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Welcome! Today we are still in the grip of a coronavirus lockdown. We'll discuss
the nature of coronavirus and pandemics in general.. and who better to shed light
on these issues than laureate professor Peter Doherty
you heard right, he is a Nobel Prize winner! He shared the Nobel Medical prize
for his discoveries about transplantation and killer t-cell
mediated immunity which is particularly relevant to the corona virus pandemic
we're seeing today. He was Australian of the year in 1997
and he is also known as an Australian living treasure. And he's still active in
the research community and is doing stuff on immunity to influenza at the
Doherty Institute which was named after him - it's the big building right in
the middle of Melbourne. He is the author of the book "Pandemics: What Everyone
Needs to Know" - which is a topic of one of our previous interviews which we did in
2014, and he also did a talk at the Science Technology & the Future
conference in 2013 on "Pandemics & the Future". Despite his high profile I found
Peter really down-to-earth and easy to talk to and Science Technology & the
Future is not primetime television, it's just the YouTube channel, but I feel that
we are really lucky to host a Nobel Prize winner - not only is he the Nobel Prize
winner but knows what he's talking about!
So today we'll discuss COVID19, its similarities and differences to
influenza, how infectivity works, combating the corona virus, achieving
rapid responses to pandemics, the idea of strategic infection of COVID19 or
variolation as some call it - which is the main topic of my recent
interview Robin Hansen. Also we're just discussing rejuvenating the
thymus to help boost our immunity with age which is a major topic my interview
with Aubrey de Grey just recently, and also modeling viruses and diseases in
computers.. so and there's much much more.. so
you're in for a treat! So if you like this content please subscribe and share
to anybody who might have a benefit from it! Adam Ford: Welcome Peter Doherty, it's great to have you here
again! I've interviewed you before; and we actually did an interview like in 2015
on or was it 2013 on pandemics your book - so yeah..
Peter Doherty: It's remarkably prescient to review pandemics [the book] in Australia .. nobody had ever heard of it
here, so it was sold globally by Oxford University Press
but it got less coverage in Australia. Adam: Well let's start off with
the nature of the COVID19 virus? What is COVID19? and how
does our immune system respond? Peter: it's a corona viruses what we call a beta
corona virus - one of the common cold viruses is a beta corona virus. You
know it's possible that that common cold virus jumped in human beings 10 or a
100 thousand years ago in much the same way as COVID19 has now, but it's
just got very mild so this corona virus there what were called positive
strand RNA viruses, unlike influenza though they do
mutate and we can track lineages, for instance I've just heard that we can we
can track within Australia where a particular virus may have came from;
where whether it came from Ruby Princess [cruise ship] or something else on the basis of the
little mutations in that virus but it's not mutating like flu. Flu lacks
any proofreading mechanism, [it] throws off enormous numbers of mutants, and so far
with COVID19 the virus hasn't thrown off mutants which would change virulence
or a change specificity for neutralizing antibodies for instance. So
it's a pretty standard sort of virus really yeah. We expect people will
be infected that they will be pretty solidly immune at least for a few years,
but of course we don't know that because we've only known about the virus for a
few months, so a long-term immunity still a question. I think we can
make a vaccine against it, but there are some issues we have to be careful
of. Adam: Right. Is it similar to the SARS virus which seemed to come out of wet
markets in China? Peter: Yes, there are three viruses that are very similar. We believe
all three have come out of bats of one sort or another - it seems bats are an
enormous reservoir of these things and there's been a Chinese lady scientist
actually has been looking very seriously at this. A lot of really good science
going on and the Chinese Republic now as well as in Hong Kong and so forth. But it
looks as SARS we we are pretty happy came from bats into a little animal
called the civet cat which was then sold through live animal
markets. It might have been infecting people for years for all we know, but it
it was Chinese New Year and people traveling spread it and so forth. But the
only spead outside Asia really was to Toronto where one guy who, was
what we call a 'super spreader', went from home I think and caused an outbreak
there but otherwise it didn't get into the West.
Then there's the MERS virus which is a Middle East Respiratory Syndrome virus
it's, we think is a virus that's come out of bats and has gone into camels, and then from
camels into humans. So I've actually one of the words of advice if you're
trying to protect yourself is never kiss a camel - people do! People do kiss camels!
This virus is killing 34 percent of people and infects, and it's still
active but it's only infected relatively no [0] numbers of people -
it's got from the Middle East, they have had outbreaks in Thailand and so
forth in Eastern Asia I guess. I'm never I'm never sure what East and
West is anymore it's East or West of what? you know.. And SARS killed
about 10% of people - this one [COVID19] kills many many fewer people but it's
incredibly more infectious. The suspicion is that it's come from bats, possibly
through a strange animal called the Pangolin, but the initial focus of
infection seemed to be around the seafood market in Wuhan, which is where
the live animal market is. I didn't think at any stage it had come from seafood
we've never had a virus that's jumped into humans from cold blooded species as
far as I'm aware. And the Pangolin though it looks like a reptile is actually a
mammal it has scales. Adam: Yeah, it's a weird animal - but you mentioned in
2013-14 (when we had a science technology & the future conference) that bat
viruses were only recently became aware of.. I think it was
a virus lyssavirus.. Peter: Yes yes, we've known for a long time that the
biting bats particularly blood-sucking bats in it in South America will bite
cattle and cause rabies, we've known they carry rabies. Rabies is what's called
a lyssavirus and we've also had case fatalities here of lyssavirus. So we
have a virus that's very very similar to rabies virus in our bats, but it's never
made the jump into biting carnivores the way rabies does. I mean rabies is
transmitted by a dog bite or a badger I not sure about Badgers or a
raccoon bite.. it'd be another one that would do that, or a fox. But we've
never had that in Australia. But we have three hundred licensed bat handlers in
Australia - if you get that in your house you never try to catch it,you call the
RSPCA or whatever they call in your state and you ask them to find you a
licensed bat handler, or ask for contact so you can get one, because they're all
vaccinated against rabies - and people consider that this virus which is in
our bats is as close to rabies as we can protect with a vaccine. So it's very
similar but it hasn't jumped. This sort of thing is right through nature
actually there all sorts of things that are a potential threat will just sit
around and do nothing - suddenly we've got a problem. That happens with plants so
you can have a plant saying that garden there's nothing happens for decades and
then suddenly the damn things everywhere and nobody knows why!
Adam: Well you've written a lot about our influenza before - I think it was the
main subject of your talk at science technology & the future - this is
extraordinarily infectious. But you were mentioning before that coronavirus
doesn't mutate as much .. the the corona virus is as extraordinary
infectious pehaps even more so, but this is what makes it dangerous. Seasonal flu
arises because of mutation, is that something we don't need to worry about?
Don't we need to worry about a seasonal COVID virus, like COVID21 or
something? Peter: I think it's less likely but it's something we'll watch. I mean
the question will be with this virus is once we've got good herd immunity - that
is many many people have been infected and recovered, or we've had a very good
at vaccine - which is embellished and expanded that herd immunity to just
about everyone, the question is whether this virus will maintain in nature by
human to human transmission? So we know influenza viruses do because influenza
viruses mutate very easily and the seasonal fluids are simply
mutated versions of the standard flus, and we have to deal with about one
of those about every year really. And that's remarkable to actually
because the mutation rate in flu is enormously high - it's throwing off
enormous numbers of mutants but we still only have to deal with one of them in a
particular year, so there's it's not a very efficient process for getting into
humans and creating a major new pandemic
epidemic rather.. We call them seasonal epidemics but
they would be global and people in the norovirus field, you know the thing that
causes diarrhea on cruise ships - if anyone ever wants to go on one of these
damn things again. They're a mutated virus and they call them pandemics - so it's
just a matter of the nomenclature. So and of course the pandemic strains of flu
are the ones that come in from another species (from pigs was the latest one)
or from wildlife or whatever. Adam: About nomenclature , what is the
difference between pandemics and epidemics - 'epi' means over and above
right? So is pandemics just like a like a local case of an epidemic?
Peter: A pandemic is a global infectious disease issue with a
new virus that's come into the human population. You can look at the HIV
situation as a continuing pandemic if you like, I mean it's still active, it
came into the human population in a big way at - least in the beginning
of the 1980s. It may have been in human beings before that but didn't get out of
Africa or wherever. So I think of it as a continuing pandemic. Pandemic
for influenza - the definition used to be that it was a novel virus that had come
from somewhere else and spread between I think it was two or three WHO regions -
now that's very arbitrary because the WHO regions aren't like say taking one of
those chocolates that's what shaped like an orange and is
in little segments - some of them are really close because it depends on
where the regional offices are. And that was the definition of the 2009 pandemic.
People got into trouble about that because everyone thought
pandemic means horrible terrible disease but in actual fact their definition the
WHO definition back in 2009 was simply on the spread of it! So
people were a bit skeptical after that of
the WHO pandemic definition, because the 2009 swine flu didn't seem any
worse than the usual seasonal flu. There are reasons for that we could discuss
later. They don't think about flu viruses is when they do mutate apart from
mutating to avoid neutralization by the immune response, and that's why they
escape and they become new seasonal epidemics. When they do mutate - change
virulence sate - they generally become less virulent, and that's what happened in
1918 with the terrible pandemic. By 1919 the virus wasn't causing as much disease;
wasn't as severe - it was still bad. By 1920 it was just part of the influenza
background really. Adam: Did you say the swine flu
was not as dangerous as a seasonal flu? Peter: It didn't look that way to people,
and the reason for that was with influenza we usually get a novel
pandemic influenza (and with a seasonal) we usually get a U-shaped curve.
The very very young are very susceptible because they have had no prior
experience of any type of influenza, and the very old susceptible; or the older
from 70 on are susceptible, because their immune systems are failing in the sense
of being able to deal with a new challenge. But the reason that 2009 one
looked pretty mild was the older people weren't affected much, and the reason for
that is we had a very similar virus in 1977 - so a lot of people have been
infected with that virus at the time and when they were younger and they were now
seemingly immune to the new virus. It had cross reacted - they were both
what we call h1n1 viruses though from different origins. And so we didn't get
those usually high death rates in the older. What we did see though was it
was bad in indigenous communities as flu virus always is - it always infects and
damages our indigenous communities more than it it does the broader
community, and the other thing about it was, it was putting quite a number of fit
young adults in hospital - very sick some in ICU some dying including heavily
pregnant women. And that was a characteristic of the 1918 pandemic. The
virus it wasn't a U-shaped pandemic it was a W and so, the very young
were very susceptible, then it came up again for the young adults, dropped off
again a bit and then was worse again in the elderly of course. Adam: Strange,
well, I want to ask about the various responses around the world
especially early responses to this COVID19 pandemic, some of them were
dismissed, some people were quite dismissive and
weren't really listening to the science. So now I think what I talk about science
communication - so, what went wrong there do you think? Peter: We're kind of all into denial and it depends how closely
you're watching a situation, which we really don't want to acknowledge these
horrible things out there that are gonna get us, unless it's a horrible
thing about a horrible person did; we love to think about bad guys, you know,
all these really bad guys, that's why we have armies, because you know we think
we're gonna be attacked by really bad guys. But we don't like to think so
much about bed bugs and you know some of the people who I think are extremely
irresponsible tried to transfer this discussion from a bad bug to the bad
guys, yeah. There was a terrible Hollywood movie called 'Outbreak'
which was an absolutely ridiculous movie. But you know at least one of our major
national leaders lives as though he's the personal star in a Hollywood movie
and all you do is rewrite the script if you want to change the course of the
problem unfortunately it doesn't work that way. So I think there was a
lack of engagement at the beginning, and then we started to see what was coming
out of Wuhan and anyone in the science community who worked on infection
immunity became very concerned. Mike Catton here
our Institute who runs VIDRL which is the state virus
diagnostic reference lab in Victoria, which is part of our Institute - that's
why our Institute is unusual - because it incorporates the state caustic labs for
bacteriology, virology, World Health Organization Influenza Center, and all
that stuff along with the standard academic department. We're the closest
Australia has to what the Americans call a CDC Center for communicable diseases.
And so Mike picked up on it early - he said, this is worrying the Chinese
put out the sequence of the virus. So by before the 25th of January I think it
was, when we actually diagnosed, there was this case I think from a traveler, Mike
had already set up the PCR test - and so we were ready to go in that sense. So we
were testing right from the beginning. The PCR test is very
sensitive, you know it's based on the test we used to detect genetic material
from rapists, and it amplifies the genome - so Mike had that already set
up and they were ready to go with this thing.
Adam:Yeah, you mentioned outbreak - another movie that was brought up during
your talk at the conference I mentioned earlier was Contagion - but that's
a far more realistic film - are there any other realistic films or shows
that people can watch and hope to learn something from (other than documentaries
of course)? Peter: I think contagion it remains a pretty good movie. It's a
horrific (film). It's the same sort of scenario as for COVID19 basically.
It's a virus that goes from a bat, to a pig, to a chef, and then to Gwyneth Paltrow.
And Gwenny who's in Hong Kong pops on a plane, goes to Chicago, she has a bit of a
dalliance in Chicago, basically she's the most infectious human being that's ever lived!
Anyone who looks at this woman gets infected, and so they all start to die
around her, so it's infinitely worse than this infection. And I don't know if that
would actually be true that we would get some that's that lethal spreading like
that. It's interesting COVID19 - the SARS2 coronavirus is what they were
calling it - is the least lethal of the three. MERS is the most [lethal],
SARS is the next, and then COVID19 is the least [lethal]. And so I think I've always
thought that a really very dangerous thing you pick it up so quickly that
that you jump on it and stamp it out hopefully - but poor old Gwenny dies and
you know she transmits it and the the CDC officer actually who
goes to investigate it she dies eventually. One bit
about it that's not realistic is they develop a vaccine and they have it
out there in about three weeks I think - so you know that bits wrong. But
otherwise the director (I forget the director's name) but he's known for making serious and thoughtful movies - he took the advice of
Ian Lipkin in Columbia University who's an infectious disease specialist. And
usually I think Hollywood movie makers - they're not interested in facts -
they're interested in entertainment. But but this movie maker was actually
interested in trying to get something realistic across. So it was at the time
the thinking man's horror movie, which meant not much watched it really, because
it was too serious for them, they wanted a bad guy I think - we all like bad guys, I
I like watching murders on the TV. Adam: It's strange about our psychology how
we're particularly attuned to some dangers and it's pretty bad at detecting
others right? Peter: I think from hard lab scientists like me you
know I'm at a lab scientist and not a not a medical doctor, so I'm not seeing
patients and or talking to people a lot. The medical doctors are much more aware
of this. But when HIV hit, I think all of us in the lab
sciences suddenly started to realize just how very important and actually how
difficult social sciences are. It's behavior that's enormously important in
this, and in this disease as well. So that's why they put out those ads at the
time of HIV, of the bowling ball knocking people down, and all the rest of it - you
know they were knocking down nuns and all sorts of things.
Adam: I remember that ad yeah. Peter: [Someone?] suggested they were very randy nuns. They were pretty safe unless nuns they were pretty safe and unless
they got a blood transfusion that was contaminated - and our blood supply at
least was really quite safe. Adam: I'm just wondering is there cause to be
really concerned about the COVID19 pandemic and
if so, is there a fine line that we need to like walk on in order to not
get people into too much of a panic and act irrationally, but at the same time
get people to act really rationally and you know socially isolate - and social
isolation .. we're all gonna get cabin fever if we sit around at home all day
what are we going to do? Peter: I think the government
thinking as I understand it, I can't speak for the government, I'm not talking
to the prime minister or the health minister, I'm just speaking from the
conversations we're having around the lab. We have weekly three times a week
strategy meetings, I listen to those and if I've got questions I ask particular
people and that's great and that's where I get a lot of my information about
what's going on locally. Apart from the very good local websites the federal one
and the state Victorian one that tell you a lot of what's happening and there
are very good global websites too. A lot of information out there people want to
seek it out. And basically I think we've done exactly the right thing, I mean we
to some extent people have been frightened by it, they've been seeing
horrible images coming across so they scared of it and justifiably so. Though
most people are going to have 80% plus are going to have an inapparent or a
mild infection and we know that for most younger people
they're probably okay we get the occasional death and a child or a
younger person. I think if you go up to about age 60 the total of the deaths in
that from from 0 to 60 I think it's about 5% of the deaths are in that group.
So there is a risk and people should be aware of it - but they're not an enormous
risk, but the death rates ramped more rapidly up after age 60, 70, 80 and so it's people
of my age that are particularly at risk. So the question is how do we proceed
with this? We've been successful we think from what we can see the the community
transmission rate is is very low, and we always thought it was low. We
would actually know people were saying we're not testing enough, we were
actually doing a lot of testing! And by international standards we weren't
seeing a lot of infection even in people who are presenting as coming back and
they had colds and flu and all that sort of stuff; we weren't seeing a lot of
positives about 1%, maybe it's 2% now, in that same sort of group - people
coming in to be tested - and I'm not quite sure. So
we didn't have a community transmission problem going on the background. I think
Europe and the United States simply didn't take it seriously enough. I
think there was a lot of community transmission going on, and certainly it's
for at least six weeks in the United States. And it's everywhere - if you look at the maps,
the New York Times puts up for instance you can see it's everywhere, and many
parts of the country it's doubling in incidents and number of cases every five
days. So it looks as though we've avoided that, we've shut down early enough.
Though people may think we get enormous numbers of tourists, it's
nothing like Europe does. So I think we may have we may have caught it.
And we can actually now - because the little mutations in the
virus, not that it's changing virulence or changing antibody specificity (because
of those little mutations), I've just been hearing how we can actually trace the
where a particular virus would have come from - you know one with the
healthcare worker for instance - Ben Houghton was talking about this - with one
with the health care worker where we know it didn't come from the
hospital, but we know it came from a party you went to for instance. So
if you can trace at that level you can really trace. And so what may happen
as time goes by if we can really really keep it low, is we presumably though they
will relax some of the controls, they all have to be prepared to put them back on
again but I presume like they'll relax some
of the controls because it's costing an enormous amount of money and it can't go
on forever - that's part of the equation. I mean our whole strategy really
has been directed not a getting rid of the virus, so you know if we're
extraordinarily lucky will have, except we won't be able to allow anyone in
without two weeks quarantine - but our whole strategy has been directed at
flattening the curve; keeping the case numbers down, so we don't have overwhelm our
hospitals, and our intensive care units, and our doctors and nurses. And we don't
want a lot of tired doctors and nurses trying to [give] care to ICU patients where
you might have put a tube in their throat. And that's right you can get an enormous amount of
infection through vaporized droplets that are very small - get deep in the lungs
and stuff - we don't want that to happen to these guys because
They're the frontline; there the soldiers, and and we need to
protect our army. That's also true of police, check out operators at
supermarkets, all these people are in the frontline, and we should all applaud for them
I think. Adam: Absolutely yes, that's a really good way of putting it. And
flattening a curve has been the mainstay of most of the messaging put out
there by the (Australian) government and other governments around the world as well.
I think that's a really good initiative. But social distancing isn't
perfect - society is porous - I mean all it takes is just
random chance - going to the supermarket which we all need to do and
someone's affected there. Peter: Yeah people my age particular you're worried about the
random chance.
Supermarkets been pretty satisfactory, my wife tells me at 7:00 in the morning if
you get there early all the distancing has all marked
out the numbers that allow dinner or marked out, checkout operators are behind
plastic screens, and so if you're wearing a reasonably decent mask, which is
probably a good idea in the supermarket. She's made one from a table napkin - you
can make it - I think actually a mask that in some ways would be better for
this sort of purpose from a table napkin that's why finely woven. She had six
layers of cloth over her nose. Adam: Running around looking like a bandit! Peter: No, she looks rather colourful actually - it's rather a nice table napkin. It doesn't have
anything embarrassing on it - so and the other thing about that is that when
she gets home all she does is take that off and throw it in the washing machine.
So she's not worried that sterilization - she's only doing this every couple of
weeks, so I think it not a bad way to do it, and she's not depriving a
health care worker of a mask, which we're still in short supply. So I
think that's the issue. But what could happen with this
is if the case numbers really go way way down there are various ways of checking
community transmission. One is when you do get a case then you test very
intensively all around that person all their contacts people in that local area,
and we've now got enough testing capacity to do that. We can now test very
intensively in what you might call a potential hot spot. The second thing we
can do, and this has been done over the years for things like polio and
for the norovirus (the one that causes diarrhea on cruise ships), we can test
sewage - and you can pick up one in 10,000 positives. So if we went to that and we
were testing sewage from particular locations, initially just from the whole
of the urban community, but then from particular locations in urban
and rural communities through their sewage system,
we could say whether the virus is active in that community, because you know it
does come out in stool and so forth. And the genetic
material can be picked - it may not necessarily meaning much infectious
material there, but the genes may be there - and so we don't think stool
transmission maybe is terribly important except maybe in the kids stage. It was
important in SARS, we know that from a building in Hong Kong which had a very
poor sewage system which was infecting people actually, because the pipes were all
sort of interconnected. Adam: That's interesting because I watched a video where somebody
said that that was an issue - it could .. stool to mouth he called it but..
yeah okay well that's great, I'm glad to hear that it's not so.
Peter: It's not a major issue we think the main issue with transmission is droplet
inhalation if you're inhaling - that's why the 1.5 to 2 meter distance
if you're (inaudible) - it is important because.. and we also think that I mean if
you did say use the table napkin type mask we think it might be reasonably
good at keeping out say 5 or 6 micron droplets - it wouldn't be good per the
smaller droplets but we think it might be reasonably good, so that might be a
plus. But you don't need to wear a mask if you're out in clean air I
think and you're keeping away from people. How you approach the
supermarket's and so forth is another matter. It's the ICU doc's
we're really worrying about, those small droplet sized particle. And then the other
way of course you get infected is hand to face - and so that's why
there's all the hand washing advice and then also it can survive
certainly three days on plastics, cardboard various estimates from 7 hours
to 24 hours, but that would depend on the cardboard as much than anything else.
Would also depend on how you did the experiment if you put the virus on and
the usual sort of tissue culture fluid we
a virus in, it probably wouldn't survive all that long on say
cardboard. But if you put it on in mucus, snot, phlegm, that stuff, it would
survived longer because a lot of viruses would survive much longer in mucus.
And it will survive very long if you're shedding any infected cells - that also
happens. So you can't really say absolutely but I treat anything you
bring into the house, when there's a lot of infection around I treat anything in
in the house you bring in, as potentially could be infected - so you know just be
careful the way you handle it at that stage. But if your set a plastic bag
aside for three to five days or something, it's probably fine. Just if
you're putting it straight in the fridge you might want to wipe it down with a
bit of alcohol or something. Adam: Ok - I must remember that after shopping! Let's talk
Let's talk about the current research into COVID19 - how do we combat this? What
research programs at the moment do you think look promising for
generally combating COVID19 / Coronavirus? Peter: Well there are two ways. Apart
from trying to understand the disease a lot better because we've only seen the
disease now for less than four months so there's still a lot of work on
understanding what the actual disease is. The severe disease and that some
interesting aspects to that that there may be very different from flu. I
hadn't realized that until actually saw an English physician (an ICU
guy I think) talking on TV last night, saying there may be a problem with
oxygen exchange rather than with clogging up the alveoli the end
stage of the lung bronchioles and stuff with with crap - which is what will tend
to happen with fluid to make it should be a problem in the oxygen exchange
level - which is really interesting which would suggest other sorts of approaches
that people who do hematology for a living would know a lot more about than
I would. So I'll be interested in people will know they'll be following up on
that very aggressively but the two solutions we have to this that come out
of the lab, I mean the lab solution contribution at this stage has been all
the testing. But set that aside for a minute the two
possible solutions are a vaccine which I think we can make but as everyone says
it'll probably take at least a year. Most optimistic as to what I've heard one of
the American vaccines is that if it goes ahead and it all looks safe - they could
have the human safety testing to the stage where they're looking at
large-scale human safety tests a human efficacy testing we call a phase 3 trial
say from September, and production a product to get out into people's arms in
early in the year. So that would be about the fastest you can possibly go and that
means everything has to go well! It has to be protective when you do what we
call preclinical testing, we have to do those initially in say lab animals -
ferrets can get infected a little bit so you can use them - and then you need to go
to rhesus macaques or one of the monkey species. There's a manipulator mouse
model too that you can use so if it looks good in preclinical stages, then
you go through safety testing in humans and you scale up the numbers
in those tests and so forth. So vaccine - that's the way that we would
really do this - the only concern about a vaccine is vaccines don't work all that
well and the elderly, and we are the target group of course. So there's
another possibility and there's also enormous activity on this I'm aware of a
little of it, and that is to find specific antiviral drugs. Now we know
that some drugs may have a bit of activity, they're being tested as
an anti influenza one, there's a an anti HIV drug, there's an anti Ebola drug,
there's hydroxy chlorophyll that president Trump's talked about a lot - they're all going
through tests in proper randomized clinical trials, so we know whether they
actually do something or it's just anecdotal. Because that's always a
problem you know - it's so easy to fool yourself with these things, especially
when you want a good outcome. So that's been done but there are also both people
doing large-scale compound screening, a drug
discovery. They have enormous numbers of compounds, and they simply screen across
to see whether they're likely to bind to the virus and stop it infecting the cell
and then we also have people doing what's called drug design - designer drugs.
A designer drug would be Relenza or Tamiflu the anti influence of drugs and
Mark von Itzstein at Griffi h University who made the initial Relenza along
with Peter Coleman and Graham Laver other Australian scientists who made
Relenza is actually doing that so this is a process where you try and
match your knowledge of the structure of the viral protein, that's determined by
what we used to call x-ray crystallography we now call structural
biology, that's what the using big synchrotron (for) at Monash University
and then by knowing the structure you design a molecule on your computer
to fit it and then you can see whether that molecule can be made and used. So
you're collaborating with various other people. I always say that if you're a
kid who's a computer nerd and has few social graces this is the job for you
but in actual fact I mean Mark's quite an affable sort of guy so that's not true
at all really - he's quite a normal human being. So the
point about the drug that I want to come to - these drugs can be used to treat
and get rid of the virus in an infected person but they can also be used for
prevention, or what we call prophylaxis. So what you would think of there is
there's a drug called - I'm forgetting on the name of the drug - but it's actually
to anti-hiv drugs, anti-aids virus drugs - and what happens is that people
who are at high risk, which means their behaviors high risk, of contracting aids
can take this drug every day, because the same virus is used to treat it.
So what you could do for the elderly is have a drug like that which they would
take every day and just stop them getting infected. And of course most of us are
doing that for blood pressure or cholesterol - everyone in the HIV
community is taking any HIV drugs if they're positive which keeps the virus
down. So there's nothing very remarkable or revolutionary about this, we would
just have to get those drugs through and safety tested to make sure that they're
okay to use in humans. It could be a lot more straightforward actually testing a
drug than a vaccine because we can test the drug the efficacy - and in severely
afflicted people you can you can always go a bit further with someone who's very
very severely compromised by an infection for instance. In testing you
can take more risk because they likely are going to die anyway. So it's easier to get
approval, because everything has to be approved nothing gets put into
humans without approval. Adam: Yes, interesting - Wow! A lot to think about there!
What about rapid response - I mean like at the moment like we could
have, if we kind of been able to detect it, we could have actually achieved a
rapid response we had the technology & the knowhow - you mentioned h7n9 I think it was during your talk at the conference
and mentioned seed stock where there they created a great deal of seed
stocks that would be ready and prepared to boost into a vaccine if there was a
scare given a certain virus - was there anything done for the
corona virus in this regard? Peter: Well that's the issue you know with flu viruses when a
novel flu virus comes along we can go fairly quickly to a vaccine because
we've got all the strategy and the safety testing done for other flu
viruses. So the general attitude of regulatory agencies like Food and Drug
Administration in the United States, our TGA the Therapeutic Goods Administration
is that that we can go forward quickly these because we've got so much
experience with flu vaccines. With h7n9 this was a virus that came along - oh
I forget exactly the year 2017 I think I'm not sure about that - but it's one of
these viruses that jump from chickens into humans, like the original bird flu
- the h5n1, and was killing humans - particularly older people as flu viruses
do - particularly older men in fact. And so we were very concerned that
this might jump in to humans, but after the big bird flu scare in 2005 with h5n1
we just got ready to go if we needed to without producing a lot of product. And
we didn't have to do it - it didn't make the jump - it didn't start transmit
between humans - it was just bird to human. So that you can interrupt fairly quickly
you get rid of live bird markets and so forth and you make sure that people,
particularly in urban settings, that they're not handling live chickens where they can
catch this. So that was handled - as was the h5n1 earlier. And so we can do that
with flu quickly. But in hindsight it's a pity we didn't go further with
testing the candidate SARS vaccines that were being made, MERS vaccines.. (etc)
Some of these were giving a bit of a safety signal - they were there were a
couple of vaccines that signaled that maybe they made even the disease worse
in monkeys - so we wouldn't want to go on with them, but there are other ones that
looked as though they were fine in monkeys and it would have been good
actually if some of those vaccines had gone into
people to check they were safe, because we'd probably be able to use that as a
background for this virus (COVID19) and go ahead. But perfectly naturally the
vaccines were dropped because there was just no SARS threat anymore -
the virus wasn't around. There was still work going on on the MERS virus - it
still takes away, it still there. And I think there were over 200 cases in 2019,
but that was worldwide and what did happen was that some of the
people who had been looking at this a lot, for instance like
Bill Gates's organization that's been doing a lot to combat these diseases
where the funding isn't there to study them - because they're not an
immediate threat and from the pharmacology industry, pharmaceutical
point of view there's no income stream that would come from having the products.
But they set up this pandemic vaccine preparedness fund, and that's the fund
that for two years supported the research at Paul Young and
his group at the University of Queensland whose protein plant vaccine
they supported the research on developing the basic platform, which is a
platform that keeps the structure of the virus protein in good shape because we
want that for a good antibody response. And that vaccine that was supported by
SIPY? I think it is I always forget acronyms, for two years is now in a trial
in the CSIRO animal lab Geelong. And the CSIRO is producing a lot
of that stuff, and we're doing a lot of the lab testing for them. So that's the
first Australian vaccine to get it off the ground.
There are other candidates being made, including in our Institute of different
types of vaccines. The Americans already have an an mRNA vaccine - that
message it's genetic materials to make protein. They put that into arms and
people some time back now - so they're they're pushing on fast without.. I think
there is something like some 60 vaccine candidates in various sorts of testing
at the moment, and then the question is how quickly we can bring forward a safe
vaccine? So the international fund was good for that. I think now what we
need to push for, after this is over, keeping up that strategy and maybe
funding it a bit better for other potential threats. And the other thing
we need to think about is maybe having a similar thing for drugs -
antiviral drugs - because the Relenza and Tamiflu and Miniver - all these drugs
against influenza neuraminidase work across
all the influenza viruses: seasonal viruses, pandemic viruses, and influenza B
viruses which are different type of influenza virus that's maintained only
in humans. Always those drugs all work against the whole class of it, so if we
push ahead with an anti-SARS drug that blocks some part in the pathway
that was shared with this virus we'd be in a lot better shape with the therapy.
So I think we need an international agency paid into by government or
whatever .. philanthropists .. to fund long-term drug research into classes of
virus that are a potential threat. You might think for instance about the
Nalepa virus - which is virus that jump from bats into pigs into people -
different type of virus, but it's been circulating a bit in Southeast Asia and up
as far as India. And so that class of viruses I think we should think about
blocking drugs - because as our population grows and we clear forests
and all this sort of stuff and we have this rapid can travel all around the
planet we're going to always be at risk of these things. And in 1918, we didn't get
the virus in Australia till 1919 it had to come by ship - that's what protected a lot
of people. Adam: Controversially in lieu of an actual vaccine, that could come I guess
hopefully in 9 months but maybe even in 18 months if things go okay, if
social isolation doesn't work well enough too - would something like strategic
or voluntary small dose / low dose infection like variolation work in
order to gain immunity? Or nudge herd immunity? Is that something that we
should be considering?
Peter: Well let's tell people what variolation was - variolation
comes.. it's probably about a thousand years old or more. It was first done by the
Chinese, and what they did is they took - I mean smallpox was a terrible scourge - to
kill people that disfigured the ones that survived. Never wiped humanity out -
I don't think it's likely that an infectious pathogen would wipe out
humanity. But certainly COVID19 won't because 80% of people are fine. But what
what they did early on in China was they took a bit of smallpox material - it
causes box on the skin - and they snuffed it up people's noses or they
scratched it into the skin, depending on where it was done. That sort of
caught on in the Middle East, what they did was do in young children. Young
children had a good immune response, they generally survived smallpox. So what
you were doing essentially is giving them smallpox and they survived. Whereas
if they got it when they were older they'd have a much worse disease. We do
the same thing actually with measles and mumps. The vaccine we give to kids is very safe,
but mumps, particularly in older men, was a real problem - I mean a terrible disease
and hospitalized people for a month or so, and big problem in military during World
War I and World War II - and a lot of men may have been left sterile by it! So
it's not an unthinkable thing. So what happened then was the Chinese
practice of infecting people with smallpox caught on in the Middle East.
And a very feisty English lady, Lady Mary Wortley Montagu, who was married to the
English ambassador to what's now I guess Iran - those countries - Persia..
the plenipotentiary, he was the plenipotentiary.. I'm not sure what the
difference between a plenipotentiary and an ambassador is but that's what he was.
She took the practice back to England, interested the local doctors in it,
and Edward Jenner the physician was a variolator - he was scaring small pox
into young people's arms. And of course you know some Tim kids did die from this,
and so it wasn't it totally innocuous - and it got across to America too.. there was a
doctor called Boylston who took it up there - if you're ever in Boston if you
know Boston at all - Boylston Avenue is named after him, it's right in the
center of Boston.. So Edward Jenner though realized that milkmaids weren't
getting smallpox, and he reasoned that the pox virus on the teat of the cow, cow
pox, was actually protecting the milk maids, so they were getting infected with
that. Even though we didn't understand infection at all at that stage. So he
took some of the stuff off the teat of the cow, scratched it into the arm of a
small boy, and then gave him smallpox - a bit hard to get through an ethics committee
now.. And that's where Vaccinia came from. So Vaccinia .. 'Vacca' is the cow, so
vaccination refers to cows. So the anti-vaxxers of the 19th century
all drew cartoons with people with cow horns coming out their head or looking like cows by
being vaccinated with cow virus - which of course is totally absurd! But the way
it was done, they grew the virus in the skin of a cow and a calf and basically
you can see some engravings of this - people in the late 19th century
fashionable Parisians coming into a tent - set up I suppose in leVoir or somewhere -
with a calf tethered outside, where they took the material from the calf,
they scratched it into the arm of people. And that's vaccination or vaccine yeah
that approach with a bit of modification to grow it in cell cultures as well as
in cattle was used to eradicate smallpox and we've eradicated now one of the
vaccines that's in test too long for a British group from Oxford is what's
called modified vaccinia Ankara this is a very mild of aksinya strain where they
plot a bit of the Koran virus genome into the vaccinia and they're using the
vaccinia to vaccinate to vaccinate people so you could be very lating MVA
or vaccinating people with MVA scratching it into the arm now that's
the way people in my generation we're all vaccinated like that very very
ill a tional vaccinations scratching it into the arm and and and it would come
up as a little postural or nodule and and then go down and we beam in so I
mean with co19 I don't know but it would take a brave self to to be a test can
it's possible but you'd have to be enormous ly careful that they didn't get
any dose through their nose but there would be ways of doing this I mean
another way of doing that is to actually attenuate the köppen 19 virus and that
it don't buy attenuating you would actually knock out some of the genes
that allow it to cause disease and allowed to multiply a whole lot and then
you would have what's called an attenuated vaccine and that's really
what the mumps and measles vaccines are they're attenuated vaccines the Sabin
polio vaccine is one of those it's an attenuated vaccine they were just
weakened decades ago much been a much more primitive way by passage in women
for tissue cultures and they underwent mutation to lose virulence they were
tested very thoroughly in monkeys and so forth and then given to humans this is
something that could be achieved in the near term if like the vaccine timeline
enter looking length can be longer if it was an absolutely catastrophic situation
if it was like the situation that's depicted in contagion where you know
everyone who's within a hundred feet of the virus gets and dies yes it could be
reasonable but I don't I think with a virus where 80 plus percent of people
are definitely mildly infected and worse than also not sick enough to go into a
hospital more than 80 percent are not sick enough to go into hospital I don't
think you would take risk of that I mean the thing about a vaccine is you have to
give it to large numbers of normal people
you can't take Christmas vaccines and and you can take risks with end-stage
therapy if someone's very very sick and you've got something you think might
work you can try it pretty easily people will approve that especially if
it's a gets approved for it using humans for
some some other purpose but you can't take risks with vaccines and the
magnitude of the severity of this threat is not that it's not great enough to do
that I mean you could say well yes we'll take a risk but only with the people who
are really at risk so you could say well we'll take a vaccine that looks a bit
risky maybe and we'll give it to the elderly I mean these are the people or
at risk they can try it must not working anymore so and you know they're all
getting imputation credits or whatever it is so and I'm just being trivalent we
know how to put anyone at risk of course but I mean the elderly might weird with
people like me if we've had a good long and happy life and and have achieved a
reasonable degree of satisfaction people like me would would say volunteer I
certainly wouldn't I'd give it a go and and see if that that works better but we
wouldn't want to be giving a vaccine that had any risk at all to young people
so you know these are all theoretical arguments there's no way anything is
ever given to anybody in this sense without going through extremely thorough
review processes both the level of institutions like our medical school
ethics committees and and then by our own Therapeutic Goods Administration or
Andy and everything is always done along dark guidelines done by the FDA so so
you know these are policy decisions any risk at all with a particular target
group for a vaccine I think it's pretty unlikely
so the situation where the majority of people are really out and about because
they've had infection or whatever or because they just have to relate they
relaxing controls because there's just uncertainty much virus out there but
people like me will start to be very careful I just want to ask a couple of
questions about the future and looking ahead quickly now I don't know how
popular rejuvenation biotechnology or regenerative medicine is really outside
of futurist circles but one and fascinating is some of the research
being done about restoration of the thymus and somehow stopping the lymph
nodes from blocking naive T cell production I'm not sure if you've heard
of him I'm not sure pop up the details right Yanko nicola jude gitch from
arizona i think is i know yeah yeah perfectly feasible that's been it's been
talked about for generations and we've done the experiments in my spheres
people have done experiments where they transplant young pharmacist into all
mice and all that sort of things we we good at transplanting downside there's
been a body of research on that for decades and but of course that the
immune system is not the only thing that goes wrong and all people I think the
Perl problem for us with the elderly we can keep people alive if they had don't
have functioning immune systems quite it quite readily really would do it all the
time we give them human immunoglobulin it's it's basically the plasma flagship
plasma serum fraction that comes off from blood donations and CSL which is an
Australian company of course is a leading Australian blood products
company and this is one of the major blood products so we can give the people
passive immunization with with immunoglobulin they need to be injected
every month or so I think it is or maybe more frequently I'm not sure though
because there's a half-life for the antibody had sort of washes out in the
blood but but we've got all sorts of people protected in the society before
by that that's why we don't up to what kids in who don't have an immune system
in a bubble anymore we can protect them and there's an enormous effort that's
really very very very fast and this is more on the drug side of things though
it's an antibody these are monoclonal antibodies these
are very very specific antibodies for the virus so this is another protective
mechanism we could use we we could take firstly there's convalescent serum from
people who have recovered it from infection that's being looked at by CSL
how they get that stuff out there and we're keeping a close watch of course
and all the people who had it they're good potential donors but we could also
import it from China or Italy or any country that's had a high incidence of
infection and we could give that to people that would protect the elderly as
just as it would protect the vulnerable who have diabetes and various other
problems which make them much more susceptible and we could add to that if
as long as we're sure they're safe monoclonal antibodies against the virus
and we can manipulate those monoclonal antibodies to remove one of the
potential dangers of antibody and that's what's called the immune enhancement
where the bit of the antibody molecule if you think about an IgG and him in a
globulin GE molecule it's an Y shape so so two arms of the Y if you think of
antibody binding to a protein as a lock-and-key mechanism two arms of the Y
have the same key on but another part of the third part of the Y actually sticks
to a cell called a macrophage or mono site which has the job of mopping things
up in the body but it can by sticking the virus through its lock and key to
the antibody and then the antibodies sticking to a cell you can get a
phenomenon called immune enhancement where the antibody helps
to take it into the macrophage and you increase the severity of the infection
that's one of the things we're concerned about with vaccines and we have to
watchful but if you've got monoclonal antibodies made in culture you can chop
off that third arm of the Y so that can't happen so you'll have the bit the
binds to the virus stops at binding say to a cell surface protein that allows it
get into the cell and and stops the infection that way so monoclonal
antibodies may be a very very important in this both as a transitional kind of
biological drug and and for prevention and therapy and and in the long term may
be added to the human immunoglobulin we normally take to protect the vulnerable
so so you know we've got an incredible armamentarium of modern science that
none of this existed in 1980 and this virus is not I think gonna kill as many
people as 1918 flu did and basically that that armamentarium though we have
to take a little time to bring it into into actual use and most of the delay
really is not in producing the stuff these stuff so this stuff something made
already the monoclonal so the drugs and stuff probably making preliminary drugs
the long-term problem is in two things one it's in it's in testing for safety
and the other one is in ramping up production to get a lot of doses now
someone said about a vaccine where we're going to need a billion doses because
we've got eight billion people no we won't need eight billion doses because
by the time we get around to the vaccine you might think probably half the people
on the planet have been affected and hopefully you're not in Australia we may
have shut it down but but if half the people on the planet are infected and we
test them and I've got anybody's will they don't need a vaccine straight off
and then of course the younger people anyway are relatively protected so if
you feel prioritizing the vaccine the very first people to get a vaccine or
any protection would be health care workers frontline personnel indigenous
communities people who are at risk from intercurrent problems like diabetes and
and I guess in the end analysis all the people from sixty on so so anyway that
but they're all policy decisions now Caucasian seem to have like a genetic
variation a to I think he called it is that something that we could like confer
on to other people through some sort of somatic future gene therapy program I
too is a mystical ability complex protein I to is one of the molecules
these these molecules present little bits of virus to the other arm of the
immune system the so mediated immune system the killer T cells my colleague
at the Institute Catherine kids yes works on this and that's what I worked
on for years that's what I discovered we just can't have a part of this story way
back and that's why I got the Nobel Prize and so a to is does seem to
control some resistance on Caucasians against
flu strains because it presents a peptide it a - is very common in
Caucasians and it presents a peptide which is cross-reactive between a lot of
the flu viruses and gives us some background immunity T cell immunity
doesn't give us kind of sterilizing immunity we can get with viruses because
the immunity has to be recalled from what we call it B in memory now we're
getting a bit complicated here I know that I'm afraid immunology is a
complicated subject but that can convert a degree of protection and Catherine did
beautiful work in collaboration with a wonderful group in at Fudan University
in China during the age seven and nine incidents of several years back
examining the cell cell mediated immune response and showing that the capacity
to make rapid cellular immune responses which presumably indicates cross
reactivity cell memory well was broadly protective even in people who were
hospitalized those who had a lot of those cells did well those who didn't
did badly but there's a problem that a2 is though it's common in Caucasians it's
not common in our indigenous communities except of course where as is often the
case there has been crossbreeding so to speak between Europeans and and digits
people and but it's a lower lower levels in our indigenous communities we think
that could be one of the reasons indigenous communities are more
threatened by flu now I don't think we know about a lot about that yet with
covered 19 and the corona virus but that's one of the things that
Catherine's lab is working flat out on and there will be other similar labs
across the planet who are doing this as well well I think you also mentioned in
a like a sigh future talk that there was there has been a lot of our
technological progress and that's part of the reason why I've seen such great
progress in bayonne compact infections but what about intellectual progress and
we I think you were mentioning that there hasn't been as much intellectual
progress as this pain technological code is gonna be a problem moving forward
oh well it's what you made my intellectual progress oh it's fantastic
intellectual progress inside the community about the science it wouldn't
be a surprise to you if I say that very few of my American scientist scientific
comfort colleagues would have voted for Donald Trump which is who is a primary
symptom of major intellectual decline so intellectual progress it's not my field
I'm a lab scientist and I trained as a bitch but you know I I have written a
lot of books and things and I've talked with a lot of people over the years one
of the privileges of winning the Nobel prizes anyone talk to you no matter who
you are so so I've enjoyed some contact there
I think intellectual progress in the sense of the incredible technologies we
have that they're one of the things we've had since we've obviously become a
point of contact for the the covered 19 research in Australia there's a lot of
extraordinary interest and really intriguing offers from people who have
say various IP prep various communications data handling
resources that would normally be used commercially for various activities from
Van Coons that were but asking you know can my people help with this and of
course the data generation data data handling our epidemiologists that we've
been hearing so much about lately all depends on that massive computational
capacity our genetic analysis the sequencing of these viruses it's been
done for instance in the by Ben Hammonds group at the Daugherty Institute as is
giving us rapid sequence information on these viruses that allows us to track
lineages of viruses that's all that all depends on massive computational
capacity it depends on computing capacity and all
the rest of it so intellectual in the sense of the technology is extraordinary
intellectual in the sense of how we approach
these complex and difficult problems well that's another question I think
though many political leaders have done very well and stepped up to the plate
Justin Trudeau has been magnificent Dan Andrews our premier in Victoria's being
great Scott Morrison has done really well with this he's he's tried to he's
got on top of it and took him drinking a little while I mean it's unfamiliar
territory and these guys are very busy but he he got on top of it he's been
been putting out solid policy and doing all the right things on the particular
on the financial front that really needed to be done so it's been a straw
Denari in an intellectual sense to watch a a fairly right-wing government should
we say become essentially the the most socialistic government in our in our
history of recent times but I guess they won't maintain forever but I hope it
will cause a certain reset in the way we think about things I think I think this
neoliberal libertarian model which is is simply toxic I mean unfettered
capitalism without proper regulatory rules and without when income
distribution is simply toxic and I think we only maybe we're starting to realize
that we have to make sure that everybody in our society has some some sort of
roof over their head that they have some sort of income no matter how poor or out
or even psychologically dysfunctional they are we need to make sure that
everybody has basic needs and what we've seen in this latest situation is the
resources can be found to do that and I think it doesn't damage our economic
model in the long term to find those resources and maybe just give the rich
people a little bit less and and stop stop this this capitalist model which is
basically basically destroying society quite frankly and you can see it at most
obviously in the United States where in this particular form of intellectual
poison has been so prevalent and so there are great great people great
institutions great philanthropists great people of great wealth who are
doing an enormous amount that's good and you Bill Gates would be obvious of
Warren Buffett's another object these way not everyone may love Jeff but he's
been putting a lot of money up there as well
various people Andrew Forrest has been putting money out there maybe there's
some other ties there a bit but the money is out there and that's important
and so I think we need to do a rethink on how we run our society because
running a society on the basis that some people always have to be out of work and
suffering is pretty crap in any decent human beings mindset and that's the way
we've been running our society that some people always have to be out of work
otherwise there'll be a problem with labor I think we have to rethink these
things I'm talking way out of turn I'm a lab scientists economists but I saw a
generation that experienced the enormous return to society of what happened after
World War Two inside Britain and in Australia and it wasn't necessarily all
done by labour Prime Minister's there were liberals as well though who are
doing this but but the introduction of national health systems in Britain
Canada Australia essentially and and and also the the maintaining of a social
safety net we've been ripping that social safety
net as people are more and more challenged by automation globalization
and all the rest of it and maybe I think we now need to think maybe in some of
the terms of some sort of a minimum wage maybe we give it to everyone give
everyone a minimum wage take it back from the from the rich by having a 60%
tax rate on it look I could talk about ubi universal basic income and rights to
accommodation for a long time but I have taken a lot of your time Peter
so it really has been wonderful to talk to you about all this and so many topics
are being covered if there's any sort of concluding statements that you know you
can think of making yeah well my concluding statement would be
this this isn't the end of the world by any means I think people realize that
it's not going to wipe out humanity it's it's a it's a dangerous and deadly
disease but I think within a year for various reasons will be largely through
this but it may take that long we need a vaccine what we need though from people
everybody each and every one of us is responsible behavior and taking
guidelines I think the government guidelines that have been put out I've
been put on on the basis of a serious epidemiological modeling some of that's
just been released people complained because it was all modeling based on
northern hemisphere data book but you know that's the data we had we didn't
have enough data from Australia you can't model in a serious way without
having a data Stata sets and and that's where the data was coming from modeling
in Australia will come later as we progress with this so we'll get through
this it's not going to be a massive long term problem but we need highly
responsible behavior now watch what government is saying comply with what's
being said and and and by doing that you will protect people who are very
vulnerable including many disabled people and so forth and and you will
protect what's enormous ly important protect our frontline people supermarket
checkout operators our police our Anna bubble of course every every aspect of
our health care workforce from ambos and nurses to check-in people to to the to
the ICU doctors and nurses who are greatest risk thank you so much I
appreciate this so thank you for listening and watching and he liked the
channel please subscribe okay well thanks oh yeah yeah good luck with it