The Safety & Efficacy of Potential COVID Vaccine

Can you describe what's going on with these mRNA viruses and how they differ, excuse me, mRNA vaccines and how they differ from a regular vaccine and what's coming down the pipe from Pfizer? These are mRNA vaccines. It's different in that it doesn't actually contain the virus, but it boosts your body's ability to fight off the virus. Yeah, so there are many different ways of developing vaccines. And the idea, the general idea behind a vaccine is that we want to give you kind of an ersatz infection. We want to expose you, make it as if you had been infected, but without the risk of getting the disease to trick your immune system into mounting an immune response so that your body is then prepared if it gets the real infection to fight it off. And one of the simplest ways you can think about it is so-called live attenuated virus. This is an old technology where you take the virus to the laboratory, you culture it hundreds of times and hope for mutations that weaken the virus's ability to make you sick, but nevertheless keep the virus able to elicit an immune response. And then we give you that strain as a shot and you have, let's say, a mild illness, you develop antibodies and immunity and it's sustained. Or you can have inactivated virus, like one of the Chinese, the Sinovac vaccine that was one of the first to start, which was out of China, is a live attenuated virus. So that is, I'm sorry, did I say live attenuated already? I can't remember. But anyway, the Sinovac vaccine is a virus in which they take the virus, I'm sorry, no, it's not like the previous example. In this case, we take the virus and we treat it, let's say, with heat or with chemicals to kill the virus, but still have it be immunogenic. And that's another approach. And there are many other approaches, a dozen or so, or nine or 10 different approaches, one of which is this mRNA idea. And here what is done is, so I'm sorry, before I tell you about that, another approach might be to take the RNA from the coronavirus that codes for a very important protein, the spike protein on the surface of the coronavirus and insert that into a really benign virus, let's say like a cold virus, for example. So we take this other species of virus, we genetically engineer it so that we insert some material, some RNA into it, let's say, that forces that virus when it infects your cells to give you a common cold, but also to express this protein as if you had been infected with COVID or coronavirus. And then you mount an immune system to that immune response to that protein, and now you're immune. So we gave you like a mild illness and we protected you from a more serious one. The mRNA viruses, vaccines are sort of like that. We inject you literally with RNA. And the idea is that your cells take up the RNA and start making the protein, the alien protein that your body would have made. Like if we had infected you with a real coronavirus, the real coronavirus, as many people remember from high school biology, the virus can't reproduce on its own. It inserts its genetic material into our cells, which then start producing the virus itself. But now in a sense, instead of giving you the whole virus, we give you a little part of it, just some part of its genetic material, the mRNA, which in an ideal world does the same thing, gets inserted into your cells. You start expressing this protein, which then your body attacks and you develop an immune response to it. And we are amazingly lucky that our scientists have been able to develop not one, but two different vaccines. And we'll have many other vaccines using different modalities. I have no doubt that come out in the next year or two. But the Moderna and the Pfizer vaccines were very lucky that they exist and that they are apparently quite effective. But the story is not over on those. I don't know if you want to talk about that, but it's good news, but I don't want people to get over optimistic either because it's my job to be a bit of a downer. Well, this is the unfortunate narrative that people keep saying. The virus is killing, it's like the average immune system is 99 point whatever percent effective in protecting you from the virus, meaning 99 point whatever percent of the people who get the virus survive. Whereas 99 percent of people overall survive. One percent will die of all people who are infected approximately. And if you're older than 70 or 80, 20 percent will die. So why is the number that people keep talking about far less than that? Why is the reported number of people that get the virus who actually wind up dying, it's not one percent. We're not seeing one percent nationwide in terms of people getting the virus and dying. No, we know the answer to that question. I don't think there's any ambiguity scientifically. So in order to really compute these numbers, it's not easy. You're right. We have to look at how many people have to have a way of ascertaining who is infected. And then we have to have a way of ascertaining of those how many die. And and and that's called the infection fatality rate. And there was just a recent meta analysis looking at very good data from around the world, multiple studies using different approaches that estimated that the infection fatality rate is between point five and point eight percent. And there's something called the case fatality rate is the fraction of people who have symptoms who go when infected, who die. And that number is about twice that. So about half the people get the virus and have no symptoms at all. So if you get symptoms, you have a higher risk of death. And so you can double point five to point eight becomes one to one point six percent of people who who develop symptoms from the disease die. And there was another very good study that was just released a couple of weeks ago that estimated the infection fatality rate to be about one percent. So there's a lot of numbers I've thrown out. But this is symptoms. Yeah, but even without symptoms, the infection fatality rate is certainly not less than half a percent and could be as high as one percent. I would say it's going to be in that range, the IFR, the infection fatality rate. Isn't there a large percentage of people that get it that don't have symptoms? Half about half, we think that's right. OK. All the people who get it don't have symptoms. But you said ninety nine point something percent of people who get it survive. And that point something is important. So I would say that if you said ninety nine point five percent of the people who get infected survive, I would say, yeah, could be. But it's somewhere in there. I don't I don't think I gave a number. I think I said ninety nine point something. But the point being that unfortunately, a lot of people saying this vaccine is ninety four percent effective or ninety percent effective. Yeah. What that means is that if it reduces your risk of death by that fraction. So for example, in the vaccine trial, in the Pfizer trial, these numbers are approximate. They had about forty three thousand people in the trial. Half of them got the vaccine. Half of them did not. And in the people who got the vaccine, nine people up to nine, let's say nine or ten, got even though they were vaccinated, still got coronavirus, still had the disease. The vaccine was not perfect. And in the people in the arm that did not get the vaccine, the other twenty thousand people, let's say 90 people approximately got coronavirus. So what the vaccine did is is it reduced your probability of getting the disease from 90 out of twenty thousand people over the time window of the study to 10 out of twenty thousand people. So the point here is is that the vaccine is reducing your risk of getting seriously ill if you're infected. And and and it's not and you're certainly better off. In other words, you would have had, let's say, a one percent chance of dying before. And now you have a point one percent chance of dying, 90 percent lower than that because we we've given you the vaccine. I completely, I understand exactly what you're saying. What I'm trying to say is there's an unfortunate narrative where people are saying I'm not going to take a vaccine because the human immune system is more effective than the vaccine. That's not true. That's what I wanted to get out of you. Yeah, yeah. Yeah. Go ahead. Well, no, I'm saying the vaccine the whole way vaccines vaccines work is it enhances your your performance. You know, it's like it stimulates your immune system to make it even better at fighting the virus. There's there's no sense in which you could argue that an unchallenged immune system is superior to a challenged immune system, a system that has been, you know, been given a vaccine. So this is what's important to tell people, right, because this narrative of ninety nine percent of the people who get it ninety nine point whatever your immune system is effective in fighting off this disease. Whereas with the virus, it's only ninety plus whatever percent effective in preventing the virus. So this is not a this that's not a good narrative, correct? That's right. And the way to think about it is just to pick some round numbers as you were saying and like and like like me, you sometimes use the word virus when you mean vaccine and you use the word vaccine when you mean virus. I'm sorry. I do that all the time. Yeah. I do that all the time. It's so annoying. Yeah. And I think for the sake of argument, you have an unvaccinated you have a ninety nine percent chance of surviving if you get infected. Right. You have to add to that the benefit of the vaccine, which is a ninety percent, let's say, effectiveness. So it'll reduce your probability from ninety nine percent chance of surviving to ninety nine point nine percent chance of survival. Thank you. That's exactly what I wanted to get out of you. Yes. And that when when you talk about the people that took the vaccine and we know you have the data between the difference of the vaccine, the people that got the placebo, the people that got the vaccine that still wound up getting covid, did they do health screens on these people and find out what comorbidity factors they may have had and see if there's anything that would indicate that there's particular risks? We don't know that yet. Those results haven't been released. And also what we don't know. So we don't know the answer to that, but we will know. And also what we don't know yet is we we don't know how safe the vaccine is. So first of all, just to be very clear, both Pfizer and Moderna have released interim results. And we have every reason to believe that the final efficacy results will be about the same. So as they complete the trial in the coming month or two and more people get sick in both arms, we don't expect suddenly the vaccine not to work. I mean, we've gotten to a point where it's we're pretty sure that the vaccine will be effective. But we don't yet know the safety of the vaccine is one thing we know, nothing we don't know. And we also don't know something else is very important for people to understand again. And since everyone needs to be an immunologist now, imagine that you're doing a trial and you're trying to see whether a vaccine works or not. You have to define what counts as works, what counts as an end point. So let me give you three possibilities. One possibility is we're going to measure does the vaccine prevent you from even getting infected? Or does the vaccine say you're not or do we say the vaccine is not going to be able to stop you from getting infected? The virus is going to take root in your body, but the vaccine is going to prevent the virus from making you seriously ill. Or do we say actually the outcome we really care about is death. Does the virus reduce your probability of death? So it's possible that the vaccine, for example, might just to illustrate this point, prevent you from getting seriously ill, but not reduce the probability of death. In other words, in the Pfizer trial that I just described to you, in the vaccine arm, 10 people got sick and in the placebo arm, 90 people got sick. What if in both arms, one person died? One out of the 10 in the vaccine arm died and one out of the 90 in the other arm died. We would say that the vaccine was effective at lowering your probability of getting ill, which is great, but it had no effect on dying. That's possible. It's possible that the vaccine will work at different phases of the illness process. And so the Pfizer trial revealed that there was a greatly reduced probability of people getting infected. The Moderna trial actually showed that its vaccine reduced the probability of people getting seriously ill, which is great. But it might in fact have no effect on mortality still. We don't know. Furthermore, we also don't know whether this vaccine, even if it works, even if it works to reduce your probability of getting sick or dying, whether it works to reduce your ability to infect other people. So maybe we've started vaccinating the population. We're reducing the individual recipient's probability of getting sick, but they still can spread the disease. So this is something else that's not known. So we don't know the safety. We don't know which outcomes are really being affected. And we don't know if it affects infectiousness. And all of these things are things we will soon learn in the coming year, but we don't yet know them. So I just, it's fantastic news that we have a vaccine, but I just don't want people to get, think it's a panacea. Episodes of the Joe Rogan experience are now free on Spotify. That's right. It's free from September 1st to December 1st. They're going to be available everywhere, but after December 1st, they will only be available on Spotify, but they will be free. That includes the video. The video will also be there. It'll also be free. That's all we're asking. Just go download Spotify. Much love. Bye-bye. Mwah! Mwah! Mwah! Mwah! Mwah! Mwah! Mwah! Mwah! Mwah! Mwah! Mwah!