Earlier this week marked five years since the World Health Organization declared COVID-19 a pandemic.
Immunologist and Nobel Laureate Professor Peter Doherty, AC, who is also patron of the medical research institute that bears his name, spoke to 360info Senior Commissioning Editor Suzannah Lyons about attitudes towards public health today, how we best prepare for the next pandemic and the still great potential in medical research.
You've been paying attention to the state of public discourse for years. I'm curious as to how you would characterise it today.
The whole character of the public discourse – the public conversation – has changed. And of course, it's changed with social media particularly. And also it's become more polarized.
Some of us look back to an era where Australia and the world in general embraced a more collective view that everyone deserved a fair go. That's been greatly eroded, not so much in Australia as in the United States, but it's much less than it was.
One group we perhaps don't talk enough about is the vaccine hesitant. How would you describe them and how can we better reach them with our public health messaging?
I think vaccine hesitancy is very understandable. Vaccination is a medical procedure, there's no medical procedure without some risk and that's certainly true of vaccination. And what we saw through COVID-19 was that the new vaccines that were brought in very quickly — and I think did save a lot of lives — actually weren't tolerated particularly well by a number of people.
It's certainly true older women were hit by the vaccine that was made here initially by CSL — the one that came out of Britain, an adenovirus-vectored vaccine — and several died and that vaccine was quickly withdrawn.
But then the mRNA vaccines were causing considerable distress, particularly to adolescent males. And a number of kids went into hospital with myocarditis and there has, I think, been some permanent damage. So it's quite understandable and it's always a risk-benefit equation.
So how do you win people's trust back? You try to point to the evidence.
And the evidence is that the standard vaccines of childhood are really extremely well-tolerated and they're safe and effective. And yet there's enormous pressure against those. That's the gold standard, really. We need to get our kids vaccinated with those vaccines of childhood.
There seem to be more bugs around these days. Are we seeing humans at a greater risk of disease, be that viral, inflammatory or even rising rates of cancer? And how can we best respond to that?
The fact that rates of cancer are on the rise may just be because we're living longer.
The perception there are more bugs around, there's probably not more around, but there's a hell of a lot more people. If you look at the world in 1900, there were 1.6 billion people. Now there are 8 billion people.
And a lot of those people are in Africa and they're coming in contact more and more with wildlife. Part of the reason for that is the food situation in Africa is getting steadily worse due to climate change and various factors like wars, and people are going to the jungle to harvest, say, bushmeat and so forth. So there's the danger of viruses jumping across.
This is certainly the case with Ebola. We just saw a case. There's a new virus that emerged in the Congo. It appeared first in three children who died after eating a bat.
And the other thing that's happened with influenza is after the Second World War, the US and Australia particularly got together to try to improve food security in East Asia, particularly in China, and help them build massive chicken industries.
And these birds are multiplying influenza viruses and getting them across into people. So it's a much greater risk from influenza. Then of course, there are the live animal markets and with many more people, they become more dangerous. Above everything else, there's long distance planes and mass international tourism.
Changing human behavior is complex. I think governments need to keep their public health agencies strong and on the ball. And the recent firing of a lot of people from the CDC, which is the premier agency in the US, of course, has been deeply disturbing.
I believe 5,000 of them are now back at work. I mean, this is what's happening. The US is in total chaos. President Trump is a chaos generator.
So public health agencies need to be strong, people need to be aware of them. And unfortunately, the COVID-19 experience led to a lot of disillusion on various people's parts, a lot of which was fed online, of course.
If we ever get a serious disease, I mean, COVID wasn't as serious as it could have been. But in 1918-19, with the influenza pandemic, with maybe a quarter the size of the population we've got now, 50 to 100 million people died. Now, if we get a virus like that back again, I hope we can persuade people to actually listen to public health measures, because initially that may be all we've got.
What is your one piece of advice for Australians ahead of the next pandemic? And are we sufficiently prepared?
Quite frankly, we can never be sufficiently prepared for any catastrophe. We can't keep our focus on it and we don't have the money and the time span to do it. So we are improving our capacity. I think the new [Australian] CDC will get the states working better together.
The states did pretty well and we did pretty well through the pandemic. And the Morrison government, for all its flaws, did shut down international air travel quickly and did the right thing in the main early on. And it really depends on the public going along with what's asked of them.
It sounds like the chaos in the US could have an impact on us here in Australia. Do you think that's likely to be the case?
I don't think it will have a lot of effect on our preparedness or what our governments will do or what the institutions that are responsible will do. I think all the state labs and state governments performed really well, though it would have been better if we could have had better coordination between them.
It's very difficult in Australia to run a national clinical trial because, unlike the military, it was decided at the time of Federation that health would be left with the states
Since your Nobel Prize-winning discovery in 1973 of "how the immune system recognizes virus-ridden cells" we've seen great advances in immunotherapy. What do you see as the potential of this field into the future?
Immunotherapy has taken over as a major earner for pharmaceutical companies and as a major treatment option for medicos, particularly with chronic and autoimmune diseases. Immunotherapy with monoclonal antibodies has really revolutionized treatment of multiple sclerosis, some cancers and rheumatoid arthritis and there's much more to do.
T-cell immunotherapy initially didn't get very far. Then we had these immune checkpoint inhibitor monoclonal antibodies which were used to wake up T cells that had gone to sleep in cancers and eliminate the cancers.
And we're combining that now with various approaches where we give individuals a vaccine made from their own cancer cells and then use the immune checkpoint drugs and that I think has a lot of potential.
There's great potential in this area as there is great potential in all areas of molecular medicine.
How much do we still have to find out about the immune system?
We've got so much information and this is true across the biomedical research spectrum, but there's still a whole lot of things we don't know. The two great complex systems we have for dealing with the external environment are the brain and the nervous system and all its attachments and organs, like the eyes and the ears and all those sorts of things.
The immune system is the other one that reacts to foreign invaders. It's totally different from the brain in that it doesn't have a central processing unit.
It's a mobile system. The cells move around the body and they move in and out. We don't know where a lot of events are actually happening. We know the lymph nodes are very important. We don't even know how big it is at any one time, because there are a lot of cells off in various tissues and we don't know how it counts. You know, we have reasonably stable numbers of white blood cells in blood, we don't know how that works and why. How does that work?
So there's a lot of questions just as there are in neuroscience. I mean the understanding of consciousness, for instance, which I always approach with great trepidation.
(Laureate Professor Peter Doherty AC is an immunologist, Nobel Laureate and Patron of The Peter Doherty Institute for Infection and Immunity, a joint venture between The University of Melbourne and The Royal Melbourne Hospital. This interview was originally published under Creative Commons by 360info)
