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“As a species, we have been an abject failure in dealing with a worldwide crisis. We politicize things for money, political reasons and some kind of weird power, even when it kills us in the process. We already have a World Health Organization (WHO). Would it be so difficult to staff it with the best scientists from every country, without any political pressure and follow their recommendation worldwide, without local bureaucratic interference? The first vaccine approved by the WHO — no prizes for guessing — mRNA Pfizer.
Humans have a way of complicating life by breaking even common sense into silos guided by politics, power, hubris, and finance. We read history and shake our heads when we see some of the haunting tragedies of mankind. And yet, we continue making the same fundamental mistakes. To paraphrase, “The tragedies will continue; we just will have different entries and exits.””
Dinesh Arab is a cardiologist.
He shares his story and discusses his KevinMD article, “The vaccine rollout’s tragic dance.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and 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 on the show we have Dinesh Arab. He is an interventional cardiologist, and he wrote the KevinMD article “The vaccine rollout’s tragic dance.” Dinesh, welcome to the show.
Dinesh Arab: Thank you, Kevin. Thanks for having me. This was an article that I felt very strongly about, and I actually wrote it and submitted it. I blog regularly, and I submitted it to my editor in India, and he said that it was too political to run. So I tried your blog, and so thank you for accepting it, and thank you for publishing it.
Kevin Pho: And we’ll talk about that article in a little bit, but first off, can you share your story and journey to where you are today?
Dinesh Arab: Sure, Kevin. So I’m an interventional cardiologist now. I was born in India, I grew up in India, and I went and did my medical schooling in India. And then I went to the U.K. and did my training in emergency medicine there, then came to the University of Buffalo, did my internal medicine and general cardiology, then went to Loyola in Chicago and did my interventional cardiology there, and then moved down to Daytona Beach. And I’m an interventional and a structural cardiologist here, part of a group, and I do like to write, and that’s what I do part time.
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Kevin Pho: Now, over the past year and a half of the pandemic, tell me how that’s changed what you’re seeing in your cardiology patients.
Dinesh Arab: I’ve been covering the pandemic since it broke. It’s something that is of great interest. I’m an internist at heart as well, as you can see. And it went from being just a viral disease, something akin to the flu, to a disease that was causing ARDS, to a disease that became an immune response, to a disease that was attacking the vascular endothelium, and those were the patients at risk. So it went through the whole spectrum, from an infectious disease to a cardiovascular problem to an immune problem, and it was fascinating to cover the whole thing.
Kevin Pho: All right, so let’s go into the KevinMD article that you wrote. This was back in May. It’s titled “The vaccine rollout’s tragic dance.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?
Dinesh Arab: Yeah, so like I said earlier, I was covering this pandemic since it broke, and I’ve been writing for the local paper, columns in real time as things happened, from when the disease hit, to how the vaccine race started and the different types of vaccine platforms, to when the vaccines were released. So once the vaccine platforms came out and we saw the efficacious results, the mRNAs were the clear winners, with 90 to 95 percent efficacy, as opposed to the DNA-based and the inactivated viral platforms. I was happy that we all, as a country, got it. We were health care providers; we were first in line, and it was very reassuring.
And my folks still live in India. I kept calling them, and I said, “Hey, when are you guys going to be getting your vaccines?” And they said, well, this stuff is not available there; even if you want to pay for it, you can’t get it. And that led me to do some investigation as to why that was the case. And I did find that, even though vaccines were developed at rapid speed, different countries, due to different political agendas, approved certain platforms because they were part of that platform manufacturing process, and not approving things because they were efficacious. So it’s essentially the politicization of medicine, if you may. And we’re seeing that play out now, because even in the United States, the AstraZeneca vaccine isn’t approved in the United States, and I believe in other countries, some of the mRNA platforms still aren’t approved.
Kevin Pho: So go into more detail about how that politicization, how that inconsistency in the approval process, how has that affected the vaccine rollout specifically?
Dinesh Arab: I think in the U.S., I keep saying, we are the lucky bunch. The mRNA technology was predominantly a U.S.-based rollout. The companies are predominantly U.S.-based, both Moderna and, even though BioNTech is European, they teamed up with Pfizer. So the majority of us, I think, have got the mRNA vaccines, with a few percent getting the J&J.
If you look at India, the situation is a whole lot different. Actually, when Pfizer got approved by the WHO, they approached India in December, and the Indian authorities actually told them, “Listen, you got to do local trials for us to approve you,” which was not a palatable thing for Pfizer at that point. So they actually withdrew, and India actually approved an indigenous vaccine, which is called Covaxin, which is an inactivated virus platform, while it was still in trials. It was still, I think, just entering phase 3 trials when they approved it. And I think Russia did the same thing with Sputnik. They approved the vaccine when they were in trials and declined vaccines with published data, so that was a whole bit of an oxymoron.
If you look at the WHO, at that time only the mRNA vaccines were approved. But across the world, the rollout has been pretty much whatever the local political situation is. And to a doctor, it’s very confusing as to why something that works can’t be rolled out across distribution platforms.
Kevin Pho: Now, what are some of the reasons for that? Like, why is it that some regulatory agencies in some countries approve certain vaccines, whereas others in other countries don’t? Is it just pure politics? Do they have different approval methods? Do they have different bars that need to be set? Now, what are some of the reasons why different countries have different approval schedules?
Dinesh Arab: It’s a little bit of speculation on my part, but I think it’s a little bit of all of those, and I think it’s a little bit of a financial situation as well. And it’s the old adage: If it isn’t about the money, it’s all about the money. And I think that when countries invest a lot in a certain system, if you look at the three big countries that did not approve mRNA platforms, they were Russia, China, and India, which have all been making indigenous vaccines. And so they approved their own vaccines, and for good reason. They didn’t want the American technology into those systems.
When the situation changed, though, they’re changing now, because it’s a scale of things that sometimes are spiraling out of control. So they’re reaching back and saying, “No, no.” Now India has come back, and actually, as we speak, they’re having all sorts of talks with Pfizer. And the same reasons that they gave back in December to reject Pfizer, saying you need to do a local trial, they say, well, maybe you don’t need to do a local trial now. And then there was something about indemnity, which they’re taking up with Pfizer. So I think it’s changing now, but it’s come at a cost, a human cost and human life.
My own family over there, as a physician, obviously I would have liked them to get an mRNA vaccine. I get the point: If vaccines are not available, then yes, you take what you can get. I get that point. At some point, there was a bigger need than vaccines could be made. But now, with everybody firing on all cylinders, I really think countries should be able to get the vaccines that they need. And that comes to the other part, about the intellectual property, which people are asking to waive, and that’s another story altogether.
Kevin Pho: So we’re speaking now at the beginning of June, and I want to ask you, where do we go from here? I just read an article, I believe in the Washington Post, that right now we’re going to evolve into a world of haves and have-nots, where only the proverbial rich countries are going to be immunized, and then there are going to be poor countries who are still struggling to receive the vaccine. Now, where do we go from here, in your opinion?
Dinesh Arab: I think there’s a little bit of both. I think there are rich countries, and then I think that there are the middle level of countries, and then I think the real poor spectrum, it’s like any population or any society that cannot afford anything at all. I think for the rich, it’s not a problem. I mean, if you look at the U.S., we have close to over 50 percent vaccinated already. Same thing with Europe; they’re going along pretty well. If you look at Africa, I think they’re pretty much left behind, and I think with AIDS there and COVID hitting, that’s going to be a bit of a disaster if we don’t step in and help them out, because they cannot afford these levels of these vaccines.
And then there’s the whole bunch of middle-level countries right now. I mean, it’s India, Brazil, the United Arab Emirates, the whole Middle East. These countries are affluent. It’s not like they can’t afford a vaccine; it’s just the politics of it. And I think waiving the intellectual property of the U.S. just for that, if we couldn’t produce enough, yes, but if you can produce enough and you have the means to pay for it, I think you should. And yes, for the ones who, I think the same thing happened in Africa with the HIV drugs. There was a legal battle, and I think the drug companies lost, and so they were able to make generic drugs. It comes to a whole other thing as to who’s going to police, and the quality regulation of all this new technology, with this waiver of patents. But that’s a different story altogether.
Kevin Pho: We’re talking to Dinesh Arab. He is a cardiologist, and he wrote the KevinMD article “The vaccine rollout’s tragic dance.” Dinesh, what is your take-home message that you want to leave with the KevinMD audience?
Dinesh Arab: Well, my take-home message is that we are physicians, and we are doctors, and we should practice medicine without looking into the politics of medicine. And if you look at that, that’s how we normally practice medicine on a routine basis. We look at therapy A, we look at therapy B, and if therapy A is better, we go with therapy A. The COVID pandemic was a little different because, yes, therapy A was better, but there was not enough of therapy A. So yes, we did therapy B and therapy C. But as things come back to steam and come back to real time, I think we should go back to just practicing medicine as if this is the best treatment; that’s what our patients should get.
Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.
Dinesh Arab: Thank you, Kevin. Thanks for having me.
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