The race is on and the stakes high. A safe and effective vaccine in the near future is the best chance we are told of controlling a virus that brought so much death and economic destruction in the first half of 2020. A vaccine without side-effects administered to the whole population and giving total protection is what we seek but are unlikely to achieve. Things just don’t work this way, but that should not stop us trying.
There is already an impressive global governmental commitment; enormous resources aligned, vaccine candidates synthesised, clinical trials underway and vaccine production lines under construction. What we are witnessing is a minor miracle of cooperation that augers well for a successful vaccine. That outcome will be far short of the ideal, but then we don’t need perfection only sufficient “herd immunity” to hamper the movement of Sars-Cov-2 through global populations and allow us to get on with our lives.
A vaccine’s job is to create an immune response without producing the disease or other nasty side-effects and enable the body to respond immediately if it encounters the real virus at a later date.
Vaccination as a concept has been around for over 300 years since Edward Jenner reasoned that cowpox was a milder form of smallpox providing dairymaids who had suffered the former to resist the latter. In a spectacularly unethical clinical trial – only a proof of concept study really – Jenner took material from a cowpox blister on the hand of a dairymaid Sarah Nelms and scratched it into the skin of an eight-year-old boy called James Phipps. James suffered a mild fever suggesting he had caught cowpox. Armed only with this suggestion and nothing more, Jenner inoculated James with matter from a fresh smallpox lesion. It worked; lucky for James he did not contract smallpox and lucky for Jenner he had just discovered vaccination. He off course reproduced his results in other victims and by 1800 achieved some considerable fame at home and then in the US where Thomas Jefferson became a fan. Interestingly, Jenner made nothing from his discovery and even suffered a financial hardship in his campaign to bring his innovation to the masses; vaccinating the poor free of charge.
Similarly, Jonas Salk in the 1950s is supposed to have refused to get or take royalties for his polio vaccine famously saying when asked what he made from the patent “There is no patent. Could you patent the Sun?”. There is a dispute about Salk’s philanthropy some suggesting this phrase merely meant his team had looked into the possibilities of a patent since it was based on a modified virus, a natural product, it was deemed impossible to patent. Anyway, society benefitted and Salk got a Noble Prize for his toil.
There are maybe 100 Sars-coV-2 vaccine candidates in the running and considerable ethical challenges to rushing the programme. It must be safe, it must be effective and it must be high quality. But a process that would typically take eight years is being compressed into 12 months and even less if the Oxford Team is to be believed. So what if we get it wrong in some places, we simply need to cut some corners to get something out. Jenner would be struck off the medical register and most likely imprisoned were he to perform his clinical studies today. A colleague of Jonas Salk trailing a rival polio vaccine caused those who use it to contract polio and all its life-long attendant side-effects. Still, we needed, and have greatly benefitted from, a Polio vaccine.
Perhaps given the circumstances and the economic damage of delay we might consider a “natural vaccine” in the way that not too many years ago, before a vaccine was available for it, parents organised chickenpox parties so their children got the condition while young. Chickenpox is normally mild when contracted in childhood but in later life it can be severe and cause long-term side-effects.
As we learn more about the Sars-Cov-2 virus we better understand it and its health impact. We know it is generally a mild condition for 90% of the population. We know it kills the elderly, those with co-morbidities and the obese and we need to throw a ring of steel around these vulnerable individuals. We also know that there seems to be a dose effect; the more virus inhaled and the more often this happens, the more likelihood of serious and fatal outcomes. This is why so many healthcare workers on the front-line tragically died. With this knowledge would someone be brave enough even to consider “natural vaccination” where healthy adults are infected with the “live” virus in controlled conditions so that we build up the necessary population herd immunity of about 60%.
No, nothing about Covid-19 is that simple and where we get some poorly defined protection from our encounters with the virus some individuals also have some protection from encounters with other viral infections such as common cold and surprisingly other vaccinations such as BCG. What Jenner did with smallpox and parents did for their children at Chickenpox parties is not it seems a strategy for Covid-19 and the implication of this is that a vaccine is far from certain.
Photo by padrinan is licensed under CC BY-NC-SA
I am a pharmacist in Belfast.
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