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10 Apr, 2020 06:18

Covid-19 pandemic was 100% preventable – immunologist

As the Covid-19 pandemic cripples economies and healthcare systems worldwide, scientists are scrambling in a race of prestige for a vaccine against the novel virus. We talked about this with Dr. Vincent Racaniello, the Higgins Professor of Microbiology & Immunology at Columbia University Vagelos College of Physicians and Surgeons.

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Sophie Shevardnadze: Dr Vincent Racaniello, the Higgins Professor of Microbiology and Immunology at Columbia University, great to have you with us. So, Professor, it takes years for a vaccine to be developed, for instance, the Ebola vaccine took six years of work. Why does it take so long?

Vincent Racaniello: Well, the key is you have to make a vaccine that's not only safe but works. And that takes many years to figure that out. And you can't give people, especially healthy people - who are the targets of the vaccine - you can't give them something that's going to make them sick and that's not going to work. And so you have to test it first in the laboratory, in animals, and you have to test for safety. And then finally, you have to test it to see if it prevents the disease that you're looking for. And years is not bad. It took 50 years to make a polio vaccine. So we're doing much better than we used to.

SS: So scientists are actually promising to have a vaccine against the coronavirus by the end of 2021. How do we know that it will be there for a fact? 

VR: Well, there are no guarantees in vaccinology. But what's really encouraging is that I think there are over 60 companies working on SARS-CoV-2 vaccine using all different technologies. So we have all sorts of approaches that we can use to develop vaccines these days, we're not limited to just one or two kinds. And so I think that really improves the likelihood that one of them at least or maybe two,are going to work. So I have pretty good confidence that out of those 60 different approaches... and I was looking at the list last night, it's amazing how many different kinds of vaccine approaches are being taken. One of those should work. 

SS: So we have people who have contracted the virus and recovered. Why can't we just replicate their antibodies and blood cells or something and give that to everyone? 

VR: We can. In fact, that is one of the approaches that's being tried. We can in a very fast approach, we can take antibodies or serum from those people who have recovered. We can give them to other people to try and resolve the infection. But that's not a long-term solution. Other companies are isolating the cells from those patients that make antibodies and perpetuating them in cells so we can have longer-term solutions. But none of that is permanent immunity. It's only temporary. And we want a vaccine to give you permanent immunity. 

SS: But if you contracted COVID-19, can you get it again? Do you have a permanent immunity to COVID-19 if you had once? 

VR: That's a really good question, and we don't know yet because we don't have much experience with this virus. But if we look at other coronaviruses - and there are a number of them out there that infect people - immunity after infection lasts about a year and then you can get reinfected. But the disease is much, much milder. So I think it will be similar for SARS-CoV-2. You will be immune for about a year and then maybe you will be reinfected, but you may not even notice it or it would just be a mild common cold type of infection. I think that is most likely the outcome. 

SS: So many experts say that the current peak may be past us this summer. But the second wave may be coming in autumn. As of now, more than 265 thousand people have officially recovered plus all those with no symptoms, those who didn't even register as sick. That means all those people are already somewhat immune to the virus and their number is constantly rising. Will these people be enough to build the so-called herd immunity and mitigate the second wave? 

VR: So from my calculations, we need somewhere between 50 and 70 percent of the population to be immune to prevent spread of the virus, to achieve the herd immunity that you're saying there. And I don't think that we're going to achieve that in this first wave of infections. I think we do have more people infected than we know because throughout the world the testing is not uniform and it's not extensive enough. So I think more people are being infected, but it's not going to reach 50 and 70 percent. And so, unfortunately, there will be a second wave most likely in the winter, for example, when it gets cold again. 

SS: So will we have to go on another lockdown in winter? Or are we going to just prolong the current one indefinitely until we have a vaccine? 

VR: I hope we don't prolong the current one. I think that that would be difficult for the world to take. I think that the current lockdown will probably end around June or so, then maybe at least here in the temperate climates in the northern hemisphere, probably around November, there'll be another wave of infection. I think it will be much milder because there'll be a lot of population immunity. And I don't think we will have to go into another lockdown. And perhaps by then we will have some antivirals or serato help treat people as well. 

SS: 35 laboratories worldwide are currently working on a vaccine against COVID-19. Some have already started clinical testing. If you were to bet a hundred bucks on who's going to be the first, what country would you bet on? 

VR: I would bet on the world, because that's the way I'm looking at this. I'm not betting on a country. I would really like all scientists globally to look at this as a global problem and not one for their country to solve. And I hope that any company or university that makes a vaccine will share it with everyone else, because we're all in this together. We're all dying and getting sick together no matter what nation we are in. So that's the way I view it. 

SS: Well, I'm pretty sure that whoever gets it first will share it with the rest of the world. But I meant like in terms of advanced vaccine research, which country do you think could be first to come up with a vaccine? That's what I meant. 

VR: Yeah, I understand. I just don't know because I'm most familiar with what is going on here in the US. But throughout Europe, there are vaccine approaches and in your country as well. So, you know, just having the greatest number of laboratories working on it doesn't guarantee success. So it's really hard to predict. I couldn't do that. 

SS: Going back to we're all in this together, and I think the same way exactly. People have put all their differences aside, political included, and they're helping, coming together worldwide. But if and when the vaccine comes out, how will it work exactly? How do you administer the shot to literally everyone in the world? Who gets it first? Is it going to be a thing that rich people get first, or will the medical staff get it first? Or how do you make sure that everyone gets it? 

VR: That is a wonderful question. And I hope that people who are in charge are thinking about that right now because you think about all the doses we're going to need. So first, I'm hoping there's more than one vaccine so that we don't have to just take one only and make so much of it. But obviously, we're going to need multiple nations producing this vaccine. So the way it's produced has to be shared. It has to be produced in large quantity in multiple countries and in each country, there has to be a coordinated effort to distribute it at multiple places. Obviously, you can't just have it at one place within a country. You need it throughout the country. There are a number of approaches being used and some of them require injection, others require what we call a skin needle patch, which doesn't require a needle - it would be great if we could use that, that way you don't need trained personnel who have to inject the vaccine. But there's no doubt it's going to be a logistical nightmare because you really, really have to scale up the number of places where people are immunised. Otherwise, you're not going to cover everyone. It would be good to be able to start this in the summer of 2021, for example, before the fall arrives when the next circulation begins. 

SS: Do we have any idea how much that vaccine could cost, the COVID-19 vaccine? I'm just thinking once again in terms of accessibility to everyone. 

VR: Well, I am hoping that governments will pay for it. I'm not sure how much it's going to cost. Some companies have already said they would donate so many doses of the vaccine, which is great. I think every country should pay for it and help circulate it. And that will get rid of this issue of whether rich people get it first, which is completely unacceptable, right? Everyone should get in line to get it. And that depends on governments paying for it. No questions about it. No questions. 

SS: Like Cuomo said, COVID-19 is a great equalizer and we're all equal in front of it. What about the people who refuse to be vaccinated? For the sake of public safety, do you think they will be forced to get a shot? 

VR: I've been thinking about that a lot also, you know, because I think if we had a vaccine today, probably everyone would take it. But maybe next year or the year after, as you say, there'll be people who don't want to be vaccinated. Right now, we don't force people to take vaccines. We tell them they can't send our kids to school, for example, and they have to homeschool them. So I would think the same would apply to this virus. I think we can vaccinate enough people even with those vaccine deniers there. I think we can vaccinate enough people to give herd immunity so that that's not a problem. 

SS: You know, there's been a couple of studies that suggest that countries which have a mandatory vaccination against tuberculosis, like post-Soviet countries, Portugal, Ireland, some others as well, are less affected by the current pandemic than those that don't have this policy. What's your take? I mean, can this so-called BCG vaccine provide protection from COVID-19? When I look at the numbers in the post-Soviet countries, in Portugal and Ireland, I mean, there's definitely much less than whatever we have in Europe or America. And in terms of mortality, there are much fewer deaths in those countries. 

VR: So I think we have to be careful when we interpret those data. First of all, the testing is not the same in every country globally, and that could influence the results. Plus, if you just simply look at the number of COVID-19 cases in countries with BCG vaccination, there may be other factors that are making a difference that we don't know about. So in any event, the numbers are very small. The difference caused by BCG is little and I'm not sure that that would be a useful approach for the entire world to take. 

SS: So if COVID-19 itself dwindles and mutates into another flu-like seasonal thing, you know, like many epidemiologists predict, is there any point in this vaccine whatsoever then? 

VR: So if we look at all the coronaviruses that we know about, the four seasonal coronaviruses that infect us every year, SARS-1 and MERS coronavirus, none of them change in that way to evade immunity, what we call antigenically stable. So I would say this one is no different and we are gonna use one vaccine and it will be effective for years to come. There won't be a need to change it every year like we do for influenza virus. 

SS: Everyone's talking about immune system in the past two or three months. Our immune system actually is a mystery. What defines a strong immune system? Is it age, absence of chronic disease, bad habits? What is it? 

VR: Well, that's a great question. Immunologists, the people who study the immune system would really like to know why, as we age, our immune systems get weaker. That's one question. And why in some people, our immune system is actually detrimental? It overacts and makes us actually sicker in a number of these patients with SARS-CoV-2 infection, you know, the immune system is actually causing some of their pathology. And we have no idea why some people have that and others react quite normally. It's a big mystery in the immune system, but obviously figuring it out is going to help us in the future to treat these infections. In the moment we can use therapies that blunt the immune system in certain patients. So, for example, there's an antibody to a receptor for a cytokine that's being used and seems to have good promise in some patients. So we're learning slowly how to blunt that overexuberant immune response. 

SS: Do we have any idea why some people have a breeze with coronavirus and others just succumb to it? Is there a rule of thumb there? 

VR: No, we have no idea. If we did, we would be able to treat those individuals who have a problem and that, you know, explaining that difference it's partially about your immune system, about it being in control and not overreacting, but it's also about controlling the virus, right? So in some people, the virus seems to be able to be controlled. Well, in other people, it's not. And this is not just unique to coronaviruses. This happens with all viruses. Whenever you infect the population of people with any virus you get a whole range of outcomes. You get people who don't even get sick and at the other end, you get people who die. 

SS: Just to precise one more time. With those who have no symptoms at all, but they get the virus, that doesn't mean that they don't have the symptoms because their immune system is stronger than others'? 

VR: No, it's probably that their immune system is not overreacting because a lot of our symptoms of an infection by a virus are caused by our immune system. So if you have a virus and you have shown no symptoms, the virus is there, but you're not overreacting. 

SS: Would you say that I should be boosting my immune system like crazy to protect myself from the coronavirus? Or should I just leave it alone? 

VR: I think you have to leave it alone because we really don't know enough to say, yeah, you should be boosting it. I mean, we do know that there are certain things you shouldn't be doing. For example, you shouldn't be smoking because we know that suppresses your immune responses, especially in the lung. So those kind of things are obvious. But in terms of boosting, we really don't know enough to be able to recommend that. 

SS: What about in general, would you think that maybe our immune systems have weakened by relying on pills to combat the regular seasonal flu virus? Because every time it's a flu season media, everyone is just selling you all those pills and the supplements to sort of boost your immune system… 

VR: I don't think that influenza virus antidotes have anything to do with it, what I think is a big factor in regulating your responses to virus infections are the bacteria that are colonising you. You know, the microbiome in your respiratory tract, in your intestines. You know, we acquire those at a young age and I think they're very important for modulating the effects of a virus infection. And I suspect that when kids are raised in a kind of a sterile, clean environment, they don't get the right bacteria, the good bacteria. And again, this is another area of study that is ferociously underway and people are trying to figure out what's going on. I think that's more important than anything you could take for influenza virus. 

SS: So you've mentioned that the family of coronaviruses have been around forever, there's this group that is long known to humanity. Why haven't we got a universal vaccine against them already? 

VR: That is a great question. We actually should. I would say we could have prevented this pandemic, but we weren't ready for a number of reasons. Because, you know, the problem is that companies that are making vaccines and antivirals, they want to make a profit and so they don't make them if there is no virus to make them against. And so after SARS-1, it disappeared very quickly there was no incentive. We should have been working on antivirals, broadly-acting coronavirus antivirals and even vaccines. I think it's an indictment of the way we make preventative medicines in the world. And I hope that changes after this outbreak. 

SS: Well, the genome of COVID-19, is said to be almost 80 percent similar to the SARS that we had in 2003. So if we had created a vaccine against SARS back then wouldn’t we have the COVID-19 pandemic today? No, probably not, right? 

VR: I think we could have designed a vaccine based on SARS-1 that would have prevented this current virus. Yes. I do think it was absolutely preventable. And it's an indictment of the way companies work that it wasn't. 

SS: So the vaccine against SARS was not developed because there was no financial sort of gain in it, like you say, because it was too small and it went away. Should questions of common public health be regulated by laws of economics like that? 

VR: No, I don't think so. I think it's a big mistake. And now we see the outcome. We have this pandemic that could have been prevented. And I think it slowly changes. There are some nonprofit organizations that raise money to fund the development of antivirals and vaccines for what we consider rare diseases. And those kinds of non-profits are going to be the future in vaccine development. They'll be able to develop a vaccine for a rare disease and bring it to the point where if the disease becomes more common, the vaccine will be ready to test. 

SS: Should there be some kind of, I don't know, a permanent vaccine research centre that will just work on cures for everything new we encounter no matter the sales potential of the future drug? 

VR: I think that's one approach. And you know, in the US we have the NIH Vaccine Research Center, which was founded with that idea. But that's not big enough. It's not big enough to do all as you're suggesting. But I think every country that can do this, that has the research capability should, yes, establish a vaccine research institute and fund it well and have experimental vaccines develop and brought to the point even through safety trials in people where if there is an outbreak, they could be deployed very quickly. 

SS: You know, a lot of research coming up with vaccine nowadays depends on artificial intelligence. Is it a good thing? I mean, is it smart enough to actually do the job? 

VR: I don't think we're there yet. I think the AI needs to have some information in order to make programming decisions. I don't think we're there. I think they can make suggestions. But in the end, you know, it's a biological problem. You still have to make a drug or a vaccine that works in an animal. And so I think AI is getting good at suggesting what to try, but it's not there at hitting it the first time. 

SS: There's so many conspiracy theories about the whole COVID-19. What do you think about the version of it being artificially fabricated? 

VR: I think these are all crazy theories. And, you know, people like to engage in conspiracy theories and blame other people for the world's problems. But, you know, if you look at the genome of this virus, it's very clear that no human could have made it. It just has some very interesting features that are so clever that only nature could have come up with them. So I think any of these theories, conspiracy theories - got out of a lab, accidental outbreak, accidental release, deliberate release - I have zero faith in them. They don't make any sense to me. And I think people who are promulgating them should really use their time in a better way. 

SS: What about a larger sort of philosophical question? I ask all of my guests who actually come onto my show, because a lot of people feel that this is something to make us actually take a step back and sort of re-evaluate the way we live. I mean, a lot of people have said that this virus could have had any other form. I mean, you could be, I don’t know, having pink flowers, as a symptom of the virus, but what you have is that you're sitting at home and you are coughing and you can't breathe. And that's how our planet felt  for the past 20 years. But we just wouldn't hear it. Do you think there's something symbolic about the form of the virus or do you think there's like maybe a greater, bigger idea that is sent down to us humans to think why we came to this world and what we're doing to it? 

VR: Well, you know, humans can interpret things that happen any way they want, but this is a biological planet. And it's all driven by nature and natural selection and evolution. There's no consciousness behind something like a virus. Viruses emerge because they can. From the days of the first cells on earth, billions of years ago, there were viruses, they are parasites and they've been here ever since. They don't care what they infect, they just infect automatically. And this disease could have been much worse. It could have been much milder. But I think the lesson is that viruses are always going to be with us. We'll never be able to get rid of them. They're always going to be emerging. There will be a SARS-3 and a SARS-4 and other viruses coming not just from bats, from other animals. And we need to be ready for it. We weren't ready for this one. And I'm hoping this lesson teaches people that we really need to be more prepared for the next one. 

SS: Professor, thanks so much for this wonderful insight. Stay healthy. Stay safe. Hopefully we'll talk again when times are better. 

VR: Thank you. Good talking with you. 

SS: Take care, same here.