Duke, UNC experts discuss progress on coronavirus vaccines

On Tuesday, Dr. Anthony Fauci, the top infectious disease expert in the federal government, said he was “cautiously optimistic” that a coronavirus vaccine would be available to Americans by the beginning of 2021. With over 100 different vaccine candidates to prevent COVID-19 in various phases of development, that might sound like good odds. On Wednesday, experts at Duke discussed the process of testing a vaccine and the many steps it takes to go from the lab bench to a patient.

Before clinical trials begin, vaccines have to go through basic testing. Researchers must first determine if a potential vaccine is safe. Only after that can they study if it actually causes an immune response. Then, they provide a “challenge” and see if a vaccinated subject is protected after being exposed to the virus.

The Duke-NUS Medical School in Singapore has developed a potential vaccine and may begin human trials in August. This vaccine is based on a new kind of technology that uses tiny particles to deliver the coronavirus’ genetic material called RNA, closely related to DNA, into cells. When cells take up the viral RNA, they make copies.

According to Dr. Ooi Eng Eeong, a professor of medicine at Duke-NUS and co-director of Viral Research and Experimental Medicine Centre, this could stimulate a more specific immune response against the coronavirus.

“RNA replication simulates a viral infection,” according to Ooi. This helps train the immune system to recognize what it looks like when the coronavirus makes copies as well as what COVID-19 infected cells look like.

“You get two arms of the immune system activated. One to prevent infection through antibodies, two is to kill off infected cells so it can’t spread,” Ooi said.

How long clinical trials take will depend on how widespread COVID-19 is in the communities hosting the trials. This is because researchers can quickly see how effective the vaccine is if subjects are frequently exposed to the coronavirus.

Once doctors have a vaccine, they will need to distribute it. With COVID-19, a rapidly spreading disease that no one had immunity to until months ago, the logistics of vaccinating over 7 billion people in a short time may be even harder than the high-speed effort to developing the vaccine.

David Ridley is a business professor at Duke and director of the Health SEctor Management Program. He describes himself as less of an optimist than Fauci.

Manufacturing a vaccine typically takes years and requires large supplies of the vaccine as well as other materials, like medical-grade glass, rubber, and sterilized water to make the final distributed product that goes out to hospitals and doctor’s offices

“Will you and I be vaccinated this year? No way!” said Ridley. He does think a vaccine could be approved by the end of 2020, but it won’t be widely distributed because initial production will be limited.

Since vaccinating everyone immediately isn’t possible, a coronavirus vaccine will need to be prioritized. Ridley says healthcare workers, frontline workers, and people especially vulnerable to COVID-19 should be at the front of the line.

Thomas Denny, a professor of medicine and chief operating officer of the Duke Human Vaccine Institute, agreed. “If we can’t keep [first responders] going, then we’re in trouble.”

It’s important to not neglect the other materials besides the vaccine. For instance, it was slow to scale up personal protective equipment because manufacturers “have been burned in the past,” according to Ridley, when governments end up not buying material.

Offering contracts in advance will help manufacturers feel confident they won’t lose money. “I’m very confident that these manufacturers will behave themselves,” Ridley said, given the global spotlight on vaccine developers.

Dr. Myron Cohen, a medicine professor and director of the Institute for Global Health & Infectious Diseases at UNC, pointed out that no vaccine is perfect. “Even if you’ve been vaccinated, it will not reduce the obligation of a new normal,” and so masks and social distancing will still be needed in the midst of a vaccination campaign.

There’s also concern that people may not want to get a coronavirus vaccine. Denny pointed out that most people living today did not experience diseases like polio back when they were widespread. “What we’re seeing today is how much death there can be with a new disease we don’t have a vaccine for.”

“We have not really communicated what we know about vaccine safety to the public in ways that they can understand,” Ooi said. “Science needs to be a bit proactive in reaching out to the public.”

This story was originally published June 24, 2020 at 3:09 PM with the headline "Duke, UNC experts discuss progress on coronavirus vaccines."