Best Laid Plans...
About a month ago, I wrote a blog about "the emerging threat of Coronavirus". Back then it wasn't a pandemic and the UK death toll stood at a grand total of two. This is probably the most flagrant understatement in the history of science writing but...things have changed since then.
I'm not going to write a blog about what's going on in the world right now because you're living through the same pandemic I am - you know exactly what's going on. Instead, I'm going to write about the next steps science will be taking. The businessmen and politicians are all working around the assumption that we'll have a vaccine ready in 18 months. How realistic is that projection? What’s taking them so long? And what do we do if we can’t find one? Let’s take a tour of the frontline on our war against SARS-Cov2...
“Immune” doesn’t mean immune
The human immune system is a network of organs, glands, chemicals and bio-machines which combat infections and keep records of them for future use. It’s the elegant product of three billion years' worth of evolution and probably your most valuable possession (and I say that as a man who owns part of the original 35-mm print of Return of the Jedi).
The basic idea is that when your body first encounters a harmful particle it slowly manufactures things called “antibodies” which act like flags that stick to the particle and tell other cells to eat it. Once the threat has been neutralised, those antibodies hang around in your bloodstream - sometimes for the rest of your life - which means if you come across the same infection later, you're prepped and ready. Your blood is like a liquid fingerprint of every disease you’ve ever defeated and this is what we mean by “immunity”.
Really, it’s a misleading word because it doesn’t mean your body is bullet proof or that the virus can't get inside you. You can still contract it, it's just that you've had a dress rehearsal and your immune system knows all the moves. Your best bet at defeating a virus is therefore to have already had it. But how do you make sure you’ve already had a dangerous virus without being killed the first time? This is where vaccines come in.
When you inject someone with a vaccine what you’re actually doing is injecting them with a dead version of the virus. Technically "dead" isn’t a useful word either because viruses aren’t living things, but there just aren’t any words to describe killing something which isn't alive. Frankly, I wish more zombie movies would focus on these important linguistic difficulties.
Ambiguous language aside, a vaccine is a “dead” version of a virus which your body overcomes, producing antibodies in preparation for a future strike. When the real, living virus comes along, your body is prepared and can do its work ten times faster. That’s why vaccines are important against viruses. They’re not a “cure” by any means; it’s still the immune system we’re counting on - vaccines just give the immune system a rigorous training session, like practising martial arts on a dummy before tackling a live opponent.
Why Does It Take So Long To Make A Vaccine?
Step 1 - Make Sure It’s Actually a Vaccine
Getting a vaccine right is difficult. If you break the virus down too much it won’t trigger the body’s immune response and you might as well be injecting them with water. You’ll have invented the homeopathic vaccine and will no doubt get a homeopathic Nobel prize (it’s an empty box) but you’ve just wasted everyone’s time.
If you go too far the other way and inject someone with a virus that’s still potent then congratulations, you’ve given everyone Covid-19. No Nobel prize for this either. Obviously.
You have to get a version of the virus which is dead enough to be safe, but harmful enough for your immune system to pounce. That takes a while.
Then you need to make sure the virus survives transportation from the factory to the needle you stick in someone's arm. It sounds weird but you have to make sure your solution contains preservatives to look after the virus. I know. You're actually protecting a zombie version of the thing which is causing all the problems. But...you know...keep your friends close and your enemies closer etc.
Once you have that sorted, you also need antibiotics because bacteria will get into the mixture during production, transportation and injection. And finally you need to make sure all those substances don’t interfere with each other and de-stabilise the cocktail. Then, after a few months of testing in petri dishes and computer simulations, you'll have a workable vaccine candidate so it's time to move on to...
Step 2 - The Ethically Tricky Bit
It would be lovely if we could simulate a fully detailed human body with all its interlocking systems on a computer. But I’m afraid we’re about a century away from that kind of technology, so if we want to test a vaccine there is no viable substitute for trials on living organisms. The other problem is that there aren't enough human volunteers for all the thousands of trials and retrials needed, so the only option is to use animals with similar metabolisms to ours...mice, rats, pigs and monkeys usually. This is a tough dilemma but there's no way around it. It's animal testing or no vaccine. Simple as that.
Now, there are plenty of animal-rights activists who would argue (quite fairly) that the answer to the conundrum is simple: don’t develop the vaccine. They would argue that we don’t have the right to save our own skin at the expense of other living creatures and we just have to let the virus do its work. I’m not going to get into my personal stance on the issue, I’m just going to state the facts as they are: if you want the vaccine to protect yourself and your children, it's going to come at the expense of animal testing. Which also takes time.
Step 3 - Does It Work?
Finally, after lots of trial and error, you're ready to carry out human experiments. The first round is mostly to make sure you don’t just make the person more sick. This can still go wrong because something that looks safe in a petri-dish and doesn’t harm a single mouse or monkey can still cause damage to the first humans who try it. Animals are close proxies, but there are always unforeseen complications.
The second round of trials is when you start looking to see what actually works. And the only way to do this is to give people the vaccine, wait for their body to produce the antibodies and then (sharp intake of breath) expose them to the real coronavirus and see how they cope. If they don't, then it's back to the lab. If they seem fine then you've got something promising and you can move on to bigger test groups.
This whole process moves at a turtle's pace because you don’t want to rush a single step. It’s literally life and death science, so cutting corners isn’t an option. 18 months is a moderate estimate but the alternative is to rush things and get something which either doesn't work or is dangerous. What we need from the world's biologists is a vaccine. What they need from us is patience. What they don't need right now is misinformation, sarcastic or not.
There May Be Trouble Ahead...But While There's Moonlight...
A few days ago the WHO released a statement discouraging countries from issuing “immunity passports” for people who have recovered. Their statement said “there is no evidence yet that people who have had Covid-19 will not get a second infection.” That sounds scary because if our bodies don't develop immunity to coronavirus, a vaccine won’t be possible. However, a little context is important.
They aren’t saying “nobody develops immunity to coronavirus” they’re just saying it’s too early to know how immune we are. Some viruses are extremely difficult to catch a second time e.g. chickenpox, whereas some viruses mutate so rapidly you can’t build immunity e.g. Hepatitus C. We don’t know where coronavirus fits on this scale so the WHO is merely saying it’s early days. Issuing “immunity passports” would be unwise when we don’t know how susceptible people might be to a second infection. If you give everyone a false sense of immunity you’re putting them directly at risk.
One of the studies currently being misquoted by a lot of fear-mongers is a paper by Jinghe Huang and Fan Wu from Fudan University, which found that 30% of people who had coronavirus didn’t develop antibodies. That sounds worrying because it suggests a third of all people can get reinfected, but once again, context is queen.
Firstly, the sample group was 175 people who only had mild cases of Covid-19 in the first place. Secondly, most of the people who didn’t develop antibodies were under 40 i.e. people who don’t show symptoms in the first place...which is absolutely what you’d expect. Most symptoms are the result of you producing antibodies and since young people often don’t present symptoms for Covid-19 (we’ve known that since the beginning) the fact they don’t develop antibodies is nothing new.
The question yet to be answered is how symptom-less people were still able to recover without antibodies. The authors of the paper make it very clear that these antibody-free people have still defeated the virus, they're just using one of the immune system's other tricks and we don't know what it is.
However, let’s be pessimistic and assume this single paper is representative of the global population. That would mean 70% of people will have reasonable immunity to Covid-19 after a vaccine. That’s not the best we could have hoped for, but it’s not a disaster . It means we can stem the tide of the virus but it’s not quite high enough for “immunity passports” to be issued.
For a helpful comparison, consider the influenza virus which mutates so rapidly people need booster shots every twelve months to stay safe from the latest strain. The seasonal flu vaccine is about 67% effective and that’s enough to stop it becoming a pandemic. Flu is, instead, an “endemic” virus which means it’s a permanent feature of the biological landscape and we just have to accept it being a part of life.
Given the speed at which coronaviruses mutate, I'd say there's a pretty good chance it will go the same way and a single one-shot vaccine is unlikely. Never say never, but if I were a betting man I'd say it's more probable the coronavirus vaccine will become part of our annual vaccine regime along with the seasonal flu shot. A nuisance, but something we're just going to have to accept.
On The Plus Side...
You don’t hear much from polio these days, or cholera, or tuberculosis, or leprosy, or bubonic plague, or spanish flu, or bird flu, or swine flu, or ebola or zika and the list goes on. These diseases which once threatened the world are still very much out there. In fact we’ve only ever eradicated one disease from nature (smallpox). But the reason these illnesses are no longer holding the world ransom is because we’re a clever species and we solve problems. Hell, even the AIDS epidemic is on the decline and that’s a disease which is impossible to vaccinate against. Progress is sometimes slow but we always, always win these fights.
When it comes to dealing with coronavirus we have the world’s smartest people on our side and right now they have unlimited government support and money...which they've never had before. So think about it. We've been able to beat all these other diseases on a global scale without public endorsement and funds. Now we have that too, we can stack the deck heavily in our favour. At the time of writing there are at least 70 major vaccine research projects underway globally to tackle SARS-Cov2 and there are some encouraging results already.
There’s a group led by Chuan Qin at the Peking Union Medical College in Beijing who have already found a vaccine which has been trialled on monkeys and given every single one of them perfect immunity to coronavirus.
There’s a group led by Michael Farzan at the Scripps Research Institute in Florida who have successfully identified a vaccine which causes rats to produce huge amounts of SARS-Cov2 antibodies.
There’s a group led by Haitao Yang at Shanghai Tech University in Shanghai which have found a possible medicine which attacks one of the proteins in the coronavirus molecule, meaning it might act as a medicine rather than a vaccine and it seems to work on all strains, meaning it would be a mutation-proof cure.
And then my absolute favourite...A team of researchers at the University of Texas led by Bert Schepens have found that it’s possible to extract antibodies from llamas (who seem to have good coronavirus immunity) and use them to prevent infections in humans! Yeah, that’s right. Forget drinking bleach. Llamas might be our secret weapon in the coronavirus battle. Llama power!
Welcome to the Coronapocalypse
I’ve been using the word “coronapocalypse” a lot recently. I think people assume I’m making some sort of dark joke, but I’m not at all. The word apocalypse doesn’t mean end of the world. It actually means "uncovering" or "revealing" and in a Biblical sense the word is always referring to a transition from one way of living to another. An apocalypse isn't an end. It's a change. And we're living through one right now.
To quote the novelist and political activist Arundhati Roy "Our minds are still racing back and forth longing for a return to 'normality', trying to stitch our future to our past and refusing to acknowledge the rupture. But the rupture exists...Nothing could be worse than a return to normality. Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas...or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it."
I mean look at what's happening. Name me one country which hasn't suddenly realised how valuable its healthcare system is. Name me one country which isn't going to take a long hard look at its own systems of politics, finances and welfare and ask the question "is this really what we want to go back to?" People are suddenly remembering the importance of care-workers, volunteers at retirement homes, delivery drivers, bin men, doctors, nurses, teachers (woo!), the police and all the other people keeping things going.
I recently re-watched the 2011 Steven Soderbergh movie Contagion. Nine years ago that film looked at what might happen if a bat-based virus from China caused a pandemic. A lot of it is eerily prophetic but there's one thing it gets very wrong. The film depicts a complete collapse of society with riots in pharmacies, looting of grocery stores, garbage piling up in streets and shootings in suburbs. We haven't seen that. What we've seen is something entirely different.
On my way to work I see rainbows in windows and hand-made posters thanking the NHS. I see people in supermarkets laughing with embarrassment when they turn a corner and end up less than two meters from someone. People are stepping out of their houses in the evening to nationally applaud nurses and doctors, hundreds of thousands of people volunteer to deliver care packages to the elderly. In my school science department people are holding a weekly quiz - we never did that before.
I’ve heard from long-lost University friends reaching out after a decade to ask how I’m doing. I'm exchanging silly jokes with work colleagues I wouldn't normally talk to. And I’m talking to my dad on the phone more. He’s an NHS worker at one of the largest coronavirus field hospitals in the country and I’m damn proud of him.
The older machines of society have come off the rails. Coronavirus will possibly become endemic and we’ll have to start looking out for each other as a regular thing rather than as a 12 week exception to the norm. It’s going to force us to be a little more community-minded because now when you walk past someone on the street you're thinking the same thing they are "oh I'll bet they're going for their daily exercise during the pandemic." How remarkable is that to have this hive-mind telepathy where we're all thinking about the same thing.
We're making sacrifices to protect society and we're thinking about people less fortunate than ourselves. Yes I know the cynics will say "how awful that it took a pandemic to make us be nice to each other and the environment" but what does it matter? We're doing it aren't we?
This is the coronapocalypse and we’ll emerge a slightly wiser, more humble species. I’m not saying the world will suddenly tick along like magic. There’s going to be fallout and struggle and fear and pain for a while. But we’re the product of three billion years of evolution and we’re smart. Viruses don't end us, they teach us.
We're not going to get around this pandemic. We’re going to get through it.
I love science, let me tell you why.