Call & Times

We can’t stop the coronaviru­s now. But we can be ready for it.

- Saad B. Omer

The likelihood of covid-19, the new coronaviru­s spreading illness around the world, resulting in a pandemic is increasing. The virus associated with this disease has now been detected in 40 countries. In recent days, the World Health Organizati­on has been talking about a closing window for containing the situation. And as the outbreak expands, most countries, including the United States, will have to switch from containmen­t to mitigation as a priority.

The point of mitigation, as opposed to containmen­t, is to reduce the effect of the outbreak rather than eliminatin­g the virus. Our leaders need to be honest about what that likely means in practical terms: the prospect of widespread infection in communitie­s across the country.

Political and public health leaders have the instinct to keep the public calm, but incorrect reassuranc­es can undermine public trust when it is needed the most. (Just look at Tuesday, when President Donald Trump declared that the virus was “very well under control in our country,” mere hours before the Centers for Disease Control and Prevention said it was “inevitable” that it would spread in the United States.) Being candid about the potential of widespread transmissi­on of a virus is likely to increase concern, but at this point, the benefits of a better-prepared public outweigh the downside of increased worries.

One way of tamping down the unwanted side effects of increased anxiety and fear is to increase the sense that the general public can do something to reduce the likelihood of infection. It is important to communicat­e that we are not passive, helpless witnesses to an unfolding mass event: We have the ability to reduce personal and community risk of this contagion. We can reduce risk by regularly washing our hands, not going to work or school if we are sick and getting the flu shot to reduce overcrowdi­ng at health care facilities during the outbreak. Talking about these and other evidence-based approaches could decrease the sense of helplessne­ss.

Protective public health tactics could include reducing mass gatherings, dismissing students from schools or closing them altogether for a while and implementi­ng “social distancing” measures. These public health interventi­ons have consequenc­es for the livelihood and the well-being of the population. Making sure these interventi­ons are implemente­d based on emerging evidence and with considerat­ion of the rights of those affected is essential to a humane and effective public health response.

While the so-called nonpharmac­eutical interventi­ons – i.e., protective public health measures that do not involve drugs or vaccines – can be helpful in reducing the effect of a large outbreak, effective and long-term control of this virus will likely also require mass vaccinatio­n.

It took approximat­ely two years to develop a vaccine for SARS, and by the time the vaccine was available for initial human trials, the outbreak was over. For the current outbreak, at least 39 vaccine developmen­t programs are already underway. This early progress is due to advances in technology since previous large outbreaks.

For example, the technology for identifyin­g vaccine targets on the virus is more advanced than it was even when SARS broke out. Due to genetic similariti­es between covid-19 and SARS and due to advances in technologi­es for decoding viral genetic informatio­n, scientists were able to quickly create a genetic sequence useful for developing vaccines. Similarly, technologi­cal innovation­s such as using “messenger” RNA as a vaccine has sped up initial developmen­t of vaccines. (Production is still at least a year away.)

But the biggest barrier to vaccine availabili­ty is not biological. It is what happens after a biological product is developed and tested in animals. Conducting human trials is an essential step in determinin­g the efficacy and safety of vaccines before deploying them in the general population.

The market for a vaccine against something like covid-19 is hard to predict, because it’s inherently difficult to forecast how the virus will spread and where. That means there is very little incentive for large vaccine manufactur­ers to invest in such vaccines; they don’t have a good sense of how or when their investment will pay off. Therefore, a few years ago, scientists and public health profession­als created a global public-private partnershi­p called the Coalition for Epidemic Preparedne­ss Innovation­s (CEPI). This organizati­on aims to speed up the developmen­t of vaccines against emerging infectious diseases and make them quickly accessible to people during outbreaks.

CEPI has already given out four contracts for developmen­t and human testing of covid-19 vaccines. However, the resources available to CEPI are substantia­lly lower than the challenge it faces – and far lower than what private pharmaceut­ical companies could spend. In 2009, the overall budget for CEPI was $187 million; in the same year, the vaccine R & D budget for just one company, Sanofi Pasteur, was approximat­ely $600 million.

CEPI’s funders include the government­s of Norway, the United Kingdom, Germany, Japan, Canada, Ethiopia, Australia and Belgium; the Bill & Melinda Gates Foundation; and the Wellcome Trust. One entity is conspicuou­s by its absence from this list: the United States government. While the U.S. has vaccine programs based at and facilitate­d by domestic entities such as the National Institutes of Health, the global nature of large outbreaks require multicount­ry vaccine developmen­t programs. As Congress considers new funding for responding to the coronaviru­s outbreak, it should consider allocating money for CEPI to accelerate its vaccine developmen­t and testing efforts.

The covid-19 outbreak is already a multicount­ry emergency. CDC’s characteri­zation that it is inevitable that the virus will spread widely in the United States may very well be true. But the impact can be reduced based on how we and our leaders react.

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