Race to Develop Coronavirus Vaccine: Dr Badran

2019 Novel Coronavirus (2019-nCoV) is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.

"With each new threat comes the call for rapid vaccine development," Dr. Magdy Badran says.

Since 2003 the world has faced three outbreaks caused by coronaviruses — Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now the current outbreak caused by 2019-nCoV.

Scientists have yet to find a way to stop these outbreaks before they start. But over the past 17 years, they have drastically shortened the time it takes to develop a vaccine after a new virus emerges.

How Do Vaccines Work?

Vaccines are like a training course for the immune system. They prepare the body to fight disease without exposing it to disease symptoms.

When foreign invaders such as bacteria or viruses enter the body, immune cells respond by producing antibodies, which are protein molecules. These antibodies fight the invader known as an antigen and protect against further infection.

Unfortunately, the first time the body faces a particular invader, it can take several days to ramp up this antibody response. For really nasty antigens like the measles virus or whooping cough bacteria, a few days is too long.

The infection can spread and kill the person before the immune system can fight back. By injecting the vaccines into the body, the immune system can safely learn to recognize them as hostile invaders, produce antibodies, and remember them for the future.

If the bacteria or virus reappears, the immune system will recognize the antigens immediately and attack aggressively well before the pathogen can spread and cause sickness.

Vaccination Greatly Reduces Disease and Death Worldwide. Immunization currently prevents 2-3 million deaths every year.

Unless an environmental reservoir exists, an eradicated pathogen cannot re-emerge, unless accidentally or malevolently reintroduced by humans, allowing vaccination or other preventive measures to be discontinued.

While eradication may be an ideal goal for an immunization program, to date only smallpox has been eradicated, allowing discontinuation of routine smallpox immunization globally.

Vaccination will likely be part of multi-faceted public health response to the future emergence of a pandemic illness.

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In addition to other measures designed to respond to and control a pandemic, such as surveillance, communication plans, quarantine, and disease treatment, deployment of effective vaccines has the potential to protect lives and limit disease spread.

Eradication requires high levels of population immunity in all regions of the world over a prolonged period with adequate surveillance in place. The next disease targeted for eradication is polio, which is still a global challenge.

Immunization prevents deaths every year in all age groups from diseases like diphtheria, tetanus, pertussis (whooping cough), influenza and measles. It is one of the most successful and cost-effective public health interventions.

An additional 1.5 million deaths could be avoided, however, if global vaccination coverage improves.

The 1918-19 influenza pandemic killed an estimated 40-70 million people worldwide. Other, less severe, pandemic influenzas emerged in 1957-58, 1968, and 2009.

In the latter three cases, researchers developed influenza vaccines targeted specifically to the circulating virus, though experts disagree about how effectively the vaccines curtailed disease spread.

A Faster Vaccine Development for 2019-nCoV

Multiple companies are working on a vaccine to fight the coronavirus. Several groups are working on a vaccine for the new coronavirus, but there’s no guarantee that it will be ready before the end of the current outbreak.

Scientists are already racing to develop a vaccine for 2019-nCoV — a feat that experts say is technically possible, but still may not come in time to help during this outbreak.

Several groups started working on a vaccine for coronavirus shortly after Chinese scientists shared the virus’s genetic sequence in an online public database on Jan. 10.

Two pharmaceuticals say they will have a vaccine ready for testing in animals in one month. Another pharmaceutical estimates that it could have a vaccine ready for a phase one clinical trial in people in three months.

Newer vaccine technology is used, based on specific DNA or messenger RNA (mRNA) sequences of the virus. The chosen sequence codes for a viral protein, such as one on the surface of the virus.

This type of vaccine can still elicit a protective immune response in a person. But because the protein is only a small piece of the virus, it doesn’t cause illness. Scientists using this method can also start designing a vaccine as soon as they have the virus’s genetic sequence.

With other methods, they would need to work with actual virus samples in the lab. This technology bypasses many of the traditional steps to vaccine discovery and development. So it’s very fast.

One of the trials is aiming to have a vaccine ready for testing in people in 16 weeks, by developing a vaccine by growing viral proteins in cell cultures. Another company estimates it could have a vaccine ready for market within a year.

These rapid timelines may be “feasible” for the development of the vaccine. But they may be too fast for careful evaluation of the safety and effectiveness of the vaccines.

Given the urgency of preventing further spread of the virus, this rapid pace is expected. Once scientists have created potential candidates, the vaccines still have to go through animal testing and small and large clinical trials in people. These stages are needed to make sure the vaccines work and are safe.

Vaccine for People at High Risk

As this is an emerging disease and there is only limited data available, we do not yet know which groups of people might be prone to a more severe outcome following infection with coronavirus.

With the current outbreak, the World Health Organization estimates that only around 20% of people infected developed a serious illness. There’s so much that we don’t know about this virus.

Its epidemiology, its transmission patterns, who the vulnerable populations are. It appears at this point that older inpiduals, probably immune-compromised inpiduals, inpiduals with other medical conditions seem to be the ones who are affected the most by the severe disease.

Generally, young children, elderly people and those with underlying conditions (e.g. hypertension, heart disorders, diabetes, liver disorders, and respiratory disease) are expected to be more at risk of developing severe symptoms.

During the 2002-2003 SARS outbreak, it took about 20 months for a vaccine to be ready for testing in people. By then, the outbreak had been contained with public health measures like isolating infected people, setting up quarantines, and identifying people who have come in contact with those who are sick.

These steps are already being done in the current outbreak. Whether these can contain 2019-nCoV depends on many factors, some of which are still unknown — like how quickly the virus spreads and how serious the illness it causes is.

There are currently no vaccines against coronaviruses. That is why it is very important to prevent infection or contain further spread after an infection. Even if a vaccine makes it through all the rounds of testing, it’s unlikely that drug makers can manufacture enough vaccine to protect everyone who might be exposed to the virus.

It’s time to develop a universal coronavirus vaccine that would work against all viruses in this family — even the ones we don’t know about yet. Different types of coronaviruses share some of the same features, so a universal vaccine could theoretically be developed. But “we know from efforts to develop HIV or influenza vaccines, that this is not easy.

There have been 37,594 confirmed cases and 814 deaths from the coronavirus outbreak as of February 9, according to official figures. A vaccine is not a short-term solution controlling this current outbreak of 2019-nCoV, but it is an important tool that could control it for subsequent years if this virus continues to circulate in humans.