Unlike HIV, the coronavirus is more open to the development of a vaccine and one should be within the grasp of modern science by June next year, writes Chris Bateman for MedicalBrief. That’s the optimistic view of one of the world’s most highly cited biomedical researchers, Dr Larry Corey, addressing South Africandoctors.
Together with four fellow scientists, he developed today’s anti-retroviral drugs, saving millions of lives, especially in South Africa where 5m people are currently on life-prolonging HIV/Aids treatment, rendering most of them non-infectious and making the epidemic manageable by turning HIV into a lesser, chronic disease.
The guest on a 25 June webinar hosted by Discovery Health and Medical Brief, in conjunction with the Desmond Tutu HIV Foundation, the SA Medical Association, the SA Private Practitioners Forum and the Unity Forum for Family Practitioners, Dr Corey said that COVID-19 was ‘more of a discernible virus than HIV.’
“I’m optimistic that with C-19, we’ll have more clinical efficacy than HIV, which is uniquely different and difficult. This is within the grasp of science and if my optimism proves true, it will take us a year to know this in a discernible way. By June 2021 we should have a solution,’ he told an audience of over 1,500 South African healthcare workers in a session facilitated by Professor Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Diseases and Molecular Medicine at University of Cape Town. The webinar was introduced by Dr Maurice Goodman, chief medical officer at Discovery Health, who said the 11 COVID 19 webinars Discovery has hosted so far have drawn 20,000 participants who gave them an average 95% excellence rating.
South Africa’s HIV experience invaluable
Praising South Africa for the infrastructure it had built to handle the HIV epidemic and it’s stellar clinical and academic trialists with whom he’s worked intimately over several decades, plus its community involvement, Dr Corey said this country knew how to recruit vulnerable populations for research trials of several major diseases such as TB, MDRTB and HIV/Aids.
“In HIV we wanted them, (trial recruits), to be a bit younger. Now we want their parents,” he joked in an illusion to the coronavirus’s ability to render the elderly more seriously ill.
Currently, the most-promising chimp adenovirus vaccine trial, which was piloted in the UK but ran into human trial efficacy problems due to lower pandemic numbers, was a fortnight ago taken up under the leadership of Shabir Madhi, professor in vaccinology at Wits University and the director of the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit there. Professor Bekker told the webinar that on its first day, Professor Madhi’s trial unit was forced to close its gates to hold back an almost overwhelming number of eager volunteers.
The investigational vaccine (ChAdOx1 MERS), protected two groups of rhesus macaques from disease caused by the Middle East respiratory syndrome virus, MERS-CoV, a relative of the acute respiratory syndrome coronavirus which causes COVID-19. It is currently considered a front runner candidate for success.
Dr Corey said there were currently multiple CORONA-19 vaccine and monoclonal antibody trials, most aimed at preventing the virus landing, by neutralising its highly effective spike-like structure. In the US there were multiple research platforms, the aim being to enable licensing as quickly as possible.
In a clear reference to President Donald Trump’s threat that a vaccine would be confined to the US, Dr Corey said the reality was that the major US-based pharmaceutical companies were commissioning companies to produce as many as seven billion doses of vaccine.
“The US has 330m people so we’re obviously way over that. There’s a conscious recognition of global citizens and a global economy, whether it’s for altruistic or economic reasons, it’s being directed in that way,” he revealed.
While he could see the utility of the now-ubiquitous phrase, “Warp Speed,” in connection with developing a vaccine, (given the historically unprecedented 9m people infected in the first six months of the viral outbreak), it was not one he favoured.
“It’s a political, not a scientific term. The press characterises this as a race for a vaccine. It has some utility in terms of risk and going for success, but I think the quality tortoise is going to win this race,” he said.
Echoing several leading global researchers in recent weeks, he stressed that what was needed was multiple vaccine trials, with proper medical oversight and large study cohorts to enable robust outcomes. In the US licensure of drugs with the Food Drug Administration was an issue, but this had forced innovative ways of speeding up individualised vaccine trials.
“We’ve doubled the size of cohorts to 30,000. You can save six to 12 months that way. Often, we have two-to-one randomisation instead of one-to-one. We’re hoping after 6-7 months, post-acquisition, there’ll be 150 kinds of end points to define when the first real efficacy analysis will be. We’re harmonising trial end points and follow-up to look at post-acquisition events, plus harmonising the requirement that all companies allow access to NIH, (the US National Institute of Health), statisticians for cross-platform analysis,” he added.
The idea was to acquire and correlate biomarkers to bridge research platforms and get results as quickly as possible to enable companies to manufacture hundreds of millions of vaccine doses should there be success – and to thus enable quick distribution. While there was a need to get a vaccine into the arms of people with unprecedented speed, he reminded his audience that it took nine years for an HPV vaccine to be developed.
He likened the outbreak of COVID-19 to HIV, but said the major difference was that it spread far more rapidly. It took two to three months, “before we even began thinking of how we can understand this virus and do things. We tried ventilation, oxygenation – we didn’t really understand it. Only now are we re-purposing drugs like anticoagulants and steroids and potentially, finding a vaccine. We’re starting to produce some tools to get out of this mess. It’s the only way. Social distancing is helpful, but can never be totally effective with symptomatic transmission and the kind of pathogenesis we have.”
He said monoclonal vaccines were being aimed at older people, especially those in nursing homes in the US which had been devastated by the virus with 30-40% mortality rates. Caregiver nurses often worked in multiple nursing homes, aggravating spread.
“We’re hoping the antibodies can last 4-6 months, with potential for longer term or at least a stop gap for CORONA-19,” he added.
Dr Corey said he considered South Africa a second home and hoped he would be able to return to collaborate with research colleagues from June next year onwards.
Once uploaded to the Discovery site, Dr Corey's webinar can be found here