Exclusive interview: William A. Haseltine

Nordic Life Science got an exclusive chance to ask scientist, businessman and philanthropist William A. Haseltine, well known for his pioneering work in cancer, HIV/AIDS and genomics, about his views on the COVID-19 pandemic.

William A. Haseltine, PhD, (born 1944) is an American scientist, businessman, author and philanthropist. He has been a professor at Harvard Medical School and is well known for his pioneering work in cancer, HIV/AIDS and genomics. He has also founded more than a dozen biotechnology companies, including Human Genome Sciences, and he serves on advisory boards for numerous international entities.

Throughout his career he has also become more dedicated to trying to improve access to high quality, affordable healthcare for people in low, middle and high income countries alike. He is currently Chair and President of ACCESS Health International, a nonprofit organization that fosters innovative solutions to the greatest health challenges of our day.

During the COVID-19 pandemic Dr Haseltine has frequently been interviewed by the media and he has shared his expertise in the field of global human health. Nordic Life Science got an exclusive chance to ask him about his views on the COVID-19 pandemic, both in the Nordics and globally, and what he believes is the way forward and out of it.

When did you realize that this new coronavirus was going to spread globally and cause a global pandemic? What were your thoughts?

”My organization, ACCESS Health International, has an office in Wuhan, China. In mid-January I was getting direct reports from people in Wuhan about the outbreak. One person had three grandparents die within two weeks and other people had many of their friends and family members fall ill. I was able to observe, in real time, what was happening throughout January and in early February in Wuhan, as well as other Chinese cities.”

”From my perspective, the situation took a very dark turn when the President of the United States ignored the early recommendations and warnings from the CDC.”

“From my experience with viruses over the years, I’ve come to understand their potential for very rapid spread and the inability of most health systems, particularly those in the United States, to contain them. From my perspective, the situation took a very dark turn when the President of the United States ignored the early recommendations and warnings from the Centers for Disease Control and Prevention. At that point, it was clear that we were open to the disastrous effects of this new virus.What has surprised me, as well as many medical professionals, is the severity of the disease. It first appeared to be pneumonia. Now, we understand that it is best described as a multi-system disease, affecting the lungs, brain, heart, kidney, liver, intestine, pancreas, and circulatory system.”

Cape Town, South Africa – 6 April 2020 : Empty streets and stay home sign in Cape Town during the Coronavirus lockdown

Early on you warned about the causes of the disease and you have written about the three enemies of epidemics: ignorance, denial and complacency. Would you say that the world has been able to handle those enemies so far during this pandemic?

”Some countries, especially those that experienced SARS, understood both the human and economic cost of an infection like this, acting quickly and avoiding the ignorance, denial and complacency that would only increase the number of deaths. Other countries, such as European countries, were slow to respond but eventually came to understand what was at risk and avoided the three major dangers. Unfortunately, many countries in the new world, Russia, India, and the Americas fell into the traditional response of denial, ignorance, and complacency. Now, they are suffering the consequences.”

“One thing I would like to acknowledge is how serious the infection is. As many as 80% of those who are infected have symptoms, 20% of those infected require hospitalization, and of this 20%, there are people who require intensive care. Depending on where you are, between 1-5% of those infected die.”

“One thing I would like to acknowledge is how serious the infection is. As many as 80% of those who are infected have symptoms, 20% of those infected require hospitalization, and of this 20%, there are people who require intensive care. Depending on where you are, between 1-5% of those infected die. Extrapolate that to what will soon be 200,000 cases per day. That means 160,000 people will fall ill, 40,000 people will require hospitalization, and 8,000 people in the world will require intensive care. Somewhere between 2,000-10,000 people will die each and every day as a result of this infection. I do not believe that people comprehend the magnitude of the tragedy that has befallen us through the three evils: ignorance, complacency, and denial.”

We have experienced SARS and MERS recently, why do you think we were so unprepared?

”Preparation requires understanding, forethought, organization, and some expense. No government took those necessary steps. Since World War II, for the most part, we have been privileged to be spared of global pandemics. HIV is the exception, but even with HIV the impact of the disease was felt unequally across the world, which was also the case for other infections, such as Ebola and Zika. There was a belief in many parts of the world that widespread disease “would not happen to us.” It is a lack of imagination. Many people warned both publicly and in publications that such an event was inevitable, but no country took those warnings seriously enough.”

”There is a deeper reason why we were so unprepared – our understanding of infectious disease, biology, and science in general is limited and most people have not learned the scientific, technical, and medical realities of modern life.”

“There is a deeper reason why we were so unprepared — our understanding of infectious disease, biology, and science in general is limited and most people have not learned the scientific, technical, and medical realities of modern life. I would argue that this should be a wake-up call to restructure our education systems, so that no one is left in the depths of ignorance of the natural phenomena that imperil all of our lives at all times.”

Empty street in Barcelona

You were one of the first to recognize the danger of AIDS. Could you describe some of your experiences and lessons learned from working with this pandemic?

”AIDS was a more difficult issue to bring to the public than this virus, because it was sexually transmitted. In most countries there are serious taboos and restrictions in discussing sexual behavior. Only two countries, Brazil and Thailand, responded quickly and well, and those two countries have less inhibitions about discussing the sexual aspects of human nature. Unfortunately, in this epidemic, of those two countries, only Thailand has responded well. It was also much easier in the AIDS epidemic to focus on small marginalized populations; people who were gay, male homosexuals, and Haitians. It was difficult for people to imagine that this could be a rapid heterosexual disease. In fact, a book called The Myth of Heterosexual AIDS was published, showing just how much some people refused to believe it was a risk to them.”

“Like the COVID-19 epidemic, our political leaders were very slow to recognize the seriousness of the problem with AIDS. Ronald Reagan refused to say the word AIDS until very late in his administration, and he never publicly admitted the magnitude of the problem. The government was also very slow to allocate funds for AIDS research, and it took the death of a public hero, Rock Hudson, to begin to mobilize public support.”

“Like the COVID-19 epidemic, our political leaders were very slow to recognize the seriousness of the problem with AIDS. Ronald Reagan refused to say the word AIDS until very late in his administration, and he never publicly admitted the magnitude of the problem. The government was also very slow to allocate funds for AIDS research, and it took the death of a public hero, Rock Hudson, to begin to mobilize public support. People with HIV suffered from a stigma that people with COVID-19 don’t suffer from. This was only mitigated by a concerted effort to normalize the disease, such as Princess Diana holding AIDS babies and hugging AIDS infected men. In both cases, the scientific and medical communities responded with alacrity and efficiency. The pharmaceutical industry was slow to react, but eventually did an excellent job.”

“A question that I have always asked is what would the response be of political conservatives and libertarians to a volcanic eruption, a major earthquake, or a tsunami? Why is it any different from this natural disaster, which is a virus?”

“In this case, the biomedical research apparatus is fully engaged in moving quickly and our doctors have responded with heroism and exceptional activity, as they did in the previous epidemic. Specifically in the United States, the enemy of rational response has been political conservatism and libertarianism, both inappropriate in the face of a natural disaster. A question that I have always asked is what would the response be of political conservatives and libertarians to a volcanic eruption, a major earthquake, or a tsunami? Why is it any different from this natural disaster, which is a virus? The fact is that a virus is a natural disaster. This could be because a virus is viewed much more as a human agent, which it is not, rather than a natural element, which it is.”

You have said we should not put too much hope in a vaccine, both for HIV and also not for the new coronavirus. Can you elaborate? What are the hurdles?

”Vaccines work for the infectious diseases that our body naturally clears and remembers, such as polio, measles, mumps, chickenpox, and many of the childhood diseases. They are childhood diseases for exactly that reason. Once seen, they are never forgotten. Therefore, the only susceptible population are children. That is not true for diseases like malaria, HIV, tuberculosis, or herpes. These organisms infect us and never leave. They are more typically transmitted among adults, but not limited to them. Vaccines are extremely difficult to make, because these diseases are designed to evade the immune system. In general, the coronaviruses have a very different way of interacting with our bodies, which makes a vaccine questionable. It is not as questionable as HIV, in which we are never able to clear the virus.”

“A COVID-19 vaccine may be used for many billions of people, so it must be extraordinarily safe.”

“However, from many decades of study of coronaviruses, we now know that this virus infects us and then the body forgets it. An individual can certainly be infected time and time again by the exact same cold-causing coronavirus. You may be infected and clear the infection, yet the following year, you may be infected by that very same virus. At this point, it appears that this is what happens with this infection too. The body very quickly forgets it, which is measured in a very rapid loss of antibodies to the virus in many of the people who have been infected, such that this virus could reinfect without undergoing any change.”

“It is different from influenza, in which influenza could reinfect a person after it has mutated and changed. The coronaviruses don’t need to change to reinfect. Under that circumstance, we are not sure about vaccines. To add to that uncertainty, although vaccine candidates are able to raise potent antibodies in animal studies and in humans, none of them have been shown to protect infection of the nasal passages in animal studies. That raises the very serious question of whether they will actually prevent the entire disease, some diseases, or no diseases. The safety and efficacy of a vaccine is also a critical issue since they are used for fully healthy people. A COVID-19 vaccine may be used for many billions of people, so it must be extraordinarily safe.”

A doctor in a protective suit taking a nasal swab from a person to test for possible coronavirus infection

When it comes to COVID-19 treatments, which ones so far have you seen that are most promising?

”For seriously ill patients, the treatments that seem to reduce mortality are medical practices, like proning patients by putting them on their stomachs, managing intubation and ICU care more carefully, and moving people as quickly as possible from ICU to step-down facilities. Using tools that are currently available, those simple processes have made a significant difference in survival, reducing the death of patients that require intubation in ICU care from about 80 or 90% to about 50 or 60%. There has been some success in using existing drugs, such as anticoagulants.”

“If used properly, these can substantially reduce the mortality of ICU and intubated patients by as much as 80%. This would drop mortality from 80 to 25 or 30%, which is a very dramatic reduction. The use of dexamethasone, which has been modestly successful in reducing deaths from 80% to 60% or 60% to 30% depending on the situation, and the use of a combination of drugs – kaletra, ribavirin, and interferon – can also reduce the number of deaths of severely ill patients. There are very few drugs that make any difference in retarding the early stages of infection and preventing people from progressing from early to late stage.”

Azidothymidine (AZT) was a failed cancer drug that sat on the shelf for twenty years before you proved its effectiveness against HIV. On what shelf do you think we will find the treatment for COVID-19?

”Effective treatments for COVID-19 were developed as treatments for SARS and later for MERS. Those include drugs that affect heat enzymes and processes the virus needs to replicate. It is a great tragedy that those drugs stayed on the shelf and were never stockpiled. Had the protease inhibitors, helicase inhibitors, and other anti-SARS drugs been stockpiled, nobody needed to have died from this infection. It would have been entirely preventable by stockpiling drugs, and many people like myself pointed out that should have been required.”

”If there is a single greatest failure in anticipation that could have made the biggest difference, it is the failure to stockpile anti-SARS drugs, which would have stopped COVID cold.”

“Unfortunately, all countries have failed in their duty to protect their people from coronavirus infections by not stockpiling drugs. It is ironic that exactly those drugs that inhibit SARS and MERS also inhibit the COVID virus. They never passed the safety standards, were never put through clinical trials, and were never stockpiled. If there is a single greatest failure in anticipation that could have made the biggest difference, it is the failure to stockpile anti-SARS drugs, which would have stopped COVID cold.”

How can we be better prepared for a new pandemic or a new wave of this one? Describe your dream scenario?

”Biologists understand most of the potential threats from the natural world. In the future, we should have drugs stockpiled to protect ourselves against those threats in the same way as we have drugs stockpiled to protect ourselves from what we regard as bioterrorism. I myself have developed drugs that are currently stockpiled by the U.S. government to protect us from bioterrorist attacks. We should realize that nature is a far greater terrorist. If we didn’t realize it before, we should realize it as a result of the COVID pandemic.”

“Additionally, every country should make sure they have a fully functioning and coordinated public health service, capable of creating policy and implementing that policy at a national, regional, and local level in an integrated fashion. We should also encourage our biopharmaceutical industry to develop class-specific drugs that are capable of effective treatment of the biological threats that we currently perceive.”

Rome, Italy – 10 March 2020: A city Police man wearing a face mask walks across the deserted Trevi Fountain square.

What can we do today to fight this virus that we could not do, or not do so quickly, during the HIV/AIDS pandemic? And vice versa?

”For HIV/AIDS, we were blessed by having 30 to 40 years of intense research on retroviruses. That was motivated by the understanding that retroviruses may be involved in treating cancer in humans. Without the foreknowledge of these viruses, we would have been helpless for a decade or more in the face of the HIV epidemic. Unfortunately, there has not been the same kind of focus on coronaviruses, despite our experience with SARS and MERS. There was a high level of support for a very short period of time in the study of the coronavirus immediately after those outbreaks, but that support quickly evaporated when the outbreaks ended. Therefore, we were left with a vastly incomplete picture of the nature of this virus. It is true that we are doing our best to remedy that defect, but it will take time to understand the full subtlety of this virus.”

Transmission electron microscope image of SARS-CoV-2 isolated from a patient in the U.S. Virus particles are shown emerging from the surface of cells cultured in the lab. The spikes on the outer edge of the virus particles give coronaviruses their name, crown-like. Image captured and colorized at NIAID’s Rocky Mountain Laboratories (RML) in Hamilton, Montana.  Credit: NIAID

“To put that in perspective, it is only now, after 35 years of intense research of HIV, that we are beginning to completely understand how that virus interacts with a human cell and the human body in a way that allows us to interfere ever more effectively in its action. Even with all the marvelous tools that we now have, we are in a far more primitive state with our understanding of coronaviruses, despite the havoc they have already caused in two epidemics in this early part of the century. I will point to one area in particular; the coronaviruses play havoc with our immune system in ways we have never previously seen.”

”The coronaviruses play havoc with our immune system in ways we have never previously seen. These are “get it and forget it” viruses.”

“As I mentioned, these are “get it and forget it” viruses. The human body appears to forget that it has been infected. How does that happen? We do not know. The next issue is how can this particular coronavirus cause such massive damage to the human body and not be limited to just the lungs? There were too few cases of SARS or MERS to understand the full ramifications of infections. Many of the symptoms and pathologies we associate with COVID infections were probably extant in MERS and SARS patients. However, there were too few patients to accumulate the knowledge necessary to understand the full range of what was happening. Unfortunately, that is no longer the case with COVID, where we have more than 1, 400,000 [update November 2020] people worldwide who have already died from this disease.”