When the first indications of a new virus emerged in Wuhan, China, Julie Gerberding knew more than most what it might mean.
She had been director of the U.S. Centers for Disease Control and Prevention during the SARS epidemic in 2003. Also caused by a coronavirus — a cousin, more or less, of the novel coronavirus that causes COVID-19 — it sickened nearly 10,000 people worldwide.
Gerberding, an infectious-diseases physician who completed her medical residency at the University of California-San Francisco, also treated some of the first AIDS patients.
During her time at the CDC, she was a national resource, lending her expertise to the response to the anthrax attacks.
Now the executive vice president and chief patient officer at Merck, she recently discussed her perspective on the pandemic with us.
Given that it’s a matter of when, not if, the next pandemic comes, how can we be better prepared?
We need to be thinking upstream. Instead of waiting until something happens and then racing to create a vaccine or antiviral medicines, we need to think about how to predict where the likely viruses or bacteria will emerge. We need to intensify the ability to detect things before they actually spread in populations.
We also need a much bigger freezer-full of medicines and vaccines that we can pull out when we need them. We may not have the medicine and vaccine for the exact virus that emerges, but we could make vaccines for the families of viruses that we know about and that are most likely to emerge. That would really cut the time needed to develop a vaccine or an anti-viral treatment for a specific outbreak.
An organization called CEPI (the Coalition for Epidemic Preparedness Information) is already working on this. It’s a partnership of countries, including the U.S., and foundations, such as the Wellcome Trust and the Gates Foundation, and others. CEPI is working to expand the ability to develop what we call platforms for vaccines. If we had a coronavirus platform, when the next coronavirus emerges, we could more rapidly put the specific information about the new virus into the vaccine or tweak the antiviral medicine to more specifically attack the new variant.
You have drawn parallels between AIDS and COVID-19. What did we learn from HIV that we can apply to COVID-19?
I consider both to be pandemics. In one case, we’ve been having a slow pandemic for 40 years. In the case of COVID-19, it was an astonishingly rapid global spread of a deadly pathogen. But in both cases, we’re dealing with a formidable foe.
The second thing they have in common is that they disproportionately affect some of the most vulnerable and stigmatized people in our society. In America, for example, that means people of color and those who are in socioeconomic circumstances that prevent them from protecting themselves or getting good care. On a global basis, certainly the people in the most resource-limited countries are the least empowered and the hardest hit. We’re going to have to think differently about how we create response planning that is inclusive of the most vulnerable people in our society.
In both cases, people too often transfer their fear of the virus into fear of the people who are at risk. The consequences of that are stigma and too often actual assaults on people who are perceived to be in the risk groups.
Finally, in both cases, especially early on, misinformation and disinformation interfered with people’s accurate understanding of what was happening, and the common-sense measures needed to protect themselves.
What stands out about the CDC’s response to the coronavirus pandemic?
There’s no question that COVID-19 has been a daunting challenge for every public health agency. The CDC launched a tremendous effort to support our state and local health organizations. Altogether, they deployed more than 9,000 people to support the outbreak response. This includes the disease detectives of the CDC’s Epidemic Intelligence Service. They helped with things like the outbreak investigations in the meat packing plants and some of the nursing homes and health-care settings.
So the CDC has been out on the front lines, rolling up their sleeves, pitching in and doing what they can to help our state and local responders manage the pandemic. Their job is to help understand the who, what, when, where, why, and how of disease transmission.
And that, of course, adds insights and evidence that results in updated CDC guidance documents. One of the things I try to emphasize to people who say, “Well, first they said one thing, then they said another thing,” is that it’s important to continuously adapt to the new science as it emerges. That’s what good science does.
When a new pathogen emerges, you don’t know everything, and you have to do the best you can with the information you have. As you learn more, of course your recommendations are going to evolve. People should understand that it is a healthy sign of progress in responding, not something that indicates that there were mistakes made early on.
Another thing the CDC has done, in spite of all the attention on some of the early missteps related to testing, is to create more than 7,000 science-based guidance documents and respond to more than 74,000 inquiries from doctors, nurses and others on the front line. The CDC is an incredible information resource to both professionals and the general public.
How have the partnerships between government, industry and academia worked against the pandemic?
The first thing I would point out is that there are more than 830 novel vaccines, antivirals and immunotherapies in various phases of clinical development for SARS-CoV-2 on a global basis. That is breathtaking.
I think how long it took us with AIDS to even have one antiviral, and now we have this whole chest full of innovative medicines and vaccines in various stages of development for combating the coronavirus infection. None of that would have happened without government investments in research and academia, and biopharma investments in high-risk entrepreneurial research, much of which was started long before this particular outbreak. And then, of course, the larger pharmaceutical companies have stepped up to speed development of the most promising products and manufacture them at scale.
The partnerships to achieve the new medicines and vaccines are brilliant. Merck’s partnership with a small company called Ridgeback Biotherapeutics to help develop a promising antiviral is just one example. Likewise, Merck’s partnership with Johnson & Johnson to manufacture their vaccine will help supply the global need more quickly. These are just two of many unprecedented examples of how we are all coming together to do everything we can to help contain this pandemic.
The health consequences of SARS-CoV-2, are obvious. What are some of the other public health effects?
We are concentrating, of course, on the numbers of people infected, hospitalized and dying. But the pandemic is taking a much bigger toll than that. Hundreds of thousands of people are missing their cancer screenings. They’re not getting their prescriptions refilled for their diabetes, their hypertension or their other medical conditions. And they’re missing their immunizations. So, we are at risk for this pandemic having a very long tail of poor health.
We are already seeing increased mortality from cardiovascular disease and diabetes complications because those diseases are not being managed well. And, unfortunately, we’re going to see delays in cancer detection, which means harder-to-treat cancers with worse prognoses.
Near and dear to my heart is the fact that, around the world, children are missing their childhood immunizations, particularly their measles vaccines. Even in the United States, we have under-vaccinated an entire cohort of children against pediatric diseases, as well as teenagers against things like HPV cancer and other serious vaccine-preventable conditions.
So my message to the public is this: Return to care. Check on your cancer screenings. Pay attention to your chronic conditions. Catch up with your immunizations and those of your family members. Get back to the routines of taking care of your health beyond the COVID-19 crisis.