if coronavirus vaccine is never developed?

 COVID-19 is one of the largest and most immediate  threats to human life in the modern day, with millions of infections and hundreds of thousands of deaths to its name. It seems like every day we learn frightening new facts about the disease, like its extreme contagiousness, or its apparent ability to cause massive strokes in some of its victims. But, for many there’s a light at the end of the tunnel: The COVID-19 vaccine that will grant us all immunity from this terrifying virus. 

 

But, we’re sorry to report that actually getting an effective vaccine for COVID-19 isn’t necessarily in the cards. That’s right – like a lot of the most dangerous and complicated problems facing humanity today, the hope for a simple, silver-bullet answer to our problems might just be a futile and even dangerous fantasy. You’ll likely see countless articles about the various vaccine development projects across the globe, and how all of these tests are claiming to be standing on the doorstep of a major breakthrough. However, experts like Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy,think that news like this is building dangerous false hopes among the public. The idea that a vaccine will definitely be developed and available in the next several months has led many to underestimate the virus,both in terms of its immediate negative effects and its potential to infect even wider swathes of the global population. Even if we do get lucky and find a workable vaccine, the battle would be far from over.

In Osterholm’s own words, “even if we had a vaccine that showed some evidence of protection by September, we are so far from having a vaccine in people’s arms,” as global development and roll out would likely be a wildly uneven nightmare. And even that feels optimistic compared to the possibility that a vaccine might always continue to evade us. Today, we’re going to explore that worst-case scenario: The fact we may never see an effective vaccine for this virus, why this might be the case, and what a future where COVID-19 is never fully wiped out could look like. 

First, with so much seemingly positive news about vaccine development breaking every day, why might all of this come to nothing? After all, we’ve come up with successful vaccines for horrific viruses in the past, like Smallpox and Polio, so why not COVID-19? Well, this situation is a lot more complicated than most of the general public currently understands.

 The degree to which a virus is amenable to an effective vaccine has less to do with the symptomatic traits of the virus, and more to do with – as veteran researcher Adolfo García-Sastre puts it – the “specific characteristics of how the virus infects.” Hence why a disease as deadly as Smallpox can be conquered, and a disease as annoyingly simple as the common cold continues to be impossible to vaccinate against. Unlucky for us, all evidence currently points to COVID-19 being closer to the common cold on this scale than something like smallpox. Naturally, this is extremely concerning because the rate at which COVID-19 causes serious illness and even death in its victims is also far closer to smallpox. Researchers have found that the characteristics of COVID-19, in terms of its virulence, are extremely similar to that of an earlier coronavirus:SARS, which came to prominence in the early 2000s. Unlike with COVID-19, SARS was caught and contained quickly, leading to it burning itself out after only killing 700 people, compared to COVID-19’s multiple hundreds of thousands deaths. 

At the time, scientists developed two different vaccines for SARS that they tested on lab animals, and found some extremely disturbing effects: While the vaccine did activate antibodies in the immune system that allowed the test subjects to respond to SARS, the antibodies weren’t actually enough to stop the virus from causing serious damage. A quick science lesson on how vaccines work:Vaccines introduce molecules of certain viral or sometimes bacterial pathogens – known as antigens – into the body in order to train the body’s immune system to recognized fight a pathogen. The body already does this naturally, but this can take valuable time – time during which the disease can progress to dangerous levels. Vaccines allow the body to have the antibodies before the first infection even begins. This essentially nips a burgeoning pathogenic threat in the bud, unless a pathogen undergoes regular antigenic shift, like the flu virus or common cold. This means new antibodies will need to be produced for each strain of the pathogen that mutates. Rachel Roper, a professor of immunology at East Carolina University who played a part in those aforementioned SARS tests, believes there’s credible evidence to indicate that COVID-19 might just be resistant to vaccination altogether.

 And it’s not just SARS that sets the precedent for this – The FDA has never approved a single viable vaccination against any coronavirus,including SARS, MERS, and the common cold. In some ways, it would actually be more surprising to find that they could develop a vaccine for COVID-19. There’s also a common saying in scientific research circles “mice lie, and monkeys don’t tell the truth.” Meaning that results discovered in animals aren’t always generalize to human subjects – so even promising results in mice don’t necessarily mean those same results will carry over to humans. 

Researchers like Roper have also highlighted the possibility that rushing into a bad vaccine could be far worse than not having any vaccine at all. Experts have pointed to past horror stories like Dengvaxia, a 2016 vaccine for the notoriously vaccine resistant dengue-fever that was used on around 800,000 Filipino schoolchildren, and had some disastrous results. Authorities looked into the deaths of 600of these children, all of which were possibly killed by a phenomenon known as “immune enhancement.” This is when, due to poor design and testing,a vaccine does the opposite of what it was intended to do and instead of helping the body, it makes the infection worse. This is because, in the event of immune enhancement,the antibodies actually help the virus progress further through the body rather than preventing it. While instances like this are relatively rare– and definitely shouldn’t be used as proof by anti-vaxxing soccer moms who are in the process of bringing back measles – but it’s still a risk worth considering before anyone tries to rush in with a half-baked vaccine plan. 

However, while a badly-made vaccine could be calamitous, vaccines that only work for a relatively short period of time could still be useful, as they may at least slow some of the spread of the virus. While it’s become clear that some countrieshave most likely been hiding or misreporting the true extent of their infections, antibodydata coming out of China has raised some more cause for vaccine concern. Patients who recovered from the virus showeda low antibody count, meaning that people who’ve caught the virus in the past, orget vaccinated for it, are at risk of getting infected again either way – though scientistswill need more data on this before making any conclusive observations. Christopher Whitty, the UK’s Chief MedicalOfficer, also shared some pretty grim tidings as a result of his team’s research. He said there’s been “concerning” evidencethat it may be impossible, artificially or otherwise, to stimulate long-term immunityfrom the virus, seeming to corroborate the results of the Chinese data. He does offer a small glimmer of hope in this,saying it doesn’t necessarily mean there’s no chance for a somewhat effective vaccine. However, it does cast some serious doubt onwhether a lifelong vaccine for COVID-19 could ever be developed. You may be tempted to think, “Well, lookat the rate that COVID-19 is infecting and killing people. Surely that would be effective motivationto develop a vaccine as soon as possible, with the world’s united resources.” But once again, historical precedent stepsin to dash these overly optimistic hopes.

 HIV was first officially discovered and namedin 1984, and in the several decades since, it’s killed over 32 million people. Still no vaccine, in spite of the devastatinghuman toll and the billions of dollars spent on research over the years. Scientists have had similar difficulties creatingan effective vaccine for adenoviruses and rhinoviruses, which can have similar symptomaticeffects to coronaviruses like COVID-19. Of course, none of these viruses are exactlythe same as COVID-19 in terms of its virulence and its rate of mutation – the two decidingfactors in the effectiveness of a vaccine. But it does stand to prove an important point:We’ve had high hopes for different vaccine development plans in the past, only to bebrutally disappointed by the outcomes. In the grand scheme of things, we’re stillin the very early days of COVID-19, and as more data about the disease trickles in overtime, we’ll gain a better understanding of what exactly we’re dealing with here. So that’s why we may not be able to counton a COVID-19 vaccine to swoop down like superman and save the day, now the real question is:What does this actually mean for all of us? If we’re not all biding time for the developmentof a vaccine here, what’s the endgame for our global fight against the disease? Well, we must once again turn to history forthis. 

The groups of experts who’ve cautioned againstputting all of our eggs inside the vaccine basket have instead suggested a set of sweepingsocietal reforms that would allow us to adapt to the presence of COVID-19. David Nabarro, professor of global healthat Imperial College, has said that figuring out ways to work around the constant threatof the virus through individual choices and government legislation is really the onlyAnti-COVID-19 method we can truly rely on. This is referred to as “Plan B”, withPlan A being the expression for the traditional vaccine path to ending the current globalcrisis. Take the aforementioned HIV/AIDS pandemicthat’s been raging since the early eighties. Thanks to impressive developments in antiviraldrugs, HIV is no longer the absolute death sentence it used to be – with many HIV positivepeople living long and fulfilling lives. The creation of pre-exposure prophylaxis,or PrEP (Narrator note: pronounced “prep”), medication has also gone a long way in preventingfurther infections in the absence of a viable vaccine. While some research teams race to find a potentialvaccine for COVID-19, others race to find useful antiviral drugs for treating patientscurrently suffering from the disease. If a cheap and effective antiviral drug wasfound, it could circumvent the vaccine issue by massively reducing the severity of thecases, if not the overall number. You’ve probably heard a number of optionsparaded as “miracle cures” in the news – from the Hydroxychloroquine championedby US President Donald Trump, to the anti-Ebola drug remdesivir, to experimental blood plasmatreatments. Of course, all of these are essentially shotsin the dark at the moment, and anyone trying to tell you otherwise is more than likelytrying to sell you something. At the time of this writing, in late May,2020, there are no consistently effective antiviral drugs approved for the treatmentof COVID-19. On the upside, if any of the antiviral drugsbeing tested to treat COVID-19 do turn out to be effective, we should find this out inthe coming weeks, as randomized antiviral drug trials are an exponentially faster processthan vaccine testing. However, it’s still worth asking: What ifour saviour doesn’t come in the form of antiviral drugs, either? What does a world without vaccines and antiviraldrugs for COVID-19 look like? It’s likely that the world may, in time,return to some semblance of a new normal. While a truly extensive lockdown would bethe most effective way to let COVID-19 burn itself out – think the course of the SARSinfection, just on a much wider scale – it would also likely lead to global economiccollapse.

 Therefore, what most experts recommend isa slow easing of containment procedures in several months’ time, but only if buttressedby regular mass testing to detect and stomp out pockets of the virus before they can becomeepidemics. This new way of living would also be builtaround the idea that lockdowns can restart at any time if deemed necessary, so it’slikely periods of quarantine would come in fits and starts for years to come in orderto minimize damage. This new normal would also feature a certaindegree of social distancing as standard, changes to social norms like the elimination of shakinghands, and the expectation of a constant state of caution and vigilance. Of course, it’s worth noting that, whenall is said and done, many experts still believe that creating a viable vaccine for COVID-19is a strong possibility – and the debate of whether COVID-19 is vaccine resistant ornot is a contentious one, that will require more data from cases and studies to trulyanswer.

 However, even if – in the best-case scenario– we do manage to create a workable vaccine and accompanying antiviral treatments, we’llall be better off for exercising the caution and consideration that comes with knowingjust how bad the worst-case scenario can truly be. Now go check out “What Is It Actually Liketo Have COVID-19?” and “COVID-19 (Coronavirus) Long Term Health Impacts”