Latest / Health Ethics Podcast / How We Could End the Pandemic

Transcript

How We Could End the Pandemic · Health Ethics Podcast

• 0:10
  Welcome to the COVID Ethics Series podcast, a conversation with leading experts about bioethical
• 0:15
  issues that have been exacerbated due to the COVID nineteen pandemic. I'm Brian Pilkington,
• 0:21
  and I teach bioethics at Seatonhole University and at the Hackensack Marine School of
• 0:25
  Medicine. I moderate the COVID Ethics Series in cooperation with the IHS Library and
• 0:30
  IHS Student Life. This podcast is a spinoff collaboration with the IHS Library where
• 0:37
  we'll have the opportunity to go deep with the experts from our series. Thanks
• 0:41
  for joining our conversation. Hello everyone, and welcome to the COVID Ethics Series
• 0:57
  podcast. My name, as many of you know, Ryan Pilkington, and
• 1:00
  I t ethics at the Hackensack I'm ready in the School of Medicine and at
• 1:03
  Seton Hall University in the School of Health and Medical Sciences and the College of
• 1:07
  Nursing. It is my great pleasure to be speaking with Eli Adashi, the
• 1:12
  former Dean of Medicine and Biological Sciences at Brown University. Doctor Adashi is an
• 1:21
  academic, He's a physician. He's been an executive and is the first graduate
• 1:26
  of the Tel Aviv University School of Medicine. He also spent time at the
• 1:30
  Harvard Chan School of Public Health program in healthcare Management. I could read through
• 1:36
  an amazingly long TV but I'm so glad that you're here with us today,
• 1:40
  Eli, As I mentioned when we chatted in the break, I'm a big
• 1:44
  fan of your work and I've learned a lot. I mean, you're prolific.
• 1:47
  There's article after article after article, and it's just really great to have
• 1:51
  you on the podcast to welcome thank you. So we could ask you about
• 1:57
  a host of different topics, but I want what I want to spend our
• 2:00
  time on today is how to end the pandemic. So the covid Ethics series
• 2:05
  began thinking about ethical issues that arose in the pandemic. We are still going
• 2:12
  many folks that we would have wrapped this up before. The death toll is
• 2:15
  very high. Lots of folks have been sick, and you've done work in
• 2:17
  this area. Help our audience think through how they might and how we might
• 2:23
  end the pandemic. Right Well, I would say, in general, we
• 2:29
  need to do at least two things. Number One, we need to do
• 2:39
  our very best to make it difficult for the virus to replicate and mutate,
• 2:49
  and the way we can do that is by developing and administering intern days of
• 2:55
  vaccines, which would preclude the virus from entering our upper airways, and which
• 3:06
  is where the disease begins, of course, But in so doing will prevent
• 3:13
  the virus from living space, you might say, in it multiplies and mutates.
• 3:23
  So you gain really two advantages by so doing. One is you and
• 3:29
  I will have less to worry about in terms of contracting the disease, assuming
• 3:38
  many of our fellow men and women choose to self to vaccinate themselves with the
• 3:47
  Internaza vaccine. I don't think the anti vax movement is going to disappear tomorrow,
• 3:53
  so we can't assume that. But the more of us do it,
• 3:58
  the less likely you and I are going to be living in fear of contracting
• 4:05
  COVID, and more importantly, we would be curtailing the living space of the
• 4:12
  virus, and in so doing, in the long run, assuming this is
• 4:15
  done globally, we can hopefully come to a better place when it comes to
• 4:26
  COVID, So that would be step number one. But the foreseeable future,
• 4:32
  all of us will have to be protected against the significant likelihood of succumbing to
• 4:46
  the disease if we don't immunize systemically. In other words, I don't think
• 4:53
  we can do away with the intramuscular parental injections for the foreseeable future unless we
• 5:04
  can show that either the intransa vaccine is also affording systemic immunity or vice versa,
• 5:15
  that the systemic vaccine introduces upper respiratory tract infection upper respiratory tract community.
• 5:28
  Now, because the virus mutates and changes, ideally, both the INTRNESA vaccine
• 5:38
  and the ongoing intramuscular or parental vaccine would be best served by what is known
• 5:46
  as the universal quality, which is to say, be designed in such a
• 5:53
  way that will capture potentially all future variants. In other words, identify a
• 6:00
  particular sequence in the viral genome or by viral protein sequence that is unchangeable irrespective
• 6:14
  of the development of mutants. Assuming we can identify such a universal sequence,
• 6:20
  and if we can, then we can immunize against that universal sequence and thereby
• 6:28
  spare ourself repeated injections, which is currently the practice. Of course, you
• 6:34
  and I, in a likelihood had by now maybe five different injections depending on
• 6:41
  what product you use. But if you, for example, are using the
• 6:50
  Pfiser product, I suspect you've had five or six intramuscular injections by now,
• 7:00
  the most recent one being the booster that seeks to address the omicron variant and
• 7:10
  some of its relatives. So to recap really two things. One is we
• 7:20
  need universality of the vaccine if it exists, and if so, generate the
• 7:29
  appropriate vaccine, which would essentially then get us into an annual pattern, not
• 7:36
  unlike that which we follow with influenza and other vaccines, on the assumption that
• 7:46
  it will be good for a year, because the titles do go down over
• 7:50
  time, especially in senior citizens, but not just and so that would be
• 7:57
  one element. The interine is vaccine will accomplish two things. It will give
• 8:03
  us a freedom we currently do not enjoy. We may in fact be feeling
• 8:11
  much better about taking our masks off and still feel sufficiently protected to mix in
• 8:22
  society without second thoughts, and also, in so doing, as I said,
• 8:31
  constrain the living space of the virus, which is so important, but
• 8:37
  which will only be totally effective the more people pursue that option. I would
• 8:46
  say that, in theory, at least if everybody on this planet were to
• 8:52
  be willing to have a small sniff really a vaccine that will be sprayed,
• 9:05
  let's say, into your nostrils, if all of humanity pursued this little exercise,
• 9:13
  which should be painless, we can actually probably theoretically claim that the virus
• 9:24
  will be history because it will have nowhere to thrive except perhaps in the original
• 9:37
  animal source that it likely came from, but at least as far as a
• 9:45
  human reservoir. In principle, we could put all of this behind us.
• 9:54
  Now, of course, I put a lot of qualifiers and what I shared
• 9:58
  with you, we mentioned the interi vax movement. We mentioned we probably should
• 10:03
  mention the fact that not all nations, particularly poor nations, are in fact
• 10:13
  appropriately supplied and equipped to do what we just said, and so perfection is
• 10:22
  going to elude us here. It's not going to happen. But at least
• 10:28
  we know in principle what it would take to put this very unfortunate recent experience
• 10:41
  of ours behind us, potentially for good, because unless the virus develops all
• 10:50
  the new properties that we haven't planned on, you know, then that's it.
• 10:58
  At least we've dealt with that one. Lord knows there'll be others coming
• 11:03
  down the line, so we can't take too much comfort in such an accomplishment.
• 11:11
  But theoretically, and to answer your question, this is our view on
• 11:20
  what it would take to move forward and leave this in the you know,
• 11:28
  rear view mirror, if it were possible. I want to pick up on
• 11:35
  one of the themes you mentioned the anti vax movement, and I share your
• 11:41
  opin I don't think this is going away soon. I was curious maybe one
• 11:48
  of the additional benefits of the internasal vaccines is just from sort of an ethics
• 11:54
  argument perspective, we've heard folks from the anti VAXX movement be concerned about,
• 12:00
  say, to be diplomatic, the invasiveness of the intermuscular vaccine intra muscular vaccine.
• 12:05
  Right, So it's that when there are arguments rooted in conscience and other
• 12:09
  kinds of things, well, we often hear there's something very invasive about this
• 12:15
  when you run analogies and talk about comparison to folks seem to care a lot
• 12:18
  about this vaccine, but not about other kinds of things which might seem similar.
• 12:24
  So any thoughts you might have on whether there may actually be even more
• 12:28
  success given the intranasal vaccines because they seem less invasive. Yes, no,
• 12:33
  no, I think I follow what you're saying. I'm not sure there is
• 12:37
  a satisfactory retort to this. If I had to guess, I would say
• 12:46
  that the intervax movement is not so much about the discomfort of intramuscular injection,
• 12:54
  but has a principal view that that perhaps you and I may not share,
• 13:03
  but represents a long streak, I mean, a long lasting screek streak of
• 13:16
  views that seemed to be very American, you might say, if you go
• 13:26
  back to the Scopus trial, for example, in Tennessee, quite quite some
• 13:33
  time ago. Now, I think that gives you a sense of an element
• 13:41
  of the American psyche that has strong feelings about science about vaccination that are not
• 13:54
  necessarily shared by their fellow Americans, but the a long held views. As
• 14:03
  I said, going by way back, It's hard to say exactly where it
• 14:11
  fits. Does it have something to do with the drive westward, with the
• 14:20
  with American individualism, with a very fact that the Mayflower essentially started something completely
• 14:31
  new that allowed the flourishing of opinions that are not necessarily mainstream. I really
• 14:41
  don't have a satisfactory answer to that, other than to recognize the fact that
• 14:48
  the anti vaccine movement is as probably here to stay. It is a move
• 15:00
  that's based on certain convictions that you and I'm in our chairs, I said,
• 15:05
  but I think they must be considered and recognized and appreciate it for what
• 15:16
  it is so absent. In other words, I don't think the fact that
• 15:24
  intr nasal vaccines may come our way, and by the way, I don't
• 15:30
  expect that before the end of next year. Unfortunately. I say this,
• 15:35
  unless we import an Indian vaccine which is already ready to go and is being
• 15:43
  distributed in India, it's possible that it will make its way here. But
• 15:48
  locally produced vaccines are going to take a while. So much of what we
• 15:54
  said today is theoretical from that point of view, in that I'd be very
• 16:00
  surprised if the trials that are currently listed on clinical trials do god are going
• 16:08
  to make it to the FDA and to the approval process and the distribution process
• 16:17
  before the end of next year. I could be wrong, but I would
• 16:23
  tend to air on the conservative side. That's really helpful and for all the
• 16:30
  stens to listen to the podcast, especially the bioethics students. I very much
• 16:36
  appreciate how you framed that answer, both in terms of the history take us
• 16:40
  back to the scoptual, but also the context right of what's going on.
• 16:44
  I think that's the right way to approach ethics challenges in medicine and science.
• 16:48
  I wanted to pick up on a second theme that you mentioned, a challenge
• 16:53
  to the you know, the potential perfect solution, which had to do with
• 17:00
  UH distribution globally. So you know that there are some nations which may have
• 17:06
  I have some greater infrastructure challenges in pulling this off, and so I have
• 17:10
  a cluster of questions. Pick up any you like. Is there an ethical
• 17:15
  mandate for those who have this kind of vaccines innity to share it more widely?
• 17:22
  Do leaders of nations and to come together even more so than they have
• 17:27
  done? Is does there need to be more cooperation? Is this just too
• 17:30
  multifaceted and convoluted? So any sort of general thoughts about addressing the scope of
• 17:37
  the globe as opposed to an individual nation, right, Well, this of
• 17:44
  course came up when this pandemic began and the United States I think as a
• 17:52
  nation contributed to less fortunate nations at the time and potentially still as we speak,
• 18:07
  although I am not up in the details. And then of course there
• 18:11
  are several not for profit organizations that dedicate themselves to this very mission, and
• 18:26
  so I think the United States it's doing east part, both officially as a
• 18:30
  nation as well as by another very the I think characteristic American streak, and
• 18:40
  that is, you know, the care we show to those less fortunate in
• 18:47
  nations who, for one reason or another cannot afford to enjoy the kind of
• 18:53
  abundance of vaccine, for example, that we were treated to. So I
• 19:00
  would say, to just answer your first question, this has not been absent
• 19:06
  from the scene, and in my opinion, needs to be maintained clearly in
• 19:15
  our best interest, among other things, as I mentioned, because the more
• 19:21
  extensive the immunization process, nasally or otherwise, the more constrained the virus will
• 19:32
  be globally, and the less impactful it will become. So it's not only
• 19:38
  ethically imperative that we reach out to the less fortunate, but it is in
• 19:48
  our very best interest from a practical point of view, because if we don't
• 19:59
  all ban together to exclude the virus or preclude it from its living space.
• 20:08
  We are probably not going to eliminate it entirely, which means we're going to
• 20:15
  be left at the very least annual parentual injections and potentially renewable in tornasal vaccinations,
• 20:30
  because that too, is unlikely to last a lifetime. So I would
• 20:37
  say to answer your question, there's a little question, but that we should
• 20:41
  continue to think about nations who are less self sufficient, as well endowed,
• 20:52
  as fortunate than we are and extend a helping hand to them if it all
• 21:03
  possible. Before I let you go, I wanted to ask about education and
• 21:11
  educating sort of physician colleagues, future physician colleagues, educating health professional students.
• 21:17
  So we've seen, and you've done some work analyzing this as well, but
• 21:21
  we've seen a rise in violence and hostilities towards healthcare workers. For folks listening
• 21:29
  to the podcast regularly, we had Nancy Berlinger of the Hasting Center on two
• 21:33
  weeks ago, who discussed some of the challenges of occupational stress. More broadly,
• 21:37
  so ELI for students in medical school future health professionals. Any words of
• 21:45
  advice or recommendations as they enter the workforce, sort of during COVID, during
• 21:51
  future pandemics, and with the additional stress that appears to be put on physicians
• 21:56
  and other healthcare professionals. Yes, no, you're right, we have noted,
• 22:04
  as have others, of course, or maybe we simply better documented incidents
• 22:12
  of violence in healthcare settings, although some of them were so unthinkable. By
• 22:22
  that, I mean patients killing physicians and the like. I mean, when
• 22:30
  you stop and think about it, I really have not explored the history of
• 22:38
  such a phenomenon, but I became aware of it about in twenty fifteen when
• 22:47
  a patient walked into the Brigham Hospital in Boston and ended up killing his or
• 23:00
  his mother's cardiologist in cold blood. Of course, we had a TASA experience
• 23:06
  recently, and others, and so perhaps by dint of better communication, we
• 23:15
  are all becoming more sensitized to the fact that there's also been a growing effort
• 23:21
  to account for these events, meaning actually follow the numbers, if you will,
• 23:33
  and try to estimate trends that way, Is this getting worse, getting
• 23:42
  better, staying the same. But if you were to ask me, in
• 23:48
  general, we would have to assume that some modicum of violence in a healthcare
• 23:56
  context is likely to be a more or less permanent phenomenon, the degree for
• 24:03
  which is another question, which is exactly where we often come down on the
• 24:11
  issue, and we say that it's very important that every effort be made to
• 24:18
  protect healthcare professionals, and that's really the responsibility of the facilities wherein they are
• 24:26
  employed. Mostly that refers to hospitals, but I don't see why we wouldn't,
• 24:34
  should, and couldn't invest in the security of clinics, community health centers,
• 24:45
  you name it. It could happen anywhere. It seems like the emphasis
• 24:51
  in the last few years was on hospitals, but that does not mean that
• 24:56
  it will always be that way. I think that recognition is increasingly sinking in,
• 25:07
  meaning hospital CEOs, hospital boards, physicians, I think are increasingly recognizing
• 25:17
  the import of improving local security. And I would also say that more and
• 25:27
  more outside bodies like cms, like HRQ, like the ICGME and others are
• 25:45
  building staff security into their funding and their overall plans. I recently saw several
• 26:02
  reports from these organizations and perhaps others suggesting that that awareness is now sinking in.
• 26:14
  There's also a law that I don't believe has been enacted. But I
• 26:22
  mean there's legislation in front of Congress that is committed to providing healthcare institutions with
• 26:32
  grants that would help them improve home security, if you will. Once that
• 26:44
  bill is enacted, and I suspect it will be enacted, that will provide
• 26:49
  additional funds which we understand are scarce to begin with and are hard to draw
• 26:56
  upon. Other priorities compete incessantly, but this will help. It may not
• 27:07
  be enough, it may not nip the problem in its in the butt,
• 27:14
  but it will make some positive difference and I think that's probably the best we
• 27:18
  can hope for it this time. Thank you guys. Yeah, the future
• 27:26
  legislation, I hope or hopefully which will help to better protect those healthcare professionals
• 27:33
  who are working. The phrase on the front lines, and all the military
• 27:36
  analogies which have been used throughout COVID, I think really strikes home here.
• 27:41
  So thank you so much for the time for those listening in. I've been
• 27:45
  speaking with doctor Eli A. Dashi, the former gene of Medicine and Biological
• 27:49
  Sciences at Brown University and currently tenured Professor of Medical Science with the Warren Albert
• 27:55
  Medical School of Brown University. We will post a number of a number of
• 28:00
  articles from Professor Dodge on the web page with links connected to this podcast.
• 28:06
  So Eli, thanks so much for being with us. I really appreciate it
• 28:08
  my pleasure. Thank you. Thank you for listening to this episode of the
• 28:14
  covid Ethics series podcast. Be sure to check out video versions of our episodes
• 28:18
  online at library Shoe dot edu slash covid ethics, follow the show on Twitter
• 28:26
  at Shoe Bioethics, and our moderator me at bcp ethics. And if you're
• 28:33
  listening to this show on iTunes, Spotify, or wherever you get your podcasts,
• 28:37
  please subscribe and leave a review. If there's a topic you'd like to
• 28:41
  see discussed in the future, let us know