In March when the WHO declared the COVID-19 a pandemic, the consensus in the scientific community was that humanity is in for a long haul. There was no antidote to the contagion and the most optimistic prediction was a vaccine by the middle of 2021. A shield against COVID-19 is still in the works but we are close to taking the first steps towards resolving the lethal conundrum much earlier than anticipated — the first vials of a vaccine are likely to roll out in the next two months and if all goes well there will be more than one preventive against the contagion. In a year when nothing seemed to be going right, the work in laboratories in several parts of the world is one of the few comforting developments.
For most of us, the yearning for a vaccine is a relatively new experience. The epic fight against the dreaded smallpox is part of receding memory. Immunisation programmes have, of course, become far more robust since the 1950s when Jonas Salk’s discoveries gave humanity the upper hand against the crippling polio virus. But the stakes in a vaccine against COVID-19 are unprecedented. Economies have gradually opened up after lockdowns during the early months of the pandemic, festivals have been celebrated, albeit in a subdued manner, and polls have been conducted in several countries. But it’s the vaccine that promises to set us free, give back the quintessential human freedom of association, and, most importantly, relieve the anxiety and worry that has become the leitmotif of life in large parts of the planet.
That’s what makes the research in laboratories, virtually at breakneck speed, so significant. It has evidently helped that the epidemics caused by pathogens of the coronavirus family in the past 20 years, SARS and MERS, have pushed scientists to study the varied interactions between the human immune system and contagions. These outbreaks petered out before vaccines could be developed. But the research has stood humanity in good stead in the battle against its latest bête noire.
We know that unlike other flu viruses, coronaviruses make use of various biological pathways in the human body — co-opting enzymes of the host’s cells for example. Knowledge of the spike protein — the corona or crown that gives the coronavirus its name and is its life force — has informed understanding of the ways in which the immune system behaves when a person contracts the novel coronavirus. Approaches targeting this rogue protein, whether through genetic material as in the case of the vaccines developed by Moderna and Pfizer or through a viral vector from chimpanzees as in the Oxford-AstraZeneca vaccine, have benefitted from earlier trysts with coronaviruses.
The caveat, based on historical evidence, that vaccines take years to develop should thus be measured against humankind’s nearly 20-year-long endeavour to neuter coronaviruses. But it’s a serious caveat, nevertheless. We can say for certain that the frontrunner candidates are apt at training the immune system to recognise the spike protein of the novel coronavirus and produce antibodies to target it. But are they enough to prevent transmission? Or is their efficacy limited to preventing individual recipients from falling sick? On current evidence, we can only answer the latter query in the affirmative. A conclusive answer to the first question will require periodic swab tests on the participants of the final trials — and tests, as our experience of the pandemic has shown, are a fraught issue.
All this means that the novel coronavirus could be at large months after the first jab is administered. The initial months of the vaccination drive — perhaps even the first year — could be akin to an extended inoculation trial. The emerging data is likely to necessitate fine-tuning the initial products and as several experts have pointed, asking scientists working on different anti-COVID vaccines in different parts of the world to join forces — or create a bouquet of complementing preventives.
In more ways than one, this could be the make-or-break period in the fight against the pandemic. Contemporary medical history shows that achievements in laboratories often have a long and tortured path to people’s well-being, especially the most vulnerable. India, for instance, produces 60 per cent of the world’s vaccines and is home to the largest manufacturer, the Pune-based Serum Institute. Yet, the country also has the largest number of unvaccinated children in the world. NSO data shows that less than 60 per cent children receive the entire basket of vaccines. Securing 1.3 billion people will require a massive public policy effort at bolstering the country’s public health infrastructure, roping in the private sector without imperilling equity and obviating black markets as well as checking the diversion of resources from regular immunisation programmes.
The key challenge will be to institute transparent mechanisms at points where science and research meet public policy. Inoculation drives have a history of making communities edgy. Rumours run rife and vaccine hesitancy has been the Achilles heel for almost every immunisation programme in history — a Lancet paper of May 2019 reported “delay in acceptance or refusal of vaccines despite availability of vaccination services in more than 90 per cent countries in the world”. In case of the COVID-19 vaccine, with much in the realm of the unknown, any opacity on safety issues will come in the way of building public confidence in the work in laboratories.
The sheer scale of the anti-COVID vaccination makes it unprecedented in human history. Securing localities, districts, states, even entire countries or regions will not be enough against a virus that multiplies at a dizzying speed. The herd to be inoculated against the contagion has dimensions not scaled in human history. That makes the medical, economic and public policy dilemmas inextricable from the ethical aspects of vaccine distribution. Too often in recent history, inoculation drives have left the marginalised in the lurch. The novel coronavirus forces us to do things differently, it demands a different conception of herd from science and public policy.
This article first appeared in the print edition on December 1, 2020 under the title ‘Reimagining the herd’. firstname.lastname@example.org