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 rollout 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 recognize
and 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 generalizable 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 600
of 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 countries
have most likely been hiding or misreporting the true extent of their infections, antibody
data coming out of China has raised some more cause for vaccine concern. Patients who recovered from the virus showed
a low antibody count, meaning that people who’ve caught the virus in the past, or
get vaccinated for it, are at risk of getting infected again either way – though scientists
will need more data on this before making any conclusive observations. Christopher Whitty, the UK’s Chief Medical
Officer, also shared some pretty grim tidings as a result of his team’s research. He said there’s been “concerning” evidence
that it may be impossible, artificially or otherwise, to stimulate long-term immunity
from 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 on
whether a lifelong vaccine for COVID-19 could ever be developed. You may be tempted to think, “Well, look
at the rate that COVID-19 is infecting and killing people. Surely that would be effective motivation
to develop a vaccine as soon as possible, with the world’s united resources.” But once again, historical precedent steps
in to dash these overly optimistic hopes. HIV was first officially discovered and named
in 1984, and in the several decades since, it’s killed over 32 million people. Still no vaccine, in spite of the devastating
human toll and the billions of dollars spent on research over the years. Scientists have had similar difficulties creating
an effective vaccine for adenoviruses and rhinoviruses, which can have similar symptomatic
effects to coronaviruses like COVID-19. Of course, none of these viruses are exactly
the same as COVID-19 in terms of its virulence and its rate of mutation – the two deciding
factors 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 be
brutally disappointed by the outcomes. In the grand scheme of things, we’re still
in the very early days of COVID-19, and as more data about the disease trickles in over
time, we’ll gain a better understanding of what exactly we’re dealing with here. So that’s why we may not be able to count
on 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 development
of a vaccine here, what’s the endgame for our global fight against the disease? Well, we must once again turn to history for
this. The groups of experts who’ve cautioned against
putting all of our eggs inside the vaccine basket have instead suggested a set of sweeping
societal reforms that would allow us to adapt to the presence of COVID-19. David Nabarro, professor of global health
at Imperial College, has said that figuring out ways to work around the constant threat
of the virus through individual choices and government legislation is really the only
Anti-COVID-19 method we can truly rely on. This is referred to as “Plan B”, with
Plan A being the expression for the traditional vaccine path to ending the current global
crisis. Take the aforementioned HIV/AIDS pandemic
that’s been raging since the early eighties. Thanks to impressive developments in antiviral
drugs, HIV is no longer the absolute death sentence it used to be – with many HIV positive
people 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 preventing
further infections in the absence of a viable vaccine. While some research teams race to find a potential
vaccine for COVID-19, others race to find useful antiviral drugs for treating patients
currently suffering from the disease. If a cheap and effective antiviral drug was
found, it could circumvent the vaccine issue by massively reducing the severity of the
cases, if not the overall number. You’ve probably heard a number of options
paraded as “miracle cures” in the news – from the Hydroxychloroquine championed
by US President Donald Trump, to the anti-Ebola drug remdesivir, to experimental blood plasma
treatments. Of course, all of these are essentially shots
in the dark at the moment, and anyone trying to tell you otherwise is more than likely
trying to sell you something. At the time of this writing, in late May,
2020, there are no consistently effective antiviral drugs approved for the treatment
of COVID-19. On the upside, if any of the antiviral drugs
being tested to treat COVID-19 do turn out to be effective, we should find this out in
the coming weeks, as randomized antiviral drug trials are an exponentially faster process
than vaccine testing. However, it’s still worth asking: What if
our saviour doesn’t come in the form of antiviral drugs, either? What does a world without vaccines and antiviral
drugs 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 be
the most effective way to let COVID-19 burn itself out – think the course of the SARS
infection, just on a much wider scale – it would also likely lead to global economic
collapse. Therefore, what most experts recommend is
a slow easing of containment procedures in several months’ time, but only if buttressed
by regular mass testing to detect and stomp out pockets of the virus before they can become
epidemics. This new way of living would also be built
around the idea that lockdowns can restart at any time if deemed necessary, so it’s
likely periods of quarantine would come in fits and starts for years to come in order
to minimize damage. This new normal would also feature a certain
degree of social distancing as standard, changes to social norms like the elimination of shaking
hands, and the expectation of a constant state of caution and vigilance. Of course, it’s worth noting that, when
all is said and done, many experts still believe that creating a viable vaccine for COVID-19
is a strong possibility – and the debate of whether COVID-19 is vaccine resistant or
not is a contentious one, that will require more data from cases and studies to truly
answer. However, even if – in the best-case scenario
– we do manage to create a workable vaccine and accompanying antiviral treatments, we’ll
all be better off for exercising the caution and consideration that comes with knowing
just how bad the worst-case scenario can truly be. Now go check out “What Is It Actually Like
to Have COVID-19?” and “COVID-19 (Coronavirus) Long Term Health Impacts”
