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[00:00:07] Angela: . Hello, and welcome back to Communicable, the podcast brought to you by CMI communications ESCMID's, open Access Journal, covering infectious diseases and clinical microbiology. My name is Angela Huttner. I'm an infectious disease doctor at the Geneva University Hospital in Switzerland, and editor in chief of CMI comps.

[00:00:25] Angela: I'm joined by my co-host, Erin McCreary, fellow editor at CMI, comms id, pharmacist Extraordinaire, and Director of Infectious Disease Improvement and Clinical Research Innovation at UPMC in Pittsburgh, USA.

[00:00:40] Erin: Hi. Excited to be here, and we're very excited to welcome two esteemed guests today to discuss vaccines, a topic that really shouldn't be controversial at all, and we're excited to dive into it.

[00:00:50] Erin: Like most things, understanding the secret sauce or really how we built it often helps us appreciate the greater good and makes things more relatable. While our listeners are mostly healthcare providers and researchers in the microbiology, virology, and bacteriology space, we hope today's thoughtful discussion on vaccine platforms and technology helps us all have better conversations with our families, friends, and patients about the importance of vaccines.

[00:01:14] Angela: Our first guest is Barney Graham, infectious diseases physician and scientist. He has a BA from Rice University, MD from the University of Kansas and PhD from Vanderbilt University.

[00:01:26] Angela: He retired as Deputy Director of nihs NIAID Vaccine Research Center in 2021, ,

[00:01:32] Angela: And is now professor and director of the David Satcher Global Health Equity Institute at Morehouse School of Medicine in Atlanta, Georgia.

[00:01:41] Angela: He's an inventor of vaccines and monoclonal antibodies approved for human use to prevent or treat RSV, Covid 19 and Ebola. He's authored over 500 scientific publications, is a member of the National Academy of Sciences and the National Inventors Hall of Fame, and has received multiple awards for the advancement of science.

[00:02:01] Angela: . Time Magazine has recognized him as one of the world's 100 most influential individuals and a hero of the year in 2021, and as one of the 100 most influential individuals in health in 2024.

[00:02:15] Angela: Barney, that is quite an amazing biography. We are so honored to have you here. Welcome to Communicable.

[00:02:22] Barney: Thank you. It's a pleasure to be here to see you again.

[00:02:25] Angela: Our second guest is Gary Kobinger, Canadian Immunologist and Virologist. Currently professor in the Department of Microbiology and Immunology at University of Texas Medical Branch, Texas USA, and until recently, director of the Galveston National Laboratory. The biosafety level four facility..

[00:02:43] Angela: Gary has held previous professorships at the University of Manitoba and the University of Pennsylvania. Additionally, he was the chief of the Special Pathogens Unit at the National Microbiology Laboratory of the Public Health Agency of Canada and Winnipeg, Manitoba for eight years.

[00:03:00] Angela: Gary is known for his critical role in the development of both an effective Ebola vaccine and effective treatment that being ZMAb. His work focuses on the development and evaluation of new vaccine platforms and immunological treatments against emerging and reemerging viruses.

[00:03:16] Angela: Finally, Gary also created and Co-leads Guard, which stands for Global, urgent and Advanced Research and Development, a nonprofit organization that implements low cost strategies for research and development of vaccines and diagnos. Tools against emerging and neglected infectious diseases, thereby improving access to healthcare for populations worldwide.

[00:03:38] Angela: Gary, welcome to Communicable. So glad you're here. Thank you for, the introduction and, I feel, honored and very happy to be here .

[00:03:46] Angela: We are very glad both of you're here. . So as our listeners know, we always start with a get to know you question.

[00:03:51] Angela: So here it is. What is an odd or otherwise memorable travel experience you've had during a road trip or other travel?

Erin, you first.

[00:04:00] Erin: Sure. So I, love to travel. I travel quite a bit, both for work, for some professional engagements and I grew up moving a lot. I was actually born in Bangkok, Thailand, for those of you who don't know. And I went to Norway in, summer of 'cause we saw Taylor Swift in Amsterdam and then we decided to go to Norway for a week. And we walked into a restaurant in Bergen, Norway. And I hear someone go, Erin McCreary. I was like, what? And I look over my shoulder and standing, there was a girl who was in my undergraduate sorority, I hadn't seen her since 2009.

[00:04:33] Erin: And we just happened to run into each other in this restaurant in Norway. So it's just like, as cheesy as it sounds like the world is so small, we're so connected. And so it was a good little reminder.

[00:04:42] Angela: Very cool.

[00:04:44] Angela: I think it's really hard to actually narrow it down to one. I thought about this so much and the thing I kept coming back to it's just so memorable to me. I doubted whether I should share it because it was such a stupid thing that I did.

when I was, I think about 24 years old, I was a medical student. and NYU, which is where I went to med school, allowed me to go to West Africa to do an elective there as a student. So I was in Bamako, Mali, it was like my first couple days there and I had to go up to the, hospital, the, which is really high, up above the city on this beautiful plateau.

[00:05:18] Angela: and so I got myself up there and I was like working in the lab and I was trying to be really good. And when I finally got out it was like getting dark and I thought, okay, well I can just, grab a, taxi these like makeshift taxis and it'll be fine.

but nobody was around one of the only few people I could find was, somebody who was probably a med student and he was very kind and he said There will be no buses to Bamako. the only way to get to Bamako now is to get on the back of my little moped.

[00:05:46] Angela: the voice of my dad in the back of my head saying like. do anything stupid and I was like, well, okay. So, I did it. I got on the back of this moped and this guy flew down the cliff., It was really, really terrifying. but it was absolutely beautiful because it was twilight, just the energy, the air, everything.

[00:06:06] Angela: At any rate, I felt that I had to take a chance, kind of trust the universe, and this young man was an absolute gentleman, took me exactly to the door where I needed to go in the town of Bamako.

[00:06:18] Angela: And, it was just something I've never forgotten. It was a beautiful experience I wouldn't recommend that anybody ever do that. And I hope my daughters are not listening.

[00:06:27] Erin: It turned out okay, but don't ever do what I did. Well, we're glad you're here, Angela.

Yeah. it was actually kind of a pseudo manufactured crisis. It was not a real problem.

[00:06:37] Erin: Barney, what's your.

[00:06:38] Barney: well, you know, I've traveled a lot in Africa, in Asia, working on HIV vaccines and also Ebola vaccines and antibodies in Congo. and so I've had a lot of travel disasters that I don't really wanna recount I guess I'll tell you about the time I had the most fun. in Eastern Africa we collaborated with, Ivy and Walter Reed groups to do some of our, advanced clinical trials for HIV vaccines that we developed at the BRC.

[00:07:10] Barney: And one trip was to Uganda and, While we were working in, Entebbe and Kampala, we took a trip down to one of their, peripheral sites in Jinja. Jinja is, on Lake Victoria, and it's the head of the white Nile River, the river that flows north. And they, at that time, they still had about three or four miles of rapids.

[00:07:34] Barney: And so, Nelson, Michael and I were at the head of the raft that, we went down to, conquer the rapids on the the white Nile River coming out of Jinja. And now, coincidentally, my daughter-in-law, her father grew up in Jinja. And, so the world is small. It's a. Very interconnected place and, I encourage everybody to learn more about all its little nooks and corners.

[00:08:01] Angela: Oh, wonderful. And how cool that you got to do that with Nelson Michael, who by the way, , taught me a lot of stuff in 2014 when there was the Ebola outbreak . Big shout out to him.

[00:08:13] Angela: Gary, you,

[00:08:15] Gary: I'll tell you a short one that was kind of interesting. It's work related. it was, in DRC, the Democratic Republic of the Congo, 2006 or seven, going to. An outbreak of Ebola and, being part of a, international team for, controlling the outbreak as, quick as possible. So I was part of the first wave of people, deploying everything was in a bit of a rush,

[00:08:39] Gary: so within 72 hours. We were on the commercial jet, flying to DRC. And then I got there in the evening around like 8:00 PM meetings until midnight and then up again on 4:00 AM to get on the small plane to go to the site. and getting close to the site, the pilots, the problem was that he didn't want to land.

[00:08:59] Gary: he was suggesting we have to jump. Because he didn't want his wheels to touch the ground where Ebola was. so after a bit of talking, we convinced him to, land the plane because we couldn't just jump and, throw the equipment out. And that we would, clean up the wheels with bleach and everything so that it feels good about this plane.

[00:09:16] Gary: finally it landed And then took off, so quick. the Interesting part of the trip was that we started the outbreak, but actually we were dropped off with three laptops, three guys, three cell phone and two bottles of water. And that was it. we had to wait seven days until finally the equipment arrived.

[00:09:34] Gary: so it was, an interesting being dropped in the, the middle of the outbreak, but without any of our equipment to do diagnostic as we were supposed to. everything turned well by the way. And, on top of this, that was my first outbreak. And, it was, the first of many. you learn quickly to bring at least, which I was the only one of three, lucky enough, brought, change of clothes, in my little backpack. Together with my computer in case this kind of thing would happen. Uh, yeah. Plan B. [00:10:00]

[00:10:00] Erin: Yeah. Wow.

[00:10:01] Erin: Wow. That's crazy. That makes our travel stories seem so silly, Angela. Yeah, I know,

[00:10:06] Angela: right? We pale in comparison. I thought my moped down the mountain was pretty cool, but jumping off a moving plane actually takes the cake.

[00:10:13] Erin: Definitely. That is a life experience for sure. But, aligned with the fact that we have two of the world's masters on vaccine construction here with us today.

[00:10:22] Erin: And so we're gonna jump right into the nuts and bolts of how this is created. So Barney, let's start with you. Your work on a vaccine for RSV ended up laying the groundwork for the COVID-19 vaccine design. Can you tell us about that RSV vaccine and how it served as the model for the COVID work?

Yes. I started working on RSV, 40 years ago, back in 1985, motivated by, HIV that I saw during my residency training to become a viral immunologist. I asked Peter Wright, how do I become a virologist? He handed me a vial of RSV and said, see if you can grow this and come back six months later and tell me how you did.

[00:11:02] Barney: Anyway, the people in that lab were very helpful to me and, I spent 20 years trying to understand the vaccine enhanced disease back in the mid sixties with the very first attempts at making RSV vaccines and spent most of my time trying to understand pathogenesis and then.

[00:11:21] Barney: 2008 when, Jason McLellan a young postdoc joined the Kwong lab at the VRC. We launched, an effort to understand the structural biology of the F protein on the fusion protein, which is the main target on the virus for, neutralizing antibodies. And so, epitope by epitope known epitopes at the time, we started solving structures and eventually by 2012, we were able to identify some antibodies that could hold the thing together.

[00:11:54] Barney: And we were able to capture the pre fusion state of the F protein. unlike all the efforts on HIV that had come before where conformational evasion was just one of the problems for neutralization. Solving the conformation of the pre fusion form of f glycoprotein before it rearranges to do its thing for, viral entry, really is pretty much solve the problem for, immunogenicity and, effective immunity against RSV.

[00:12:25] Barney: So turning the pre fusion f into a vaccine antigen, worked and, that led to, trying to extend those observations to other envelope viruses like coronavirus. And so as Jason moved to universities, Dartmouth and then UT Austin, we continued our work on trying to show whether, stabilizing fusion proteins in their pre fusion state would make them better vaccine antigens.

[00:12:52] Barney: So that's sort of the story in brief.

Yeah, I mean, it's pretty amazing to see that hard work pay off and as you say it, it worked. So how does it feel to see the RSV landscape today? I mean, we went from nothing to, now we have multiple vaccines, multiple antibody products.

Well, it's very gratifying and exciting for me to see, babies, under six months of age, having ways of being protected, both from maternal immunization or for direct antibody transferred to the young infant.

[00:13:24] Barney: So that's, fantastic. having vaccines for the elderly is kind of a bonus. And what we now need to do as a field is solve the problem for the six month to 5-year-old child who also has a lot of disease. And we, we don't have. Solution for that right now. We also don't have a solution for getting these vaccines into low income countries, which is part of the reason I'm now at Morehouse School of Medicine directing this global health equity program.

[00:13:52] Angela: Do you wanna tell us a little bit about that?

[00:13:55] Barney: well, I left the VRC at the end of 2021. I left federal service and, moved to Atlanta, Georgia, which is where , some of our grandchildren are living. And so I joined the faculty at Morehouse School of Medicine. This is a relatively small medical school. It's in its 50th year of existence this year.

it is focused on health equity and health justice. This is part of its mission statement it's a wonderful place to be working if you're trying to solve, problems of equity and fairness. the thing that I think has changed is mRNA. Coming on the scene and, showing to be effective and very safe, creates a new possibility for distributive manufacturing because it's, a synthetic product.

[00:14:43] Barney: the supply chain is being solved. It can be done on a small footprint with a small amount of equipment, a small number of people. It can do small batch manufacturing that could serve regional purposes. so I think with mRNA, it creates, options, that were never achievable when you needed a whole campus full of bioreactors.

[00:15:06] Barney: there's several places on the African continent, in South Africa, in Senegal, in Rwanda, that are making good progress in making mRNA . So it doesn't solve all vaccine problems and it's not going to be the tool for everything, but it opens up the possibility of, expanding research capacity in low income countries and eventually regional manufacturing in places where they haven't had access to new products in the past.

I work and consult and advocate for those kinds of things. And then most of my work really is trying to, work with young students there, and help them find international experiences to open up a vision for their life in public health.

this is great to learn about this whole global health aspect. Gary, what has your experience been with mRNA vaccines?

[00:16:02] Gary: Well, as, Barney said the big advantages the manufacturing is easier and it can be more local. That said, of course you need a cold chain. which means that, brings for some location, another layer of complexity.

[00:16:16] Gary: we were able to bring mine city to the most remote location. but again, it's not so simple. And what brings the level even higher is the documentation that goes with clinical, grade vaccine. and so that becomes, a lot more cumbersome. But, you know, again, mRNA vaccine is, a very promising new tool that is important that will play an important role, but it won't solve it all. And, there is still a very good platform, To tackle the issue of, vaccination and protect population. but right now, one of the biggest hurdle is, acceptance, of those vaccination campaign.

[00:16:50] Gary: not so much the tools, to vaccinate. Of course, we don't have vaccine against everything, but there is a lot good tools now, and mRNA is one of the most recent and definitely very promising one, but it doesn't prevent, or remove, from, the roles of, other very good vaccine and polio vaccine and, all others to, keep, moving forward and protecting population against infectious diseases.

[00:17:12] Gary: so I think, it's always a matter of, risk benefit, not only in terms of the vaccine to the recipient, but also from the platform perspective to what are the risk benefit at the. Population level, country level, what are the, plus and the minuses, the cost associated with this?

what do we need in terms of, infrastructures? some vaccine platform, are easier to use in specific environment than others. the more options we have, the better prepared and able we are to protect population with tools that are very well adapted to the needs basically.

[00:17:46] Angela: Yeah. I'm going to pivot now to a totally different vaccine. you mentioned Ebola before Gary played a leading role in developing the currently licensed vaccine against Ebola, which is the rVSV ZEBOV vaccine. Air Vbo is now the trade name, which is strikingly effective and now used routinely in the field.

[00:18:10] Angela: that vaccine is certainly not mRNA. It's a live vaccine. can you tell us about it? What were those challenges in early development and

[00:18:20] Angela: now that we do have mRNA technology, what do you think of R-V-S-V-Z BO?

I think it's still a great tool. And by the way, I'm gonna start by saying that, the real, leader into that, early vaccine development was Dr. Heinz Feldmann, he really, spearheaded, that project from the beginning.

[00:18:36] Gary: You know, VSV Ebola, was not produced as a vaccine initially it was, generated to study, the glycoprotein, the component of Ebola, , which binds into target cells and to study it into, a different virus, which was VSV, so that it could be used actually in level two as well. VSV is an animal virus that is not known to cause disease in humans, although there is documented, infection farmers, for example, that have antibodies.

so it's, recognized as a very safe. Animal virus that doesn't infect human. And so to put the glycoprotein from Ebola into that context made it possible to work in level two. And that was really the initial, tools, that was developed that, so it was really , basic biology and virology.

Just for our audience? Can you tell us what level two is?

[00:19:25] Gary: Oh, I'm sorry. Yes, yes, so Ebola is, we all usually understand it's a virus that is quite dangerous.

[00:19:30] Gary: it needs to be, studied in the highest level of containment, which is level four. So there's four level 1, 2, 3, 4. one is, your kitchen counter, so to speak, but more in a lab setting. Level two is more for protecting what you work with.

[00:19:44] Gary: And not necessarily yourself. So there are viruses, bacteria are not pathogenic, they don't cause disease. But you wanna protect them from the environment. You don't want contamination. Level three, you're starting to protect yourself. And level four is really full fledged, protecting yourself from a deadly, pathogen.

here you are in a space suit [00:20:00] so, VSV, the vaccine, as of today was made in level two. , basically as a non-pathogenic, virus. a virus that doesn't cause disease in humans and was made to study. But this evolved, with Heinz . Why not using this as a vaccine? I think early on when the first data, came out of those studies, the immune responses were, extremely good, very robust, It appeared from the start to be a, very promising vaccine platform.

that said, I think, in our little community we were thinking, well, this is a good gold standard, but I'm not sure that it will ever be a clinical product because it's still an animal virus modified where we added, the glycoprotein from Ebola virus and removed the one that was, to the VSV virus.

We knew everything can be done. from a, regulation perspective . It's just a matter of, showing safety data. but The issue was perception We thought that it's not the first live, vaccine, as we say, live vaccine, which is based on a virus that replicates what vaccine core that replicates. Yellow Fever is a good example of this. And it's, I think probably the most efficient vaccine out there, one dose for life. but it was still, at the time where perception mattered.

Aside from this, there were other platform like adenovirus, like, DNA, RNA came later on. but they seemed to be very potent and maybe with a better safety profile or, a better acceptance profile. we moved VSV initially as more gold standard for other vaccine platform , trying to get to that level.

[00:21:32] Gary: in 2014, we had the clinical grade a lot to move into a phase one. at the time I was the chief in Winnipeg and I offered it to WHO. I was not the only one by the way. GSK offered their, adenovirus base Ebola vaccine. and the first, offering was declined, but a few months, after that, as the situation worsened in West Africa, then clinical trials were, initiated and, part of the history of this vaccine now. I think it's a phenomenal vaccine still. I , think that long-term protection is not well, understood and that we may need at least a booster and maybe something else, a booster with the same or a different vaccine, I think will be useful.

[00:22:12] Gary: but again, as you said, there's other platform. They were there at the time. Some are new, like, mRNA, are they gonna be able to bring more benefits, again to fight that infectious disease? Maybe. I don't know. I, think data needs to be, generated and we'll see.

I will tell you, Gary, I actually did not know it was directly from you, this donation of this experimental Ebola vaccine to WHO in the summer of 2014, I was here in Geneva and I think WHO was of course very happy to have access to these vaccines, but. that vaccine had never been tested in human beings in a trial, let's say.

there were some, perhaps lab workers who had, received the vaccine, but it had not yet been tested in a trial. So they did ask us at the University of Geneva. To rapidly put together that phase one trial, which we did. but I'll tell you, we had a terrible time, something about VSV that it was developed in the states using VSV.

This is the v. Vesicular Stomatitis virus as the vector. That's a beautiful idea for the United States. For North America, but VSV has no presence right now in Europe. so that as the vector was a nightmare for our regulatory, authorities. In fact, because we're talking about Switzerland, right?

[00:23:31] Angela: VSV infects livestock, just letting people know who might be just like regular infectious disease doctors in the hospital. You may not know this, but VSV, like Gary said, it's a virus that infects livestock, maybe some human farmers. it's not a real problem for humans, but livestock, I mean, that really interferes with milk supply, right?

[00:23:52] Angela: So for Switzerland, yeah, this is a country that lives on cheese and chocolate and those industries are so important and we had. A devil of a time trying to get that through, I mean, we almost didn't have a trial. we fought tooth and nail to get that aspect of the trial approved. And in fact, for our healthy volunteers who did this phase one trial with us, we had to collect their saliva, we had to collect their urine.

we had to make sure they were not shedding VSV, they were not allowed to, have contact with other human beings. They were not allowed to go on farms, after vaccination. it was really a big deal for a European center to. Trial of this vaccine in a place where VSV has no presence right now.

[00:24:39] Erin: So I guess, Angela, for our listeners that are less familiar with the signs, that may have been a little alarming what you just said. to clarify, how did this story end after receipt of vaccine. Are people both protected from Ebola and unlikely to harm their farm animals? Is that true? Yeah.

[00:24:54] Angela: Yeah. I can absolutely assure everyone that, here in Geneva, we were testing the very highest doses of this VSV Vectored Ebola vaccine.

[00:25:03] Angela: We had the highest doses and we really were checking everyone. We were checking blood, urine, saliva, We found it in the blood. This is a normal thing. there was viremia, this is what we wanted. This is what we expected. This is how the vaccine takes, but we did not find it in the urine.

[00:25:20] Angela: We did not find it in saliva. and so there was no shedding that we could find. and no, there was no, cow that was infected. We had no trouble at all. the viremia, the vaccin anemia was very transient itself, even in the participants who got the highest doses.

this was one of the, point of discussion, including in Africa where people are actually closer often to cattles and, animals. a lot of families have their own animals and it's actually a big part of their economy, and the wealth of a family.

[00:25:50] Gary: but the issue was more misdiagnosing. VSV infection does, present a bit like, foot and mouth, but it's not as damaging as foot and mouth at all but, it's a worry that if you have the symptoms of foot and mouth, then the vet may trigger, responses to that, including culling of animals, without that being a foot and mouth.

[00:26:09] Gary: But it turned out that there's not a single documented transmission of a vaccinated individuals to any animal, including in Africa, again, where hundreds of thousands were, vaccinated And, many of them, were close to their animals including the same day because they were coming to the center, being vaccinated and going back home.

[00:26:28] Gary: nobody was staying there, in the phase three. and after that inactives, uh, outbreak setting. so this, was all, a point of discussion and, theoretical problem that was discussed extensively, but at the end, turned out to not be, an issue, in real life basically.

[00:26:41] Gary: But it was good to document that people are not shedding the vaccine the discussion even went, can somebody that is vaccinated infect another person that is not vaccinated? But also this was never documented somebody that infected or , co vaccinated, another person, that was not directly vaccinated.

[00:26:59] Angela: Gary, , one thing we never did, 'cause we had a budget, We didn't actually check stool for the vaccine virus. And I always wanted to know, is there some fecal oral? , Is it a bit. Poliovirus esque. do you or Barney know of, VSV in the stool? can it shed that way?

In nonhuman primate.

[00:27:20] Gary: we found, traces, at very early, when that was the highest, peak of the vaccine, as you say, as we want it to be at two or three days. but it was all degraded. We had to, kind of reconstruct it to understand what that happened. So, it doesn't survive the gastrointestinal, travel.

[00:27:38] Gary: and it's, really traces There's more in the urine, for example, and saliva and it's still very, very low, and inactive. but, you really need to go in the blood or physicals if you see any, and then in animals. We never saw that day, as I remember correctly.

[00:27:52] Erin: Yeah. This has been fascinating to learn. I think you both have talked about two different platforms, so to speak. putting a virus in another virus, and then everything we discussed with the mRNA platform and how that was translatable across multiple viruses. So to get a little more macro level and step back a bit about development, both of you have been advocates for prototype pathogen preparedness or developing vaccine designs in advance for the family of viruses so that, if there's an outbreak or a pandemic, you're readily prepared to pivot and to have that science and technology available, which is really just amazing.

[00:28:25] Erin: can you tell us a little bit more about that? So, I guess, Barney, let's start with you and maybe go back to the COVID space for a bit. You know, how in your eyes did that set you up for success in 2020? And then how is that gonna work, you know, both today and in the future?

Yes, at the Vaccine Research Center, that opened in, 2000, 2001 timeframe.

[00:28:45] Barney: We had been responding to all these outbreaks and, you know, there was, smallpox scares in around nine 11. In 2001, it went to West Nile sars, the first SARS and Avian Flu, on and on and on. chikungunya, MERS, coronavirus, and then Ebola in 2014. So, our work on RSV and then on coronavirus, solving structures of, similar type fusion proteins and all those, responses that all, had to be reactive instead of proactive.

[00:29:23] Barney: and then Zika came and Zika, since we had done a DNA vaccine for West Nile. We quickly made a DNA vaccine for Zika and got it into Central and South America within about 16 months. and yet that was too slow for, the epidemic was already over by the time we got the vaccine out there.

[00:29:43] Barney: Like, what happened to the ad vector vaccine in Liberia, the epidemic was already over by the time it even got into the field. And so we started thinking about, how could we do better and be more proactive and taking the example of DNA, going from one Flavi [00:30:00] virus to another, or, structure-based vaccine design, taking a fusion protein from different envelope viruses even across different families.

[00:30:09] Barney: And, a paper was being written between about 2015 and 1617 on a, prototype pathogen approach to pandemic preparedness and taking a family-based approach to this problem. and then, we implemented that idea after 2016 because we found that, we had a response in the government to Zika.

The DNA was the most immediate, the secondary was going to be mRNA. So we ended up testing three different mRNA products in our monkey model. During that 2016 timeframe. and then the third component was gonna be Steve Whitehead's, live attenuated approach that he had taken for dengue. But anyway, 10 micrograms of mRNA was as good as four milligrams of DNA.

[00:31:01] Barney: So it was extremely better and more potent. And something had changed between 2013 and 2016. Something in that formulation, the delivery, the sequences, I'm not sure, but RNA all of a sudden was working. So we started a, collaboration with Moderna in 2017 on the Coronaviruses and the Paramyxoviruses with NEPA as a prototype for Paramix XOs.

[00:31:28] Barney: And Mers. Coronavirus is a prototype for Corona. And by 2019 had, shown that either DNA or protein using the vaccine designs we had, would protect against lethal challenge in animal models. So we had already paid for and were prepared to take the NEPA vaccine mRNA into, into phase one clinical trials in the first quarter of 2020 and then on January 6th, found out that this could be a beta coronavirus and, flipped from the para Mixo family to the Coronavirus family for a demonstration project. talking about the prototype pathogens and then doing that, and then the coronavirus is coming out so quickly, I think, spurred a lot of other groups.

WHO Cepi, and others to take on this family based or prototype pathogen approach to, not that it will solve all problems or that everything can go that fast, but it is at least a way of organizing the work. and so WHO and NIAID are probably pushed this, the farthest at this point, but, I think it is a way forward to at least to organize the work.

[00:32:38] Barney: And there's now groups all over the world, sort of organizing family by family called the corks, the WHO organized courts to work on these different virus families.

[00:32:49] Angela: Gary, any comments?

[00:32:51] Gary: No, I think it's fascinating to hear, how. Things progress. we see often, what works, but we fail to, see what was less optimal, basically. And everything, all the work that was done, left, right, and center to basically get to a solution that is in our mind, at least, always work in progress.

whatever we have, we can improve. and that's why I think it's important to not get, too focused on one, tool, but to, to keep, your eyes on, all the possibilities, including the future possibilities especially for, earlier career scientists, it's very important to hear about All the work that goes around, what, was done? The path to that solution is at least as important as solution itself, especially when you wanna understand a bit better, how these vaccines are.

And it's not only a matter for early career scientists, I think it's very useful for people that are curious, about vaccination. And I think it helps also, with acceptance of vaccine, in the population for people that can have access to that kind of knowledge.

your, exercise here, this podcast, is quite useful I think, because it can be accessible by anybody

[00:34:00] Erin: Yeah, I like that you segued into the public wanting to access this and might not understand the science to this degree or even be interested in it, but having the experience and the familiarity may enhance acceptance. any advice you have for, you know, how you educate the gen pop, in encouraging people to enroll in the early trials. and how you educate the medical community in moving us toward a broad acceptance of vaccination. once vaccines are approved and proven safe and proven efficacious, why is there still this hesitancy and some to uptake the vaccine?

I think that's probably the most important topic right now for Vaccinologist including public health, official.

[00:34:38] Gary: I would start by saying, I think what's key is transparency. when you're on the side of, with the development of vaccines, and from the first step to the end completely, should be a fully transparent process you would be surprised how many people from the community contacting me with questions and, sometimes, challenging, what publication they could find online and how curious some people are.

[00:35:02] Gary: I think this needs to be encouraged. people that are in the community that have questions, they should be able to ask those questions. They should be able to challenge, every step of development, every little platform or big platform or whatnot. today I still think that, protein-based vaccine, which are the first, very early generation of vaccine are still very important. They have still a very important, safety profile. and if they work as that kind of platform, let's do it. and I'm saying this 'cause people are more comfortable with those 'cause they have been, around for, so long and they have had time to gain more knowledge.

[00:35:35] Gary: But what's important is really to communicate to the population, to people. And ultimately, I will say this, It's my opinion. Maybe not share about all of you and maybe not share by everybody, but I still personally think that vaccination is a personal choice. I think that if we cannot convince people that the vaccine is good for them, we need to go back to the board and communicate better.

[00:35:58] Gary: ' cause it's very easy vaccine have saved more people than everything but one solution. That solution is clean water. Well, anybody on this planet, I think that has a sense of understanding of infectious disease understands that drinking dirty water from a puddle in the middle of a country where it's, always warm, or hot, it is not a good idea.

[00:36:22] Gary: and drinking, by the way, contaminated water in Canada is not a good idea either. So again, vaccine have saved, so many lives. Let people ask, let people understand. it's not a perfect, intervention. There are side effect. Let's communicate them. most are extremely mild, but for some people, could be more severe.

Let's communicate all this. Let's educate people. let them make their own educated choice and not force vaccination on people. I think this is a very thin line to walk because people are being forced into something. They don't often, uh, react the right way. And I think right now what we are experiencing is mainly due to a lot of push, in some extent very, very hard push where people were being told, if you don't get vaccinated, you're gonna lose your job.

[00:37:06] Gary: We're gonna fire you. I think it's a very risky position to take personally. I think it's better to convince those people with hard data and show them the benefit of vaccination, let them decide. There are exception to this. If you decide to work a cancer, department, you don't wanna get vaccinated and you put those patients at risk, then you shouldn't be there.

[00:37:24] Gary: but you shouldn't lose your job. You could go to another department and work there as an example. I'm just telling you an example. Like everything there are exceptions. but overall, large majority of people wants to get vaccinated because they know that they're gonna be a bit tired.

[00:37:38] Gary: If that's the side effect, it's nothing compared to. risking your life, and getting the disease or being handicapped by a disease that leaves you, with severe consequences of the infection.

. When I was a kid, there was a kid that was in my class, that was, in crutches, from polio. You don't see them anymore. and I hope we won't see them back, although this polio is still active, and this is one of the, I think, infectious disease that we shouldn't see around it anymore.

[00:38:04] Gary: but it's not an easy one. So it's a big discussion. But I'll conclude with this. I think we should encourage people to ask questions. We should answer those questions. We should get into those discussion and do it in an open mind.

[00:38:16] Angela: thank you Gary. I will tell you, very transparently, one of the reasons I really wanted to do this episode is because our listenership is doctors, it's healthcare professionals, it's pharmacists, it's people who are in that chain between real vaccine experts such as you two and the general public.

[00:38:36] Angela: And we are now living in a time when one of the deputy directors of the CDC just said, I think people now need to go to their primary care doctors to get their information there. The CDC does have some level of, a credibility problem . Because of current, leadership. And so now our listenership is gonna be frontline.

[00:38:59] Angela: so it's really nice to try to help them to understand how these vaccines work so that they can then turn around and inform their patients, their families, school teachers, et cetera, who are coming to them with questions about safety, efficacy, the value of getting a vaccine, yes or no. It requires more time, more effort from everybody involved because, like you said, it's often case by case, giving more information, reassuring people.

[00:39:28] Angela: But it does seem to be overall quite effective in not letting one group, depolarized and, be too manne about how they view this tool among other tools. Barney, Do you have any comments?

I agree with everything Gary just said. the first step is listening.

[00:39:48] Barney: we have to listen better there are no bad questions. We have to be able to answer questions without being defensive, and I agree that, teaching is better [00:40:00] than mandates. I grew up in a farming country in Kansas and I've always said that, a Kansas farmer will vaccinate his animals.

they will, vaccinate themselves. If you just explain why. If you tell them what to do, they won't do it. I can guarantee you, if you tell me what to do, I'm not going to do it. But if you teach instead of mandate, I think it can be much more effective. The other thing, is I think we have to do a lot more work with our young children because our third and fourth and fifth graders can understand biology a lot better than we acknowledge.

they can be the teachers to the parents and the grandparents. so we have to do a better job of teaching biology to our young people and also teaching critical thinking. and that kind of thing is being lost from US educational facilities at least. Teach about how to think, thinking about how you think is an important, concept.

it will help people, when they hear things that may or may not sound like they make sense. They can ask, what is the motivation behind that? who's going to gain from their, associations or their investments if, you do it their way instead of this way? and so I just think there's a lot of educating that we could be doing both to the general public during a crisis and to our children, before the crisis.

[00:41:33] Erin: , I think we all empathize with this. It's like raising teenagers. Like you can't tell them no or don't do this, or this is bad for you, or this is good for you. They have to come to that realization on your own. So I couldn't agree more. It's like every single patient is different and we don't like that answer as a society or as a global community because that's more work and that's challenging and that takes more time and skill things that we don't have.

[00:41:54] Erin: Right. especially in the American healthcare system, physicians apps are increasingly under pressure to see a patient every four minutes. Right. And that's not enough time to sit, especially with a new patient and get into their own personal motivation or fear in why they would or would not accept a vaccine.

[00:42:11] Erin: But the only way we're gonna move this needle is to, get to the individual person and, have them make an informed decision about what's best for them. So something I think about a lot is time's the only thing we're never getting back, and it's our most precious human resource.

How do we fix such a broken system where, patients can come to these conclusions on their own. And I do agree that I think the youth are the future. It always have been, always will be. But I think that there's a lot of opportunity, to start to coach this earlier rather than just saying, you can't go to school if this doesn't happen.

That doesn't give anyone the why. And even school-aged children deserve to know the why. So.

[00:42:45] Angela: This conversation is making me remember something.

[00:42:48] Angela: So in 2021, full disclosure, Gary Kobinger, approached us here in Geneva because we had this, population of healthy volunteers who had participated in our 2014 phase one trial testing that VSV Zebo vaccine. And Gary asked us, would you be willing to track down some of those volunteers and do another phase one trial where we test a booster vaccine, in those patients who'd already been primed with the VSV ZEBOV vaccine?

[00:43:21] Angela: I will, be very happy to hear Gary tell us about it in detail. But this vaccine was a DNA vaccine. And I'll tell you, we had, a wonderful group of, participants. Our volunteers are very special people. of them, are doctors without Borders. Workers, who were going down to Africa back in 2014.

[00:43:41] Angela: but a lot of our volunteers were local Geneva residents who simply wanted to help, and wanted to get the world closer to a vaccine that could work against Ebola. Some of them of course would be a bit fearful about a new vaccine and a DNA vaccine of all things.

[00:43:59] Angela: So we organized some information sessions for this population that we were hoping to recruit into this booster trial. And Gary very kindly got online, from Canada, and we just talked to the participants. a lot of people dialed in. And Gary was able to just speak very honestly about, potential safety issues.

This is what we know, this is what we don't know yet. This is why we do trials. Of course. And you said something Gary, that I thought was so great. You said, you know, we're eating DNA all the time. Every time you eat plants, you're eating a lot of DNA, you're ingesting a lot of DNA. I think that really reassured a lot of people and ever since then I actually think about that. I think, you know, all these people who are so scared about what am I putting into my body? You know, actually it turns out you're putting, like two kilos of DNA every day, And if we can take the time, to talk to people and put it in terms like that, it really kind of helps. We had a very good recruitment rate for our phase one trial recruitment was not a problem Gary, any words on that?

I mean, . This was a, bit of an easier population 'cause they were in the medical field and they understood vaccination the risk and benefit very clearly. so there was a bit maybe easier for them to, make up their mind.

[00:45:17] Gary: but it was very interesting, two things in my view. First, that the number of people that wanted to participate was very high and that was a great sign. The second thing is, why we picked DNA is, because it worked, in all the models we had been studying.

[00:45:29] Gary: But, more importantly to us was that the safety profile was the best, the side effect was. Barely detectable. there was some, pain on the side of injection. It's not because it's DNA or it's RNA or it's anything. It's the needle that goes in skin, in the muscle, does create pain and it's part of the side effect.

[00:45:46] Gary: but what was interesting along the, trials, if I can disclose this, is that at one point these people worked together. They were talking to one another, and then they realized that they all somehow thought that they were in the control group, the placebo group. Because they had no side effect.

[00:46:01] Gary: And then they realized that while they could not be all in the placebo group because it was only, a small number of, the participant that were in that group. And so it created an interesting dynamic, in these trials where, participants were talking to one another and saying, well, we cannot be all in a placebo.

[00:46:17] Gary: So really the level of side effect is extremely low. and it made actually them more interested into the vaccine. They came back and said, well, if I'm in the placebo, can I then get the vaccine at the end of the trial? so that, that created another level of discussion. I was very happy because,, with the, approval from, the regulators.

[00:46:36] Gary: In Switzerland, I was able to participate. I can disclose that. and it was fun to be myself, uh, participant in the trial itself with everybody else.

[00:46:45] Angela: Gary, you're revealing all our secrets.

[00:46:48] Gary: Gary

[00:46:49] Angela: was a trial participant.

[00:46:51] Angela: it was the first time I had done a vaccine trial where people weren't having tons of reactogenicity. everyone thought, oh, I must have gotten placebo. I didn't have a fever. I didn't have anything.

[00:47:02] Angela: and then we started to notice, that the women volunteers were really not having any reaction. and then we were starting to joke to ourselves like, women just don't complain. Right. You know, like we, women we're just tough, you know? And these guys, you know, they're kind of whiny, And then Gary comes along and he gets injected and you were like, you know, I know why, men aren't feeling anything 'cause we have more muscle mass. Long story. But with this vaccine, there actually is a preliminary step that you have to take to get the DNA into the cells.

[00:47:35] Angela: you do have to do this thing called electroporation. Where you do have to do a little zap.

[00:47:40] Angela: And so Gary decided that, ah, the reason the men feel it more is 'cause they've got more muscle mass. So we all thought that was very funny.

[00:47:48] Gary: Supposed to make them feel better too.

[00:47:51] Angela: Yeah, exactly. Yeah.

[00:47:52] Angela: Yeah. But we really did notice a very stark divide between women reported pain versus the male, reported pain. But, anyway, actually I'm ashamed to say we've taken longer than we thought to get the results in because Gary is doing all kinds of interesting, antibody assays and, we're really getting into depth about, innate immunity, humoral immunity, lots and lots of results to dig into.

[00:48:17] Angela: And so we actually are submitting those results hopefully this week, Gary. so that paper will come out, we hope soon,

[00:48:24] Barney: Can I add one thing? I just wanna point out that. mRNA is in every living thing on earth.

[00:48:30] Angela: so right.

[00:48:31] Angela: Yeah. these are things people may not even know, they may not put that together, but it helps to hear things like this. we're ingesting RNA all the time and DNA for that matter. Yeah. Gary, I wanna come back to one thing. We learned that Barney is working very hard on access, to vaccines in different settings, and you are too. Can you tell us about Guard this organization that you founded?

[00:48:55] Gary: Yeah. it's basically a not-for-profit, uh, that is, trying to, advance diagnostic vaccine and therapeutics, at very low costs.

[00:49:05] Gary: So, overall as of now, after this was starting in 2018, so after seven years, we are working, about less than 10% of the average cost of others, that are in that same sphere. sometimes we're actually lower than that. but on average, and so it definitely, which reduce the cost.

[00:49:25] Gary: but it's not all positive in the sense that, you know, when you don't have investors, that see a return, then of course it's a bit more difficult to raise money. but I think more and more, there's two things that are happening, I think at minimum is, there's more interest into the, way and strategy of, advancing tools.

[00:49:44] Gary: a lot more young investigators are coming to us, are very interested, and, they want to help, they want to contribute. but they don't wanna make millions and billions. they just wanna help others. And, so that adds to that change, I think from, at least from my [00:50:00] generation.

[00:50:00] Gary: and I think it's great and we see more. Scientists of all ages, and clinician, really spending more time and we sit also, again, I think it's great to see Barney, after leaving this, last big job, spending more time into access. And let's face it, a lot of those infectious disease, at least that are close to my heart, are neglected tropical diseases.

[00:50:21] Gary: And which means that economically speaking, there's no future for those vaccine the way they are now. It doesn't mean that you cannot save thousands and tens and thousands of life from, devastating, diseases. And it's not only the disease is the impact on the community, the economic impact. If there's a Ebola case in the village, trust me, the village shut down.

[00:50:40] Gary: There's no trade, there's nothing happening. it's beyond, the direct, damage of, this infectious disease. we are right now, Started more in the sphere of, diagnostic because, also this is the first thing that needed to do. What is the disease?

[00:50:55] Gary: You need to identify it. And then you need to differentiate who is infected from, who is not infected. And a lot of those tools to diagnose the tests that are being developed also very expensive. when in fact you can develop them at variable costs. So that's where we are now. it's not against the for-profit, format, it's complimenting the for-profit format with an approach that will serve, population that otherwise don't have access to those tools at all. Zero. And so that's where we're starting. but behind this, I think the narrative that we are also pushing for, and that when I have a chance to talk to, uh, executive in big pharma, by the way, we've added a tremendous, communication and collaboration with Merck, not only for VSV vaccine, for other things as well.

they want to solve problems. They want to help. of course they are a for-profit company. and for us, there's nothing wrong with that. it's again, the fact that there's a lot of diseases for which there's no solution that are economically viable.

[00:51:53] Gary: So there's no investment. And that's where we try to be. And, we see this as being complimentary. the narrative we're trying to push to big pharma is. why don't you all apply? what I call naively the Walmart concept, before Walmart retails was, working at a 20, 30%, profit margin.

[00:52:11] Gary: Walmart came in and said, we'll do less than 3% profit margin. I will make more money because we'll do volume. And I'm trying to push that narrative on, pharma. Why don't you treat everybody on this planet, reduce your, profit margin? That sometimes is 10000%, 10000%. It's unreal. Then of course, only a very small portion of the world population can access that kind of, expense.

[00:52:36] Gary: and afford that kind of expense. And so let's lower the profit margin and let's go on volume. Let's save everybody on this planet for every, disease. I don't think it's gonna slow, investment personally, because that will be more. More money generated for doing more research and development.

[00:52:51] Gary: but again, it's a shift from the past. and I think it's great right now to see more people getting involved in everything that lowers cost, that, promotes access, and to see the younger generation also being so motivated. Honestly, I'm, so impressed, the people that came, to us, to work, very, very, talented, young investigators and, it's honestly looking really good in my view, for the future to lower costs and, improve access.

[00:53:17] Erin: That's awesome. I think we covered really nicely. There's a lot of beautiful things about the current system and then a lot of opportunity for reform. So I guess to kind of end, this is a question for both of you and maybe Barney, you can start us off if you could do anything. So with everything we've talked about today, if you had unlimited resources and the global collaboration, we're moving toward increasingly.

[00:53:37] Erin: what's next? What vaccine or infectious diseases challenge would you want to take on?

One of the premises of this idea of, working on the viral families is because, you know, there's 26 viral families that are known to infect humans. Some of them are more studied than others, but the whole premise is to generate the basic research data that we need on all the different viruses and not leave anything out.

[00:54:05] Barney: you could still prioritize within categories, but it's a way of, covering everything. And we now have the technological tools to do so much. We could solve so many problems. I think we could solve 80 or 90% of the problems we have right now ahead of time if we would. Focus and if we could, convince high income countries, that it is in their mutual interest to work with low income countries to solve regional problems before they become global problems.

[00:54:40] Barney: and that, would benefit everyone. And it would also, build the research capacity in, low income countries and building the, human capital people who know how to do these things is the first step in getting to a point where you can do some regional manufacturing. So if we really wanna solve, and reduce pandemic threats of the future, we have all the technology tools right now, we just don't have the policies and practices or will.

[00:55:10] Barney: to really deploy the resources that are needed. The high income countries can supply resources and low income countries can supply manpower and samples and the things where most pandemics emerge. So if I could see anything happen, it would be that. And, part of that is to, get everyone involved.

[00:55:30] Barney: make sure we don't leave any talent on the earth untapped. You know, there's so much talent right now everywhere that is either dismissed or ignored or just blocked from accessing all the resources they need to do their very best, So that's what I would love to see happen.

[00:55:50] Angela: Gary, how about you?

[00:55:52] Gary: Well, I think what Barney just said is, amazing and, I think actually we're moving towards that. I'm quite optimistic that, it's not too far the knowledge that is necessary, as he said, for 90% is, there, or close to, be acquired.

[00:56:06] Gary: So I think from that knowledge perspective, we're very well positioned. Again, I think the intent is there, and coordinating all this is where it's complicated and it's difficult. But again, it's a matter of the more we talk about it, then we see the benefit or we explain the benefit, the more likely we are to move towards this.

[00:56:23] Gary: more from a, maybe a little technical. perspective, if I would have to, show myself in the future, I would love to see every one being able to develop their little diagnostic tests and being able to develop the vaccine and therapeutics. they may need, from information they would download from the internet, from the government, their healthcare provider.

[00:56:39] Gary: And, I'm just, using the image of the coffee machine, which most people have in the house. so this, is technical challenge, but I think it's still, somewhere where we could, be going. and that would be, quite interesting also from a cost perspective, if we would get that technology.

on the second level, , we're talking about vaccine. It's, basically modifying the immune response and preparing the immune response to fight back an infectious agent. there's a lot of knowledge that came out of all these studies and, also basic immunology. this field could grow not only to protect against infectious disease and it, there is a big footprint in the cancer area where, there's cancer vaccine.

[00:57:16] Gary: but you can imagine also that all this, immunology could, allow us to, Modulate and adapt everybody's immune system in the most beneficial way. For example, limiting the, appearance of autoimmune diseases or making them, more, tolerable or, disappear. and, that involve also in my view, allergies that are growing.

[00:57:37] Gary: If you look 50 years ago today, allergies a much bigger problem now. and so anyway, the vaccine is, one field that is growing, that has already a lot of challenges in front of them. but, there's a lot. Of, fun to have there.

[00:57:50] Gary: And, fascinating work. I think that, we'll see being done in the future.

[00:57:54] Erin: I'm an optimist for sure. I try to be a pretty positive person, which some days is harder than others. But I remember when the checkpoint inhibitors first came out in the oncology space, and I remember just like running up and down the halls of the hospital, like being so excited because I was like, guys, finally, instead of pouring toxic things to try to kill evil things in humans and hurting humans along the way, we've flipped the narrative to now we're just gonna make the host better and we're going to augment the things that can help within the host and what amazing science and just kind of like mindset in general.

[00:58:23] Erin: Like, I thought that was so phenomenal. And of course, now those are the, most commonly used, highest billing drugs globally. I think that what you just said about understanding the immune system and how do we really just continue to make the host better is just, really, really, really cool science and a cool.

[00:58:37] Erin: direction. with that, Thank you for sharing your time. Thank you for everything you've done for patients around the globe, with your teams and with your research jumping out of planes and all of the things that we did to get here today.

[00:58:48] Barney: Well, Look at us sitting in different continents, talking to each other this wasn't possible in 2001 and two when the first SARS came.

[00:58:57] Barney: If the first SARS came before we had any structural information, before we had any real tools to do much of anything before we could. Do these kinds of video calls with everybody together from everywhere we would've been sunk. and so, if you wanna be optimistic, you can thank the universe for holding COVID back for 20 years.

[00:59:20] Barney: 20 years earlier, it would've been even worse.

[00:59:23] Angela: Well, you guys actually are bringing all this hope and I didn't think it would be such a hopeful, discussion

[00:59:30] Angela: Do you have any messages for that young investigator, who may be in a country where there doesn't seem right now to be that level of support, or, guidance

[00:59:42] Gary: yes, absolutely. I'd say to all these young, , investigators and whoever's interested, just get involved. Contact people that are involved in what you wanna do and passion. Your passion will solve it all. you'll be part of, that.

[00:59:55] Gary: Bigger group, global group that, where we're all working the same goal, [01:00:00] and, the same, hope and, and dreams.

[01:00:02] Barney: Well, the only thing that matters to me now at my age is how young people are going to, carry on. and like I said before, there's so much talent on earth that we just have to release it. people studied biology. People loved biology before NIH existed in 1953. You can always study biology.

[01:00:25] Barney: you can do it with a lot of resources or you can do it with small resources and the better and better. We understand things in some ways, the simpler they get. as we turn more biological, processes into more engineering, as we gain more knowledge, we can turn them into engineering projects.

once it becomes an engineering project, you can solve it. You can always solve an engineering problem. We need to turn more of our biology into engineering ideas. You know, the, the f protein, the spike protein, they're just little machines that move around and bring membranes together. So we can turn biology into engineering, as we understand it better, it becomes simpler.

[01:01:09] Barney: Young people need to take what we know now and, a few years from now, maybe when things are calm, they can start rebuilding and take it to a better place.

[01:01:19] Angela: I think that's a great, point to end on. Thank you so much again to our guests. Barney Graham in Atlanta, Georgia, and Gary Kobinger in Galveston, Texas. USA

[01:01:30] Angela: And thank you for listening to communicable the CMI Comms podcast. This episode was hosted by Erin McCreary in Pittsburgh, Pennsylvania, USA and Angela Huttner in Geneva, Switzerland, editors at CMI Comms ESCMID's Open Access Journal. It was edited and produced by Dr. Katie Hostetler, oy and peer reviewed by Dr.

[01:01:49] Angela: Eren Ozturk of Ankara University, Ankara, Türkiye, Theme music was composed and conducted by Joseph McDade. This episode will be citable with a written summary referenced by A DOI in the next eight weeks. And any literature we've discussed today can be found in the show notes. You can subscribe to Communicable wherever you get your podcasts, or you can find it on ESCMID's website for the CMI Comms Journal.

[01:02:11] Angela: Thanks for listening and helping CMI comms and ESCMID move the conversation in ID and clinical microbiology further along.