Politics with Michelle Grattan: Nobel Laureate Professor Peter Doherty on the coronavirus crisis and the timeline for a vaccine

Politics with Michelle Grattan: Nobel Laureate Professor Peter Doherty on the coronavirus crisis and the timeline for a vaccine.

The coronavirus SARS-CoV-2, which causes the disease COVID-19, has infected nearly half a million people and taken the lives of more than 21,200.

No person in Australia is more qualified to speak on the science of this global pandemic than Professor Peter Doherty. Professor Doherty was awarded the Nobel prize for medicine in 1996 for his work studying the immune system. The Doherty Institute, now at the forefront of Australian research on the coronavirus, bears his name.

In this episode of Politics with Michelle Grattan, Professor Doherty discusses the particulars of the pandemic - including how controlling this pandemic differs from that of other illnesses:

“It’s a problem of dealing with a respiratory infection,” he said.

“It’s different from, say, AIDS. We can all modify the way we behave in the sexual sense, but we can’t decide not to breathe. And so it’s very important that we keep that social distancing right at the front of our mind. In fact, one of the best pieces of advice I’ve seen is, think [as if] you’ve already got it and you don’t want to transmit it to anybody else. And if you think like that, you’ll protect yourself. ”

Scientists from The Doherty Institute were the first to successfully grow the 2019 novel coronavirus (COVID-19) from a patient sample. According to Professor Doherty, a COVID-19 vaccine could be available within 12 to 18 months.

“There are a few new concerns from experiments with the earlier SARS and MERS viruses in lab animals…that some vaccine formulations could give you what we call a bit of immunopathology, and even make the disease worse,” he said.

“So we have to be careful with the vaccine. But there’s also good evidence that a safe SARS vaccine worked well in monkeys. Targeting the same protein, the first COVID-19 vaccine product from the University of Queensland has already gone into lab animals.”

Listen to the full podcast for more from Professor Doherty, including how his research and institution is furthering the vaccination effort, how the virus affects the body and the future of the crisis.

Transcript (edited for clarity)

Michelle Grattan: Experts have been much quoted in the coronavirus crisis, but no one has better qualifications on this subject than Peter Doherty. His research on the immune system won him the Nobel Prize for medicine in 1996, and he’s authored a book titled Pandemics: What Everyone Needs to Know. The highly respected Doherty Institute is named in his honour and he is its patron. The institute is where much of the vital Australian research on the virus is being done. Peter Doherty joins us today from his home in Melbourne. Please forgive the audio not being ideal from a home telephone.

Peter Doherty, just before we drill down into the detail, let me ask you, what does everyone need to know about a pandemic? What would be your most urgent messages?

Peter Doherty: With the pandemic the necessity is to listen to what’s being said by the relevant authorities, the public health people, and in this case, who is seeing a lot of that articulated by the prime minister, the chief medical officer, and state premiers and their representatives as well. So listen to what’s being said. Take notice and follow the instructions. MG: Mind you, one of the features I speak of, what’s been going on is that not all the authorities are on the same page. There is a difference, including among the experts, isn’t there?

PD: There’s differences of opinion re some of the policy issues. I don’t think there’s much difference of opinion or much difference space anywhere between the various scientists and so forth. But policy, of course is a much more difficult issue and I do I don’t interface with that. But it’s way above my paygrade ‘policy’, I’m just a lab rat. So really there has been some confusion in messaging early on. I think that’s gradually come together because there is now a sort of national medical committee on this chaired by the prime minister. And we are a federal system and we’re all familiar with the idea that we get different messages from different states in Australia. But I think basically everyone’s much on the same page. It’s just a bit of the details might differ. But everyone is advocating, social distancing and responsible behaviour. And that’s the really important thing.

MG: Now, in this pandemic, don’t we know especially about the transmission of the virus, the infection, the mutation?

PD: We are learning very quickly, Michelle. You know, we’ve only known about this virus for at most four months. And what we’re learning is a lot about how it transmits and how readily it transmits. The initial idea is transmitted about the same level as influenza. It seems to be transmitting at a higher level and that, if anything, we give it an r-nought. That’s the number of people who are likely to be infected by any single person around two-point-five to three. And of course, people are really crowded together. One person can infect many, many more than that. And we all know the stories about the dinner party of 12 where one was positive when they arrived and all 12 were positive by the time they left.

MG: Say nothing of the wedding where I think some 36 people or thereabouts were infected.

PD: Yes. Yes. It’s the problem of dealing with a respiratory infection. You know, it’s different from, say, AIDS. We can all modify the way we behave in the sexual sense, but we can’t decide not to breathe. And so it’s very important that we keep that social distancing right at the front of our mind. In fact, one of the best pieces of advice I’ve seen is - think as though you’ve already got it and you don’t want to transmit it to anybody else. And if you think like that, you’ll protect yourself.

MG: Is it this high rate of infection that makes it a pandemic?

PD: Yes. Yes. Because it’s spread globally. We didn’t have a pandemic with SARS, the initial one , the very similar virus, but more lethal, that came up in 2002, 2003, because it just didn’t spread as effectively as this one. This one’s spreads really fast. And that’s why it’s got to a lot of countries. It’s now in one hundred and ninety six countries. The only place that SARS, the original SARS went out, of Asia, was to Toronto. And so this is an incredibly infectious virus that very readily spread by travellers and so forth. And that’s what makes it a pandemic. A pandemic means across the planet, of course. So all the people and all people are at risk here.

MG: I think we haven’t heard a lot about what’s happening in Africa. We’ve heard more about Europe and Asia. What’s the story in Africa? And when it really gets going it presumably could be particularly bad, you’d think.

PD: Absolutely. It will be terrible because you’ve got a lot of people in Africa with what we call co-morbidities, other medical problems, due to a variety of things. And what we think is that, what we know, is that if you don’t have a strong public health system and sophisticated science, you won’t be testing very extensively for it. We’re familiar with that because we’re getting calls from all over the Pacific region, and local region, to help them set up testing. But it will never be the case that there’s extensive testing in many of those communities, they just don’t have the infrastructure. So that’s one of the reasons I argued in that pandemics book that you mentioned, that basically it’s very, very important to maintain the infrastructure. So we don’t really know, but we’re pretty certain that this virus is in just about every country and without any real capacity for monitoring, the only thing they can do to try and protect themselves is social distancing.

MG: Just on this question of testing, we hear the numbers are ramping up. But surely as this spreads, you’re going to need round after round of testing, because if someone tests negative today, it doesn’t mean that he or she will be negative in a month’s time, does it?

PD: No, the main point of the testing at this stage is, I think, well, firstly to monitor the infection, but also to identify people who are definitely clinical cases of this. Now, basically, the testing we’re doing is all for the presence of virus. That is what’s called a PCR test. This is very similar to the tests that used to identify rapists. Basically, it identifies a genetic sequence and identifies that the individual has in there nose and throat, the genetic sequence of the virus, which means they’re infected. That means that we’re only detecting people with current infection. We’re not detecting people who might have been infected and recovered. For that, we need a screening antibody test to detect the footprint of an infection. That is the antibodies that have developed as their infection goes on and will now be protective. So we ask about background incidence at this stage. The Chinese are ahead of us on that. And I can talk about that if you want me to.

MG: Well, tell us. Yes. About the Chinese.

PD: Well, while the Chinese were initially reporting from Wuhan from the massive outbreak that they got onto so dramatically that they were seeing a 2.5 per cent death rate. Now, that’s pretty terrifying because the death rate for the normal influenza is about nought point one per cent. Okay. So we’re talking about twenty-five times as many people dying. Now, what wasn’t understood right at the beginning and what they, because they were so obsessed with identifying the likely transmitters and clinical cases, is that actually is a lot of really asymptomatic or completely asymptomatic infection in people who can also be carriers. And once they were able to get those figures, their estimate of the death rate has dropped from 2.5 percent to 1.4 per cent. So that’s that’s good. I mean, it means that, see, the death rate go down is good. They were initially reporting that the death rate in people from, in their 80s or something like 14 or 15 percent, well, that’s at least halved, it seems. So that, again, is good.

MG: How do you explain the differences in the case numbers between, say, Italy and Australia? Because both are first world countries, both have solid medical health systems?

PD: Well, Italy did have a fairly stringent procedures - the government here adopted early on. We’ve delayed the onset in Australia and we bought a lot of time. We’ve also got a pretty sophisticated medical laboratory scene, though, Italy has too really. But Italy didn’t take those steps and they got the disease, and in big numbers, I think they had it for a while before they even realised they had it. We’ve been doing a lot of background testing. People have been saying we’re not testing enough. Well, actually, nobody can test enough because there’s not enough reagents on the planet and all the rest of it. But we’ve been doing a lot of background testing. By international standards. And until about Tuesday of last week, even when we were testing people who were coming in to the fever clinics at Royal Melbourne Hospital, which was set up to deal with this infection or testing the people that were being sent in by their doctors, because they had some sort of respiratory disease and so forth. We were still finding less than one per cent of people positive. So that means there was very little background infection in the community in Melbourne. And if you think of the demographics and so forth in Melbourne, Melbourne is exactly the sort of place you’d expect a lot of it. Now, with respect to the disease, Sydney has been a bit ahead of us. They’ve they’ve climbed up more quickly than we have. So, of course, that’s a major portal of entry into Australia. And they all came into Australia from somewhere else initially. So we think we bought a lot of time and now we’re starting to see it ramp up. And and actually also the criteria for testing are being relaxed a bit and we’ll see more positives come up because we’re going to be testing more broadly that will sort of flatten out and and we’ll we’ll start to see a more stable situation, if you like.

MG: One argument has been that countries perhaps have should adopt the so-called herd immunity course of dealing with this virus. Could you explain how that works? And what do you think of that argument?

PD: Well, it’s the basis of all the responses, in a way. The difference is that the herd immunity argument that has been presented has been, well, let everyone get infected, take the consequences, and the sooner everybody’s infected, the sooner it will be immune or large numbers will be immune. And then the rate of transmission will drop, the risk will drop and people can get back to work. So that’s that’s the sort of argument that was being attributed to the Brits and to the Dutch. Now we all want to see herd immunity. We just want to get there a bit slower and to back up a bit. You know, you get infected with the virus, you recover from the infection, you’ve then got antibodies in your blood and your immune, and you’re not going to get re-infected again. And we don’t think there’s any good evidence you can get re-infected again with this virus. So once you’re in that category, you’re free and clear. We could take all the people who’ve had the infection, recovered and just send them out to live normally. And that may be something that can be done in the later time, because, you know, they are the people who could help look after people and deliver stuff and do all that sort of thing and be at no risk to themselves. So what we want to do here and what the prime minister’s trying to do is to flatten the curve. That is to slow the rate of infection, and the reason for that is we don’t want to get into the situation the Italians got into where their health services were simply overwhelmed. It’ll be hard not to see some of that. For instance, you know, the Italians got into the situation where they’re having to take people off of ventilators, older people off ventilators to try and save younger people. We would hate to have to do that. And of course, the doctors may have to do some of that, if people don’t behave responsibly and don’t keep their social distance and don’t do everything possible to stop spread. That doesn’t mean that we don’t want herd immunity. The herd immunity we want is one that develops slowly because we’ve flattened the curve, and then what we would really like to add from the point of view of the herd immunity is a good vaccine, because if we could take the people who’ve been infected and recovered and then we could vaccinate everybody and and have total herd immunity, it’s a possibility, this whole, this virus may actually die out.

MG: Well, how far do you think we are from the vaccine?

PD: The vaccine, we’re all giving out the figure of 12 to 18 months. There are a few new concerns from other experiments that were done earlier with SARs and MERS that some vaccine formulations, not all, but some, could give you what we call a bit of immuno-pathology. That is they might actually make a little bit worse or or contribute to some bad, bad situation. So we have to be careful with the vaccine. But the first vaccine product from the University of Queensland, I’m told, has already gone into lab animals. And it looks, it’s going well from what I know and of course, in the United States, a different type of vaccine has already gone into people. So we have to go through safety testing. The first one is what we call a Phase one trial, where we test it in people, make sure it’s safe, and of course, we can always also bleed them and get antibodies so we can see what they’re doing. That will only be quite a small number of people. Then you go to a phase two safety XEZ trial with a larger number of people. And then you get it out there in a broader, much bigger trial where people might be getting natural challenge, but that’s what takes the time. It’s not really doing the, making the actual product at the beginning, but it will be a time lag in actually producing a lot of this stuff. A lot of it is in the time you need to actually test it for safety.

MG: We all understand it’s a long process, but nevertheless, a year to 18 months in a very long time in this modern age.

PD: Yes. Yes, it does. And a lot of us think that it may be possible to speed that up. It depends how well it goes. It really depends how safe it looks at the early stages. And of course, it’s possible as this is being done globally and we and the United States and so we’re not the only country is doing it. Some people may push it ahead much, much quicker and take more risks to get to what could be quite a safe vaccine. If you think back, you know, think back to the early polio vaccine, the measles vaccine, mumps vaccine and so forth, they didn’t go through anything like this - extended safety testing. There was a measles vaccine that was made early on, which was a killed virus rather than the live virus, we use now, though, that was damaging and you wouldn’t want it push ahead with that one million.

MG: Now we’re seeing obviously progressively tougher measures being imposed and various institutions and businesses shut down. A lot of those social problems and dislocation. Would you like to see a more total shut down to try to knock this thing on the head somewhat earlier than will be done through its staged approach?

PD: Well, you can see how difficult that is. I mean, what’s happening is the chief medical officer advising the prime minister. And so with that, they have staged a response. So we we’ve seen some staging of that. And it can go further if these measures don’t work. They’re pretty dramatic, really, what’s been introduced. If that doesn’t work then we can, we will expect to see more, more extreme measures. But you can see the difficulty of it. For instance, you know, we’ve got all the social distancing, but then the Centrelink thing crashes and you’ve got lines of people stretched out, trying to get to Centrelink. So they’re not keeping their social distance. They would probably do so if they were in a different situation. So it’s a very difficult situation. The other thing is, you know, with schools, we’re not really sure that schools are a major source of transmission. We do know that children can be infected, they don’t seem to be as infected as much, and they certainly don’t seem to be as severely clinically infected. But there are questions know what about the children who are in socially vulnerable situations? What about the children and health care workers and essential staff? Because we can no longer call on granny, because granny is at great, great risk of severe disease. So it’s a complex situation. And I think the way the response is working reflects that complexity. And that’s why we haven’t seen total lockdown.

MG: Would you like total lockdown, though?

PD: I think, it’s really, you know, the natural instinct of a basic scientist is to go for it. But basically, as you think about the social issues and social context, you realise that that’s a difficult option. The government’s being advised by top epidemiologists, these are the people who study the spread of infectious disease. And as far as I’m aware, some of the people from our institute. As far as I’m aware, they’re acting on that advice.

MG: What’s your own position on schools?

PD: Again, much what I said. I think it’s a very, very difficult situation. And I leave that to the people who are actually, who study the spread of infection. I’ve studied the nature of infection. I’m interested in what’s called pathogenesis: how a disease actually works inside the individual or the animal. But there are other people who are highly specialised and very skilled in trying to work out the spread characteristics and what determines them. We know with influenza from the work of Ben Cowling in in Hong Kong, is one of the guys who’s been advising us, that influenza is certainly a major cause of infection in the home. We do not know that for this virus.

MG: Your, obviusly, your preoccupation is the science. But like everyone else, you have to organise your own life. Do you have and are you seeing them at all?

PD: Yes, we have four grandchildren and we won’t see them for ages except at a distance. And if they come and stand outside, we can wave to them or we’ll have drinks at 20 paces or something, I don’t know. So, no, we’re not seeing our grandchildren. We’re socially isolating at home. I’m doing everything by cell phone or computer and Skype or Zoom or whatever and trying to obey the guidelines. We have a three times a week morning conference, an hour long conference, three times a week in the morning on what’s going on in the institute. It’s all to do with testing, expanding testing, developing clinical trials, developing alternative vaccine candidates, developing antibody tests for screening people. We’re collaborating with overseas companies. We’re collaborating with philanthropy. A lot of money coming in from various people, a whole complexity of issues. It’s all extremely energetic, I should say. People are working seven days a week. Some are getting exhausted, particularly on the testing side. And it’s been an incredible experience to live through so far. And, you know, if I lived through it, I might try and repeat Daniel Defoe’s book, Journey of the Plague Year, written by a scientist, not in the 17th century whenever it was.

MG: Well, you’ll certainly be able to update your pandemic book. Peter Doherty, thank you so much for talking with The Conversation today.

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