The United States leads the world in medical research and healthcare spending. In 2005, President George W. Bush announced a detailed and comprehensive plan written by the Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) to prevent and respond to infectious diseases at the state and federal levels. Congress allocated $8 billion to map outbreaks, accumulate resources, and create preparatory policies.
Despite nearly two decades of anticipation, the COVID-19 pandemic has provoked tremendous loss of life, exhausted the medical system, and started an economic downturn in the United States [1, 2, 3]. In hopes that the long-awaited vaccine will restore normalcy, Congress has directed almost $10 billion to Operation Warp Speed, an initiative by the U.S. Department of Health and Human Services and the Department of Defense to “produce and deliver 300 million doses of safe and effective vaccines with the initial doses available by January 2021.” The arrival seems a long ways away, but is a sprint in the research world.
The science of immunization makes progress slow. Coronaviruses such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and SARS-CoV-2–the disease agent of COVID–have a surface protein S that gives the viruses their characteristic crown-like appearance and their ability to attack host cells. Previous research on SARS and MERS indicate that a weakened or killed coronavirus with modified S proteins could stimulate antibody production and confer immunity; however, these vaccines were never developed .
COVID vaccine candidates have been researched at unprecedented speed, but not at the expense of safety and effectiveness. Dr. Rachel Presti, a Principal Investigator of the NIH-AIDS Clinical Trials Unit at WUSM and Medical Director of the Infectious Disease Clinical Research Unit, underscored the importance of thorough and representative vaccine testing in the final Phase 3 human trials of COVID vaccines in a Zoom seminar from the Harvey A. Friedman Center for Aging at WashU. Isolating an agent that effectively targets human cells without causing the painful and dangerous symptoms of SARS-CoV-2 is the first challenge. Hasty vaccine administration could harm not only recipients, but also public perception of vaccinations—a historically contentious topic in the United States. After analyzing two telephone surveys from the National Immunization Survey-Flu and the Behavioral Risk Factor Surveillance System (BRFSS), the CDC estimated that flu vaccination coverage was only 62.6 percent among children and 45.3 percent among adults over 18 years old. Distrust in vaccines could be especially detrimental this winter. Dr. Presti underscored the importance of the influenza vaccine during the ongoing COVID pandemic. While the familiar flu vaccine does not protect against coronavirus, it would prevent an even worse scenario of co-infection. Vaccines can only give immunity if a critical mass of individuals receive it.
Since the highest priority is the health of clinical trial participants, studies often draw from a pool of relatively healthy volunteers. Lack of diverse participation may contribute to non-representative findings on the vaccine. COVID-19, however, disproportionately affects people older than age 65 and minority groups. Adults over 65 constituted 80 percent of COVID-related hospitalizations and have a 23-fold greater risk of death. To achieve maximum protection, “we need dedicated programs to expand vaccine coverage,” specifies Dr. Presti. This starts with clinical trial recruitment. Researchers must create a vaccine that works well for older adults with slower and weaker immune systems. Clinical trials must also recruit minorities and essential workers that have been most affected by the disease. The COVID-19 Prevention Network formed by the National Institute of Allergy and Infectious Diseases, with an arm at WashU, is working to respond to this global pandemic, conduct Phase 3 efficacy trials for vaccines and antibody treatments, and ensure fair representation. For more information about vaccine testing at WUSTL, email firstname.lastname@example.org or call 314-454-0058.
Even if every individual was able to receive a dose, no vaccine works 100 percent of the time. Not all vaccinated individuals develop immunity. A vaccine would, however, be a major step toward recovery. Moderna, an American biotechnology company, is using messenger RNA—the transition molecule between DNA to proteins—to engineer a vaccine that is currently in Phase 3 testing. Their study is close to full enrollment of 30,000 participants. Other Phase 3 studies are being conducted globally. While researchers work hard to deliver a vaccine, it is imperative that we act with vulnerable populations in mind. Physical distancing, face masks and good hygiene are here to stay.
Edited by Haley Pak
Illustrated by Angela Chen