Full Text | Relying on India Alone for Vaccine Production Is Unfair: Peter Hotez

A hellish second wave took the Indian government completely by surprise. The three lakh per day cases are now seeing some reprieve, but experts warn that these numbers mask the spread of Covid in rural areas and the number of deaths, that have clearly been undercounted across many parts of the country. Unfortunately, the biggest failing has been a dysfunctional vaccine strategy.

Mitali Mukherjee spoke with Professor Peter Hotez, Dean for the National School of Tropical Medicine at Baylor College of Medicine in Houston and the Co-director of the Texas Children’s Center for Vaccine Development (CVD). Prof. Hotez described the situation in India as tragic and a health crisis that will plague India for years to come.

He described the second wave as a watershed tragedy that the government must treat as a “homeland security” crisis. Prof Hotez described the Indian government’s decision to place a ban on vaccine exports as unfortunate but also pointed out that it was unfair and implausible for the world to have depended only on a few vaccine manufacturers to produce COVID vaccines. He said there would be a domino effect of India falling short of vaccines and it was critical that a coherent Universal Vaccine Policy was formulated at an international level. The Dean for the National School of Tropical Medicine at Baylor College of Medicine also highlighted the dangerous ramifications of rampant misinformation that was being spread about vaccines and exacerbating vaccine hesitancy.

The following is a transcript of the interview, originally published on May 22, 2021. The questions and responses have been edited lightly for style and clarity.

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MM: Hello and welcome to Business on The Wire, I am Mitali Mukherjee. A surge in cases is now easing off across many urban pockets in India, but the truth remains that figures are spreading and cases are spreading in rural India. Also true, that deaths are likely much much higher than what is being reported at this point.

The only thing that could stand out, or to help our country at this point, could be a clearer vaccination strategy, but many question marks have emerged on that as well. Supply is running out, a pricing barrier has been put up, and access to those vaccines has become more complicated, thanks to an app.

What are the repercussions of this wave that India is facing and what could the spillover effects be for countries across the world?

Joining me to talk about that is a man who has dedicated most of his life studying vaccines and trying to work in the area of infectious diseases. I am joined now by Professor Peter Hotez. He is dean for the National School of Tropical Medicine at Baylor College of Medicine in Huston. He is also co-director of the Texas Children’s Centre for Vaccine Development.

Mitali Mukherjee: Thank you very much for taking time out and speaking with me. I want to start with what you’re making of and how you’re reading the situation in India as you see it, you know, sitting so far away but obviously getting a sense of the magnitude of the situation, the size of this tragedy.

Peter Hotez: Yeah I know, I mean it’s as you pointed out, I only know what I see from my friends and colleagues and you know, hear from the Baylor College of Medicine or Texas Children’s Hospital, you know we have so many faculty, students, professors, post stocks residents who have family in India. So I get just the most horrific reports from them and it’s just so heartbreaking, so even though I’m not there, I feel I have some sense of what’s going on from listening to their testimony and also what I see on social media, which I think is mostly accurate.

And there’s no question in my mind that this is a humanitarian catastrophe, I have one of my former students, medical students, who’s a professor now at the University of Houston, Dr. Bhavna Lall. You know, tells me she basically is up all night, you know because of the time difference, being on the phone with cousins, and cousins of cousins, who are desperate for oxygen or desperate for transportation to the hospital, or there’s no hospital beds available and they’ve been sent home and have to manage basically intensive care in the home which is, of course, impossible.

And the scope of this tragedy is slowly building in my mind, you know, I thought what happened in New York City was terrible, what happened in Texas last summer was terrible, this is worse, there is no question. And it just breaks my heart when I think of the staggering...not only death toll, but you know one of the things that we learned about COVID-19 is yes, death’s a huge part of it, but it’s the beginning because people have devastating long term consequences, what we sometimes call ‘Long Haul COVID’, and this will plague India for years to come. And not to mention, the emotional trauma and mental health aspects. So this will be one of the great watershed tragedies in the history of modern India, I believe.

MM: There is also concern around the variants that India is battling with, Professor, the B1617 and B1618. As you said, there seem to be early studies about the fact that this is more virulent in nature, the transmissibility is higher. But is there enough data, have you seen anything to suggest that it is causing a greater number of deaths as well? Because anecdotally, from what we get in terms of, you know, the number of cremations that are happening or what the death certificates indicate, this is a much much higher spike than anything else dealt with before.

PH: Yeah, I mean, you know, in the beginning, what we were hearing is the 617 variant, the B1617, together with the B117 variant, which rose out of the UK, the latter one, were both there and it wasn’t clear in my mind whether which of the two was more responsible. It now looks like the 617, but some people call the 617 ‘617.2’. I know it’s a dizzying array of numbers, seems to be the one that’s out competing with the others. But they’re both bad actors, right, they both cause serious illness, even the B117 variant which started, which is now the dominant one in the United States, is deadly and it affects young people as well.

And of course, you have the other problem, that the health system of India is fragile to begin with, you know, you’ve got densely populated areas in a size about a third of the United States. Even on a good day, it doesn’t take much for hospitals and hospital systems to be overwhelmed, and now you’re seeing this massive surge in hospital admissions. So in my mind, it’s still a little difficult to sort out, because you’ve got the perfect storm of so many variables.

So first, you have the incredible urban density in the big cities like Mumbai and Kolkata and Chennai, and you know the list goes on right, these are where the world’s most megacities are located. So you have incredible density, so there’s a lot of virus transmission, high virus inoculum happening because people are so close and living in crowded conditions, problem number one.

Problem number two, you have both the B117 and now the B617, two variants which seem to be more transmissible and maybe causing more viral load.

Three, you have hospital systems getting overwhelmed so quickly, and we saw this where I am in Texas, especially in South Texas, that’s when the mortality numbers go up. With hospital systems, it’s not so much the beds, it’s the trained staff, you know, we had this problem in New York, we had this problem in South Texas. You don’t have enough physicians, nursing support, you know, to manage an ICU. Any bed can be converted to an intensive care unit but that’s not the issue, it’s the staff, the trained staff. You know, that’s what saves lives, the trained nurses and the respiratory technicians and all of the people who know how to monitor the equipment and fix the broken equipment. This is what you need and then that starts to break down. So all those things are happening at once, I think, to really cause this terrible devastation.

Family members of a man who died due to the coronavirus disease (COVID-19), mourn before his cremation at a crematorium ground on the outskirts of Bengaluru, India, May 13, 2021. Photo: Reuters/Samuel Rajkumar

MM: How do you think this is going to play out in the next couple of months, Professor? You know, as you pointed out, there is going to be longer term damage of this, there is already talk of a wave three, which is ironic considering the fact that this wave two, you know if you want to call it that, has just begun to move into rural parts of India where there is also tremendous loss of life and there are many many people afflicted. From what you’ve seen over the last year or so of covid, how do you think this will play out for India in the second half of the year?

PH: Well, what I’ve seen happen, at least here in the United States and I’ve seen it in Europe, there’s always a bit of an auto-correction if you want to use that phrase, that people on their own, figure out that they need to do social distancing. And then sometimes there’s government-mandated social distancing and masks, and then the numbers start to decline, and also people get infected and recovered and they have some partial immunity for a period of time. That often translates into a series of waves and that’s what we saw, for instance, here in the US in January. And so, that’s likely one scenario but there’s no question to really get out of this, what you’re going to have to do, just like we have to, vaccinate our way through it. And that worries me as well because look at the scope, what’s the population of India? 1.1, 1.2 billion people, you know our numbers that we calculated say you need 75, three quarters of the population vaccinated, think of that, you’re talking 800 million people immunised. Two doses, that’s 1.6 billion doses of vaccine and where does that come from?

It’s great that the Biden administration stepped up, they’re going to donate 20 million doses of Pfizer, Moderna vaccine and maybe 60 million of AstraZeneca vaccine. What’s that? That’s a section of a suburb of a major city in India, right? It’s as you say, a drop in the bucket, so I think what’s going to be absolutely critical is the international level. We have to sit down, all the leaders of the major Indian vaccine manufacturers. And whether it’s Serum Institute of India, which is an extraordinary organisation, or we work with Biological E, or Bharat Biotech, and there are several others – just simply ask the question, what do you need to be successful? And then just open it up, whatever the vaccine producers in India need. That’s what we have to do, because ultimately India is... that’s part of the greatness of India, its ability to make vaccines for the world. Now we just need to help India help itself and give them everything they need to be successful.

Also read: Full Text | 'Govt Should Have Evaluated, Acted Upon INSACOG Warning': Rakesh Mishra

MM: I do want to talk about vaccines at length, but just to, you know, finish our discussion with regards to the virus itself, professor – there is another fear that is now growing, that this is far more contagious and perhaps lethal for children. In fact, in many children who have got COVID, there has now been an increase in the percentage of MISC or Multisystem Inflammatory Syndrome. From everything that you’ve seen so far, does it look like these variants are indeed more lethal for children, or are children more susceptible to it?

PH: So it’s really interesting, I’ve just been asked the exact same question about Brazil and the P1 variant, and the answer is I just haven’t seen the data. I mean, you know, when you’re getting so many people infected and there’s so much transmission, it’s hard for me to say that there’s disproportionate effects on children as opposed to just so many people that are getting infected and yes, kids are going to be swept up along with this and we do see MISC, so I don’t have the answer whether there’s something unique about the variants that are emerging in India that are specific for kids, or if it’s just matter of the volume.

You know, when you look at the numbers, I have to believe that a significant percentage of the country is getting infected. And I can’t tell you exactly what, but you know when I talk to my colleagues here at medical school where I am a professor, and I have vast numbers of Indian friends and colleagues who are professors here, every one of them has not just one or two family members, but dozens of family members infected. Every one of them personally knows people who lost their lives to COVID, and to me, that’s a sign that something huge is going on because when that happened, that’s the same thing that happened in New York City, the same thing that happened in parts of Texas, when everybody starts to know many people that become infected.

I know it’s not very precise and it’s a bit off the cuff, but I think there’s some merit to it, that tells me that there’s some huge percentage of the population being infected, and I would also say that when that happens also, this is when a public health crisis takes on bigger dimensions, ceases to stay just within the health sector, right? This becomes an economic crisis, this becomes a homeland security crisis. This is a homeland security crisis for India, and my heart just goes out to the Indian people and my colleagues and their families.

MM: So let’s talk about the vaccine situation as it stands, professor. You know in March 2021, I think you made some comments about lauding India’s efforts, talking about how India in collaboration with other universities, was working on vaccines that will rescue the world. But here we are, in the month of May where the Indian government has banned vaccine exports, where the government itself has fallen woefully short in terms of booking enough supply of vaccines and the population stands at less than 10% that is fully vaccinated and perhaps only about 2%. I beg your pardon 2% that is fully vaccinated and 10% that has got one shot at this point. How do you make sense of it, you know, is it disappointing to see the turn of events that moved from January onwards?

PH: You know I think, when I made that statement, I still stand by that statement because you know, I’ve always said it’s part of the greatness of India, that Indian science and Indian industry have worked together to do something that no other country has done, which is take on the mission of making vaccines for the world. And this predates COVID-19, I mean Serum Institute, for years has been making vaccines for Africa and same with my colleagues at Biological E and Bharat Biotech and others. You know, to my unyielding admiration that they’ve been doing this, and when COVID hit, I think the whole plan for the world was never set as much, it was never explicitly stated, but it was understood that the world would rely on India for producing COVID vaccines. And that was a blessing, a blessing to the world.

Now, India is struggling and I think we have to be careful not to be too critical at this point, because especially what can I say, coming from the United States, look what we did. To my embarrassment, we hoarded, our government hoarded vaccines just like everybody else did. So the last thing would be me in a position to point a finger at India. So I’m worried. More than disappointed or pointing fingers, I’m worried for the world because now there’s a domino effect.

The domino effect is we depended on India to make the vaccines for the world, now India’s struggling. The vaccine producers have to make vaccines for India, and now what happens for Africa? What happens for Latin America? In retrospect, it was unfair to put that burden on India in the beginning, to say that “it all depends on you, India, to make vaccines for the world”. That’s not how it should ever work.

The policymakers should’ve been in a position to build a vaccine development capacity in Africa, to build a vaccine development capacity across Asia, to build a vaccine development capacity across South America. And the truth is most of the world’s LMICs, the lower middle income countries, never really stepped up to do this in a big way, so that’s the failing, really. And this has been something I’ve devoted my life to, not only developing vaccines for neglected diseases but build vaccine development capacity across the world and we’ve been doing this in Latin America, in the Middle East, and now we’re starting to do that with Africa.

But you know, we’re a small organisation, at Baylor College of Medicine or Texas Children’s Centre for Vaccine Development, so we can’t do it alone. And this has to be, in the long term when we get through this, which we will, I think that’s the other lesson – if you rely too much on one country something like this could happen, we should’ve anticipated it and we need to build more capacity globally.

Representative image. A medical worker prepares a dose of the "Comirnaty" Pfizer-BioNTech COVID-19 vaccine in France, April 29, 2021. Photo:/Eric Gaillard

MM: Even so, professor, just for India, the elementary sort of barometer of a well-functioning vaccination programme is that it is available to all those who should be vaccinated. What do you think the long-term repercussions might be for a country like India, that is now falling very very short in terms of our vaccination targets? If you look at the wave or the spike, our vaccination rate is much lower than our infection rate even now, despite us having, perhaps, crossed the worst part of our second wave.

PH: Well, it was like at the beginning of our epidemic. The question was, was it a problem in the vaccination infrastructure, in the ability to get vaccines in the arms of people, or is there a problem in vaccine production capability. Or more likely, it’s how it always is, it’s never just one thing. It’s probably both, you know I think one of the problems that we found here in the United States for vaccinating is we never really had a good system in place for vaccinating adults, our whole system was built on vaccinating children.

Normally, gradually, we have started to put some pieces in place for vaccinating adults. So when COVID hit, I don’t think there was that much understanding what needed to be done, there was heavy reliance on the pharmacy chains, because a lot of our pharmacies here are franchised to chain stores, and hospital systems. And it turned out that that only got us so far, especially in low-income neighbourhoods, where many are pharmacy deserts, you can’t even find pharmacies. So that whole infrastructure had to be built in the middle of a pandemic, and I suspect something like that is going on in India as well, that the system is more oriented towards vaccinating kids. Vaccinating adults is a different proposition, so I think that’s probably one thing that’s in place. And second, I think in certain terms of scaling up and moving rapidly, again there needs to be a better understanding of what the issues are, what don’t the manufacturers have that they need. Is it supply, is it trained personnel, is it simply the scale of it? In doing this rapidly, again, most likely some combination of all these things.

So I think the key is one of the things I’ve said in the US, and again it is very hard to extrapolate from the US, which in comparison is a tiny country in terms of population to India. Pointing fingers right now, a certain amount has to be done, to a certain extent it’s inevitable. But right now it’s more about what do we do now to put infrastructure in place and build things as we go along.

And the other thing I’ve said in terms of the US government is that I think our US government is making good effort to help India and help other countries, it’s just that the scale is too modest, you know. Great, you want to donate 20-80 million doses of vaccine, but it’s nothing. Great that you want to do patent wavers, but a patent waver is not going to generate 1.6 billion doses of vaccine. So I’ve asked the Biden administration to perform a more comprehensive plan which includes actually producing the vaccine. I mean, when you look at the scale globally, look, we’ve got 1.1 billion people in Subsaharan Africa, a billion people in India, another half a billion people in smaller low-income countries of Asia, 650 million people in Latin America – we’re talking 7-8 billion doses of vaccine, and I don’t think anybody anticipated the scale of that.

And as good as the Pfizer, Biotech and Moderna vaccines are – that’s what I got, the Pfizer Biotech vaccine – it’s a new technology and with any new technology, it becomes an engineering problem. You can’t scale it up that rapidly, that’s why you need low cost, unfussy, durable vaccines for a situation like that and that’s what we’ve been doing. We’ve been making coronavirus vaccines for the last decade, and we made a prototype COVID-19 vaccine as soon as we had the sequence. We transferred that technology to Biological E in Hyderabad, and now they’re scaling up production as fast as they can. It’s going into phase three trials and I have to say, I really like working with Biological E. They’re really good scientists and smart, and I learn a lot from them and they’re really committed to this. So I’ve also been really impressed with the Indian regulatory authorities, they’re moving as expeditiously as possible without compromising safety.

So I think, everything that I’ve seen first-hand says to me that they’re doing all they can and as efficiently as possible without compromising safety and that’s why I say, the focus now is to say these vaccine producers in India, they’re doing all they can. We have to ask them, what is it that they need?

Also read: How the Modi Government Overestimated India’s Capacity to Make COVID Vaccines

MM: What do you think the global solution might look like, professor? As you pointed out, one is opening up patents and the other is sharing when one is hoarding. There are several governments that have held onto far more, in terms of doses that they require. But I also want to sort of layer this question of mine with a point that none of this is new, even when trials were being conducted, it was clear that the trials were not being conducted in developed countries but in developing nations. And the outcome, as we see it, is the fact that the vaccines are now moving in haste and are far more accessible again, to the developed world. Do you, frankly, see a solution coming out on a global platform? Do you think there will be that call of “humanity is larger than nationality”?

PH: Well, you know I’ve devoted my life to something known as neglected diseases, so by definition, I am the most optimistic person you’ll ever meet. So with that caveat, I will say yes. And by the way, I would add that it’s not that the world doesn’t learn from past pandemics we have. With each pandemic over the last 20 years, we have put in some level of infrastructure. So for instance, after SARS coming out of Southern China in 2002, we created international health regulations ‘IHR 2005’. After the H1N1 pandemic, the pandemic flu in 2009 we put in the global health security agenda. After Ebola in 2014, in Africa, we put together CEPI, the Coalition for Epidemic Preparedness Innovations. And I think all of those things are helping in this current pandemic.

After this one, I think there are a few things we need to recognise, and one is that as wonderful as India is in terms of vaccine production, just relying on India alone is unfair and not radical. We need to figure out a way to reproduce what India’s done, and do it in multiple countries across the world. No vaccines, for instance, are produced on the African continent. South America, Central America profoundly underachieved. There are some in Brazil and Cuba but nothing like what India does, and so that has to be reproduced there. There needs to be something like the Indian producers in the Middle East, we don’t have anything like that. So I think that’s one of the pieces we need to put in place.

And I think we need to realise that that’s an investment. It’s not just building bricks and mortar, not just building the factory – that’s the least of it. It’s the training of human capital, we don’t have enough. Just like the ICUs right now in India being overwhelmed because there’s not enough trained nursing staff and doctors to manage the load, it’s the same for vaccine production. You know, vaccine production is not like producing small molecule drugs, there’s an art to it, there’s a 20-year learning curve, and you have to build that in place.

India has done it and we have to do it for the rest of the world, and this is part of the problem when you look at the amount of investments and the time horizons for vaccine infrastructures, usually on the order of decades, leaders don’t like things that are on the order of decades. They want to show what they’ve done in the four years they were in office and it doesn’t work like that with vaccines. So it does take visionary leadership to build vaccine infrastructure, but we have to figure out a way to do it and that’s really critical.

I think the other piece to this is, you know, in the US, the reason why 6,00,000 Americans lost their lives from COVID-19 is partly due to the SARS coronavirus. I say partly because, in equal measure, it was due to defiance of masks, defiance of social distancing, even defiance of vaccines for political extremism on the right. We got, now, a globalised anti-vaccine anti-science move that’s very aggressive, and I see it infiltrating into India as well. Some of it is coming from Russia as well, the Russian government is – this is reported by US and British intelligence – piling on a whole system of what is called “weaponised health communication”. And they’ve been doing this well before COVID-19, and they’ve been doing it to destabalise democracies. They’re using anti-vaccine sciences, a wedge issue. And now Noveta, the analytics group, has reported that they’re even doing this to discredit other COVID-19 vaccines in favour of Sputnik V, their vaccine.

So that has to stop. I’ve written a paper, an essay in Nature, which is one of the very important science journals, a couple of weeks ago, that says we have to look at this anti-vaccine, anti-science movement as now a globalised empire that’s got many moving parts. We’ve got to create a United Nations Agency Task Force to really look at how we confront it, and we have to treat anti-science as seriously as we build an infrastructure to prevent nuclear proliferation, or you know you name it, global terror or cyberattacks. It’s gotten that serious. What’s really interesting is that this caused an uproar in the anti-vaccine, anti-science community, so I’m getting this wave of white nationalist attacks against me on social media, on email. You know, they say an army of patriots is going to come and hunt me down, to which I say – look, it’s just me, my wife and my special needs daughter and the cat, you don’t need a whole army of patriots. One patriot will be more than enough, or two patriots. I laugh, but it’s really very scary and a very scary time for me and my family right now.

MM: No, I can empathise completely with the fear and anxiety you must face, and I have seen some of that hate on your social media platforms. What do you think the best way might be to take on this vaccine hesitancy, though, professor? You know, I was speaking to a doctor within India who is also making the point that we need to keep fine-tuning for cultural context. For example, there are completely unfounded WhatsApp messages going around, saying that the vaccine causes fertility issues. So there are several pockets in India, in rural India, where people do not want to take this because they are just scared of what the side effects might be.

PH: So let’s take that fertility issue, and the claim is that the COVID-19 vaccine causes infertility. Well for one, it’s not true, and second, it does not even have any biological plausibility. But remember where this came from. As I started debunking, first the anti-vaccine groups, you know, starting more than a decade ago, claiming vaccines cause autism. I have a daughter with autism and I wrote a book called ‘Vaccines Did Not Cause Rachel’s Autism’, which made me public enemy number one. They began calling me the “OG villain”, which I looked up and means the “original gangster villain”. So you’re interviewing the original gangster villain today.

And I think I was partly effective in terms of taking some steam out of the anti-vaccine movements, and they started looking around for other things.  So what did they do? They started gloaming on the HPV vaccine, the Human Papillomavirus vaccine for teenage girls for cervical cancer and other cancers, now it’s given to both girls and boys. Guess what their first assertion was – it causes infertility.

So what they’ve done now is they’ve copy-pasted the fake assertion about the HPV vaccine and stuck it onto the COVID-19 vaccines. So the fact that people are getting WhatsApp texts saying the COVID-19 vaccine causes infertility, my premise is that that’s not some home-grown grassroots thing that’s rising. This is deliberate disinformation that’s coming out of the US anti-vaccine movement that is now globalised.

MM: Will it be enough, though, to attempt to pour core scientific facts over this? You know, it’s very organic, people feel this very strongly, like I said even in rural India, people are talking to each other and saying, “You know, I know someone who got the shot and they got a fever, they are probably going to die of it so don’t get the shot.” How do you tackle vaccine hesitancy? Can it just be tackled with scientific facts at this point?

PH: Well, I think, you know, you have to put as much pro-vaccine accurate scientific information out there as you possibly can, and that’s what we’re doing in the United States. Public service announcements and that sort of thing, but you also have to recognise that it’s not that these people are ignorant or not that these people are not thoughtful. They are, but they are inundated with garbage, and when you’re inundated with garbage it starts to have an effect, right? So that’s why I think we really have to look at how we…what are our options for dismantling this terrible anti-vaccine, anti-science empire. Because that’s what it is. These are people monetising the internet of the fake news, they’re selling fake nutritional supplements. You go to Amazon.com and look up books on vaccinations, it’s almost all fake anti-vaccine books, COVID conspiracy books. So people are monetising this situation, and we have to figure out a way to cut off the money.

And we have to do something about Russia, we have to have a frank discussion with the leadership of the Russian government. Maybe the UN Security Council, they’ve got to stop this practice, there’s no other way around it.

And, by the way, for scientists like myself to talk about this stuff is not easy. I mean, I got my medical degree and my Ph.D. in biochemistry to make vaccines, to help people, not to lead a charge against the anti-vaccine, anti-science move. And I have to talk about very uncomfortable things like who am I to talk about Vladmir Putin, right? Or the Russian government, or disinformation. Who am I to talk about how people are monetising the enemy. This is not my comfort zone or even my expertise, but I do it because I feel it is necessary to save lives.

MM: Tell me a little bit about the vaccine that you’re working on, where the stage three trials have begun. What kind of feedback you’re getting, you know, how soon you think you’ll be able to supply this in generous measures across India or perhaps across the world?

PH: Yes, so our group which is called the… so I’m a professor at Baylor College of Medicine where I head our Tropical Medicine School, and also co-director of our Texas Children’s Centre for Vaccine Development, we’ve been making vaccines for 20 years for neglected diseases, and then we adopted a coronavirus programme about ten years ago, working with the New York Blood Centre. They had a very interesting concept for producing the receptor binding domain of the protein in yeast, and we made a prototype SARS vaccine, for instance, more than a decade ago. When the COVID-19 sequence came in, we used all their same approaches and moved very quickly, and then licensed, non exclusively, the technology to Biological E. They’re scaling up production. Our goal is not to make money, we didn’t file any patents on it because, you know, we don’t want the intellectual property to be a barrier. Our goal is not to make money, our goal is to do this for humanitarian reasons. We’ve really loved working with them, as I said, Biological E is just some of the best vaccine scientists we’ve ever worked with. And they’re now scaling up production because they know how to do this.

It’s the same technology used to make the recombinant Hepatitis B vaccine, which is done through yeast fermentation. And people have been giving recombinant Hepatitis B vaccines for 40 years, so there’s already a deep knowledge base on how to do this. It’s not like they have to learn a brand new technology, so they were able to hit the ground running, in scaling it up. Now they’ve done phase one, phase two trials, it’s very much a Bio E vaccine, although we’re certainly helping and are in discussions with them every week. And now the Indian Regulatory Authority has given them the green light to move into phase three, so the hope is that if all the stars align, this could be released through emergency use by the summer. That’s the aspirational goal, and then come up with a global strategy working with CEPI, the Coalition for Epidemic Preparedness Innovation, to launch a global strategy as well.

MM: One final question to you, Professor. You know, here in India, children have not been to school in a year and a half and it looks like this year will also go down in the same way.

PH: That’s terrible.

MM: Yes. A week back, the government had shut down vaccinations for those over 18, the 18-45, because we simply don’t have enough. And when we look at your part of the world, it looks like there is at least light at the end of the tunnel. How long do you think it’s going to be before countries can get to some semblance of being on par, in terms of returning to normalcy or some kind of a pre-COVID life? Because things, as you said, as you know from your colleagues and friends, look quite dire at this point.

PH: Yeah, I think in the US it’s happening now. We’re already seeing, you know, things are coming back to life very much and the economy is picking up. My friend was at the Houston Airport, and he said it was just packed. People are seeing friends and family again, they’re traveling. So I can’t say it’s pre-pandemic. I think I said on a newscast that the world’s going to look like it did in 2019 very soon, and then I quickly got admonished for that. They said 2019 was not a very good year, you should have picked a different year. I said, “Okay, you pick whatever pre-pandemic year you like.”

And I think the same will be for India, but the only way to do this is to vaccinate your way out of it. You know, the social distancing and the masks - these are all important measures and they’re saving lives. But they’re an interim until we can vaccinate, and that’s got to be the priority – vaccinate as many people as you can, as quickly and safely as possible. I’m up in the middle of the night, thinking about India on Zoom calls with Biological E and others, doing everything I can, and that’s just got to be the priority. We have to scale up vaccine production, and as I keep saying, the one take home is we’ve got to do everything we can to ensure the success of the Indian vaccine producers, and to ensure the success of the vaccinators. The people who are actually delivering the vaccines, putting that infrastructure in place. Because if you don’t do that, then nothing happens, nothing good will happen, and that’s got to be the priority.

MM: We live in hope, professor. At this point, hope is all we have. But thank you very very much, I know how busy you’re running and I really appreciate this conversation with you and all the insight that you had to share. Thank you.

PH: Thank you. You know, I love India, I love the Indian people, and I hope that you’re successful.

MM: Thank you indeed.

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