Pearls and Irritations

The challenges facing President-elect Joe Biden and his team are daunting; A polarised population, high levels of unemployment, a likely Republican-dominated senate, and the perseverance of COVID-19 to name a few.

Biden is rightly giving priority to establishing public health initiatives needed to reverse the current US increase in coronavirus infections that were ignored by his predecessor.

On current trends the US might soon be recording 200,000 daily cases of COVID-19 and, by January, up to 4000 deaths a day. It is clear that the ‘lame-duck’ Trump administration will do nothing about this situation before departing on 20 January 2021.

They have advised position states that it is impossible to contain the spread of the deadly virus this side of an effective vaccine. Trump’s promised cures for the infection have not materialised.

The news about the production of an effective coronavirus vaccine is promising, but all public health experts, and certainly the incoming President, realise that even the most optimistic timetable for the vaccine will see this dark winter in the US feature hospitals swamped with critically ill patients, increasing numbers of deaths among front line medical staff (over 1000 already this year) and thousands who don’t die from their infection, left with serious health problems.

Biden has sprung into action naming his new advisory coronavirus task force. He clearly would like to use the momentum from his win to allow him to be a positive force for coronavirus containment even before he is inaugurated. Absent from the committee, sadly, is Tony Fauci. Trump in his reckless politicisation of the pandemic encouraged his followers to ignore the advice given by Fauci, actually calling him an ‘idiot’. At his last rallies, the “Four more years” chants were increasingly replaced by “Fire Fauci”.

I would bet money on Biden having called Fauci, expressed his appreciation for what he has done, asked if he could be consulted silently, and explained that his new task-force must try to influence Trump supporters. With Trump still belligerent, refusing to accept the results and blocking the establishment of a transition task force, resurfacing of the Fauci/Trump controversy would be counter-productive.

The task force includes Rick Bright, former head of the Biomedical Advanced Research and Development Authority, who, after being demoted by Trump, spoke out against the administration’s approach to the pandemic and Luciana Borio, director for medical and biodefense preparedness on Trump’s National Security Council until 2019. Good people who Trump wasted.

The doctors and scientists on the new task-force are all excellent choices and I was pleased that the global nature of the struggle was addressed with the appointment of Beth Cameron, director for global health security and biodefense on the White House National Security Council during the Obama administration.

Biden would like to immediately reach out to mayors and governors and indeed suffering Americans with a first priority being to mandate the wearing of masks when social distancing is not possible.

However, with Trump advising his supporters to not accept the results of the election and a refusal to wear a mask being seen as an action that supports Biden, it’s hard to see this urgently needed strategy being accepted. The Governor of Utah has mandated face masks and it will be interesting see if this is adhered to.

Now for the vaccine news that is raising hopes that the pandemic can be suppressed in 2021. It was announced on 9 November that scientists In Pfizer’s Mainz laboratories have produced a candidate vaccine that may be able to prevent COVID-19 induced disease in 90% of recipients. If true, it is remarkable, very few vaccines have such success.  

Evolution has resulted in us being born with an immune system that can ‘recognise’ millions of different chemical structures which, on entry into our bodies would be recognised as ‘non-self’ and, as such need to be removed. Because we have to recognise such an array of possibilities we have relatively few cells, when born, that can recognise a given entity. When non-self is recognised however, the cells doing the recognising multiply efficiently so that a second encounter is met with a faster and more efficient response.

Vaccines to protect us from infections are designed to provide, safely, the first encounter with proteins found in a particular micro-organism, ‘arming’ our immune system for a real attack.

COVID-19 has a three-dimensional structure on its surface that allows it to lock onto a structure found on the surface of human cells lining our throat, nose, airways, and eyes. Once binding has occurred this so-called ‘spike protein’ cuts a hole in the human cell and the virus pop inside. There it has its way with us using genes it carries to have our cells instructed to make copies of the virus (for some imagery think of a USB stick inserted into a portal on your computer)

Scientists have been confident that if we were to provide individuals with an immune system that had been primed to recognise this spike protein a vigorous response when the real thing presented itself, would stop cells being infected and prevent disease resulting.

There are 11 experimental vaccines for the SARS virus that produces COVID-19 in various stages of development around world. Pfizer and one other company are experimenting with an approach to vaccination never tried before. Most vaccines more or less try and provide us with inactivated ‘bits’ of the bacteria or virus that could harm us so that we are primed for the real thing.

The Pfizer vaccine utilises a technique by which our cells are deliberately exposed to the genetic blueprint (messenger RNA) required to produce just the spike protein the virus uses as described above. Our bodies respond and make this protein which is then immediately recognised as non-self so we make antibodies to this protein.

In theory, any encounter with a complete virus would see it neutralised before it could get started as its spike proteins are attacked. That is what the Pfizer vaccine seems capable of doing.

Pfizer has vaccinated 43,000 people with its mRNA vaccine. Two doses were given three weeks apart. So far 93 of the volunteers have been found to have the COVID-19 virus in the routine swabs used to test for the presence of the virus. Pfizer claims that 90% of these positive tests were not associated with any illness. In other words the virus could stop infection causing disease.

This vindicates the scientific validity of using the nRNA approach. With good news surrounding COVID-19 in such short supply, many have somewhat prematurely anticipated the light at the end of the tunnel, with stock prices for the travel, hospitality, airline and many other currently Coronavirus suppressed industries soaring. But the emphasis should be on cautious optimism.

All this data comes via a press release. There has not as yet been any peer-reviewed publication examining the data. Encouragingly it has been reviewed by the independent expert panel established in the US to assess efficacy who are optimistic. We know however, that people can be infected and suffer no disease. We do not know whether the infected, but well, recipient of the vaccine were heavily or light infected. We do not yet know if the vaccine would stop them from transmitting the virus to others. No data is available from studies of the elderly population. As yet we have no data on the longevity of any immunity produced (from the vaccine?).

mRNA is very fragile and the vaccine preparation must be kept in liquid nitrogen until just prior to use; a fact that could make distribution difficult. We expected that any coronavirus vaccine would need two doses to be effective but hoped that one might do the trick and make mass immunisation easier.

Nonetheless, this is really hopeful news and Australia is in line to purchase the vaccine if finally approved. A lot more work is needed and is happening. Pfizer says it could provide 50 million doses of the vaccine in a few months and 1.3 billion doses by the end of 2021.

In the meantime, it would be so dangerous was this news to result in a relaxation of personal commitment to current containment strategies in Australia which are working but fragile.

For countries like the US, experiencing massive rates of infection and associated deaths, the vaccine news should be filed at the back of the cabinet under ‘future hope’ as renewed efforts to reduce tragic rates of infection with evidence based tactics are emphasised, and yes in some cases, mandated. Good luck Joe. Look at Victoria, world.

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