Over the past few weeks, Dr. Peter Hotez, codirector of the Center for Vaccine Development at Texas Children’s Hospital, has appeared on CNN, MSNBC, and Fox News, offering his views on the typical production cycle of vaccines, COVID-19 testing shortages, and the potential value of antibody therapy. Even with a reputation built across four decades as one of the nation’s leading experts on drug and vaccine delivery, Hotez says that, sometimes to the disappointment of his hosts, he’s loath to use these appearances to make long-range predictions about the race for a cure or when stay-at-home or social-distancing restrictions might be safe to lift.

“One of the things about a new virus agent is we build in a lot of assumptions when we really don’t know a lot about it,” 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. “So new virus agents set you up to make you look stupid. I’m always very careful to show some humility around them and say, ‘There’s a lot of things we don’t know.’”

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 one of what’s believed to be more than seventy COVID-19 vaccine candidates in development, yet Hotez says there are still so many unknowns about the fundamentals of the virus itself that even if a vaccine were found to be safe and effective in record time, he’s “still not sure it would be a silver bullet.”

“Even with a vaccine, we’re still going to have to put in place thoughtful rules for returning to work, and at times we still may need to implement social distancing,” Hotez says. “A vaccine is going to be an important technology, but it’s still not necessarily a panacea.”

On the National Podcast of Texas, recorded Tuesday afternoon over the phone, Hotez explains why it’ll take a comprehensive national plan that’s yet to emerge for us to safely return to work or school, and outlines the unique challenges Texas faces in its fight to get a handle on the virus.

Three takeaways from our conversation:

1. Hotez believes it is undeniably problematic that despite being the nation’s second-largest state, Texas ranks nearly last when it comes to COVID-19 testing per capita.

“The low rate of testing means we’re kind of shooting blind. And when you have that low rate of testing, what it means is you often don’t know about your epidemic until patients start showing up in the intensive care unit. Because that’s one thing that you can’t make up, right? If you have a patient in the ICU from COVID-19, you know about it. And that’s why I know things are bad in Houston, because we’re starting to see an increase in the number of patients coming into the intensive care units of the Texas Medical Center hospitals. And we expect that will reach a peak around May 1. And that’s what we hope to avoid. We hope to have more testing in place, so we didn’t have to find out that communities are getting being affected by ICU admissions. But unfortunately that’s the reality.”

2. Hotez is hopeful that finding an effective vaccine for COVID-19 might be possible more quickly than the average of ten to twenty years. But he also cautions that the standard vaccine timeline doesn’t leave a lot of wiggle room for compression.

“There’s no question that putting enough money behind it and doing more things in parallel, we can greatly accelerate timelines. But I think you hit up against the wall at a certain point because you need time to evaluate these vaccines to see if they actually work. Even though we’ve been testing our vaccines on laboratory animals, you still don’t know for sure if they’re going to work in people. And you want to know that they’re safe, that they’re not triggering any safety signals, any adverse reactions. And those two things are tough to compress. And I understand a lot of vaccines are now moving into the pipeline for clinical trials, including, I hope, ours, but then that’s where the bottleneck occurs. So we certainly won’t have it in time for 2020. Maybe if all the stars align and there’s no unexpected problems, maybe 2021? But how many times have we done anything substantive and there are no unexpected problems? There always are. So we’re doing our best and we’re working nonstop. But we have to be mindful of the fact that the record is four years and trying to do this in less than two is going to be a struggle. But I don’t want to throw cold water on it. This is country that built the Manhattan Project and created the polio vaccine. So we don’t know for sure.”

3. Hotez says that Texas’s size, poverty rates, and high volume of businesses that operate on a global level present the state with its own set of challenges when battling a highly contagious virus.

“We’re a region with a health disparity component. We saw this when the virus moved into New Orleans. We saw a very high case-fatality rate, especially with people living in poverty. And the reason for that is people who live in poverty have trouble practicing social distancing because they live in crowded neighborhoods, and there are cities in Texas that have that problem. Also, a high percentage of African American and Hispanic populations have underlying diabetes, hypertension, and renal disease, which we know are major risk factors for more severe illness or even death. And our cities are our gateway cities. Houston for instance, is the most international city in the country and that’s a huge, vibrant part of our economy. But it creates some vulnerabilities in that we have people coming into Houston from all from all over the world. We’re a hub to two major airlines and have the big Port of Houston that’s accommodating the widening of the Panama Canal. That puts us at the center of international commerce, and there’s also the oil and the gas industry, which by its very nature is extremely international. This is what makes Texas such a very cool place to be. It’s one of the reasons why we live here, but it also helps create some vulnerability as well.”


(Excepts have been condensed and edited for clarity.)