Paul Offit, M.D.: The latest on COVID-19 vaccines and their safety, herd immunity, and viral variants

**Peter Attia** (0:11)
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Now, without further delay, here's today's episode.
I guess this week is Dr. Paul Offit. That may be a familiar name to some of you because Paul was previously on the podcast in November of last year. At the time, we spoke about the COVID-19 vaccines just prior to their first approvals. I wanted to have Paul back to get an update on the vaccines and to get a sense of what the next year is going to look like. As a refresher, Paul's a pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and virology.
He is the director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at the Children's Hospital of Philadelphia, CHOP. And he is a professor of vaccinology at the Perlman School of Medicine at the University of Pennsylvania. He serves on the FDA committee for biologics evaluations and research vaccines and related biologic product advisory committee evaluating not just the COVID-19 vaccines, but vaccines for influenza and other infectious diseases. He is the co-inventor of the rotavirus vaccine. In this episode, we start with an update of all four major classes of vaccines, specifically talking about the two that are most utilized, which are the mRNA vaccines and the adenovirus vaccines delivering DNA. We then talk about some of the safety concerns that still remain around both of these, and Paul does a very eloquent job, in my view, of explaining what is and is not a legitimate concern, both in the short term and the long term.
We talk about the variance and what the implications are of variance, and we get into what herd immunity actually means. In other words, how much of it is going to require a breadth of natural infection versus how much is going to require immunization. And we get into then what's going to happen with respect to other populations being immunized, most notably people under the age of 18
Something that I think many of you will find interesting in this discussion was a deeper dive into the nature of immunology and how the short term immune response, usually mediated by what's called the humeral system, differs from the longer term immune response, which we call the cellular immune response, the memory immune response, how these two function together and the importance of the latter in providing durable immunity. We also talk a little bit about the origin of this virus.
I think there is a very interesting discussion around whether this virus originated in a lab or it originated quote unquote naturally. And while a year ago, people who suggested it originated in a lab were viewed as sort of conspiracy theorists, I don't think that's necessarily the case today. And we talk a little bit about that. Finally, we talk about the future. I think most people, Paul included, would agree that it is not a question of if, but rather when we see another major coronavirus outbreak, given that this is the third one we've seen in 20 years, what can we do to be better prepared for it? Neither of us pull punches on what we think went wrong here. And most importantly, how would you need to remedy that in the future? So my hope is that you'll find this podcast to be accretive to knowledge you've already gained through the recent podcasts I've done on this topic, along with whatever else you're listening to on this topic. So without further delay, please enjoy my conversation with Paul Offit.
Hey Paul, it's great to have you back. Thank you so much for making time. Obviously at the time that we're recording this, I know you're busy with some news that we'll get to later, but nevertheless, it seems like it's about the right time for us to pick up this discussion again, because the last time we spoke, we were just on the cusp of watching a number of vaccines hit that first phase of early use authorization. As we stand here today, I actually can't tell you the numbers, but tens of millions of people have been vaccinated. And in some ways, there are still a lot of questions. So let's start with just an update, the lay of the land for people. Broadly speaking, right, four strategies, four scientific strategies in place to create vaccines. One of them is an mRNA vaccine, which we'll talk about. The second, something that's a little more tried and true, at least something that's been done a number of times before, using an adenovirus to deliver DNA. The third is delivering directly purified protein of the virus. And the fourth, probably the oldest trick in the book, is using live attenuated virus. Can you give us just a broad overview of where each of those four are and maybe what it says about the scientific challenges of the approval process for each?