Learning from AIDS: there’s more than one way to tame a virus
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The HHS secretary promised a vaccine within two years.
Anthony Fauci urged caution, telling reporters “we don’t have any idea how long it’s going to take to develop a vaccine, if indeed we will be able to develop a vaccine.”
The stakes were high. Plans were being drawn up to build new hospitals to treat the afflicted, communities were mourning lives that had been cut short and massive death tolls were predicted. The nation was riveted on the search for a cure.
The HHS secretary was named Margaret Heckler, it was 1984, and the scourge was AIDS.
COVID-19 isn’t AIDS, but lessons from more than three decades ago are relevant.
The AIDS experience shows that vaccines aren’t the only way to tame a virus, that concentrated and collaborative science can produce remarkable solutions, and that in times of crisis it is especially important to protect the vulnerable.
Science remains uncertain, cures elusive. AIDS never respected national boundaries or human longings for intimacy and neither does COVID-19.
The fight against viruses is often described as war, but it is an imperfect analogy.
Unlike human enemies, microbes can’t hear us making plans, so there’s no reason not to say as much as possible out loud, honestly and clearly. Communication enables collaboration that accelerates science, while transparency, including about uncertainties, brings the public into the quest as partners.
Obfuscation gums up the scientific gears and breeds conspiracy theories that cause people to fight each other instead of the real adversary. Expecting the best and refusing to plan for the worst can have catastrophic consequences.
This time Fauci is far more confident that a vaccine will work. He’s saying that if everything goes right, millions of doses could be available this winter for use in trials.
The public -- and President Donald Trump -- aren’t paying attention to Fauci’s caveats.
Expecting the best and refusing to plan for the worst can have catastrophic consequences.
Trump has promised that millions of doses of vaccine will be ready before the end of the year. The administration isn’t helping matters by invoking science fiction, code-naming its plan to speed vaccine development “Operation Warp Speed.”
There is little substance behind the slogan. No leader, no leadership, no plan.
Vaccine manufacturers are talking about “emergency access,” possibly in the fall or winter, but large-scale Phase III trials that could create firebreaks if there are outbreaks are more realistic. Especially for vaccines based on technologies like mRNA that have never been used in an approved product, it would be extraordinary -- even by the standards of the COVID-19 response -- to grant Emergency Use Authorizations in the absence of a robust safety database.
Any decision to grant a vaccine EUA would be fraught because the public is skeptical of FDA’s independence. Decisions made to grant an EUA to chloroquine and hydroxychloroquine and a yo-yo policy on regulating serologic antibody tests create the impression that FDA is willing to cut corners. Distrust in government agencies fuels fears that the president, catering to a nation weary of social distancing, is willing to risk the lives of others to enhance his chances of reelection.
While it may be celebrated in the moment, rolling out an ineffective or flawed vaccine could create adverse effects that might take months or years to discern and could create a deadly false sense of invulnerability. It would also destroy public confidence in science and medicine for years to come.
There’s good reason to believe that unlike AIDS, a COVID-19 vaccine, given sufficient time for testing, will be safe and effective. HIV is a far more stealthy and deadly foe; unlike COVID-19, the human immune system doesn’t beat AIDS.
Plan B if vaccines don’t work
It is also possible that efforts to create vaccines will not succeed, or that they will be partially successful, or will take far longer than society can wait. So far there haven’t been any vaccines approved against a human coronavirus, including the common cold.
And as with AIDS, the lack of a vaccine isn’t necessarily a disaster.
Announcing the early data on remdesivir, Fauci said it reminded him of data about the first effective AIDS drug, AZT. Like remdesivir, AZT was far from a cure, but it proved for the first time that the virus could be tamed.
If the first cohort of vaccines doesn’t defeat COVID-19, there’s unlikely to be a single, neat solution. More likely, a more complex approach will be needed.
As with AIDS, testing and public health measures will be critical.
Industry and academic scientists certainly aren’t holding their breath waiting for a vaccine. While tremendous resources are being devoted to vaccine development, hundreds of therapeutic approaches are being investigated (see “BioCentury’s COVID-19 Resource Center”).
Technologies that weren’t possible when AIDS struck, from mAbs to RNA interference and stem cell therapies, may make big contributions.
Or the answer could look more like AIDS treatments: antiviral cocktails.
And while the disease course is different from AIDS, COVID-19 also might not be eradicated for decades; however, effective medicines could render it less lethal, and far less disruptive to society.
COVID-19 will be driven off the front pages and banished from our nightmares faster if the fight against it is undertaken openly, communicated honestly, and implemented equitably.
Further analysis of the coronavirus crisis can be found at https://www.biocentury.com/coronavirus.