Merck CPO Julie Gerberding On The Deadliness Of Covid-19

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CNBC’s Tyler Mathisen interviews Merck Chief Patient Officer Julie Gerberding and Scripps Research Executive Vice President Eric Topol from CNBC’s Healthy Returns Summit today

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Interview With Julie Gerberding And Eric Topol

Following is the unofficial transcript of a CNBC interview with Merck Chief Patient Officer Julie Gerberding and Scripps Research Executive Vice President and Scripps Research Translational Institute Founder and Director Eric Topol live from CNBC’s Healthy Returns virtual summit on Tuesday, May 12th.

TYLER MATHISEN:  Good, as always, to remember that more people recover from this illness than those who succumb from it, which is not to minimize the pain and distress of those we have lost and the families of those people have suffered.  As we move now to our final discussion, sort of to tie it all up, join me in welcoming Julie Gerberding, who used to run the CDC and is now the Chief Patient Officer at Merck.  We also expect to have Eric Topol with us.  He is the founder and director of the Scripps Institute and a best-selling author.  We're working out a few technical hairballs there.  Julie, I'm sure you understand, so it will be you and me at first.  And welcome, we're delighted to have you with us.

JULIE GERBERDING:  Thank you, I'm happy to be here.  Thank you.

TYLER MATHISEN:  So glad you could run the anchor leg with us here.  You were one of the first people way back in January to sound a kind of clarion call.  Maybe even before some of the people who are both in government now, including Dr. Fauci and others, you realized that this coronavirus was a beast of an entirely different sort.  What told you that?

JULIE GERBERDING:  Well, you know, I had been involved very much in the original SARS outbreak in 2003, and one of the characteristics of that outbreak is it wasn't very transmissible at the community level.  So when I saw the case numbers in China, and then when I recognized the situation on the cruise ships and other people in very confined areas, I really could see that this was going to be a much more transmissible problem in the community.  And that was frightening.

TYLER MATHISEN:  Did you have a sense, beyond the transmissibility of the illness, which was truly alarming, did you have a sense of how deadly and vicious it was?

JULIE GERBERDING:  Well, you know, my first fear was the fact that the original 2003 SARS coronavirus had a very high fatality rate, about 10 percent.  So imagine if this very transmissible virus had that kind of a fatality rate.  So I was very worried about how serious this was going to be.  When I recognized the data coming out of China that indicated it wasn't as fatal as we had feared, I still didn't feel much relief when the numbers started showing that it was significantly more deadly than influenza.  So we were dealing with something that was highly transmissible and had a fatality rate that was significantly higher than what we were used to dealing with in seasonal influenza and even in the 2009 influenza pandemic.  So on a global basis, this was a huge threat, and indeed it proved to be a pandemic of the kind that we haven't seen for a century.

TYLER MATHISEN:  I want to talk a little bit about the experience in China and then the experience we've had here in the United States with more cases by far than any other country.  But I guess I would like to ask you what we've learned so far about this pandemic, this virus.  Was it realistic, ever, that we or China could contain this virus?

JULIE GERBERDING:  Well, I think it was worth a try.  And we have to give China some credit for the fact that they made heroic efforts to try to clamp down and reduce the transmission of this virus, and I think it did buy the world some time so that we could understand a little bit better what was happening there and take some of the steps for preparation that were necessary. So that was not something that you would argue against doing, but it did not prove to be successful.  And no one was surprised when we began to see this spill over into other countries and when it ultimately spread across the world. The biggest lesson learned, I think so far, has been that when the world faces a pandemic like this, people can really align around the idea of mitigation and working together to try and reduce the surge in cases so that our health systems have a chance of managing the tremendous burden that they encounter, and that those social distancing measures actually do have an impact.  I think we had that hypothesis based on the experience in the 1918 influenza pandemic.  But country after country, community after community, we are really seeing the data that the kinds of steps that are intrusive and challenging and difficult for everyone to sustain actually do save lives, slow down the peak of the curve; and ultimately, if we are willing to sustain the course, they will help lower the area under the curve, which means lives will be saved while we are waiting for treatments that reduce mortality or vaccines that can protect us from infection.

TYLER MATHISEN:  Before I bring in Eric Topol, who is now good -- Mr. Topol, welcome.  We're glad to have you with us.  Because we're on kind of a thread here talking about the origin of this disease in China, I want to ask you, Dr. Gerberding, the Chinese incidence appears to have fallen very, very dramatically.  They had a high rise and then a very steep falloff.  If the numbers of new cases coming out of China are to be believed, why did that happen there?  What can we learn, what can we take from their experience; or is the take-away that the Chinese were never really honest about the numbers in the first place and aren't being so now?

JULIE GERBERDING:  Well, of course I don't have insight into the ground truth in China, since I'm not in the government and I'm not privy to some of the confidential communications that are probably going back and forth.  But as I said, I think social distancing can really matter, and in China they have the capacity to impose mandatory social distancing that exceeds anything we could probably imagine experiencing in the United States or in the western world.  So if that is what it takes to really contain the epidemic, we've learned an important lesson there. I suspect, however, that like we're seeing in other countries, as China gets back to business and people begin to resume their normal lives, we're going to see hot spots there, because this virus hasn't gone away, and there's nothing that says that the risk today of a hot spot emerging is any less than the risk was several months ago.

TYLER MATHISEN:  Eric Topol, weigh in here.  We have about 4 percent of the world's population in the United States, but we've got something like 28 -- a third of the coronavirus cases, 28 percent of the confirmed deaths.

ERIC TOPOL:  Right.

TYLER MATHISEN:  Why have we been hit so hard, so much --

ERIC TOPOL:  Good to be with you, Tyler and Julie.  I think the main issue is that we were so far behind the outbreak.  So, instead of getting the testing in gear even before it arrived in the U.S. with the first patient January 21st, we were basically paralyzed for at least a month and a half; and at the same time, of course, we know South Korea mobilized, they got testing going right away, and they got in front of the outbreak. So if you just look at that and you look at all the other countries in the world that were successful, and there's over 20 of them, the common theme is that they got testing going early, they had containment, and they wound up with much better outcomes. So we're at the main, I think, breakdown that led to everything else was just never getting any sense of containment, letting the virus run rampant through the U.S., diffuse spread; and you know, we're living with that now, unfortunately.

TYLER MATHISEN:  So I guess that leads me to a question, Mr. Topol, about science and government working together.  And I would love, Julie, to hear your thoughts on this as well.  Generally speaking, what you just pointed to would be either a failure of science or a failure of government to react quickly enough, or a failure for the two of them to agree and coalesce around a strategy.  So talk to me about that and whether science and government -- let's focus here on the United States -- have been working well together.  Eric?

ERIC TOPOL:  Well, I guess I would start and say that our government wasn't working because it was -- it knew that we needed the tests, but even though they were failing and they were contaminated, there was no back-up plan and so we were caught flat-footed.  And, in fact, other countries started testing randomly, even before there was a patient in their country.  Iceland is notable, but several others, as well. So we were totally unprepared.  We were in a state of denial; that is, some of our leading government officials, that this wasn't even going to come to the U.S., which was, you know, remarkably naive. So the science -- I mean, any epidemiologist would know that this was going to come, come to the U.S., and we just had no readiness whatsoever.  And the inability to test for what really turned out to be a couple of months just let this just go like a wildfire through the country.  And we are in this irrevocable path where we know --

TYLER MATHISEN:  -- how do you think they can be used to improve our overall health care system?  And I'll ask the same question to you, Eric, in just a moment.

JULIE GERBERDING:  The serious and I think most tragic learning in all of this is how fragile our health system is when it comes to managing surge capacity.  Now, this was something that was known and has been an issue several times in recent years when we've had a bad flu season or in 2009 when we had the flu pandemic, but we really have not yet sufficiently invested in surge.  Our health systems operate on thin margins and try to minimize the unnecessary utilization or stockpiling, so to speak, of resources.  And yet, when we see a requirement that exceeds our baseline capacity, it's really hard to meet that capacity.  And so the incredible effort on the part of health workers, Merck and Pfizer and Lilly came together and said, we have many health workers, let's allow them to volunteer and pay their salaries so that we can help augment the health care workforce, which was spread so thin.  These are problems that should have been anticipated and, yet, they are very difficult to solve.  We don't have the mentality that pandemic preparedness is a national security capacity that we need to manage in the same way we manage our defense capacity, so that we have something available if we need it and just pray that we don't.  So I think that's really one of the most important things that I hope changes as we go forward, that we will have redundancies and capabilities to manage surge. On the other side, though, there is a good thing in this, and that is the science, in that we have really I think understood that science has advanced so far.  It's on our side, and we're really beginning to identify the marvelous engagements, as we've been hearing all afternoon, in the antivirals and the immunologic therapies and the vaccines that hopefully will come down the pike sooner rather than later.

TYLER MATHISEN:  Eric, I guess it's early to come away with deep learnings.  Because as we began this day, we asked Dr. Gottlieb what inning are we in, and he said, Maybe we're in the second inning, and this may be a double header.  We don't know when this is going to come back.  But talk to me a little bit about from where you stand, what are the deep learnings?  And I know in another question -- and I know it's one that you have an opinion on, and that is from one of the viewers, how rapidly is the virus mutating?  Knock that one out first, maybe, and then go to the deep learning.

ERIC TOPOL:  Yeah, well, that's one thing that's really fortunate, Tyler, is the virus is not mutating in any rapid way.  In fact, it's quite slow.  So while that gives a wonderful ability for genomicists to track the virus from state to state, country to country, just by those mutations that are basically innocent, we haven't seen a new strain at all.  And so that's one of the only good things about the COVID-19 virus story.  Mutations, yes; but they're basically just good for detective work for tracking the virus and nothing more.  There is no evidence that there's been a mutation that is pathogenic, that is worse transmissibility or worse potency or anything like that.

TYLER MATHISEN:  And what about that deep learning question?

ERIC TOPOL:  Usually I ascribe deep learning for artificial intelligence, for deep neural networks.  But here our learning hopefully is substantial, because this I think is the greatest public health blunder, catastrophe, in the history of the country.  So hopefully we'll learn a lot.  But the one thing that we have to learn besides preparedness is that we have a very shaky information system.  So we are the third largest country in the world, and instead of having all our data together, like so many other countries that have real health systems, learning health systems -- I'll give you an example.

In the UK they have this ICNARC, which is every ICU patient, real time, being able to learn from each of those patients.  So, for example, if you know that mechanical ventilation can make people worse, you're going to learn that much sooner than in the U.S. where we have lack of cohesiveness, which is so incredibly not coalesced with that rich data that we could have to help guide us and learn from every patient.  So that's something that we need to work on in the future.

TYLER MATHISEN:  Okay.  I'm going to ask a couple of questions about reopening the economy, and then we'll go to a kind of lightning round with the time we have, we'll spill over just a little bit.  Dr. Fauci, this morning Dr. Gerberding said, in front of Congress, that we risk needless suffering and death if we open society too soon and then run the risk of reinfection or a spread of it.  As we have seen in some of the states where steps have been taken to reopening the economy, the case count has been rising and rising rather dramatically. On the other hand, the testing count in some of those cases has been rising rather dramatically, as well.  So there's a confusion, I would think, among epidemiologists to the point of are we seeing more cases because we're reopening, or are we identifying more cases because we're testing more? So how do you get to the bottom of this, and if you are a policymaker or an epidemiologist, make the conclusion that we reopen too soon; or not?

JULIE GERBERDING:  Well, first of all, the frame of this is the fact that while there are hot spots where many people have been infected, as a population of people across the United States, the vast majority of us have not been infected and we are not immune, and we remain susceptible. So anything that introduces the virus into that population of people is prone to set off another hot spot and increase the probability of transmission.

That's just a fact, and we don't need testing and a lot of other interventions to figure that out.  I do think that the epidemiologists have a tough job because testing is all over the map, and we also recognize that now we have a variety of tests, some of which are more accurate than others, so we have that confounder, but the lagging indicater and the one that probably is the most meaningful in terms of the morbidity and mortality of the recrudescence is the hospitalization; and that, we don't need a test to observe.  We can count the number of patients who are admitted and the number of people who are in the intensive care unit.

And as those numbers begin to increase, we know that we've gone too far in relieving our social distancing.  It's tragic to have to get to that point, but that's exactly what Dr. Fauci was trying to say this morning, is that if that's what we do, we can anticipate that we will pay a big price.

TYLER MATHISEN:  That's very interesting.  We were speaking yesterday in a different venue, I was, with the mayor of Scottsdale, Arizona.  And he made exactly that point; that the real telltale for him is hospital admissions, ICU admissions, and that that, you don't need a test to know about that.  You have the real numbers. Mr. Topol, you mentioned earlier sort of the slowness and speaking with conflicting voices.  It feels to me as though the messaging around coronavirus has been -- there's been a lot of dissonant messaging:  We've got tests for everybody.  No, we don't; yes, we do.  This is going to go away; no, it isn't.  It's a serious threat; no, it isn't.  There's been a lot of conflicting messaging that I think has confused people.  Am I right?

ERIC TOPOL:  Absolutely.  No, I think -- you could go back to, you know, March 6th, when everyone can have a test, and we still aren't there here in May.  So, no, there's been terrible problems with mixed and missed messaging, and I think that has certainly set us back, as well. But, you know, I think that the problem was that we were flying blind during those months, part of January, all of February, and the first half of March.

And now we're flying blind again because we don't have the testing infrastructure in place.  The other thing that we could do, of course, is get digital surveillance.  We've already seen this week a report about using smartphone apps for just collecting symptoms.  And what we can also do is get resting heart rate.  If we did that for 100 million people, or even a tiny fraction of that, of Americans that have a fitness band or a smart watch, we could get resting heart rate as a way to not fly blind while we're waiting for the testing infrastructure to get whole.

What I'm amazed about, Tyler, is that we've had all these weeks of relative lookdowns or absolute lookdowns, and we still haven't gotten this testing story right.  Of course, the problem is, if you don't get that right -- and that includes testing people who don't have any symptoms, even random testing, at scale, you know, we haven't done that yet.  And if you don't do that, you're not ready to do contact tracing and isolation.

TYLER MATHISEN:  Yeah.

ERIC TOPOL:  So the basic steps here, we're just violating.

TYLER MATHISEN:  I guess I find that -- we'll skip beyond this, but the idea of using smart devices for patient monitoring.  Americans have a very ambiguous, ambivalent relationship with sharing personal data.  On the one hand, they're very scared of an intrusive government listening to what they do or say; on the other hand, they are more than happy to share their location with Waze all the time to help them get through traffic.  But I see a big opportunity there for personal monitoring devices. Dr. Gerberding, let me go back to a question about reopening the economy. Can we ever really go back to a fully reopened economy unless we have an effective vaccine against this disease?  And how hopeful are you that we will be able to come up with a vaccine?  Coronavirus is the common cold -- the common cold is a coronavirus, and we have no vaccine against that.  What tells you we'll be able to have a vaccine on this, and will we really go back to normal until we do?

JULIE GERBERDING:  Well, let me say a few things about the vaccine.  And I say this with some humility, because Merck did cross the finish line with a vaccine for Ebola that was developed under somewhat similar circumstances, an emergent public health crisis in western Africa and then a second public health crisis in the Eastern DRC. And I think some of the things we learned there in that context is that when you have an emergency like this, you really do rally the biopharmaceutical ecosystem to come to the rescue, and people will put aside their competitive pressures or the things that are normally on their plate and work hard to try to contribute to solutions.

These situations demand multiple shots on goal; we saw that with Ebola, and we are certainly seeing it now with more than 130 antivirals and many dozens of vaccine candidates, some of which are in clinical trials already.  So those shots on goal is important, and I think that allows us to have more confidence that something will cross the finish line that will be valuable and hopefully provide durable protection.  The bar for safety is very high in this regard, so we can't promise that we're going to give the right balance of a great vaccine that's also very safe in the fastest manner possible, but we should be hopeful that we have a prospect of doing that.  And ultimately, the way to end the pandemic, we have three choices, and all could come into play.

One is that we do find treatments that lower the fatality rate and the hospitalization rate to the point where it is more like seasonal influenza and we can manage it; or we develop a vaccine that offers protective immunity to broad swaths of the population; or, worst case scenario, we just wait until enough people have had it that we develop population-level herd immunity and the epidemic can't be propagated.  I am most hopeful that we'll find antivirals fast.  I think the prospects for a vaccine are an area that we should be optimistic; but the timeline is challenging, and herd immunity will eventually happen one way or another, but I hope and pray that that isn't what we have to resort to.

TYLER MATHISEN:  One last question to you, Dr. Gerberding, before I go back to Eric for the final question of the afternoon.  There's been increased worry about children, and at one point there was some thinking that children were relatively resistant to this virus.  But we've seen lots of cases now in which the illness is either detected or some other manifestation of this illness, something like an inflammatory response, like Kawasaki, has taken effect.  Talk to me a little about that, and then answer a couple of questions that I asked Dr. Gottlieb this morning.  If you had a young child, would you send that young child away to sleepaway camp this summer, day camp this summer; and what about going to either a public or a swim club swimming pool?

JULIE GERBERDING:  So, yeah, I think the situation with the pediatrics, the very, very young infants as well as children, is confusing.  Because we typically expect, or basically every respiratory virus with which I'm familiar, that the children will be the sort of cesspool where the virus gets transmitted in daycares or schools, and that children are really important in the transmission at the community level.  Now, clearly we know children are not immune to this virus.

We have plenty of examples where children have been ill and hospitalized, but they are a minority of the cases.  And so that suggests that either they manage it as a mild upper respiratory illness and that doesn't go any further, or there's something about their receptor status or their host immune response that protects them from developing the symptomatic disease. We don't know how capable they are of transmitting, even when asymptomatic, but as we see the epidemic expand and we have the opportunity to study the disease more closely, the awareness that some children do develop this very difficult autoimmune disorder, something like Kawasaki's disease, if it's not exactly Kawasaki's disease, this is a very serious and often fatal condition.

And so this tells us we have a lot to learn, and we better keep an open mind about the status of our children in this context. So if I had young children, I have to admit that I would not send my young children to camp or to the swimming club this summer until I was confident that my community was not a place where there was active transmission. I hope I'm wrong about that.  And as the studies that Dr. Topol has been talking about get conducted and we understand better the true bottom of the iceberg that is there under the tip, which are all the cases with symptoms and in hospitals, I hope as we understand the true prevalence of the disease in our communities, we will get answers to this question; and I hope that happens sooner rather than later.

TYLER MATHISEN:  I guarantee you, there are millions of parents, including this one, who hope that your hope proves true and that camp is able to happen and swim days are able to happen. Eric, wrap us up here.  We've obviously seen a major outbreak in this country, in Italy, in Great Britain, and to lesser extents in other countries.  But there are other parts of the world where this disease has not ripped through yet the way one might expect.  How worried are you about what could happen as this disease begins to manifest in countries that are even less prepared than we are, or were, to contend with it; countries like Brazil, countries in central and sub-Saharan Africa, countries in Asia and maybe Latin America?

ERIC TOPOL:  All right.  Well, I think the ones that have signed on now to be major trouble spots, countries, are certainly Brazil, as you mentioned, Tyler, India and Russia.  Those are the ones that are really on the rise.  And to add to that, Mexico.  We haven't yet seen the signal of this diffuse spread with cases and fatalities through the continent of Africa, but that's certainly a major liability going forward. So I think this is what many of us think.

There will be a second cycle that Tony Fauci referred to earlier today, and also I know was discussed throughout this program, not the rebound story, but as it cycles around the world because of these other continents that are just now kind of showing up. But just to think that the U.S. is in the same category as Brazil, India and Russia as to its response, it's really -- has to be categorized as a pathetic response. Now, on the other hand, we are really good at things like developing neutralizing antibodies and drugs and vaccines.  So that's the sanguine side of this, and hopefully that will be good for all people in the world, not just those in the U.S. So we have a counterbalancing of seeing momentum, really unprecedented momentum in the programs for drugs and neutralizing antibodies, convalescent plasma and the vaccine.

Hopefully, as these other continents show what is inevitable, and we go through what will be a two- or three-year story at the least with respect to additional cycles and ever-present, you know, we will have remedies.  And I do think that in the months ahead we will see the fatality rate drop down, because we're starting to see therapies that are proven to be effective.  And one just other note, I should have mentioned, Tyler.

When you asked about the messaging, the mask story was just really abominable; that we shouldn't wear a mask because there weren't enough masks, then we should wear masks.  So this has just been part and parcel of the problem of not having a consistent, uniform science-based communication.  I hope we'll see that improve, because this is going to be a long haul.  And as Scott asserted earlier today in the program, whatever inning you want to put it in, it's in the early phases.

TYLER MATHISEN:  Lots of lessons learned, and we've certainly learned a lot today.  Dr. Topol, thank you for leaving us on that hopeful note.  Dr. Gerberding, as someone who is on the front lines in this fight, working with your researches at Merck and elsewhere in the industry, we thank you.  And thank you both for your time today, really appreciate it.

ERIC TOPOL:  Thank you.