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Parenting in a Pandemic

Greg Kwasnik
With the COVID-19 pandemic upending daily life as we know it, the world has become a confusing place for high school students – and their parents. To seek some clarity, we decided to reach out to a Kendall Hoyt P ’23. Not only is Kendall a current Holderness parent, but she’s also an expert in vaccine development policy for emerging infectious disease pandemics.
In addition to working as an Assistant Professor at the Geisel School of Medicine at Dartmouth and lecturer at the Thayer School of Engineering at Dartmouth College, Kendall is the author of “Long Shot: Vaccines for National Defense.” Earlier in her career, Kendall worked in the International Security and International Affairs division of the White House Office of Science and Technology Policy. She also served on the National Academy of Sciences Committee on the Department of Defense’s Programs to Counter Biological Threats.
 
Kendall generously agreed to take time out of her busy schedule to answer some of our questions. What follows is her interview, edited for length and clarity.
 
You currently work at Dartmouth. Could you tell us a bit about your work?
I’m on the faculty of the medical school, and I teach in the engineering school. I study vaccine development policy for emerging infectious disease pandemics and bioterrorism. I spent the last couple of years in England and Norway working with CEPI, which is the Coalition for Epidemic Preparedness Innovation. They are a pipeline accelerator for epidemic vaccine development and they’re playing a central role here at the moment. They pivoted rapidly, and have eight development contracts out for COVID-19 vaccines right now.
 
In your view, how serious is the COVID-19 pandemic?
I think it’s the most serious outbreak we’ve faced in the last hundred years. The last time we saw something like this was the 1918 flu pandemic, which killed, according to the low end of the estimates, 50 million worldwide. This [COVID-19] is highly transmissible and for some, it is not a mild virus. The real kicker is we have no medical countermeasures. We had a flu pandemic in 2009. The virus was novel but it wasn’t super lethal and we eventually had a vaccine for it. We are not set up to respond to coronavirus the way we are set up to respond to flu. Unless and until we have widespread testing, some kind of therapeutic, or a vaccine, we really are defenseless, which is why we have these draconian, non-pharmaceutical interventions – the social distancing measures. It’s our only defense.
 
How long will it take to develop a vaccine?
The best-case scenario estimates are 12 to 18 months. One thing to bear in mind is that for all drug development, from a standing start to finish, 90 percent of those candidates fail. That’s just the nature of drug development. Worldwide there are over 100 different candidates that have initiated investigation right now. The hope is that one of those at least – hopefully more than one – will work. The real challenge will be in scaling manufacture and getting sufficient safety and efficacy data in a timely fashion.
 
Assuming a vaccine is developed, how long would it take to get everyone vaccinated?
There are so many considerations. One is just the scale. Do we have the manufacturing capacity and can we coordinate efforts globally to safely produce this vaccine at scale? That’s number one. But then, what happens if we only have 100 million doses? There are 7.8 billion people on the planet. How do we allocate that in a fair way? Who gets what, when? And then, let’s say we have enough. Can you make it mandatory? Right now, our main problem is getting the vaccine. But having the vaccine will present problems as well.
 
In the meantime, what can we do to slow the spread of the disease? Social distancing?
Yes, that’s what you can do. There is tremendous responsibility on the individual to protect others.
 
It seems like social distancing has worked so far. Is that accurate?
That is accurate, and it’s kind of amazing. If you could hermetically seal your interactions with everyone else, the virus would burn out. But we can’t – it’s actually impossible to do. So every little thing we can do creates a layered defense that reduces the probability and slows the transmission.
 
You have a teenager at home. What advice would you give to high school students about the situation they’re currently in? I’m sure there’s a lot of anxiety out there.
I’m sure there is anxiety but I think there’s also resistance. I think teenagers feel invincible and asking them not to see their friends at this age is like asking them to hold their breath for three to four months. Yes, they understand how important it is, but they need to take a breath and that sort of clouds their judgment sometimes. I think it’s a valuable lesson about our responsibility to one another; you need to take action every day to protect vulnerable people in your community. They count on you. If ever there was a time for you to teach that lesson, this is it. Also, it’s a chance to teach them resilience in the face of change and cancelled plans. But what we’re asking of them is quite profound given their age and developmental needs. It is important for them to be with their friends. It is important for them to have independence and break away from the home. They require more of our empathy and less of our impatience. It helps if I don’t just tell them what they have to do, but if I take a deep breath and explain why they need to do it. Spending time outdoors - hiking, biking, canoeing, camping - has been a great outlet and opportunity for my kids to exercise some freedom and independence at this time.
 
Does this pandemic change the way you view your work in technology and biosecurity, or does it just confirm what you’ve been studying throughout your career?
I’ll tell you what my son Eli said. He goes to Holderness. He came in and he said “Well mom, this is your ‘I told you so’ moment. You’ve earned it, and I want you to make the most of it.” And then he glanced at his watch and said “You’ve got one minute.” So I guess that’s one way of saying I always – and not just me, but everyone in the field – expected this to happen. Which really begs the question of why we’re not more prepared.
 
So why aren’t we more prepared?
I think there was a lack of respect and support for the experts in government who were trying to prepare for this. There were a lot of actions that could have been taken, specifically with regards to diagnostic preparedness and ramp-up that would have changed our current outbreak trajectory. If you look at what’s happening in the U.S. versus South Korea, they were able to ramp testing to keep pace with the growing number of infections, and as a consequence they were able to isolate individuals that were infected and trace their contacts and test them and isolate them as well. That flattened the curve early on.
 
Has anything in your experience prepared you for a pandemic like this?
We haven’t seen anything like this, on this scale, since 1918. The West African Ebola outbreak was very instructive in terms of vaccine development. That showed us that we can and we should embed research in outbreak response and that it’s possible to develop vaccines in real time. It showed us a lot of the things that we need to invest in now to be able to move faster in the future – and we’ve already done a lot of that, CEPI being one of the main organizations that has been applying a lot of those lessons to accelerate development. They were able to do exactly what they were designed to do, and it’s stunning. They pivoted on much of their research and rapidly negotiated eight coronavirus vaccine contracts. They have one candidate, in particular, that was ready for Phase One testing 63 days after China published the genetic sequence for this virus, which broke all land speed records.
 
How long will the COVID-19 pandemic last? When will life go back to normal?
We need widespread serological testing and diagnostics. The serological testing will tell you if you’ve been exposed. We also need to understand, if you’ve been exposed, how long and how strong is your immunity? If we can figure out that you are not at risk of transmitting this to other people, that’s one way out of it. Another way out of it, and hopefully we’ll have all three things, is let’s say we develop some sort of an antiviral or monoclonal antibody that reduces the clinical severity of this disease? The death rate goes down, and the strain on the healthcare system goes down. That’s manageable, and you can tolerate more illness. Or three, a vaccine – but that’s going to take the longest. So unless and until we have at least one of those measures, I don’t see us getting out of this. It’s so widespread at this point, I think it’s unlikely to just disappear.
 
Service is central to the Holderness experience. How can we serve others during this difficult time?
I would think locally. So here in Lyme [N.H.] we have a neighborhood watch where we check in on our neighbors. Nobody is getting out, so we don’t know if somebody is not ok. We do this by phone so we’re not infecting them. If you have young drivers in the family ask them what you can do for them – particularly your elderly neighbors that should not be going out. Offer to retrieve groceries or collect medicines or whatever you can get for them on a weekly basis so that they don’t have to go out. These are just little things that you can do on a local level that make a huge difference. I would also think about what you can do to support caregivers and health care workers as well as individuals who are unable to work and/or have lost their jobs.

Looking toward the future, what gives you hope?  
For a long time we’ve needed to invest in vaccines as a public good, not as a commodity. That’s not necessarily true for all vaccines, but it’s true for these kinds of vaccines – what I call epidemic vaccines. I think we are going to come out of this with a better appreciation for that need, and also better systems – more institutional support for developing vaccines as a public good. So things that are done with shared IP [Intellectual Property] and at a low price with access for everybody. I think we’re going to need to collaborate. The fastest route to a vaccine is going to be not necessarily a competitive one but a collaborative one with global cooperation. I am hoping this message translates to society as well. There have always been limits to what we can accomplish with individual self-interest. I hope we will come out of this with a deeper appreciation for our responsibilities to one another and the value of cooperation for the broader social good.
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