How to deal with a mutant virus

Count 2020 as a lucky year. This may seem strange, given that the world has faced a pandemic that has killed nearly 1.8 million people and damaged the economies of many countries. “Good luck” refers to the over 90% efficacy of the two vaccines – Pfizer Inc.-BioNTech SE’s shot and Moderna Inc.’s candidate – which obtained emergency approval after thorough clinical analysis. Enormous leaps in science and technology have contributed to this and could accelerate the end of the pandemic. Even more vaccines are on the way. Unfortunately, there is a risk that this early success will lead to satisfaction.

The virus responsible for Covid-19 disease – SARS-CoV-2 – is mutant, as viruses do all the time. This happens at random. Sometimes the changes give a variant a slight advantage over his colleagues, but often do not make any difference from an immunological point of view. Over time, however, it is possible to develop mutations that are less sensitive to the protection provided by vaccines. For this reason, a coordinated global surveillance effort is needed to ensure that we are on the verge of changing the virus. Unfortunately, this does not seem to be happening.

The UK is well ahead in this surveillance effort, led by the Covid-19 Genomics UK Consortium, a group of scientists who have analyzed the entire genome of more than 150,000 SARS-CoV-2 viruses isolated from infected people. This gigantic undertaking helped them identify 1,777 changes in the virus’s proteins, including the so-called variant B.1.1.7, whose apparent ability to transmit more efficiently worried experts and forced home stay measures and travel restrictions. in Great Britain. the variant is impressive in that it harbors more mutations, a total of 23, than has been seen so far in a single virus, with eight of them in spike protein – the prominent rod-like structure that decorates the outside of the virus and is targeted by most vaccines , including Pfizer and Moderna. Although there is still no clear evidence that this variant is more resistant to existing vaccines, it raises concerns.

I was concerned about the possibility of “escape” mutations once vaccinations were launched on a large scale, but it seems that these changes occur even in the absence of large-scale inoculations. The problem is that, although we have control over the types of changes that take place in the UK, we do not know how many other variants are circulating in the European Union, the USA and Asia, because the data are not properly tracked. This needs to change if we are to manage the virus effectively.

What needs to be done? Three things. First, governments around the world need to work together and increase their surveillance of the virus to match that of the UK, so that we can better assess any changes in response to vaccination. We will soon know if variant B.1.1.7 is as sensitive to vaccines as the most common strain is likely to be. But we need any new variant found around the globe to be evaluated for its ability to react to vaccine-induced immunity, so that we are not surprised. The diary for this already exists: this is done for the flu virus and we develop a new vaccine every year. The same should apply here, if necessary. In addition, a set of rules needs to be developed and agreed globally on what is a matter of concern. For example, do we develop vaccine candidates for each new variant found with mutations – which would have meant about 4,000 candidates so far – or only those who have been shown to be less sensitive to our vaccines in laboratory tests?

The next step is to make sure that vaccine companies work closely with governments and develop versions of their vaccines that include any new concerns. Although there is a cost and effort in doing this, it will be relatively low for those using new technology, such as Pfizer-BioNTech and Moderna with their mRNA photos and AstraZeneca Plc and Johnson & Johnson with their “vector-viral” vaccines. “. These technologies are suitable for the rapid development of new candidates in less than two months. Companies should perform preclinical and non-human primate testing to compare these new vaccine candidates with those that have already been approved. In this way, they will be ready to carry them out in trials, if the need arises.

The last piece of the puzzle is the regulatory framework around the introduction of new vaccines on the market. Again, we have an existing flu vaccine playbook. Companies, regulators and governments need to come up with a set of simple rules so that we don’t have to wait for massive trials at a later stage before launching a new vaccine formula. It should be possible to get a mass-modified vaccine in a few months if the preclinical work is already done.

I am optimistic that all these things can be done. We already have the UK doing large-scale genomic analysis. A rejuvenated center for disease control and prevention in the US would be a significant addition. With a few other regions, such as China and the EU, joining, a global consortium could systematically track the virus. And our pharmaceutical and biotechnology industry has demonstrated its ability and desire to move fast.

After so much good initial news about the vaccine, it would be a shame to lose ground in the fight against the virus, especially if it can be avoided. We just need to act on these things as soon as possible.

This column does not necessarily reflect the opinion of the editorial staff or Bloomberg LP and its owners.

Sam Fazeli is a senior pharmaceutical analyst for Bloomberg Intelligence and research director for the EMEA.

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