Why vaccine is unlikely to help the CoVID-19 crisis, and what is the alternative?
In recent weeks, all the global media broadcast the idea that coronavirus pandemic will not be fully over until vaccine is developed. However, this might be a big misconception. In the pharma world, currently there are two main research streams going in parallel — one is focused on vaccine and another one concentrates on treatment drugs. More than 160 laboratories around the world are conducting CoVID-19 trials, with around two-thirds of them focusing on vaccines and on-third — on drugs suppressing the virus. What the difference between these two categories? In short, the vaccine contains dead or suppressed fragments of the virus and is injected to a person that has not had the disease before — in order to stimulate the production of antibodies and provide immediate immune response against the virus infection in future. The suppressing drugs contain a substance that is supposed to stop the virus spread or kill the virus-occupied cells in the body that is already suffering from the virus. So why CoVID-19 treatment drugs could be a much better bet compared to vaccines?
1. Treatment is likely to be developed (much) faster. Vaccines are normally taken years or decades to develop. 17 years since the world battled an earlier coronavirus, SARS-CoV, no licensed vaccine exists. Trumps’ administration first mentioned and the media widely spread the foreseen “12–18 months” timeline for the vaccine development. Many scientists relate to this timeline as simply “not realistic”. There are even grimmer views, as Imperial college scientists suggested there is no vaccine in the foreseeable future and there might never appear one against the coronavirus. On the other hand, there are already positive results from initial trials of different treatment options against CoVID-19. There are two ways to develop it: the long one — to design a new drug from scratch, and a shorter one — to repurpose or adjust a drug that is already on the market to fight the coronavirus. Chloroquine is perhaps the most well-known early repurposing example. Apart from it, today in CoVID-19 trials there are more than 15 candidates antiviral, oncology and other drugs that were approved by the FDA to treat other conditions. Even if none of the existing medicines work — still even developing the treatment from scratch will be faster than producing a vaccine. Today, out 71 treatment drugs around 40 are in the pre-clinical stage, while 30 are already in the clinical stage. Out of 49 vaccine studies, only 2 have advanced into the clinical stage. This is not even taking into account that each development stage for vaccine normally takes much longer compared to treatment drugs. As a result, developing successful treatment appears not only a faster way to relieve of CoVID-19 crisis, but also a more realistic bet than the vaccine.
2. Cost, scale and timing of the action. Ok let’s imagine for a second that we have both the vaccine and the treatment drug developed at the same time. How many people need to take them? In case of treatment — all people that fell sick to the virus — now officially around 1mn people. Plus maybe 1–2mn of cases not currently captured or asymptomatic. Ok, let’s assume this will not happen tomorrow, but in a month, and we then will have 10mn cases globally. So, we need 10mn treatment course doses. How many vaccine doses will we theoretically need? Roughly speaking, we need to vaccinate everyone who hasn’t been infected with the virus. The herd immunity theory supporter may argue that 60% of the population being immune is enough to stop the pandemic. Given 8bn world population and 10mn people who are currently sick (and maybe 10mn that already overcome the virus), we will need 8bn*60%-20mn = 4.78bn doses of the vaccine. I’m making these calculations and assumptions simple and rough, because the difference in scale between 10mn treatment cases and 4,780 mn vaccinations is gigantic enough in order not to care about the precise assumptions. And all of those doses will need to be produced, packaged, shipped and then distributed under medical supervision throughout the world — and someone needs to pay for this. Never before the world seen such an example of one-time rapid global vaccination, like the coronavirus one global media expect to happen soon. At the beginning of April, several weeks after the pandemic started, the most powerful country in the world (the US) was not able to fully supply their medical stuff with simple generic KN95 masks. Given all those facts, how much time, cost and agitation will the global distribution of 5bn vaccines take?
3. Protesting potential against vaccine. The key point is both vaccine and treatment are going to cast some side effects, which is normal for modern medications. When you bring already infected and potentially suffering individuals the treatment that will help them — they are likely to be willing to accept it, even despite knowing about the possible adverse side effects. But the odds are different if you are trying to make a healthy individual accept the vaccination. Vaccine injection typically makes people experience mild but definite illness symptoms of the disease in exchange for theoretical protection against the virus in the future (probability of getting which is far less than 100%). In China you might be able to force people to get vaccinated, in the US and Europe you cannot. Various mass vaccinations have already caused sporadic protests. Coronavirus topic already causes unrest, with people setting on fire 5G towers in the UK and protesting against lockdowns in the US. Mass coronavirus vaccination might infuriate many people and stimulate social unrest. Moreover, the game theory scenarios are also possible, as many people might refuse vaccination relying on others who will get vaccinated and create “herd immunity” that ultimately will protect those that voluntarily refused. If the proportion of such “smart refusals” is large enough the global vaccination will fail.
4. Virus mutations. CoVID-19 is spreading for only 4–5 months around the planet, but scientists already found significant mutations in the virus. Even given the most optimistic timeframe for vaccine of 12–18 months, the vaccine might get outdated by the time of its release. Moreover, if in 1 year we will have 4–5 different CoVID-19 strains around the globe, we might need to go through 4–5 rounds of vaccination, which is again unrealistic.
The majority of coronavirus cases are asymptomatic or mild. Only 20% of infected develop symptoms and 3–4% die. Finding the treatment that helps the most severe cases and brings death rate down to zero might be enough to overcome the CoVID-19 crisis. One of the most prominent treatments currently is Gilead’s remdesivir, a drug originally developed to treat Ebola that showed improvement in 68% of critically ill COVID-19 patients in a small study. Other promising treatment drugs are above-mentioned chloroquine, artificial antibody drugs (e.g. Roche’s Actemra and Sanofi’s Kevzara), repurposed anti-HIV drugs as well as a dozen of others. This is actually very positive news, meaning that we do not need to wait years for the hyped but shallow vaccine strategy to work, and the crisis could be over much faster than is currently thought.
