Francis Collins on trusting science and how Covid communications failed

FNIH director and current White House science adviser Francis Collins told a group of reporters last week about his passion for both the Cancer Moonshot and the new biomedical research agency known as ARPA-H. But he also revealed his pain at seeing people reject the Covid mRNA vaccines being developed with stunning speed, and lamented that he and other health officials failed to communicate the ever-changing science behind the Covid recommendations.

“The biggest thing that I know I didn’t do, and I think a lot of the communicators didn’t do, was say this is an evolving crisis, that’s going to change every time we make a recommendation, whether it’s about social distancing or the ‘use of masks or vaccines,’” Collins told reporters gathered Sept. 16 for the 21st Health Coverage Fellowship held at Babson College in Wellesley, Massachusetts. “And we lost their trust as a result of that.”

Collins, who stepped down after 12 years as NIH director, was on a slippery slope back to his lab to study diabetes, epigenomics and the accelerated aging disorder progeria before President Biden appointed him to become its scientific adviser, a move he said was “not part of my life plan” after the sudden resignation of Eric Lander amid a workplace abuse scandal. He will continue in this role until his successor is confirmed (“It’s up to the US Senate. What could go wrong?”).

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Here are some of his observations, including his “current obsession” with the country’s failure to end hepatitis C using the cure at hand, condensed for clarity:

On what went right and wrong with the pandemic response:

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During 2020 and 2021, while the Covid pandemic was getting weird and spreading around the world, I don’t think I ever felt a greater sense of the unanimity of the scientific community to come together, to devise strategies to combat this worst pandemic in more than a century. Many of us worked 100 hour weeks. I was certainly trying to make sure that no stone was left unturned to invent vaccines and therapeutics and diagnostic tests that could save the lives we were losing every day. And I felt like that, like every day I have to make the right decision, or it will potentially cost someone their life.

Then we had this remarkable experience with mRNA vaccines where you went from knowing the sequence of the virus to designing the mRNA vaccine in 48 hours to 63 days later, having the first patient injected in a phase 1 trial, a impressive speed. And I never dreamed that six months later, when anyone who wanted the vaccine could get it, that 50 million people weren’t and still aren’t. [vaccinated]. The Kaiser Family Foundation estimates that more than 300,000 Americans are in cemeteries today because of the misinformation, the doubt, the suspicion, the mistrust that led them to say the vaccine is not safe for me. How did this happen? I never saw that coming. And the consequences of that are all around us now. And it continues. We are still losing 400 people a day, many of them still unvaccinated.

How did we all fail? We failed to convey the scientific information in a convincing manner. Basically we were dramatically outnumbered by lies and conspiracies on social media. We should have had our own version of flooding the system with truth instead of having the system completely flooded with lies. Some people I’ve talked to have said, you know, every lie, every conspiracy about Covid, whether it’s the chips in the syringes or whether it’s going to make you sterile, every one of them was predictable. We should have vaccinated people against this ahead of time, because that is exactly what will happen in a situation like this.

About a possible solution:

Maybe we need a Communications Corps for the United States. I am deeply concerned that trust in science has taken a significant downward turn, and that is really putting us in a very bad position for what comes next: the next pandemic, polio, certainly climate change.

On religious leaders and Covid vaccines:

This is one of the things that breaks my heart the most that has happened in the last two years. There is certainly a reliable source of information that perhaps could have been a great help in this, but we discovered how fragile our connection between science and faith was in the pulpit and also how divided our country really was.

About Cancer Moonshot Goals:

The way the moon spot has been formulated is that we will reduce cancer deaths by 50% in 25 years. There’s nothing like, “Okay, we’re going to end cancer forever.” Unfortunately, these are not things we can publish and be sure you can provide. I think we could do a combination of preventions and treatments to get that 50% reduction, but that’s not 100%. This is a very difficult problem, and I think that’s what we’re learning over and over again.

How cancer and hepatitis C are connected:

A personal obsession right now, when it comes to cancer prevention, [is] the most common cause of liver cancer. What would that be? Hepatitis C, a virus that is acquired through the exchange of blood from one infected person to another, so these days, often because of the opioid crisis, is through dirty needles. Two and a half million people, at least in the United States, are chronically infected with hepatitis C. Forty percent of them don’t even know it because we haven’t done a very good job of doing the kind of screening that ideally would be. necessary But guess what? There is a cure for this.

It’s one of the most exciting developments in medical research in the last 15 years, and most people haven’t heard about it. It’s because of our health care system and the fact that most of the people who have this are not those who have golden insurance policies to cover what was initially a $90,000 cost for the treatment.

When supplying clean needles:

Bring it. I don’t have to convince the president of the value of this, but you probably know that in the current political climate, anything that involves this as a requirement will immediately be put on a lightning rod. Much of the Republican Party doesn’t believe this is justifiable with public money, and they worry that it could actually encourage more people to abuse IV drugs. The evidence for this, of course, as you know and as I know, is not there, but the thought process is still there.

About ARPA-H, basic science developments and clinical application:

We have mRNA vaccines that have been fantastically effective in Covid. It completely revamps the way we begin to think about what we might do with vaccines, including cancer. That would be a pretty good project. How would that happen right now? It is not so easy to see. ARPA-H, which is now a reality, is designed to do things like that.

On the next NIH director:

This, of course, also requires Senate confirmation, in these current times where there is so much political tension over virtually everything. And that certainly relates now to whoever is chosen for that circumstance, whether it’s questions about human fetal tissue research or whether it’s going to be about Wuhan and how this virus actually started. So it won’t be an easy confirmation process.

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