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United Minds’ Forward to Work: Understanding Treatments and Vaccines


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United Minds’ Forward to Work: Perspectives to Guide Re-entry webinar series explores different considerations for people, culture, and change leaders managing the return to work.

In our second session, “Understanding Treatment and Vaccines,” Duke University Professor of Global Health Dr. Mike Merson and Global Director of Element Scientific Communications Dr. Frank Orrico discussed:

• Mitigation and containment
• Blunting impact with treatments
• Vaccines as the key to normalcy
• Implications for businesses

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United Minds’ Forward to Work: Understanding Treatments and Vaccines

  1. 1. Forward to Work Understanding Treatments and Vaccines
  2. 2. 2 With us today Dr. Mike Merson Wolfgang Joklik Professor of Global Health Duke University Dr. Frank Orrico Global Director, Element Scientific Communications
  3. 3. 3 Mitigation and containment Blunting impact with treatments Vaccines as the key to normalcy Implications for businesses Calls to action What we’ll cover:
  4. 4. 4 from mitigation to containment
  5. 5. - Social distancing/ protective measures - Testing - Treatment - Prevention The path to normalcy 5 Source: Drew Harris — New York Times Flattening the Curve Fast actions save lives and prevent healthcare systems from being overwhelmed outbreak without protective measures outbreak with protective measures HIGH FATALITY RATE patients cannot all be treated effectively LOW FATALITY RATE patients receive effective treatment HEALTHCARE SYSTEM CAPACITY PROTECTIVE MEASURES Individuals - Don’t panic, just be careful - Wash hands - Don’t touch face - Stay home if sick Governments - Fast, widespread testing - Limit large gatherings - Trace contacts
  6. 6. Source data: The COVID- 19 Tracking Project Texas Oklahoma New Positive Cases - NY/NJ/CT & All Other States Bars are daily new, lines are 7-day rolling average 6 Where we are today: Looking beyond the big picture
  7. 7. Widespread testing is critical 7 South Korea: COVID19 cases Jan 20 – May 14 Source data: Our World in Data IDENTIFY positive cases TRACE contacts ISOLATE potential spreaders
  8. 8. Am I infected? Diagnostic tests 8 What they measure - PCR: Viral genetic material - Antigen: Viral protein Strengths - Some are very accurate - Antigen testing is cheap and fast Weaknesses - False negatives/user error - PCR doesn’t facilitate mass screening
  9. 9. Was I infected? Serology tests 9 What they measure - Antibodies to COVID-19 Strengths - Fast and relatively inexpensive - Help to assess true extent of infection Weaknesses - Lots of bad tests on the market - Don’t tell you if you’re immune - Don’t tell you if you can infect others
  10. 10. 10 Source: Harvard Global Health Institute, The COVID Tracking Project (as of May 6) More and better testing will support recovery Notes: Testing data quality varies by state. The COVID Tracking Project's data reflects available numbers from all 50 states, the District of Columbia and US territories starting March 16. (Previous days reflected fewer location.) New Daily COVID-19 Tests Reported in the US Target: 917,450 test/day by May 15
  11. 11. 11 But treatments and vaccines are the next frontiers “The best near-term hope: An effective therapeutic drug. That would be transformative, and it’s plausible as soon as this summer.” “A successful vaccine will allow Americans to reclaim the country’s safety and sovereignty. The first country to reach this prize will be the first nation to recover.” The Wall Street Journal Scott Gottlieb, MD - FDA Commissioner 2017-2019
  12. 12. 12 blunting COVID-19 with treatments
  13. 13. 13 Goals of COVID-19 treatment - Protect against infection - Prevent disease from getting worse/critical - Shorten hospital stays - Save lives
  14. 14. 14 COVID-19 is complex, so we need many approaches + COVID-19: NOT JUST A RESPIRATORY DISEASE nasal heart eye liverIleumlung - Antiviral therapies
  15. 15. 15 Research overview Sources: Milken Institute, Antibodies Antivirais Cell-Based Therapies RNA Based Treatments Dormant/Discontinued Scanning Compounds to Repurpose Others Antivirais COVID-19 Treatments and Vaccines (combined) 216 treatments in consideration 133 vaccines in development 1,518 clinical studies
  16. 16. 16 Existing medicines A quicker path to testing - (Hydroxy)-chloroquine (antimalarial medication) - Azithromycin (antibiotic) - Favipiravir (influenza antiviral) - Lopinavir-ritonavir (HIV antiviral) - Nitazoxanide (antiviral, antiparasitic) - Dexamethasone (corticosteroid) - Interferon-beta (immunomodulator) - Intravenous vitamin C - Angiotensin-converting enzyme 2 or ACE2 (CVD diseases, acute lung injury) - DPP-4 inhibitors (used for diabetes) - Enoxaparin sodium (anticoagulant)
  17. 17. 17 Remdesivir T: RNA building block T: remdesivir FDA grants Remdesivir emergency use authorization for COVID-19 The drug is not a cure, but has been shown to help the sickest COVID-19 patients. HOW IT WORKS:
  18. 18. History repeating itself: convalescent plasma HOW TO “BORROW” ANTIBODIES: The Race to Get Convalescent Plasma to Covid-19 Patients COVID-19 patient Recovery Blood draw Screened for Virus-neutralizing antibodies in plasma Prophylaxis Therapy COVID-19 patient COVID-19 exposure Serum 18
  19. 19. 19 Neutralizing antibodies made in the lab POTENTIAL USES: 1. Prevent people at high risk from becoming infected 2. Prevent those infected from developing severe respiratory problems 3. Treat people who are already in respiratory distress Spike protein
  20. 20. 20 Neutralizing antibodies in development
  21. 21. 21 Modulating immune response to COVID A delicate balance - Too much can harm you - Too little leaves you vulnerable
  22. 22. 22 Defusing overactive immune responses
  23. 23. vaccines…the key to normalcy 23
  24. 24. 24 Recovery phase: additional waves Pandemic Waves (1918 - 1919)
  25. 25. 25 Creating a vaccine at pandemic speed Source: CEPI Access: Geographic spread of manufacturing and development Sites and pursuit of emergency Authorization before licensure COMPRESS clinical development EXPAND early large-scale manufacturing
  26. 26. 26 Three things to avoid: Vaccine efficacy: Ability of a vaccine to work as intended to protect from illness Vaccine-associated risk: Probability increased adverse event that harm the individuals or population ACCELERATED TIMELINE - Harmful side effects - Vaccine immune enhancement - Long-term public distrust
  27. 27. Vaccine approaches: 27 41 21 17 16 12 11 7 7 2 Protein subunit RNA-based Other Non-replicating viral vector Replicating viral vector DNA-based Inactivated virus Virus-like particle Live-attenuated virus Source: Milken Institute
  28. 28. Vaccine candidate landscape 28 Ongoing Human Trails: - CanSino Biologics — Ad5-nCoV (Phase 2) - Moderna — mRNA-1273 (Phase 2) - Wuhan Institute of biologicalProducts/Sinopharm — inactivated (Phase 1/2) - Wuhan Institute of BiologicalProducts/Sinopham — inactivated (Phase 1/2) - Sinovac — inactivated + aluminum (Phase 1/2) - University of Oxford/AstraZeneca — ChAdOx1 (Phase 1/2) - Pfizer/BioNTech/Fosum — BNT162 mRNA (Phase 1/2) - Inovio Pharmaceuticals — INO-4800 DNA (Phase 1) REPURPOSING DRUG ANTIBODIES GMP PHASE 1/2 VACCINES PHASE 2/3PHASE 1GMP 2020 Mar Apr May JulJune Aug Sep Oct DecNov 2021 Jan Feb May MatApr Jun Jul Aug Sep
  29. 29. Science will prevail over COVID, but it’s going to take time 0 10 20 30 40 Confirmed Unconfirmed Confirmed Unconfirmed Confirmed Unconfirmed Confirmed Unconfirmed North America China Europe Asia and Australia* Numberofprojects 20 m 11 m 4 m 3.25 m 65 days 6 1812 Months SARS April 14, 2003 H5N1 influenza Feb. 11, 2006 H1N1 influenza April 27, 2009 Zika April 24, 2016 Coronavirus Jan. 13, 2020 NIH Vaccine Research Center: Vaccines For Emerging Disease Sequence Selection to 1st Human Injection 29 Source: Nature Reviews, Drug Discovery
  30. 30. 30 good to know, but ... what do we do in the meantime?
  31. 31. plan for workforce re-entry 31
  32. 32. Employers must start by building trust with their people Updated on: April 17, 2020 Source: Weber Shandwick and KRC Research, Coronavirus Pulse Poll: National Survey Results of employees are afraid their employer will bring people back to work before it is safe 45% 84% of employees want their employer to provide better health and safety precautions before they come back THE BEST WAY TO BUILD TRUST WITH YOUR EMPLOYEES? Involve them in creating your re-entry strategy
  33. 33. 33 Consider internal and external factors to keep employees healthy and safe • Look at the local situation – the circumstances in the communities where you’re situated • Consider whether the community infrastructure exists to enable your people’s re-entry (e.g. childcare, safe options for commuting, etc.) • Rely on trusted sources • Learn from those who are going before • Adjust on-site expectations not only by job / role but also by employee risk factors • Adopt new containment practices and protocols • Encourage symptom identification, recovery and isolation with paid sick leave and other supportive policies • Retain a medical advisor or in-house clinician to support re-entry • Consider providing surveillance technologies, but understand their limitations INTERNAL FACTORS EXTERNAL FACTORS
  34. 34. Who should re-enter and when? 34 Low infection risk Higher infection risk LOCATION-FLEXIBLE ROLES 01 02 Prioritize the return of employees who fall into this segment Hold on returning employees here – watch and learn Hold on returning employees here – watch and learn Highest risk category – find other alternatives until risks are reduced Adapted from Governor Cuomo’s guidance for re-opening New York State “ON SITE” ROLES
  35. 35. Key elements of a re-entry plan Every organization has its own set of risks and business realities, but all employers should be developing protocols in these areas as part of re-entry planning: Testing Requirements Handling of New Diagnoses Contact Tracing Metrics for Shutdown Site Entry Workplace Configuration Work Schedules Commuting & Travel Sanitation Procedures Mask Requirements Ventilation TESTING LOGISTICS CONTAINMENT
  36. 36. Testing your workforce We need better diagnostic tests to make screening for COVID-19 inexpensive and routine.” WHAT TO KNOW SCOTT GOTTLEIB, FORMER COMMISSIONER OF THE FDA - Employers can now test for COVID-19 as a condition of entering the workplace - Testing isn’t always accurate - Availability of tests varies - Employers should consider providing free testing and establishing pop- up locations where tests can be administered - Employer-sponsored testing must take into account employee privacy considerations - Testing needs to be linked to HR and Legal strategies and broader community-based contact tracing 36 The reasonable win is not zero cases but dealing with the cases you do have effectively.
  37. 37. Surveillance technologies: worth it or not? Symptom checking apps Fever screening cameras Social distancing wristbands Digital immunity badges Contact tracing apps 37 “. . . [some] experts said companies would be better off investing in a proven health intervention — lab testing for coronavirus — for their employees rather than shiny, new surveillance technologies.” NEW YORK TIMES
  38. 38. • Widespread testing (with right test) is critical, but might not be accessible • Our immediate hope is in therapeutics • Vaccines will get us back to normal, but they will take time • Proceed with caution in returning to the workplace Key takeaways 38
  39. 39. Trusted resources 39 COVID-19 News and Breakthroughs: COVID-19 Therapeutics Development: COVID-19 Johns Hopkins Disease Tracker: COVID-19 University of Washington Health Metrics: STAT National Institute of Health:
  40. 40. questions 40
  41. 41. 41 Forward to Work: Perspectives to Guide Re-entry Every Friday at 12pm EST, May 8 through June 19 (except Memorial Day weekend) Focusing on six perspectives: 1. Public affairs 2. Public health 3. Operational readiness 4. Employee resilience 5. Learning and development 6. Corporate reputation Topics to evolve / get added based on emerging trends
  42. 42. Forward to Work Understanding Treatments and Vaccines