An example of international cooperation and predictive planning in the health sciences
The clinical picture of the latest coronavirus epidemic in China has emerged with the identification of the virus 2019-nCoV. It is not yet possible to predict the global outcome but, compared to earlier SARS and MERS coronavirus epidemics, we have witnessed an increased level of preparation and international collaboration amongst our colleagues that promises to mitigate against the worst outcomes of this emerging threat with an early vaccine.
What is the history behind this preparedness?
In 2015 the World Health Organisation (WHO) published a list of high-risk infections. This accelerated R&D on dangerous pathogens that are the most prone to generate epidemics. The list included SARS and MERS and, as a result, a Target Product Profile for a MERS vaccines followed soon after.
Two years after the WHO published its list, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched at Davos. This innovative private/public partnership has since raised over $700m to fund vaccines developments to prevent future epidemics.
The emergence of DNA vaccines
Conventional vaccines stimulate the immune system with an infectious agent, or components of an infectious agent, modified to avoid harm but ensure that the immune system neutralizes the infectious agent. DNA vaccines are introduced into the patient as a plasmid containing the DNA sequence encoding the antigen(s) against which an immune response is sought. It relies on the in-situ human production of the target antigen which stimulate the production of the antibodies. One crucial advantage they have over conventional vaccines is that they can be manufactured quickly.
Whilst DNA vaccines for coronaviruses have not yet been approved for human use, the results of a first-in-humans study of a MERS coronavirus DNA vaccine were reported last year with convincing evidence of efficacy. It is now in phase II.
Early last week it was reported that human-to-human transmission occurs. Further details followed at the weekend with details of the identification of the 2019-nCoV. This work, using the latest sequencing methods and viral culture, has defined the causative virus of the epidemic in China. Rapid sharing of the genomic results showed that whilst 2019-nCoV is similar to SARS and MERS, it has differences in its RNA sequence.
The sharing of research and genomic sequences, and the awarding of further CEPI grants, has enabled several companies to work on new vaccines in concert with each other. Inovio were previously given a grant by CEPI to develop a DNA vaccine against MERS and have been awarded a further $9 million to develop a DNA vaccine for 2019-nCoV. CEPI has also engaged the University of Queensland, CureVac and Moderna as partners.
There are still enormous challenges to care for the afflicted patients and to control the spread of the infection. It is clear however that through international collaboration, together with funding of innovative work on vaccines, we are much closer to a preventive therapy than any earlier viral epidemics.
Coronavirus – sources of current information and guidance
RCP event on 12 February 2020
Coronavirus Outbreak: An Expert Update for Doctors
Gov.uk rolling updates
Lancet coronavirus landing page