The world is facing great challenges from the novel coronavirus (COVID-19). Countries have adopted measures to contain the virus, with China, being the first country hit by the outbreak, imposing strictest measures. How should China’s approach be evaluated? How far away are we from a vaccine? Global Times (GT) reporter Wang Wenwen talked to Dr. Richard Hatchett, CEO of the Norway-based Coalition for Epidemic Preparedness Innovations (CEPI), on these issues. CEPI is a global partnership with public, private and philanthropic organizations whose mission is to accelerate the development of vaccines against emerging infectious diseases and enable equitable access to these vaccines during outbreaks. Dr. Hatchett previously held leadership roles at the US Biomedical Advanced Research and Development Authority.
GT: How would you say about the Chinese government’s measures in containing the spread of the novel coronavirus?
Hatchett: The speed at which the virus has been identified is a testament to the changes in public health and the growth of scientific expertise in China since SARS and the strong global coordination through the World Health Organization (WHO). The rapid dissemination of the virus’ genetic sequence by Chinese authorities enabled scientists around the world to initiate research into potential vaccines and treatments. All of this is to be commended.
Right now, the only tools the world has to contain the virus are non-pharmaceutical interventions—such as travel restrictions, school closures, cancellation of mass gatherings, isolation of cases, and quarantine of people who have been exposed to those cases. China’s efforts to contain the virus have imposed enormous costs on Chinese society but have clearly been successful at reducing transmission in China and have likely delayed and reduced the transmission of disease internationally, buying time for the rest of the world to prepare. This has been enormously important.
As critical as they are, the imposition of such measures obviously has a knock-on effect on how people live their daily lives. To sustain such measures for the long term, it is important to enlist the public’s support and to view the public as an ally with these efforts. Society needs to come together in solidarity against the common enemy of disease, even while the members of that society practice social distancing to protect themselves and each other and especially the most vulnerable.
The Chinese and public health and medical authorities should be commended for their courageous and heroic efforts to contain and control the growing epidemic. They deserve the world’s admiration and gratitude.
GT: Did other countries which have been affected by the virus cope with it in an effective manner? What is your suggestion for them?
Hatchett: I am concerned that few other nations will have the resources or capabilities to do what China has done, but I am encouraged that, at least at present, Hong Kong Special Administrative Region and Singapore seem to be holding their own against the virus as well and South Korea and Italy who have both substantially ramped up their control and containment efforts. What we know from modelling and from deep historical analysis of the use of comparable interventions in 1918 is that for such interventions to be successful (at least with a disease like influenza or COVID-19 that moves fast and where some degree of asymptomatic or mildly symptomatic transmission is thought to occur) they need to be used early, fast, and in a sustained way.
The very best real-world demonstration of this that I’ve ever seen is the comparison between outcomes in St. Louis and Philadelphia in 1918, which used nearly identical interventions but implemented them at different points in their local epidemics. The difference was that Philadelphia waited 16 days from the first known civilian case of Spanish flu to implement the interventions while St. Louis, having the advantage of lead time and seeing what was happening on the East Coast, implemented theirs two days after the first known civilian case. The bump at the tail end reflected St. Louis lifting the interventions due to severe pressure from the business community after six weeks, then re-implementing them as the number of cases began to rise. It is important to convey a message to the business community about the importance of supporting such interventions – working with public health authorities’ efforts to reduce disease transmission.
The Chinese mainland, Hong Kong Special Administrative Region, and Singapore have demonstrated that it is possible to limit the transmission of the virus in a way that will buy significant time for the development of therapeutics and vaccines, and it will be critical that all nations study their success and find ways to sustainably implement comparable interventions as part of their own efforts.
GT: What lessons could all the countries draw from this global public health challenge?
Hatchett: The most important lesson is that epidemic infectious diseases are a transnational threat to collective security that requires collective action. No country can seal itself off from such threats and the risks to the global population and world economy are immense. COVID-19 will likely be the second pandemic of the 21st century; it will not be the last.
Emerging infectious diseases like COVID-19 do not respect borders. They affect us all. They are an emergent property of our globalized, interconnected world—a world that gives microbes innumerable opportunities to evolve, spread, and cause epidemics. Only through a concerted, global response can we hope to stop viruses like COVID-19.
GT: Can you brief us the global efforts in developing a vaccine? When do you predict a vaccine can be developed and what are the difficulties to reach people who need it?
Hatchett: Health authorities in China, and now around the world have initiated aggressive public health containment measures that may slow the spread of the disease, but they are unlikely to stop it. These interventions are important because they can reduce the intensity of epidemics, as it seems to be occurring in Wuhan and Hubei, but they will not reduce the overall number of people who get sick. Only a vaccine can do that.
So far, CEPI has invested in four vaccine platform technologies to develop vaccines against the COVID-19. Our hope is that, with our partners, we can get an investigational vaccine from the pathogen’s gene sequencing through clinical testing in 16 weeks. This is an extremely ambitious timeline – indeed, it would be unprecedented in the field of infectious diseases.
The earliest stage of clinical trials (Phase I), to establish the safety of investigational vaccines, would then take approximately two to four months, and then the vaccines would move into larger trials to demonstrate that they can produce an effective immune response. There are no guarantees of success, but we are working as fast and as hard as we can to deliver a safe and effective vaccine available for broader use. If all goes well, these vaccines may begin to be more broadly available within the next 12-18 months.
But developing the vaccine is only part of the equation. If we are successful, we will then need to manufacture large quantities of the vaccine – potentially billions of doses – and work with partners to see that it is delivered across the globe. The logistical challenge will be enormous, and the delivery effort itself will cost billions.
COVID-19 presents a global threat. And it will hit developing countries, where the medical and public health infrastructure is limited, the hardest. Attack rates will likely be higher in the densely populated megacities of the global south, and case fatality rates will likely be higher as well, because access to intensive care facilities will be limited to non-existent. Equitable access to any vaccine that might be produced is therefore of vital importance.