It was first detected in China back in December 2019, and since then COVID-19 has swept across the globe causing potentially fatal respiratory issues in many people who get infected. Major events across the world have been canceled, the final weeks of sports leagues have been postponed, and a large chunk of the world’s population is in enforced or self-imposed quarantine. International and local governments are working to slow the spread and “flatten the curve” of the infection rate. At the same time, scientists and epidemiologists are working to understand and combat what has become known as SARS-CoV-2, a new type of coronavirus.
Once the virus that’s causing the sickness was isolated, scientists in labs around the world have been working continuously to understand the genetic makeup, it’s mechanism of infection, and, most importantly, the ways medical professionals can treat and cure the infection. We don’t have a cure, yet. What doctors and nurses can do is treat and manage the symptoms of the disease to help patients fight it themselves. As you might expect, the long-term solution to eradicating from the six populated continents is to develop, test, and roll-out a vaccine. Jackson Ryan explored what’s going on right now in the process to create a vaccine for cnet, where this article appeared in its original form.
It can be a slow process to develop a new vaccine. There are lots of testing phases to go through to ensure that it’s safe, through clinical trials, as well as making sure it’s actually effective, too. The director of the National Institute of Allergy and Infectious Diseases in the US, Anthony Fauci, has said on multiple occasions that it’s going to take a year to 18 months to get one made, and most experts tend to agree with this assessment.
In our battle chest against infectious diseases, vaccines are massively important. There are plenty of viral diseases that don’t have treatments but are kept out of circulation due to vaccination programs. Even in the face of this proven effectiveness, not everyone is behind the idea of vaccines. Here, we’re going to explore exactly what a vaccine is, why the world needs them, and how they’re going to be deployed against this novel coronavirus.
Here’s what we are going to cover below:
- How do vaccines work?
- How are vaccines made?
- Vaccinating against COVID-19
- How long will we have to wait for a vaccine?
- What options do we have at the moment?
- What protection measures can we all take now?
How do vaccines work?
A vaccine works by prompting your immune system to learn how to battle against agents of infection, such as bacteria and viruses. The World Health Organization says that vaccines are “one of the most effective ways to prevent diseases.”
As humans, we’re pretty darn good at fighting off a lot of diseases, thanks to our ability to evolve a natural system of defense against the bacteria and viruses that make us sick. This system is called the immune system and is made up of a range of different white blood cells that will hunt down and attack anything that shouldn’t be in our bodies. Their mechanisms vary, with some white blood cells devouring the infection and others that have instructions for the body for what chemicals to produce to take out the bodily invaders. There are other cells that memorize the germs they’ve fought off before so that your body can fight them off swiftly if you catch the disease again.
Vaccines are a smart way we’ve developed to fool your immune system, but in a good way. A vaccine lets your body think it’s infected so that those white blood cells can figure out how to fight a disease. As an example, with the measles vaccine, it will trick your immune system into reacting to measles, even though you’re not actually sick. Once your body has learned how to fight the fake disease, the white blood cells create a memory of what to do if you catch it for real. If the measles virus gets into your body, it’s kicked to the curb quickly with this prior knowledge.
You may recall the name Edward Jenner from your high school science classes, he invented the first vaccine back in the 18th century. He conducted one of the most famous experiments ever, in which he took the pus from milkmaids with cowpox and gave it to a young boy. Cowpox is a virus that occurs mainly in cows and passed over to milkmaids, making them sick in a similar way to smallpox, but nowhere near as deadly. Surely enough, Jenner’s experiment subject, the young boy, got sick with cowpox and recovered before being given a dose of smallpox. The boy didn’t catch smallpox, since the cowpox sickness had taught the boy’s body how to go about fighting off disease that was so similar.
That was back in 1796, and we’ve come a long way in our understanding of vaccines since then. You’re not getting injected with pus anymore, and there are stringent rules and regulations around them and the type of testing they must go through before they get rolled out across the world.
How are vaccines made?
There are a few different things that go into a vaccine, and it’ll differ depending on how the vaccine works and what disease they vaccinate for. There are things that go into all vaccines, though.
The key to a vaccine working is the antigen. This is the ingredient that is going to get your body learning how to fight it. There are a few different ways the antigen can be introduced into your body; sometimes there’ll be molecules of a virus, usually it’s RNA or a protein, other times is a weak or deactivated version of the living virus. If we go back to the measles vaccine, that one will have a very weak version of the actual measles virus. Once injected, the body’s white blood cells figure out the dangerous protein in the virus and figures out how to break it down.
Next to go into a vaccine is the adjuvant. This is a substance that will make your body amplify its response to the antigen. Not every vaccine will have an adjuvant, it depends which disease it’s vaccinating for.
So that the vials for vaccines could be reused a few times, there are some that used preservatives so that other, potentially harmful bacteria, couldn’t grow. One of these preservatives is a chemical called thimerosal. There has been a lot of talk about it over the years because it contains ethylmercury, a form of mercury that very easily passes through the human body. There’s zero evidence that thimerosal causes any harm to people, so says the CDC. In Australia, they have moved towards single-use vials so there is much less use of preservatives in vaccines. What’s vital in science’s quest for a SARS-CoV-2 vaccine is an antigen that’s going to stimulate the body to make the white blood cells needed to fight off the viral infection.
Vaccinating against COVID-19
SARS-CoV-2 is the pathogen that’s at the center of this outbreak and it belongs to a type of virus called coronaviruses. They get their name because they look like they have little crowns on the virus when you look at them under a microscope.
Scientists reckon that it’s the spikes on the crowns that are going to help get a vaccine for SARS-CoV-2. The spikey projections make it possible for the virus to get into a human cell, where it will then start to replicate quickly, making people sick. The proteins are made of “spike proteins”, or “S” proteins. There has already been a map made of these projections using 3D modeling and it’s thought at this point that they could be the right antigen to get a coronavirus vaccine developed fast.
Scientists are focusing on the S protein because we already know about it from previous outbreaks like SARS in 2002-3. Being familiar with this part of the virus has given them a leg up in creating a vaccine against the S protein. In animal modeling, it seems viable to have an immune response to the protein.
Around the world, there is a concerted effort to get a vaccine for SARS-CoV-2 and quick, all working on different ways to make your immune system react. The approaches that are getting the most attention at the moment are the ones that use a pretty new method of vaccination, called “nucleic acid vaccine”. Basically, the scientists are able to program the vaccine with a little bit of genetic coding that will be used as the antigen.
Moderna, among other biotech companies, is figuring out new designs for vaccines for SARS-CoV-2 that they can roll out quickly. The process is to get a piece of the genetic coding for the S protein and fusing it together with fatty nanoparticles which then get injected into the body. Over at Imperial College London, there’s a team using a similar technique to create a vaccine by using the coronavirus RNA, it’s simplified genetic code. In a similar vein, Inovio, a biotech firm out of Pennsylvania, are working to generate strands of DNA that will get the human body to have an immune response. There’s a lot of speed in this process, but so far nothing has come to market out of it.
Other vaccine efforts are coming from Johnson & Johnson, as well as Sanofi, the French pharmaceutical manufacturer. They’re working in conjunction with the US Biomedical Advanced Research and Development Authority to get a vaccine made. Sanofi’s tactic is to mix the DNA of coronavirus with the genetics from a virus that will be harmless, whilst J&J is planning to switch off the dangerous parts of SARS-CoV-2 so that their vaccine won’t make you sick but will still train your body to fight against the real thing.
Another tack to the research is to find different adjuvants that will make the immune response stronger, and this work is being done by places like Boston Children’s Hospital. The Harvard Gazette says that this approach is going to be most useful for older recipients of a vaccine, because their body is slower to respond. By really getting to grips with adjuvants that boost vaccines, it’s hoped that the elderly population will get a combination of ingredients that will really boost their immunity to SARS-CoV-2.
How long will we have to wait for a vaccine?
A year to a year and half is the current timeframe that we’re looking at getting a full vaccine online, according to Fauci, of the infectious diseases institute. Human trials should be starting within days in the USA, in an interview with 60 Minutes in Mach Fauci said this is impressively quick turnaround time.
“The good news is we did it more quickly than we’ve ever done it,” Fauci told 60 Minutes.”The sobering news is that it’s not ready for prime time, for what we’re going through now.”
What’s the hold up with getting the vaccine ready? It’s a multi-step process, with lots of regulatory hoops to jump through.
“For any medicine to be sold it needs to go through the standard process of clinical trials including phase 1 [to] 3 trials,” explained Bruce Thompson, dean of health at Swinburne University in Australia. “We need to ensure that the medicine is safe, will not do harm, and we know how effective it is.”
There’s no use just assuming that a vaccine is going to work, that’s not how science works. There needs to be rigorous testing, including the recruitment of thousands of volunteers to make sure any vaccine is safe and actually useful. The full process looks something like this:
- Designing the vaccine: the pathogen is studied and scientists work out how to make the immune system attack it
- Studying in animals: animal modeling needs to be done on new vaccines to make sure that it works with no extremely bad side effects
- Phase 1 clinical trials: this is the first stage of human testing, where the safety, dose, and side effects are figured out. They’re only small, but important, trials
- Phase 2 clinical trials: the analysis is deeper in terms of how the vaccine works on a biological level. there are more test patients in this phase and how their body responds is checked out. In the case of coronavirus, they’ll likely look for the way in which the immune system is stimulated
- Phase 3 clinical trials: at this stage, there is a large sample of people in the trial and it’s completed over a longer time period
- Regulatory approval: once the testing is over, it’s over to regulators like the US Food and Drug Administration, the European Medicines Agency and Australia’s Therapeutic Goods Administration. Their job is to look at all the experimental evidence and the trial results to see if the vaccine can start to be used
In the past, this process has been very drawn out, taking more than a decade for a new vaccine to move through these steps from design to approval. Even once the science is completed, the vaccine still needs to get made in factories by the drug companies in scales that will get immunity widespread as soon as possible.
The process is getting sped up for the SARS-CoV-2 vaccine. In a STATnews report, it says that Moderna’s vaccine has leapfrogged animal testing and gone directly into phase one human trials with its mRNA vaccine. The trials are due to get underway at Seattle’s Kaiser Permanente Washington Health Institute, where they’re already recruiting test patients.
Whilst the wheels of progress are turning, everyone on the front line against SARS-CoV-19, the doctors, nurses, health workers, and medical specialists, must stick with conventional treatments against the virus.
What options do we have at the moment?
If you want to not get sick, the best thing to do is not come into contact with the virus. We’ve got some tips on that further down.
First, we need to dispel any thoughts about antibiotics. They’re designed to fight bacteria and are completely ineffective against a virus, which SARS-CoV-2 is. Anyone who gets infected is going to be asked to self-isolate for 14 days to prevent them spreading the infection further. If you get significantly sicker, such as being short of breath, a very high fever, or extreme lethargy, you need to get in contact with health professionals.
When a patient gets admitted to hospital with COVID-19, the treatment entails managing the symptoms as best as possible. When a patient has problems with their lungs and can’t breathe on their own anymore, a tube gets placed in their airway and then connected to a ventilator, which is a machine that will help them breathe.
There is nothing specific that can be done to cure COVID-19 at this point, but scientists are working on them. Areas being studied include experimenting with antiviral drugs to attack the virus and trying out other drugs that are used on HIV and other viruses, there have been some promising results with this, so far.
Remdesivir is an antiviral drug made by Gilead Services, a biotech firm. It’s still experimental but it’s getting a lot of attention at the moment. It’s being tried out in the US, China, and Italy but because it’s not received approval from regulators it can only be used “compassionately”, meaning it can only be used on patients that are critically sick. Remdesivir isn’t SARS-CoV-19 specific, but it attacks some of the virus’ machinery, the “RNA polymerase”, the part of the virus that makes it replicate. Previous tests have shown that it’s worked on human cells and in tests using mice.
There’s still debate around how effective it will be and there are more tests that need to be completed before it will get widespread use against SARS-CoV-2, that’s if it does get approved.
Other treatment options
Kaletra/Aluvia is a medicine normally used for HIV treatment and has been used to treat COVID-19 in China. An Illinois-based pharmaceutical called AbbVie released a statement saying that the drug was being offered experimentally in the early stages of the disease. The statement also suggested that they were working with international health authorities such as the CDC and WHO.
Chloroquine has been used to treat malaria for at least 70 years, and is being mooted as a candidate for COVID-19 treatment. The drug seems to stop viruses from attaching to human cells, where they can start to replicate. It’s also proved to offer a boost to the immune system. In a letter to Nature’s editor on Feb. 4, there was evidence presented to show that chloroquine had been effective in fighting SARS-CoV-19. A study out of Guangdong in China reported that patient outcomes were improved when chloroquine was used and “might improve the success rate of treatment” and “shorten hospital stay.”
What protection measures can we all take now?
Waiting around for a vaccine against SARS-CoV-19 isn’t the best idea due to the timescales involved. To stop the spread of the virus that’s causing so much devastation, you need to maintain personal hygiene and practice what’s known as social distancing. “The best thing to do is the simple things like hand washing and hand sanitizing,” Thompson said.
We’ve never seen an outbreak of a new virus like this before, and we all need to live our lives differently to stop it from getting much worse.
The WHO has a plethora of resources at hand to help you understand how you can protect yourself at the moment. We know that the virus spreads due to human contact and community transmission is occurring globally. There are a few key things you need to do to stay as safe as possible:
- Wash your hands for at least 20 seconds, that’s about two rounds of “Happy Birthday”, there’s some more tips here.
- Practice social distancing, which means staying three feet or one meter away from anyone, especially if they’re coughing or sneezing
- Keep hands off your face, especially your eyes and mouth since this is how the virus gets into your body
- When you have to cough or sneeze, do it into your elbow
- If you’ve been somewhere with cases of COVID-19, stay at home and self-isolate for two full weeks
To get the most up to date information about the coronavirus pandemic, regularly visit the WHO website.