The Economic Hurdles of Vaccines | Joe Rogan & Peter Hotez

I find that a lot of people that are steadfast in their resistance to vaccines, they also believe in a lot of other questionable things. It seems like these things get lumped into these groups of things that they don't trust the government about. Right, right. Yeah, I think that's probably true. Yeah. That's what's left about having a fancy government. Which was interesting. It was interesting. So, you know, I said we need to hear from the Centers for Disease Control and more in the Surgeon General. Now they're starting to speak out. But people accounted for that and said, well, part of the problem was people don't trust their government. And I said, well, that's true of some. But I think most people, if we had a more visible public health force out there, people would listen to it. Well, I think that what you're talking about in terms of these poor neighborhoods and these parasites getting into people's system and affecting cognitive development. And what was the other one besides Chaga? What was it? Toxicoriasis was the one that affects cognitive development. And the fact that there's actual cures for these things, too. I mean, that... I estimated in a paper there are 2.8 million African Americans living in poverty with toxicoriasis. Wow. This is not a rare disease, Joe. This is a common disease. But it's so unknown. But it's occurring among the poor and it's a chronic and debilitating infection. It's not dramatic. It's not Ebola. It's not killing people. Is this mostly in warmer climates as well? It's probably... It's more common in the south than in the north. Is it because they have longer time to stay alive? Yeah, because the eggs are in the environment and the worm develops within the egg. Is there any other diseases that are going on that we don't know about? The most we're not aware about? Yeah, sure. There's other... There's a brain parasitic infection called cystocercosis. What's that one from? That one is from eggs, often from individuals who have a tapeworm. So that's... We're seeing cases of that. There's some of the viruses transmitted by mosquitoes. One of the ones we don't talk about a lot, which is a very serious infection, is West Nile virus infection. That's got very high rates of not only encephalitis, but also one of our faculty members, Christy Murray, is showing very high rates of depression and other neurologic debilitation for... And that's another one we could probably use a vaccine for, but there isn't the market incentive to do it. West Nile virus does come up though. At least that's discussed in the news and people are aware of it. Right. Right. As soon as you said it. Right. But there's no vaccine. There's no vaccine, but there could be. What is it? There could be. What's holding it back? What's holding it back is lack of market forces, lack of financial incentive for the pharmaceutical companies to take it on. So there's an extremely large investment to develop something along those lines? That's right. Yeah. I mean, vaccines are, from an investor's perspective, a tough sell because there's a possibility... First of all, you need many years of clinical trials. It can sometimes take two decades from the original conception of a vaccine to actually going through a clinical trial. So the Hookworm vaccine I've been working on, we've been doing it since the 1990s. So we're talking decades long time horizons when you talk to an investor about something with decades long time horizons. Yeah. You figure it out, right? The lights go out, I mean, very quickly. That's where it gets gross, right? Because this is all, we were relying on these private businesses to invest money to cure a public health issue. That's right. That's right. That seems kind of crazy. Well, so in response to that, what happened was after the Ebola fiasco in 2014, where we didn't have any Ebola vaccine in Guinea, Liberia, and Sierra Leone, a group of individuals came together at Davos, the World Economic Forum, and including the Gates Foundation. And they put around... They developed this concept, or which an organization called CEPI, the Coalition for Epidemic Preparedness Innovation, to incentivize biotechs and pharmaceutical companies to embark on diseases for which of pandemic potential, like Ebola, like Lassa fever, like MERS coronavirus infection. And that was great, but the problem was they didn't address these poverty-related diseases. So those of us who were working on poverty-related diseases are still kind of on the outside looking in. It just seems like having everything managed by private companies that need to... They need to have some sort of a financial incentive to attack these diseases. That seems like a crazy way to deal with health crises. That's right. That's right. And so what I've recommended, as I said, that organization CEPI is great for what it's doing, but we need another mechanism. What I've proposed is that since these diseases are so common among the poor in the G20 countries, these are the 20 largest economies to put together public sector funds for that purpose. Public sector funds for investing in developing vaccines and treatments? Not for poverty-related diseases, these chronic debilitating diseases. And in fact, we can show that using working with health economists, we actually work with a terrific health economist. His name is Bruce Lee of all names. He's a professor at Johns Hopkins. Seems like you would change your name. Yeah, right. He loves it. And he's been able to show that our vaccines are not only cost-effective, they're cost-savings, meaning that they're economically dominant, that they'll actually save money. The problem is, it still doesn't help you with the fact that you still need some, but the return is on public health. You still need somebody to come along and provide that investment. So what's happened is our technical ability to develop vaccines has outstripped our financial instruments that we have to do it. So I get a stream of young people in my office wanting to go into global health. I mean, the commitment for this next generation, I know they get a lot of bad press, but a lot of my impression is this next generation, their commitment to public service is at an all-time high. And they say, you know, Dr. Hotez, I'm all in. I'm going to go into global health. And they're a little bit disappointed when I tell them, get an MBA or get a law degree, because where we need the innovation now is in the finance sector. There must be a business model out there that would work, that would figure out how to do this. I just don't have the background to do it. It seems like once the momentum is in the corner of this being handled by the private sector and that the private sector has to develop these vaccines and these treatments, and they have to do it with some sort of a financial incentive. If they don't have a bucket of gold at the end of the rainbow, they're not going to take a ride. That's right. That's right. So fuck, that's crazy. That's crazy. But that's the reality. And so what the exciting thing about what I do is, you know, developing these vaccines for poverty-related diseases, there's no roadmap. Right now, they're in clinical trials. I don't know what the roadmap is to get to licensure and getting these vaccines out to the public. The terrifying thing that keeps me up at night is there's no roadmap. Right. So it's both good and bad. There is... How much does it cost to get a vaccine, I mean, in general, from developmental period to actual application? Well, the pharmaceutical companies have traditionally said billions, but I don't think that's the case. I think one of the reasons they're doing that is because they're also recovering their R&D costs. You know, they're putting money into R&D that they charge in order to, you know, either make a profit or at least stay even. So for instance, the cervical cancer vaccine, the HPV vaccine, that, you know, when I last looked was $420 for the three doses, it doesn't cost $420 to make that vaccine. It's just that they're recovering their R&D costs, which is fair enough. So one of the things that we're proposing to do for our neglected disease vaccines is we'll delink the R&D costs. In other words, if we've gotten grants, whether it's from the Gates Foundation in the past or the NIH or the European Union or the Dutch government or the Carlos Slim Foundation, we're not going to pass those costs on. We'll just, you know, that was used for R&D and we would just cause for the cost of goods. So at least we can get it down to just a couple of dollars a dose, a few dollars a dose.