CareTalk Podcast – Jason Kelly Testing Our Way Out of the Pandemic

Do we still need testing now that vaccines are rolling? Ginkgo Bioworks Founder, Jason Kelly, joins CareTalk to discuss how testing can help the world battle the pandemic.

David Williams:

Welcome to CareTalk, America’s home for incisive debate about healthcare, business, and policy. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO CareCentrix. So David, who do we have on deck today?

David Williams:

Well, John, it must be a guest from last year, because for some reason we’ve got somebody who’s an expert about testing for COVID-19, but we’re way past that, John. We’re talking about vaccines now.

John Driscoll:

Whoa.

Jason Kelly:

It’s all done.

John Driscoll:

Jason Kelly, the CEO of Ginkgo Bioworks. Welcome.

Jason Kelly:

Nice to be on.

John Driscoll:

What possessed you to name your company Ginkgo Bioworks anyways, and what does that stand for?

Jason Kelly:

Well, all right. The whole theory behind Ginkgo is we’re going to make it as easy to program cells as it is to program computers, because at the end of the day, they run on digital code, right? ATCs and Gs, not zeros and ones, but you can read it and you can write it. And so we think of it like programming and we wanted to pick an organism that was around back around the same time as our favorite organisms, the dinosaurs, and ginkgo trees have been around since then. They’re a living fossil. They’re a few hundred million years old. So that’s how we landed on the ginkgo tree.

John Driscoll:

Awesome. And are you creating organisms right now as we speak?

Jason Kelly:

Yeah. We, to our knowledge, design more synthetic DNA than any other place on earth. So basically, you go on your computer, you type ATC GGG, you hit print, and out of the machines at our lab or at partner companies of ours, like Twist Bioscience, the DNA gets printed, and then we add it to the genome of a cell to make it do something new. Kind of like installing an app on your phone or something like that.

John Driscoll:

And that reminds me of that Isaac Asimov thing, that what we now treat as normal used to be science fiction and what’s science fiction now will be normal in the future. Is it true that you were quoted that you’re going to turn seaweed into car seats?

Jason Kelly:

Seaweed into car seats. Anything is possible that I could have been quoted on. Actually, I’ll tell you a thing that just came out from a really cool company, a company called Bolt Threads just announced they were going to have a partnership with Adidas to do mushroom-based shoes. And so it just came out two days ago and you see them grow these giant, looks like giant marshmallows, of mushrooms. And then they’ve turned it into one of the kind of classic Adidas shoes with Adidas.

John Driscoll:

So David, I’m not going to get into a reference to you and mushrooms, so why don’t you ask the next question and get us back?

David Williams:

Yeah. Well, John, I’m going to have to say, I’m a little more concerned than I was before. I mean, you told me I had this ginkgo guy coming on. I thought we were going to be talking about supplements, because I used that to cure my depression and insomnia, et cetera. But no, I think this is quite interesting, obviously, on the synthetic biology. Now, like everybody else, you’ve been pulled in the other direction due to the pandemic. And testing is one of those things that was just a major issue that you and I know John identified upfront along with many others, but maybe we could just roll back a year or so and say what have been some of the issues since the start of the pandemic as they relate to testing?

Jason Kelly:

Yeah. I mean, so just so you know how we got into it, right? So Ginkgo’s goal, like I said, it’s to program cells like you program your computers, and just like Google would have cybersecurity or PayPal would have fraud detection, in the long arc of Ginkgo, we think it’s important for us to have biosecurity, because that is how you’re going to enter an era where we can engineer biology broadly in a way that’s safe and responsible. And COVID-19 represents this sort of, for lack of a better word, opportunity to build out biosecurity infrastructure. And so back in March of last year, when it was clear this thing wasn’t going away, we opened our platform up. We said we’d do $25 million of free work using our infrastructure that led to a project with Moderna, for example, as well as a few other folks in the work on raw materials for vaccines.

Jason Kelly:

And then the other area we leaned into was testing, but not diagnostic testing. Testing for purposes of keeping businesses and schools open. So sort of a surveillance style testing.

John Driscoll:

Yeah, and I think what drew Jason and I into kind of founding and co-founding Testing for America, David, is that we have technology available to solve our problem. And in many ways, the first vaccine for the economy and for society is really sensible testing. And we had the tools and we didn’t invest in it and scale it fast enough. And I think what’s interesting is one of the biggest social challenges of the last year has been opening and keeping open schools. And at TFA, we’re involved in keeping up on a historically black college, Delaware State, proving that a public college could be kept as open and running with people actually in class, as some of the private schools with all of their endowments.

John Driscoll:

And now Jason, you’re leveraging that same synthetic biology technology to keep open schools. So maybe talk a little bit about why testing is sort of the infrastructure, and we’re all talking about infrastructure these days, that we needed to keep schools open and how it’s working in the public schools that you’re working in.

Jason Kelly:

Yeah. Happy to. Yeah. So I think the key thing to first realize is there is a big industry of diagnostic testing. And you get a diagnostic test because you’re sick, right? You’re like, “Oh, I think I might have this and so I’m going to go to my doctor and get checked up and see what’s going on with me.” And so there’s a lot of motivation to go out and get yourself tested.

Jason Kelly:

Surveillance testing, or monitoring testing it’s much closer to weather satellites or something, right? It’s a way to know how is the virus spreading around in our communities and what are the targeted public health efforts you can make so that you can help spread without having to close the whole place? Because we know that closing the whole place is very socially disruptive, right? It hurts the economy. It hurts students, right? That’s like your last line of defense. And so in a perfect world, you’d know exactly where the thing was and you’d be like, “Hey, let’s close that school.” Or, “Hey, let’s just close that classroom, because I know that that classroom had a positive case, but keep the rest of the school open.” And so the idea is if we had better monitoring, we could be more targeted, which makes life less miserable while we wait for everyone to get vaccinated.

Jason Kelly:

And we just haven’t needed this. We haven’t had something like this happen since 1918 at this scale. And so we tried first to just throw diagnostic testing at it. And it turns out, diagnostic tests, no one wants to have something stuck way up their nose once a week as part of their monitoring efforts. And so you had to develop new technology. And so that’s what we’ve been doing the last year, just trying to make it easy enough. Yeah.

John Driscoll:

And we didn’t even have the capacity to do it [crosstalk 00:06:55].

Jason Kelly:

For a long time, that’s right.

John Driscoll:

We didn’t even have capacity to test sick people for a while, but then that got built up. And now we have enough capacity, and so the question is, can we run the experiment of using testing to make life more livable while waiting for widespread vaccination? And that’s sort of the new opportunity.

David Williams:

So I guess the thing is, with school and trying to get people to do pooled testing, you just have to take advantage of the fact that teenagers love to spit and drool all over the place. And then just sort of somehow organize that for testing. But how does that work in practice? I mean, do I have it more or less right?

Jason Kelly:

Yeah. It’s more like picking their nose that we get to take advantage of. So here’s the trick. If you want to do testing of every student every week, once a week in a school, which is sort of what resonates with both teachers and parents, in our experience. And this is what we’re doing statewide in Massachusetts. We’re doing it in Baltimore city public schools, we’re doing it in Newark, we’re doing it in Milwaukee. This works in a wide range of places. It needs to be non-disruptive to the school day and not require a healthcare professional to do it. And so what we landed on was what we call a classroom pool test, which is the students self collect all the way down to kindergarten. They put a Q-tip in their nose. It is just like picking your nose, like some of the school videos, like YouTube videos to explain it to them.

David Williams:

Yeah. You’re doing something you’re doing anyway.

Jason Kelly:

Exactly. Yeah, anyone can do it. And you walk to the front of the room, you put that Q-tip-sized swab into a tube. The whole class puts their swabs altogether. Teacher just observes. Administrator comes by, closes the tube, puts it in the box, ships it to a lab, lab runs a PCR test, and tests the whole class at once. And it’s either no, life goes on as normal or yes, and then you would do a follow-up test to see who in the classroom was the positive case and you’d do follow-up mitigation. And so it’s like eight minutes for a classroom. You can do it once a week, very easily. It’s inexpensive, because it’s 25 tests for the price of one. And so that’s the strategy is classroom pool tests. And it’s working. We’re doing it across, I don’t know, now I think a thousand schools and many students.

John Driscoll:

And what’s interesting to me, Jason, and really exciting, is that it’s working in urban areas. It’s working in public. It’s not just a private school elite thing where they’ve [inaudible 00:09:18] the technology. This is an affordable technology. With people just so wanting this vaccine to be done with us, and it really isn’t, I mean, how important do you think surveillance testing is now and will continue to be, based on what’s effectively a viral threat that doesn’t appear to be going away? In fact, it appears to be morphing, whether there’s B.1.1.7., all the different, pick your number, pick your version. What’s the role of surveillance testing?

John Driscoll:

Because I think the one thing we’ve proved is if you shut down the economy and shut down schools, a lot of people suffer, and particularly those at the lowest end of the economic spectrum. What’s the role of testing now?

Jason Kelly:

Yeah. I mean, I think the way to think of it is, it is one piece of a much better biosecurity infrastructure that we should have on the other side of COVID. And you can think of it like we’re kind of unpatched systems taking in viral code all the time, right? And that approach to public health, I think we’re just going to need to improve. And so I do think much better monitoring, I think much faster vaccines are the two things that are going to come out of COVID-19 that are going to change completely how we deal with infectious disease in the future.

Jason Kelly:

And we’ve already got the rapid vaccines. That got invested in and proven, and now we’re kind of muscling up the supply chain there. I think in the next six to nine months, we get to run the experiment of widespread monitoring to see how well that can work. I think it is an experiment worth running. So, we’ll see. Yeah.

John Driscoll:

But I think you hit on a really important point, because I think there’s really a three-part strategy. It’s improve therapeutics, improve vaccines, and testing.

Jason Kelly:

What happened with therapeutics, John?

John Driscoll:

They’re continuing to get better, that Regeneron cocktail, and they’re figuring out a way to get it into workflow at the appropriate time, and there’s other therapeutics behind it. But I think that for me, what the variants show is that this is not going away. That the taking in this new code or really new threats.

John Driscoll:

But I still worry that there’s not an awareness that we’ve just had effectively, I don’t buy the China story, but effectively a war on our society, delivered through a biological vector. That if we had surveillance testing, as your point, as part of infrastructure, not just for this particular virus, but for everything, I think it would strengthen our defenses. Because if you look at the convergence of man and the environment, and man and technology and biowarfare threats, this feels like it should be part of our public health and frankly, public security infrastructure.

David Williams:

Well, John, let me pull you back. I know you’ve got this China syndrome as usual, but let me pull you back into the here and now. So, I’m hearing great things about the pool testing in the schools, and I have kids in the Massachusetts schools, public and private. And my understanding is that there was a real push for this from parents. The states took it on. Now obviously, you guys have been helping to make it happen. But now they’re actually having trouble getting people to actually participate in it. And they’re trying to understand, why? What would it take to get someone to do it? Because the kids are saying, “Well, I’m not that worried about getting COVID. My parents are vaccinated and I’m kind of sick of it. And I maybe have to show up to school 10 minutes early, which I don’t want to deal with.” So what’s actually kind of going on practically on the ground?

Jason Kelly:

Yeah. It’s really interesting. And it varies by community. So part of it, I’d say it’s a little bit less on just people thinking it’s too much time out of their day. You do see a question of like, “Is this collecting personal information about my kids?” Right? And this is one of the areas on that where the pooled collection actually helps, because everybody’s getting all put together in one, but you don’t know which swab belongs to which person by nature of how you collected it. We don’t even collect the names of the students. It’s just Mr. Smith’s class or whatever. But that’s one of the bigger concerns.

Jason Kelly:

And then people are just, particularly in communities that have been hit very hard by this, they’re going to have a lack of trust in the medical system, lack of trust of people in positions of authority, and on and on. And so an important part of this is public health messaging and engaging with that community and trying to meet them where they are. So they should be hearing from the teachers, they should be hearing from other parents. They shouldn’t be hearing from a biotech company in Boston, right? And so like getting leaders on the ground to actually get real experience and feel like they understand and trust the platform, and then having them talk to folks in their community, that’s what we’re finding works well. But it’s a big part of this.

Jason Kelly:

Don’t underestimate, half of this is technology and half of this is social, which makes sense because, infectious disease spreads by people, right? Half the element of this whole thing, it really is how people respond to interventions. And so you got to think about that just as much as the technology. I think that’s true.

John Driscoll:

Yeah, see David, that’s where I think that this notion of it is being kind of part of our, not just public health, but personal health security infrastructure, we’ve got to sort of have a different view of this. With zoonotic viruses, viruses that can jump from different species to us, we are going to be dealing with more and more of these threats. And that’s where I think that what Jason’s doing is pathbreaking around creating a rationale and an infrastructure that I think it’s going to be essential, because I suspect that this won’t be the only COVID virus.

John Driscoll:

I mean, we’re actually seeing these other versions of it are just new versions of COVID viruses. And there’ll be more. But I do think there’s basically COVID fatigue, and without some combination of public and private leadership, Jason, I think it’s going to be hard, other than raw fear of the economy shutting down and schools shutting down, to keep people focused on it and keep folks like you to get paid to do it. Because I think that pool testing of this sort is going to be the new normal, if we’re going to get this right.

Jason Kelly:

Yeah. I’m sort of cautiously optimistic for the first time since we got involved with this a year and a half ago or whatever, John. I think you have federal leadership that is supportive of the idea of building out this kind of technology for reopening schools. You have a lot of funding that’s just gone out to states to support it. And you have, I think, parents and state governments that are motivated to keep schools open, but you have a big un-vaccinated population with students and we still have a big outbreak in this country. And so balancing those things, and it is a great opportunity to validate how monitoring on a regular basis can be used for containment. I think it’s really a unique moment. Well, yeah, I guess that’s what I would say. Yeah.

David Williams:

Well, John, you do, as usual, a good job of painting a nice portrait of the hellscape that’s out there for all of us. And I want to know about-

John Driscoll:

This is manageable. David, this is manageable. You’ve got to take more of that ginkgo. This is completely manageable.

David Williams:

I take enough of it. I emptied the bottle.

John Driscoll:

I think what’s frustrating to me is we didn’t invest. We didn’t over-invest in testing and surveillance and containment upfront, because it’s a little bit like broad spectrum antibiotics that blow out your entire system. When you shut the economy down, we really couldn’t target, contain, target, contain, heal, care for our country. And I think that’s going to be the new model. And I think what Jason and I have been brainstorming about is how do we get people from a public health and a national security perspective dialed in there? Because the technology that he is adopting and applying to the private sector, other countries are using in both their national defense, their research, and their public health infrastructure and winning that race. And part of that is building up our capabilities here, is kind of actually, I think, what’s going to drive economic success in the 21st century.

John Driscoll:

I think biology is going to be one of the big vectors, with synthetic biology, with big data and AI, and you see it in China’s massive investments in their biotech infrastructure, Jason. I don’t know whether you want to speak to that, but in addition to being public health oriented, it’s also going to drive the economy.

Jason Kelly:

Yeah, that’s right. And the other thing I would say, John, is the only thing COVID has taught us is that biology doesn’t respect borders, right? And so if the U.S. is thinking about building out biosecurity, which I think would be wise considering just the very obvious national security risks associated with 30,000 letters of RNA over the last year. And so if you’re going to build U.S. biosecurity, it’s global biosecurity, right? There is no such thing as just U.S. biosecurity.

Jason Kelly:

And so I think the U.S. should take this opportunity to particularly in the next year, help other countries out. Yes. Yes, we should be the vaccine manufacturing plant for the world. Yes, we should be developing the types of technologies for monitoring and the global weather satellites for infectious disease, right? Of course. This is what the U.S. does, right? And so I think there is a unique moment for us and with this administration, I think there’s a chance they lean into it over the next year to build all that. And we absolutely should. We should.

David Williams:

Kind of on the near term thing here, so John, you go into China, you go into five years from now world war seven.

John Driscoll:

I’m having a hard time tracking.

David Williams:

No, but I’m trying to figure out John, okay, we’re going to get the schools reopened. Well, guess what? The summer’s coming. What is going to happen in the summer? We’re going to go round to the beach and figure out who is positive on the beach? How does the pool testing work for that?

John Driscoll:

Well, I think it comes back to the social aspect and that Jason touched on is, do we have leadership that pays attention to public health and thinks more than one Twitter cycle ahead? And with that, locally and nationally, I do think that private and public union, teachers, leaders, conservative, we do now understand that we have had a threat and it has hurt us. And I think turning that into action and to Jason’s point, there’s a huge economic opportunity, but it’s foundationally. We’re only going to reopen the economy and keep it open and schools, if we continue to build out this infrastructure. That’s the lesson of the last six to twelve months. And so I’m probably modestly optimistic as well on that. But I think understanding the threat and the opportunity is what’s going to get us there, because viruses, I mean, you just look at Michigan right now.

John Driscoll:

You’re seeing explosions, micro explosions of the virus. It’s unclear why. And I don’t know whether Jason, you’ve got any experience in the pool testing in those schools, but they’re really suffering right now. I think I’ve got enough therapeutics, but they’re really suffering from just their [crosstalk 00:21:03].

Jason Kelly:

Well, and then you’re starting to see places close schools again, right? This is what’s going to happen. I mean, David, to answer your question, I think schools are actually kind of a unique organ in society in the sense that they cross cut everybody, right? And so I actually think they’re kind of centers of community or public health. They’re unique in that respect.

John Driscoll:

They absolutely are. Absolutely.

Jason Kelly:

Really. It’s an unappreciated thing, but if you actually start regularly doing monitoring in the schools, it helps keep the schools open, it keeps kids safe, and it also gives you, if you’re a public health department in a state, it gives you awareness of what’s going on, right? And so that is-

John Driscoll:

It’s your public health dashboard, David.

David Williams:

All right, John.

John Driscoll:

I mean, are you tracking? David, are you tracking?

David Williams:

John, now I got a question for Jason. So there’s a lot of money involved here. Now, Jason, when no one was looking, you guys borrowed, let’s just round it down to a billion dollars, from Uncle Sam. Now this is, I think, in the same tranche as when Kodak had to give this money back, but you guys were legitimate. So you’re going to pay it back? What are you doing with it? We’re talking about global biosecurity infrastructure. What’s going on? In all seriousness, we put some investment. We’ve got something riding on you guys.

Jason Kelly:

Yeah. Yeah, so we got approved for a loan from the development finance corp, DFC. There was an executive order last summer that allowed DFC to provide loans to U.S. companies for the first time. It’s been an international development organization in the past. And so, yeah, we were one of the first folks to be approved. And the idea is it is earmarked for this type of building up biosecurity infrastructure in the U.S. and also supply chain surety. And the work we’ve been doing in particular around vaccine supply chains, that’s what we’re going to earmark a lot of it for now.

David Williams:

I actually have a question about that one. So we talked mostly about testing here. You mentioned upfront that you had done some work in terms of vaccine development and there’s been, really, a terrific number of vaccines manufactured at this point. And it’s notable that even with J&J out of the picture for the moment, that the Pfizer and the Moderna vaccines have really scaled up. And you have some role in that, and I would like to hear just a little bit about that.

Jason Kelly:

Yeah. I mean, so the short answer to this, the challenge around nucleic acid vaccines, the exciting thing is they are fast. And so developing a new one is just a matter of getting a new sequence for a variant, synthesizing some DNA, putting it through a process at Moderna or Pfizer, and you can get a new vaccine out pretty quick with this technology. That’s really exciting. The downside was they’d never been made at scale, a new type of vaccine technology. So trying to produce hundreds of millions of doses, the supply chain had gaps all over the place. And so what we’ve been doing is just finding places where we can be relevant to that. So the two big categories are basically anybody who is doing a fermentation, where you grow bacteria up to produce the DNA.

Jason Kelly:

We can help optimize that fermentation. So you grow the cells better, you get more DNA out. And then the second area is turning DNA into RNA. You need all these enzymes to do that, and those enzymes are in short supply. And so working on better ways to make those in the future so that the cost for mRNA vaccines goes down, capacity goes up, and you can maybe get these out to countries that aren’t just the U.S. over time, is where we see opportunity, so.

John Driscoll:

But those vaccines, David, I think really make the point about what Ginkgo and what Jason is doing is so exciting. And with the genetic code of the virus laid out, within 48 days, we had a design for an mRNA vaccine that would work. That we could literally program to find, solve, and cure the body for this virus. It’s pretty remarkable that we can now-

Jason Kelly:

Yeah, it’s code as drugs, right? And Moderna, they talk about it that way, right? They’re like, “Yeah.” The beauty of it is their drug is encoded in the RNA. You put new code, and your drugs. It is a really exciting development. And honestly, no one would’ve ever pegged it at the efficacy it ended up hitting. Before this whole thing started, that was just-

John Driscoll:

Everybody was betting against [inaudible 00:25:28]. Again, it’s a biopharma company that was using the technologies that Jason’s used. Why he’s focused on corn versus people, Jason, you got to explain that to me at some other point. To really create the drugs use using the same tools, the things that are making us sick to make us heal, and programming it is, it’s really amazing.

David Williams:

Well, John, I’ve had all my questions answered today and I’m going to rest easy that COVID-somnia or whatever they’re calling it is now cured from me, as well as any lingering or approaching virus. So I’m going to say thank you to Jason Kelly from Ginkgo and Testing for America and John Driscoll from wherever you’re from. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll. Jason, it has been a joy to connect on this and focus on something that I still think, while we’re modestly optimistic, we still need to make out the point that this is an essential element, but you’ve given us a reason to be confident that American technology can still win, even if it’s beyond most people’s imagination. So thank you for that. I’m John Driscoll, the CEO of CareCentrix. Thank you, Jason. And if you like what you’ve heard or you haven’t, please tell us.