What happens if a coronavirus vaccine cannot be developed? Scientists advise having a 'B' plan

• Direct. Last minute about the coronavirus in Spain
• Education. College grades improve during confinement
• Economy: Declaring that you have no income will be enough to collect the minimum vital income

All scientists, the pharmaceutical society and governments are committed to developing an effective coronavirus vaccine as soon as possible with investment of millions. But there is a second, less popular possibility: that a vaccine will never be developed . The hypothesis that we must learn to live with the virus if not forever, for a long time, can become a reality. The ongoing trials are being given a lot of echo. Announcements about every small step in finding a way to immunize the world of the Sars-CoV-2 are followed day by day. Right now, there are 101 experiments in progress. Many experts seriously consider the possibility that the solution might not come . Or if it does come, which is likely, it won't be as fast as you might expect.

Unlike HIV and malaria, large mutations do not occur in this coronavirus. The next step that scientists studying the disease await. Anthony Fauci, immunologist at the White House table of experts, has spoken of 18 months for its development. Other scientists are more cautious when talking about organ systems, they don't work mechanically. It depends on how they react. In the production process, the most difficult part is demonstrating that the vaccine works and is safe: you cannot risk inoculating anything that produces unwanted side effects.

"From five to 10 years"

There are different techniques to produce vaccines, with different times. Being able to achieve the vaccine in a year and a half would be something unprecedented in history , which has never been achieved. "There are a hundred projects with various techniques, each with its advantages and disadvantages. We do not know which candidate will reach the expected results first," says Sergio Abrignani, an immunologist who works in Milan. "In normal circumstances it would take five to 10 years , with an average of eight, to get to the pharmacy with a vaccine. In my experience, it will be difficult to have a vaccine within two years if we want to be effective in two fundamental aspects: that it is safe and it provokes a positive immune response and it is maintained over time. When I hear about a vaccine that will be ready for September, it sounds like science fiction to me. I would like to deny this possibility. " Therefore, experts suggest governments consider a plan B : long coexistence with the virus.

In 1984, when the discovery of HIV was announced in Washington, the then Secretary of Health, Margaret Heckler, considered that a vaccine would be developed within two years. Today, 32 million dead later, the world is still waiting for the solution to the virus . The AIDS virus mutates continuously. It is the main difficulty for its treatment. Fortunately, the Sars-Cov-2 does not appear to have these characteristics. Between 2015 and 2016, the first Dengue vaccine was registered, a disease that kills about 400,000 people a year, but in 2017 its use was discontinued because it was found to worsen the symptoms of the disease. It took 28 years to get a chickenpox vaccine , for papilloma virus, 15. No rhinovirus and adenoviru vaccines have ever been developed or marketed, which, like coronaviruses, can cause cold-like symptoms (there is only one vaccine). against two adenovirus strains that are not commercialized). Until now, a coronavirus vaccine has never been tested: the Sars vaccine was abandoned during the studies because the disease was defeated in a few months and also caused side effects in some patients. Each in its own way, Sars and Sars CoV-2 share 80% of the genome and work the same way, clinging to a specific receptor found in the cells of the lungs . This explains why scientists developed the tests so quickly. They had a small advantage.

Roben van Exan, a cell biologist who has worked in the vaccine industry for decades, interviewed by the New York Times , predicts that the cure for this coronavirus will not be approved before 2021 or 2022. "And it is an optimistic view , with a Very low probability, but worth a try. " As a rule, researchers follow rigorous safety checks before inoculating experimental vaccines. During phase 1, the vaccine is tested on a dozen people; they reach one hundred in phase 2 and improvement in phase 3. In general, months pass between one phase and another, so researchers can study the results before moving on.

It is clear that to obtain a result in 18 months it is necessary to burn some stages. If a vaccine is effective in the first tests, health authorities could consent to an emergency use for doctors and nurses before the end of the year . Only after hundreds of tests and vaccinations would researchers be able to understand the effects of the vaccine.

One year for approval

After finding it, companies will need to produce millions of doses and add it to the annual vaccination schedule. Companies typically build new custom structures for each vaccine and generally need five years to get them because they are guided by a rigid procedure. To that end, the Bill and Melinda Gates Foundation has announced that it will build factories for seven different vaccines, thereby saving production time. Fulfilling the production tasks takes the researchers sleep. Even putting vaccines in vials takes time. "Producers must have millions of vials and millions of caps to close them," Vijay Samat, a former director of vaccine production at Merck, told the New York Times . "Precise filling requires specific machinery. Each vial is individually inspected, undergoing various tests. Once ready, they must be stored and shipped at a certain temperature." Of the rest of the stages of creating a vaccine, production is the phase that lasts the longest. Hope in the race against time comes from a new type of Messenger RNA vaccine. Rather than injecting disease-specific antigens to stimulate antibody production, these vaccines give the body instructions to create the same antigens by injecting a synthetic gene into the cell. This system does not need to grow the virus or bacteria and it is easier and easier to produce. The problem is that today a vaccine of this type has never been tested for humans . It could work but the production phase would probably be longer. So far vaccines have been created with this technique against influenza, Ebola or Zika that have been applied in guinea pigs.

The approval phase of a vaccine is not a mere formality. Administration researchers must prove that it is as safe as pharmaceutical producers consider, analyzing even the smallest detail, as well as several studies . If the different phases can be accelerated, the same does not happen with approval, a procedure that could take more than a year. History, unfortunately, teaches and warns that we have to be cautious. In the 1950s, a vaccine against poorly produced polio was approved in a few weeks. Many children died.

If the vaccine is not in a short period of time, Sars-Cov-2 will probably keep us company for many years and we will live with a disease that cannot be eliminated . Thanks to HIV antivirals, AIDS has become a chronic disease and is no longer a death sentence as in the 1980s. Also with Covid-19 disease, scientists are working to find cures with old and new drugs, but the studies have just begun. In many cases, empirical tests are used in hospitals, where some patients are given remndesivir, the drug against Ebola, treatments with blood plasma or chloroquine. However, randomized controlled studies are lacking and there would be a problem in producing the drug on a large scale . 271 therapies are studied, of which about 10% of clinical studies have not been approved by the American administration, for example. The rest fall: they are not effective, they are not better than existing drugs, or they cause too many side effects .

Living with the virus means revolutionizing our lives. Wearing a mask will be as common as carrying a mobile phone. A coughing attack will be seen as a threat. Amesh Adalja of John Hopkins Hospital has stated that "October 2020 will not be like October 2019" . There are many possible scenarios: from a projection of hundreds of thousands of deaths in August to new waves while we wait for the arrival of the new normal, with foci of Sars-CoV-2 for at least a couple of years. Hardly everything will be back to how it was before in a short time.

In accordance with the criteria of The Trust Project

• Covid 19
• Coronavirus
• Diseases
• Respiratory diseases
• Pneumonia
• Vaccines
• Italy

COVID-19An elderly married couple affected by the coronavirus is reunited in the Italian hospital where they were admitted separately

Covid-19The medical odyssey of the woman who had a high fever on December 26 in Milan: "I have found antibodies to the coronavirus"

Covid-19The tourist bonus that Italy prepares to sustain the summer holidays