Business & Politics
Race For A Cure – The Search For A Covid-19 Vaccine And Its Implications For Public Health
24th July 2020
The race is on to find a safe, effective vaccine against Covid-19 which would allow for an exit from lockdown restrictions, quarantines and social distancing. Producing a vaccine is a mammoth task by any standards, but manufacturing a safe, effective inoculation in a matter of months for a virus against which no one has immunity, is unprecedented. While modern technology has allowed for the most extraordinary scientific discoveries, the process is not without its challenges, be they medical, political, ethical or logistical.
Despite its complexities and unknowns, the novel coronavirus SARS-CoV-2 has one major feature that could play to our advantage. Unlike the seasonal flu, Covid-19 has so far seen minimal mutation; it is quite stable over time which makes it an ideal viral candidate for a vaccine. Even if it mutates over the course of several months, it is unlikely to render any vaccine useless – it will continue to offer a reasonable level of protection. In the public imagination, vaccines are often viewed as a cure-all, but this has dangerous implications as it may lead to the abandonment of social distancing and handwashing altogether.
Even the most effective vaccine in circulation today, the MMR (97% effective), does not provide complete protection – therefore, we should not become complacent even if a vaccine is found. It may also be the case that a vaccine will not necessarily prevent infection but will protect against severe disease in the most vulnerable populations. To diminish the effects of the disease from pneumonia to a common cold would relieve the burden on hospitals and allow for the lifting of travel, social and economic restrictions which would, in itself, constitute a major public health victory.
There are currently over 160 vaccine candidates being investigated, many of which are using entirely new techniques. Despite the lightning speed at which these vaccines are reaching the human trial stage, Prof. Sarah Gilbert, a vaccinologist at Oxford University, has reassured the public that the usual safety steps are not being missed out – work previously carried out in stages, is now being done in tandem. The research teams are developing the vaccine “at-risk”; however, this doesn’t mean a safety risk but a business risk – they are paying upfront for its mass production before they are sure of its success.
The desperate need for a vaccine in the shortest possible time has raised some ethical questions surrounding the issue of human challenge trials. This type of trial involves deliberately infecting a small number of vaccinated volunteers with Covid-19 in a controlled setting to see if the vaccine offers protection. If successful, it could help fast-track vaccine production and distribution.
“The desperate need for a vaccine in the shortest possible time has raised some ethical questions surrounding the issue of human challenge trials”
There are, however, many questions surrounding this technique. As the disease caused by the novel coronavirus remains poorly understood, many believe that a challenge trial would be unethical as there is currently still no reliable treatment and volunteers would be unable to give their full informed consent. If researchers don’t have a full picture of how the virus behaves, logically, this would mean they are unable to inform volunteers of the risks involved in participating.
Stanley Plotkin, a vaccine developer at the University of Pennsylvania, has responded to this argument by highlighting the fact that we are facing a pandemic with a high mortality rate. While the medical community would not want to cause harm to any volunteer, harm is already accumulating around the world. Therefore, if we can take action to reduce the total amount of harm, then it’s worth doing. He also states that challenge trials should only be performed on young, healthy people, but this approach also has its safety limits. If it is restricted to a small, homogenous group, this will limit its applicability to the wider population, not to mention the potential for missing issues that could only be caught in a larger, more diverse study demographic – a robust response in young people could mask harmful effects in older persons.
Quantifying risk is also a problem as young people are increasingly suffering severe complications from Covid-19, thus raising questions about the ethics of challenging any age group. The severity of the outbreaks in Brazil and the US may provide scientists with a unique opportunity to study the effectiveness of a vaccine quickly without the need for challenge trials at all. Testing a vaccine in an area where the virus is circulating widely (and naturally) is much more ethical. Here, the high infection rate is due to an inadequate governmental response to the pandemic, as well as delayed or ineffective lockdown measures, as opposed to deliberate infection by a research team.
The anti-vaccination movement poses a serious problem for any nation’s plans for mass immunisation. If there are any safety issues with the new vaccine, this could damage credibility and affect confidence, thus leading to decreased uptake. US infectious disease expert, Dr Anthony Fauci, says this could make achieving herd immunity impossible. ‘Anti-vaxxers’ are not the only political threat to public health; equitable distribution will also be a key issue in the coming months.
There is a growing fear of “vaccine nationalism”, an issue which Chloe Taylor compares to an arms race in a recent CNBC article. Governments are already trying to procure priority access via investments, which poses ethical concerns for those poorer countries who may not have the purchasing power to enable mass vaccination of their populations. This could prove problematic for developed nations too: if the virus continues to mutate in parts of the world unable to access the vaccine, it could once again pose a threat to global health, even to those already immunised. Therefore, fair and equal access to the vaccine for developed and developing nations alike is in everyone’s interests and requires collaboration between pharmaceutical companies, governments and patient-centric organisations such as MSF and WHO.
Featured photo Obi Onyeador