COVID-19: What if coronavirus vaccine don’t work or ever found, could humans learn to live with it?
In 1984, the US Secretary of Health and Human Services Margaret Heckler announced at a press conference in Washington, DC, that scientists had successfully identified the virus that later became known as HIV — and predicted that a preventative vaccine would be ready for testing in two years.
Nearly four decades and 32 million deaths later, the world is still waiting for an HIV vaccine.
Instead of a breakthrough, Heckler’s claim was followed by the loss of much of a generation of gay men and the painful shunning of their community in Western countries.
For many years, a positive diagnosis was not only a death sentence; it ensured a person would spend their final months abandoned by their communities, while doctors debated in medical journals whether HIV patients were even worth saving.
The search didn’t end in the 1980s. In 1997, President Bill Clinton challenged the US to come up with a vaccine within a decade. Fourteen years ago, scientists said we were still about 10 years away.
The difficulties in finding a vaccine began with the very nature of HIV/AIDS itself. “Influenza is able to change itself from one year to the next so the natural infection or immunization the previous year doesn’t infect you the following year. HIV does that during a single infection,” explains Paul Offit, a pediatrician and infectious disease specialist who co-invented the rotavirus vaccine.
“It continues to mutate in you, so it’s like you’re infected with a thousand different HIV strands,” Offit tells CNN. “(And) while it is mutating, it’s also crippling your immune system.”
HIV poses very unique difficulties and Covid-19 does not possess its level of elusiveness, making experts generally more optimistic about finding a vaccine.
But there have been other diseases that have confounded both scientists and the human body. An effective vaccine for dengue fever, which infects as many as 400,000 people a year according to the WHO, has eluded doctors for decades. In 2017, a large-scale effort to find one was suspended after it was found to worsen the symptoms of the disease.
Similarly, it’s been very difficult to develop vaccines for the common rhinoviruses and adenoviruses — which, like coronaviruses, can cause cold symptoms. There’s just one vaccine to prevent two strains of adenovirus, and it’s not commercially available.
“You have high hopes, and then your hopes are dashed,” says Nabarro, describing the slow and painful process of developing a vaccine. “We’re dealing with biological systems, we’re not dealing with mechanical systems. It really depends so much on how the body reacts.”
Human trials are already underway at Oxford University in England for a coronavirus vaccine made from a chimpanzee virus, and in the US for a different vaccine, produced by Moderna.
However, it is the testing process — not the development — that holds up and often scuppers the production of vaccines, adds Hotez, who worked on a vaccine to protect against SARS.
“The hard part is showing you can prove that it works and it’s safe.”
If the same fate befalls a Covid-19 vaccine, the virus could remain with us for many years. But the medical response to HIV/AIDS still provides a framework for living with a disease we can’t stamp out.
“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,” Offit says. “It’s not the death sentence it was in the 1980s.”
The groundbreaking development of a daily preventative pill — pre-exposure prophylaxis, or PrEP — has since led to hundreds of thousands of people at risk of contracting HIV being protected from the disease.
A number of treatments are likewise being tested for Covid-19, as scientists hunt for a Plan B in parallel to the ongoing vaccine trials, but all of those trials are in very early stages.
Scientists are looking at experimental anti-Ebola drug remdesivir, while blood plasma treatments are also being explored. Hydroxychloroquine, touted as a potential “game changer” by US President Donald Trump, has been found not to work on very sick patients.
“The drugs they’ve chosen are the best candidates,” says Keith Neal, Emeritus Professor in the Epidemiology of Infectious Diseases at the University of Nottingham. The problem, he says, has been the “piecemeal approach” to testing them.
“We have to do randomized controlled trials. It’s ridiculous that only recently have we managed to get that off the ground,” Neal, who reviews such tests for inclusion in medical journals, tells CNN. “The papers that I’m getting to look at — I’m just rejecting them on the grounds that they’re not properly done.”
Now those fuller trials are off the ground, and if one of those drugs works for Covid-19 the signs should emerge “within weeks,” says Neal. The first may already have arrived; the US Food and Drug Administration told CNN it is in talks to make remdesivir available to patients after positive signs it could speed up recovery from the coronavirus.
The knock-on effects of a successful treatment would be felt widely; if a drug can decrease a patient’s average time spent in ICU even by by a few days, it would free up hospital capacity and could therefore greatly increase the willingness of governments to open up society.
But how effective a treatment is would depend on which one works — remdesivir is not in high supply internationally and scaling up its production would cause problems.
And crucially, any treatment won’t prevent infections occurring in society — meaning the coronavirus would be easier to manage and the pandemic would subside, but the disease could be with us many years into the future.
What life without a vaccine looks like
If a vaccine can’t be produced, life will not remain as it is now. It just might not go back to normal quickly.
“The lockdown is not sustainable economically, and possibly not politically,” says Neal. “So we need other things to control it.”
That means that, as countries start to creep out of their paralyses, experts would push governments to implement an awkward new way of living and interacting to buy the world time in the months, years or decades until Covid-19 can be eliminated by a vaccine.
“It is absolutely essential to work on being Covid-ready,” Nabarro says. He calls for a new “social contract” in which citizens in every country, while starting to go about their normal lives, take personal responsibility to self-isolate if they show symptoms or come into contact with a potential Covid-19 case.
Read the full article here: Life without a working Coronavirus Vaccine