This week, the director of the National Institutes of Health (NIH), Francis Collins, MD, PhD, answers questions from host Serena Marshall. Listen and subscribe on Apple, Stitcher, Spotify, or Google so you don’t miss the next one. And if you like what you hear, a five-star rating goes a long way in helping us Track the Vax! Serena Marshall: As now the longest-serving NIH director, how do you describe the moment we’re in, in our country and in this pandemic? Francis Collins: Well, let’s be honest. It’s been an incredibly difficult year, 2020. And here we are now with the deaths of more than 400,000 people from this worst pandemic in 103 years. And we are not done. Maybe we’re starting to see just a little bit of a turnaround in what has been the highest rate of hospitalizations and deaths ever since it began, but we still have a long way to go to get out of these terrible woods. For all of us at NIH, seeing that we are the largest supporter of biomedical research in the world, we have a big responsibility here to push this forward in every possible creative, innovative way to try to come up with better approaches for diagnostics, for therapeutics, for vaccines. And I have been utterly consumed by that now for more than a year. Just trying to make sure we are not missing any opportunity to bring the best possible science to bear on this terrible pandemic. Serena Marshall: You’re one of the few carryovers from former president Trump’s COVID-19 Task Force. How do you see things evolving or changing from what was set up then to what we’re dealing with? Francis Collins: It’s a little hard to tell, this being still very early in the Biden administration, exactly how all of the science efforts are going to be organized; but there’s such a sense of encouragement that science is at the table. Science is going to be the way in which decisions are made. Science is being invited to be innovative and creative, you know, [with] a lot of really remarkably bright people joining this administration. Serena Marshall: How was it for you working under the Trump administration? Francis Collins: Mostly, I’ve tried to keep my eyes on what we can do, and not to get too drawn into that. There have been some moments that were stressful. Scientific decisions were sometimes overruled by political considerations. And that was not a happy circumstance that you would really want to have to take part in. [But] I think again the best thing I could do is to try to bring whatever skill I have in terms of science, medicine, and management of research, to try to help the people of the world who are suffering. Serena Marshall: We just heard President Biden set a new goal of 1.5 million vaccinations a day. Is that feasible? Should the goal be higher? Francis Collins: Everybody’s trying to figure out what should be the way in which we portray the goals, and there’s various approaches to this. I learned this running the human genome project more than 20 years ago. You want to give a stretch goal so that people think, “Wow, that’s really going to be hard to meet, but maybe we’ll be inspired to do it.” But you don’t want it to be so much of a stretch goal that it’s going to fail for sure. And then everybody feels discouraged and the public gets disillusioned. So how do you hit the mark right? Some people would say you’re better off to underpromise and then overdeliver. There is no right answer there. I guess, what’s really limiting what can be done is the ability to manufacture doses. Despite the fact that people seem to think that’s a dial you can just turn, it doesn’t work that way. The manufacturing requires a factory. It requires a production line. It has to be incredibly high quality and quality-checked and sterile and all of that. So, the main thing that’s keeping us from being able to ratchet this up right now is that between now and the end of March, even with everything going really well, there will only be about 200 million total doses of Pfizer and Moderna together. And since that’s a two-dose strategy for both of those, that’s a hundred million people. It’s really hard for me to see how we would get beyond that, unless the Johnson & Johnson vaccine ends up also being safe and effective. And we hope to learn that very soon. That would be a big boost. So maybe we would get a boost in doses by March. But still, I think anybody who tells you that we’re going to be able to immunize substantially more than a hundred million people by the end of March, just hasn’t looked at the realities of what the production can put forward. Serena Marshall: Did stepping away from the World Health Organization in the midst of a pandemic hurt collaboration when it came to responding with all of those different groups and individuals? Francis Collins: It’s not realistic to say in a worldwide pandemic that you can’t work or you shouldn’t be working with the rest of the world. As we see new variants arising in South Africa and Brazil, could anybody say that it’s not, even in the United States’ self-interest, [worth it] to be engaged with the rest of the world? Of course it is. I’m really glad we are back in that mix. Serena Marshall: Looking forward, where do we go from here? Francis Collins: If there’s anything we should have learned from this, [it’s that] complacency is your worst enemy. And if we have another pandemic coming — and it would be very hard for somebody to say that’s not going to happen given the [trends] over many years — then we ought to be prepared in a way that is guided by what we’ve learned this time. And we’ve learned a lot this time!
