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Hartford HealthCare Podcast
The Science Behind the Vaccine with Dr. Sam Pope
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In this special episode, Hartford HealthCare’s Steve Coates sits down with Dr. Sam Pope, ICU medical director at Hartford Hospital and pulmonologist with the Hartford HealthCare Medical Group. They discuss the science and many aspects of the COVID-19 vaccine including safety, potential side effects, efficacy and even the prospects of alternate uses for similar vaccines.
For more information about the vaccine news and resources, go to HartfordHealthCare.org/vaccine
On the floors, is there a lot of hope today?
SPEAKER_01A lot more hope than before. I think that everybody feels the excitement. It's uh I mean it'll bring tears to your eyes because we have all seen this up close and it's it's been hard. You know, wearing an N ninety five all day, seeing people pass away, families not able to visit. It's been really rough and uh we're all relieved that this this has an end in sight.
SPEAKER_00Um very much. Welcome to the Hartford Healthcare Podcast. In this special episode, Hartford Healthcare's Steve Coates sits down with Dr. Sam Pope, director of the Medical ICU at Hartford Hospital. They discuss many aspects of the COVID nineteen vaccine, including safety, potential side effects, efficacy, and even the prospects of alternative uses for similar vaccines. Here's Steve Coates.
SPEAKER_03Doctor, thanks so much for joining us today. It's a historic day at Hartford Healthcare and across the nation. And the best sign of hope since the pandemic began, we speak uh on Monday as the COVID nineteen vaccine arrived at Hartford Hospital for distribution across our health system. First the Pfizer vaccine and then the Moderna vaccine will be coming as well. Both are considered messenger RNA vaccines. Explain to me what messenger RNA vaccines are and why they're so effective, especially against COVID-19.
SPEAKER_01So we know, and and thank you for having me. Um very much uh am excited about being here on this day. So messenger RNA uh is is in all living things. It's uh it's part of the way our body turns the genetic code of DNA into proteins, and so it's the intermediary. So inside each of our cell nuclei is uh a double helix. Most people know about the double helix of DNA. Um RNA actually is um required uh to be made um against that DNA template, and then the RNA transverses out into the cell itself where it's translated into a protein. And so we're basically skipping that step. So this is messenger RNA that looks just like your own uh messenger RNA in your body that we're injecting, and there's a delivery system with a lipid carrier to get it into your cells, um, and then your body reads that blueprint, turns it into a protein. Um, that process goes on inside your own body every day, all day long. You don't have to think about it. We're just using the body's own machinery. These vaccines are not new, actually. We've used the first uh published um detail of an animal um messenger RNA delivery system that created a protein was in 1990. And so it's not that this is uh is is new science. It's actually science that's been worked out over 30 years. Um but it's just that this will be the first time we've mass print.
SPEAKER_03So unlike a f the flu vaccine, this is not putting putting the the virus into you. This is simply almost like is it almost like tricking your system to do this?
SPEAKER_01Aaron Powell It actually is actually using the you know the machinery of your own body um to produce the the protein we're interested in here, which is the spike protein um that people have seen, I think, on the surface of coronavirus. So this is just that piece of coronavirus that we're having your body build on its own. So instead of injecting you with the spike protein itself, which is what we've done with most of our prior vaccines, this is using this uh blueprint system to produce a spike protein, which which is much more effective, it turns out.
SPEAKER_03Aaron Powell So for the Pfizer vaccine, they're saying twenty-one days until your second shot. For the Moderna, we're saying I think it's twenty-eight. Why why the need for the second shot? Aaron Ross Powell, Jr.
SPEAKER_01So the second shot is really just to boost your immunity. So the first shot creates quite a bit of antibodies and not too dissimilar from actually being infected with coronavirus itself. And so both shots do that. So the the amount of antibody produced against this spike protein if you were infected with COVID is roughly similar to the first shot, at least within the ballpark for most people. But after you get the second shot, the the amount of antibodies produced is much, much greater. And so we figured out that if you use this sort of prime the pump, so to speak, and then you give the body, you present the body with uh more of the vaccine, which produces more of the spike protein, it really triggers an immense amount of antibody response.
SPEAKER_03Aaron Powell So if someone gets the f the first shot, doesn't get the second shot, or w is late in getting the second shot, what kind of problems would it not be effective?
SPEAKER_01Aaron Ross Powell So we don't know exactly how effective. We do know that there's divergence even at the 14-day mark with the Pfizer study, we started to see divergence between the two groups. So the group that had been vaccinated were catching COVID at a rate less than the people who were in the placebo. So the people who were not vaccinated were starting to catch COVID at a greater rate. So we know that the curves diverge even after the first injection, but we don't know how lasting that immunity will be. We do know that after the second injection, this this increase in the amount of antibodies produced is quite substantial. So on the order of about a log difference, so ten times almost as many antibodies produced, roughly. And so we think that that's probably going to give us longer lasting immunity before our antibody titers start to drop down. We don't know how long, but we do know that it produces a lot more a lot more bang for the buck. And it uh if you miss your second dose for whatever reason, we just do not know what will happen. Um you probably would become able to be infected with coronavirus more quickly, but uh that's complete conjecture. We do not know.
SPEAKER_03Aaron Ross Powell Approval of the COVID vaccine was expedited, and it looks like the messenger RNA vaccines are amazingly effective. Are we going to see more usage for other infectious diseases and what could those diseases be?
SPEAKER_01Yes. The the short answer is very much. Um in the past, uh we have done some significant work with messenger RNA uh delivery systems. So both SARS and MERS, um, we were able to produce uh messenger RNA vaccines and they were tested in humans. Um they were only phase one studies, but both of those infections died out before we really had to move on and attempt to vaccinate in a phase two or phase three trial. But a lot of the legwork was done, and so it really allowed us to um have all the background science done so that once we knew the viral genome, it made it very easy because then you know exactly what sequence. Messenger RNA is really there are four um very basic building blocks of RNA, of messenger RNA. And so once you know the sequence and how long something needs to be, you can actually just order it up from a commercial lab. And so the background science of this was already done. Once we knew the genome of the virus, we could order up the messenger RNA with the exact sequence we wanted to build the spike protein, and that actually is produced much, much quicker than traditional vaccines. The one thing that this did allow us to do is push this along. So I think we were going to have messenger RNA vaccines eventually. Um and I think flu vaccine is a prime candidate because we have to, as people know, we we grow those in eggs. There are some um alternatives uh to produce influenza vaccine, but we do grow them in eggs. So we have to start early in the year, we have to guess at what we think the circulating flu strains are going to be, and then grow these viruses in eggs. And so sometimes the virus that actually starts to circulate is not the exact um strain that we picked or strains that we picked. Messenger RNA technology allows you to produce a vaccine much more quickly, and so we can wait, you know, and try to see exactly what will be uh uh circulating in the community and would potentially be able to make a vaccine that's very, very effective, much more effective, and more particular to that strain of influenza. But influenza is not the only one. There are many, many different usages of a messenger RNA vaccine. Anytime that you are trying to produce a protein in high quantities in the body, this technology probably will allow that to happen.
SPEAKER_03Aaron Powell The efficacy of this drug is tremendously high. Could you ever have imagined back in March, April, May when we were when they were talking about a vaccine that we would have a vaccine that is 90, 95% effective?
SPEAKER_01Aaron Powell Not at all. I think that all of us were surprised. We were used to dealing with vaccines which are much left less efficacious. I think that um there were people who who had ideas that this might work this well, people who had been researching messenger RNA vaccination for, you know, years. I mean, this has been around s certainly, you know, as I stated before, for thirty years, but in a vaccination, you know, at least 15. And so um people knew that we could produce proteins that were very specific to a virus. So the spike protein here really looks exactly like the spike protein that's on the coronavirus. There's no living material that's produced, there's no the rest of the virus isn't present, so you're only producing this one piece, but you're producing an exact replica. And so it's no surprise that if you can make a whole lot of antibodies against that uh protein, that it should be highly effective at preventing an uh infection.
SPEAKER_03For people who are getting the vaccine or considering getting the vaccine, just your message to them about the safety of the drug.
SPEAKER_01So I can tell people the science here is is really groundbreaking. I mean, this is is I mean, we all have said this repeatedly, but this really is a miraculous development that we've been able to, you know, we've we've laid the groundwork through years of research to be able to do this so quickly and potentially, you know, end this pandemic before next summer. And I can tell people that, you know, despite what you hear, you know, this is is it is tested technology. This is human messenger RNA that we're we have you know, we have a delivery system to get it into you with a minimum of side effect, um, a side effect profile that's very similar to influenza vaccine or shingles vaccine, you know, in terms of the muscle aches or fever that you might have. Very, very similar side effects. And the lasting effects of the vaccine itself should be very similar to being infected with coronavirus. So, because we're producing the exact same antibodies. And so we have not thankfully seen a lot of long-term immune sequela of uh COVID infection. We certainly have seen people who have chronic cough or shortness of breath or headaches, but those are generally effects of the uh infection itself or the cytokine storm, not from the antibodies that are produced against the spike protein. So here we're gonna produce these spike protein antibodies, and there should not be any sequela long term of doing so.
SPEAKER_03Aaron Powell On a personal note, we talk about the front lines, and you are a person that's that's on the front lines as a critical care physician. We're in the second wave, as they call it. Uh the numbers are increasing. We're where we were in April, but mortality isn't where it was. Good news. What have we done? How have we learned and what have we learned to to kind of address this?
SPEAKER_01Aaron Ross Powell Yeah, so there's there's three reasons for that. Um the first is what we've learned in terms of managing people who get very sick. And so in the very beginning of this, um we were using mechanical ventilation very early, you know, so we know now that people who have this are very susceptible to what we call ventilator-induced lung injury. So if you need a ventilator, you have to go on the ventilator. We don't have an option, but we're really pushing the limits much more than we ever have with any other viral or bacterial pneumonia with a ventilator and ICU usage. And so we're really trying to hold off. And so we've developed a lot of mechanisms to deliver oxygen to ventilate somebody without a ventilator using non-invasive ventilation to try to stave that off. So that's that's one, and we've really been we have all along become increasingly uh aggressive about that. And so it gives people time to heal. Second thing is we are we have drugs now, so remdesivir, steroids, tocelismab, you know, these regenerant antibodies, which are actually spike protein antibodies exactly like the virus produces, believe it or not. Like we have all these things available to us that we did not have in April and May. And then the last thing is the people we're seeing now who are coming in are actually people who are catching this from small group gatherings. And so it's generally a younger, hopefully slightly healthier clientele than people who come in from nursing homes and skilled facilities. So they still are getting sick, and it's a number of them are still dying, and some are still getting very sick and requiring ICU care. But we are, you know, we've learned a lot. We have medicines and then we're treating a slightly younger population of people.
SPEAKER_02Aaron Powell On the floors, is there a lot of hope today?
SPEAKER_01Aaron Powell A lot more hope than before. I think that everybody feels the excitement. Uh I mean it'll bring tears to your eyes because we have all seen this up close and it's it's been hard. You know, it's uh you know, we're in an N ninety-five all day, seeing people pass away, families not able to visit. It's been really rough. And uh, you know, and we've seen a lot more COVID than we've seen of any other disease state ever. And uh I think that people have had a hard time seeing that because it's all happening behind closed doors in a hospital people can't visit. And so we're all, you know, relieved that this this has an end in sight. Um very much.
SPEAKER_03Doctor, thanks for joining us. Thanks for all you do. Thank you to your colleagues as well. We wish you the best in the coming weeks and months.
SPEAKER_01All right, thank you so much.
SPEAKER_00Thank you. Steve Coates and Doctor Pope. For more information about vaccine news and resources, go to Hartford Healthcare.org slash vaccine. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening.