As one of the nation’s leading experts on drug and vaccine delivery, Dr. Peter Hotez, codirector of the Center for Vaccine Development at Texas Children’s Hospital, has become an almost ubiquitous presence on CNN, MSNBC, and Fox News. But while he’s reliably been loath to discuss the politics surrounding the COVID-19 pandemic, across the last week or so, as Texas’s numbers have risen, he’s done a noticeable about-face; he’s begun using his television time to counter a White House narrative he describes as a “fairy tale spun by mediocre people” and to decry “an absence of federal leadership.” He ended a recent tweet about the federal government’s failure to enact an evidence-based plan with a simple “WTF.”
“I’ve really worked hard to only talk about the science and not publicly criticize the White House or other elected officials, but I’ve had to depart from that,” says Hotez, who also serves as dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and has an endowed chair in tropical pediatrics at Texas Children’s Hospital. “What pushed my hand was the steep rise across our Southern cities, knowing that our low-income neighborhoods are especially getting hit, and, most likely, though the data isn’t in yet, it’s people of color, African American, Hispanic, and Latinx people that are piling into the hospital. So we are as a nation are failing to protect our vulnerable. And I reached a point where not being political, not really getting to the root of the problem, is in itself immoral.”
Hotez believes the White House needs to embrace a three-step process and explain the direness of the pandemic to the public, prioritize a federal strategy, and allow the CDC to take a leadership role that sets real parameters for the states. He blames the White House, not necessarily Governor Abbott and leaders in other states who opened early in the process, for the current resurgence.
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“I feel the governors across the Southern states were set up to fail by a federal government that never provided clear-cut directives,” Hotez says. “The strategy was just ‘let the states figure it out and the federal government will work to provide backup’—FEMA support, ventilator manufacturing, and PPE. But they didn’t provide clear-cut epidemiologic models on where each of the states was headed. They failed to provide clear information about what would happen if the states did nothing or if the states opened prematurely. They failed to tell the states, ‘This is what you need to do to save lives.’ And the reason they needed to do that was they were tone deaf to the fact that all of these governors, not just the Texas governor, are buffeted by forces to the left and right. And the governors needed the cover from the federal government to say, ‘Hey guys, look, I hear what you’re saying, but the CDC and the federal government is telling me if I don’t do X, Y, and Z, this many lives are going to be lost.’ And that would have given a lot of the governors a lot of cover to do what needed to be done. And so I place the blame squarely in the hands of the government and CDC for not being proactive and out there in the lead.”
In his third appearance on The National Podcast of Texas, recorded by phone Thursday morning, Hotez lays out a plan for a national strategy that would likely hinge on another quarantine period but would be more likely to allow schools to open safely in the fall. He also discusses the latest on vaccine research (his team at Baylor is working on one), the similarities between anti-maskers and anti-vaxxers, new approaches to diagnostic testing, and why it’s unlikely America could develop herd immunity.
Three takeaways from our conversation:
Hotez says that without a federal strategy in place this summer it will be incredibly difficult to reopen schools without causing another big spike in cases and hospitalizations.
“The current strategy is death by a thousand cuts. Doing it piecemeal is just going to ensure failure after failure. Right now, for instance, we want to open up the public school systems in Houston, San Antonio, and Dallas. But how do you do that in the middle of a raging COVID-19 epidemic? A week, maybe two weeks after you open the schools, some kids are going to get sick. What do you do then? And then some teachers are going to get sick and parents are going to get sick. And I believe that all it takes is one or two or three teachers going into the hospital, sick with COVID, and it’s lights out. That will demoralize everybody. And then we’re going to have to figure out something else. So I just feel that once again not only is the state being set up to fail, but a lot of the school systems in places where COVID-19 is still raging are being set up to fail as well. This idea that we’re going to do social distancing with a bunch of little kids? Kids hug each other, they cry, they need to be comforted by their teacher. They throw up, they have accidents. This is what kids do. And we’re going to have strict social distancing? No chance. We’re setting up the teachers to fail. It’s unfair.”
Hotez believes that without federal intervention, this week’s single-day record for new cases (just over 60,000) will begin to look like the new normal, or worse.
“In lieu of any kind of federal strategy or plan, the default is tragic. The default says we have 40,000 a day a couple of weeks ago. Then we have 50,000 last week, then 60,000. Next week? 70,000. And within a pretty short period, we’re going to reach Dr. Fauci’s apocalyptic prediction of 100,000 new cases a day, and it’s going to continue to climb. That’s how this virus works if you don’t have a strategy. And then we’re going to have to deal on top of that with a flu epidemic that we deal with every year. And that itself is pretty serious. And now we’ve also got a new situation where we’re seeing a drop-off in measles vaccinations among kids, because parents have been skittish about bringing their infants and other kids to the doctor because of all the COVID circulating. So who knows, we could be looking at a triple epidemic of these three. This is really starting to unravel society. This is going to affect the economy and the security of our country. Even if there is a change in leadership in November with the election, there’s a lot of damage that could be done between now and then. And that’s why I’m pushing so hard on this, because I still think there’s a lot we can do right now.”
While COVID-19 may be caused by a novel coronavirus, Hotez does have particular experience with coronaviruses. In March, he testified before the House Committee on Science, Space and Technology about a vaccine his team created in response to SARS, but because he couldn’t find the necessary funding to begin clinical trials, it sat untouched for four years in a Houston lab freezer. His team is now working on vaccine candidates, yet on The National Podcast of Texas in April, Hotez said even if a vaccine was found this year or next, he was “still not sure it would be a silver bullet.” A few months later, his position hasn’t changed.
We’re going to have vaccines. Creating an immune response against the spike protein and neutralizing antibodies is an old-school problem in biology. And we have a vaccine that we’re excited about, and there’ll be several. The problem is in the Operation Warp Speed vaccines. I don’t know that they necessarily picked the best candidates for inducing high levels of virus-neutralizing antibodies. So I suspect that many of the early candidates will only be partially protective, not completely protective. So ideally what you want in the vaccine is to do two things: one, to prevent you from getting sick and dying. The other is to stop the actual infection and interrupt transmission. And I think those first vaccines may help in the former, which is still very important, but it means we’re still going to have to maintain a lot of public health infrastructure. These are not replacement technologies, these will be companion technologies that we use alongside masks and everything else. And that’s going to require a lot of public health communication that doesn’t really happen right now. Operation Warp Speed has still failed to implement any kind of communication strategy. And hopefully that will come eventually.