Vaccination Insights: Part II

Daniel Kraft: Lessons from Ebola and SARS were learned, but sometimes lost, let's say. The trick is how do we codify that and learn? Dylan George: One of the things that has been a little bit disturbing to me too is that people are starting to talk about this as a once in a lifetime event. It happened to be this, a one in a 100 year event, but I'm pretty confident that we're going to see more public health emergencies coming forward. We live in an age of epidemics and we need to get comfortable with that. We need to transform our capabilities going forward. Daniel Kraft: Hi, I am Dr. Daniel Kraft. Welcome to Healthy Conversations. Today I am in a healthy conversation with Dr. Dylan George, who's a VP at Ginkgo Bioworks. Dylan George: I'm super excited for the conversation. Daniel Kraft: Dr. George or Dylan, you've got an incredible background of how would you say what it is that you do and how is that riffing into our new age of pandemics and data is the new oil? Dylan George: Throughout my career, I've been looking at how to use data and analytics more effectively for understanding infectious disease outbreaks so that we can either protect war fighters, civilians, or now in this particular situation, kids in schools so we can stay safe from particular outbreaks and in this situation, pandemics. Daniel Kraft: And how would you sort of define data today? Dylan George: There's so much data out there. The range of data that we need to think about to fight a pandemic goes well beyond just diagnostic clinical information. We have these digital devices that tell us geography of where we're at and what we're doing. That's all can be sucked in to help us think about patterns of life and how we interact with one another, and so how a pathogen would actually be transmitted across those. Daniel Kraft: A year ago we were all glued to our TVs, tracking raw numbers of cases, deaths, hospitalizations. Things have gotten a lot more sort of nuanced since then. Where are data experts like you now focusing on in terms of new forms of data and what's coming next? Dylan George: The thing that's top of my mind right now is the variants and how do we actually track them? The biggest challenge that we have with trying to get better genomic sequence data is right now we're essentially looking in just a couple places so we don't have a broad sampling or representative sample of what's going on in the world. The horrendous situation in India, as we're seeing the numbers climb there, it just takes your breath away. My heart definitely goes out to those people. They're in the teeth of it and we need to figure out how to help them move forward. And then the challenge becomes adding the sequence data to the epidemiological data, the demographic data, all of that to create a full picture of what's happening in the population. Bringing various data sets together in a fusion is really where the power is going to lie. Daniel Kraft: It's an infodemic in a good way, but also a challenging way. The data is one piece, but we actually want to drive from that insights or from the insights, action. Dylan George: There's lots of discussion about supply chains. We need to think about the information supply chain. What do we need to do to collect data? What do we need to do to aggregate it, share it, analyze it and present it and communicate it effectively so that we can provide the evidence that would allow us discriminate amongst different policies, different clinical decisions, or just different personal decisions? Daniel Kraft: I love the idea of supply chain. Are there ways you think that we can sort of integrate these new data forms in ways that really affect your driving or your health journey? Dylan George: That's really the hope. What we're witnessing right now and the various waves of COVID in the United States largely is being driven by how we are either opening up and reconnecting with one another and reengaging because that connection is what's allowing the transmission of the pathogen to happen. It's that decision making process that we can make healthier choices is what's really critical here. Daniel Kraft: And you've got this fascinating background. You've done work in Africa, you've been in the Obama White House. Dylan George: I was a serial federal employee for over 10 plus years. After being an academic, I started working in the Department of Defense as a civilian, thinking about how do we keep our war fighters safe from infectious diseases? And so we were using a range of different analytics to kind of capture a lot of information. When we inserted war fighters in a particular geography, it's like how would we protect them? when I moved over to HHS, the Department of Health and Human Services, I worked for an organization called the Biomedical Advanced Research and Development Authority. They were the ones that do the strategic national stockpile thinking about these pandemic scenarios, nuke detonations and Armageddon scenarios. And then I worked in the White House and the Obama administration trying to help with the Ebola response in 2014 and '15. Now I've just started at Ginkgo, but the trajectory through all of this is trying to use data and analytics to help individuals and groups of people be more effective in staying healthy and avoiding infectious diseases in some capacity. And it's been a great career and it's a hard place to work too, because we need to try to connect what will be useful for the individual, but at a population level. Daniel Kraft: To that point, if you were to wave with a magic wand, how would you adjust the near future, the more distant future, back to your friends who are still in government? Dylan George: The last thing I was able to help too was with the Biden/Harris transition team get ready to hit the ground running. We were able to talk to a lot of the private sector, a testing companies that are actually pushing out tests and all the supply chain associated with the pipette tips, the reagents, the swabs. The thing that was just humbling and inspirational to me was how many private sector companies were working at risk or against interest to actually help out in the response. The innovative entrepreneurial spirit of the United States and the people that live in the United States is just something that we need to cherish and we need to support and move forward. But more importantly though, too, when we think about vaccines, when we think about drugs, the government has explicitly accepted that they can't build them, they can't manufacture them at scale, and that's why we work with the J&Js, the AstraZenecas, the Pfizers of the world to do that. We need to think differently about how do we leverage the private sector more effectively to really bring the capabilities for speed and scale to guide public health interventions? The United States led the data revolution. It just hasn't sunk into health care and public health. Daniel Kraft: In a sense, one of the silver linings of the pandemic is it's been this catalyst for new collaborations for folks who used to compete to come together. It's been exciting to see the unleashing, sometimes relaxation of HIPAA regulations and new forms of payment. At the same time, many of us have been disappointed by the overall response to COVID in the United States. Dylan George: COVID has humbled us and it's repeatedly humbled us. The testing issues have been something that we need to work out. South Korea, Taiwan and even Israel have done an exceptional job with testing, with vaccination capabilities and then also with the data. We owe a debt of gratitude to the volunteers that stepped forward and met the moment, the people at Johns Hopkins University, the people at the COVID Tracking Project, they provided data so that we could understand what was happening with the virus and how it was spreading and hurting us and what was happening with the response. We need to think about how that it's not just volunteers, but a sustained capability to do this going forward. Now, I will say though too, the vaccine development, hands down miraculous. The unfortunate thing about that though too is that it still took a year plus to get it at scale so that we're pushing it out and going forward. In the interim public health interventions, the washing hands, the social distancing, the staying at home, the figuring out who can congregate and how, that's all being guided by data. We need to supercharge data so that we have more public health impact and lower the negative adverse effects economically from those measures. Daniel Kraft: A hundred percent. Not only just the data, but how you sort of interface with it. In February, March, you're in the DC where my parents live, I was scattering amongst different websites and trying to enter their data and get them a spot for vaccination. It was a mess and it's very localized and hyper localized. Maybe talk a bit about sort of the opportunity, how we might create sort of that next generation public health infrastructure 2.0. Dylan George: I've been an advocate for something called the National Center for Epidemic Forecasting and Outbreak Analytics. This is a capability to help us do what they do with weather forecasting. Weather forecasting 50 years ago was rubbish. Today it's pretty good to the point where it's like if you see a forecast of 80% rain tomorrow, you're going to take an umbrella with you and it's going to help you make decisions. We need to have analytics at that scale and at that scope to help people make individual decisions to protect themselves against infectious diseases. And we need to be able to infuse data scientists into the federal government to oversee these things in a more effective way. And if we don't, we should have the motivation, given what we've seen with COVID over the last year. Daniel Kraft: My Fitbit or my Whoop and my Aura Ring and my Apple Watch can provide data and I can be an individual node of public health as we've seen to be crowdsourced that, ala Google Maps or Waze to give you hyper-local actionable information. Dylan George: I'm super excited about the advances that telehealth has made during the last year. We need the data system to aggregate all of that so that we can understand how we're going forward. There's money for this National Center for Outbreak Analytics and there's money for genomic sequencing as well, but also there's companies that are doing amazing work. One of the reasons why I joined Ginkgo as well is that they saw what was happening. They paused what they were doing in their normal course of business and they pivoted towards testing in schools. They're in 18 states, over a thousand schools. They figured out how to do a turnkey solution so you could do pooled testing in the schools and actually keep our kids safe. Daniel Kraft: Folks listening may not know about Ginkgo. I always think of them in the realm of synthetic biology and programming life. Dylan George: Physics has transformed the 20th century. Biological engineering is going to transform the 21st century in a very similar fashion. Figuring out how to engineer cells and program cells in a systematic way that it's consistent is what Ginkgo is all about. And the reason that they pulled me in and they're building out a public health and biosecurity division because they also know with great power comes great responsibility. We need to make sure one, that we use that power responsibly, effectively, but also to meet these moments of the pandemic so that we can actually move it. And that's why the Ginkgo started getting involved in testing, tracking the variants, helping with optimizing the vaccines. Daniel Kraft: You might imagine when a new variant or an entire new virus strain or another type comes out completely, whether it's SARS-CoV 22, we'll be able to sequence it immediately and potentially almost like a fax machine, send that data over and print a new version of your mRNA vaccine that might even be in your kitchen sink in the future. Dylan George: It's my hope that we can develop data systems that will help us understand what we're seeing in the world, and then warning signs will go up and then the medical countermeasures like vaccines and drugs will start churning and start developing. But having the kind of control system, the guidance system that will help us know what interventions will work the best for us as individuals and as a population while the manufacturing of the vaccines develops and goes faster. That's the world we're in. I think that we can get there. Daniel Kraft: One thing unfortunately that's also been moving fast in this time of pandemic is the infodemic, bad data sometimes from bad actors. This challenge is now with vaccines. We have vaccine hesitancy. One trend we're seeing in polling right now is a high rate of hesitancy, particularly amongst parents. Is herd immunity the goal? How do you think about herd immunity and about hesitancy and all the things that might be limiting or accelerating us getting to that goal of getting enough folks vaccinated to really put a dent in this? Dylan George: A lot of times in the press, people have been talking about this magic number and once we hit that magic number, it comes to a screeching halt. Really what it means is that that's the beginning of the end, but it's also that it's a moving target, and so for things like measles where you have a lifelong immunological response to the pathogen, we know what it is and it's high, but we can attain it. For other sorts of pathogens, it's much squishier and for COVID, we haven't quite figured it out yet. It's a really useful concept, but it's not a hard fast science of when we hit that number, it's all done. Daniel Kraft: How do we create sort of done a lot of experience with data, but the dashboard piece, because no clinician wants to get just more data, they want to understand how does that change where they're driving with their patient? Dylan George: Yeah, I love that you asked this question though too because as a clinician you think this way because it's just like what is the clinical decision? What is the differential that I need to go through and what is the action that I need to do for the person in front of me? That to me is the information supply chain in how we actually drive, but it has to be rooted in the decisions to action. Everything else is just nice to have, but once we drive towards those decisions, then we know we've got something real. It's like we've talked a lot about with people to donate blood to help people in need. We need to start talking to people about donating data to help people in need in responding to clinical situations, but also public health situations. We need to start shifting our mindset that data is the new oil, but it's also the new way of protecting our kids, our families, and our communities in an effective way. We need to do it safely. We need to do it in a privacy preserving way, but that's what we need to start moving towards, a world where we're sharing data to keep everyone safe. Daniel Kraft: All ships rise, and it might be sharing the data from your crowdsourced digital thermometer like a company called Kinsa who gives you really interesting maps of where there's a hotspot in fevers in a particular locality or data from your local sewage, which you can pick up hotspot early and the fact that if we're donating data, we're all going to hopefully benefit from that as well. Dylan George: I mean, this is the way Google Maps works. Daniel Kraft: Speaking of Google, they did a project several years ago called it Google Flu Trends. You can just tell from someone's search history or the crowdsourced searches who's looking for flu symptoms, and that would be several weeks ahead of the CDC report. There might be a hotspot for the seasonal flu. Dylan George: Absolutely. I mean, you've already mentioned Kinsa Health, which is using Bluetooth-enabled thermometers to people that are checking their temperatures or their kiddos' temperatures on an ongoing basis. They similarly are seeing signals for elevated population level temperatures in particular places well ahead of clinical data. Clinical data is a lagging indicator because it's like whether or not somebody feels sick and then they go to a doctor, and then whether the doctor is prescient enough to know that it's like they need that particular diagnostic, whereas it's like with the Bluetooth-enabled information, it's right there. You get the signal right now. It's not very specific, but it's an indicator and it's a leading indicator versus a lagging indicator. The company, Whoop, was doing a program where they have they're high performance sorts of sensors that people use to keep track of sleep. They actually were able to use some of those kinds of sensors to understand when potentially people were infected with COVID, but I think there's a great promise there too. Daniel Kraft: If we do a fun thought experiment and it's two years from now, what might that sort of look like for an average clinician? Dylan George: I'll take a slightly different thought experiment for you because I've been thinking about the school testing from the Ginkgo's school perspective. They've figured out how to, like I said before, they figured out how to do pooled testing in a classroom of 30. They could do it like five to 10 minutes without a clinician there. Now think about it it's like if you could aggregate all of the other schools around there, the collective nature of bringing all that information together can help people in different places know that something is coming, but if you could do it across the nation, keeping our kids safe, keeping our kids in school learning, and our parents able to keep working without losing their minds because they're trying to teach their kid and do their day job is going to be a big boon. Trying to do that, the wisdom of the crowds is going to be the kind of coin of the realm in the next little while. Daniel Kraft: Yeah, so it's really next generation or revolution, and you've been involved with something called Bio Revolution. First of all, what might Bio Revolution be? Dylan George: If you think about the Data Revolution, different technologies have allowed us to do things that we hadn't even thought about 10, 20 years ago. I mean, everybody walks around with some sort of mobile device and sometimes multiple mobile devices to actually help us understand what's happening to ourselves and the world around us, and it has completely transformed our capabilities. What the Bio Revolution is trying to figure out how to actually program cells like we would a computer so that we can create new enzymes, new products, new capabilities that will be manufactured by cells in different ways. At Ginkgo Bioworks, they were a part of optimizing particular molecules and particular enzymes that helped with the manufacturing process at Moderna. It made things go faster. MRNA, CAR T therapies, those are all being driven largely by the Bio Revolution and skills that we've learned and techniques that we've learned from there. New things are going to be coming online faster and in a more impressive way in the years to come. Daniel Kraft: Yeah, it's an incredible, Brave New World that's only accelerating. It's like Gattaca. Dylan George: As with every technology there is, yes. Daniel Kraft: Yeah. I always say, you can 3D print a medical device or a gun. You can use AI for good or for bad. We've looked at a bit about where we're going. Maybe let's take a little bit of a back to the future look. You did some great work at OSTP. What is OSTP? What did you learn there? Dylan George: Yeah. Back in 2014 and 2015, West Africa was being hit by the Ebola virus. I was working at the Biomedical Advanced Research and Development Authority at the time, and what we did is we galvanized all of the federal modelers that were doing any kind of infectious disease modeling. We started setting up weekly calls to say it's like, "Okay, what are you learning? What are you understanding?" We were able to help inform where we should allow people to come back into the United States to minimize infection of follow on from those. I was then moved up to the Office of Science Technology policy to help Dr. John Holdren, who was the science advisor to President Obama at the time. I was asked to come and advise him on the Ebola response, and it was a great experience to try to figure out how to make the federal bureaucracy in the machine work to meet a moment. Some of my best friends have come from that experience, and it is impressive the range of things that can be done, and so that's why seeing what the new administration has come in with and pushing forward, it's been great to see the new efforts in vaccination turning things around. It's been a breath of fresh air. Daniel Kraft: The new lessons from Ebola and SARS were learned, but sometimes lost, let's say, or shelved in the last administration. Dylan George: There's the ever present panic and neglect cycle. It's like when an outbreak is happening, people light their hair on fire and are all hands on deck and moving with all diligence and effort, and then when it passes, they start to forget that it even happened and then neglect the things that are going forward. We need to for pandemics, one of the things that has been a little bit disturbing to me too is that people are starting to talk about this is a once in a lifetime event. It happened to be this, a one in a hundred year event, but I'm pretty confident that we're going to see more public health emergencies coming forward. We live in an age of epidemics and we need to get comfortable with that. We need to transform our capabilities going forward, and again, I do think that the government is going to have to be consistent in providing resources to actually fight this going forward. Daniel Kraft: It's like our friend, the famed epidemiologist, Dr. Larry Brilliant, called this pandemic, almost a practice pandemic in terms of its transmissibility and lethality, and so we can hopefully use this moment to catalyze that future. Just like Sputnik sparked the Space Age, COVID is sparking a bit of a health age if we take those lessons and all the new energy and collaborations and goodwill and move that forward, so lessons learned today can prevent the next pandemic, not just support the current one. Dylan George: I'm hopeful. It's like when looking at experiences like what we saw in South Korea a handful of years ago, they had a big scare with MERS-CoV. Ripped through a lot of their population, fortunately died down, but they learned from it. They built a testing capacity and in early stages of COVID, they were very impressive. We need to meet this moment like you're saying, and really say, this is our Sputnik moment to launch the health age. Daniel Kraft: Right, and we're going to an ever more, ever interconnected world, so we're all in one spaceship earth as passengers and collaborators. Dylan George: Absolutely. Daniel Kraft: In closing, speaking directly to the many health care providers that are listening, I love a quote I saw on the Bio Revolution site, we're now in this convergence of a digital world with biology, and that creates all sorts of new opportunities and challenges, but take us home here. Dylan George: The first thing I want to say to the health care provider community is thank you. It has been impressive to see how many people have been volunteering, how many people have been working to the bone, how many people have been really putting their own families at risk to keep us all safe, and so first of all, thank you. It has been exciting. It has been humbling and inspiring to see that kind of dedication. The second thing though too is if data is the new oil, if I think we all have to start thinking collectively how we can share the data, how we can analyze the data, and how we can keep one another safe. Again, thank you for the efforts that you've been putting into respond to this moment. It has been humbling and I'm deeply grateful. Daniel Kraft: Thank you, Dr. Dylan George, for all the amazing work you've done in the past and are doing now, work with Ginkgo Bioworks and beyond, and thanks for joining us on Healthy Conversations.