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NOTINE LONG years have passed between the isolation of the measles virus in 1954 and the approval of a vaccine. The world waited 20 years between the first trials of a polio vaccine and the first US license in 1955. So marvel at how scientists around the world are on the way to producing an effective polio vaccine. SARS–VSOV-2, the virus that causes covid-19, in one year.
And not just any vaccine. The first data from an end-stage trial unveiled this week by pharmaceutical companies Pfizer and BioNTech suggest that vaccination reduces your chances of suffering from symptoms by more than 90%. It’s almost as good as for measles and better than the flu shot, only 40-60% effective (see article). Suddenly, in a gloomy winter, there is hope.
Unsurprisingly, the news from Pfizer on November 9 woke up the bulls in the markets. Investors have ditched stocks in Clorox, Peloton and tech companies, all of which have benefited from the coronavirus, and instead turned to companies like Disney, Carnival and International Consolidated Airlines Group, which will do well when the sun shines again. (see article). the OECD, a club of predominantly wealthy countries, estimates that global growth in 2021 with an early vaccine will be 7%, two points more than without.
There is indeed a lot to celebrate. Pfizer’s result suggests other vaccines will work as well. More than 320 are in development, many in advanced testing. Most, like Pfizer, focus on the peak protein with which SARS–VSOV-2 wins entry into cells. If one vaccine has used this strategy to boost immunity, others probably can too.
Pfizer’s vaccine is also the first to use a promising new technology. Many vaccines stimulate the immune system by introducing inert fragments of viral protein. This causes the body to make the viral protein on its own by inserting genetic instructions contained in a form of RNA. Because you can modify RNA, the vaccine can be modified in the event of a mutation of the spike protein, as has recently been the case in mink. This platform can be used with other viruses and other diseases, possibly including cancer, which was BioNTech’s original goal.
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So, celebrate how far biology has come and how efficiently it can manipulate biochemical machines for the good of mankind (it will be time to worry later about how this power might be abused as well). And celebrate the power of science as a global business. Drawing on contributions from around the world, a small German company founded by first-generation Turkish immigrants has successfully worked with an American multinational corporation headed by a Greek CEO.
Yet despite the good news, two big questions arise, on the characteristics of the vaccine and the speed of its distribution. These are the first results, based on 94 symptomatic cases of covid-19 among the 44,000 volunteers. Further responses must wait until the trial has collected more data. It is therefore not clear whether the vaccine stops severe or mild cases, or whether it protects the elderly, with weaker immune systems. It is also not known whether the inoculated people can still cause life-threatening infections in those who have not yet received the injections. And it is too early to be sure how long the beneficial effects will last.
Clarity will take time. Over the next few weeks, the trial is expected to be declared safe, but additional vaccine monitoring will be required. The companies expect the immunity to last at least a year. The efficacy of over 90% is so high that this vaccine can offer at least some protection to all age groups.
While the world waits for data, it will have to grapple with distribution. Vaccines will be scarce for most of next year. Although RNA jabs may be easier to do on a large scale than protein-based jabs, Pfizer requires two doses. The company said it would be able to produce up to 50 million doses in 2020 and 1.3 billion next year. Sounds like a lot, but America alone has more than 20 million first responders, medical personnel, nursing home workers, and active duty soldiers. Perhaps one-fifth of the 7.8 billion people worldwide, including two-thirds of those over 70, are at risk of severe covid-19. No one has ever tried to vaccinate an entire planet at once. As the effort increases, syringes, medical glass, and staff may run out.
Worse yet, Pfizer injections should be stored at temperatures of -70 ° C or even colder, well beyond the reach of your local pharmacist. The company is building an ultra-cold chain, but logistics will still be difficult. The vaccine comes in batches of at least 975 doses, so you need to assemble that many people for their first injection, and the same crowd again 21 days later for a booster. No one knows how many doses will be wasted.
As long as there are too few vaccines to circulate, priorities must be set by governments. Much depends on how well they are carried out, within and between countries. Modeling suggests that if 50 rich countries were to administer 2 billion doses of an 80% effective vaccine, they would prevent a third of deaths worldwide; if the vaccine were provided based on the population of rich and poor countries, this share would almost double. Details will depend on the vaccine. Poor countries may find ultra-cold chains too expensive.
The national response to these problems is the establishment of national committees to allocate vaccines optimally. The overall answer is COVAX, an initiative to encourage equal access of countries to supplies. Ultimately, however, the solution will be to keep working on more vaccines. Some might survive in commercial refrigerators, others will work better on the elderly, still others might provide longer protection, require a single injection, or stop infections and symptoms. Anyone that works will help increase the supply.
Only when there is enough for everyone will anti-vaxxers become a hindrance. Early reports suggest that the jab causes fevers and body aches, which may also put some people off. The good news is that 90% efficacy makes vaccination more attractive.
The tunnel in front
The next few months will be difficult. Global death rates have passed their April peak. Governments will struggle with the logistics of immunization. America is rich and has world-class medicine. But that is likely to be missing because the virus is raging there and because the transition between administrations could cause chaos and unnecessary delays. The wasting of lives when a vaccine is at hand would be particularly cruel. Science has done its part to eliminate the virus. Now comes the test for the company. ■
This article appeared in the Leaders section of the print edition under the headline “Suddenly I Hope”
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