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Pinning Hopes on a Vaccine

Terry H. Schwadron

June 14, 2020

Even as the putative coronavirus vaccine remains months away at the earliest appearance on the public health stage, it already is starting to hog more than its share of controversy as well as the hope it will bring.

That’s quite something, since we are dealing directly with continuing deaths, more outbreaks of the virus and a tidal wave of joblessness and business shutdowns and turndowns. We couldn’t wait, and we’re already blaming Science for not having an instant answer to contagious disease. So now, we simply are ignoring disease.

We don’t even know what the vaccine needs to be, since we’re still trying to dope out the full effects of the illness it will target. Still, politicians with widely differing agendas, financial markets and day care centers, hospital ICU workers and subway riders are putting all their hopes for a relatively normal status for society on an injection that doesn’t exist yet.

From its first would-be injection, this vaccine has to work pretty perfectly without causing any safety side effects even as the illness itself works mysteriously through a global population — the equivalent of doing precision work while hanging from the open window of a moving vehicle.

Plus, the vaccine — or combination of several vaccines to cover the different medical aspects of coronavirus — must prove capable of massive manufacture and complicated delivery everywhere almost at once and that teeny-tiny matter of getting people who don’t want to wear masks or temporarily stop going to bars actually to take the vaccine.

But there is progress on vaccines, with a number of positive announcements even in the last two weeks, based on samples so small that they lack even repeatability, to say nothing of medical validity.

Still, strangely I have a lot more faith that we will solve the scientific questions than the human ones.

The Medical Progress

There are more than 100 research teams globally trying to solve the vaccine puzzle, but our federal government is picking up to seven to back with investments towards earliest delivery. The best progress recently was reported by U.S. company, Moderna, which is based on shooting bits of virus genes into human cells to prompt and build a natural immune response. Other currently leading approaches are from the University of Oxford (Britain), which build on the idea of stimulating protein production in cells to fight disease, an effort to which the U.S. government has pledged a billion dollars, and CanSino Biologics (Canada/China). Other approaches use dead coronavirus cells, including from former patients.

In short order, we’ll be hearing about clinical trials, with hope perhaps hyping the results. Those initial positive results from Moderna involved just eight volunteer patients, hardly a barometer of safety. Separately, there have been some advances announced about our collective abilities to produce vaccines in mass, and to obtain enough glass for vials or syringes and the like to serve the entire United States and other countries. Of course, there have also been news reports about financial interests of the guy we’ve put in charge of developing vaccines.

So, the first issue we are going to face in vaccines involve enforced patience. As with re-opening the economy, even that normal wait for clinical trials to run their course are already running into opposition on the political front, with Donald Trump already manically claiming that there WILL BE a vaccine for distribution by the end of the year.

In short, we should anticipate that there will be huge political and economic pressures to put whatever vaccine candidates look promising into public use before they pass safety muster. Just look at the hydroxycholoqine treatment example, now found in actual clinical setting to do little to nothing to prevent the virus from taking hold. History says premature reliance on under-tested vaccines prove disastrous.

And worsening the situation, of course, is that without a national testing program in place, without reliable statistics, we have little idea of the literal targets for such a vaccine or vaccine combination. The statistics we have are crude by effective vaccine standards, and recent reporting by The Atlantic Magazine has unearthed the fact that different states, naturally, are using different analysis and statistics, further gumming up the targeting work.

And then there is the issue that the virus itself will mutate, requiring flexibility in any vaccine.

The Human Factor

Of all the difficulties ahead facing vaccine development, what worries me a lot is that the same streak putting individualism over public health and immunity will simply worsen.

Between anti-vaxxers, who have a surprisingly strong political base, and the Don’t-Tell-Me-What-to-Do crowd, even if we get an effective vaccine, I worry that large portions of the country won’t take it.

Seasonal flu shots have been available for years, and only about 45% of the country takes them, even at no out-of-pocket cost and wide availability. And once they do, flu deaths normally are reduced by between 40% and 60%.

Coronavirus is far more lethal than flu, and the expectations may be higher for effectiveness. Without the vaccine, there will be continuing questions about sending kids to school, or putting consumers in stories, workers in factories or travelers in airplanes.

Of course, what I worry about the most is that the Trump government will give me political talk, and politically tinged actions, and not the straight medical information that should guide decision-making.

It’s almost as much to worry about as the disease itself.


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