Thursday, June 8, 2023

Opinion | Coronavirus vaccines were a near miracle. We need another.



It can’t be emphasized often enough that the vaccines against the coronavirus pandemic, in particular the mRNA vaccines, proved a triumph over adversity that saved millions of lives, thanks to years of investment in basic research, advances in genomics and other disciplines, massive federal aid, and productive cooperation among policymakers, scientists and the private sector. That feat was completed not long ago — but we need to do it again.

As professor Eric Topol at Scripps Research pointed out, the virus that the vaccines targeted in December 2020 is not the one we face today. At the outset, vaccines were highly efficacious, breakthrough infections or reinfections were rare, and the virus didn’t seem to be gaining more immune evasion or transmissibility. “We were prevailing over the virus,” he said. But mutations brought omicron, including the present subvariant, BA.5, with the “highest fitness, growth advantage, and immune evasion since the pandemic began.” While vaccines plus boosters offer protection against serious illness and death, the evolving virus seems to be one step ahead of the sheriff. Simply chasing each new variant with a booster is not a smart or sustainable strategy.

What’s needed are next-generation vaccines that induce broader and more durable protection against known variants and the unknown. President Biden, quite optimistically, promised in his State of the Union address this year to be ready to deploy a new vaccine against a new variant in 100 days. Though Operation Warp Speed, under President Donald Trump, took less than a year to produce the first vaccines, the long and difficult history of vaccine development suggests humility is in order. But a discussion at the July 26 White House summit on next-generation vaccines offered a window into the future.

Even as viruses mutate, they often have a “conserved” region, a spot that remains the same. This is a promising target; a vaccine that effectively hits it will continue to work against future variants. Another approach is to build a vaccine that can induce an immune response against the virus even as its spike characteristics evolve. Anthony S. Fauci said the National Institute of Allergy and Infectious Diseases, which he leads, has awarded some $42.8 million to four academic institutions to advance broadly protective vaccines.

While vaccine injections provide a strong overall protection, there are tantalizing alternatives. The advantage of a next-generation inhalable vaccine would be to set up a nasal barrier blocking transmission where the vaccine particles enter the body. Akiko Iwasaki, a Yale biology professor, told the summit, “This is akin to putting a guard outside of the house in order to patrol for invaders, compared to putting the guards in the hallway of a building in the hope that they would capture the invader.” Yet another technology described to the summit is a patch with very tiny needles that deliver the vaccine efficiently without pain.

The new ideas face scientific, developmental, manufacturing, financial and regulatory hurdles, and must clear clinical trials. But the government would be wise to do everything possible to help. The Fauci “ouchie” was just short of a miracle. Now we need another.

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