The Global Story: Will the new cancer vaccine survive RFK Jr’s America?

This BBC podcast is supported by ads outside the UK. Listen to Choiceology at schwab.com slash podcast or wherever you listen. It's everything your business needs in one place, saving you time, headaches and serious money. Stop paying for missing pieces. Go to odoo.com. That's O-D-O-O dot com to learn more. Hey there, it's Asma Khalid, one of the hosts of the Global Story podcast from the BBC. And as a bonus for your feed, we're bringing you one of our favourite episodes of the week. Now, every weekday on the Global Story, we try to tell one big story, individually. In this episode, we look at a scientific breakthrough that comes with a lot of baggage here in the US. A vaccine for skin cancer that has shown promising results in a recent clinical trial. What's notable is that this is an mRNA vaccine. And you all might recognise that term, mRNA, because it's the same technology that was used in some COVID vaccines. And that is what is making this new scientific breakthrough so politically tricky. The COVID vaccine, in particular, is one of the most widely used vaccines in the world, and it's one of the most widely used in the world. And it's one of the most widely used vaccines in the world. And it's one of the most widely used vaccines a Hungarian-American scientist by the name of Dr. Katalin Karikó was wandering the halls looking for a copy machine. And when she found one, she came across another researcher. They struck up a conversation. And so I was bragging that I work with RNA and then he was telling me that he wanted to develop a vaccine. And that's how, you know, we started. Dr. Karikó and her research partner would go on to spend years working together on what was sometimes a scientific dead end, an mRNA vaccine. For years, their efforts amounted to little. But in 2023, after the development of the COVID vaccines that used mRNA technology, they were awarded the Nobel Prize for Medicine. Together, they have saved millions of lives, prevented severe COVID-19, reduced the overall disease burden and enabled societies to open up again. Last week, there was another watershed moment. From that saying, I'm going to be a scientist. I'm going to be a scientist. Same mRNA technology, a potential cancer vaccine. And yet the news comes in a tough climate for vaccines. Last year, the U.S. Health and Human Services Secretary, RFK Jr., cut half a billion dollars of funding into mRNA research. From the BBC, I'm Asma Khalid in Washington, D.C. And today on The Global Story, the new skin cancer vaccine and the promise and politics of mRNA technology. I'm Tom Whipple. I'm a science writer and I present Inside Science on BBC Radio 4 and the World Service. Well, Tom Whipple, welcome to The Global Story. It's a pleasure to have you with us. Thanks for taking the time. It's a pleasure. Today on the show, we want to dive into the health and policy debates around mRNA technology, particularly here in the United States, where I sit in this political moment. But the reason that we wanted to have this conversation today is because of a major medical breakthrough that made headlines just the other day. What is being described is a personalized cancer vaccine. Now, to be abundantly clear to listeners, it is not like you or I, Tom, could take a jab and have immunity from developing skin cancer. This is a different type of vaccine. Nonetheless, I'm hearing it described as a game changer. Can you explain what was actually announced and why it is being, seen as so significant? Yeah, so as you say, this isn't you would get your summer booster shot and then not be able to catch skin cancer for that summer. It's absolutely not that. There is a reason which we'll get into why the word vaccine is still perfectly appropriate. But what this is, is that if you've got a skin cancer, or in theory, we'd like this to work for lots of cancers, you remove it. But the real worry is it comes back. We all know about it. It comes back. It comes back. It comes back. It comes back about metastases and the idea that cancer spreads in the body, even after you've removed it. What this is doing is it is training your body to attack it. It's training it to attack the cancer cells that are there in the tumor so that your body's own defenses take it out. And so in that sense, it's very much like a vaccine in that the idea of vaccine is you show it a little bit of a thing, you show your body a little bit of a thing that you want to attack, and then your immune system is trained to attack it. And so it's training your body to attack it. And so it's trained and away it goes and attacks it. This is a really big deal. So the caveats are we don't yet know how well this works. We know this has gone through stage three trials, which is the final stage of trials before you can introduce a drug or a treatment. We know that the companies that made it, Merck and Moderna, are confident that this is clinically significant and useful. It prevented cancer from returning. In a significant number of patients, it helped them live longer. This isn't a magic bullet. But the reason it's so significant is because doctors have been trying to do this for 30, 40 years. They've been trying to make a cancer vaccine because it's such a simple and appealing idea. And it seems like it should work. And until now, largely, they've failed. So the fact that this has succeeded, and in particular succeeded using mRNA technology, which is this big coming technology, suggests that we could be on the cusp of having a new wing to our cancer treatments and also a wing that's a lot more gentle than many of the treatments that we're used to. So just to make sure I'm following here, Tom, this has gone through all the necessary trials. It has not yet, this vaccine, received the approval here in the United States from the FDA, the Food and Drug Administration. But it looks like it's on track to be possibly used by the public in the near future. Yeah, look, once you've gone through phase three trials and been successful in your determination, that's when you gather together all of the data that you've got, and you present it to the regulator and you say, da-da, we think we've made something that he will want. And then it is up to the regulator to say, yes, you have, or yes, you haven't. But look, if you want a sense of the confidence in this, you just have to look at Moderna's price. You know, this is something where people are betting a lot of billions that actually they've got something that works. So it sounds like we might need to be cautious still, but it sounds like we can be cautiously optimistic at this point. Can you walk us through exactly how this is different from the way that a traditional vaccine would work? So all vaccines, the principle is that your immune system learns by seeing things. Now, if I get infected by measles, my immune system will learn what the outside of a measles virus looks like. And provided that measles hasn't killed me, when I then see measles again, my immune system will know exactly what to do with it. It will have the antibodies and T-cells ready to chomp it up, get rid of it. And I am completely immune from measles. The principle of a vaccine is to do that without having the. Provided I'm still alive bit. Excellent. Yes. It's to show you what a virus, a pathogen, some sort of bacteria looks like without actually getting you the infection bit. So there are lots of ways of doing this. Normally what you do, so you get an attenuated version of the virus. What they've done is they've serially bred the virus to make it weaker and weaker. And. And so it doesn't give you measles, but it looks similar enough to the measles virus that does give you measles that having had it, your immune system knows exactly what to do with the real thing when it turns up. You have to develop that specifically for that particular virus. But the thing that made mRNA different is that they were programmable vaccines. So there is something that's known as the central dogma of biology, and it is DNA makes RNA makes proteins. And what proteins do make the body work. So I think almost all listeners will be familiar with DNA. It is very crudely the blueprint of you. DNA is like the instruction manual, the thing you get when you get flat-packed furniture. But the instruction manual isn't enough unless you have the person to read it and then turn the flat-packed furniture into the bookshelf. And that's sort of what RNA or messenger RNA, that's where it comes in. So there was this idea, could we hijack this process? One of the pioneers of this idea was a Hungarian scientist called Katalin Karakó. I grew up in Hungary in a very sleepy small town. We did not have the running water, television set, refrigerator and so on. But nobody had, so I didn't know we don't have. She'd been plugging away at this from 1985. You know, she started to do a lot of research on this. She started to do a lot of research on this. Either. either, without the pandemic. I remember I was working at times during the arrival of those vaccines. And we were looking each day, the UK had some of the best data in the world during pandemic. There's a lot we did wrong, but the data was astonishing. And you could see the death rate by age group in each day's death data. So how many people have been infected and how many people died? We also knew that we were vaccinating people starting at the oldest and then working down. And what you saw was this astonishing thing. In each age group, there would be this sudden dip in the over 85s, this sudden dip in the over 80s, this sudden dip in the over 75s. You could see in real time the effect of the vaccines. And you were saying you would see a drop in the data once the vaccine was given? Yes. You've got this sort of two, three, four week lag for immunity, fatality rate. They've brought it down an order of magnitude. The Health and Human Services Secretary saying that mRNA vaccines don't perform well against viruses that infect the upper respiratory tract. And he is saying that the pandemic showed us this. It sounds like you are saying that is just not accurate. The pandemic actually showed us the efficacy of these vaccines. Look, I've long since left the situation where I feel like I can change anyone's mind about anything to do with COVID. But it's just not true. The fact is, before the vaccines, in a Western country with the age stratification that you have in the US and the UK, you're looking at about a 1% overall fatality rate. And afterwards, there wasn't that. I mean, look, I do think when you have somebody in a high position. You have a position of authority in the health department in the United States saying one thing, and you have others in the medical community saying, no, no, this mRNA technology has been effective. It is a scientific breakthrough. People can get confused. I have another question here about an allegation surrounding these mRNA vaccines. And that is that, are they less safe than other forms of vaccines? And Tom, the reason I'm asking this is because. Because when the funding for mRNA vaccine research was pulled, the Department of Health and Human Services here in the US issued a statement that said, in part, that technology that failed to meet current scientific standards would be phased out in favor of evidence-based, ethically grounded solutions like whole virus vaccines and novel platforms. So are mRNA vaccines less safe than traditional vaccines? I don't think there's particularly good evidence for that. I mean, every intervention has some side effects. If it's going to work, it has side effects. Every intervention will vary on that. I mean, there's certainly going to be whole virus vaccines, which are far less safe. There were side effects to this. There's myocarditis, pericarditis effects on the heart. They were rare. They were normally not that severe, but they were. They were present to an extent that in the fittest, youngest age groups at times of low prevalence for COVID, you could make the case that the cost-benefit analysis didn't work. And these were very, very finely balanced arguments. Now, what I would say is these were signals that were really hard to pick up until you started doing this at population scale. And that gives you a sense of how low the side effects are. But it would be completely irresponsible to say that they weren't there. But let's park this. So you might think, and I disagree with you, but you might think that the side effects of this weren't worth it for much of the population for COVID. Fine. But what about cancer? Because even if you think COVID isn't that bad, and for a lot of population isn't that bad, it would be my contention that it's not. And I think that's a good thing. I think it's a good thing. I think it's that cancer's pretty bad. And that actually, the side effects have to be pretty stonking in order for you not to take a treatment for cancer. And that is indeed why we do surgery and chemotherapy and radiotherapy and all these things that you definitely wouldn't do for COVID, but do do them for cancer. Tom, if we can fast forward. Earlier this month, in August, the FDA, the Food and Drug Administration approved the COVID-19 vaccine. And they did. And they did. And they did. And they did. And they the first mRNA flu vaccine made by Moderna, the same company that is being heralded for this new skin cancer vaccine. And my understanding is that initially, the FDA had declined to even review Moderna's application for a flu vaccine developed through mRNA technology, but then seemed to reverse course. Why is that? It's slightly different with the flu vaccine in that we do have a flu vaccine that we use every year, that changes every year with the strain of flu that's circulating. Flu changes a lot. So you have to tweak the vaccine each year. And that's done with a traditional vaccine manufactured technique. So there's less of an impetus to use something fancy and expensive like mRNA or comparatively expensive. But the mRNA does offer better strain matching. Sometimes you get the strain wrong. What you're generally doing is you have these flu surveillance people who are looking at what's happening in Australia during their winter, and then trying to fast forward to what's happening in the Northern Hemisphere during its winter. And sometimes they get it wrong. Whereas with mRNA, you can match better and you can move more nimbly. So I think there was there was elements of politics, the word mRNA has become political in a way that isn't helpful. And I don't want to speak to the FDA's particular decisions on the flu vaccine, because I'm not across it. But I would say that there are advantages of the mRNA, but there's less of a compelling public health case than there might be in other uses of it. From where I sit in the United States, Tom, it seems like there are two conversations happening at one time around mRNA technology. There is the scientific conversation. And in a previous life, in fact, I used to cover some biotech. I was based in Cambridge, Massachusetts. And, you know, I remember interviewing one of the co-founders of Moderna. This was years ago. And there were many people in and around that ecosystem, really excited about the potential of this type of technology. And that continues to exist, right? And then on the other side, as we've discussed, there's this political conversation we're having with RFK Jr. and his decision to cancel half a billion dollars worth of funding for mRNA research. You know, earlier we mentioned Dr. Carrico, who helped develop this technology. She went on to later win the Nobel Prize, along with her research partner. And when these funding cuts were announced last year, she spoke with my colleagues here at the BBC, in which she said. It was based on misinformation and not evidence. He ignored evidence. He ignored facts. And the U.S. ability to develop vaccine during the next pandemic suffers tremendously. And in her view. I was moving to the United States from Hungary, from Hungary, when I couldn't here in the U.S. I couldn't do. I moved to another country. So it seems that, you know, scientists need to move to another country if they want to advance. On this messenger RNA vaccine field. So it is a national security for the U.S. will suffer. So what does it mean for Americans if the government chooses not to fund these technologies? Look, she's devoted her career to this. So perhaps unsurprisingly, she was cross and baffled. And she moved from Hungary in order to do her science. So there are plenty of other people who are far less constrained, who will pick up sticks and move to do the science where it works. But if there's another pandemic and it's a worse virus, and actually we can make a vaccine quite easily using mRNA, people are going to have to rather rapidly reevaluate their views. And I suspect having a U.S. that has pulled out of research, probably pulled out of the sort of manufacturing that will be required to make those vaccines at scale, will be bad for the world as well. But you've got plenty of private companies and you've got, particularly in Cambridge, you've got the world's leading biotech scene with a bunch of investors. So I suspect you will find that there's plenty of money swilling around. I think a very easy argument for someone like works terribly well in viruses. think it's worth the risk in viruses. And I'm making this case, I disagree. And I want to say I disagree. But it's an easy argument to make, say, look, a virus doesn't kill many people. Comparatively, I don't think we should be giving them this new technology. It is a far easier argument to then say, but cancer is a different issue. Obviously, the risk benefit changes completely. So I suspect you might well see that pivot. Because I suspect that the US will want to keep on funding this stuff. Well, Tom, thank you for taking the time to walk us through this all and, and help us try to make sense of it. Appreciate it. Cheers. That was Tom Whipple, host of the BBC. Inside Science program and a writer for the Times of London. We contacted the Department of Health and Human Services for comment. They responded in part, quote, Secretary Kennedy has been clear that he believes the mRNA products warrant heightened scientific scrutiny. HHS continues to support mRNA research where the science shows promise, including for hard to treat cancers. As always, if you have questions, complaints, story ideas, you can reach us here at The Global Story anytime. Our email address is [email protected]. Our episode today was produced by Lucy Paul and Sam Chantarasek. It was mixed by Travis Evans. Our digital producer was Sam Greway. Our executive producer was James Shield, and our senior news editor was Chyna Collins. I'm Asma Khalid. Thanks, as always, for spending some time with us, and we'll be back again tomorrow.