Vax to The Future: Shattering Myths Around the Science & Future of Immunization

Narrator: 0:01

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased evidence, proven facts powered by ENCORE Research Group.

Dr. Michael Koren: 0:14

Vax to the future, Vax stands for vaccines. And then this is our own version, not the trademark version of the DeLorean, showing you that this is now not a time machine, but a way to get more time in your life due to vaccines. Right, and so there's a lot of controversy about vaccines, which is really interesting from my perspective, because there wasn't much controversy in the past, for whatever reason, because the politics of our country, this has become more and more of an issue. So let me ask you a simple question who here is afraid of vaccines? Alright. So it looks like we have an audience that already believes in it. Not everybody's like that. So I'm going to ask you to do something. I'm going to present some information and let me ask you a question who has a friend or a family member, somebody who's afraid of vaccines Everybody. So sometimes you get into these discussions and it gets political or it gets ugly, frankly, but it shouldn't be. This is about science and our goal here is for everybody to live a wonderful life, to live a life that is as long as possible free of infections as possible, with a few side effects from the drugs and interventions that we provide for you. But not everybody necessarily believes that, because we have a big trust issue in this country from a number of different perspectives. So what I'm going to show you is all just scientific data. It's not political at all, but it's hopefully for you to help other people who may have a trust issue. Come and learn more about this. It's very, very important that we teach everybody what's true and what's not true, including people who are skeptical, because in my experience with the skeptical people, they also want to know the truth. They also want to know the truth, but they're worried about what they can trust, and that's why we have this whole made evidence platform is so that we talk about the truth, and we talk about the truth. It's important to talk about what you know and also what you don't know, and that's what happens in a lot in the country now is that people don't say what they don't know. They assume that they know something, and anytime they don't have a good answer for a question, they make something up because they've been told that if you don't say something, then people won't trust you. But it's actually the opposite. People don't trust people that just make stuff up. They trust people that say I don't know and we have to figure it out together. Right, so on the same page. Okay, so what is a virus? We're going to start with that concept. So one of the best definitions is from this group of scientists. It's called virus, is simply a piece of bad news wrapped up in a protein, and so what's interesting is that a virus is the simplest of living things. In fact, some people say they're not even sure if a virus is a living thing, because all virus does is recreates itself. It does nothing more than recreate itself, and it's so simple that it doesn't even have this cellular mechanism to do on its own. A bacteria is a little bit more complex, and a bacteria can reproduce itself without having a host, without anybody else. A virus needs another tissue in order to do its job of reproducing itself by itself. If you put a virus on the floor here, it would all die. You put a bacteria on the floor here and reproduce itself. So a virus needs you or me or an animal or a cell to reproduce itself. So this is one of the great ironies A lot of people don't trust vaccines because they tell me oh, I don't want to put RNA or DNA in my body. That sounds very dangerous. That sounds very, very risky. What does a virus do? Its only job is to put RNA and DNA in your body. So if you're worried about genetic material in your body, you should be really worried about viruses, because that's all it does. And there's a reason we're worried about that, because there's some theories that have some pretty good data that viruses are responsible for cancer and aging. And that's because our immune system is good, but it's not perfect and viruses do get into our body and do put its nuclear material in our body and our fact. Our cells have ways of protecting themselves against viruses that already got into our body. So again, if you're worried about having genetic material in your body or your friends are, tell them. Well, if you're worried about RNA or DNA injections or therapeutics, you should be really worried about viruses. What I'll also show you is that the stuff that we're studying, that involves RNA and DNA treatments, is not a whole virus. It's not a whole organism. We are so good now that we just give a little piece of RNA. That isn't for the whole virus, but it's just a piece that says this we want you to recognize this little tip of the virus, not the whole one. So and I'm going to show you this but the old school vaccines, we would take a virus, we would kill it and then we would inject it into people. Obviously there's other steps, but that was basically the concept. Again, the whole virus, kill it, you put it into people and then your immune system would know that that's the bad guy. And nowadays we don't have to do that. All we do is we say, okay, we know how that tip is made, that spike protein. We don't have to do the whole spike protein, just the tip of it. And we're going to teach your body that when you see that guy, then you fight this whole virus. And how cool is that? There's another thing I can say. This is the coolest thing in the world is that technology has gotten to that point, but people don't understand that. So we all have to help people outside there understand that. Okay, all right, next slide. Once viruses get into your system, bad things happen. Let me get it in the way so you can hear this Viruses, they will replicate themselves, reproduce, and at an incredibly fast rate. That's why we get sick, and that illness accelerates itself. You may have a little bit of sniffle and you say, okay, well, it's not that bad, and then 12 hours later you can't get out of bed and another 12 hours later you need to go to the emergency room because you can barely breathe. That's because of how fast these viruses can replicate once they get going, and they also mutate. They change. Mutation means change, so they change their genetic material as they're replicating, which makes it harder for your immune system to keep up with it. So one of the ways viruses cause a lot of problems is because they get in there, your immune system is getting revved up, and then they change so that your immune system has to regroup, and so that's the only reason that we want to get the viruses at the very early stages. We want your immune system to be ready. So again, as I mentioned before, viruses really can't do anything by themselves. They require a host, they require cells from usually a human. They can actually infect plant cells also, but for most parts, the viruses that we deal with are infecting human cells or animal cells. So they need that in order for us, in order for them to do their damage. And again, as I mentioned, the only job is all they do. They do nothing else. They don't eat, they don't drink. They don't drink anything other than try to inject their nuclear material into a human cell or an animal cell. And some viruses have DNA and some viruses have RNA. I want to get too technical here, but just to remind you from high school, biology is DNA has two strands and RNA has one strand. So some viruses are double streamed to DNA viruses. Some are single-stranded RNA viruses. The flu and COVID are both RNA viruses with eight genes. That's it, eight genes. And there are other viruses out there, like small pox, that are much more complicated than our DNA viruses. But we've been able to get rid of small pox and hopefully we'll do the same for COVID and flu. But I think we went one too far. All right, there we go. So how do you become immune to a virus? Well, there's basically two ways. You can read here that the way that most people get immune to a virus is you get the disease, you get sick, you hopefully recover, and if you recover, then your immune system recognizes the bad guy and your immune system can now protect you, because the next time Now that usually works, but I'll tell you where maybe it doesn't work perfectly. So let's say that you had the measles. Okay, that's a virus, your body, you get sick usually get as a kid. You don't get too ill, you get a rash and you get some fever and chills, and then your immune system's ready and your immune system has a memory. And the next time you expose the measles, you won't get sick because your immune system's ready and it won't let the virus get into your cells. There are viruses, though, that when we fight them, they get into our cells in a place where our immune system can't get at them. So a good example of that are herpes viruses like chickenpox. There are other herpes viruses, but chickenpox is a good example is that you get sick, your immune system fights it off, it hides in your neurological cells, right, and then what happens 50 years down the road when you have chickenpox? Does everybody know what you get? You guys are smart. Okay, so that's an example of a virus that never actually completely goes away, but it's dormant under ourselves. Okay, so that's one of the reasons why we want to avoid the virus to get there in the first place, so there's no sanctuary for that virus to stick with us. Okay, and this talks about the other way of becoming immune to viruses, which I believe is the better way, which is get a vaccine. So when you take a vaccine, especially the new vaccines you're getting, you're not getting a live virus anymore. You're getting a signal to the immune system that will protect you from getting infected in the first place. So there will be no chickenpox in your eventually. We don't have this type of technology yet for chickenpox, but we will assume when you give a chickenpox vaccine in the future, it will prevent that primary infection. But we do have that technology for RSV, just for a sensational virus. We now are developing it for influenza and, of course, we have it for COVID. And what happened last month to substantiate how important this technology is? Does anybody know? Other then, Sharon, do you have a slide on that?

Speaker 3: 11:34

You do.

Dr. Michael Koren: 11:34

Okay, we'll get to it. Then I'll leave a question. Something happened this past month that substantiates the importance of the technology that we're using in the COVID vaccines, and you guys think about it. When that slide comes up, we'll see if you figured it out. Do you remember the day? I remember within it was Monday and I could figure it out, I remember. Second, I remember it was Monday because I gave an interview and then literally the next thing I heard was this announcement, and I would have, of course, mentioned during my interview, had I known about it 30 minutes earlier. Okay, all right, so this is. This is big, yes.

Speaker 3: 12:15

What's the controversy now about the people in their 70s and older taking the COVID vaccine and creating heart problems?

Dr. Michael Koren: 12:23

Okay, we're going to definitely address that, but I don't think it's a controversy. I think there's misconceptions and actually the concern is actually younger people. So the COVID vaccine I'll just give. The punchline is as you get older, become at higher risk and the risk benefit for COVID vaccine as you get older is very clear cut. There's no question whatsoever. In younger people they don't get a sick from COVID. So the younger people. There may be a discussion about whether or not a possible side effect is more important than the benefits of vaccine, but when you're seven years old, there's no controversy. Older, the controversy would be in a 20 year old, not a 70 year old. Okay, so getting to this, I'm going to move to this side. This is how your body works and this is a little bit of a scientific graph, but I'm going to walk you through it. So when you get infected and zero is the timeframe of infection First there's a period where you're asymptomatic, and for viruses it can be anywhere between zero and five days. For COVID, typically two days. On average. It could be a little bit longer, a little bit shorter and but as this is happening, the virus is building up in your system and then it's presenting its antigens, its proteins to your immune system and its nuclear material. So the first thing that happens is that your body responds with something that's called IgM, which is an antibody. And so IgM is a very large, complicated antibody. It takes the first effort to go after the virus and if you remember, remember when we were giving antibody infusions during COVID, we had vaccines. That's what they were doing. They were taking what's called convalescent plasma, which is basically the noncellular part of your blood, the part that's not red and giving it to people, because it had this IgM in it and so it worked. It's not the best thing, but it worked. But actually the more important thing is what's called IgG, and IgG is a much more numerous antibody. It's a smaller, more nimble molecule and it can get to the action more quickly. But that takes a little while for your body to rub that up. It starts getting. It says 14 days. Here. It takes about 10 days, you know, between 10, 14 days before it really gets rubbed up, but this also lasts for a long time. So we know that after COVID infection you have high levels of IgG against COVID in your body for at least six months. So people have definitely had who's had COVID here and who's had COVID more than once. Okay, so it's almost always more than six months after, and the reason it's more than six months after is because the IgG is starting to decrease and typically the second time you get it it's a slightly different strain the first time and you need the higher IgG levels to prevent you from getting reinfected with something that is a little bit different than the original infection. Okay, so this is the way your immune system works. And then the other part of the immune system, which is not listed here, is what's called cellular immunity. These are antibodies made by something called B cells. The cellular immunity is something called a T cell and that has the memory. So that's going to be the guy that looks around and sees something that doesn't like and it tries to eat it and then, once it eats, it says, oh okay, we know what this is, and then it sends a signal to make more of the B cells and to send out those antibodies. So your immune system is fascinating, it's fabulous, and it goes both from a cellular immunity standpoint, where cells that actually do some of the dirty work, and what's called the antibody mediated immune system, which is the B cells.

Speaker 3: 16:08

Okay, Does that make sense?

Dr. Michael Koren: 16:11

Okay, all right, so now we're getting really scientific. I'm very proud of the team for putting together these really scientific things. Is this artificial intelligence trying to? Okay? So this is the way an antibody looks. All antibodies look like this. It's a common structure and all the blue stuff is just the structural components of it, it's not the action components of it. The green stuff is the action component of it, and the green stuff is what's different for each different virus. So the way your body makes it is that most of it is a structural component. That's the same for all different viruses, and the green is different from the different viruses. And this is the specificity. That's how your antibodies know what to go after. And, as I said, all you need is a little piece of the spike protein. Well, the antibodies know that that particular piece of spike protein is particular for the Omicron strain of COVID, omicron H2N3, or whatever the number may be at the time, and that's how specific it gets, and that's all coded in the tips of these antibodies. And so I mentioned IgG and IgM. This is IgG. Igm has five of these guys all together that are all surrounding a centerpiece. So everybody has a little bit of a different structure. But this is the main structural component, the unit. And then over here this gets a little, a little bit more complicated. But the take home message is that the antibodies can work in different ways. And this is a cell. The red is the receptor, the concept of receptor, as everybody understands that that's the part of the cell that takes in different molecules or recognizes different molecules. So on the surface of your cell you have these little interesting components it doesn't quite look like that, but sort of looks like that which can touch other things and say, okay, I recognize this, I'm going to bring it in, I don't recognize this, I'm going to throw it away. And so the antibody can work by blocking the receptor or can work by blocking the bad protein. Either way, does that kind of make sense? Okay? And then it also can hit the cell directly and cause some activation of an effect. So, interestingly, the IgG will hit other immune cells and get them to work. So IgG not only goes after the virus but also is a recruiter for other cells in your body to also fight the virus. So it's kind of like the polarity of cells. The viruses are coming, the viruses are coming. And then this gets a little bit more complicated, but a antibody can actually send the signal that this cell is so sick that you just got to kill it to control the damage. I'm not going to talk about that. That'll be the next lesson. Okay. So what is that vaccine? All right, so we have two definitions. So who has used chat GPT here? Okay, and who has heard of chat GPT? Who? Has not heard of it. Okay, so this is a chat. Gpt is a product that Microsoft Corporation has put together that's using artificial intelligence, and you have a personal relationship with Roger, roger, yes, okay, how's it going?

Speaker 3: 19:36

Great, you guys are in good terms. Yeah, you're dinner on Friday nights. No, it's cheap.

Dr. Michael Koren: 19:44

It is All right, he just provides information, okay, all right. So Sharon said okay, well, we're going to, we're going to prepare the doctor with artificial intelligence and you tell me which one you like better. Okay, so the chat. Gpt definitions here. A vaccine is a biological preparation that provides active, acquired immunity to a particular disease. It typically consists of a weakened, killed or parts of disease causing microorganisms such as a virus or bacteria, or a synthetic substance that resembles a part of a microorganism. When administered to a person, a vaccine stimulates the immune system to recognize and remember the pathogen without causing the disease itself. The immune system responds by producing antibodies and memory cells which are capable of quickly recognizing by the actual pathogen if the person is exposed to it in the future. This helps prevent a less than a certain disease, making vaccines a powerful tool in the prevention of the spread of infectious disease. Protecting public health, vaccines have been instrumental in reducing the incidence of many serious illnesses and been critically controlling, eradicating certain diseases throughout history. So that's Roger's version. And that's basically what I've been telling you for the last 15 minutes, so I don't disagree with that, but this is my version. Dr Korner, a vaccine is a product that prepares our immune system to fight the bad guys. Okay, so which is a better definition? All right, and again that's the thing, is that you have to take this information and make it approachable to people, and that's really what a vaccine does is that it prepares our bodies to fight the bad guys. All right, so this is so. I'm not. You know, I love science and technology, so I'm not dismissing artificial intelligence or Roger, except that this is the gallon of fried eggs.

Speaker 3: 21:22

And he has a tendency to hallucinate.

Dr. Michael Koren: 21:23

He does. That's actually a huge problem. Yes, it's a huge problem, which is why you don't want to take, you don't want to take out a fried egg, but anyway so. But technology has been amazing, so especially medical technology. Information technology has been amazing in lots of places. That's so much in healthcare. It's interesting Information technology has been very uneven in healthcare. But the science of basic science has been amazing. So I'll just give you an example, do you remember in 1996, there was this big scare about the bird flu.

Speaker 3: 21:59

Yeah.

Dr. Michael Koren: 22:00

Okay, so, they had the big scare about the bird flu. Everybody was getting really, really nervous and you know how long it took to create a vaccine. It took you can see it right there 11 years. So it was identified in 1996. We didn't have a vaccine in 2007. Wow, 11 years, 11 years, okay. And then there was other vaccines that were made, so we had H1N1 swine flu. That was identified in 2009. And we had a vaccine available in a couple months. You know why? That was Because we already had the vaccine, because we had this. We had H1N1 30, 40 years ago. You remember, during the 70s, joel Ford got out there and said that we have the swine flu coming and we have to prepare everybody with vaccines, and it was a big disaster because they didn't have a bad flu season that year. Do you remember that? We all have to remember that. Okay, yeah, so that was when I was in junior high school I think a while ago, but it was at the Bacal. Actually, because they really worried about the swine flu, they made a vaccine. That turned out to be not a great vaccine, but the good news is that we had a vaccine ready when it came back. Yes, question.

Speaker 3: 23:15

How come that was an H1N1, too, wasn't it?

Dr. Michael Koren: 23:18

That was even earlier than that. That was 1968.

Speaker 3: 23:21

I got that. Yeah, that was nasty. Yeah, it almost did me in, but I was 15. Yeah, yeah.

Dr. Michael Koren: 23:29

So that was actually about as bad as COVID in terms of the impact in society, but our society was very different then. So, even though that was incredibly nasty flu, hundreds of thousands of Americans died from it, but it didn't stop the country the way COVID stopped it. Because our politics are different, our whole perspectives are different. The Spanish flu was back in 1918. That was actually five to 10 times worse than COVID. Five to 10 times worse than COVID in terms of its impact.

Speaker 3: 24:08

Are they all H1N1s?

Dr. Michael Koren: 24:10

No, not necessarily the ones that. I mentioned are, but not necessarily, and all H1N1s. They can be slightly different, also they can have some genetic variability. But to your point and the point I'm trying to make here, is that if you happen to get lucky and the virus that comes out is something that you've already dealt with, you'll have a vaccine, but if it's a new virus, you won't be so lucky. Okay, so that's the point of this. MERS came out. MERS is very similar to COVID as a coronavirus and there was a lot of concern about that. This is going to be. This is called Middle Eastern Respiratory Syndrome Virus and, for whatever reason, it didn't affect that many people. About 8,000 people died and then people isolated and didn't spread as easily as some of the others. So we never developed a vaccine. And then you see these other. There's another avian flu that was this is H7N9, to your answer question. So that was 2013, 2017. And they, by the time they were going to get ready for a vaccine, it was not an issue anymore. We weren't finding any more of that virus. So you can see that there's all kinds of the worst virus out there. There's a 90% mortality rate for people infected with Ebola. It took five years to develop a vaccine, so we have a vaccine for that. So you can see that the typical timeframe is years. So how long did it take to go from identifying COVID-19 to having an approved product?

Speaker 3: 25:34

A year

Dr. Michael Koren: 25:38

And the genetic material for the virus was identified in January of 2020. The phase one studies were done in May of 2020. We participated in the phase three studies for Pfizer, Moderna and Novavax starting in July of 2020. And, if you remember, it was approved one week after the election and President Trump wanted it before the election, but that didn't happen. The first vaccine was Pfizer, and then Moderna. One day after the other was one. It was early November, so you went actually from identifying the virus to an approved vaccine in about 10 and a half months and now the same thing happened. We can do it in about four or five months, Because, you know, we learned from each other. That's incredible. Yeah, it's just unbelievable. It's just absolutely incredible. And these are safer vaccines because they're very specific to the target because of the messenger RNA technology. So that's people. Okay, All right. So this is actually my favorite slide of the whole presentation. Who's here? I've heard of Nesimus. Okay, All right. So it's interesting. When I talk to I have a lot of patients and you guys are you know you're here and you're sort of a selected sample. You're biased, obviously very intelligent, coming in. You are, you really are, but not everybody's like that, and so there are several groups out there that are very, very skeptical about it, and it's not everybody in the group I get. This, it's just a predilection. So it's interesting that people who consider themselves evangelical are very skeptical and African Americans are very skeptical, and you know why that's ironic, because those are the two groups that started vaccines in the United States Is that crazy. Think about that. So let me give you a little more details. Do you know where the concept of vaccines comes from? Africa? Yeah, in the Middle East. It's actually. It comes from Africa, in the Middle East. And it was. The observation is that you know there's a lot of nasty viruses and diseases out there and people figured out just through observation that if you got a virus in a certain way typically if you made a cut or a wound and put the virus actually puss when the person was infected into the wound, rather than halting the virus, you would get less sick and you'd be protected from the future. So that was an observation that was made 500 years ago 600 years ago in Africa and the Middle East, and so people in Africa were typically getting vaccinated for smallpox, which is the worst of the viruses. Smallpox epidemic would kill 30% of the entire population in six weeks, and so people in Africa figured out that this is the way to protect the population from that, and so that information came available to Europeans in the early 1700s, and when the first clinical trial was ever done, it was done at the Newgate Prison in Great Britain, and it was done because somebody it was royalty was so worried about their kids dying from smallpox that they wanted to test this concept from the Middle East and Africa, and so they got permission from the king to take six prisoners and to create big cuts in their legs and to put the pus of smallpox victim into that leg and see if they got sick. So they did that. They inoculated them and then they put these people. They were prisoners that were in there for life. They were given the opportunity to be released for prison if they survived the experiment and they then got put into rooms of smallpox victims to see if they got sick. And none of them got sick. So it actually worked. So a guy named Cotton Mather he was evangelical, he was involved with the Puritans and the people that came over we remember that, of course and he had a slave called Onesimus, who was a very intelligent guy and he was saying like, what tell me about it? What happened in Africa? So Onesimus came over from Africa when he was 10 years old. He was vaccinated, he was inoculated. And Onesimus said well, this is how we do it, this is why we do it. And so Cotton Mather said listen, let's work together on this. Can you help me do a project here in Massachusetts where we inoculate people and see what happens? And sure enough, they knew that what was happening in Great Britain would eventually come to the colonies, because there were ships going back and forth and Cotton Mather worked with Onesimus and they inoculated about 270 people in Boston area and they wanted to see what would happen when the smallpox eventually got there, and what happened is that the people who were inoculated had a likelihood of dying from smallpox of only 2%, whereas the people in the community that were not inoculated died at a rate of 16%. So it was actually the first important clinical trial ever done in the United States and one of the most important in the history of the world. It was a collaboration between an African and an Evangelical. Now, Cotton Mather was kind of a bit of a controversial thing. They had a very interesting relationship. So Cotton Mather told Onesimus well, I'll free you if you become Christian. And Onesimus says, yeah, that's not my religion. And so that's what was interesting. The other thing that was interesting about Cotton Mather was that you heard the Selma Witch trials. So he was one of the attorneys for the Selma Witch trials and he convinced the jury that the testimony from a dream can be admitted into court. Yeah, so it's called spectral evidence. And so Cotton Mather said well, people don't have dreams for no reason. There's got to be some truth to that. So I picked the exact number, but more than a dozen young women were executed. It was like 16 or 18, were executed based on the dreams of people and so obviously progressive. So Cotton Mather was the son of a fellow named Increase Mather who was president of Harvard College. One of the other presidents and Cotton Mather tried to become president of Harvard College but they wouldn't let him because of his uneven background. But we have to give a hand for getting scheduled Onesimus and coming up with this concept. So really, really cool. So we have friends out there that are either African-American or evangelical. He said hey, we're the ones that started this whole thing. All right, so how are vaccines made here? You can see that and this is all the old school stuff that first you had to grow a virus and then you could grow the again. We talked about the fact that viruses need a cell, so you typically grow them in eggs, often from chicken embryos. So that is easy. Actually, we did some studies that looked at vaccines that were made from viruses that were grown in tobacco leaf. So you can do that as well. So once you get that, you have to get the antigens for the virus that's going to trigger the immune response. As I mentioned, back in the old days, we just take the entire virus, kill it and then make it back to see how it would. It would be purified a little bit, but you basically want to hold that whole virus in there. But nowadays you can use just pieces of it. You have the technology that you can take a piece of the virus around in a whole box and then there's a very extensive process of purifying and this is, can you imagine, if you're growing a virus in an egg. There's a lot of stuff in there that you got to get rid of to get to the just the current. So you go through this series of purification processes over and over and over and over and over again. It could be 100, it could be 500. And even then there's a possibility of impurities because it's hard to get every little thing out. So the older school vaccines were more likely to cause an immune reaction, that's an allergy. That's not related to the antigen but related to a contaminant, because the viruses were actually grown in something that could be a contaminant. So, for example, if you had an egg allergy and you had a virus, you had a vaccine that was grown in eggs. Then there could be some egg protein that would cause an allergic reaction. We don't have that anymore, but the mess of RNA stuff. You know why? Because it's all made from scratch in test tubes using basic chemicals. So what?

Speaker 3: 34:40

yes, I have another question. Yes, when you said reactions and stuff, it's a thing now I heard on Channel 4 where, like you take the flu and the monies shot together, they say if you take the COVID vaccine and the flu shot together, it could, you know, after a while, give you a stroke.

Dr. Michael Koren: 34:57

Did you hear that? Give you a stroke.

Speaker 3: 34:58

Yes.

Dr. Michael Koren: 35:00

I don't know if you've seen it, while I said that it was on Channel 4. I thought we were going to do this. How much do you think Incommon? Okay, yeah, okay, so this is what happens. Stevenson is a cardiologist from Cleveland Clinic who I've known for many, many years. I published more than one paper with him. So what happens is this is that when we get information from surveillance, you're seeing hundreds of thousands or millions and millions and millions and millions of case reports. And if there's a case report that says somebody happened to get a flu and a COVID vaccine at the same time, what happened? So that's what's called an epidemiological observation, which, quite frankly, may or may not be true. I have to study more carefully because this is the first time I'm hearing it. But, having said that, there may be some reports of that. But the beauty is is that we're now looking at it critically in research trials. We're doing one right now. We actually have a research trial that combines the COVID and the flu vaccine in the same vaccine. Now the problem with what you're referring to is that if you have different vaccines that you're giving at the same time, some of the other ingredients may not be compatible. So it may have nothing to do with the actual flu and the COVID protein, but it may have something to do with other elements of the vaccine, but there is no combined COVID flu vaccine available in the United States or any place right now, except right here in this office. So we're actually doing it, it's only. It's only available as an investigative product. So we are studying that concept, but I'm not actually familiar with the details, but I will look them up. But I can assure you that this is not major, because I would have heard of it it was major. Okay, may involve the addition of an adjuvant, a material, the other thing. I'm going to make one other point. This is actually the most important point. So if you hear about a side effect, of anything, any kind of medicine right. The first question you have to ask is what is that side effect versus the benefit? You should never, ever, ever make a judgment about something based on just the benefits or just the side effects. Okay, If somebody says that this medicine, well, it's great medicine, I've taken it. Somebody gets on TV and I've taken it and my energy level is 50% greater. You going by it? No, because your energy may be 50% greater, but 50 people died from it and no one necessarily lived longer. Okay, flip side. Somebody says, oh, you take this medicine and don't take this medicine because 50 people died from it. Do you not take it? No, because you don't know how many people live longer. So yeah, 50 people died from it, but 5,000 people live longer. Well then, that's a good bet. So, it's actually the biggest misconception in the media and in medicine is you never weigh the risk and the benefits. You can't possibly know what to do unless you weigh the risk versus the benefits. So something as simple as an aspirin Aspirin causes GI bleeding. Aspirin can cause horrible welds in your body. Aspirin can cause anaphylaxis and your blood pressure will drop to nothing Is that a reason not to take an aspirin. No, because aspirin also reduces heart attacks and reduces strokes. In some cases gets rid of your headache. So everything in medicine is risk versus benefit. So never, if anybody ever tells you that something is great, say, well, what's the downside? If they tell you something sucks, it's horrible, you say what's the upside? You learn nothing more from this lecture. Always ask what the opposite thing is, because you can't make a good judgment without one versus the other.

Speaker 3: 39:02

Yes, but women also depend on the person individual.

Dr. Michael Koren: 39:05

Absolutely. That's a second lesson of that evidence. You give them that evidence lesson here. So the first thing is risk versus benefit, and then it's customizing it to your circumstances.

Speaker 3: 39:16

Correct.

Dr. Michael Koren: 39:17

I mean I might be allergic to something close to aspirin, so everybody's like oh you can't take it so if somebody tells you that aspirin is great, well, it may not be great for you for that exact reason. So you have to look at it for the overall population risk versus benefit. And then you and the other thing about you is not only what you're sensitive to but your personal risk. So you look like you're over 30 years old, are?

Speaker 3: 39:41

we ready, yeah, ok, nice.

Dr. Michael Koren: 39:46

All right. So, as I said, so, the stuff for COVID in terms of myocarditis or herocarditis, which could happen actually a little bit more in younger people than older people, and the reason for that is because younger people have a more robust immune response and because of that they're going to have all those antibodies that get rushed to the front and sometimes the antibodies get a little bit overly aggressive and cause inflammation, and younger people are at much lower risk for serious complications of COVID.

Speaker 3: 40:18

Yeah.

Dr. Michael Koren: 40:20

So in that situation, who am I? So if you're 30 years old and they come to me and they say, do I need a vaccine? And they say, well, you're healthy, you're 30 years old and you do everything you want, you probably don't need one, because if you get sick you're not going to get any problems. But there's another thing. It's not only your individual risk, it's who you're going to expose. I was going to say who you go home with, right? So if you're 30 years old and you live with an eight-year-old grandparent, well then, you want to get a vaccine Because your individual risk is really, really low, but you're making a big difference for somebody else. Ok, so all these things are factoring in how you make good medical decisions, and that's why we have met evidence, because when you get on Google, they say this is good, this is bad, this is good, that's bad. Life isn't like that. Life is about risk versus benefits and who you are and who you're surrounded with, and that's how you have to think about things. Thank you your question, though. Thank you for that, all right, so now, ok, we've got the antigen and we'll get back to this and then you have to make it so that you can give it to somebody. You can't give a bunch of protein to somebody. You've got to put it to something That'd be some fluid or something. So you create an adjuvant, which is our medical term for something that enhances our ability to get into your body and also to get your immune system on board, and there's also other chemicals that will allow it to have a lot of shelf life and other things. So these are all the steps to make your vaccine and then you've got to get it to the places where they need to go, and that's the logistics. Going from a manufacturing facility to little bottles to doctor's offices or public health places or wherever it goes is another big step to the process. That takes a lot of time and effort. It's more complex than you think. Logistics are actually important, all right, so that's how it's done traditionally, but as I mentioned, for the RNA stuff is now we're not dealing with any cells. They're no cells at all, it's all built in test tubes. So we build an mRNA from basic components and there's no impurities because everything starts pure, and so you build it based on the genetic code for that little piece of the protein that you want to identify that will trigger the immune system. So the technology is absolutely fabulous and it can be very, very specific because we can map that sequence and we can make sure it doesn't match any other sequence. So literally there's a library now where that sequence can be matched against known sequences to see if that's a unique segment. And just doing the mathematics of it, you can get anywhere between 20 and 30 base pairs of the messenger RNA and create something that's unique from everything else. Just going to nail that virus and nothing else.

Speaker 3: 43:11

Like getting DNA from a tooth from someone one ago.

Dr. Michael Koren: 43:14

You just need a piece of it Exactly, Not the whole body, you got it. You know that, all right. So what I like to tell people is that messenger RNA medicines are just a set of instructions. It's an email. And you know the other thing that's cool about it For people that are worried about genetic code in their body RNA is destroyed by your body within a day and a half. Yeah, so one of the challenges of RNA technology was that when you put it into a biological system like an animal or human, your body breaks it down really quickly because it's built to just be a messenger. It's like what's it called? Snapchat, yeah, where it's like that email that disintegrates after 20 seconds. That's what messenger RNA is in your body. So we've actually had to use technologies to make it last a little bit longer so that it becomes useful, but your body is breaking down RNA all the time because it's just a short-term messenger, all right. So this is just reminding you in high school biology, college biology is that DNA is in your nucleus. That's where all your genes are. RNA is in the cytoplasm that's outside the nucleus and RNA is responsible for taking the information from DNA and going to ribosomes and making a protein. So when people talk about their word about RNA affecting their genetics, it can't affect your genetics because the genetics are DNA in the cell nucleus and RNA is all outside of the cell nucleus. There's nothing to do with the DNA in the nucleus. So structurally your body is built, it just can happen, and this is I remember. These are the Watson-Crick base pairs that they discovered at the structure of DNA back in 1954 and won the Nobel Prize in. Medicine for it. So again, this was a subtle lesson from high school biology or college biology, but on the mind of you is that RNA and DNA are made of what's called base pairs, which are these little mini-nino-acid proteins, and it's either an A at the I could see thymine or I'm not pronouncing exactly right, I'll remember in a second, but anyhow, there's basically four base pairs ATGC for DNA and for RNA it's AGUC. So for RNA it's U instead of a T and U is for uracil. All right, so this is the answer to my question. So the reason we're excited about this is because these two scientists won the Nobel Prize in medicine on October 2 for discoveries that led to the RNA vaccines. And this is Dr. Drew Weissman, who is an immunologist. He actually taking his career. He is a professor at the University of Pennsylvania. He was at the NIH. He actually worked with Dr. Erick Fauci at the NIH for a while. He went to medical school, got his MD PhD at Boston University and he went to college with me. So we actually graduated together. I don't know, since I'm 18 years old and we took lots of classes together in college. So we're very proud of him that he won the Nobel Prize. And this is Carolina Caraco, who is a Hungarian biochemist who escaped communist hunger at the time with all of her worldly possessions in a teddy bear. So she had a two-year-old child that had about $900 and some jewelry to their name, and they hid it inside of a teddy bear to smuggle it out of Hungary because otherwise it would have been confiscated, and so she got to the United States with that and she met Dr. Weissman at a copy machine and she started telling him about what she had learned about synthesizing RNA and he was working on an HIV vaccine then and he said, yeah, we wouldn't want to know about RNA, but we can't make it stable. And they got together and they figured out how to make RNA stable for a vaccine and because of that breakthrough, they won the Nobel Prize on October 2nd. So that's a pretty cool story. They were excited that. Yeah, I've obviously had some personal satisfaction for me since I've known Drew since I'm 18. They're not good friends, but we did actually take a lot of classes together, including we took a class together when I was a sophomore in college on molecular biology, and the crazy thing is that the professor won the Nobel Prize in medicine in 2017 for breakthroughs understanding circadian rhythms the genetic basis of circadian rhythms. So kind of interesting. At least, I find this interesting. All right. So there's a couple other things that you should be aware of when we talk about vaccines, so something called balance. Balance is really since your means of power, it's the number of strains targeted, and that's the key thing is that when you go get your flu vaccine. You go to whatever your pharmacy is and say I want a flu vaccine. Ask them is it quadrivalent? It should be now sometimes they'll try to give you a cheap one or one. That because a lot of people they run out of these vaccines so they try to push off the less effective ones. The quadrivalent means quad is four. It means that it's coding for four different strains. That's for people over six days at now, yeah, and others too. Oh, the young people. Yeah, did you get it? No, I heard it was only for the long term. Well, they may be rationing it. Yeah, that's fine For that reason, but there's no reason why you're the person who can get it. Check out their pharmacies because some might say, you don't have it in other states. And then an epitope is another thing that you probably won't hear about, and it gets a little cranky, though, but it's actually the number of sequences in a virus that are being targeted, and so, yeah, epitope. So if you ever hear that word. That's what it means. So this is the number of strains, that's the number of sequences, all right, and then we have yeah. So this gets into what we're doing here now. So, as I mentioned, as we speak we are working with Moderna on a product that has both a flu and a COVID vaccine together and we think that this will be eventually how the whole system works, and the reason for that is because it's just going to be working medium for people. So, as you know, you have childhood vaccines that combine a lot of different things together and instead of having to come in three or four or five times, kids get on one shot and the same thing is going to happen for adults, more likely than not, a yearly vaccine for COVID, flu and then eventually RSV. Those are the three nasty viruses that lead to hospitalizations and problems for older people, and eventually they'll all be in the same vaccine. So we have under investigation here as we speak, the combination of flu COVID, and we're really excited about that. We also think that this is ultimately going to be the standard, because it's less costly. Giving one shot. Worse, coming back and giving multiple shots is going to be better, and it's going to be cheaper and less pain, I'm sorry. Less pain, yeah, less pain. There you go. Exactly, you got it All right and yeah. So what's going to happen in the future? So we're going to have, I believe, as I mentioned, we're going to see faster and faster turnaround time. So the way flu vaccines have worked historically is that experts with slaughter pigs in China to kind of figure out what strains of virus are more likely to infect humans two years down the road. But you won't have to do that anymore because with the new technologies, when people start getting sick, the first person getting sick will send their samples to a lab and in three days you'll know the genetics of that virus. And then, within three days and he sends it to one of the companies that builds these RNA vaccines and they'll have a target vaccine within two weeks. And then the testing part will take longer, but that'll get shorter and shorter to get more and more confidence in the way this thing works. So if COVID were to hit again, we would have a vaccine in four or five months and eventually it could be as short as two months from identifying a virus having a vaccine. You'll already know some of the shortcuts. Oh yeah, exactly, that's right. So that's the future. And then we're also going to be able to make these that are really, really targeted just to the most pathological viruses and the parts of the virus that are most likely to elicit the best immune response, the most specific immune response, so we have the lowest possible dose and the lowest possible side effects. And again, the research is going to be a key part of this because, in order to do these breakthroughs, we have people like you that are incredibly helpful. Who here has been involved in one of our vaccine studies before? Anyone One of our vaccine studies before? Oh, I see, yeah, thank you. Thank you very much. It's tremendous that you're doing that. So, just for everybody else, we've had about oh, between the flu, covid and RSV. We've had probably about 2,000 people in Northeast Florida participating in these studies, all doing well, thank God, and hopefully protected against these nasty diseases. So it's really remarkable and we've been a major contributor to that internationally. So Jacksonville has become an area of the town for this type of work because of what you guys are doing. So thank you for that.

Narrator: 53:34

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