COVID-19 pandemic: What lessons are we learning?

6th April 2020

For Alexander von Gabain, the EIT Health Supervisory Board Chairman, molecular biologist and multiple company founder, the pandemic reveals the shortcomings and limits of an outdated understanding of innovation.

 

Looking at the coronavirus from the perspective of a molecular biologist – is this virus a particularly strong and therefore viable one?

Scientifically speaking, viruses can be both virulent and transmissive. The Ebola virus, for example, is so virulent that an infection can lead to death within a few days, because it reproduces extremely quickly. However, it is not very transmissive. The Rhinovirus, responsible for the common cold, on the other hand, is not very virulent at all. Indeed, it doesn’t need to be, as it is very easily transmitted. So, it counts on its high level of transmissibility to spread and thrive. COVID-19 is a novel virus that has only just crossed over from animals to humans. It seems to me that it has not yet clearly “decided” on a strategy, in the sense of a genetic orientation. It is easily transmitted and appears to be highly virulent, at least in a critical tranche of the population. I think that if the virus is still with us in ten- or fifteen-years’ time, its virulence could well be lower, with its high transmissibility proving more successful. Then we would be able to coexist with it, like the cold virus, where everyone can still ride public transport despite being infected and sneeze without having to worry.

How long do viruses need to “mature”?

It usually takes several seasons or generations of humans for a virus to adapt to a human population and find its main transmission route. Some viruses, such as the Epstein-Barr virus, typically acquired unnoticed in our youth, we carry with us all our lives, usually without symptoms.  This virus has lived with us for millions of years. Indeed, in its original form, it is largely assumed that HIV was also not so virulent either – HIV is not as easily transmitted. Unfortunately, however, HIV lost its low virulence over a period of several decades, because, among other factors, at some point there were enough opportunities for transmission, and thus no longer any reason to spare the host.

In the current COVID-19 pandemic, the world’s health authorities are trying to control transmission rates by banning contact between people. Are quarantine-like measures the right way forward?

The measures implemented by most governments are important and appropriate steps in preventing a steep and rapid increase in the rate of infections. They are also the lessons drawn from past epidemics and diseases.

However, today we have many more options at our fingertips, such as combining molecular biology and IT. We’re also able to precisely trace infection routes thanks to contact data, meaning we can identify groups that are infected far more quickly. Also, we can and indeed must test people for IgG antibodies, which show that someone has successfully fought off the infection.

These people are no longer dangerous to others and could start working again, especially in critical areas. This would be a targeted way of avoiding other real dangers and maintaining a functioning society – something we badly need, as this virus will still be with us for many months to come, albeit hopefully with slow growth rates.

Scientists as well as several companies are promising the rapid development of vaccines. CureVac, for example, wants to deliver a vaccine as early as this summer.

This represents a tragic confusion of innovation with inventions or discoveries. Hardly anyone now being cited in the global media has held a position of responsibility in a process that has developed an initial idea through to the approval of a finished product. These vaccine statements are frankly rather dubious. The simple fact is that it usually takes several years to gear up large-scale production of vaccines, even if all the regulatory authorities work as quickly as possible. Why? Well, firstly, you need convincing preclinical data. Secondly, you must then go through three rounds of clinical trials to test the vaccine’s efficacy and safety in smaller and larger groups. What’s more, vaccines are highly complex biological agents that are not easy to produce. They must have the same quality and protective effect from batch to batch, day in, day out. In our present situation, paradoxically, those who do have experience in mastering these complex development processes are rarely being given a say. If all goes well, I would be happy if there was an effective vaccine available by 2021. And even then, I have my doubts.

Is there nothing to be gained by shortening the testing phases?

What are the phases for? Well, the first is for establishing the safe dose and the optimal vaccination schedule – you have to prevent the people being vaccinated from developing an autoimmune disease, for example. In phase two, tests are performed to identify the correct vaccination plan and the vaccine’s immunological effectiveness. You need to make sure that the immune response that protects against an infection does in fact occur. Even if you were now able to work with smaller case numbers, you would still have to bring these patients together in already overloaded hospitals – a massive logistical challenge! You then need to solve the problem of reliable large-scale production. Anyone promising vaccines within mere months is naively underestimating the many steps necessary on the path from an idea or concept through to a finished product. This is why I am so keen to get across the importance of networks like EIT Health. Such networks are able to bring together all of the experts needed to handle such complex processes at the right time, and can also recombine existing innovations, thereby accelerating them.

The European EIT Health network links a range of different players, including large and small companies, research institutions, public authorities, insurers, among others, to create innovations and bring them to market quickly. Is a network a better weapon against pandemics?

Without a doubt. In such times of crisis, we must move past the notion that a single disruptive idea alone constitutes innovation.

We need to better network existing players and recombine existing technologies in innovative ways. One such example is the case of a fledgling US company that has developed an easy-to-use sterilizer technology for protective masks. In the face of global shortages, this system can process and reactivate up to 100,000 masks a day.

Such a company needs to be brought together with the right players, who can then further develop and disseminate the technology on a massive scale – exactly what we’re trying to achieve with EIT Health.

What are the chances that COVID-19 will lead to the creation of novel innovation models and that we will learn from this crisis?

I am optimistic – the chances are good. The 2008 financial crisis taught us how to get economies back on track again, and this crisis will no doubt end up showing us that everyone has to cooperate – doctors, universities, industry, health insurance companies and politicians alike. It’s also important that these decision-makers learn to work together in regional and cross-regional open innovation networks such as EIT Health before such challenges occur.

But why has so little been learned from our experiences with the two other coronaviruses, SARS and MERS? Surely this would have been the right time to develop vaccines as a preventive measure?

Indeed, we are very badly prepared. Ironically, in the cases of SARS and MERS, cousins of COVID-19, researchers were already developing a vaccine. There were candidates that showed promising results in animal models, i.e. in mice and primates, against SARS. However, these developments weren’t followed up on for financial reasons. If society wants to go down this route, then we need to provide incentives for small, medium and large vaccine companies to complete the development of products for just such emergencies. One idea could be to create incentivisation schemes in which the development costs are borne by the public purse, for example. Another approach could be to create a scheme similar to the “orphan drugs” developments in the US. These medicines are very expensive to develop, but they save the massive societal cost of severe untreatable chronic hereditary diseases. Because of this, the American FDA demands lower approval fees or even issues vouchers that can be worth more than 100 million dollars for them. The same approach, i.e. providing incentives for development, could also be followed for vaccines, even if they may never be needed, so that they are available for potential pandemic outbreaks.

How long do you think the Corona crisis will continue?

We don’t have enough information to correctly evaluate this virus – we’re fighting an enemy whose strategy in human populations is unknown. We don’t even know just how widespread it is and whether the notion of achieving herd immunity is merely illusory. We simply do not have enough data. Only when we know more will we be able to give a better indication of just how long this crisis will last.


• More about Alexander von Gabain: Download his CV


This interview was conducted by Cathren Landsgesell for the Wiener Zeitung and published there on 3 April 2020 (in German).