{"id":31155,"date":"2020-05-15T15:24:35","date_gmt":"2020-05-15T15:24:35","guid":{"rendered":"https:\/\/virusreports.net\/a-coronavirus-vaccine-could-take-longer-than-12-to-18-months\/"},"modified":"2020-05-15T15:24:35","modified_gmt":"2020-05-15T15:24:35","slug":"a-coronavirus-vaccine-could-take-longer-than-12-to-18-months","status":"publish","type":"post","link":"https:\/\/virusreports.net\/a-coronavirus-vaccine-could-take-longer-than-12-to-18-months\/","title":{"rendered":"A coronavirus vaccine could take longer than 12 to 18 months"},"content":{"rendered":"
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As much of the world remains at home due to the coronavirus<\/a>, a lot of people have put their hopes of a big economic reopening on a vaccine. With more than 100 vaccine candidates<\/a> for Covid-19 in production, things seem to be looking up \u2014 and the conventional wisdom, often restated by White House officials<\/a>, is that this medical reprieve could come within 12 to 18 months.<\/p>\n

But some experts caution even 12 to 18 months might be optimistic for a Covid-19 vaccine: The previous record<\/a> for getting a vaccine was four years, and a clich\u00e9 in the field is that vaccine development is measured in years, not months.<\/p>\n

That\u2019s not to say that the chances of a widely available vaccine within 12 to 18 months are zero. But they\u2019re not 100 percent either. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me the 12- to 18-month timeline is \u201cvery ambitious.\u201d Kendall Hoyt, a vaccine and biosecurity expert at Dartmouth, told me it will be a challenge, but arguably doable: \u201cIt\u2019s conceivable we could have something in that timeline \u2014 if everything goes right.\u201d<\/p>\n

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Andressa Parreiras, biomedic, and Larissa Vuitika, biologist, work in a laboratory during the extraction of coronavirus genetic material in Belo Horizonte, Brazil, on March 24.<\/figcaption>Pedro Vilela\/Getty Images<\/cite><\/p>\n

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There are two major problems. First, it\u2019s not clear whether a vaccine can even be developed; it\u2019s possible \u2014 as has been true for other pathogens, like malaria and HIV \u2014 that even the world\u2019s best scientists just never crack the Covid-19 coronavirus.<\/p>\n

Second, even if a vaccine candidate does show promise, time is a necessary component of this line of research. Scientists need months to evaluate not just if a vaccine is effective at conferring immunity for months, but also if it\u2019s safe, since side effects could pop up weeks or months down the line. Safety has important implications for public health, too: Any harm from a Covid-19 vaccine could be used by anti-vaccine advocates, who\u2019ve already spread their message even with the facts against them, to perpetuate their agenda.<\/p>\n

Even without a vaccine, there\u2019s still a chance that other scientific and medical innovations come around that make Covid-19 significantly less dangerous, even if they don\u2019t outright cure it. Advances in treatment, along with enough health care capacity to see all infected patients (still a work in progress<\/a>), could bring an end to at least some social distancing even if a vaccine doesn\u2019t.<\/p>\n

And some experts are still hopeful a vaccine will come quickly. \u201cI\u2019m optimistic,\u201d Natalie Dean, a biostatistics professor at the University of Florida, told me. \u201cThere\u2019s just so much work being done in parallel.\u201d<\/p>\n

But a vaccine savior may not come as quickly as we all hope. For policymakers, that means putting more stock in other medical treatments as well as a vaccine, and boosting other measures, like testing<\/a> and tracing<\/a>, that will let states somewhat ease social distancing even without a vaccine. For the general public, it means preparing to stay home, to some degree, for longer than they might prefer.<\/p>\n

Vaccines really do take time<\/h3>\n

Experts emphasized that vaccine development takes a lot of time \u2014 and it\u2019s not just due to bureaucratic hurdles or overly cautious measures.<\/p>\n

For one, a vaccine candidate, which can be validated as the real thing through research, has to be discovered. This alone takes a lot of work, with scientists still tinkering with different types of vaccines \u2014 some of which have never been successfully developed and used in humans \u2014 to see what can work with Covid-19 as well as other kinds of viruses. That can range from the traditional vaccine, in which a weakened version of a virus is used to spur immunity, to newer kinds of vaccines, like the potential use of messenger RNA to attempt to more precisely trigger an immune response. (For more on the different kinds of vaccines, I strongly recommend Derek Lowe\u2019s post on the topic at Science magazine<\/a>.)<\/p>\n

Whether a truly successful vaccine candidate is developed is the first big hurdle. \u201cThings can fail for multiple reasons,\u201d Hoyt said. \u201cSomething that can look very promising in the lab just might not behave in a human body in a way that we expect it to.\u201d<\/p>\n

This isn\u2019t just true of vaccines: A 2017 analysis<\/a> in PLOS One<\/em> found that less than 10 percent of drugs that entered clinical trials between 2006 and 2015 were ultimately approved by the Food and Drug Administration. So for every 10 articles you see about promising new drugs, chances are nine of those drugs will fail.<\/p>\n

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Employees of the Institute of Virology at the Philipps University of Marburg work in a research laboratory on January 24.<\/figcaption>Arne Dedert\/Picture Alliance via Getty Images<\/cite><\/p>\n

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Other experts are more optimistic on this front. Adalja noted that there\u2019s a coronavirus vaccine for cows<\/a> \u2014 not for the SARS-CoV-2 virus that\u2019s sending people into hiding today, but for another type of coronavirus. That gives Covid-19 vaccines better odds than HIV vaccines, Adalja argued: \u201cI don\u2019t think the same obstacles that apply to the HIV quest even come close to the coronavirus vaccine quest.\u201d<\/p>\n

Even if we do get a promising vaccine candidate, though, the work of making sure that candidate is safe and effective will take time. Researchers need months to make sure that immunity lasts in the long term, while making sure the vaccine doesn\u2019t produce nasty side effects that could, albeit typically in rare cases, make the cure worse than the disease.<\/p>\n

And if a vaccine candidate does make it through all these trials and into manufacturing, that won\u2019t be the end of the challenges. This is a vaccine that the entire world will want. \u201cThere will be a capacity problem because a large percentage of the world population will need a vaccine,\u201d Hoyt said. \u201cYou\u2019re just not going to get enough. Vaccine companies are not built to produce enough vaccines for the whole world in a short time frame.\u201d<\/p>\n

Stuart Thompson at the New York Times<\/a> analyzed the many steps required for a vaccine candidate to make it out into the real world: academic research, pre-clinical work, three phases of trials, building up factories and manufacturing, and distribution. From the first point to the last, a vaccine could take up to 16 years.<\/p>\n

Thankfully, there are ways to speed that along. Some of these steps can be done in parallel. Public and private entities could start building vaccine factories right now, as Bill Gates has already promised to do<\/a>. Human challenge trials<\/a>, which directly expose healthy people to the virus, could help test for immunity more quickly (though some people in the field are skeptical<\/a>, because setting up these trials could take longer than more traditional studies).<\/p>\n

Even without human challenge trials \u2014 which can raise genuine ethical concerns if there\u2019s no treatment for the virus people are being infected with \u2014 there\u2019s a case for optimism on this front as well: Because coronavirus is already all over the world, testing for immunity in real-world settings (unfortunately) won\u2019t be difficult. With some viruses, this isn\u2019t so easy; Dean pointed out that this was really hard for the MERS vaccine because the virus wasn\u2019t widely circulating. \u201cIt\u2019s so rare,\u201d she explained. \u201cThat\u2019s not a problem here\u201d with Covid-19.<\/p>\n

According to Thompson\u2019s analysis, if every step is successfully sped up, there\u2019s a chance that we could get emergency vaccine deployment by February 2021 and full distribution by the end of that year. But, again, those are big ifs \u2014 assuming that a lot of bets do pay off in the end.<\/p>\n

\u201cFinding a working vaccine in that time frame would be remarkable,\u201d Hoyt said. \u201cIt would be something to be very, very proud of. Having enough of that vaccine for everyone in that time frame would be a miracle.\u201d<\/p>\n

There are real risks to rushing a vaccine<\/h3>\n

Beyond the unavoidable time constraints, there are good reasons that vaccines take a long time to develop and distribute: Without months or even years of evidence, there might not be enough proof that a vaccine works as promised. That could lull people into a false sense of security, or lead to dangerous side effects down the line.<\/p>\n

There\u2019s some good reason for caution with Covid-19. In the New England Journal of Medicine<\/em><\/a>, experts with the Coalition for Epidemic Preparedness Innovation warned that vaccine trials for the coronaviruses SARS and MERS \u201craised concerns about exacerbating lung disease, either directly or as a result of antibody-dependent enhancement.\u201d<\/p>\n

Now, modern vaccines are very safe<\/a>, based on large reviews<\/a> of the research<\/a>. They have helped eradicate diseases<\/a>, including smallpox, at the national and global scale.<\/p>\n

But one of the reasons these vaccines got to be so safe is because the researchers and manufacturers behind them followed rigorous scientific standards. They made sure these medicines produced lasting immunity without major side effects. They made sure the vaccines were produced in safe conditions without contamination. They made sure the people administering the vaccines were properly equipped and trained. These things can be viewed as hurdles, but they\u2019re there to protect people.<\/p>\n

If these steps aren\u2019t properly followed, there\u2019s a real risk. In 1976, America rushed out<\/a> a vaccine in response to fears of a widespread swine flu outbreak. It turned out the swine flu that year wasn\u2019t as widespread as officials feared, and the improperly tested vaccine led to a rare neurological disorder, Guillain-Barr\u00e9 syndrome, in 450 people<\/a>. \u201cIt caused more harm than it saved,\u201d Josh Michaud, associate director for global health policy at the Kaiser Family Foundation, told me.<\/p>\n

Vaccine production has come a long way since 1976. But it\u2019s come a long way in part because we have regulations and safeguards to try to guarantee efficacy and safety, and those protections now might slow the arrival of a cure beyond the 12- to 18-month window. <\/p>\n

And lapses still happen, like a European H1N1 flu vaccine that increased the risk of narcolepsy<\/a>.<\/p>\n

The potential harm here is not just at the personal but social level. If a Covid-19 vaccine leads to bad side effects, some experts worried that anti-vaccination groups \u2014 already perpetuating concerns about the disease, even when the facts aren\u2019t on their side \u2014 could capitalize on the problems to spread their message. That would be a public health disaster.<\/p>\n

\u201cWe\u2019ve already seen anti-vaxxers rallying against the vaccine we don\u2019t even have yet,\u201d Tara Smith, an epidemiologist at Kent State University, told me. \u201cIt is huge in my mind that we need to do this as quickly as possible but not skimp in any way on any of the safety mechanisms.\u201d<\/p>\n

Still, the risks of rushing also have to be weighed<\/a> with the realities people are dealing with right now. Covid-19 is killing hundreds of thousands of people around the globe. It\u2019s forcing places to shut down their economies and individuals to stay home \u2014 causing harm not just through losses in jobs and income but also to activities that helped sustain people\u2019s mental health and happiness. There may be a risk of harm from a rushed vaccine, but keeping the world trapped in its current condition carries risks and harms as well.<\/p>\n

It\u2019s a balancing act. And we may not know if we\u2019ve struck the right balance until a vaccine has been out in the world for a few months or years, giving researchers time and data to see if it\u2019s truly safe and effective.<\/p>\n

\u201cEverything is cost-benefit,\u201d Hoyt said. \u201cGoing to the grocery store is not risk-free currently. Which risk would you rather have?\u201d<\/p>\n

Other medications and efforts could help fill the void<\/h3>\n

At the same time, humanity doesn\u2019t necessarily have to rely on a vaccine to get us out of the current situation.<\/p>\n

The story of HIV is instructive. While a safe and effective HIV vaccine has eluded humanity for decades, we have developed antiretrovirals that can combat HIV so well that it becomes undetectable in the body<\/a> \u2014 even preventing its spread \u2014 and other treatments<\/a> that make it much less likely someone will catch the virus from someone who\u2019s HIV-positive. People now treated early for HIV can live as long<\/a> as their HIV-negative peers. There are many differences between HIV and the coronavirus, but this shows that there are alternatives to a vaccine.<\/p>\n

With the coronavirus, research into non-vaccine treatments is still early. So far, the results have been mixed with remdesivir<\/a> and disappointing with hydroxychloroquine<\/a>. But, again, it\u2019s early, so there could be a big breakthrough at some point among the 280-plus non-vaccine therapeutics currently under study<\/a>. Short of a blockbuster drug, a new process in hospitals and clinics could at least help treat Covid-19 patients much more effectively and safely.<\/p>\n

The downside, though, is producing these alternatives could still take weeks or months. \u201cWe need more time,\u201d Saskia Popescu, an infectious disease epidemiologist, told me. \u201cIt\u2019s going to be a while until we really understand some of the medical interventions that work and don\u2019t work.\u201d<\/p>\n

Other medications and treatments could also help make a vaccine. If one of the concerns with human challenge trials, for example, is that they will expose people to a virus that can\u2019t be treated, that concern is obviously going to be mitigated if there are medications that can effectively treat Covid-19. That could open the door to more aggressive means of testing a vaccine, speeding up its development and deployment.<\/p>\n

Outside of treatment, there are also public health interventions that could help control the coronavirus without a vaccine. Other countries, such as South Korea<\/a> and Germany<\/a>, have aggressively deployed widespread testing<\/a> and contact tracing<\/a> to isolate people who are infected, quarantine their contacts, and deploy community-wide efforts, like lockdowns or other forms of social distancing, as necessary. These measures alone aren\u2019t enough to let life return to normal \u2014 as South Korea and Germany are learning<\/a> \u2014 but they make it much easier, experts say, to put out embers before they become wildfires.<\/p>\n

Again, this will take time \u2014 likely more than it should. The US has made some progress<\/a> in recent weeks in doing more testing, but the great majority of states still don\u2019t have enough<\/a>.<\/p>\n

These public health interventions and the prospects of non-vaccine medications aren\u2019t the best possible outcome \u2014 a vaccine still holds that claim \u2014 but they could offer some relief. As people get tired of staying home, the reprieves and hope the alternatives provide could help buy time until a vaccine arrives \u2014 whether that takes six months or many more years.<\/p>\n

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Support Vox\u2019s explanatory journalism<\/strong><\/p>\n

Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. Vox\u2019s work is reaching more people than ever, but our distinctive brand of explanatory journalism takes resources \u2014 particularly during a pandemic and an economic downturn. Your financial contribution will not constitute a donation, but it will enable our staff to continue to offer free articles, videos, and podcasts at the quality and volume that this moment requires. Please consider making a contribution to Vox today<\/a>.<\/p>\n<\/div><\/div>\n

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