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This article is sponsored by Novavax.
In this special sponsored episode. I’m joined by Dr. Filip Dubovsky, chief medical officer at Novavax, to discuss topics like COVID-19 and influenza in the fall and winter seasons, the importance of education to understand your vaccine options while given the freedom to make that choice, navigating misinformation, and mistrust, what’s next as a society and the details in between.
Through human evolution, we know that prevention is better than treatment, so how do we explain that only about 68 percent of the American population has received their primary COVID-19 vaccine series? Additionally, although booster shots have been available to all adults for nearly a year, and many may be eligible for a second booster, less than 50 percent of people over the age of five in the U.S. have received their first booster dose.
The current influenza and COVID-19 landscape
“Our health organizations have known for decades that vaccination is the best protection against influenza,” says Dr. Dubovsky. “And we’ve learned over the past two and a half years that vaccination against COVID-19 is critical.”
In the fall and winter seasons, experts are anticipating a COVID-19 surge similar to what we saw last year, and we know best as a community never to bet against a virus. This surge will likely overlap with the influenza season, which is expected to escalate based on this year’s Australian flu season.
Recently, we’ve seen spikes in COVID-19 cases and hospitalizations globally. Thankfully, we have vaccine options with multiple technology platforms, including the three main types of COVID-19 vaccines available in the U.S.: mRNA, protein-based, and viral vector.
Receiving an annual flu shot and staying up to date with COVID-19 vaccines, which include boosters, are essential to help with protection. The convergence of COVID-19 and flu can exacerbate the negative effects of both diseases, as people with flu and COVID-19 at the same time can have more severe disease than people with either flu or COVID-19 alone.
The importance of vaccine options
From the start of the COVID-19 pandemic, our world’s technology has evolved in terms of available vaccines. There are now COVID-19 vaccine options, including vaccines that use traditional vaccine technology, which have already been used to help prevent other infectious diseases. COVID-19 vaccine options may help decrease vaccine hesitancy by giving people the freedom to choose the best option for them. Additionally, diverse racial and ethnic representation in COVID-19 vaccine trials is important to reflect our diverse populations and determine the vaccines that benefit each population or region the most. Having multiple vaccine options may reduce the risk of shortages when vaccines are needed most and offers people flexibility in their immunization choices.
Public health experts and doctors should continue to educate people about their COVID-19 vaccine options. With continued public education and awareness about the safety and efficacy of the various vaccine options, more trust may be built in our communities in vaccine options and, therefore, confidence in vaccine options.
People should talk to their doctor about what is right for them. Individuals may be able to get a COVID-19 vaccine and a flu vaccine during the same visit if they are eligible.
Navigating misinformation: Prevention is better than having to receive treatment, and vaccines are intended to help prevent people from falling seriously ill and potentially dying. Unfortunately, vaccine hesitancy has contributed to the emergence of new variants and ongoing waves of infection.
Misinformation and misunderstanding of vaccines have increased since the beginning of the COVID-19 pandemic, and the data and guidelines around the virus are constantly evolving. This highlights the need to share accurate information about COVID-19 vaccines, respond to gaps in information, and confront misinformation with evidence.
Where do we go from here? Globally, we need to continue to emphasize the importance of getting vaccinated in the effort to transition from a pandemic to an endemic phase. This won’t be the last pandemic the world will see, but if everyone does their part to focus on the public health need for prevention and protection, vaccination can potentially lessen the impact of disease.
Lastly, we must underscore the importance of staying up to date on vaccinations, especially in the fall and winter as COVID-19 and flu season converge. Different vaccine options are available at this point in the pandemic, so people should be encouraged to have conversations with their doctors or pharmacists to determine what’s right for them.
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Transcript
Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we have a special sponsored episode. I’m joined by Dr. Filip Dubovsky. He’s an infectious disease physician, executive vice president, and chief medical officer, responsible for medical and clinical affairs and related activities at Novavax, a recognized leader in vaccine development. Dr. Dubovsky brings more than 20 years of infectious disease experience to Novavax. Filip, welcome to the show.
Filip Dubovsky: Thank you very much.
Kevin Pho: Just briefly introduce yourself and share your story and journey to where you are today.
Filip Dubovsky: Right. So I’m a pediatrician, and even when I was training in pediatrics, I knew that my career was going to be in vaccines. I was the guy who volunteered on weekends to be in the vaccine van, rolling into areas of East Palo Alto to vaccinate the indigent there. After my training as a pediatrician, I went on to do pediatric infectious disease at the Center for Vaccine Development at the University of Maryland. After that, I went across town to Johns Hopkins, where I got a master’s in public health and did a preventive medicine residency.
It was at the very end of that training, when I was doing an externship at the NIH, that my boss asked me what I thought about malaria vaccines. I told her, “Well, you know, that’s impossible. You can’t really do that.” She challenged me to go read about it, so I did. I read the literature, and I said, “OK, you know, I think there are some leads here. There’s some stuff we can do.” And she said, “Great, because I just got a Gates Foundation grant.” So we both quit our jobs, set up some coffee tables in our basement, and started a nonprofit. Over the next five or six years, we were very successful in raising more money and doing a lot of really great work. We eventually joined PATH, which is a large international NGO, and we developed more than 25 vaccine candidates and took a little more than a dozen into the clinic.
After I did that, I knew that to further train in developing vaccines, I had to join the commercial sector, the private sector, because that’s where vaccines are developed. I ended up joining MedImmune, AstraZeneca, and about two and a half years ago, I came here to Novavax.
Kevin Pho: All right. For the majority of this interview, we’re going to talk about a COVID and vaccine update. We are talking in the middle of the fall. In terms of COVID and the flu, what are experts anticipating this fall, and why is getting vaccinated for both COVID and the flu so important?
Filip Dubovsky: Right. So the public health sector has known for decades that the best protection against influenza is vaccination. It’s really the only way to go. And we’ve learned over the past two and a half years that vaccination against COVID is critical. It keeps people from dying, it keeps you from going to the hospital, and it keeps you from getting sick, and that’s really the goal.
As we know, the fall is when flu comes out, and that’s also when we are anticipating a spike in COVID. You know, we’re already seeing this, right? We’re seeing this in Europe, which is a little bit ahead of us, and we’re seeing this in the Far East. There are some pretty stark statistics coming out of Europe. In the U.K., the hospitalization rates increased by 45 percent over a week, and that’s attributed to COVID. So I think we’re looking at a pretty rough season. Whether we see flu and COVID at exactly the same time, no one really knows, because that hasn’t necessarily been the pattern over the past two years.
Kevin Pho: After a few months of the pandemic, we’ve had a few different types of vaccines. Why is it so important to have more vaccine options for COVID and flu?
Filip Dubovsky: Yeah, you know, the main reason is to drive use. If you give people a choice about the products, they’re more likely to take one than not, and that means the entire endeavor of trying to increase vaccination rates is on the upswing. That’s really what we as a medical and public health society are trying to do: get the vaccination rate as high as possible to keep people from getting sick.
Kevin Pho: As we speak now in the fall of 2022, in general, what is the vaccine uptake in the United States?
Filip Dubovsky: People are tired of the pandemic. Their behavior has changed. They’re no longer masking, they’re congregating now, but they’re also not being vaccinated, and it’s that lack of fear that is really leading to decreased vaccination rates. I think, depending on what we see in the fall upswing, we may start seeing increased vaccination. My hope is that people get vaccinated before the upswing, because that would allow them to be protected, obviously.
Kevin Pho: So do you think informing the public about these different vaccine options will increase the adoption of vaccines and boosters?
Filip Dubovsky: I mean, we hope so, and we have some data to support that. We know that in countries where vaccines are available side by side on an even playing field, people choose the various kinds, and they choose them for primary vaccination as well as for boosters. So I think giving people a choice to increase vaccination rates is a reasonable goal. It really allows them to look at the benefits and risks of each of the products, discuss them with their physicians and public health advisors, and make rational choices about what they choose to be vaccinated with.
Kevin Pho: So can you help us understand the differences in the vaccine technologies that are currently available for COVID today?
Filip Dubovsky: Yeah, there are really two technologies that are currently available in the U.S. and have broad use. One of them is the mRNA technology, and the other one is a recombinant protein technology. mRNA technology delivers the genetic message directly to the body, where it goes into the cells, and it makes your body into a little vaccine factory. In fact, the cells express the spike antigen on their surface, and you generate an immune response against that.
The other technology is recombinant protein technology with adjuvants. That’s a technology that’s been around for decades. What you do there is, in a factory, you actually make the outside spike protein of the virus in the proper three-dimensional conformation, and then you deliver it into the body with that adjuvant, which boosts the immune system against it. The benefit-risk is positive for both of these products, but they are different, and different people may look at the various aspects of these and make choices about what they choose to be vaccinated with.
Kevin Pho: As a physician and researcher, what is your perspective on how the public has responded to the push for COVID-19 vaccination, and why do you think that is?
Filip Dubovsky: Yeah, it’s really interesting. When we look back to the early days, people were frantic to be vaccinated. There were long lines when the first vaccines came out. There was a group of people who thought that things were moving a bit too fast, right? They elected not to be vaccinated; they were called vaccine hesitant. There are many reasons people choose not to be vaccinated. It could be a personal choice of having the liberty and freedom to do as they choose with their bodies, it could be fear, and it could be just a lack of belief in science and technology, or other things.
That has really been compounded by the fact that people are no longer scared. Everyone knows someone who’s had COVID recently, and it seems like it might just be a bad case of the flu, perhaps. But I think that’s a misperception. People are still getting very sick, and they’re dying. Now we know that you can get long COVID even if you have mild disease, and even if you don’t get long COVID, there’s this whole host of sequelae, medical sequelae, that can happen after you’re infected, and that hang on for a while after you clear the infection. So with the hope of preventing all of those, as well as the hope of preventing transmission to your friends and loved ones and of preventing you from being a place where new variants can emerge, I think vaccination is key.
Kevin Pho: So let’s say I’m in the exam room, and I’m talking to a patient who’s a little bit hesitant about getting a booster because of some of the reasons that you mentioned, that there’s this lack of fear. You mentioned some of the sequelae and long COVID symptoms. I think I just saw an article in the newspaper recently talking about long COVID. Tell me some of the messages I can communicate to that patient regarding long COVID and the other sequelae that are associated with COVID currently.
Filip Dubovsky: Yeah, I think one of the key messages is that you can get sequelae. Sometimes it’s unclear to people. They think, “I have to get really sick before I can get either sequelae or long COVID,” and that’s just not factual. There’s now a lot of literature that helps us understand that these things do happen. So even if you don’t get very sick, you still could get sick in the long term. And the best protection against either immediate illness, which can still lead to hospitalization and death, or the sequelae is vaccination.
Kevin Pho: In terms of sequelae, what specifically should patients be worried about, and what kinds of specific long-term, long COVID symptoms are we seeing currently?
Filip Dubovsky: Yeah, I mean, listen, it’s protean. It is very broad; it’s almost anything, and it’s really hard to dissect out. But what we’re seeing is a lot of cardiovascular, and we’re seeing things around diabetes. Really, though, you name an organ, and people have attributed some long-term side effects to COVID. We know that the virus can impact many organs of the body, so we will follow that as well.
Kevin Pho: Has the adoption of COVID-19 vaccines and boosters changed the way the public views vaccines in general?
Filip Dubovsky: People were debating in the early days, lay people, whether they wanted a viral vector vaccine or mRNA, or to wait for a recombinant protein, just based on the education they were getting themselves from the internet, from news sources, and from the public health experts. You know, there was a real lively debate happening out there among people. So I think people understand a bit more. They also misunderstand a lot. There’s a lot of misinformation out there, and it’s still out there now, about both the benefits and risks of vaccines. So I think that’s one of the major differences.
Now people are more sophisticated. They think they understand a bit more of what the territory looks like, and that leads them to have choices in what they want to be vaccinated with. My guess is it’s going to spread to other vaccines as well. When you think about flu vaccines, there’s also a broad range of technologies there, and people can make choices about which vaccine they receive.
Kevin Pho: Now, you mentioned misinformation, and as a physician who is on social media a lot, that’s something I try my best to combat. There’s so much medical misinformation out there. Now, you work for a vaccine technology company. What’s most frustrating to you when you see all that misinformation about vaccines out there? What in particular is most frustrating for you?
Filip Dubovsky: You know, what really frustrates me is this belief that vaccine companies are really out either to do harm or to do nothing but make a buck, and that’s just not the way it works. If people were truly interested only in financial gain, they wouldn’t be making vaccines at all. That’s not really a very lucrative line of business. The people who make vaccines are people who are trying to prevent people from getting sick and dying. That’s what I’ve been pursuing my entire career: different ways to keep people from being ill. Prevention is obviously better than treatment, and that’s what we all work for. I come to work every day at a vaccine technology company, and I feel like I come to work every day on public health.
Kevin Pho: Do you have any advice or tips on how physicians like myself can help clear up any type of misinformation surrounding COVID and vaccines, in the exam room, on social media, or in mainstream media, for that matter?
Filip Dubovsky: Yeah, so I think there’s a group of people who will maintain their mistrust no matter what, and arguing with facts and science is unlikely to sway the needle. We saw this back in the anti-smoking campaigns, where people brought rational arguments about disease prevention to the argument, and it didn’t work at all. But when you started talking about how it made your teeth yellow or made you stink, then people started to accept that, or allow that to sway them. So there’s a certain number of people for whom, no matter how you argue the science, it isn’t going to work.
There’s an emotional appeal you can make. When I talk to people who have chosen not to be vaccinated, I point out the fact that I have been, and my family has been. We’ve been vaccinated very aggressively because we don’t want to be sick, we don’t want to spread COVID to our family and loved ones, and we don’t want to be the person who breeds the next variant that can cause a lot of harm. So perhaps that could be helpful, a little personal touch. And, you know, leading by example is always a decent thing to do.
Kevin Pho: Now, one of the things that I’m noticing, and perhaps you’ve noticed too, is that there’s an increasing amount of distrust of medical authorities out there. I’m seeing it all the time in my exam room, where patients sometimes question the advice that I give them. They question the advice from, say, the CDC or other public health officials. What’s your take on that? What’s your comment on this increasing public distrust of medical institutions?
Filip Dubovsky: Yeah, so some of it is the vast collection of medical information. You can go to your favorite search engine and get a whole host of things that make you feel like you’re an expert, including misinformation that’s available on there. So I think that’s one aspect of it.
Living through this COVID thing, you know, the messages that came out from the public health authorities globally were confusing and mixed, and that’s because we started off knowing almost nothing. We knew nothing about the virus: how it behaved, who could be infected, how to prevent it. That’s how science works, right? You come in not knowing, and as you learn more, you change what you think to be the truth. So naturally, the messages are going to change across two and a half years of learning about COVID, and I think some of that may play into it. You hear this, at least I hear it: “Well, you know, last week you said not to wear my mask, and you were saying to wear masks, and now we don’t need to wear masks anymore.” So the evolution of science is being misperceived, I believe, as a lack of knowledge, and those are two very different things.
Kevin Pho: Today we have a special sponsored episode. I’m joined by Dr. Filip Dubovsky. He’s an infectious disease physician, executive vice president, and chief medical officer, responsible for medical and clinical affairs and related activities at Novavax. Filip, do you think the pandemic is over? And if so, why continue to get vaccinated as we go from pandemic to endemic?
Filip Dubovsky: So we are going to eventually get into the endemic phase, where we have disease without these horrible spikes, but a couple of points. We’re not there yet. The other point, I think, is you should never bet against the virus. I’ve spent about 20 years trying to guess what’s going to happen with influenza, season on season, and I’m always wrong. It’s not just me; everyone’s always wrong. The point is that there’s incredible evolutionary pressure for the virus to find a way to keep replicating. As vaccines come into play and as people become immune, you’re going to get escape variants, and these are the things that cause the next wave. That’s why there’s this race to try to get on top of that with different vaccine technologies, either those that need to be updated to the new variants, or those that are more universal and appear to impact the variants without being updated.
Kevin Pho: Now, a lot of people look to our last pandemic in the early 1900s for clues going forward. Looking at some historical context, is there anything that we can learn from that past pandemic that could predict the course of COVID going forward?
Filip Dubovsky: Yeah, I mean, that was a different virus, obviously, with different kinds of features. Another flu pandemic, back in 2009, you know, was much less severe, and that taught us a bit about how to respond. My guess is that based on how we responded to the 2009 pandemic, we were able to rapidly respond to this pandemic. What you saw here over the past two and a half years is something that’s never been done before: In that time frame, you’ve seen multiple really good vaccines being developed and deployed. It normally takes 10-plus years to develop a vaccine. It’s a long and laborious process, and what we’ve shown is that with proper preparation and with proper resources, you can really accelerate the entire endeavor. You know, this has been really lifesaving for a large fraction of people globally, and it shows that when we as a humanity pull together, we can get great things done.
Kevin Pho: What are some of the lessons that we could learn from the COVID-19 experience?
Filip Dubovsky: Well, I think the last one that I just mentioned is a big one. You know, this won’t be the last pandemic. They come at unpredictable time gaps. This one isn’t done yet, and until all the variants kind of calm down and we get into more of a steady state, we really won’t be out of a pandemic situation. But if we all pull together, if we focus on the public health need and deploy our resources against that, we can really do a lot of good.
I think the other thing we learned is that people really did not respond very well to the pandemic. They didn’t respond well to having to be at home. The social isolation was profound, and the economic impact was very large. The social isolation was especially profound on our children and teenagers, where there was, you know, a lot of mental illness as their daily lives were disrupted, and that’s still ongoing as far as I can tell. So I think all of those are features, and it’s one of the reasons that we really want to be able to be prepared for the next one.
Kevin Pho: What more can health care clinicians do to help educate their patients about the importance of vaccination?
Filip Dubovsky: Yeah, I think to remind people that, you know, vaccination is a well-understood technology in health care prevention systems. We’ve been using these for decades. Think about childhood vaccinations and the lifesaving benefits those have provided humanity. And this is just another vaccine. It’s a vaccine against a respiratory virus, and we’ve already been vaccinated against multiple respiratory viruses. So this is just the next vaccine that we’ve had to develop to protect ourselves against disease.
Kevin Pho: Now, looking into your proverbial crystal ball, what do you anticipate the next year or two will bring?
Filip Dubovsky: Yeah, so we’ve seen this interesting pattern in some places globally where, when we see a lot of COVID, we don’t see much flu, but when COVID starts coming back down from its peaks, the influenza flares up. So I think we’re still going to have some unstable influenza and COVID transmission, which is going to be tricky for us to manage as far as getting the vaccinations right, and the same with the booster doses.
But eventually, I think people are so fatigued with COVID and the frequent boosting that we’re going to get to an annual cycle, much like we do with flu. What we’re thinking is going to happen is that we’re looking toward annual vaccination, with either a combination COVID-flu product, or one jab of COVID on the right side and flu on the left side, or vice versa, probably in the fall season, because that’s when people crowd together, and that’s when flu has classically had its biggest impact. It just makes sense to be able to vaccinate against two diseases in a single health care visit, whether it be at your pharmacy or at your physician’s office.
Kevin Pho: And my final question: What are some of the take-home messages that you want to leave with the KevinMD audience?
Filip Dubovsky: Yeah, so, you know, I’m a big believer in vaccination and vaccine technology, and prevention is obviously the right thing to do for any disease, and that includes COVID. I think we should all strive to find ways to get the message out there that people should follow the recommendations and be vaccinated and should be boosted. My children are vaccinated. I think children should be vaccinated. Even if you aren’t scared of severe disease and death, it’s no fun being sick, nor is it fun to be the person who transmits the virus to someone else, and these can all be prevented to some degree by vaccination. So go out there.
Kevin Pho: Filip, thank you so much for spending time with us and sharing your time and insight.
Filip Dubovsky: Thank you. It’s been a pleasure.
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