Although we in the Netherlands seem to be leaping from one lockdown to the next, there have been plenty of hopeful innovations surrounding corona over the past year. Innovation Origins looks back on the most notable developments and peers ahead into the new year with internist-infectious disease specialist Astrid Oude Lashof. Will we finally be rid of the virus?
To answer that last question straight away: No. According to Astrid Oude Lashof, an internist-infectiologist affiliated with the Maastricht University Medical Centre, it won’t be be any time soon. Regrettably. “But what we do see is that we are becoming better at responding to a new variant. All over the world, scientists are doing research and sharing data. Now we can see much faster how virulent – pathogenic – the new Omicron variant is. With this data, governments are able to anticipate more readily, and it allows pharmaceutical companies to adjust their vaccines more rapidly. I think that’s a great development.”
Another development that Oude Lashof is very excited about involves the diagnostics of the virus. “We’ve gotten better in the past year at detecting the virus earlier. PCR tests are getting better, faster and more reliable. But serological tests, where the blood is examined for virus particles and antibodies, have also become faster and more reliable. The advantage is that you can tell immediately whether a patient is presenting with antibodies or not. That’s a very nice development. Patients who do not have antibodies or who do not produce them can be treated with antibodies more quickly this way. Especially in the case of the Delta variant, this reduced the risk of mortality and fewer people were admitted to the hospital.”
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A look back at 2021 is not complete without mentioning vaccine technology, Oude Lashof states. This is the first time that the reasonably new mRna vaccines have been deployed on such a large scale in the world. “This breakthrough means that vaccines can be adapted and produced more quickly. That this technology is now being used globally is completely new. Smallpox was eradicated thanks to vaccinations; in the end, almost everyone got a shot for that. But not nearly as many people as nowadays – also because, of course, there are more people in the world today. I find the speed of how things are going today particularly fascinating. From the development of vaccines to the vaccinations themselves. But unfortunately we have to acknowledge that this applies mainly to wealthy countries; the pace in low-income and, to a lesser extent, middle-income countries is still lagging behind.”
There is also no solution (yet) for people with compromised immunity to get vaccinated. We wrote earlier this year that doctors at the university hospital in Tübingen, Germany, are working on this kind of vaccine. “Such a vaccine is not yet registered in the Netherlands. It is complicated to develop a good and safe working vaccine for people with poor immunity. It concerns relatively small groups of people who cannot receive a ‘normal’ vaccine for health reasons. In April 2020, it was still assumed that we would get there with herd immunity, but because we are now constantly being confronted with new variants, this appears to be very difficult. That is why it is still very important that scientists are still working on this.”
Generic covid vaccines
The same applies to generic vaccines. These vaccines are intended to protect us not only against current virus variants, but also against any future mutations. Without having to develop new vaccines for these or modify existing ones. “Now you see that pharmaceutical companies are having to adapt their vaccines to Omicron, which happens incredibly quickly with the current technology – around three months. That’s already extremely fast. But it would be even better if you could find a vaccine that also protects against new mutations,” the infectious disease specialist explains.
To do this, scientists are looking for a component of the virus that does not change easily. “Not even with new mutations. But that’s no easy task. In the case of the influenza virus – flu – we have been trying to do that for decades. This is also a virus that mutates a lot and keeps coming back. But despite extensive research, we have yet to find a key particle that does not mutate. But that doesn’t mean we should just stop, then you will never find it. On the contrary, I think it’s important for science to keep looking for it.”
And what does Oude Lashof think of reports that refer to the new hope in these fearful days: Covid pills? Laughing, she notes: “Nice names. Molnupiravir and Paxlovid.” Then in a more serous tone: “I’m not convinced yet. It’s not the Holy Grail that’s going to help us out of the crisis. It sounds very nice, of course. ‘Are you infected? Then just take a course of pills that will prevent serious symptoms or hospitalization.'”
According to her, what counts as far as these pills are concerned, is that you administer them at the earliest possible stage of the infection. “But how many people get tested right after the first cough? Some people do take a home test, but these are less reliable than a PCR test. With these viral inhibitors, you should start the course of treatment no later than five days after an infection, or it will be less effective.”
“But even that efficacy of the drugs still falls short when you look at the initial figures. For Molnupiravir, a group of 1,400 people were studied, half of whom received the new molnuvirapir and the other half a placebo. This, of course, did not include people infected with the Omicron variant. In this study, mostly white people participated and 75 % of them are overweight. This does not accurately reflect reality. Also, the group is too small to really be able to draw conclusions. In the figures, the difference in hospitalizations between the placebo and the drug takers is not remarkably large. But there is a difference in the total between admissions to hospitals and deaths. Participants who received molnupiravir were admitted less often and fewer people died compared to those who received a placebo.”
More research needed
Still, Oude Lashof is keen to stress that she is not against these covid medications by any means. According to her, it would help if this research was extended further and focused on better and more reliable self-tests. “If study groups become larger, let’s say at least five thousand people, there is a greater chance that we will be able to find a clearer effect. But in order to use medication effectively, the current self-tests also need to be better. A negative self-test currently doesn’t say much if you have no symptoms or only mild ones. We are working hard on that. Wouldn’t it be great if we could automatically prescribe medication after a positive self test? That shouldn’t pose a problem with today’s technology. This would enable us to relieve the pressure on healthcare considerably.”
But the number one priority, she says, ought to be to vaccinate the entire world. “If we really want to get rid of the virus, we should try to vaccinate the whole world within the next three months. The less the virus circulates, the less likely it is to mutate. In low-income countries, far fewer people are vaccinated; this is where the virus has a much better chance of spreading. You also have a population – especially in the southern part of Africa – with relatively lower levels of resilience. Due to diseases like HIV, or malnutrition, for example. The immune system of these people does not clear up a covid infection, or does so much more slowly; the virus remains in the body longer and consequently gets the chance to mutate within the body as well. This is why it would be beneficial if patents on vaccines were released so that vaccine copiers could – provided they can do so safely – scale up production worldwide.”
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