The coronavirus pandemic has been rattling the world for months, and as deaths keep piling up, scientists are racing to find a vaccine to put an end to the health crisis.
“By the beginning of 2021, we hope to have a couple of hundred million doses,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said.
With multiple vaccines in the making, particularly one by U.S. biotech company Moderna, Fauci’s optimism is not completely unwarranted. However, finding a vaccine is no easy feat.
“Everything will have to go incredibly perfectly if that’s going to happen,” Dr. Larry Corey, an expert in virology, immunology and vaccine development told CNN about Faucci’s timeline expectations.
The road to the vaccine
The process of making the vaccine follows the same principle for almost every virus. Whenever the body is fighting a virus, it develops antibodies, which are proteins that are specifically made to fight that virus. When creating a vaccine, scientists often use the germs that cause the virus in the first place, only that this time, those germs are weakened or dead. Then, by introducing these germs to the human body in the form of a vaccine, the body can create the immunity of protection it needs if it were to encounter the virus in an organic environment. It also seeks to create memory cells, which help give your body biological guidelines of how to fight the infection along with the antibodies.
However, even though the process for developing vaccines are similar, not every virus is the same.
The major problem with some viruses is that they mutate, making it almost impossible to pin down a formula or composition for the vaccine to work. Influenza, for example, is able to change itself in a year, meaning that the influenza that infected a population will not have the same molecular disposition than the one infecting the same community in 12 months, making efforts for a completely effective vaccine difficult. There are other viruses that are even more aggressive, like HIV, which can mutate in a single round of infection. The known variability in viruses causes many doctors to say that getting an effective vaccine out by the beginning of next year is a highly ambitious goal.
“There are some viruses that we still do not have vaccines against,” Dr. David Nabarro told CNN. Dr. Nabarro is a professor of global health at Imperial College London, who also serves as a special envoy to the World Health Organization on Covid-19. “We can’t make an absolute assumption that a vaccine will appear at all, or if it does appear, whether it will pass all the tests of efficacy and safety.”
“It’s absolutely essential that all societies everywhere get themselves into a position where they are able to defend against the coronavirus as a constant threat, and to be able to go about social life and economic activity with the virus in our midst,” Nabarro said.
Additionally, experts say that even if the development of a vaccine is successful, an effective vaccine could take decades to produce. Because of the chaos that the virus has brought on to the country, President Donald Trump created an operation called “Operation Wasp Speed”, whose sole purpose is to find a vaccine for the virus. Moncef Slaoui, the designated chief of the operation, said that he would not have taken on the job if he didn’t believe that they could produce a vaccine in 18 months. However, even Slaoui, who is a vaccine research veteran, admitted that the timeline is still “very aggressive.”
“We’ve never accelerated a vaccine in a year to 18 months,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, told CNN. “It doesn’t mean it’s impossible, but it will be quite a heroic achievement. We need plan A, and a plan B.”
The reason why vaccines are so helpful is because they act to prevent the disease so people’s bodies don’t have to suffer through the sometimes-mortal effects of the virus. However, experts suggest that if a vaccine were to fail, they would have to find an effective way to deal with the disease once the patient is infected.
“In HIV, we’ve been able to make that a chronic disease with antivirals. We’ve done what we’ve always hoped to do with cancer,” Paul Offit, a pediatrician and infectious disease specialist who co-invented the rotavirus vaccine, told CNN. “It’s not the death sentence it was in the 1980s.”
One of the advantages of finding a treatment that works is that by reducing the days of recovery or severity of the infection, a weight would be lifted from the nearly-collapsed health system. Like the vaccines, a number of treatments for COVID-19 are being tested at the moment. However, most of these are at very early stages and not cleared yet for routine use in hospitals. One of the more promising drugs is remidesivir, an experimental anti-Ebola drug that has been proven to reduce recovery time and lower death rates amongst patients.
Other treatments include blood plasma and the infamous hydroxychloroquine, which was called a “game changer” by president Trump but has failed to work on very sick patients.
“The drugs they’ve chosen are the best candidates,” Keith Neal, Emeritus Professor in the Epidemiology of Infectious Diseases at the University of Nottingham told CNN, adding that the problem has been the “piecemeal approach” to testing them.
What if there is no vaccine?
In the unlikely scenario that no vaccine can be found in time experts suggest that a different approach has to be implemented when it comes to preventing infection.
“The lockdown is not sustainable economically, and possibly not politically,” says Neal. “So we need other things to control it.”
Theoretically, the virus could stay in communities for months, or maybe even decades, if experts can’t find a way to prevent it. Even with treatments and vaccines, the virus could still take the lives of thousands of people every year if governments don’t find a way to control it. Some experts suggest that changing the approach to personal accountability could work, requiring people who fear being infected to take responsibility and isolate themselves until they feel safe. This would also mean more flexibility from businesses and employers.
“It (must) become a way of behaving that we all ascribe to personal responsibility … treating those who are isolated as heroes rather than pariahs,” says Nabarro. “A collective pact for survival and well-being in the face of the threat of the virus.
In addition, a strong health system is a vital piece for a safer existence with coronavirus.
“Absolutely critical is going to be having a public health system in place that includes contact tracing, diagnosis in the workplace, monitoring for syndromic surveillance, early communication on whether we have to re-implement social distancing,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, told CNN. “It’s doable, but it’s complicated and we really haven’t done it before.”
The good news is that even though there are some obstacles, there are also some promising resolutions. For instance, although the coronavirus has mutated before, it doesn’t do so as rapidly as HIV, or even malaria, which is a good sign for a potential vaccine. Furthermore, the virus seems to be responsive to some of the treatment medications that are being tested.
Dr. Fauci says he remains optimistic. “It will be when and not if,” he said in relation to having a vaccine option in our future.