Post-CTSI forum reflections: UB experts discuss COVID-19 strategies and lessons

When vaccine researcher John R. Mascola, MD, outlined the COVID-19 story — from the pandemic’s first appearance to the authorization and use of vaccines — at the University at Buffalo Clinical and Translational Science Institute (CTSI) Annual Forum on March 17, among the most engaged audience members were several of the university’s notable and frequently quoted infectious diseases experts. While these researchers have been studying the coronavirus for the last year-plus, they welcomed the opportunity to hear from Mascola, a co-author on many of the publications on the Moderna mRNA vaccine and the Director of the Dale and Betty Bumpers Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH).

They also embraced the chance to join Mascola for a post-presentation conversation. The UB researchers who participated were:  

• Alan J. Lesse, MD, Associate Professor and Vice Chair for Education; Senior Associate Dean for Medical Curriculum, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences
• Timothy F. Murphy, MD, SUNY Distinguished Professor, Department of Medicine, Jacobs School; Senior Associate Dean for Clinical and Translational Research; Director, Clinical and Translational Science Institute; Director, Community Health Equity Research Institute
• Thomas A. Russo, MD, Professor and Chief, Infectious Disease, Department of Medicine, Jacobs School
• John A. Sellick Jr, DO, MS, Professor, Department of Medicine, Jacobs School; Section Chief, Infectious Diseases, Veterans Affairs Western New York Healthcare System; Hospital Epidemiologist, Kaleida Health

Now, roughly a month after the forum and that conversation with Mascola, UB’s Lesse, Murphy, Russo, and Sellick are reflecting on COVID-19 strategies and lessons.

Russo: We learned that large, collaborative clinical trial efforts — from interdisciplinary teams, from multiple institutions, from multiple countries all working together — were able to rapidly develop high quality data that is broadly applicable to multiple patient populations with resultant improved outcomes. This pandemic showed that if everyone cooperates and works together we are able to generate information that improves patient care on a timescale not previously felt to be possible.

A second [strategy that advanced patient care], greeted by some resistance in journals and also by investigators, [is] the rapid dissemination of data in an open fashion. At the beginning of the pandemic, China released the sequence of the virus. This enabled people who had vaccine strategies based on code to get going.

Sellick: In the world of infectious diseases, we are always looking at prevention. All the signs were there that something like this was going to happen. This is our third major coronavirus disease in the last 15 years. What we saw with this one is that we relied on supply chains that were not there. Everything has moved to just-in-time manufacturing and just-in-time supply, and all of a sudden you have a pandemic.  This is forcing us to think about how we get ready for the next one so that we do not repeat what we just did.

Murphy: COVID-19 has placed a spotlight on the health inequities in our entire system of healthcare. People who are underserved and racial and ethnic minorities have suffered the most from this pandemic. We have incredible research that led to highly effective and safe vaccines that are going to bring this pandemic to an end. But we do not have good ways to get the vaccines to the folks who need them. We need to address the root causes — why is a huge segment of our population suffering disproportionately from the impact of this pandemic? It is because of the structural problems in our healthcare system and we need to figure out how to change those inequities.

Russo: In terms of the community, one of the things I think we learned from this pandemic is the critical importance of a central, uniform message. That messaging should be developed and configured by public health officials, and informed by science. Certainly, there are going to be knowledge gaps, [but] we can extrapolate in a biologically logical fashion. As an example, [the messaging around] mask usage was confusing. We did not need trials to tell us masks were going to both protect others and ourselves against SARS-CoV-2 infection. Initially, there were critical shortages of masks for the healthcare providers who needed them. So, the message of “please reserve them for healthcare providers, because they are at greatest risk” got misconstrued into “the rest of us do not need them.” What we should have said is, “Pre-fabricated masks to healthcare providers, but for those people that can sew, make masks. While we are still dealing with shortages, that will be better than nothing.”

Lesse: Some of the things that we are currently doing as a partnership of university experts plus trusted community members makes a big difference, presented in the right settings.

Murphy: With regard to communication, we have to use multiple different approaches in order to reach many different audiences. If we are talking specifically about vaccine hesitancy, what are the reasons? There are so many explanations for why people are hesitant, and there are ways to approach each one.

Lesse: The politicizing of science and the politicizing of facts has become a major problem. There needs to be a consistent, steady, reasoned voice. You have to be transparent — you have to say exactly what you are doing and exactly why you are doing it. “There are pluses and minuses, and we know this, and we are happy to hear your concerns, but this is what we think is best.”

Sellick: We have to rely on science. What we have seen [recently] is that the CDC is systematically going through various [treatment] guidelines. Every time I think things are going to slow down a little bit, all of a sudden more guidelines have been updated, and I have to look to see how it affects what we do in the hospitals. This is a good problem to have, because for the first year of the pandemic we were not getting a consistent message and we were relying on things from other countries.

Russo: I think the first lesson was that our public health system had been significantly eroded. We were in between pandemics or healthcare crises, and those funds were diverted elsewhere. When the pandemic came along we were ill prepared to handle it. In the United States, there is both a central component and a statewide component to public health; those entities were in different degrees of disarray. This pandemic will end, but we have to remember that we cannot divert resources for public health, because there will be another pandemic. I guarantee it.

Murphy: One of the problems with our response as a country to the pandemic is there were 50 different responses — 50 different governors making 50 different decisions — and it led to many unnecessary deaths. We need national coordination.

Sellick: States were fighting against and outbidding one another to get equipment and supplies. That does not work. There needs to be a much different system. The federal government cannot determine what goes on at every town in the United States, but they can at least get everybody on the same page and say, “Here is where we are getting the supply. Here is what we expect you to do. Here is the data we are going to gather. Here is what we are going to do with the data.” It took us more than a year to get to that point.

Lesse: In addition to national standards for treatment, we need to make sure that we have a well-funded system for analysis and data-gathering. In the past, it has been the CDC. During this pandemic with massive death totals, we were not relying on the CDC — we were relying on Johns Hopkins University and the COVID-19 Project, because there was nobody else organizing the information that we needed in real-time. We were massively behind the rest of the world in sequencing of viral strains for variants. [Now], we have caught up.

Russo: Another lesson relates to vaccines. Infectious disease and public health officials know that vaccines are the number one medical advancement in terms of preventing life loss and significant morbidity and mortality. We have struggled to achieve a high level of vaccine acceptance over the past 20 years, due to the fact that we have eradicated or significantly controlled so many of these infectious diseases. Because of the success of the vaccines the public no longer appreciated the severity of these infections. Further, the rise of the “anti-vaxxer” movement that is based on misinformation fueled mistrust. We are now blessed with multiple vaccines directed against SARS-CoV-2, and we have now gotten hundreds of millions of doses into the arms of individuals. What I am hoping for is that the people of this country and of the world see that vaccines are an extraordinarily positive thing in medicine. I hope that people will appreciate how vaccines saved us from this pandemic and will more broadly embrace their use moving forward.