• Published on Sep 17, 2020

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: Hi, Everyone. I'm Dr. John Whyte, Chief Medical Officer at WebMD. And you're watching Coronavirus in Context.

Today, I'm joined by the president of the American Medical Association, Dr. Susan Bailey. Dr. Bailey, thanks for coming on today.

SUSAN BAILEY: Oh, it's my pleasure. Thanks for having me.

JOHN WHYTE: Let's start off, you're an allergist, immunologist. Perfect background to talk to us about the vaccine. What's going on?

We recently heard about a clinical hold. What's your thoughts on the timeline that everyone's talking about?

SUSAN BAILEY: Well, you know, the vaccine timeline, as everybody is aware because of Operation Warp Speed, has been greatly amplified. But no steps are being skipped. I think it's important for everyone to understand that all the manufacturers are going through the standards phase I, phase II, phase III processes. It's just that some of them have kind of overlapped a little bit.

And the federal government has subsidized the vaccine manufacturers. And so some of them are already actually making vaccine for the public before it's been approved, with the hopes of, you know, the phase III trials coming out OK. The, the--

JOHN WHYTE: Otherwise, they're going to have to throw it out. So--

SUSAN BAILEY: Exactly. Exactly. And so in a normal market in a situation, manufacturers would never take on that kind of financial risk. So that's why-- that's one of the reasons why it takes so long. But the-- the pause in the AstraZeneca Oxford vaccine for a patient that developed transverse myelitis, you know, it's sobering, because as we know transverse myelitis can either be a response to a viral infection or to an autoimmune reaction from a viral infection. And so there's a great deal of concern that that might, indeed, be vaccine related.

And the AstraZeneca vaccine is a viral vector vaccine, a Trojan horse vaccine, if you will, that brings in a spike protein-type particle for the body to develop an immune reaction to. Whereas the two others that are in phase III trials in the United States are actually mRNA vaccines. A totally different type of vaccine. Actually, it's a new technology that's really never been proven to be effective.

JOHN WHYTE: But from an immunology perspective, so let's say, you know, they're testing 30,000 people in phase III clinical trial. And say a transverse myelitis is one in 20,000, you know, one in 30,000. How concerned are you, though, about safety issues where we're going from 30,000 people to 300 million people? What's that timeline that we really need for post markets, you know, surveillance, from any immunology perspective. So how do we know?

SUSAN BAILEY: Well, really the only way you know is by getting it to more people. And the fact that there are multiple vaccines in various phases across the world that are all going on simultaneously, although, obviously, they can't really, you know, completely share phase III data. But at least we will have an accumulation of many more patient experiences with certain types of vaccines than in an individual trial of 30,000 patients.

So I'm hoping in the long run that will be very helpful to us in terms of kind of having some post marketing surveillance on steroids, because we've got so many different, you know, types of vaccines out there at the same time. But I think it just highlights the importance of not cutting corners, being extremely safe, and very aware of the fact that if this vaccine does not have the complete confidence of the physician community, we won't be able to get the confidence of our patients.

JOHN WHYTE: Well, talk about that. Because we need transparency. And drug development in general is not transparent by its very definition. And there's already misinformation out there. There's misinformation about other vaccines that people aren't taking that we know folks need.

We've seen it in HPV. We've even seen it in PNEUMOVAX. What's the role of physicians and physician leadership in being out there? You know, there is a lot of physicians on social media. But others will say you know what, I don't want to get in to that. And then other voices are amplified and heard.

So what's the AMA doing in terms of physician leadership, physician voices on topics like vaccination?

SUSAN BAILEY: The AMA is trying to be very proactive in developing physician leaders to-- to amplify the message of evidence and good science. We have what we call an Ambassador Program that physicians that are AMA members can sign up for and get intense education about AMA messages and ideas and thoughts that we want to get out. And-- but you've got to be established as a trusted source of information before anybody is going to trust you in the future.

So we, through the JAMA Network, their incredible body of work, and hopefully, you know, being a trusted agent for those to look to, that we can amplify that message. But you've got to-- it's got to be multi-pronged. You've got to do social media. You've got to do press releases. You got to do MMRs. Especially in this day when you can't have meetings, it's especially challenging.

JOHN WHYTE: Should we have more physicians on social media?

SUSAN BAILEY: I think we should. I think that it's, um, a great way to communicate with the public. And it is-- patients are craving good, honest, trustworthy information from their doctors. And I think not only is it a good way for us to communicate with each other, I think it's a good way to spread good science messages to-- to our patients.

JOHN WHYTE: Now, it's great to have an immunologist on because I've got a lot of questions.

SUSAN BAILEY: Oh, boy.

JOHN WHYTE: I want to ask you, antibody testing, what's the role of antibody testing? It's kind of gone through these cycles over the last, you know, six, seven months. Tell us the latest. What's Dr. Bailey's recommendation?

SUSAN BAILEY: Uh, my recommendation at this stage of the game is that antibody testing should still really only be utilized as part of an overall evaluation of a patient, not as a definite diagnostic point. It should be used to help determine whether a patient who's had COVID-19 is a candidate to donate convalescent plasma or for community surveillance. Since the antibody responses do seem to wane fairly quickly after acute infection, at least IGG, they're not breaking out various antibiotic classes, we may be looking at much more of a T-cell mediated immune response that is a little bit more challenging to measure.

JOHN WHYTE: Do you think there's reinfection possibility? Or is that pretty low?

SUSAN BAILEY: You know, I don't think we know that either. There's the case out of Hong Kong that's been reported. I have not seen any of the data about that. But it-- there-- there are so many hot spots in the country. People are not traveling around like they were at the beginning of the pandemic. If reinfection were a common thing, I would think that we would have seen a lot of it by now. And-- and I don't think we really have. So, um, I don't know. Don't know.

JOHN WHYTE: Instead of reinfection, let's talk about multiple infections. Let's talk about flu, influenza, and the importance of the flu vaccine. And talking about lots of misconceptions about the COVID vaccine that's not even here yet, we've got plenty of misperceptions about flu. And I'm sure you've heard it as I've heard it, you know, it gave me the flu last year, when we know it-- it hasn't. So what do listeners need to know about the flu vaccine this year?

SUSAN BAILEY: The flu vaccine, if you have-- if there's ever been a time when it has been more important, it's this year. There's going to be plenty of flu vaccine available. There aren't going to be any shortages. It's important for people-- we just have to reiterate this message over and over again. The flu vaccine does not have any live viral particles in it. That is unless you get the nasal spray. That's a different-- that's a different thing. But the flu shot cannot give you the flu.

If you feel bad after a flu shot, it may be just because of the immune response that you're getting to the shot-- and that's a good thing-- or you waited too long and caught the flu before your flu shot had a chance to kick in and it was just bad timing. So a flu vaccine is safe. The AMA wants everybody over the age of six months to get a flu vaccine this year. We just can't risk overwhelming our health care system this winter with a so-called "twindemic" flu and COVID at the same time.

JOHN WHYTE: Some people might get it at the same time.

SUSAN BAILEY: Oh, yeah--

JOHN WHYTE: So if people with flu keep coming to the hospital, people with COVID coming to the hospital, then perhaps people with both coming in. I want to get back to, you know, how quickly does the flu vaccine work post once you get your shot?

SUSAN BAILEY: Typically, within 14 days you people should be fairly well protected.

JOHN WHYTE: Because people don't always understand that. It's not like you get it, and boom, you know, you're protected right away.

SUSAN BAILEY: It's like putting on a coat of armor and you're immediately immune. It takes a while for it to kick in.

JOHN WHYTE: Right.

SUSAN BAILEY: I've gotten questions, no, the flu vaccine won't keep you from getting coronavirus. There's some people that don't understand that.

JOHN WHYTE: It's from viruses. Yeah.

SUSAN BAILEY: Yeah. When we do have a COVID vaccine available, I'm sure the two are going to be compatible. So you can get a flu vaccine and then get a coronavirus vaccine. And I would not be at all surprised in the future if we see combination flu, coronavirus vaccines that people get every year.

JOHN WHYTE: Let's talk about burnout. You heard it from many of your colleagues as well. The, you know, the response of being there every day, seeing death, seeing morbidity, taking care of patients, being on the front line. Physicians were burned out before COVID. We're having shortages still in some areas of PPE. What is the AMA doing about burnout?

SUSAN BAILEY: You're right, burnout has been a longstanding problem. And it's been on the AMA'S radar for a long time. Burnout is not a moral failing. Burnout is not a form of personal weakness. Burnout is a systems issue.

Burnout is the result of being asked to function in a medical world that is not there to help you do your best job, unfortunately. And that we need to help systems understand what policies and procedures and scheduling, and you have it, that they are utilizing that are contributing to burnout. There's some evidence that physicians in private practice have less burnout, possibly because they're making their own decisions and understand that-- why they're being made?

JOHN WHYTE: What keeps you up at night?

SUSAN BAILEY: What keeps me up at night? I worry about the physician population becoming not only burned out, but just becoming completely demoralized by the whole pandemic. The-- you know, in the beginning, we had Health Care Heroes. And you know, people were given physicians and other front line health care workers pats on the back for putting themselves in harm's way. And that's kind of been forgotten.

Public's memory of things like that, unfortunately, is very short. And one of the messages that I like to talk about when I talk to medical groups is that physicians really are heroes, and that it's just bred into us by the nature of our medical training, and that regardless of whether you feel like a hero or not, you are. And as a physician, we have a very special calling. And we still-- we will always have our patients, which is what gives us the most joy.

JOHN WHYTE: Well, Dr. Bailey I want to thank you for taking time today. I want to thank you for your insights. Thank you for your leadership of really helping try to improve the health care system for physicians or other providers, for patients.

SUSAN BAILEY: Happy to join you anytime. Thanks so much.

JOHN WHYTE: And thank you for watching Coronavirus in Context. I'm Dr. John Whyte.

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