The COVID-19 Vaccine and the Economy

March 2021

Hi everyone and thank you for joining. We just hit three o'clock and I'll turn it over to George to start the presentation, George.

Great, Michael, thanks very much and good afternoon everybody. Thanks so much for joining us. I think this is gonna be a really extremely informative call and I really appreciate you taking the time to be with us today. So a couple of housekeeping items. First of all I wanna introduce our panelists. Joining me today will be Vince Lecce. Vince is our market leader for our Rochester market here at Key Private Bank. And then we'll also be joined by a very special guest, Dr. Stephen Thomas, who is the chief of infectious diseases at the SUNY Upstate Medical Center. So if we look back a year ago, it's hard to believe a year has gone by but really about a year or so ago, the world acknowledged that there was a new virus that emerged in Wuhan, China. And soon thereafter it's quickly spread around the world became known as the great pandemic and probably the worst pandemic in over 100 years. As the virus spread in an attempt to limit further contagion economic activity was completely halted. Things just stopped, which was totally unprecedented. You had subways halted, planes were grounded, business were closed basically. And those people that actually had a job were sent home. Schools at the same time were also closed, family gatherings were essentially halted or maybe just canceled altogether. And really we've kind of found ourselves, being really reacquainted with terms such as big as hand washing. We learned new terms like contact tracing, masking up and social distancing. And I guess at first a lot of these things seem really quite scary. It was a new pandemic, something we hadn't really experienced in people's lifetimes, if not before. And persistent frankly, there were some concerns about this new disease related to the virus itself called COVID-19. All till since this pandemic first started a year ago there've been over 106 million cases of COVID-19 and some 2.3 million deaths linked to COVID-19 around the world. That said as from transition to summer and then summer transition to fall there was really kind of a new narrative of hope really that began to emerge. And we've talked about in some of these calls in the past, and in fact, this is our, I think our 16th call we've had to talk about this event the past year or so. But that narrative hope I think was really important and the attempt was really premised on the view that vaccines might be developed to actually safely inoculate our society and really rid us from this terrible and unknown disease. Excuse me, as a result of billions of dollars, and really counseled hours of research two vaccines were also approved late last year. And really several others are promising going through the state of development have some promising potential. As result discussions involving cases to hospitalizations have really moved away from hospitalizations and fatalities and really shifted now towards manufacturing capacity and distribution and vaccinations and so forth. All really as a result of some human ingenuity, that is just an unrivaled. The sense of what's actually happened in the past year or so. And I think we're gonna get into a discussion about that this afternoon. So I guess if I could just kind of jump ahead a little bit, more important, I guess to maybe put the numbers in this more specifically, you can see on this slide, for example, that since the peak roughly a month or so ago cases of COVID-19 are down roughly 48%. This is from John Hopkins University and they do a great job of tracking this. You can see cases have fallen significantly. They're still really elevated where they were probably in the summer but they are certainly trending in the right direction. This is on a seven-day moving average. Similar in the lower left, you can see hospitalizations are down roughly 33% from their peak and fatalities lag, but they're also starting to kind of elevate that bubble as well. So again, we're kind of moving this conversation, this narrative away from cases although that certainly is something we should pay attention to, but now we're turning our focus to a vaccine rollout. You can see this slide. I think there's probably more progress that needs to be had. And we'll get into that with, with Dr. Thomas in a few minutes, but nonetheless you can see some progress has been already achieved. Where roughly 60 million doses have actually been administered across the country that results in some 35 million or so people have actually been vaccinated which translates to roughly 11% of the population. And I think there's probably a good reason to be hopeful that we'll see that number continue to inflate higher going forward as well. Going back to the economy for a second though, the economic hit that associated with COVID-19 what was really just massive. And as I said earlier economy essentially just stopped, it just ground to a halt. The result of that came and really what triggered sort of really kind of try to correct that and overcome that with some massive intervention by central banks around the world. Promises and assurances to do just about anything they could to really provide liquidity to the markets really manifest themselves on this slide here. We're looking at really our four central banks around the world looking at the upper left, which is the U.S Fed Reserve, the European Central Bank on the upper right, the Bank of England on the lower left and the Bank of Japan, all four major central banks and other parts of roles who also injected tremendous amounts of liquidity into the market to really withstand and we kind of forced all that economic hit associated with COVID-19. At the same time, companies has also been involved. Other fiscal authorities also been quite aggressive to try and provide stimulus payments directly to consumers and businesses. And that's also started manifest itself in many important ways. And by all accounts like to see that rise further in the coming weeks ahead. What turns all from that from the economic perspective is really what we call reflation. So this is not necessarily inflation per se but we're seeing reflation, if you will, or maybe a lift of prices for pretty much all asset classes. Stock prices we know about them about them and about a year or so ago, interrupt some 100% since then inflation expectations also started to rise not to the point that we're worried about that just yet but we've been saving in that as well as something to pay attention to this year. Similarly, energy prices have also stored tremendously in the past few months or so and home prices across many parts of the country are also up quite strongly. So while we know that vaccines are really part of the story it's probably important to note that they are very important. So when we hear from central bank officials, again around the world, they point to one thing as really being critical as the outlook. And that happens with vaccines. To quote, Jerome Powell recently, he gave a press conference just a few weeks ago. He talked about there really is nothing more important right now, in the economy than getting people vaccinated. And of course, as he thinks about forecast the economy and his colleagues do it at the Fed Reserve, they note that the most single important thing that they could really talk to has to do with the vaccine itself. So I think that's a really important point. The other valid point is that vaccination, I guess the perception of vaccinations and people's willingness to get the vaccine itself are starting to rise again. So there was maybe a little bit of pessimism around this, in this September period of time, but you can see in this slide people have become more receptive to getting vaccines more recently which I think is also welcome news. We look at other things beyond employment numbers and we'll talk about that in a second but we also can look at things that are really measured in real time to understand the impact from COVID-19 and the economic fallout associated with that. This is looking at some key data from Google and Apple and really it's some information piled by Dallas Federal Reserve. And essentially what they use to track mobility, so they can measure our phone, their cell phone behavior how long we actually are traveling in a car, for example, how far we are away from our home itself. And you can see those numbers really fell off dramatically in the summer and the really the spring of early last year. It has since rebounded. They were weaken a little bit at the end of last year but since then it started to stabilize and turned higher. So again, by all accounts, we are starting to see some positivity with respect to mobility, again. Which again is somewhat supportive for the economy itself. At the same time, I wanna mention the fact that employment is actually recovering too. Which I think is really central to the outlook going forward as the vaccine development and the rollout of the vaccination program itself. And how that actually be more of a broadening impact to the overall economy. This is just looking at the number of jobs in various sectors of the us economy beginning on the upper left which really measures the entire workforce of the U.S roughly 140 million workers. That number is still roughly 10 million below its prior peak. So we've made some good progress from where we were just a few months ago but more progress is still needed. If I tease out some of the data even further I really emphasize the chart in the upper right of this page to show you essentially the leisure and entertainment sector which really was significantly impacted by COVID 19 for probably obvious reasons. That number is still quite considerably below where it was and the prior peak. So I think that really is kind of tied to again to the outlook around vaccinations, being critical to get the economy reopened in a more complete way. So with that out of the way let me just turn it over now to Vince to give you a personal introduction to our guest speaker today. Dr. Stephen Thomas, Vince.

Great, thank you, George. And good afternoon, everyone. Thanks so much for joining us today. Dr. Stephen Thomas and I have been friends for many years and fortunately when I asked Dr. Thomas to speak to this group, he jumped at the opportunity to expressing his desire to cut through the noise and misinformation that's out there about COVID-19 and it's vaccine. Dr. Thomas is an infectious diseases physician scientists at SUNY Upstate Medical University in Syracuse, New York. Where he serves as the chief of the division of infectious diseases and director of the Institute for Global Health and Translational Science. He spent more than 20 years in the U.S army serving at Walter Reed Army Institute of Research and played a key leadership role in the U.S government response to the Ebola and Zika outbreaks. Since COVID-19 he has led SUNY Upstate's incident command and is the coordinating principal investigator for Pfizer's COVID-19 vaccine trial. Throughout this pandemic, Dr. Thomas has written numerous articles for Forbes, has been featured on CNN and other local and national television media outlets. And to top it off, he's also an entrepreneur. In 2020, Dr. Thomas co-founded Phairify, a web based platform which provides a free forum for physicians who exchange information to discover their true collective and individual fair market value, which in turn assist them in making educated decisions throughout the recruitment and contract negotiation processes. Quite the mouthful, quite the resume, doctor Thomas. So thank you so much for your service to our country, for your service as a frontline worker during the COVID-19 pandemic. And of course, for taking time out of your incredibly busy schedule to join us this afternoon.

Thank you very much, Vince. And thanks, George, also for the for the invitation. It's great to be here with you.

Great, let's start by taking a step back and understand how we got here. What exactly happened that triggered this global pandemic? and what should we know about its origins and initial development?

So the COVID-19 pandemic is, COVID-19 is the disease that is caused by SARS-CoV-2. Which is the virus that infects a person and then causes COVID-19. And we've seen this twice before. So we saw this with MERS-CoV, which is the middle Eastern respiratory syndrome virus. And then we saw this with SARS-CoV-1, which was back in 2002. They're all caused by Corona viruses. And these viruses exist in a bunch of different types of animals, but especially in bats. And so what has happened is that these viruses that are in bats then jumped to another species of animal and then those animals come in contact with people typically through either breeding or through in the marketplace, et cetera. And then those people get infected. And if those viruses cause a respiratory infection it then allows one person to pass to another person. And so we think that that's exactly what happened that this SARS-CoV-2 was in a bat, it jumped to an animal called a pangolin which was being traded and bought at these wet markets in the province in China that George had mentioned. And then it passed to people and then before we knew it multiple people had been infected and because many people don't have symptoms initially those people then traveled and by the time the doctors in China had kind of put up the red flag that at the end of December 19 that they were seeing these clusters of pneumonia cases that they couldn't diagnose. The cat was kind of out of the bag and people had already dispersed around, around the country and the continent and ultimately the planet. And so this is kind of how we, how it started and where we find ourselves now.

So Dr. Thomas, again, thanks for joining us today. It's really a privilege and I should have mentioned this beginning but if people have questions there is a way you can actually submit a question, by kind of hovering over the bottom part of your screen. You'll see a bubble icon pop up with three dots. You can click on that little icon with three dots and submit your question. I'll try and get to that over the next 40 minutes or so. But maybe just to kind of pick up where you left off, Dr. Thomas, it's different a little bit, I'd be kind of curious to know, as Vince described the idea of really separating fact from fiction. So we've now been living through this environment the last 12 months or so, what do you think people really misunderstand or maybe miss appreciate most about the situation we're in?

So Initially there were a lot of folks that were making all sorts of comparisons to influenza. Primarily to try and I don't know, I think maybe downgrade the sense of urgency regarding this influenza. Influenza kills about 35 to 40,000 people every year in the United States. It hospitalizes about a million people every year. And it's a huge public health burden to the United States from October to May. But we've got to learn to live with it. The thing with influenza though, is on average, one person with influenza will infect maybe 1.3 other people. So you'll need about three people with influenza to infect another person. But that same kind of theory with COVID we think one infected person can infect anywhere from two to four other people. And so you can see that the transmission dynamics are much different. The other thing was that people were looking at sort of case fatality rates and they were saying listen, this is about the same as flu. And it doesn't really, there's only certain populations of people that are at risk. The problem is and if we just keep it national, you have 320 million people who have never been vaccinated and I've never been infected before. And so no one is immune. And so even if only a small proportion of people become sick and a small proportion of people die you're still looking at hundreds of thousands of deaths. And you're looking at an overwhelming the health care system because people get sick, they're still gonna go to the emergency department, they're gonna go to the pediatrician's office, they're gonna go to their doctor's office, they're gonna need to be admitted to the hospital. And so for a healthcare industry in the United States works at about 90% capacity in a non pandemic situation. Then you quickly get overrun, overwhelmed and anyone who's watched the nightly news even on one night in the past year, can quickly see that. So I think those are the transmission and the impact that it can have on the healthcare system. I think those are two things that people need to be very clear on.

Great, thanks. So I'm gonna jump ahead of it. Now we can talk about the vaccine itself since you had really, kind of our front row seat so to speak, and we're in the room while all this happened. I'm kind of curious if you could just talk about the process itself, maybe in layperson's terms around the development process. I think it's still remarkable that in 12 short months even less than that, we not have one but two successful vaccines that have been developed. So how did it happen in such record time and what should we learn from that?

So historically vaccines have taken about, from sort of concept to getting on the shelf that a doctor could pull it off and administer to somebody. As long as there are no major hiccups, it's takes about 10 years. Historically, it's taken about 10 years and it's cost well over a billion dollars. And there are some reasons for that. First of all, it's a very kind of stepwise approach. So you come up with an idea, you try to invent a prototype in the lab, you test it in small animals, you then test it in larger animals, you then manufacture it in these special facilities, the FDA gives you the go ahead to experiment in humans. And then you do these very long, very expensive trials in people. And then if you're successful you manufacture at scale. These big commercial scale, hundreds of millions of doses. And so the price tag is so substantial and the risk is so great with probably more than 90% of concepts actually failing and not even making it to human testing. The companies that are responsible for kind of shepherding these products through they really try to mitigate the financial risk. And so things occur sequentially very slow, very pragmatic, lots of milestones, lots of check-ins with leadership and management about, okay we're gonna fund this program next year, et cetera. But for those of us that are in the vaccine business, I mean, for the last five to seven years, I mean people have been saying, it doesn't need to take this long and it cannot take this long because heaven forbid, there's a pandemic or even a substantial regional epidemic, we're gonna need to be able to pivot very quickly and deliver a vaccine solution very quickly. And so now enter COVID and people said, well, wait "if this normally takes 10 years "how could I possibly trust something that took a year?" Well, the first thing is this is not new technology. Let's just talk about messenger RNA vaccines cause those are the ones that currently have Emergency Use Authorization. Messenger RNA vaccine technology has been in development for 30 years. And for the last seven to 10 years other vaccines using messenger RNA vaccine, messenger RNA technology have been tested in people, thousands of people in different trials, for flu, HIV, Zika, influenza and anti-cancer vaccine. So it's not a new technology. We were not starting from ground zero that's the first. The second is that, Pfizer on its own and the companies that are part of Operation Warp Speed, they took financial risk. They did things in parallel that they would normally do sequentially. They didn't take safety risks. What I'm talking about is investing the hundreds of millions of dollars it takes to manufacture at scale vaccines which may show in human testing to not be safe or effective. Normally we wouldn't do that until we had proven they were safe and have the potential to be effective`. So they took financial, they took financial risk. The other big thing is that, when you're making vaccines against diseases sometimes these diseases occur so infrequently that you have to do really huge trials and you have to follow your vaccine recipients for multiple years to collect enough cases. Now, unfortunately or I guess fortunately there was so much COVID going on at the time that these vaccines were doing their trials. They very, very quickly collected the number of cases they needed to, to demonstrate efficacy. So there's other reasons as well but those were our three primary reasons headstart on the technology parallel process and lots of COVID. Those are reasons that they were able to get this done and get Emergency Use Authorization in less than a year. Again, it's important though, that people know Emergency Use Authorization is not FDA approval. It is not a license. There are lots and lots of requirements that these companies have under an EUA that they must meet to maintain that EUA. And one of those is that they need to pursue licensure as quickly as possible and in a reasonable timeframe, which requires more data and more information. And that's certainly what they're all doing.

I'm glad you brought that point cause I read some headline the other day which probably would be really tight article, but it said that the vaccines have not been approved to try and maybe sensationalize things a little bit if I could maybe take some liberty there. Should we be concerned about that? Should we be thinking that at some point they will become fully approved or how does that factor into our thinking around vaccines?

So Emergency Use Authorization has been used before COVID it was used once before I think with anthrax and the safety requirements are no different. It's really kind of the requirements for the amount of data that you have. And they basically said, "listen you need to have at least two months "of safety data to even file an application "for an EUA with us." And people say, "well, geez eight weeks "really isn't that long, a period of time." Why did they choose eight weeks? Well, when you look at all of the vaccines that have been developed and you look at all the safety follow-up and you look at all the safety databases that are available for these vaccines, the vast, vast majority of safety events occur within six weeks. And so if they're immediate or if they're delayed they're occurring within six weeks of administration which is why the agency said, "well, we want you to go to eight weeks." And then the next step would be we want you to go to six months. So that's sort of, when you can meet the standard for an EUA is after two months with this particular vaccine.

That's good insight. It's good information. I know that Merck was also kind of far along in this particular development program but actually stopped their program. What concerns you have about others or other candidates right now that we should be thinking about, cause it seems like we still have a supply issue we have to work through?

No, we definitely do. So again, 320 million non-immune people expand that to the globe. Cause we're all very highly connected, which we know to over 7 billion people. So we need more than one vaccine for sure to be proven, safe and effective. If we're gonna at a global scale, kind of get this thing under control the way we want it to. So yeah, that was disappointing that Merck had to bow out of the race but there are lots of other vaccines that are in very advanced clinical development. So J and J's vaccine, AstraZeneca's vaccine Novavax vaccine, they are all doing efficacy trials right now and they've done some pre-release of some preliminary information. They seem to have very acceptable safety profiles. So that's a good thing. The other thing is that they do seem to have efficacy but the efficacy it's a little bit variable. There's some differences between the vaccines. The good news is that they all seem to protect against severe disease. So the type of disease that land people in the hospital and unfortunately kills people. So they do seem to have a pretty high level and uniformly high level of efficacy against severe disease. And then the efficacy that they have against, moderate to severe disease is in the 60 to almost 90% range, which is still very good. That's probably what our expectation was initially cause if you look at, I mean, look at annual flu vaccine efficacy is about 45% and that vaccine has a huge public health benefit. So if we can get vaccines for COVID that are 60, 70, 80, 90%, that's a really good thing. We will get to the variant question a little bit later but just at face value we have three other vaccines that are, could potentially come to our shores. They'll certainly be distributed globally. And J and J has already asked, has already kind of thrown their hat in the FDA ring asking to be considered for an Emergency Use Authorization.

That's a terrific insights doctor. So maybe related to that we've heard a lot about this term called herd immunity. And maybe you could just briefly explain that and why that's significant and maybe when that might actually get attained.

So I mean, herd immunity is a very, it's a very good goal, but it should be qualified it's a very good goal to achieve through vaccination. Early on in this, there were some folks that came online and it was picked up by certain influential groups that maybe we should just let this kind of burn through the population protect that are most vulnerable, let it burn through the rest of us and achieve herd immunity which would then be, protect. That's a really bad idea. The concept is that, let's say you have 10 people in a room and seven people can be vaccinated. And three people can not be vaccinated for one reason or another. If those seven people are vaccinated the virus or the pathogen, whatever it is there is not gonna be enough opportunity for it to pass from one person to another. And so transmission is going to be lower and those unvaccinated people will still be protected by those that are vaccinated around them. But that you need about 80 plus percent protection in a population. Certainly a population, the size of the United States or even at our state level populations for herd immunity to really have the type of benefit that we would want. That being said, even though we're in a pandemic and even though the United States is certainly in an epidemic, infectious diseases are very much a local phenomenon. So it may be that, we are not able to achieve national herd immunity in the near term, but if there is enough vaccine distributed and administered in different counties, let's say or parts of different States, it is or even at the sort of institution level nursing homes, skilled nursing facilities, et cetera, it could be achievable on that micro scale which would be beneficial because that's how infectious diseases are transmitted very much in a micro spatial way.

Super interesting points, Stephen, if I can jump in here. So can you talk about that? Some of the challenges that are logistically out there as far as getting the vaccine the last mile into the pharmacists and into the people's arms. What are some of the challenges we're faced with with that and how do we overcome those?

So I guess the first one is, that we've already talked about it and George showed a graph on his general hesitancy. I mean, to have at one point 50% of the U.S population saying they're not interested in taking a COVID vaccine, even if the FDA, like gives it the thumbs up. That is probably the most significant challenge that I see. So I think it's good that as more, more and more vaccines are given and the proof of safety is building that more and more people seem to be willing. Kind of those people that were, I'll wait and see, now seem to be jumping into the mix, which is great. So that's the first challenge. The second, which probably many people know about is these first two vaccines are the Pfizer BioNTech and the Moderna vaccines, they have to be stored temperatures that are typically much colder than we would store other vaccines. And so pharmacies and even hospitals for that matter and doctor's offices weren't really equipped with the freezers that they needed to have long-term storage of these vaccines. So that was a big and heavy lift that people had to try and acquire the resources they needed to keep the vaccines cold. I guess, the third is that, the process of going from a federal central procurement and then trickled down to States and then States trickling down to counties. That's not always the way things work. And so it was a process to plan but once vaccine start flying some of those plans are found to have gaps. Again, I think as George had shown I think that lessons are being learned, I think that efficiencies are being introduced, I think that the processes are doing better and we're also finding manufacturing efficiencies. I mean, Pfizer has come online saying that they're going to beat a lot of the timelines that they had initially projected, they're finding out that you can actually get more doses out of a single vial than thought previously. So I'm pretty optimistic about the future as it relates to production and distribution. I'm just hoping people will freely take the vaccines. Whatever vaccine has made available to them.

So I do wanna talk about variants in one second, but again, we are taking questions. And one question that came in has to do with maybe you could clarify something for us, Dr. Thomas, which is does the vaccine actually prevent us from getting COVID or is it really just preventing us from getting very sick?

Yeah, that's very good question. So vaccines can do a couple of things. They can actually prevent you from being infected. So you're exposed to a pathogen but your immune response is so robust that you don't even get infected. That's a very, very high bar not a ton of vaccines work in that way. The second is that it may not prevent you from getting infected, but it's gonna prevent you from getting clinically relevant disease. And that's really the target that we go after initially, cause it's the disease which creates the public health burden. And then the other thing it can do is even though it may not prevent you from getting infected it might prevent you from being able to transmit the virus to somebody else. So it might prevent you from being infectious. And that is something that, they're exploring now there, cause it's a different study that you have to do to look at the ability to prevent transmission versus just preventing disease. But they're doing those studies and there's data that can help them infer, whether or not that's the case. Now my opinion is that, based upon how these vaccines work to prevent these it is logical and highly plausible that they will also reduce a person's infectiousness whether it's, prevents that from being infectious at all or even shortens the window in which they are infectious, because someone with COVID could be infectious for up to 10 days. And so if you can reduce that window you could have a huge public health benefits. So that information is coming but my opinion is that we're gonna find that these vaccines are reducing transmission to a certain degree.

So if somebody has had COVID and test positive for antibodies, do they still need to get vaccinated?

Yes, so one thing we've learned is that, not all national infections are created equal, meaning, not everyone gets sick and everyone who gets sick doesn't have the same severity of illness. The other thing we're seeing is that the resulting immune response that these people develop, those are also not equal. And so we follow about 350 survivors here in central New York and we're following them long-term and I can tell you, there is great variation within this population of people's immune responses initially and then how long they last. And so really until we can kind of figure this whole thing out, it is still recommended that people who have a natural infection still get vaccinated because it's standardized. We know exactly what you're getting, two doses, three or four weeks apart. We know what the data shows, the data's very tight. And so we still recommend that people get vaccinated. If you've been infected, you should wait until you are clinically well to get vaccinated. If you've been infected and someone treated you with antibodies, so either the Eli Lilly product or the Regeneron product or plasma, you really should wait about three months before you get vaccinated. But it's okay because we think most people the vast majority of people are protected for at least three months after their initial infection.

Excellent, excellent. So I did mention variants and we should probably talk about those too. That's been in the media out loud lately but what do we need to know about these mutations that are kind of popping up? And again, sound kind of scary, frankly.

They are pretty scary but one thing people should know is viruses are mutating all the time. And this specific type of virus that these Corona viruses are, so these RNA viruses they're mutating all the time. It's what they do. Most of the time it doesn't amount to anything, but sometimes it does. And more people that are infected the more opportunity there is for these viruses to mutate which is why it is so important that people get vaccinated, wear masks and physically distance until we get this thing under control. Now, specifically what is happening. So imagine the virus is a tennis ball with about 40 push pins in it. Each of those push pins are what we call a spike protein. And it's the spike protein which seeks out a cell in our body. So it could be in our nose or lungs or kidneys, wherever it is. And it's that spike, which allows the virus to attach to that cell, get into the cell and then make baby viruses and infect other cells. So the theory is, if I can develop an immune response against that spike protein I can prevent that interaction from occurring. And I can prevent someone from getting sick. Now, these mutations that we're seeing unfortunately are in that spike protein. So what happens is the spike protein It's like a lock and the antibody is a key, if you change the shape of the lock which is what a mutation can do, the key no longer fits and therefore you can no longer block that interaction. So that's what a mutation is. The mutations are what make these variants. We've seen the UK variant the South African variant, the Brazilian variant. And yeah, we've seen some disturbing trends like the UK variant. It is clearly makes the virus more transmissible from person to person that's for sure. And the South African variant seems to have some partial escape from at least some of the vaccines induced immunity. So yeah, this is a concerning story that's being written.

But that was probably the best explanation I've heard about mutations. So thank you for doing that. That was really helpful.

I appreciate it.

Vince did you wanna ask another question?

So I'm curious, I mean, given that with the variants and everything else that we've been talking about, is COVID-19 something that you think we're gonna be living with for a long period of time or is this something that can be completely eradicated? And if it can't be completely eradicated then what should we be doing as a population to continue to protect ourselves after the worst of this has passed?

So the little phrase I've been using which is kinda corny is, COVID-19 is not something we're going to live through it's something we're gonna have to learn to live with. And I think it's gonna, it's gonna be here for a long time. But what we really wanna do is mitigate the impact that it has on our society, in our daily life and everything else. The best way to do that is, the near term target get through the pandemic. Get as many people vaccinated as possible, everybody wear masks, If you're sick, go get tested and don't go to work or school or get with other people. And stop the gathering. I mean, we know for a fact, again remember this is a highly transmissible virus so when people gather because they don't perceive themselves as being at risk really bad things happen to them, their family, their friends, their communities their state and the country. So near term target, which if we have high uptake of vaccines and people all start wearing masks and socially distance in a real way the curve could look much, much different. The downward slope could be very significant and we could have a much different summer than we had last year. I think longterm, we're gonna have to continue to vaccinate people and catch up those who are not in these kind of first groups. We're gonna end up needing to develop booster doses that are specific to the variants. And we can talk about how that happens. And I think I am confident that at some point and it could even be as early as the fourth quarter of this year I think things would be able to really start opening up in the community. I think people like me working in hospitals, we're gonna be wearing masks for a while but hopefully out in the community, we can get back to a quality of life and society functioning. Probably not like 2019 BC, before COVID but at least a new normal that is acceptable to everyone and allows us to do what we wanna do and get back on track.

So one of the questions that came in just a few seconds ago via chat has to do with the a mRNA vaccine technology itself and whether or not it can adapt to other mutations better or easier than the old fashioned vaccine itself.

I dunno, probably around seven to 10 years ago vaccinologist, folks that during the vaccine business, we started talking about this need for being able to quickly pivot. We were starting to see outbreaks of mosquito-borne diseases and other viruses that were having huge financial impacts even though they were small regional outbreaks. And so we started to invest in what they call these platform technologies. It's kind of like a plug and play. So think of it this way, messenger RNA technology is like a car and SARS-CoV-2, the virus is just the passenger. So now we want to prevent SARS-CoV-2 or COVID we make the vaccine this way. If we wanna make a influenza vaccine, we take out the COVID passenger and we put in the flu passenger. So that's kind of like a platform technology. And that's what these vaccines are. So messenger RNA, temp adeno, which is from AstraZeneca in Oxford, adeno 26 these are viral vector vaccines. These are all kind of platform technologies. And so it allows these folks to very quickly pivot and change the makeup of the passenger. So for example, I read somewhere either from Pfizer or BioNTech that they expect that it would take them about six weeks to make a new prototype vaccine to address these variants. And then it's just a matter of, doing the scale production of that vaccine and working with the regulators to understand what it's gonna take to get it out into circulation. So this is one of the good things about the platform technologies, the quick pivot, the rapid production and this is what groups like Cepi and Bill and Melinda Gates and other organizations have been investing in for the past seven to 10 years.

Sure, sure. Does the technology, the RNA technology improve immunotherapy, cures for cancer and other things of that sort too.

So that's how it started. And I'm certainly not a messenger RNA expert. The people that BioNTech are messenger RNA experts but it started out as an immuno-oncology play and anti-cancer vaccines and it continues, they continue to operate in that space. All these vaccines I mean, if you look at their history, they looked at universal flu vaccine and Ebola and Zika and MERS-CoV. So they were just waiting for an opportunity to be given like a big chance. And unfortunately or fortunately, this big chance has come in the form of COVID. And I'm glad that they've succeeded because it's a whole new, if they get licensed from the FDA or in Europe, in the EMA, it's a brand new technology that has been licensed. So it's kind of a ceiling breaking if you will. And then it allows them to apply that technology to lots of other problems that have been very difficult, very difficult to solve.

So I'm gonna ask one last question that came in via chat. And I think Vince has a closing question or two Dr. Thomas, but assuming that the, and maybe this is a question you don't wanna tip your hat necessarily and pick favorites but the question basically is, if J and J gets approved and assuming it does and it's roll actually it actually gets rolled out. Do you have a preferred vaccine that people should really take one versus the other?

Yeah, I mean, at this stage of the game with only 10% of the population vaccinated, I guess it's like children, we love them all equally. They have their pros and they have their cons. And I think that as we need as many safe and efficacious vaccines as possible. And these differences of 90%, 70%, 80%, I don't think people need to be really hung up on that right now. I think that what is most important is, when a vaccine becomes available in your area and you qualify for receiving it, you should get it because they've all, the FDA will determine if the J and J vaccine meets their marks but the initial seem promising that they're all have acceptable safety profiles and they all adequately protect certainly against severe disease and protect enough against moderate disease that they'll make a big difference. And they'll put us on the road to getting back to a reasonable quality of life.

That's great advice.

Dr. Thomas, you touched on this a little bit earlier, as far as life getting back to normal toward the end of this year hopefully if all goes well. In the meantime, what about us who have kids? I mean, should we be sending them to school? Or those of us who are in an office and going to work, what are your thoughts on going about our day-to-day activities? Should we be doing that? And if so, what, what precautions do we need to be taking?

So with schools and I'm talking primarily K through 12. So internationally, so not just in the United States but internationally, they have shown that if the school does what it is supposed to do and the parents do what they're supposed to do and the kids do what they're supposed to do, K through 12, the schools are not a source of transmission. People come to school infected that's for sure. And you have people that, we now know this person's infected and the county department of health says we got quarantine, these folks but if people are not coming to school sick, if people who are sick get tested, if people are wearing masks, if they're making people wash hands, that they're lowering the density of students in particular areas then K through 12 schools are very safe. Which is why the CDC, I think has come on pretty strongly in favor of sending kids to school. The caveat is, if the middle of a major outbreak in your county or the area that feeds into the school, you got to think twice about initiating in-person learning at that point. But I think it's been it's been very clear for a really long time that for many, many students in-person learning is the optimal learning environment. And I'm hoping that the last couple of semesters that kids have not been able to go to school, that I'm hoping that, it doesn't have too big of an effect or that we can actually kind of catch up. And it's not just school, So the hospitals, we are at very high risk cause we have hallways filled with COVID patients and roles filled with COVID patients. They're not a lot of infections occurring in the hospital because it's universal masking, people don't come to work sick, people get tested and if people test positive, they're put in quarantine. It's the same as the schools. Look at the YMCAs, for example. YMCA in New York, they publish some data. They have a lot of command and control over their environment and the infection rates that were potentially attributable to having occurred in the YMCA is incredibly, incredibly low. So if you can control the environment, you can work and exercise and learn safely.

Any final thoughts on resources and where our listeners here should be looking toward for accurate advice and getting ideas and thoughts about what's happening with the virus.

Yes the centers for disease control and prevention, they do a very good job at updating their information almost in real time. So, and I'm taking a U.S centric kind of view. So the U.S CDC is a great place to get your information, your County and your state department of health, they also do a very good job. The County might give you more real time information about specifically where you live. There might be a little bit of lag time for the state to kind of compile all of that, all of that information. And actually your local hospitals, I know that we have a lot of people who are tracking this information all the time and put information together and put it on the website. So those are three or four places that I would certainly go. There are many, many sources of incorrect information and misinformation and very kind of soft information out there. I would not encourage people to make big life decisions based upon what's feeding across their social media page. I'd go to those sources that I just mentioned.

Fantastic, Vince, thanks so much for introducing me to Dr. Thomas. This has been a real treat. I think we could probably have another three or four days with the questions and conversation given now front and center. This is to all of us, but Dr. Thomas as Vince said, thank you for taking the time out of your really busy schedule. Thank you so much for your service. We're so much better up for people like yourself that are really in the frontline of dealing with this disease and move forward to actually getting back to normal. Hopefully you have a chance to do this in person sometime again. So I think we'll just kinda wrap it up there. Thank you again, everybody for listening to us today and dialing in, we'll be back probably in a couple of weeks with another conversation somehow, somewhere. In the meantime, everybody stay well, take good care and we'll talk to you soon. Thanks so much.


Thank you.

A conversation with infectious diseases physician and Pfizer vaccine coordinating principal investigator, Dr. Stephen Thomas.

Even with the decrease in cases and hospitalizations over the past several weeks, new variants and mutations of COVID-19 have placed U.S. officials in a frenetic race to immunize as many as possible with the available vaccines. As vaccine access has risen, so has optimism for the end of the pandemic and a return to some semblance of normalcy.

But what are the realities facing individuals and what are the implications for the broader economy?

Listen to this on-demand webinar, as Dr. Stephen J. Thomas, Chief of the Division of Infectious Diseases and Key Private Bank’s Chief Investment Officer, George Mateyo as they discuss the challenges of the vaccine rollout, its efficacy, and the implications for the U.S. economy.


  • Level set understanding of the available mRNA vaccines
  • Discuss the intricacies of the world’s most ambitious immunization campaign
  • Discuss how new virus variants could impact the effectiveness of vaccines