 Peter Hotez, it's really lovely to speak to you again. You are talking here to the Illry Town Hall to whom you addressed. I think it was almost exactly a year ago, in March of 2021, when we covered a number of really fascinating topics at that time on anti-vaccine sentiment and the importance of vaccination and what was going on in Africa. It's a real pleasure to have you here today. Peter Hotez, tropical medicine specialist and vaccinologist at the Baylor College of Medicine and co-director of the Center for Vaccine Development at the Texas Children's Hospital. Welcome back to Illry. It's a pleasure to have you with us. It's great to see you again, Eric. It's been a tough year and the year that we've spoken last and look forward to catching up with you now. Thanks. So to follow on, really, from some of what we discussed last year, I want to ask you today to tell us a little bit about the global COVID situation as you see it, particularly in Kenya and Ethiopia, where Illry also has a campus, rules are being relaxed. In fact, it's a global phenomenon and your thoughts on that relaxation would be very welcome. And then I want to spend a bit of time talking about a COVID vaccine, the vaccine that you and Professor Botatzie in Texas developed. So perhaps we can start with your view on COVID globally at the moment. Well, globally, the numbers, no question about it are going down pretty precipitously. So that's good news. So we're starting to decline from that Omicron wave and also the sub variant, BA2. So they both seem to be declining pretty rapidly. Africa is doing better than the many parts of the Northern Hemisphere, although it's going down in the US and Canada as well. It's still quite high in Russia and parts of Western Europe. So those seem to be the epicenter right now. But the numbers are declining. And now we're starting to think about what does the post Omicron wave start to look like, both here in the United States and globally. Okay. So everybody wants to take their mask off. Everybody wants to play football with their friends. Everybody wants to sit in the canteen at tables with other people. Is that the right thing to be doing or should we retain a degree of cautiousness? Well, it very much depends on your local level of transmission. So for instance, what we've done here in the United States is our Centers for Disease Control is a broken down by county because the country is large enough so that the US is not homogeneous in terms of levels of COVID transmission. So we have this county level map to really look at the levels of transmission. And then it's color coded green, orange, red, and if it's green, then I think the thinking is yes, you pretty much can have life back to a pre-normal state. Now in Kenya, the official numbers look quite low and that's very good news. Now how adequate the surveillance is, I guess that's an important question. But if you look at the hospitalizations and ICU admissions in Kenya, it also looks quite modest. So it looks as though you're getting there, if not already to have something that resembles pre-pandemic existence. But here's the way I'm thinking about it. If I'm going in a crowded indoor area and I'm not having to socialize with a lot of people, I'll just put a mask on anyway to do that. I mean, it's not that much of an inconvenience. So I will generally wear a mask if I'm crowded indoors. So for instance, I'm here in my office at work right now with no mask on and my office with the door closed. But when I walk out into the hallway, I'll probably put a mask back on. And in fact, in our college, we still have that requirement. And I think that'll continue for some time. But in terms of when transmission goes way down, I think we can have a much higher level of comfort if you're vaccinated, of course. And everything I say comes with that asterisk that you're fully vaccinated and boosted if you have to have that opportunity. And remember, and I think the other big message is it doesn't mean that this is the end of the pandemic. Many of us, for instance, are still expecting another wave of COVID in the southern part of the United States and in Texas, like we saw in the summer of 2020 and 2021, and it comes in waves. And so I think the key is to have that anticipatory guidance to know that things are getting much better now. We're in a much better position than we were just a month or two ago, certainly that's nice in Kenya, but it's a fluid situation. And most of the models say that COVID-19 will return. I think there's disagreement among the scientists as to when, if you look at the models of people like Mark Lipsitch at Harvard School of Public Health, he suggested that to expect regular winter waves, at least in the northern hemisphere, starting in December, January, February. But a number of us think we'll see another one this summer as well. So the key is to have that situational awareness and to understand what's happening in your local area in terms of transmission when you have to be carefully yet again or when you'll need boosters, etc. Thank you. That all sounds like a very wise advice. Thank you for that. Okay, so you mentioned vaccination. So first of all, let me congratulate you and your colleagues on COVID vaccine, the vaccine that was developed in your laboratory. I think a very major development, particularly since it's patent free, as far as I understand it, and potentially very important product in many parts of the world. So I wonder if we can take a moment to hear a little bit about that vaccine from you. If you can tell us a little bit about what it is, comparing it maybe to some of the other vaccines, how you went about making it and where it's available currently. Maybe not to start. Thank you, Peter. Sure. So, you know, Eric, as long as we've known each other, and it's been a long time, you know, in our association with plus neglected tropical diseases, I've been interested in vaccines for parasitic infections. And we have a schistosomiasis vaccine, a now a vaccine for chagas disease and another parasitic diseases in various stages of clinical trials. And early on, we decided we were going to use a low cost approach, particularly relying on a yeast expression, because vaccines made with yeast expression, most notably the hepatitis B vaccines are made locally in countries such as Vietnam and Bangladesh and India, Indonesia, Brazil and Argentina. And the idea was, well, if you're going to make a low cost vaccine for global health for parasitic diseases, which is what you need, that would be the best technology because the highest likelihood of doing technology transfer to local production facilities. And so that's, you know, it's pretty much all we know how to do is make low cost recombinant protein vaccines in yeast and sometimes bacteria sometimes will do other expression vectors. So when we started our coronavirus program vaccine about 11 years ago, because we recognize the need to make coronavirus vaccines for SARS and mirrors, and they were also orphaned, that's the approach we used. And we did a lot of invested a lot of time and effort to show how you make recombinant protein coronavirus antigens in Piki a pasturis, which is a type of yeast that's used at the industrial scale. And so when the COVID-19 sequence hit, I came online in January of 2020, we said, you know, the same thing that we've always been doing successfully. And we used all of the modifications that we used for SARS and mirrors, including expressing it without the N terminal amino acid, because it's so heavily glycosylated and getting rid of some of the cysteines to prevent intermolecular disulfide bond formation, all of those things that you need to scale up production without a lot of roadblocks. And it worked really well for COVID-19. So we had made it and we decided that we weren't going to put a patent on it, mostly because of our feeling that, as I like to say, when your house is on fire and you can make a phone call, you don't call the patent attorney, you call the fire department. So we wanted to be the fire department. And that went well. And then we've transferred the technology to four vaccine producers so far. And we're in discussions with others. And each one is quite interesting. So one is Biological E in India. They're one of the big known vaccine producers that produces quite a number of vaccines for Africa and elsewhere. They're the furthest along, but also in Indonesia. We're doing this with Bio Pharma and in Bangladesh with Incepta. And we'll talk about in a minute a new production facility in Botswana, which came about from a very interesting way. And we're still open. We've had some discussions with Kenya. We've had some discussions with other African countries, including Morocco in Senegal about that possibility, because that's the technology that's in place in most countries in terms of low and middle income countries for making vaccines. So the one with Bio E in India is the furthest along. They've got 300 million doses produced. And now they've got really received emergency use authorization initially for adults 18 and up and now for 12 to 18 year olds. So they're starting to vaccinate the teenagers as well. So it's really exciting to come in and make that difference. And the advantage of our technology is scalability. There's no real limit to the amount you can make cost. It's probably the least expensive of the COVID-19 vaccines in India. It'll be 145 rupees a dose, which is about $1.90 a dose. Safety profile, it's probably one of the best safety profiles of any COVID vaccine, which you'd expect because it's similar technology to the recombinant hepatitis B vaccine, which also has a great safety profile, simple storage, simple refrigeration, and also acceptability because parents have been giving their hepatitis B vaccine to their young children and infants for decades. So when they see a vaccine of the same technology, they feel a comfort level there. There isn't the same concern that many families have about new technology vaccines. So when you go down the checklist, this really checks quite a number of boxes for a global health vaccine. Fantastic. And do you think it'll take its place globally in the lineup of COVID vaccines that are available to governments to buy or for people to choose? I hope so. One of the stumbling blocks has been the World Health Organization has held up emergency use listing of new COVID vaccines, in part because they've been doing that emergency use listing on the basis of vaccine efficacy data. And now what's happened, say in India, for instance, we have 85% of the population already infected. How do you do a placebo control trial now? It's very challenging. I mean, you'd have to enroll 300, 400,000 people to do a 30,000 person study. It's not doable. And I'm not even sure it's ethical at this point. So the WHO has not really figured out how to do those immunobridging studies. I mean, we showed that our bio, we showed the vaccine, which where they call it CorbiVax, is superior to the AstraZeneca vaccine in terms of virus neutralizing antibodies and durability in terms of holding up against the variants in safety. And that's the basis by which the Indian government authorized it. But I think the WHO is still struggling on that front. And we, and that's important because, you know, BioEs is prepared to donate it to the COVAX sharing facility, which would open it up for Africa. But the regulators need to come to terms with how they want to manage that. So I'm hoping that roadblock will be lifted soon. In the meantime, we're also having this fascinating discussion with the government of Botswana. So the president of Botswana came to see me last year. And he's now doing this interesting partnership with a company called Immunity Bio, where they're actually building vaccine infrastructure in Botswana, actually on the, on the edge of the Kalahari Desert. And, and so the hope is that that facility could start making this vaccine for, for Africa as, as well and others. Because I think that's going to be really important. I think, you know, for me, the big message of this COVID pandemic is that the reason we've had such horrific vaccine inequalities was by design that all of this funding support went to the multinational pharma companies who are primarily focused on the Northern Hemisphere, North America and Europe. And I think the hope was somehow all of the, that new technology would somehow filter to the low and middle income countries of the world, especially the African continent. And it really never happened or it happened way too later after the fact you see you yourself said, I think Kenya is only 15% of the population vaccinated in. And so our thinking was no, I mean, the way we have a different model where we partner first and foremost with vaccine producers in low and middle income countries who were sidelined and kind of pushed out of things like operational warp speed in the U.S. and all the G7 support. And I think that's a lesson learned that we've got to balance the vaccine ecosystem better. We're too dependent on the multinationals and the patents and all of that. And not enough on, on empowering vaccine producers, especially in the African continent. So we're trying to really build that capacity now with, excuse me, with Botswana and, and, and as well as now talking to other, other countries as well. So I think a big lesson learned is, you know, Africa cannot be left out like it was in this COVID pandemic and building self-sufficiency for vaccine production is going to be the number one, number one thing to do, which we can talk about the complexities of doing that. And presumably the, the catalysts, if COVID is a catalyst for that, those kinds of production facilities have value for a range of other diseases for which vaccines can exist and could be, could be locally developed like, like the hepatitis vaccines you mentioned, which presumably are currently not produced anywhere in Africa either. Right. What do you do, for instance, for vaccines of regional importance, but not necessarily global importance. So unless Africa, the African continent has vaccine producers, those vaccines wouldn't be made. An example would be a disease, which is of course widespread in, in Kenya, which is just a semitosis. We've developed a prototype for that vaccine, but who's going to make it, right? I mean, you're not going to get one of the big multinationals because they don't see an adequate market. So that's why it's critical disease. Yeah, that's the reason we call them neglected. Exactly. So I think that's, that's a major message that's going to be really important. So now we're also hoping maybe this facility in Botswana or others will produce just a semitosis vaccine, as well as some of the others, because that's an urgent need. I remember, for instance, years ago, the head of the African regional office of the WHO, Dr. Sambo, you know, grabbed me by the arm and said, we need a Buruli ulcer vaccine. Buruli ulcer is a big mourn in West, Western Africa and in Togo Ghana, etc. Who's going to make that vaccine? And and it's got to be, it's going to be have to be made in Africa. Okay. Yeah, well, I hope, I hope that comes to pass because that would be a major if we can catalyze this energy from COVID and make that better future for these kinds of medical products. That would be fantastic. Just one question about the vaccine itself. It contains adjuvants. What role do those adjuvants play? Are they different to what is in some of the other COVID vaccines? And adjuvants are sometimes quite expensive components of vaccines. Are they a major component of the cost of the vaccine? Well, first of all, one of the interesting aspects is the vaccines produced in yeast. So it's a vegan vaccine. So there's no animal cells, human cells, animal protein, human protein. And there are a lot of people who find that more acceptable. In fact, in Indonesia, now they're trying to have it designated as halal for Muslim majority countries because of that. So that's, that's, that's great as well. So it's the recombinant protein is on the alum together and with secondary immunostimulant such as a CPG oligonucleotide, which is TLR9 agonist or another place cases it could be done with a 3M052 adjuvant, which is a TLR7 agonist. And that really helps the vaccine as well. And, and that vaccine to be used either as a pediatric vaccine as well as well as as a booster. So, so let's say for instance, you've got two doses of the AstraZeneca vaccine, which has not held up very well against the Omicron variant by you could get boost in theory, you can get boosted with our vaccine. And that would restore its immunogenicity and as opposed to keep on getting vaccinated with adenovirus vectored vaccine, because you start making antibody to the adenovirus and then it starts limiting its effectiveness. So, so by having this as a booster as well, I think it's it can help a lot of other vaccines. So for instance, in Indonesia and elsewhere, we're looking at our vaccine as a booster for Sinovac or Sinopharm, the whole inactivated virus vaccine from China, or the AstraZeneca, which are those are some of the vaccines that are widely available in low and middle income countries to kind of help them along as well. Okay, great. Well, I hope WHO and the vaccine coordination mechanisms can sort out their their issues and get the, well, I guess it's have clinical trials on the scale that will allow this vaccine to be widely, widely approved. I definitely look forward to that. Yeah, I mean, one possibility is it could be introduced into a country and then you get your other effectiveness data sort of a phase four introduction pathway and that's being discussed. Or if things move along in Botswana, that that can move in a faster clip as well for for African countries. But the hope is that we can get my hope is that we can get the African continent vaccinated in the coming months because we need to because I think that's the only way to be that hedge against the variant. I mean, the nightmare scenario, imagine if you have the next variant that comes along, which is transmissible as something is Omicron, but actually produces greater severity of illness, then then we're going to be in very dire straits. And so we and I think we should anticipate that and vaccinate accordingly. So in that respect, how adaptable would your vaccine be to new variants? Is it would it be possible to change it slightly as new variants come along and to quickly ramp up production of a new variant type? It is whether or not that's going to be necessary as unclear because so far this is holding up pretty well against all of the variants. I've we've been asked about making an Omicron specific variant, but you know now pretty much Omicron's in the rear view mirror. And there's no evidence that the next variant coming along is going to be Omicron or Omicron like. And so I think what we've seen is the best bet has been to make vaccines based on the original lineage or close to it. And that seems to be the one that holds up the best against all of the variants to come. Okay. Great. And the last question I want to ask you because I know you have many other things to do today is around how the development of this vaccine was funded in the press around the development of this vaccine, which was announced in December. There was a lot of news around the fact that it was funded by private individuals, mainly, rather than through government grants or by big pharma or and so on. And that that in itself, I think is quite a major achievement to have garnered that kind of private sector interest. But presumably it speaks also to the fact that other people were focused on other things at that time, potentially about making money more than about making vaccines. So I just wondered if you if you had some some thoughts around how that process happened. Well, you know, we were kind of pushed out of operational work speed, which was the US development program, mostly because we were not a pharma company. And also they wanted all new technologies like mRNA or particle of vaccines or adenovirus technology, like innovation as well. The problem with innovation is it take could take you years to learn how to scale it up to the nine billion doses that you need for the world's low and middle income countries. So that was frustrating. We got a little bit of money from the US National Institutes of Health, $400,000 split several ways. So not not very much as and not much from the G seven countries. So we started raising it privately through various foundations in Texas and in New York and elsewhere and raised about $78 million, which doesn't sound like a lot considering the tens of billions of dollars given to the other pharma companies. But there's enough to get our prototype vaccine started and technology transferred to our vaccine producers in low and middle income countries. So it goes to show you that you that you can do a lot with with a little. But that was a tough part of the early on in the pandemic, trying to convince people that this this was needed and and and raising the fund for foreign being pushed out of the public funding. But we've got some funding from great sources, local foundation is here, the Claybrook Foundation, the MD Anderson Foundation, we got funding from Tito's vodka, which was not that I'm endorsing alcohol consumption. But if you do have a vodka drink tonight, see if you can get a bottle of Tito's, they're based in Austin, Texas. We some New York Foundation. That was hard work and we're still continuing to try to raise money because I want to transfer the technology to other vaccine producers. And also now we're looking at making a universal coronavirus vaccine as well, using the same similar low cost technology. Great. Okay, well, clearly clever fundraising and clever science. Peter. Well, you know, Eric, I mean, I mean, this, this is no surprise to the two of us, right? We've, you know, when you work and devote your life to something called neglected, neglected tropical diseases, you're always struggling for funds. And we've just learned how to adapt. And I think there's a lesson learned there as well. Absolutely. Thank you very much for those words of wisdom and for that excellent quick tour of this new technology. Thank you very much, Peter Hotez. Thank you. And congratulations on all your successes from Illry. As I remind you, I got my start in science working on African tropanosomalysis. And at that time, the lab was called Illrat. And I've had a very important influence on me in my chosen career of medical and molecular parasitology. So it's always exciting to come back to how it all began for me. Thank you very much indeed.