The Greek behind Trump’s antibody cocktail

I had sent him several text messages in the previous few days but they had gone unanswered. It was to be expected. Following the announcement by the US administration that Regeneron Pharmaceuticals’ experimental monoclonal antibody cocktail was used to treat US President Donald Trump for the novel coronavirus, the president and chief scientific officer of the American biotechnology company, Dr George Yancopoulos, found himself at the center of international attention.

But on Wednesday night, I suddenly received his message. “Can I call you at 11.30 p.m. Greek time? I don’t have much time, but we can talk.” The interview below includes what we managed to discuss with the distinguished Greek-American scientist (originally from the northern Greek town of Kastoria) between meetings for work, meetings at the White House and countless hours of work in Regeneron’s labs.
 

What is it like to be the chief scientific officer at Regeneron right now? Are you getting any sleep?

Sleep is not one of the things I’m worried about right now. Everyone at Regeneron is working nonstop around the clock to fight this pandemic. We will not rest until we succeed.

Everyone is talking about REGN-COV2, the monoclonal antibodies you developed, and expectations seem to be very high.

There is good reason for hope and for high expectations, and not just with regard to us. Eli Lilly just today (Wednesday) announced that it has also developed monoclonal antibodies and that the first results of its clinical trials are very encouraging. This gives us great pleasure. We are both powerful companies and I am optimistic that this double effort will pay off.

At Regeneron, we have been developing technology for the past 20 years that has to do with antibodies and this is used to treat serious conditions like asthma, heart disease and cancer, but also infectious diseases like Ebola. The antibody cocktail we developed was especially effective in this particular case.

We have an amazing team. As you know, our president – who also has Greek roots – is the legendary doctor and researcher P. Roy Vagelos, our hero and the man we always wanted to become when we were kids, and Regeneron’s vice president of research for infectious diseases and viral vector technologies is Christos Kyratsous. He comes from Kozani and I come from Kastoria. Basically, as the saying goes, lift any rock and you’ll find a Greek beneath it. The Greeks leave their mark on everything and we are certain to do so again in the battle against Covid-19.

How was the decision taken to administer the antibody cocktail to President Trump?

We were contacted by the White House on October 1, just two days after we had announced the results of the clinical trials. We got the process moving and were able to get emergency authorization from the US Food and Drug Administration to administer the cocktail. There were, as you can understand, extensive discussions with his medical team and we decided to go ahead because he was the ideal candidate.

What makes the ideal candidate?

This cocktail is particularly effective in patients in the early stages of Covid-19, with a high viral load, who have mild to moderate symptoms and whose body has not had a chance – or cannot because of a weak immune system – to produce antibodies. That last factor is absolutely essential. And of course it is not recommended for people who have a high risk of side effects of the disease because of age or underlying health problems.

How effective is the cocktail, exactly?

If it is administered at the right time, it can reduce the level of the viral load by 99%. The protection it provides also lasts several months.

Does this mean that President Trump will now have antibodies for several months?

Exactly. In fact, his doctors chose that he be given the highest possible dose, 8 grams. The usual dose administered to patients is 2.4 grams. It was their decision – perhaps an overzealous one – aimed at giving the president the best possible result and a bigger, perhaps, period of coverage, even though these are things we have not got a complete picture of yet. The only thing we know for sure is that the higher dose contains practically no risk for the patient.

So, antibody cocktails or vaccinations? Where is the focus?

These are two separate things. Antibodies are administered to people who are already sick, to treat them. The purpose of a vaccination is to protect people from becoming infected and it can be administered to millions of people all over the world, which is not possible with an antibody cocktail. So, in one sense, a vaccination is more useful because it will contribute to building a powerful wall of immunity against the virus. On the other hand, there are always people who are vulnerable or elderly, and in such cases the effectiveness of a vaccination is lower, so that’s where our contribution could be greater.

To turn to practical matters, how many doses of the cocktail can you produce?

Our production capacity right now is nearly 100,000 doses a month. It’s not enough – we know. Starting in January, though, we will be working with the pharmaceutical firm Roche and we believe that we can deliver 250,000 doses a month or more.

Until that happens, how are the patients that receive your antibody cocktail selected?

We have signed an agreement with the US government to supply 300,000 doses by the end of 2020. So, it’s up to them to decide where they will go, not us. The cocktail is administered for free and I am sure that it is distributed fairly and properly, to the patients that have the greatest need of it.

How would you describe the situation in the United States right now in terms of the pandemic?

Unfortunately, we have a lot of new cases every day and a lot of patients dying after presenting complications from the disease. This is why the US – like the rest of the world – needs treatments and a vaccine. And that’s why we cannot sleep!

Do both of your parents hail from Kastoria?

Yes, they were immigrants. They made the trip across the Atlantic during the Civil War, looking for a better life. They were very poor and, unfortunately, did not even get to finish school. My father, Giorgos, was a furrier back in Greece and this is what he did during his first years in America, among many other things. He did a lot of different jobs and fought hard so that we would not be in want of anything. He wanted my sister (who is an astrophysicist) and I to have the best education possible and all the opportunities that he and my mother were deprived of because of the difficult circumstances they faced.

You have said that everything you have accomplished is thanks to your Greek heritage. Can you explain that? What does Greece mean to you?

I remember on one family trip to Greece, when I was much younger, my father and I had gone for a hike in the hills outside Kastoria. He started crying all of a sudden as we walked in this magical landscape: “Never forget the blood that has been spilled on this ground so that you could be here today,” he told me. He always reminded me of the heroes that this country has produced and everything it has given to humanity. And I tell the same thing, whenever I have the chance, to my own children: Ourania-Sophia, Damis-Giorgos, Loukas-Achilleas and Dimitra-Alexandra.

How did your scientific career begin?

It was 1975 and I was still in high school, when my father came home with a page from the National Herald, the Greek-American newspaper. It had a feature on P. Roy Vagelos, a legend of the American pharmaceutical community who had just been named head of research at Merck. “This is how I’d like to see you one day,” my father told me. “Using your knowledge and research to save lives…” I hope I’ve made him proud… I’m sorry… I always get a bit emotional when talking about my parents.