Peter Hotez Talks Russia, Lady Gaga, and the Antiscience Movement

; Abraham Verghese, MD; Peter J. Hotez, MD, PhD

Disclosures

April 21, 2021

This transcript has been edited for clarity.

Eric J. Topol, MD: Hello. This is Eric Topol at Medscape for Medicine and the Machine, with my co-host, Dr Abraham Verghese. Today is a really special podcast. We get to have a conversation with Peter Hotez. Peter is dean of the National School of Tropical Medicine at Baylor. He is perhaps one of the most accomplished academicians in infectious diseases and tropical medicine. He's been preparing for this pandemic, perhaps unknowingly, for four decades. His background includes a BA at Yale, PhD at Rockefeller, and an MD at Cornell. And he has a new book, Preventing the Next Pandemic (2021; Johns Hopkins University Press), and can enlighten us about all sorts of things. Welcome, Peter.

Peter J. Hotez, MD, PhD: Thanks so much, Eric. It's a thrill for me to be here with you and Dr Verghese, two of my heroes. I feel very honored and blessed to have the chance to talk to you.

Topol: I don't think anyone has had the panoramic view that you've had regarding the pandemic and its antecedents, with respect to antiscience, molecular biology, and vaccinology. You're the go-to source. I'm going to turn it over to Abraham to get things rolling.

Predicting a Pandemic

Abraham Verghese, MD: Peter, what a pleasure to be speaking with you. Hats off to you for being out there and speaking reason to people who are not always willing to listen. I'm curious about this latest book of yours. Did you conceive of it during the pandemic or was it already in the works? It's incredibly timely and needed at this moment.

Hotez: It actually was almost done before the pandemic, and then I had to work with Johns Hopkins University Press to scramble and add some information about COVID-19 because it was obviously so dominant. So that became a theme of the book. When people talked about COVID-19 being an extraordinary event, I said no, it was actually more of a culminating event of lots of unraveling of different aspects of global health.

What caused the unraveling were things that none of us were ever taught to think about during our medical or scientific training: war, political collapse, climate change, and, of course, this aggressive antiscience movement and urbanization. It's also a wake-up call about how we need to re-envision medical education to train physicians to think more broadly than we do now.

Verghese: In the book, you developed the concept of vaccine diplomacy. You have also worked on a vaccine for COVID in India. Can you tell us about that?

Hotez: Vaccine diplomacy is something that I've been interested in for years. The first polio vaccines were developed jointly between the Soviet Union and the United States at the height of the Cold War. The two countries set aside their ideologies to work together to prepare this incredible lifesaving technology. We cooperated with the Soviets again for the smallpox vaccine. So, I had been writing and speaking about that.

In addition to being a working scientist — keeping up with grants and papers — I got tapped by the Obama administration to try out vaccine diplomacy with Muslim-majority countries in the Middle East and North Africa. That was very fulfilling.

I'm not really a virologist. I'm mostly interested in parasitic diseases and I've devoted my whole life to developing vaccines for poverty-related neglected diseases that no one else would touch, but which affect the poorest of the poor across the world — vaccines for schistosomiasis, Chagas disease, and leishmaniasis. We adopted a coronavirus vaccine program about 10 years ago, working with the New York Blood Center. They had some interesting ideas and approaches, but they couldn't find anyone to actually shape them into a vaccine. So we adopted it and wrote funding to the NIH. Nobody cared about coronavirus vaccines back then.

We got good at showing that the spike protein is the target of the virus, how to deliver the spike protein, and how to induce virus-neutralizing antibodies. We manufactured a SARS-1 vaccine and came close to a MERS vaccine so that when the COVID-19 sequence came along, we were able to turn that around pretty quickly. Now we're scaling up production of a COVID-19 vaccine in India and Hyderabad with Biological E. They're producing a billion doses and it's looking very good. We'll talk more about that.

I have a daughter with autism, and I wrote a book a few years back called Vaccines Did Not Cause Rachel's Autism (2018; Johns Hopkins University Press) which made me public enemy number one with the antivaccine lobby. So, those three things — vaccine diplomacy, COVID-19 vaccines, and fighting this horrible antivaccine movement — all positioned me very well in 2020-2021, because those were the big themes for this year. It's been an opportunity for me to speak about all three issues.

From Wakefield to Fox News

Verghese: I can't think of anyone with a more personal stake in the vaccine issue, as you demonstrated in the beautiful book about Rachel and her autism. I'm wondering if you can edify us on the antiscience, antivaccine movement. There's a perception that it's uninformed but it can be pretty sophisticated. The theory that if we just inform the public, people will make the right decision turns out to be not true; the more informed they are, the more sophisticated their contrary arguments become. I'd love to hear your thoughts on this.

Hotez: It started as a small fringe group after the Wakefield paper in 1998 that claimed that the MMR vaccine causes autism, but then the movement took twists and turns and accelerated in three major areas. The claim that vaccines cause autism is still the legacy fake assertion of the movement, but it has taken on three additional dimensions.

One started in 2015 when the movement was losing steam, in part because a number of us were debunking the claims that vaccines cause autism. We had provided a pretty impressive scientific body of evidence showing that there is no link, and we gave an alternative explanation, through whole exome sequencing, of what autism is and how it begins in early fetal brain development.

So the movement needed to re-energize and it took a political spin. They connected themselves with the Republican Tea Party in response to legislation in Southern California that closed vaccine exemptions. That was a rallying cry around this concept of health and medical freedom, and it accelerated across Texas and Oklahoma. A far right-wing Republican political action committee started to form with money and organization from the Republican Tea Party.

The movement took on an added dimension in 2020 when it not only became a protest against vaccines and health freedom but also against masks and social distancing. That's why we saw the big wave of COVID-19 in the summer of 2020 in the southern states and the upper Midwest. For a while, it was mostly a red-state disease because of that health/medical freedom component. And then it was exported to Western European capitals linked with QAnon. It took a very dark turn very quickly.

We are seeing it play out nightly on Fox News. For whatever reason, the leaders at Fox News have decided to go full antivaccine, particularly at night. The daytime anchors are less ideological, but the nighttime anchors are doing everything they can to discredit vaccines and scientists.

Now antiscience is a major platform of the Republican Party, and that's very scary for the country. As if that's not complicated enough, you have Putin and the Russian government creating this whole system of weaponized health communication. When the Russians tried to push their Sputnik V vaccine, one way they did it was to discredit Western vaccines.

We also have homegrown groups like Children's Health Defense and others promoting antivaccine attitudes. This triple-headed monster with Russia, far right-wing extremists, and dedicated antivaccine groups is now mainstream in the Republican Party where they have money, clout, and a lot of power. That's what is playing out right now.

In the past (and this is one of the arguments I've had with the international global health community) they've always said, "Peter, it's walled off in North America, maybe some parts of Europe." It's now a full-on globalized antiscience — I don't know what word you want to use — empire or confederacy. We have to do something about it, because for years I've been saying that this is going to be a big issue. Leaders of the federal government would contact me and say, "Peter, you shouldn't write that because you're going to give it oxygen. You're going to give it more attention than it deserves." And my counterargument is always that people don't have Compaq computers with dial-up and Ask Jeeves anymore. The world has expanded, and now here we are.

Antiscience Kills

Topol: You were prescient on that. You wrote an amazing essay in PLOS Biology recently, "Anti-science Kills: From Soviet Embrace of Pseudoscience to Accelerated Attacks on US Biomedicine." You really lay it out there. The question pertaining to exiting the pandemic, in which there is unanimity of interest, is, do you think the political polarization is going to prevent or delay our emergence out of this mess that we're in?

Hotez: It's having an effect already. Multiple news polls in the United States — from the PBS News Hour, Texas A&M, the Kaiser Family Foundation, and Monmouth University in New Jersey — have all found the same thing: that white Republicans are overwhelmingly the major vaccine-hesitant group. That's not a minority; that's a lot of people.

Now Fox News has created a kind of tribal call to defy vaccines, and that's going to prevent us from getting to the levels that we need. Remember, the new variants from the UK and California are pretty transmissible and we're going to need a very high level of vaccine coverage. I don't know the magic number, but at least 75%-80% of the population must be vaccinated. I don't know how we attain that.

And then globally, the Russians are attacking the AstraZeneca vaccine and capitalizing on the cerebral venous thrombosis events, which are extremely rare. But the Russians are piling on. Now we're hearing reports across Africa that people are allowing doses of the AstraZeneca vaccine to expire and go unused. The vaccine ecosystem is very fragile. It doesn't take much for even a good vaccine to be voted off the island if the public perception is against it. We saw that with dengue vaccine. We saw that with a Lyme disease vaccine. And we're going to see it with this one.

So even though the AstraZeneca and J&J vaccines are good vaccines, I don't know whether people are going to accept them. Antiscience does kill. People lost their lives from COVID-19 in the United States because of defiance of masks and social distancing and now vaccines. And it's going to happen globally as well. We have to look at this in a different light, and here's where I tend to be an outlier. I made a very provocative statement in that PLOS paper that antiscience is right up there with things that we build a lot of infrastructure to wall off, like nuclear proliferation, global terrorism, and cyberattacks. We need to do the same with antiscience. We have to treat it just as seriously, confront Russia about it, and do something about the antivaccine groups beyond just amplifying the message; it's just a message in a bottle in the Atlantic Ocean right now.

Verghese: That's a very powerful stance, and a very powerful metaphor to say this is equal to nuclear weapons and so forth.

Once Again, This Is Our Lane

Hotez: I have a question for you two. Everything about our training says, "Don't go there. You're not political. This is outside your lane. Just stick with the science." But at what point do you say that if we don't call it out, we can't save lives? That was the dilemma I faced last year when I watched the whole Trump disinformation campaign unfold. I was one of the first to see it — not because I'm so brilliant, but because for years I've been going up against the antivaccine disinformation campaign. I became an informal expert on it and saw what was happening when they were trying to shift deaths to other causes or say masks don't work or that COVID is a hoax and then the spectacular rise in hydroxychloroquine.

I saw the whole thing unfolding. I watched Larry Kudlow and Peter Navarro and all these people say these things and realized that this was a coordinated antiscience disinformation campaign. I said to my wife, "This is terrible. I'm a scientist." And to her credit, she said, "Look, you don't want to wake up in a year and see that all of these people have died from COVID-19. You'll feel like you haven't done everything you can to prevent loss of life."

So I did. It wasn't that I wanted to wade into politics, but to tear the antiscience out of politics, we have to call it out. It was a very uncomfortable, dark place for me. In the beginning, I didn't get a lot of backing from the professional or academic societies or even from the National Academies. I was out there alone, and that was a tough time for me.

Verghese: That sentiment, to stay in your lane, is clearly one that riled up the troops. I don't know who first said that, but it became a popular hashtag (#ThisIsOurLane). But I do think that you were the pioneer in speaking out so boldly. And Eric, you've taken your share of flack. How do both of you weather the attacks when they turn personal? Do you have a formula to avoid taking it personally?

Hotez: I'm pretty active on Twitter, with mixed feelings about it. Lady Gaga called social media the toilet of the internet, and I think she's on to something. I get attacked all the time, and rather than suffer in silence, I retweet with a comment to try to use it as a teachable moment so that Twitter followers can understand the nuts and bolts of how antiscience movements work. I'll say, "This one is coming from Russia," or "This one is coming from a political extremist on the right. Here's why this is not true." It becomes a primer on how antiscience operates. There's no roadmap to follow here, but that's one of my approaches.

Topol: What's impressive, Peter, is that you are willing to stand up, in many ways as a solo force. You have not only been on TV networks that are supportive of science, like MSNBC or CNN, but you also go right into the danger zone on Fox News where you take the wrath of the Laura Ingrahams and Tucker Carlsons. By putting yourself out there, these extremists go after you, and you become even more of a target. Your way of coping by leaving the comment on Twitter and responding is clever, but it has to take a lot out of you. Will you continue to go on a program like Fox News after the kind of stuff that has been pulled?

Hotez: I publicly said I would, so I guess I have to. I don't want to go to war with Tucker Carlson or Laura Ingraham. That's not going to be a win. The idea is, unless we can fully vaccinate the American people, we're not going to make a dent in this pandemic. So I try to enlist their help and see if we can get them to reverse their position and support vaccines. If we don't try, it's not going to happen. This is not coming from Carlson or Ingraham; someone higher up at Fox News is making a strategic decision, whether it's because they need it for ratings or for branding or for something else. There's a higher force at work there.

Topol: Your point was remarkably insightful but without a response. No Murdoch or anyone else is even trying to deny it.

Hotez: Well, I'm pretty small potatoes for the Murdochs.

The Pause Heard 'Round the World

Topol: We had the chance to work together in a unique way. Last summer after the convalescent plasma debacle with Steve Hahn, we worked in a group that's been reported on which met every week with Steve Hahn and others to try to come up with a good path forward, especially when there was a threat that the vaccine approval could be based on 32 people in a trial, at the first interim analysis. We helped, at least in some way, to get that on track because the trials were finished before there was an emergency use authorization (EUA). Could you comment on that experience? Because a lot of people think that the work we did slowed the vaccine approval process rather than make it as valid and confident as possible.

Hotez: You see what's happening now with the AstraZeneca and J&J vaccines; those could be in free fall. Because we worked with Dr Hahn and others to maintain those very rigorous phase 3 clinical trials, we've been able to maintain the level of confidence that we've had in the past.

Speaking to a couple of anchors, I made the statement that putting the J&J vaccine on pause was the right thing to do, given the severity of the adverse events, and to maintain confidence. They argued with me, saying it was a small number of events. I thought it was interesting that together with the FDA we had done such a good job of showing a high level of rigor for the vaccine clinical trials that there was a lot of public confidence around that. That was a nice thing that happened.

Verghese: The pause seems to have gone on quite long. What do you think is needed for the vaccine to be "unpaused" or for some sort of declaration to come out?

Hotez: It's clear there's going to be an association. The best outcome is if the FDA and CDC can identify a specific population at risk for this adverse event, and the more they can surgically fine-tune it, the better. For instance, the best outcome would be if they found that it happened overwhelmingly in premenopausal women on birth control. That would be a win because it's a very defined population. We could vaccinate our way around it and move forward. The more likely outcome, though, is that it won't be that specific. They'll put a black box warning on it. If that's all that happens, I worry about the public perception because we have choices.

It wouldn't be a catastrophe for the United States. But when you look at what's available for sub-Saharan Africa or Latin America, the choices are all adenovirus-vectored vaccines right now: AstraZeneca, J&J, or Sputnik V, which is probably linked to the same adverse event. It's just that the Russians are so aggressively pushing it on low- and middle-income countries with no pharmacovigilance systems, that we have no idea what's going on with that. I worry that confidence in the whole COVID-19 vaccination program in low- and middle-income countries could evaporate. That could be the fallout.

Why No Love for an Old-School Vaccine?

Topol: As you point out, the South Africa variant identified as B.1.351 responded very well to the J&J vaccine, with high efficacy. So the idea that it has been put on hold in South Africa is unfortunate. Hopefully this is going to be a short-term thing.

Hotez: We're trying to come in with our recombinant protein vaccine — which is looking very good — with Biological E in India. It's showing high neutralizing antibody titers in human volunteers and in nonhuman primates. It's an old-school vaccine, using the same technology as the hepatitis B vaccine that's been around for decades. The recombinant protein is a non-alum with CPG, an oligonucleotide. It's a high-producing yeast strain; there's no upper bound to what you can make. Biological E in Hyderabad is making 1.3 billion doses. We could easily make 4-5 billion if somebody has an interest in it. Hopefully that will come around and make a contribution.

In the beginning, when we were talking to the science policymakers about our vaccine, there was very little interest. Everybody was focused on innovation; that's all they wanted to hear about. They wanted to know about the mRNA vaccines and then the viral vector vaccines. Nobody cared about boring recombinant protein. That was a big mistake. I'm an MD-PhD and I love innovation as much as the next person, but I think they went too far.

A year ago at this time, I was very depressed because not only was I throwing darts at the Trump White House and their disinformation campaign and getting beat up, but I was also raising money for our recombinant protein vaccine and we were only getting a little bit of support from NIH. I was going to private sources and that was hard. I had to spend the first few months of the pandemic raising money. And we did. We raised $4-5 million to do the technology transfer to Biological E. And now CEPI is coming through. But that was a tough time. And hopefully now, if it looks as good as it's looking so far, we can get a much larger investment to move this forward for the world.

Verghese: The federal government now looks very different from what it was earlier in the epidemic. But nevertheless, are there things the current federal government should be doing that they're not doing? You mentioned that they should take antiscience much more seriously, to treat it as something that's been weaponized. But what else could they be doing?

Hotez: There are three or four things. In terms of the antiscience, they have to become more confrontational, and that means being confrontational with Russia and taking down some of the antivaccine content. That's not a thing people like to do. But if you need to save lives, it's going to be important. And it's not just the United States; the UN agencies need to do this as well.

The other piece is to recognize that when we are trying to build vaccines, innovation is important, but we also need to pay attention to low-cost, unfussy, durable technologies that you can scale for the world.

The third thing is doing a better job of building capacity for developing vaccines. The model of relying on the multinational pharmaceutical companies to do this — and then hope that it trickles down to Africa and Latin America — did not work in this instance. Right now, no vaccines are made on the continent of Africa. Very little vaccine is made in Latin America, and almost nothing in the Middle East. That's a long-term project but it's doable and very important. Vaccines aren't being made for many diseases because they are only of regional importance. With 90% of the schistosomiasis cases occurring in Africa, no one is going to make a vaccine for that or for brucellosis. We need to expand that capacity.

And when they say, "It's all about the patents," I say no. Even if you were to liberalize patent restrictions entirely, that still wouldn't make a difference, at least in the short term, because we don't have the human capital trained for this. It's not like a small-molecule drug, like an antiretroviral viral drug made by Cipla. There's an art to developing vaccines and it takes years of experience. You need to know not only how to scale up production, but how to do quality control and quality assurance. We need to build that capacity as well.

Lessons Learned: Vaccines and Global Politics

Topol: We went from sequencing SARS-CoV-2 in January 2020 to the completion of large trials 10 months later and the granting of an EUA, and now almost 900 million vaccine doses have been given around the world. How do you frame the COVID response with respect to vaccination and the big gap in planetary need compared with others that preceded it?

Hotez: The overwhelming number of doses have been given in North America and Europe, and maybe in some better-off Asian countries. But the ratio of vaccinations in North America compared with Africa is 40 to 1, and it would be even higher if we exclude Morocco, because Morocco, for whatever reason, is overachieving in terms of vaccination. If you look just at sub-Saharan Africa, it's probably 100 to 1. I don't see that ending any time soon.

So it's clear that the United States looked after itself. Israel looked after itself. England looked after itself. Some Western European countries looked after themselves. It's not that efforts to share weren't attempted; the COVAX sharing alliance is a good mechanism. It's very sound and well thought out and ethical. The problem is that the vaccines aren't there.

You're not going to do this with an mRNA vaccine — the technology is too new; it's too hard to scale. Eventually we'll figure out how to scale those lipid nanoparticles and even keep it stable at room temperature, but not in time for this pandemic. We knew that. So, again, there was a science policy failure that didn't recognize the urgency of balancing the portfolio with lower-cost, easy-breezy, unfussy vaccines.

Look, I was the beneficiary of the Pfizer-BioNTech vaccine. I'm grateful. They're great vaccines. The question is, what are the lessons learned? Should we now be teaching countries in Africa how to make mRNA vaccines? Is there still a role moving forward for the old-school vaccines? I think so. For me, one surprise was that we couldn't predict which ones were going to work. If you had asked me a year ago what horse I would bet on in terms of which vaccine was going to be the most effective, I probably would have picked the same one used for the Ebola vaccine, made by Merck & Co., which was for a vesicular stomatitis virus. It's amazing and has a very high level of efficacy, and they were able to vaccinate DR Congo under incredibly difficult circumstances. That's probably the one I would have said was going to work. But it didn't. It tanked. It did not work at all.

One thing I point out with the mRNA vaccines is that it's a pretty low-hanging fruit in the sense that pretty much anything you do to induce high levels of virus-neutralizing antibody works. So mRNA technology worked very well for this one, but it's unclear what's going to work the next time around. We have to keep a lot of different technologies in play.

Verghese: You mentioned that we were not taught in medical school to deal with some of the things that you've come up against in your professional career. And yet, if you study the narrative of pandemics, beginning with The Plague by Camus, it seems to me that this kind of social turmoil is entirely predictable. In some ways, you're very much reminiscent of the hero of the novel, Dr Bernard Rieux. You're fighting against all the odds and hanging in there, which I think is a great compliment to you. In your experience with pandemics previous to this, are you entirely surprised at the kind of things that you're having to deal with? Were they in some ways predictable?

Hotez: A couple of things that I didn't predict are the way the antiscience aggression actually interfered with it. Maybe I should have. Not only that Trump launched this antidisease and antiscience disinformation campaign, but that so many other political leaders adopted it as well, like Bolsonaro in Brazil or Duterte in the Philippines, or what we're seeing now in Tanzania or with Daniel Ortega in Nicaragua and a few others. I didn't anticipate that a leader of a country would throw his own population under the bus for political gain, which in Trump's case turned out not to be political gain at all and maybe was his undoing. And the behavior of Russia that was so transactional that it would launch a disinformation campaign to discredit vaccines, and to use the opportunity to destabilize democracies in the middle of a pandemic. That was a level that I didn't think global leaders could descend to. But there you are.

Getting Ready for COVID-26

Topol: As we're talking, Peter, I think of you as the "pan man" — that is, you have a panoramic view of this: the biology, the political framework, the science, all of it. But that brings me to perhaps where we're headed. Many have thought that we could develop a pan-coronavirus vaccine. With the success of the spike protein as such an incredible target, perhaps better than anyone anticipated, the fact that people are mounting pluripotent antibodies against multiple targets of the virus, and also the way we can go after it with synthetic structural biology, do you think that we should be putting resources toward a pan-coronavirus vaccine so we don't have to face this again?

Hotez: Actually, a year or two before the pandemic, we had put in a grant to the NIH to make a universal coronavirus vaccine. It got triaged unreviewed because they said it wasn't innovative, and they were right. It wasn't very innovative, but I think we could have gone pretty far with it. I still think we need that. We had SARS in 2003 and MERS in 2012. I said that it was only a matter of time before we'd have another one. And sure enough, COVID-19 came along.

But I think in addition to the variants, we're going to have COVID-26 and COVID-32. We should get ready. With each pandemic, it's not like we don't learn anything. We do. After SARS, we established International Health Regulations (IHR 2005); after H1N1, we put in the Global Health Security Agenda; and after Ebola in 2014, we put together CEPI. So it's not like we don't learn things.

For this one, it's going to be very important to put in some infrastructure for coronaviruses, just like we do for flu. There's a pretty elaborate dance now that we use for monitoring influenza and the emergence of new strains, whether it's seasonal, pandemic, avian, or porcine flu, and then quickly turning around and manufacturing vaccines. We're going to need a similar type of infrastructure for coronaviruses. We will need wide-scale surveillance and also work with disease ecologists to better understand how these viruses emerge from bats and ultimately transfer to people. We've got to put that whole thing in place.

Verghese: Peter, I'm just in awe of how much you managed to get done on so many different fronts. When this pandemic is over, you need to write a book on how to manage your time, because you're clearly doing it better than most of us.

Hotez: What's funny is that I seem like a nice person; I always get invited to these work-life balance panels, and I always refuse to go because the truth is, I just work all the time. I get terrible anxiety when I go on vacation. I have a wife who's been with me for 35 years who puts up with it. But for me it's not work; it's more like a calling.

Topol: You're a force.

Hotez: Any of my adult kids would tell you that work-life balance is not a strength.

Topol: You've represented the medical community so much in your efforts — not just when you were a special envoy to the Obama administration, but over the past year or more I get to see you almost every day on cable news. Because of your insights, the consistency of your efforts to try to get the truth out there and even to take on the naysayers of the antiscience movement, we are indebted to you. Even with all the sobering messages you transmitted today, you still maintain a smile. You still have that upbeat, get-it-done attitude. We really appreciate that and all that you're doing.

Hotez: One of the lessons that I've learned in going on the cable news networks almost every day is that the American people have a higher tolerance for complexity than we've given them credit for in the past. They like hearing from scientists. They like understanding our assumptions, how we think through a problem. We don't let ourselves do that enough. Somewhere in our training we were told that we have to speak to people like they are in the fourth or sixth grade. And it's not true. Especially when their own health or that of their loved ones is concerned, people don't mind the complexity. They like going into some detail to understand what's going on. I've enjoyed the opportunity to do that.

But it's also a lesson for how we train physicians and scientists. We three had to learn by trial and error, and in my case, more error than trial. If you talk to young medical students, despite what they say about that generation, the truth is that their commitment to public service is at an all-time high. We just don't give them the tools and the support to do public engagement in health and science communication. If we are reinventing medical education or residency education, let's build that into it. It will go over well with this generation.

That's why what you are doing is so important. These Medscape podcasts are gold, because this is what people need to hear, to see — the side of medical practice that involves communicating health. It's not something that's widely done, but it's so critical.

Topol: You are the role model. And hopefully one of the lessons of this pandemic will be don't stay in your lane, because if you had, we wouldn't be very well off right now. So thank you.

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