The feverish race is on: More than 100 coronavirus vaccines are in development.
The stock market grew giddy because eight people — eight — showed signs of antibodies that can block infection.
Many are optimistic that a vaccine will eventually take the bite out of COVID-19 — and hope is good right about now — but even at warp speed, vaccines take time. Sometimes decades. So many mysteries linger: How long might vaccine-induced immunity last? Two months? Six months? A year? Or, for some, not at all?
So many questions
As industry gears up to mass-produce one or more vaccines that don’t yet exist, there are plebeian concerns as well: Is there enough medical-grade glass to hold all those doses? Who’ll get vaccinated first? If the U.S. wins the race, will it “gobble up” early doses for its own citizens — even those at low risk — or share with the most vulnerable globally, including health care workers and seniors?
It can take years to answer all these questions, but officials vow to have millions of doses available by January. It’s a timetable never seen before, which some fear could compromise safety or isn’t realistic — or both. But necessity is the mother of invention, as a famous Greek once said, and advances in technology suggest this moon shot may, indeed, be doable.
To date, the novel coronavirus has infected some 1.6 million Americans and killed roughly 97,000. Worldwide, infections surpass 5 million, with 340,000 deaths. COVID-19 is an urgent public health priority, cautious optimism is strong in scientific circles, and the benefits of vaccine research may reach far beyond the virus at hand.
“An additional benefit of coronavirus vaccine projects, and in particular Operation Warp Speed, will be an increase in our scientific understanding of emerging viral diseases, led by virology, immunology and epidemiology, and better preparation and much faster and more effective responses to intercept any future novel zoonotic viral or bacterial pathogen introduction to the human population,” said Egest J. Pone, project scientist in UC Irvine’s Vaccine Research & Development Center, by email.
He compared the effort to the Manhattan Project during World War II, in which scientific and technical advances in nuclear physics were later developed for peaceful applications, such as nuclear power plants and nuclear medicine and research.
“An additional benefit of a novel coronavirus SARS-CoV-2 vaccine is that it may potentially confer some protection against the other four existing coronavirus strains (229E, OC43, NL63 and HKU1) that cause the common cold, so we may see a reduction in common colds,” Pone said.
Full steam ahead. Fingers crossed.
How do you develop a vaccine?
Once upon a time, scientists manipulated a whole virus to inactivate it or kill it, then injected it into people to invoke an immune response. That way, if and when people were later infected with the real thing, their immune systems were primed and ready to fight.
Jonas Salk’s dramatic polio vaccine field trials in 1954 may be the most famous example of that approach. They involved 623,972 children and more than 1 million “observed” controls. There was a great deal of controversy and criticism, but the results showed that Salk’s killed-virus preparation was 80% to 90% effective in preventing polio, which was killing some 16,000 children a year.
That classic approach to vaccine development didn’t change much through the last century — think tetanus, cholera, typhoid, measles. Development and testing often took many years.
But today, researchers have much more powerful tools at their fingertips — tools that allow them to use bits and pieces of the virus’ genetic material to provoke that sought-after protective immune response, rather than using the whole virus, as in years past. This can be done at speeds that would have amazed the likes of Salk.
This novel coronavirus surfaced only late last year, and, already, eight vaccines are in clinical trials and 110 are in development, according to data from the World Health Organization.
Whether their approach is classic (whole virus) or new (genetic pieces), most researchers are targeting the “spike” that gives the coronavirus its name. This spike allows the virus to invade healthy cells, and training the immune system to recognize it — and neutralize it so it can’t bind to cells — is the holy grail of vaccine research.
Speed bump ahead: While the new approaches are setting the fastest records in vaccine development, just a few such vaccines have ever been licensed, and for veterinary use only, says an article in the journal Nature by Oxford researchers Young Chan Kim, Barbara Dema and Arturo Reyes-Sandoval.
The current pandemic might provide the final push toward approval, they said. “This highlights the potential of vaccinology to make fast progress when appropriate international support exists, proving that where there is a will, there is a way.”
On May 18, Moderna, a biotech company pioneering therapeutics and vaccines to “create a new generation of transformative medicines,” made an announcement that sent hope — and the stock market — soaring.
The little company in Massachusetts said eight volunteers in its vaccine trial had developed neutralizing antibodies to the virus. Those are the kind of antibodies that can block infection, and exactly the kind researchers want to see.
After an analysis in Stat News pointed out some missing data in Moderna’s announcement, its stock prices fell back to earth again. For starters, there are 45 total participants in the trial, and Moderna didn’t say anything about whether there were neutralizing antibodies in the other 37.
“We’re seeing a lot of science by press release,” said Richard M. Carpiano, professor of public policy and sociology at UC Riverside. “The data come later, if they come at all. That’s not the way to do science. There’s a reason why experts sit around and discuss, debate, review findings — and they don’t do it on the public news channel.”
There’s a great deal we still don’t know about this virus, and how your immune system will respond over time.
“We aren’t entirely sure how long the antibody response against the coronavirus is protective — how long it’s going to work,” said David D. Lo, distinguished professor of biomedical sciences at UCR, who has worked on needle-free vaccines.
Lo cited research into dengue fever, a debilitating mosquito-borne disease caused by viruses akin to the ones that cause West Nile infection and yellow fever. Researchers working on a dengue vaccine discovered something peculiar, Lo said: A person’s antibody response can decline over time, and if the antibody “titer,” or concentration, falls below a certain point, those antibodies can actually enhance an infection.
“The antibodies can make it easier to infect,” Lo said of dengue. “That’s certainly a fear here. We don’t know whether an antibody response, if it’s protective in the short term, will decline to the point where you no longer have protection and may be potentially dangerous. We really don’t know about what protective immunity looks like.”
Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told that to U.S. senators earlier this month. Though rare, vaccines have been known to backfire, strengthening their target rather than killing it.
And some vaccines only protect a portion of the people who get it — the flu shot, for example, reduces the risk of of illness 40% to 60%, according to the CDC — and it’s only protective for about six months, which is why you’re prodded to get a shot every year.
An early study from the UK on antibody responses to the virus suggest that many folks didn’t develop much of an early immune response, and that long-term immune response faded noticeably after just two months.
“That means a vaccine will need to be quite effective if it’s going to stop the spread,” said David States, chief medical officer with Angstrom Bio in Austin, in a series of Tweets last month. “The polio, measles and smallpox vaccines are really remarkable medicines inducing high level long lasting immunity, but not all vaccines work so well.
“If you’re hoping a vaccine is going to be a knight in shining armor saving the day, you may be in for a disappointment.”
Sun through clouds
Pone, of UCI, said a vaccine can be engineered to be more immunogenic than the natural virus — that is, developed to induce antibodies that last for many years. Also, booster vaccines at regular intervals can ensure continued protection in the vast majority of the population.
After the Moderna announcement, cautious optimism reigns.
“Having looked at the data myself, it is really quite promising,” Fauci, the nation’s leading infectious disease expert, told NPR on Friday, May 22.
“I think it is conceivable, if we don’t run into things that are, as they say, unanticipated setbacks, that we could have a vaccine that we could be beginning to deploy at the end of this calendar year, December 2020, or into January 2021.”
Full results from the first phase of Moderna’s trial will be submitted for publication and peer-review in the next few weeks, he said. Meanwhile, the plan is to start making doses of vaccine even before scientists are completely sure it works. That ensures that, if and when approval comes, it’s ready to go.
The risk in this model is not to patients, “because the safety and the scientific integrity is intact. The risk is to the investment,” Fauci said.
Lo, from UCR, cautions against putting all eggs in the vaccine basket.
“A lot of people aren’t old enough to remember the days of the polio virus and the flu pandemic of 1918 — people wearing masks, not going to the public pool in the summer for fear of getting infected,” Lo said.
“This has to be attacked on many different fronts. A vaccine isn’t going to solve everything. You have to try to minimize the spread. You have to develop treatments and therapies.”
The anti-viral drug remdesivir has showed promise in shortening the duration of COVID-19 disease, and clinical trials investigating the use of convalescent plasma — injecting antibodies from recovered COVID-19 patients into those who are very ill — show promise as well.
With more than 100 vaccines in development, it’s likely there won’t be just one vaccine that gains approval, but several. Time will tell if one is better at controlling the disease than another.
Source: Orange County Register