In January of 2020, the world first learned of a new, highly contagious, and lethal coronavirus emerging in Central China. As the virus quickly spread to Southern Europe and eventually New York City in the United States, it set off a chain of events that would become perhaps the single greatest challenge in my 40-year career as an MD PhD pediatrician scientist.
It was exhilarating in one sense, because the pandemic gave our Texas Children’s Hospital and Baylor College of Medicine (BCM) scientists the opportunity to develop a COVID-19 vaccine technology that wound up reaching 100 million people globally. For me personally it was also a chance to appear daily on cable news channels and help educate a large American audience about viruses and vaccines. But it was simultaneously terrifying, especially from the pandemic’s awful death toll, but also because I watched an organized and politicized national disinformation campaign unfold; it often fell to a small group of scientific colleagues and me to mount a counteroffensive, even though we lacked financial backing or the communications bandwidth to effectively tamp it down. Five years later, the COVID-19 pandemic lives on through new emerging strains, the millions of long Covid sufferers, and a legacy of anti-science attacks that could block our ability to prepare for future pandemics.
Baylor College of Medicine
Making a COVID vaccine for the world
For almost a decade before COVID-19 our BCM-Texas Children’s Hospital Center for Vaccine Development (CVD, which I co-head with Dr. Maria Elena Bottazzi, my science partner for almost 25 years) had been developing coronavirus vaccines. During the 2010s we embarked on a productive collaboration with scientists at the New York Blood Center who built a vaccine concept around the receptor binding domain (RBD) of the coronavirus spike (S) protein. We found that as a recombinant protein the RBD induced virus-neutralizing antibodies without activating other potentially destructive immune responses elicited by using the whole inactivated virus.1
Through National Institute of Allergy and Infectious Diseases (NIAID)-National Institute of Health (NIH) funding we jointly developed and ultimately produced the RBD vaccine from the S-protein of severe acute respiratory syndrome (SARS) and later the Middle Eastern respiratory syndrome (MERS). Then in January of 2020, when we first learned of the sequence of the S-protein genome of the new SARS-2 virus (the etiologic agent of COVID-19), our program quickly pivoted to making the first RBD COVID-19 vaccine. We did the process development in our BCM-Texas Children’s Hospital CVD labs and then collaborated with Emory University scientists to show it worked as a highly effective vaccine in nonhuman primates following challenge infection.1
By the middle of 2020 and into 2021 we were getting calls from across the world from the ministers of science or health ministers of low- and middle-income countries (LMICs) who realized that many of the doses of the newer high technology mRNA or particle COVID-19 vaccines were being bought up by high-income countries, leaving them bereft of vaccines. Working with our BCM Ventures unit we provided non-exclusive licenses for our vaccine technology (minimizing attaching onerous patents or other strings) to several LMIC vaccine producers, including those in India (Biological E) and Indonesia (BioFarma), who scaled it up to produce Corbevax and IndoVac, respectively. An estimated 100 million doses of those vaccines went into arms, including 75 million doses administered to adolescents in India. This work provided proof-of-concept that you don’t need to be big pharma company to still do big things in the vaccine space.
Talking to the nation
In addition to sending our research and production cell banks abroad, our BCM-Texas Children’s Hospital CVD scientists would wake up quite early most mornings in 2020 and 2021 in order to work with the scientists in India and Indonesia and reach them (via Zoom) by their close of business. But in those days, I also often worked late speaking on the cable news channels, especially CNN or MSNBC. There was little time to sleep, but I did find the experience rewarding. I learned a lot speaking to a cross-section of the American people each day or evening. For one, I was pleasantly surprised to find that American audiences could tolerate quite a high level of scientific complexity. Because I had been working on coronavirus vaccines for many years, I had the opportunity to convey scientific details in-depth. I did notice that my approach was often quite different from government officials who tended to speak in summary statements without always explaining their scientific justification.
Another rewarding aspect of my public engagement was outreach to minority communities, speaking regularly to African American churches and HBCU radio stations, as well as the Spanish language television stations. I also spent a lot of time meeting with K-12 teachers and school boards to help keep the schools open and the teachers and pupils safe.
One aspect of public communication and engagement I did not anticipate was the need to counter official White House statements. In 2020, the White House pushed an agenda that made spectacular but false claims about the benefits of hydroxychloroquine, while often downplaying the severity of the pandemic.
Countering the disinformation monster
Over many years I have learned a lot about health disinformation because I have a daughter with autism and intellectual disabilities, and I have written in detail about why vaccines don’t cause autism, as antivaccine groups allege.2 This unfortunately made me a public target, but it also made me an expert (of sorts) on the operations of anti-science disinformation campaigns. Those experiences led me to be among the first to label the White House statements about hydroxychloroquine or the spread of COVID-19 as disinformation.
However, the very worst anti-science propaganda, this time about COVID-19 immunizations, emerged in 2021. The mRNA vaccines were the most widely used COVID-19 vaccines used in the U.S., and by some estimates they saved an estimated 2–3 million American lives.3 Despite their successes and the fact that mRNA vaccines were close to 90% at protecting against COVID-19 deaths,4 starting in the summer of 2021 and just as the delta variant wave was beginning in America, a pernicious antivaccine campaign unfolded. I benchmark the CPAC Conference of conservatives in Dallas in July 2021 as its beginning. At that conference, a new type of propaganda emerged —that somehow COVID-19 vaccinations could lead to government confiscation of guns and bibles.5—As ridiculous as that rhetoric was, many Americans accepted it. Then, the CPAC Conference invited some of the most toxic antivaccine activists to speak.
What happened? I believe in their zeal to push back against vaccine mandates, far right conservatives unfortunately went the next measure, and they created a new platform to falsely discredit the effectiveness and safety of vaccines. Then a pile-on ensued from far-right members of the U.S. House Freedom Caucus and a few Senators who sought to discredit vaccines, coupled with nonstop antivaccine rhetoric from the nighttime Fox News anchors.6 I was also shocked to see how some of the talking heads on Fox News who promoted antivaccine and COVID prevention disinformation also worked as professors at major academic health centers. Then, as Twitter transitioned to X, it also became a major distributor of antivaccine propaganda. The consequences were devastating. I estimated 200,000 Americans needlessly died because they refused COVID-19 immunizations, including approximately 40,000 people in my home state of Texas.6 They were the victims of a politically motivated and organized antivaccine disinformation campaign.
Anti-science is now a major and lethal force in America. The antivaccine disinformation is extending to all childhood immunizations—in 2024 we saw multiple measles outbreaks and significant increase in pertussis cases. Poliovirus was detected in New York state wastewater in 2022. Anti-science also goes beyond vaccines to include outlandish assertions about COVID-19 origins to claim that scientists either invented the SARS-2 virus or leaked it from a laboratory. Such assertions ignore the overwhelming published scientific evidence of zoonotic spillover.7 The attacks against science even extend to individual scientists, with many of us vilified or portrayed as public enemies.
I worry about the potential for permanent damage to our national scientific institutions and pandemic preparedness capabilities. Unless we can reverse these trends, our national security will remain at risk from future infectious disease threats and young people will become fearful of embarking on scientific careers. This threat may turn out to be the worst legacy of COVID-19.
Peter Hotez, MD, PhD, is Professor of Pediatrics and Molecular Virology and Microbiology and Dean of the National School of Tropical Medicine, Baylor College of Medicine, where he is also the Texas Children’s Hospital Endowed Chair in Tropical Pediatrics and Co-Director of the Texas Children’s Hospital Center for Vaccine Development.
References
1. Hotez PJ, Adhikari R, Chen WH, Chen YL, Gillespie P, Islam NY, Keegan B, Tyagi Kundu R, Lee J, Liu Z, Kimata JT, Oezguen N, Pollet J, Poveda C, Razavi K, Ronca SE, Strych U, Thimmiraju SR, Versteeg L, Villar-Mondragon MJ, Wei J, Zhan B, Bottazzi ME. From concept to delivery: a yeast-expressed recombinant protein-based COVID-19 vaccine technology suitable for global access. Expert Rev Vaccines. 2023 Jan-Dec;22(1):495-500. doi: 10.1080/14760584.2023.2217917. PMID: 37252854.
2. Hotez PJ. Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad, Johns Hopkins University Press, 2018.
3. Sah P, Vilches TN, Pandey A, Schneider EC, Moghadas SM, Galvani AP. Estimating the impact of vaccination on reducing COVID-19 burden in the United States: December 2020 to March 2022. J Glob Health. 2022 Sep 3;12:03062. doi: 10.7189/jogh.12.03062. PMID: 36056814; PMCID: PMC9441009.
4. Tenforde MW, Self WH, Gaglani M, et al. Effectiveness of mRNA Vaccination in Preventing COVID-19–Associated Invasive Mechanical Ventilation and Death — United States, March 2021–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:459–465.
5. Smith A. Conservative hostility to Biden vaccine push surges with Covid cases on the rise. NBC News, July 19, 2021
6. Hotez PJ. The Deadly Rise of Anti-science: A Scientist’s Warning, Johns Hopkins University Press, 2023.
7. Crits-Christoph A, Levy JI, Pekar JE, Goldstein SA, Singh R, Hensel Z, Gangavarapu K, Rogers MB, Moshiri N, Garry RF, Holmes EC, Koopmans MPG, Lemey P, Peacock TP, Popescu S, Rambaut A, Robertson DL, Suchard MA, Wertheim JO, Rasmussen AL, Andersen KG, Worobey M, Débarre F. Genetic tracing of market wildlife and viruses at the epicenter of the COVID-19 pandemic. Cell. 2024 Sep 19;187(19):5468-5482.e11. doi: 10.1016/j.cell.2024.08.010. PMID: 39303692; PMCID: PMC11427129.
