By Jessica W. ‘22
For many reasons, 2020 will go down in history. Perhaps most remarkably, we witnessed the worldwide spread of COVID-19. Winsor has undergone major changes this academic year, as have many institutions. Meanwhile, with the dedicated efforts of biomedical researchers, a series of COVID-19 vaccines have recently been developed and FDA approved, with many others in the pipeline. With the continued distribution of vaccines, new hope arises for the path back to normalcy. To gain a better understanding of the pandemic’s evolving situation, on December 18, The Banner interviewed Laurie H. Glimcher, M.D., pioneering immunologist and president and CEO of Dana-Farber Cancer Institute, who is also our proud Winsor alumna.
How has Dana-Farber responded to the rise in cases, especially since cancer patients with weaker immune systems may be more vulnerable to COVID?
When the pandemic first hit, we immediately shut a lot of things down in order to remove employees who weren’t essential for taking care of our cancer patients to work remotely. We have around 5,000 faculty and staff at Dana-Farber, and 3,000 of them were able to work remotely from home. We found out that there were actually some benefits to it. People saved time in transportation and had more flexibility in shaping their schedules, which is particularly important for young women with children. We can now offer some of our employees the opportunity to tailor the most efficient way to work going forward.
The other very important lesson we learned is the value of telemedicine and telehealth. Just because there’s a pandemic, cancer’s not going to wait. We were open, and our front-facing healthcare workers stood right up. At Dana-Farber, we were doing around 10 to 15 telehealth virtual health care meetings a week. Within 2 weeks, we had ramped up to doing 3,000 a week. We did the very best we could to have patients not come in. About half of our patients getting chemotherapy or immunotherapy infusions had to come in, but we made it as safe as possible for them to do so. There is no evidence that our healthcare workers transmitted a single case of COVID-19 to our patients, thanks to their efforts.
Some cancer patients indeed have a weakened immune system. So as we think about vaccinating our patients, we need to take into account each individual patient. Will vaccines work if your immune system is subdued? Will you get a good response to the vaccine? These are questions that need to be researched over time. This is an important opportunity for us to learn more about the immune system in cancer patients, and this is the type of research that will get done not only in pharmaceutical companies but primarily in academic medical centers by our scientists. We also need to be studying the immune system post-vaccination. That means not just the antibody response, but also the response of the most important cell of the immune system, the T cell, which recognizes viral proteins in the vaccine and become activated, allowing them to kill virus-infected cells. Antibodies can also kill virus-infected cells, so both are important.
It’s much easier to measure antibodies, which is why most information we have now is antibodies. It’s more laborious to take T cells out of a patient and put them in a culture and see whether they become activated when cultured with the virus. But we need to be doing those studies because we don’t know how long immunity is going to last for these vaccines yet. Vaccines like the measles and mumps vaccines last forever. But that’s not true for many other common viruses. For example, we need to take the flu vaccine every year, and coronaviruses tend to behave more like the flu. There have been some very preliminary studies but we won’t have the data that we need for another couple of years. The people that were vaccinated in Phase 1, Phase 2, and Phase 3 of the clinical trials should be followed up- how high is their titer of antibodies, what do their T-cells look like, and how long will that last?
There are two major producers of the COVID19 vaccine, Pfizer and Moderna. What is the difference between these vaccines, and how do you expect they will coordinate to cover the vaccination of the population?
First of all, we are beyond thrilled that there are now 3 FDA approved vaccines available. It was a remarkable achievement- it usually takes ten years to produce an effective vaccine. This was 10 months!
The Pfizer vaccine is much more difficult to administer because it has to be kept at -70°C degrees, so that’s being mainly sent to the hospitals because we have lots of -70°C freezers. The Moderna vaccine is kept at -20°C, which is just a regular freezer and can be stored for some time in a refrigerator.
The Pfizer vaccine is the first mRNA [or messenger RNA, complementary to coding DNA, an intermediate molecule from which protein is translated] vaccine ever to be approved. This was kind of a gamble– why go with an approach that hadn’t been proven yet? In part, because it’s much easier and quicker to manufacture large amounts of these vaccines which get translated into proteins in the body. A traditional vaccine is a protein vaccine. When you create protein vaccines, you have to make a lot of protein, and that’s much more laborious. Whereas for mRNA, you can amplify amounts thanks to PCR [polymerase chain reaction, used to amplify DNA] and other techniques. The process is much quicker and there are much fewer construction and manufacturing issues.
Pfizer, Moderna, and Astrazeneca produced mRNA vaccines. It was an enormous relief when the data from the Pfizer vaccine came in and showed that mRNA vaccines worked with 94-95% efficiency. We also found that the piece of RNA they used encoded part of the spike protein, which is what the prediction was: that that was going to be the most immunogenic part of the SARS2 coronavirus. Knowing this told us that the Moderna vaccine and AstraZeneca Oxford vaccines were likely going to work as well as indeed they have. But even 3 very efficient mRNA vaccines is not enough for a population of 7.8 billion. We need all the vaccines we can get, and there are several other vaccines in production, including the Johnson and Johnson vaccine, a DNA vaccine. DNA vaccines were very popular, but they had not worked well. However, the clinical trial data from Johnson and Johnson is looking promising. So that will give us 4 vaccines at least.
Can you share with us some insight regarding the potential safety and other concerns regarding the vaccine?
We’re just going to have to wait until many more people get the vaccine. Unfortunately, there were a couple of people in the UK who had serious allergic reactions to the Pfizer vaccine and they were treated successfully. Why didn’t we see that in the clinical trial, you might ask? Because people with previous anaphylactic episodes were excluded for their own benefit from the clinical trials. There are side effects to any vaccine, and it’s just a matter of does the benefit outweigh the risk? I think there’s no question here that it does when you realize that one in every thousand Americans have died from COVID-19.
How did Winsor prepare you to pursue STEM? What motivated you to become an immunologist?
I received a great education at Winsor in the humanities- Winsor taught me how to write and assemble my thoughts in a cogent manner. As for my inspiration to pursue medicine and science, in part it was written in my genes. My dad was a physician-scientist. I grew up in that environment, and I was always intrigued by science. However, I enjoyed my literature courses at Harvard University as much as I enjoyed my science courses, although I majored in biology.
In the first year of medical school, we were introduced to basic sciences, and we learned about the immune system. I was fascinated by the idea that we have such a complicated and powerful program that can distinguish what is self and what is foreign and hence protects us against pathogens and against autoimmune diseases.
I was so fascinated that I realized I wanted to be a physician-scientist, like my dad. I liked taking care of patients. I was particularly intrigued by autoimmunity, so I became a rheumatologist. But it was very clear to me by my third year of medical school that I wanted to spend most of my time as a researcher. So in my fourth year of medical school, I started my career in immunology at 25 years old in a laboratory at Dana-Farber. And now, I look out the window in my office and what do I see right in front of me? It’s Winsor! I have come full circle.
What’s your advice with Winsor students who are interested in STEM?
My advice is to go after it. We need more women in STEM. I devoted a good part of my career to helping women succeed in science and medicine, but it’s still not an equal playing field. There is this intersection of biology and important landmarks in your career. Having children usually falls in your late 20s or 30s, a time when you’re building your career as a junior faculty member and need to be focused on your career. I wasn’t going to give up on having children, such lights of my life. It wasn’t easy, but it was absolutely worth it. I believe we need to make it easier for women, and that’s why I’ve spent so much of my time when I was Dean at Cornell and now that I’m the CEO of Dana-Farber, raising money for women in science and medicine.
We also need to make sure that young women have mentors. I did not have any female mentors, so when I set up my own lab, I was determined to be a good mentor to my postdoctoral fellows and graduate students. I made sure that women with young children had technical help in the laboratory. I convinced NIH to do this for a group of women and I also put it in place in Cornell. I currently have a program in place at Dana-Farber as well. The first gift I raised at Dana-Farber supported a program called the Helen Gurley Brown Fellows and Mentors. Specifically, female postdoctoral fellows were placed in the laboratories of senior female mentors. It started with 5 Fellows and 5 Senior Mentors and now it’s doubled. In three and a half years, we have had 25 fellows in the laboratories of 25 female mentors. Harvard Medical School just recognized this program with an award for innovative and inspiring mentorship.
Something else we learned from COVID-19, which started with the horrific murder of George Floyd, is how unfairly distributed health care is. Every patient with cancer deserves the same high-quality care as any other patient. We’ve started several projects, for which we have raised philanthropic funds, to make sure that we are accessible to all patients. We asked, who’s dying from COVID-19? Twice as many Black and LatinX Americans die from COVID-19 as White people do. This stark contrast is completely unacceptable, and that’s because they’re not getting quality healthcare. This has been a major priority for Dana-Farber over this last year in particular. It’s not enough to just say, “I’m not racist”. We have to be actively anti-racist, and we have to put our energy and money where it is most needed. I believe that we have 2 pandemics- one of which, we know how to approach- we have the vaccines. But the second is establishing racial equity in healthcare which will be much harder, but we must do so.