Episode 8: The COVID 19 Vaccine and Cancer

[0:00:00 Speaker 3] wear a resource for learners, including every member of the live strong cancer institutes. On track, Educational pipeline, from middle school to residency were growing collection of interviews, talks and experiences the uncover the myths and the uncertainties of cancer and careers and cancer in order to empower and inspire generations of thinkers

[0:00:23 Speaker 2] and leaders.

[0:00:25 Speaker 3] This is cancer uncovered, uneducated in an empowerment podcast by the live strong cancer

[0:00:30 Speaker 2] institutes.

[0:00:45 Speaker 0] Viruses are formidable foes and in many ways, public health interventions, particularly related to infectious diseases. Ah, lot of it is about how everyone needs to pitch in to sort of take care of the community,

[0:01:01 Speaker 1] to get Covic illness around. The time of having a surgery or to get covert illness around the time of receiving chemotherapy really does increase the danger, and we want to do everything we can to drop that down.

[0:01:14 Speaker 0] But that’s why vaccines are arguably the major medical breakthroughs in public health breakthroughs because they’re so effective and they’re so effective because they’re taking advantage of biology.

[0:01:30 Speaker 1] The benefit of receiving the vaccine begins to develop on Lee a few days, even after the first vaccination

[0:01:37 Speaker 2] is given. Welcome to cancer uncovered. I am Nick Smith Stanley with the live strong cancer institutes A UT Austin’s Del Medical School 2020 was a challenging year, to say the least. In a year of political division, natural disasters and civil unrest, the Cove in 19 Pandemic dominated the news and our personal and professional lives. Since the arrival of the first confirmed case in the United States in January, 2020 over 100 million people around the world have been affected by Cove in 19, including over two million deaths In response to pandemic businesses, closed schools and universities went virtual, and social distancing became the new norm. But there is hope. In December of 2020 not one but two Cove in 19 vaccinations were released shortly thereafter, federal and local governments began a phase distribution of the vaccines to health care workers and patients over the age of 75 who have high risk medical conditions. This’ll Month on Cancer Uncovered I spend time with faculty members from Dell Medical School to learn about the current state of the pandemic, the vaccines and how each impact patients with cancer. I talked with Dr Elizabeth Matsui, professor of internal medicine and population health and a pediatric allergist, immunologists and epidemiologists who is a leading international expert on environmental exposures and their effects on asthma and other allergic conditions. Dr. Matsui also serves as director of clinical and translational research and is the associate director of the Health Transformation Research Institute. Also joining me is Dr Declan Fleming, assistant professor of surgery and peri operative care. Dr. Fleming serves as division chief of surgical oncology at Del Medical School and is the associate director of surgical services at the Livestrong Cancer Institutes. He has initiated and conducted clinical trials in the care of patients with melanoma and cancer of the colon, breast, pancreas and liver, and is active in medical education. This is cancer uncovered. So let’s talk about Covic. How did we get from just hearing this story on the news to really having this serious pandemic that’s been

[0:03:48 Speaker 0] going on here for almost a year? This was an enormous challenge to start out with That being said, there are countries in the world that have contained it, and they are, you know, diverse. And I think because they exist, it points to the fact that we have failed in so many ways to control it better. And you know, I’m a public health practitioner along with being a pediatrician at heart and what we failed in WAAS are sort of centralized public health messaging and management of the problem. And I think the failure in the kind of area of of public health is also because, you know, we have a culture that’s is less about what you might need to do is an individual to take care of your community and, in many ways, public health interventions particularly related to infectious diseases. Ah, lot of it is about how everyone needs to pitch in to sort of take care of the community.

[0:05:01 Speaker 1] I don’t think we can under emphasize the risks of covert for cancer patients. We know that the people that are most susceptible to having a really bad experience from co vid, that is, ah, prolonged illness or organ failure or even death are people that have what we call co morbid conditions, and that is other health problems that make them more week or susceptible. So they’re not able to recover from the viral illness of covert as well. And clearly, anybody who has a cancer has a significant co morbid condition, and it’s interesting that that affects things in two ways. Number one. The cancer might make the person less resilient, so they’re not able to overcome another illnesses well, so that if you get sick from cove it and it begins to put stress on like your lungs, that stress on the lungs, where your oxygen level goes down, put stress on other organs. And if you’re already weakened because of either having a cancer or going through a cancer treatment, that makes you more susceptible to a worse outcome. And we’ve looked at that in surgery, and we found that people who have major surgeries who have a code infection arm or likely tohave a worse outcome from that surgery, meaning other infections or even death, where we might not expect that to happen otherwise. And so cove. It is a big deal to surgical patients, as well as being a big deal to patients with cancer, because not only are they more susceptible to getting the infection and having more problems from it, but they’re more susceptible to longer term problems, making their recovery longer from it.

[0:06:54 Speaker 0] The only other thing that I would mention is that it’s very hard for human beings to conceptualize exponential transmission or spread. We see something like, Oh, they’re 10 cases and we don’t understand two things that one. Those were the 10 cases that were identified and early on in the pandemic. If there were 10, there were actually probably really 100. And then each of those cases infects on average, you know, roughly two people, and then each of those infects two, and so things rapidly spin out of control. So you have to intervene and have everybody on board to intervene at a time when it may be hard to convince people that it’s really is big of a problem as it is because what they see is only those 10 cases. They don’t see that there are 100 and it’s hard for them to imagine what exponential growth looks like.

[0:07:50 Speaker 2] It’s probably way harder to answer, but do you think we’re doing better as a whole in kind of putting the collective before our our own individual, I guess, freedoms. Some people like to say

[0:08:03 Speaker 0] I think so, but you know what’s happened is we have a new variant of the virus now that is more transmissible. And so that means that what we have been doing before, which you know, has been, and this is only my anecdotal experience. But if I’ve been out and about, like, you know, had to run in and pick up a prescription or something, there’s really been universal mask wearing, and I think there’s less controversy about mask wearing Now there’s more evidence that’s come out that, sadly, more and more people know someone who’s had Cove. It had long term symptoms from cove It or been hospitalized or sadly, even died from Cove It and that, I think, changes the calculation that people may make in terms of how their behaviors may affect the risk of others being infected in the community.

[0:08:59 Speaker 1] We have to air on the side of being cautious. Being cautious means practicing really good hygiene, choosing to wear a mask both for themselves and for others around them, and practicing appropriate social distancing and not putting yourselves in a circumstance where they’re likely to be around other people that might have the infection and not know about it.

[0:09:23 Speaker 2] Can you talk a little bit about how cove it has had just this disproportionate effect on racial and ethnic minority groups.

[0:09:32 Speaker 0] Yes, and I can’t remember reading this explicitly. But I remember when this first of all people were not thinking about this initially, which is a problem, but not surprising. And when, you know, public health, community and clinicians and scientists started thinking about this. Oftentimes the knee jerk responses. Oh, let’s look for a genetic cause. And really, if you understand anything about, you know, disparities and inequities. The immediate obvious reason is because people of color tend to be essential workers. And so they have a whole different level of exposure than, you know, someone like me who’s in a more kind of privileged environment. I mean, I am a health care worker, but I’m a sub specialist in the clinic. I’m not taking care of patients in the emergency room, so their exposure risk those communities exposure with the sky high. And then if you live in a crowded apartment because your income is limited and you can’t afford to live in a place where someone can self isolate with their own bedroom in their own bathroom in the household attack rate is going to be much higher. You also may be afraid to seek medical care or not able to seek medical care because you are uninsured or undocumented or underinsured. You will get likely different treatment if you try Thio engage, you know, with the health care system that can also lead to worse outcomes. This isn’t a public health crisis. You know where suddenly Oh, look, we have disparities, these despair. They exist in my line of work and asthma, and they’ve existed all along. But they tend to be kind of swept under the rug and are not sort of seriously thought about. And and I think it comes down to another example of it can be easy for people who are in a position of power and privilege and resource is do not worry about others. And aside from the obvious, important morals and ethics of worrying about others, disparities affect everyone in the community because it means hospitals get filled. And so if someone has a motor vehicle accident, they’re not going to get the same level of care that they would have gotten before. And I think it’s very hard for people to understand. You know, how connected we all are in that way. So vaccines work by exposing your immune system to a part of the virus or a dead version of the virus unaltered version of the virus so that you get the immune response that’s protective but without getting the infection. And so that’s the fundamental sort of concept behind vaccines. And there are lots of different. You know, flavors of vaccines is I think you probably picked up on in terms of like whether you pick a piece of a virus or killed virus to inject. But that’s why vaccines are arguably the major medical breakthroughs and public health breakthroughs because they’re so effective and they’re so effective because they’re taking advantage of biology, which is much more powerful, you know, then trying to create a drug that then you treat the virus with after the infection has happened so there to vaccines that have been approved under an emergency. You use authorization by the FDA in the U. S. People know them, I think, by their trade names. There’s a Pfizer, Bayan and Tech and the Moderna vaccines, and they both use the same technology, and these are the first m r n A vaccines to be really used that are on the market. What we mean by an M R N a vaccine is that the vaccine has the R N A. That encodes for part of the SARS cov to virus or the COV virus and the part of the virus that that morena and codes is what’s called the spike protein. And I think people are familiar with what coronavirus looks like now because it’s picture is everywhere. It’s called Corona because it has all of these spike proteins on its surface, and the spike protein is what it uses to enter ourselves and infect ourselves. And then it divides in ourselves, and they’re more viruses that were produced. And then they go and infect other Selves. And I know the listeners can’t see your face, but it looks like I’m telling you like a horror movie type story. So this Mara encodes a spike protein. The reason that we want thio induce an immune response to the spike protein is because if you can have an antibody identify and glom onto the spike protein, it prevents it from attaching to its receptor on the cells and infecting the cells. And so That’s sort of the key part of the virus that we want to target. And so the Mara is packaged inside a lipid nanoparticle. So that matters, because Mara is actually quite unstable. You know, you, if you have some M r and a lying out on your desk, it just degrades pretty quickly, so it needs to be stabilized. But it also needs to be packaged in a way that the Marna gets into a cell so that your cells machinery will translate it into the spike protein. And so both the Moderna and the Pfizer vaccines have Marna for the spike protein that is in this lipid nanoparticle. The other thing that the lipid nanoparticle does is that your immune system needs a danger signal in order to really start ramping up antibody production. And those air called achievements and achievements make vaccines illicit, better and stronger immune responses. And so the lipid nanoparticle also stores is an achievement. And so when you are injected with the vaccine, those lipid nanoparticles get taken up by cells. Those cells start to their little factory, starts to turn that Mara, and despite proteins and their two things, that happened to despite proteins, those cells actually start to display the full spike proteins on their cell surface is, and then they also along with that, chew up the spike proteins into smaller bits and display the little bits of despite protein on its surface. And then this activates a couple of types of cells that are a part of your adaptive immune response. B cells and T cells and B cells are the ones that go on to make antibodies. T cells help the cells make antibodies, but T cells. Also, there’s this kind of T cell that can also kill. The virus is directly.

[0:16:58 Speaker 1] The vaccine is remarkable. It has worked better than we expected, especially the M R and A vaccines. And the benefit of receiving the vaccine begins to develop on Lee a few days, even after the first vaccination is given.

[0:17:14 Speaker 0] So they have about 95% efficacy. So what that means is in a clinical trial setting 1 to 2 weeks after the second booster dose, people who had gotten the active vaccine compared to the placebo or the fake injection for 95% less likely to have co vid, and that’s not to be infected, but it’s to be infected and have symptoms compared to those who got placebo.

[0:17:44 Speaker 1] I’ve been doing medicine and science for a long time, and as a cancer practitioner we look at curves that look at how a treatment might benefit a group of people, whether they get it or not. And when I looked at the results from the clinical trials of the vaccines, it’s almost like nothing you’ve ever seen before. The first couple of days after a person gets a vaccine in these trials, some people were randomly assigned to get a placebo. That is a treatment that doesn’t do anything versus getting the treatment. And neither the patients nor the doctors knew who was getting what, so there wouldn’t be any bias or any cheating in things. And for the first couple of days after people got the vaccine of the placebo, the curves of whether or not a person got infected were exactly the same. And then, in about 10 days after the injection of the vaccine, the curve just separated dramatically. It was like a fork in the road, and the people that that didn’t get the vaccine that got the placebo they kept on the same trajectory of getting infection and the people that got the vaccine, they just stopped getting the infection. I looked at it over a three month period of time. I counted the number of people in this trial and added, like 11,000 people got the vaccine. 14 people got infected. It’s just incredible. That doesn’t mean that the risk of getting infection is zero. But it just changed the world for those people that got the vaccine.

[0:19:21 Speaker 0] One thing that I want to point out is where were decades of science behind him? MRNA vaccines before this hit, this tells you how important it is to invest in basic science research and this sort of work because we were poised. We I mean, like, I get credit for that right? We as a global community were poised for this toe happen. There had not been sort of the same sort of opportunity at the same time that this much work had been done and that we were poised to go there. Several other factors that made it happened so quickly. One is the sequence of the spike protein was available more than a year ago, now, very quickly after the pandemic, we became aware of the magnitude of the problem in China. And a faculty member at UT, Jason McClellan, described the structure like the three dimensional structure of the spike protein. And so it became, you know, very clear. Here is a sequence we know what m R and a sequence would encode for it. We can. And again, I’m not allowed. Researcher. There’s probably a black box right where they do some fancy chemistry to make these Martinez, but they knew the sequence or the code that they needed to use, and they had already had some work with these lipid nanoparticles, and so they were very quickly able to make some vaccine.

[0:20:55 Speaker 1] I do think that there is a special considerations that cancer patients and specific need Teoh Teik before receiving the vaccine. Alright, cancer patients can be in some circumstances, immune. Suppress their immune system isn’t working as well, so that makes them more susceptible to other types of infection. But we have to remember that a vaccine to get the benefits of taking a vaccine, you have to have an immune system that can react to the vaccine to develop antibodies and the like, so that you could develop protection. So if a person’s immune system is really, really suppressed, whether it be from the disease itself, like if a person has a leukemia or lymphoma or if they’ve received chemotherapy and it’s suppress their immune system, they’re not going to be able to develop the beneficial response to the vaccine that they would have otherwise. So if we look at a person, let’s say a person is going through chemotherapy for, ah, cancer. One of the things that the doctors were doing routinely is there, measuring their blood count, and they look at the white blood cell count. And the white blood cells are a component of our immune system. If the white blood cell count is really super low, there is no way in the world that we would believe that that person could get a benefit from receiving a vaccine, because you have to have an immune system that is ready to recognize what’s going on with the vaccine and respond to it. So a person who has a suppressed immune system and anybody who is considering a vaccine, whether they’ve got their chemotherapy or or an oncology patients or somebody else. We need to know that their bodies ready to respond to the vaccine to create that beneficial response. So cancer patients really need to be screened to know that their immune system is in the right place to respond appropriately. I have a lot of hopes for us as a nation and for our world around co vid their big hopes because this has been a big, dangerous disease in a big problem. What I really hope is that these vaccines, in their various forms, are able to be given as quickly as possible to as many people as possible because these vaccines work. And so I wanna see everybody get the benefit of getting that vaccine. And that means we have toe have not only the production of the vaccine, but also my prayer is that we figure out a way to organize ourself. Thio start getting people this these vaccines in a fair in an equitable way. So nobody is denied this that ought to be receiving it, and that we recognize that it’s not just important for the science of making a vaccine to have been accomplished, but we’ve gotta have the mechanism of getting this to people in place, and I want to play my part in protecting people that can’t be protected. And again, my hope and my prayer is that even if people don’t think that they’re in, ah, high risk category for getting horrible cove it and dying from it even if they say man, this is not a big deal Disease. My hope is that people are gonna say it might not ever be a big deal to me, but it might be a big deal to somebody. I’m going to do my part to protect those vulnerable people and that we’re gonna have people embrace that. And we we get very, very serious about continuing high production levels and we get very, very serious about making ways to deliver the vaccine. And we get really serious about our responsibility for protecting other people, and we’re gonna show our love for people that way.

[0:24:51 Speaker 0] So I hope we set up mass vaccination sites and that I think, is a part of what’s starting to happen in different states and what will happen in Texas. I think we want to be at a minimum at a million vaccines per day. I think ideally, we want to be closer to three million a day in order to be much closer. Thio, um using air quotes normalcy by the summertime. But rapid dissemination of the vaccine is really, really critical, especially with this variant is brewing. So that’s my hope.

[0:25:29 Speaker 1] You know, my hope is that if anybody’s on the fence about getting the vaccine, that they’ll get off the fence and again for themselves, but also for people that they know and also for just strangers. You know, we’re supposed toe show love and compassion for the people that are most vulnerable. And I really hope people embrace that opportunity in doing this.

[0:25:53 Speaker 3] Thank

[0:25:56 Speaker 2] you to Dr Matsui and Dr Fleming for sharing their insight into the ongoing pandemic toe. Learn more about their work and the contribution del medical school is making. In the response to Covic, check out our website at del med dot utexas dot e d. U. Dr Matsui is also the co host of her own podcast called The Effort Report, which covers life in academia. You could find the podcast on Twitter at the effort report. I’m next Miss Stanley with the live strong cancer institutes, and this has been cancer uncovered. For more information about the Livestrong Cancer Institute, check out our website at del med utexas dot e d u. You can follow our director on Twitter at S scale. Eckhart Eckhart is spelled e c k h a r d t. Be like to learn more about the live strong cancer institutes or have ideas of topics that we can uncover. Please email us at LiveStrong Cancer institutes at dell met dot utexas dot e d u. Please make sure that institutes is plural. And, of course, if you like our podcast, make sure you subscribe