Health care professionals in academic medicine are on the front lines of the coronavirus, besieged with an influx of patients, personal protective equipment shortages, and shifting care guidance. While worried for their safety and that of their families, they are still inspired to serve the patients who need them. On this inaugural season of the "Beyond the White Coat" podcast, listeners will hear from providers and researchers in academic medicine about how they are responding to the crisis while examining the ongoing, difficult conversations around clinical care and research.
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SEASON 1, EPISODE 3
What will it take for a COVID-19 vaccine to be developed before the end of the year? And how devastating has the pandemic been on other important research? In this episode of “Beyond the White Coat,” David Skorton, AAMC president and CEO, talks with Francis Collins, MD, PhD, director of the National Institutes of Health, to discuss how the nation can push ahead with the most critical research projects in a time when so much is constrained by unusual circumstances. This could be science’s finest hour, so how will we use this moment well?
Hosted by David Skorton, MD, president and CEO of the AAMC
Produced by Stephanie Weiner, AAMC manager of digital strategy, and Kristin Zipay, AAMC executive communications lead writer
Edited by Laura Zelaya, AAMC production manager
Francis Collins, MD, PhD, is the 16th Director of the National Institutes of Health (NIH). In this role, Dr. Collins oversees the work of the largest supporter of biomedical research in the world, spanning the spectrum from basic to clinical research.
Dr. Collins is a physician-geneticist noted for his landmark discoveries of disease genes and his leadership of the international Human Genome Project, which culminated in April 2003 with the completion of a finished sequence of the human DNA instruction book. He served as director of the National Human Genome Research Institute at the NIH from 1993-2008.
In Case You're Interested:
"NIH mobilizes national innovation initiative for COVID-19 diagnostics" (National Institutes of Health, April 29, 2020)
"Labs put research on ice" (AAMCNews, April 21, 2020)
"To address COVID-19 and future pandemics, we must answer fundamental questions" (Research!America, April 15, 2020)
"Here’s why we can’t rush a COVID-19 vaccine” (AAMCNews, March 31, 2020)
"Coronavirus testing: How academic medical labs are stepping up to fill a void" (AAMCNews, March 12, 2020)
- Podcast: Season 1, Episode 1: Who Gets That Ventilator? Bioethics in the Era of COVID
- Podcast: Season 1, Episode 2: Accelerating Transformation in Times of Crisis
- Podcast: Season 1, Episode 4: Preserving Well-being in a Pandemic
David Skorton: I'm David Skorton, president and CEO of the Association of American Medical Colleges, and today I'm joined by Dr. Francis Collins, the director of the National Institutes of Health. We're at a unique moment in the history of science and medicine. A global pandemic has elevated the worldwide need for a better understanding of this virus, and of pandemics, and for development of diagnostic tests, treatments, and vaccines. And all of that requires us to invest in topnotch research. And around the globe, people are reckoning with an unavoidable fact: more than ever, we need scientists and researchers to advance important work.
In the starkest way possible, we're seeing that lives depend on it. This new appreciation for the value of science and research makes this a time of enlightenment. But while some research efforts are advancing rapidly in this environment, other important projects may be stalled, with potential repercussions across multiple fields, and even some scientists' careers. How can we push ahead with the most critical research projects in a time when so much is constrained by unusual circumstances? On this episode of “Beyond the White Coat,” I'm talking with Dr. Francis Collins, the 16th director of the National Institutes of Health.
In this role, Dr. Collins oversees the work of the largest supporter of biomedical research in the world, spanning the spectrum from basic to clinical research. He has led the NIH, with distinction, for nearly 11 years, and is universally respected as a scientist and leader. Dr. Collins, thanks for joining us on “Beyond the White Coat.”
Francis Collins: Thanks for inviting me on, David – always good to talk to you.
David Skorton: Same here – thank you very, very much.
Well, as I noted, the research community has the nation's attention like we have not for generations. While science and facts have been under attack in some realms, the reality is that society has recognized, in an urgent way, that we do, in fact, need research to understand the biology of our viral adversary, and to develop the vaccines and treatments that will save lives. In a way, this could be science's finest hour. Dr. Collins, how do we use this moment well?
Francis Collins: That is an interesting question, David. I don't think any of us would've hoped that it would take something like this to bring science into the public eye, but that is what's happened. And when you see the way in which the public across the world are looking to science, at this point, for answers, it is a chance for us to explain what we do, how the whole scientific method is based upon rigor and evidence. And how we need all of that in order to find answers, in terms of preventions like vaccines, and in terms of treatments. You've seen all of that start to happen, now and then anyway, with Tony Fauci educating the public about what it means to run a placebo controlled randomized trial.
And to be able to say, therefore, that remdesivir actually does provide benefit for COVID-19, whereas, many of the other claims have not yet been subjected to that standard. And I think people are starting to get that. I think they're also getting the importance of paying attention to public health majors, that is really is possible, 'cause we've all been part of this, to flatten that curve by doing things individually to keep the infection rates from skyrocketing. And, yeah, I think, also, when it comes to vaccines, which most of the press about vaccines, prior to this, was all the people complaining about whether they're safe. You don't hear nearly so much about that now [laughs]; everybody is, like, "Where is it? Get me that vaccine as soon as you can. We all desperately need this, if we're going to be able to go back out in the public again."
David Skorton: Well, that would sure be a wonderful spinoff of a horrible, horrible situation, if people started to believe again in the safety and efficacy of vaccines, that would be terrific, terrific.
Francis Collins: Yes.
David Skorton: Now, we hear a lot about what researchers are doing, of course, around vaccine development and treatments for COVID, but how is the pandemic affecting basic research and medical research in fields other than COVID?
Francis Collins: Frankly, it's been pretty devastating for research in general, and certainly research supported by NIH, across all the institutions around this country, and some in other parts of the world. Because of the need for researchers to protect themselves and protect other people around them, a lot of the research enterprise has had to go into a slow-motion mood. Certainly, those who can continue to do research from their home, as I am right now [laughs] in my home office, are continuing to work, maybe harder than ever. And so, some areas of research that involve, for instance, the people who are doing data analysis or artificial intelligence programming may be able to go quite nicely forward. But anybody who needs bench access to do bench experiments is going to have a pretty tough time right now, because they've pretty much been told, "Go home and stay safe."
The idea of trying to get people back into that kind of place, obviously, is very much on everyone's mind. Similarly, clinical trials, because hospitals have found it necessary to limit anything that's not an emergency, clinical trial enrollment has dropped way back for many things that are not related to COVID-19. We're going to have a lot of catching up to do, when we get past this.
David Skorton: Well, you know, you mentioned bench research, and for our listeners who don't think about this lingo every day, tell us a little bit about why bench or basic research is so important. How is it helping us to deal with this pandemic and other issues? And can anything be done? Can we be doing anything to support those basic research labs that have had to close because of social distancing restrictions? What could be the longer-term impact on other fields?
Francis Collins: Well, let's just talk about the coronavirus circumstance, and how critical basic science that's been done over the last few years has been in our understanding, here. This is a virus that is part of a family that includes the common cold but also some very dangerous viruses like SARS and MERS. How do we know about these viruses? Well, it's from basic science, reading out what their particular RNA instruction book looks like, so we know what their genomes are all about. But also understanding what proteins they make, what protein structures are created by those viral substances, that might be the best way for us to understand drug therapy or vaccines. All of that depending upon genomics and structural biology and immunology, basic science, without which we'd be very much in the dark.
But at the moment, most of the basic science that potentially would be preparing us for whatever comes next is pretty much had to on-hold, in order for those bench researchers who are doing those experiments, that are basic but not directly related to clinical care, have had to step aside. So, we need to, as we're figuring out how to get past this, make sure that those individuals have the flexibility to do things that they can do while they're telecommuting, like data analysis and writing papers and all of that. [Laughs] But also, to figure out how, safely, to get them back to work in their physical space, as soon as we can do so. And we're already, at NIH, starting to talk about that, how do we, in a very careful way, maintaining physical distancing, increasing the amount of testing so that you know if somebody is infected, even before they have symptoms, how could we begin to reemerge into a place where you could do great basic science but not put people at risk.
David Skorton: Sure looking forward to that day, Dr. Collins, sure looking forward to that day. Now, one other thing that you've mentioned, before, very eloquently, is that the thing about basic research is that you don't always know what it's going to lead to. And if you look backwards at things that ended up being immensely practically useful, you can't always have predicted that from the other end. Do you still agree with that?
Francis Collins: Oh, totally, and you can cite many examples where the most obscure-sounding research turned out to be the place where the insight happened that changed everything. I guess everybody's favorite example right now is this whole revolution in gene editing with CRISPR-Cas. And that's now sort of words that come out of many people's mouths, "Oh, it's the CRISPR-Cas revolution." Well, where did it come from? This very obscure research studying yogurt and bacteria, and understanding viruses that attack bacteria, not us but bacteria. And figuring out how bacteria defend themselves against those attacking marauders, well, that's what Cas-9 turns out to be all about.
And here we are: we can use that same machinery to go and change the DNA sequence of any cell. And the power that gives us for things like curing sickle cell disease is so exciting, and it all came out of this really obscure area. So, don't let anybody say, "Well, you know, NIH should just fund research where you can see a direct connection to an important disease." We would miss out badly [laughs] in everything that we're going to want to know over the next many decades, if we don't continue to support, as we do, about half of our budget in these areas of basic research, that don't have a direct disease connection but provide the foundation for everything.
David Skorton: Well, as many science geeks like me are grateful for, you're doing it. Keep on doing it, please, Dr. Collins. Now, another concern has to do not so much with the research, but getting back to your comments about the people who do the research, and looking a little bit forward to those who are trainees, graduate students, postdocs, brand-new faculty members, how do you think the pause in research is affecting their career transitions? And what's your impression on how this is affecting those who are even thinking, remotely, about a research career?
Francis Collins: For current trainees, this is a tough time, there's no doubt about it. And I am particularly concerned that we do everything we can to nurture and encourage those folks, because they've had an interruption, many of them had, in what they thought was going to be a trajectory of growing more and more experienced, and generating data and publications, and they've had to put a lot of that on hold. We've done everything we can, through NIH, to try to reach out to those individuals, encourage them that this is the kind of thing we will all get through together, come up with ways to help this pause not be a waste of time but an opportunity to learn other new things. Like, maybe this is the time to learn how to be a better programmer [laughs], to learn how to work with Python or R, all of those things are being offered up.
And, yeah, at the same time, it is frustrating, I don't doubt it. And I worry about the way in which this is affecting sort of the general sense of mental health of our whole research community. This is a big stressor, and there are certainly fears and anxieties that people are experiencing, and we need to address those, too, admit that they're there, and figure out ways to support each other even in the face of this kind of social distancing. But we will get through it. And it is inspiring for me, when I meet with my lab group, which we do remotely and virtually, to hear how people are making the best of this situation, despite what certainly has put a burden on them that they didn't expect.
In terms of what it means for future trainees coming in, well, if you needed evidence that we need medical research, and we need physician-researchers, and we need all of that as part of our ecosystem, in order to be able to face whatever's coming next, here's your evidence. And to see scientists so prominently represented, and to have role models out there really talking to the public about why research is so critical, and how we're doing everything we can to find answers, I would think that would be a pretty good moment for a high school student or a college freshman to say, "Yeah, I think that oughta be something I wanna consider. I might wanna be part of that team."
David Skorton: Okay, great, okay, we'll keep on going, then – thanks a lot.
Dr. Collins, governments and citizens everywhere are looking to the research community, not only for the findings but to actually deliver hope. Hope that lives can be saved, hope that economies and communities and families can someday, soon, get back somewhere in the direction of normal. Well, this week I was thrilled to see that the NIH mobilized a new national innovation initiative for COVID-19 diagnostics, as I understand it, aiming to speed delivery of accurate and easy-to-use and scalable tests to all Americans. Please tell us more about this exciting initiative – that would be great.
Francis Collins: Well, this is a bold initiative indeed, and congress provided us with remarkably significant resources, to push it forward. I think we all understand that, if it is going to be possible to come out of seclusion and back into public spaces, and back to work and back to school, we're going to have to have the ability to do rapid and accessible testing. To discover anybody who's just gotten infected with coronavirus, and make sure that individual's quarantined and their contacts are identified. That means, ideally, we have to have an expansion of the numbers of tests that are available, but also, that they're available in an accessible point of care fashion. So that you don't have to take the sample, send it off to some central laboratory, and hope to get a result back in a few days, and we need to know as soon as we can.
So, what we announced, this program called RADx, which stands for Rapid Acceleration of Diagnostics, is inviting all of those creative, innovative platform developers out there to come forward with what they've got that might represent a solution to this. And we have resources to offer them, to help them figure out where their strong points and their weak points are, and how they could take advantage of engineering and technology expertise that we'll supply them with, business expertise, people who know about scaling and commercialization. And try to see if we can take a few of those platforms and turn them into reality, in just a few months. I think that is an incredibly bold timetable, but the time requires that.
So, this program began its solicitation just yesterday, and I gather there already have been more than 100 inquiries. We're going to have a lot of really wonderful technology geeks who are going to show us their stuff, and we're going to try to figure out how to turn that into a real transformation, across the country, in the ability to do this kind of testing. With that in place, I think our chances of being able to get back to something approaching a normal circumstance, although it'll never be quite the same, but we'll be able to do it in a way that doesn't have the high risk of a second wave of COVID-19.
David Skorton: I'll tell you what, I'm very jealous that you get to look at all those proposals. [Laughter] How exciting. I'm really jealous.
Francis Collins: [Crosstalk]
David Skorton: Hey, listen, we all know that vaccine development takes a very, very long time, depending on who you listen to, a year anyway, maybe longer. I know you're working on a new public-private partnership called, if I have it right, Accelerating COVID-19 Therapeutic Interventions and Vaccines. To coordinate, basically, an international research response to the pandemic. How's that going, so far?
Francis Collins: This is another pretty amazing experience, just started on April 3rd, and in that space of less than a month, we have 16 pharmaceutical companies contributing their best people. The academic institutions that have expertise also all lining up to help. And multiple institutes at NIH, especially, of course, the National Institute of Allergy and Infectious Disease, but also FDA in a very significant way, CDC, BARDA, and some European connection as well. That has broken itself into four working groups, one on preclinical therapeutics, one on clinical therapeutics, one on clinical trials capacity, and one on vaccines. Those working groups, essentially, meeting several hours every day [laughs] [audio cuts out] all kinds of timetables that they're living up to.
By next week, we expect we'll have a prioritized list of what are the therapeutics that ought to be next in the clinical trial, so that this is done in an organized way. The vaccine strategy, similarly, you know, there are at least four or five of these that are on a pretty fast track. But part of the goal of this partnership, called ACTIVE, is to be sure we're learning, across those protocols, everything that we could, so that they don't just travel in isolated pathways. Will we have a vaccine by the end of 2020? There's a lot of people pushing really hard to get there. That would be unprecedented, but we are ready to try things that are very much out of the ordinary in this circumstance. We're basically working with the FDA to think about ways to do trials of vaccines that don't require you to go from Phase I to Phase II to Phase III, with steps in-between; how can you make that faster but still end up with something you believe is safe and effective.
David Skorton: Well, it's terrific. We're all cheering you on. And I tell you what, you're also setting an example for us, that we can speed up our processes and try to get where we know we have to go, a little bit slicker and quicker. You know, I wanna change gears, just for a moment, and say that during these times of social distancing, for me anyway, it's been very important to stay connected to my love of making music. I've always got an instrument around or a keyboard that I can play and noodle around with. You're an estimable musician and someone I've admired for a long time. How are you coping during this unusual time? And what role, if I can ask, does music play in your life, currently?
Francis Collins: It's part of my therapy, I'll tell ya – I'm glad you brought it up, David – 'cause it does seem like we're in a very strange circumstance. I am probably working 14 hours a day, 7 days a week, on all the things that are required for COVID-19, and sometimes I get a little stir crazy. [Laughs] I barely seem to be able to get to go outside when the sun is up, but once in a while, I will sneak up out of this office and walk across the way, where my baby grand piano is sitting, and just see what kind of music happens. 'Cause that lifts me up out of what might be a feeling of burdensome oppression. 'Cause there's a lot of burdensome things happening with this, and sometimes you just need a way to clear your head, sort of get your brain to think in a more productive way about creativity. And give yourself just a sense of joy and a beauty of things that music can create.
Not that I'm particularly good at making it beautiful, but music, in its own way, has that ability for me, and I think it does for many people. And I hope everybody listening to this is also looking for opportunities like that. Even in the midst of what is a bit of a scary time, we can find beauty, we can find joy, we can remember that we are a place that emphasizes hope and not just anxiety.
David Skorton: Wonderful words to live by. Well, I wanna thank Dr. Collins for joining us today. Our ability to turn basic research discoveries into clinical applications relies on the comprehensive work you, Dr. Collins, and your teams at the NIH, and really all across the country, and beyond, are conducting at each phase. And I'm so grateful for all the work that you do. Thank you so much for spending time with us, today.
Francis Collins: No, thank you, David, it's great to chat with you. And again, I think I'm representing an amazing team of dedicated people who right now, in the midst of this crisis, are doing everything you can think of to try to get us past it. And we will get past it. We'll get through this.
David Skorton: I believe in you and all the stuff you're doing. Thank you so much. And to all our listeners, thanks for joining us, and I'll see you all, next time, for another episode of “Beyond the White Coat.”
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