Hundreds of COVID-19 vaccine candidates are currently being developed. The way emerging vaccines will be distributed to those who need them is not yet clear. The United States has nowtwice indicated that it would like to secure priority access to doses of COVID-19 vaccine. Other countries, including India and Russia, have taken similar stances. This prioritization of domestic markets has become known as vaccine nationalism.
As a researcher at Saint Louis University’s Center for Health Law Studies, I have been following the COVID-19 vaccine race. Vaccine nationalism is harmful for equitable access to vaccines – and, paradoxically, I’ve concluded it is detrimental even for the U.S. itself.
Vaccine nationalism during COVID-19
Vaccine nationalism occurs when a country manages to secure doses of vaccine for its own citizens or residents before they are made available in other countries. This is done through pre-purchase agreements between a government and a vaccine manufacturer.
In April, the CEO of Sanofi, a French company whose COVID-19 vaccine work has received partial funding from the U.S Biomedical Advanced Research and Development Authority, announced that the U.S. had the “right to the largest pre-order” of vaccine.
At the same time, India, alongside the U.S. and Russia, chose not to join the Access to COVID-19 Tools Accelerator, which was launched by the World Health Organization to promote collaboration among countries in the development and distribution of COVID-19 vaccines and treatments.
The most immediate effect of vaccine nationalism is that it further disadvantages countries with fewer resources and bargaining power. It deprives populations in the Global South from timely access to vital public health goods. Taken to its extreme, it allocates vaccines to moderately at-risk populations in wealthy countries over populations at higher risk in developing economies.
With modern vaccines, there are very few instances in which a single country can claim to be the sole developer of a vaccine. And even if that were possible, global public health is borderless. As COVID-19 is illustrating, pathogens can travel the globe. Public health responses to outbreaks, which include the deployment of vaccines, have to acknowledge that reality.
How nationalism can backfire in the US
The U.S. in notorious for its high drug prices. Does the U.S. government deserve to obtain exclusive rights for a vaccine that may be priced too high? Such a price may mean that fewer U.S. citizens and residents – especially those who are uninsured or underinsured – would have access to the vaccine. This phenomenon is a form of what economists call deadweight loss, as populations in need of a welfare-enhancing product are priced out. In public health, deadweight loss costs lives.
Secretary Azar has said the U.S. government wants the private sector to invest in vaccine development and manufacturing; if the U.S. sets prices, companies may not make that investment because the vaccines won’t be profitable. This view has been widely criticized. A commentator has called it “bad public health policy,” further pointing out that American taxpayers already fund a substantial amount of vaccine research and development in the U.S. Moreover, as legal scholars have pointed out, there are many regulatory perks and other incentives available exclusively to pharmaceutical companies.
If COVID-19 vaccines are not made available affordably to those who need them, the consequences will likely be disproportionately severe for poorer or otherwise vulnerable and marginalized populations. COVID-19 has already taken a higher toll on black and Latino populations. Without broad access to a vaccine, these populations will likely continue to suffer more than others, leading to unnecessary disease burden, continued economic problems and potential loss of life.
What needs to be done
Nationalism is at odds with global public health principles. Yet, there are no provisions in international laws that prevent pre-purchase agreements like the ones described above. There is nothing inherently wrong with pre-purchase agreements of pharmaceutical products. Vaccines typically do not generate as much in sales as other medical products. If used correctly, pre-purchase agreements can even be an incentive for companies to manufacture vaccines that otherwise would not commercialized. Institutions like Gavi, an international nonprofit based in Geneva, use similar mechanisms to guarantee vaccines for developing countries.
But I see vaccine nationalism as a misuse of these agreements.
Contracts should not trump equitable access to global public health goods. I believe that developed countries should pledge to refrain from reserving vaccines for their populations during public health crises. The WHO’s Access to COVID-19 Tools Accelerator is a starting point for countries to test collaborative approaches during the current pandemic.
But more needs to be done. International institutions – including the WHO – should coordinate negotiations ahead of the next pandemic to produce a framework for equitable access to vaccines during public health crises. Equity entails both affordability of vaccines and access opportunities for populations across the world, irrespective of geography and geopolitics.
Insofar as the U.S. can be considered a leader in the global health arena, I believe it should stop engaging in overly nationalistic behaviors. Failure to do so harms patient populations across the globe. Ultimately, it may harm its own citizens and residents, and perpetuate structural inequalities in our health care system.
Many mass immunization efforts worldwide were halted this spring to prevent spread of the virus at crowded inoculation sites. The consequences have been alarming.
As poor countries around the world struggle to beat back the coronavirus, they are unintentionally contributing to fresh explosions of illness and death from other diseases — ones that are readily prevented by vaccines.
This spring, after the World Health Organization and UNICEF warned that the pandemic could spread swiftly when children gathered for shots, many countries suspended their inoculation programs. Even in countries that tried to keep them going, cargo flights with vaccine supplies were halted by the pandemic and health workers diverted to fight it.
Now, diphtheria is appearing in Pakistan, Bangladesh and Nepal.
Cholera is in South Sudan, Cameroon, Mozambique, Yemen and Bangladesh.
A mutated strain of poliovirus has been reported in more than 30 countries.
And measles is flaring around the globe, including in Bangladesh, Brazil, Cambodia, Central African Republic, Iraq, Kazakhstan, Nepal, Nigeria and Uzbekistan.
Of 29 countries that have currently suspended measles campaigns because of the pandemic, 18 are reporting outbreaks. An additional 13 countries are considering postponement. According to the Measles and Rubella Initiative, 178 million people are at risk of missing measles shots in 2020.
The risk now is “an epidemic in a few months’ time that will kill more children than Covid,” said Chibuzo Okonta, the president of Doctors Without Borders in West and Central Africa.
As the pandemic lingers, the W.H.O. and other international public health groups are now urging countries to carefully resume vaccination while contending with the coronavirus.
“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr. Tedros Adhanom Ghebreyesus, director general of the W.H.O., in a statement. “Disruption to immunization programs from the Covid-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”
But the obstacles to restarting are considerable. Vaccine supplies are still hard to come by. Health care workers are increasingly working full time on Covid-19, the infection caused by the coronavirus. And a new wave of vaccine hesitancy is keeping parents from clinics.
Many countries have yet to be hit with the full force of the pandemic itself, which will further weaken their capabilities to handle outbreaks of other diseases.
“We will have countries trying to recover from Covid and then facing measles. It would stretch their health systems further and have serious economic and humanitarian consequences,” said Dr. Robin Nandy, chief of immunization for UNICEF, which supplies vaccines to 100 countries, reaching 45 percent of children under 5.
The breakdown of vaccine delivery also has stark implications for protecting against the coronavirus itself.
But as services collapse under the pandemic, “they are the same ones that will be needed to send out a Covid vaccine,” warned Dr. Katherine O’Brien, the W.H.O.’s director of immunization, vaccines and biologicals, during a recent webinar on immunization challenges.
Battling Measles in Congo
Three health care workers with coolers full of vaccines and a support team of town criers and note-takers recently stepped into a motorized wooden canoe to set off down the wide Tshopo River in the Democratic Republic of Congo.
Although measles was breaking out in all of the country’s 26 provinces, the pandemic had shut down many inoculation programs weeks earlier.
The crew in the canoe needed to strike a balance between preventing the transmission of a new virus that is just starting to hit Africa hard and stopping an old, known killer. But when the long, narrow canoe pulled in at riverside communities, the crew’s biggest challenge turned out not to be the mechanics of vaccinating children while observing the pandemic’s new safety strictures. Instead, the crew found themselves working hard just to persuade villagers to allow their children to be immunized at all.
Many parents were convinced that the team was lying about the vaccine — that it was not for measles but, secretly, an experimental coronavirus vaccine, for which they would be unwitting guinea pigs.
In April, French-speaking Africa had been outraged by a French television interview in which two researchers said coronavirus vaccines should be tested in Africa — a remark that reignited memories of a long history of such abuses. And in Congo, the virologist in charge of the coronavirus response said that the country had indeed agreed to take part in clinical vaccine trials this summer. Later, he clarified that any vaccine would not be tested in Congo until it had been tested elsewhere. But pernicious rumors had already spread.
The team cajoled parents as best they could. Although vaccinators throughout Tshopo ultimately immunized 16,000 children, 2,000 others eluded them.
This had been the year that Congo, the second-largest country in Africa, was to launch a national immunization program. The urgency could not have been greater. The measles epidemic in the country, which started in 2018, has run on and on: Since this January alone, there have been more than 60,000 cases and 800 deaths. Now, Ebola has again flared, in addition to tuberculosis and cholera, which regularly strike the country.
Vaccines exist for all these diseases, although they are not always available. In late 2018, the country began an immunization initiative in nine provinces. It was a feat of coordination and initiative, and in 2019, the first full year, the percentage of fully immunized children jumped from 42 to 62 percent in Kinshasa, the capital.
This spring, as the program was being readied for its nationwide rollout, the coronavirus struck. Mass vaccination campaigns, which often mean summoning hundreds of children to sit close together in schoolyards and markets, seemed guaranteed to spread coronavirus. Even routine immunization, which typically occurs in clinics, became untenable in many areas.
The country’s health authorities decided to allow vaccinations to continue in areas with measles but no coronavirus cases. But the pandemic froze international flights that would bring medical supplies, and several provinces began running out of vaccines for polio, measles and tuberculosis.
When immunization supplies finally arrived in Kinshasa, they could not be moved around the country. Domestic flights had been suspended. Ground transport was not viable because of shoddy roads. Eventually, a United Nations peacekeeping mission ferried supplies on its planes.
Still, health workers, who had no masks, gloves or sanitizing gel, worried about getting infected; many stopped working. Others were diverted to be trained for Covid.
The cumulative impact has been particularly dire for polio eradication — around 85,000 Congolese children have not received that vaccine.
But the disease that public health officials are most concerned about erupting is measles.
More contagious than Covid
Measles virus spreads easily by aerosol — tiny particles or droplets suspended in the air — and is far more contagious than the coronavirus, according to experts at the Centers for Disease Control and Prevention.
“If people walk into a room where a person with measles had been two hours ago and no one has been immunized, 100 percent of those people will get infected,” said Dr. Yvonne Maldonado, a pediatric infectious disease expert at Stanford University.
In poorer countries, the measles mortality rate for children under 5 ranges between 3 and 6 percent; conditions like malnutrition or an overcrowded refugee camp can increase the fatality rate. Children may succumb to complications such as pneumonia, encephalitis and severe diarrhea.
In 2018, the most recent year for which data worldwide has been compiled, there were nearly 10 million estimated cases of measles and 142,300 related deaths. And global immunization programs were more robust then.
Before the coronavirus pandemic in Ethiopia, 91 percent of children in the capital, Addis Ababa, received their first measles vaccination during routine visits, while 29 percent in rural regions got them. (To prevent an outbreak of a highly infectious disease like measles, the optimum coverage is 95 percent or higher, with two doses of vaccine.) When the pandemic struck, the country suspended its April measles campaign. But the government continues to report many new cases.
“Outbreak pathogens don’t recognize borders,” said Dr. O’Brien of the W.H.O. “Especially measles: Measles anywhere is measles everywhere.”
Once people start traveling again, the risk of infection will surge. “It keeps me up at night,” said Dr. Stephen L. Cochi, a senior adviser at the global immunization division at the C.D.C. “These vaccine-preventable diseases are just one plane ride away.”
After the W.H.O. and its vaccine partners released the results of a survey last month showing that 80 million babies under a year old were at risk of missing routine immunizations, some countries, including Ethiopia, the Central African Republic and Nepal, began trying to restart their programs.
Uganda is now supplying health workers with motorbikes. In Brazil, some pharmacies are offering drive-by immunization services. In the Indian state of Bihar, a 50-year-old health care worker learned to ride a bicycle in three days so she could take vaccines to far-flung families. UNICEF chartered a flight to deliver vaccines to seven African countries.
Dr. Cochi of the C.D.C., which provides technical and program support to more than 40 countries, said that whether such campaigns can be conducted during the pandemic is an open question. “It will be fraught with limitations. We’re talking low-income countries where social distancing is not a reality, not possible,” he said, citing Brazilian favelas and migrant caravans.
He hopes that polio campaigns will resume swiftly, fearing that the pandemic could set back a global, decades-long effort to eradicate the disease.
Dr. Cochi is particularly worried about Pakistan and Afghanistan, where 61 cases of wild poliovirus Type 1 have been reported this year, and about Chad, Ghana, Ethiopia and Pakistan, where cases of Type 2 poliovirus, mutated from the oral vaccine,have appeared.
Thabani Maphosa, a managing director at Gavi, which partners with 73 countries to purchase vaccines, said that at least a half dozen of those countries say they cannot afford their usual share of vaccine costs because of the economic toll of the pandemic.
If the pandemic cleared within three months, Mr. Maphosa said, he believed the international community could catch up with immunizations over the next year and a half.
“But our scenarios are not telling us that will happen,” he added.
Jan Hoffman reported from New York, and Ruth Maclean from Dakar, Senegal.
What’s the risk of catching coronavirus from a surface? Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Does asymptomatic transmission of Covid-19 happen? So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
How does blood type influence coronavirus? A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.? The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Will protests set off a second viral wave of coronavirus? Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
How do we start exercising again without hurting ourselves after months of lockdown? Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
My state is reopening. Is it safe to go out?States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What are the symptoms of coronavirus? Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying? If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Should I wear a mask? The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Misinformation is taking a dangerous hold on Fox News viewers. According to a new poll, half of all Americans who name Fox News as their primary news source believe the debunked conspiracy theory claiming Bill Gates is looking to use a coronavirus vaccine to inject a microchip into people and track the world’s population.
The Yahoo News/YouGov poll, released on Friday, found that 44 percent of Republicans also buy into the unfounded claim, while just 19 percent of Democrats believe the lie about the Microsoft co-founder and philanthropist.
According to Yahoo’s report on the poll, neither Fox News nor President Trump has promoted the false Gates conspiracy. But sowing seeds of distrust of mainstream media and the spread of misinformation is a hallmark of the network and the current president. Last month, Fox primetime host Laura Ingraham shared a tweet where she expressed agreement with a user who wrote about the debunked conspiracy theory.
“Digitally tracking Americans’ every move has been a dream of the globalists for years. This health crisis is the perfect vehicle for them to push this,” Ingraham wrote.
The poll also found that just 15 percent of MSNBC viewers believe the untrue conspiracy theory which, according to the fact-checking publication Snopes, began with the anti-vaccine movement. They chose to target Gates specifically because of his decade-long advocacy for vaccines.
According to an April report in the New York Times that looked into the right-wing targeting of Gates, media analysis company Zignal Labs found that “misinformation about Gates is now the most widespread of all coronavirus falsehoods” that the company has tracked.
This debunked conspiracy theory could be especially menacing if it deters any portion of the population from getting vaccinated, if and when one becomes available, which would then make it much tougher to rid the world of the virus.
In another poll released on Friday by Reuters/Ipsos showed increasing mistrust in the president due to his consistent habit of sharing misinformation. Thirty-six percent of those surveyed said they would be less willing to take a vaccine if it were endorsed by the president.
The picture these polls paint is both sad and obviously dangerous for all of us, especially with the current pandemic. Unfortunately, our country’s lack of trustworthy leadership means that more and more people are susceptible to bad and untrue advice that is rampant on random Reddit forums, Facebook posts and, yes, even TikTok — where conspiracy theories are paired with viral dances.
David D. Kirkpatrick, The New York Times – 28 de abril de 2020
Na corrida mundial por uma vacina contra o novo coronavírus, o laboratório que está na frente fica na Universidade de Oxford.
A maioria das outras equipes teve de começar com pequenos testes clínicos em umas centenas de participantes para demonstrar que se trata de uma vacina segura. Ocorre que os cientistas do Jenner Institute da universidade começaram mais rapidamente os trabalhos em uma vacina porque já haviam provado em testes anteriores que tais inoculações – inclusive uma no ano passado contra um coronavírus inicial – não eram prejudiciais para o ser humano.
Isto lhes permitiu sair na dianteira e marcar os testes com a sua nova vacina contra o coronavírus com mais de 6 mil pessoas até o final do próximo mês, na esperança de demonstrar que não só é segura, como também funciona.
Os cientistas de Oxford agora afirmam que se as autoridades reguladoras concederem uma aprovação de emergência, os primeiros milhões de doses poderão estar disponíveis até setembro – pelo menos vários meses antes de qualquer outro esforço anunciado – desde que se revele eficaz.
Agora, eles receberam a promissora notícia de que isto será possível.
Os cientista dos National Institutes of Health’s Rocky Mountain Laboratory de Montana, inocularam, no mês passado, seis macacos rhesus com doses únicas da vacina de Oxford. Os animais então foram expostos a grandes quantidades do vírus que está causando a pandemia – exposição que fez com que outros macacos no laboratório ficassem bastante doentes. Mas mais de 28 dias mais tarde, todos os seis estavam saudáveis, disse Vincent Munster, o pesquisador que conduziu o teste.
“O macaco rhesus é o ser mais próximo do humano que nós temos”, disse Munster, observando que os cientistas ainda estavam analisando o resultado. Ele agora espera compartilhá-lo com outros cientistas na próxima semana e depois submetê-lo a uma publicação para a revisão de pares.
A imunidade em macacos não garante que uma vacina proporcione o mesmo grau de proteção aos seres humanos. Uma companhia chinesa que começou recentemente um teste clínico com 144 participantes, a Sino Vac, também afirmou que a sua vacina se mostrou eficaz em macacos rheseus. Mas com dezenas de experimentos atualmente em curso para encontrar uma vacina, os resultados apresentados pelos macacos são a mais recente indicação de que o esforço acelerado de Oxford está se destacando como o primeiro indicador de sucesso.
“Trata-se de um programa clínico extremamente rápido”, afirmou Emilio Emini, um diretor do programa de vacinas da Fundação Bill e Melinda Gates, que está dando o suporte financeiro a muitos experimentos concorrentes neste sentido no atual momento.
Saber qual será a vacina potencial que sairá destes esforços todos como a mais bem-sucedida será impossível enquanto não estiverem disponíveis os dados dos testes clínicos.
Em todo caso, será necessária mais de uma vacina, segundo Emini. Algumas poderão funcionar melhor do que outras em grupos como crianças e idosos, ou por custos e dosagens diferentes. Dispor de mais de uma variedade de vacinas em produção ajudará também a evitar gargalos na fabricação, ele afirmou.
Mas sendo a primeira a atingir uma escala relativamente tão ampla, a que será testada em Oxford, mesmo que fracasse, fornecerá lições tais sobre a natureza do coronavírus e sobre as respostas do sistema imunológico que poderão informar governos, doadores, laboratórios farmacêuticos e ouros cientistas na busca de uma vacina.
“Este amplo estudo britânico”, disse Emini, “se traduzirá na realidade também em um profundo aprendizado sobre algumas das outras”.
Todas as outras enfrentarão os mesmos desafios, inclusive para a obtenção de milhões de dólares em financiamentos, convencendo as autoridades reguladoras a aprovarem testes em humanos, demonstrando a sua segurança e – depois disso – provando a sua eficiência na proteção das pessoas contra o coronavírus.
Paradoxalmente, o crescente sucesso dos esforços para conter o avanço da covid-19, a doença causada pelo vírus, poderá apresentar mais um obstáculo.
“Somos as únicas pessoas do país que querem que o número de novas infecções continue por mais algumas semanas, a fim de podermos testar a nossa vacina,” o professor Adrian Hill, diretor do Jenner Institute, um dos cinco pesquisadores envolvidos na iniciativa, afirmou em uma entrevista em um edifício do laboratório esvaziado pelo fechamento imposto na Grã-Bretanha há um mês.
As normas éticas, como princípio geral, proíbem a tentativa de infectar participantes de testes humanos com uma doença grave. Isto significa que a única maneira de provar que uma vacina é eficaz é inoculando pessoas em um lugar em que o vírus se espalha naturalmente ao seu redor.
Se as medidas de distanciamento social ou outros fatores continuarem reduzindo a taxa de novas infecções no Reino Unido, ele disse, o teste talvez não possa mostrar que a vacina faz uma diferença: os participantes que receberam um placebo poderão não ser infectados mais frequentemente do que os que receberam a vacina. Os cientistas teriam de tentar novamente em outro lugar, um dilema que todos os outros experimentos para a obtenção de uma vacina também terão de enfrentar.
A iniciativa do Jenner Institute contra o coronavírus usa uma tecnologia que se concentra na alteração do código genético de um vírus conhecido. Uma vacina clássica usa uma versão mais fraca de um vírus para desencadear a resposta imunológica. Mas na tecnologia que o instituto está utilizando, um vírus diferente é modificado anteriormente a fim de neutralizar os seus efeitos e então torná-lo uma imitação de um vírus determinado – neste caso, o vírus que causa a covid-19. Injetado na corrente sanguínea, o impostor inócuo pode induzir o sistema imunológico a combater e matar a doença, proporcionando uma proteção.
Hill trabalhou com esta tecnologia por dezenas de anos para tentar agarrar um vírus de uma doença respiratória encontrado em chimpanzés a fim de provocar uma resposta imunológica humana contra a malária e outras moléstias. Nos últimos 20 anos, o instituto realizou mais de 70 testes clínicos de vacinas em potencial contra o parasita que causa a malária. Nenhum ainda levou a uma inoculação bem-sucedida.
No entanto, em 2014, uma vacina baseada no vírus do chimpanzé que Hill havia testado foi fabricada em uma escala suficientemente ampla para fornecer 1 milhão de doses. Isto criou um modelo para a produção em massa da vacina contra o coronavírus, no caso de ela se revelar eficiente.
A professora Sarah Gilbert, sua colega de longa data, modificou o mesmo vírus do chimpanzé para fazer uma vacina contra um primeiro coronavírus, na síndrome respiratória do Oriente Médio (MERS). Depois que um teste clínico, no Reino Unido, mostrou que era segura. Outro teste começou em dezembro na Arábia Saudita, onde surtos da doença letal ainda são comuns.
Quando em janeiro ela ouvia falar que cientistas chineses haviam identificado o código genético de um misterioso vírus em Wuhan, ela pensou que poderia ter a chance de pôr à prova a celeridade e a versatilidade da sua abordagem.
“Nós pensamos: ‘Bom, será que vamos poder tentar?’, ela lembra. “‘Será um pequeno projeto de laboratório, e depois publicaremos um paper’”.
Mas não permaneceu um “pequeno projeto de laboratório” por muito tempo.
Com a explosão da pandemia, eles passaram a receber muitas subvenções. Todas as outras vacinas foram postas em um freezer para o laboratório do instituto concentrar-se totalmente na covid-19. Entretanto, o fechamento do prédio obrigou todo mundo a não trabalhar na covid-19 e a ficar em casa.
Os doadores já gastam dezenas de milhões de dólares para dar início ao processo de produção em instalações no Reino Unido e na Holanda, antes mesmo que a vacina comprove que funciona, disse Sandy Douglas, um cientista de Oxford que supervisiona a produção de vacinas.
“Não há outra alternativa”, afirmou.
Mas a equipe ainda não chegou a um acordo com um fabricante da América do Norte, em parte porque os principais laboratórios farmacêuticos exigem, como sempre, direitos mundiais exclusivos antes de investir em um medicamento em potencial.
“Pessoalmente, não acredito que em uma época de pandemia deva haver licenças exclusivas”, disse Hill. “Por isso estamos conversando com vários laboratórios. Ninguém vai ganhar um monte de dinheiro com isto”.
Enquanto isso, com os dados sobre a segurança dos testes em humanos de vacinas semelhantes contra o Ebola, a MERS e a malária, os cientistas do instituto de Oxford convenceram as autoridades reguladoras britânicas a permitirem testes inusitadamente acelerados para aproveitar que a pandemia ainda está ao seu redor.
Na semana passada, o instituto começou a Fase I de um teste clínico que envolve 1.100 pessoas. No próximo mês, começará o teste crucial da Fase II e da Fase III que envolverá outras 5 mil. Ao contrário de qualquer outro projeto de vacina atualmente em andamento, esse deverá provar sua eficiência e segurança.
Os cientistas declararão vitória se uma dezenas de participantes que receberem um placebo adoecerem com a covid-19, em comparação com apenas um ou dois que forem vacinados. “Então faremos uma festa e contaremos para o mundo,” disse Hill. Todos os que receberem somente o placebo também serão vacinados imediatamente.
Se poucos participantes forem infectados no Reino Unido, o instituto planeja a realização de outros testes onde o coronavírus estiver se espalhando, provavelmente na África e na Índia.
“Precisamos caçar a epidemia”, disse Hill. “Se ainda estiver devastando alguns países, talvez possamos realizar testes nos Estados Unidos em novembro”. / TRADUÇÃO DE ANNA CAPOVILLA
Scientists and science communicators are engaged in a constant battle with ignorance. But that’s an approach doomed to failure
Be quiet. It’s good for you. Photograph: Gareth Fuller/PA
Tuesday 23 August 2016 08.00 BST. Last modified on Tuesday 23 August 2016 11.33 BST
A video did the rounds a couple of years ago, of some self-styled “skeptic” disagreeing – robustly, shall we say – with an anti-vaxxer. The speaker was roundly cheered by everyone sharing the video – he sure put that idiot in their place!
Scientists love to argue. Cutting through bullshit and getting to the truth of the matter is pretty much the job description. So it’s not really surprising scientists and science supporters frequently take on those who dabble in homeopathy, or deny anthropogenic climate change, or who oppose vaccinations or genetically modified food.
It makes sense. You’ve got a population that is – on the whole – not scientifically literate, and you want to persuade them that they should be doing a and b (but not c) so that they/you/their children can have a better life.
And yet … it leaves me cold. Is this really what science communication is about? Is this informing, changing minds, winning people over to a better, brighter future?
I doubt it somehow.
There are a couple of things here. And I don’t think it’s as simple as people rejecting science.
First, people don’t like being told what to do. This is part of what Michael Gove was driving at when he said people had had enough of experts. We rely on doctors and nurses to make us better, and on financial planners to help us invest. We expect scientists to research new cures for disease, or simply to find out how things work. We expect the government to try to do the best for most of the people most of the time, and weather forecasters to at least tell us what today was like even if they struggle with tomorrow.
But when these experts tell us how to live our lives – or even worse, what to think – something rebels. Especially when there is even the merest whiff of controversy or uncertainty. Back in your box, we say, and stick to what you’re good at.
We saw it in the recent referendum, we saw it when Dame Sally Davies said wine makes her think of breast cancer, and we saw it back in the late 1990s when the government of the time told people – who honestly, really wanted to do the best for their children – to shut up, stop asking questions and take the damn triple vaccine.
Which brings us to the second thing.
On the whole, I don’t think people who object to vaccines or GMOs are at heart anti-science. Some are, for sure, and these are the dangerous ones. But most people simply want to know that someone is listening, that someone is taking their worries seriously; that someone cares for them.
It’s more about who we are and our relationships than about what is right or true.
This is why, when you bring data to a TV show, you run the risk of appearing supercilious and judgemental. Even – especially – if you’re actually right.
People want to feel wanted and loved. That there is someone who will listen to them. To feel part of a family.
The physicist Sabine Hossenfelder gets this. Between contracts one time, she set up a “talk to a physicist” service. Fifty dollars gets you 20 minutes with a quantum physicist … who will listen to whatever crazy idea you have, and help you understand a little more about the world.
How many science communicators do you know who will take the time to listen to their audience? Who are willing to step outside their cosy little bubble and make an effort to reach people where they are, where they are confused and hurting; where they need?
Atul Gawande says scientists should assert “the true facts of good science” and expose the “bad science tactics that are being used to mislead people”. But that’s only part of the story, and is closing the barn door too late.
Because the charlatans have already recognised the need, and have built the communities that people crave. Tellingly, Gawande refers to the ‘scientific community’; and he’s absolutely right, there. Most science communication isn’t about persuading people; it’s self-affirmation for those already on the inside. Look at us, it says, aren’t we clever? We are exclusive, we are a gang, we are family.
That’s not communication. It’s not changing minds and it’s certainly not winning hearts and minds.