild and not life-threatening and have been resolved without any permanent consequences, which is the way that mild cases from respiratory infections tend to behave, anyway. So, at least with the information that’s available so far, that doesn’t seem like it’s anything of a big concern, but it is something to watch.
The clotting issues, however, that does seem much more clear that there are some issues associated with the adenovirus-vectored vaccines. Those would be the J&J and the AstraZeneca (AZN) - Get Report vaccines. That is perhaps not so surprising, because adenoviruses themselves, when they infect people, can cause clotting issues rarely. So, it may be related to the vector – the virus that’s being harnessed to deliver the gene for the SARS-CoV-2. Again, you have to put that in perspective – we’re talking about this happening a few times per million people who are vaccinated. … Obviously it’s horrible if someone gets life-threatening clotting, but the risk of it happening is pretty low.
TheStreet: I want to ask, however, and I know this is controversial, but I spoke with an epidemiologist a few weeks ago who made the point that if we have these other shots by Pfizer and Moderna that appear to have higher efficacy and less risk, do we need to bother with the adenovirus-vectored vaccines (such as J&J's)? Is there some logic to that argument?
Yang: Yeah, I think so. It kind of comes down to the old inside joke that’s often asked of doctors, “Is this good enough for your mother-in-law or is this good enough for your mother?” All of the vaccines are extremely effective and all of them are extremely safe. But, the mRNA vaccines do not appear to have this rare – very, very rare – side effect. And, the mRNA vaccines appear to be more effective. In the trials, there was around a 95% number for protection of symptomatic infection and for the adenorvirus-vectored vaccines, they are in the range of high 60s, percentage-wise. If you have vaccines that are safer, even marginally safer by the smallest margin, but also more effective, then, sure, why not go with the ones that are better in both respects?
But the counterargument that some people will make is that there is a convenience factor for the J&J vaccine: There is only one dose and the storage (temperature) of these vaccines is much more convenient. In areas of the world where cold-chain is a problem, these vaccines may be much easier to distribute and to get into arms. So, I think it depends on the context. But, all other things being equal in terms of access, then sure, go with the ones that are marginally safer and more effective.
And I would add that there’s been a lot of stuff in a the press about how, “Oh, you can’t compare these vaccines, the trials weren’t done at exactly the same time and they weren’t exactly the same populations.” I think that some of that is a little disingenuous and is kind of intended to reassure the public to get vaccinated with whatever is available. But the truth is, yes, you can compare the vaccines. Generally, the (later-stage) clinical trials were done pretty much in the same way (for the three vaccines currently in use in the U.S.), in many of the same types of people, so I think it’s a little white lie that some scientists – or the drug companies or the Centers for Disease Control, even – has been telling people to encourage them to get vaccinated.
TheStreet: Following up on that, on the other end, you have what is now termed the “delta variant” and reports that some people in the U.K. are dying from COVID-19 after getting fully vaccinated. But can you talk about the way in which vaccines work – how when you give them to tens – or hundreds – of millions of people, there will be a few people for which they won’t protect, right? That doesn't mean they don't work.
Yang: When you have these numbers, like 95% or 66% efficacy, you do have to look at the context and how those numbers were derived. The numbers relate to how those original studies were done.
Those original studies were done by vaccinating people and then surveying them about whether they had any symptoms, and then comparing them to the group who got the placebo. That brings out a few points. No. 1, it’s only relating to symptomatic infection. So, we don’t know what the level in reduction in asymptomatic infection is. It may be similar, it may be lower, we don’t know. Do the vaccines have a 95% reduction in asymptomatic infection? That’s an unanswered question. And No. 2 is that these trials were done over a few months. Does that immunity start to wane? If the studies were to run longer ... would that 94% or 95% still hold? Probably not. Probably there is going to be dropping of efficacy over time. And, of course, 95% is not 100%: If you vaccinate millions of people, there are going to be people who come down with symptomatic infection.
Also, in those trials, there were some other numbers given for prevention of severe illness and death. For the mRNA vaccines, those were close to 100%. Also, for the adenovirus vaccines, they were close to 100% in that respect. Again, that was over the months that the trials were run, so we don’t know. That number may start to drop. It’s not surprising, then, to see people who have been fully vaccinated get sick. That’s completely not surprising, because, again, 95% or 66%, isn’t 100%. And, it’s also not surprising that some people have died, even though the numbers were pretty good for preventing deaths. That’s because those were trials and in the real world, things don’t always look the same, and the patient population is not the same. When these trials were done, they were specifically set up to exclude certain populations: anyone with any type of condition that would compromise their immune system. People with HIV were excluded from most of the trials – not all, but most – and people with organ transplants were excluded. When you’re getting into the real world, things are going to look different.
TheStreet: So, springing off that point, it seems like the mindset of a lot of America is now, “We’re done with COVID.” But when you look at the vaccination rates, still only around 45% of all Americans are fully vaccinated and around 53% are at least partially vaccinated. Those numbers don’t sound anywhere near what we were told would be needed to achieve herd immunity. Are we wise to throw away our masks and forget about these measures?
Yang: I won’t mince words: I think that it’s too early for the us to be just going back to normal and tossing away masks and treating this like it’s gone. Unfortunately, I think the CDC has lost its vision of its mission, which is public health. So, they’re right in one way, which is if you’re vaccinated, your personal level of protection is pretty high. If you’re relatively healthy, and you’ve gotten vaccinated, it’s true that your chance of getting sick and dying from COVID drops to a very, very low number. On a personal level, their recommendation is scientifically supported.
But that completely disregards the bigger picture, which is circulation of the virus in the population. Certainly the vaccines are not a 100% effective in preventing symptomatic infection, and they are probably are even less effective at preventing asymptomatic infection, so the vaccines don’t stop circulation by themselves and then there are many people who haven’t been vaccinated – by choice or not – children of course, most of them have not been vaccinated because it’s not available to them.
And then there are significant numbers of people in whom the vaccine may not work. On transplant patients and patients with autoimmune diseases receiving treatments that weaken their immune system, for example, probably the vaccine has a minimal protective effect. They are kind of being ignored. We need to focus on stopping circulation of the virus to help them as well. So just saying that we can all go back to normal – that’s just really leaving those people out in the cold.
TheStreet: OK, with this question, you might laugh me off the phone. But we know that animals – even pets – can get this and some animals can pass it to people. We see a clear problem with mink. And, one of the main ideas of how this started -- though it's still unclear -- was the virus jumping from some animal to people. So, does it raise the threshold of what it would take to get to herd immunity if there could be reservoirs of animals with the virus?
Yang: That’s not a silly question at all. This is something that is thought about a lot when you’re thinking about trying to wipe a disease out of a population or out of humankind -- whether there is an animal reservoir or not. It’s something that’s considered. That’s why there was such an intensive effort at wiping out polio, because there was no animal reservoir. It’s only in humans.
So, it is relevant. As for how big a concern it is, it’s hard to say. Mink seem to be highly infectable and highly contagious with it. With dogs and cats, it’s probably shades of gray; it’s probably not black and white. Surely cats can get infected, and there’s been clear cases of them getting infected. The issue is how easily they can get infected and then transmit it back into humans. That is not very clear. I don’t think it’s very efficient, as opposed to, say, mink. But it is a consideration and something to think about. And, of course, one of the hallmarks of these coronaviruses is that they are so good at jumping across species, and it’s not clear why that’s the case... It’s not a silly question, it is actually pretty relevant.
This story has been updated with a new introduction.