Waiting for the real solution. The treatment

The scientific community has achieved an unprecedented feat: a vaccine in eight months. But behind the development lies a manufacturing and distribution process of unresolved complexity. Meanwhile, the virus ravaging the world shows no sign of letting up and continues on its natural course, which is mutation. The experience gained through AIDS research has been vital in achieving this historic milestone, but there remains one aspect which, in the case of HIV, proved to be more critical than the vaccine itself: the treatment of the disease.

26 January 2021 Reading time: 5.16 mins

I belong to the generation of healthcare students who lived through the darkest days of a new and deadly disease: AIDS. Fortunately for me, I never contracted it, nor did anyone around me die or fall ill with HIV, the virus that causes the disease, but it had a profound impact on my academic training, at least the scientific part of it. I began my degree in the early 1980s, just as the world’s first cases of AIDS were being reported. I remember that in my third year of university, all of us students knew there was one question that was bound to appear in the final microbiology exam: the new method for diagnosing AIDS, the ‘ELISA test’, which is so widely used today as the definitive serological test to determine whether or not we have had COVID-19. This discovery revolutionised the study of various diseases, and the scientific community honoured its Swedish discoverers with a Nobel Prize.

Advances in treatment have meant that it now consists of just two tablets a day, but above all, research has ensured that nobody need die of AIDS any more.

At that time, the US President, Ronald Reagan, announced that we would have a vaccine within two years. Today, forty years on, there is still no vaccine in sight, given just how mutable HIV is. But thanks to that fight against the virus, our scientists have achieved three things to which we have not given due importance:

Firstly, a treatment for the disease was discovered, which to begin with was a cocktail of medicines that I used to call ‘the jar of M&Ms’ and which patients had to take every morning. As the treatment has evolved, that jar has been reduced to just two tablets a day, but above all, the medication has meant that nobody now needs to die of AIDS.

Secondly, research into vaccines has taken a leap forward, not only in terms of quantity but also in terms of quality. Twenty years ago, a Hungarian scientist, Dr Katalin Karikó, whom the world will probably recognise – quite deservedly so – as the next worthy recipient of the Nobel Prize in Medicine, discovered what the vaccines of the future would be: those based on modified mRNA (such as those from Pfizer or Moderna for COVID-19).

A vastly greater capacity to combat viruses has been achieved, leading to the unparalleled development of nanobiotechnology.

And the third has achieved a far greater capacity to combat viruses than we would ever have developed had we not been compelled to tackle HIV, and this has led to the unparalleled development of nanobiotechnology. This biotechnology is based on another of the most important discoveries of recent years, one which also deserves another Nobel Prize for its discoverers: monoclonal antibodies. And it seems we have forgotten that this is where the true solution to the current pandemic ravaging the world lies.

It is in treatment that the real solution to the current pandemic ravaging the world lies.

The last major pandemic experienced by humidad occurred at the end of the First World War, and unfortunately for the Spanish people, ever since then we have lived with the stigma of the disease bearing our surname: the Spanish flu.In fact, the first known case occurred at a military base in Kansas (USA), and it reached Europe via a French port, but even back then, just as now, some people felt that telling the rest of the world the truth was not what it needed.

Something akin to what Darwin defined as natural selection: the strongest survive at the expense of the weakest.

That pandemic killed more people than the war that was already drawing to a close, even though there are no verifiable figures on mortality from the disease in either the the Middle East or the Far East. That pandemic came to an end once herd immunity had been achieved, which, unfortunately, is something akin to what Darwin defined as natural selection: the weakest die so that the strongest may survive. The problem with determining the percentage required to achieve herd immunity is that this can only be ascertained over time. Because of this, and although it is estimated that herd immunity for this virus is achieved when 70 per cent of the population is immune (either through vaccination or having had the disease), we really have no idea, and only time will tell.

It is common knowledge that viruses mutate, and it is also well known that the more they mutate, the more dangerous they generally become – not necessarily because they are more lethal, but simply because they are harder to combat. And to back up what I’m saying, I need only refer to HIV.

In military terms, the vaccine is like a sniper who shoots at his target from kilometres away.

I like to describe the vaccine in military terms, because, after all, the fight against pathogens is a war. On one side are we humans, and on the other are invisible beings, usually very harmful ones. In military terms, the vaccine is the sniper who shoots at his target from kilometres away: any slight movement of the target (a viral mutation) or change in wind or humidity conditions (a characteristic of the patient) causes the sniper to miss his shot. Conversely, I like to define treatment as the pigeon hunter using a shotgun. It doesn’t matter how much the target moves (provided the mutations aren’t drastic), as long as the pigeon remains within a limited radius.

The disease will not be eradicated, nor will our economy improve permanently through the vaccine alone. I have already said that the current global capacity to produce vaccine doses stands at 5,000 million for all types of vaccines – which, incidentally, we must continue to produce – whilst there are 7,000 million of us. By how much would we need to increase this limited manufacturing capacity if we require two doses per person and need to immunise the global population?

Scientists were finding out about AstraZeneca’s results from the business press, and I found that rather strange.

Generally speaking, scientists who talk a lot tend to produce poor results. Those who follow me in the media will have heard me say that the first vaccine would be Pfizer’s, and I’m certainly no Delphic Oracle, but when a scientist spends more time publishing in the Financial Times than in The Lancet, that’s a bad sign. Scientists were finding out about AstraZeneca’s results from the business press, and I found that rather odd. At the same time, Pfizer was working quietly and publishing where it needed to, and the results speak for themselves: Pfizer has a vaccine that is already being administered across half the world, whilst AstraZeneca has only just submitted its applications for emergency use authorisation.

Science and economics are not the same: the former deals only with proven facts, whilst the latter thrives on expectations which, through sheer repetition, eventually become reality, because, after all, we humans are like sheep – although sometimes a little more intelligent.

For this reason, science and economics do not mix very well. The same applies to treatment. I put my faith in Eli Lilly and it failed – or at least its treatment is not effective enough – but this is common. But make a note of a few more names and dates: Merck in spring 2021, and Amgen a little later. When this happens, the financial markets will soar, but this time the optimism will be justified.

In the meantime, we’ll be fighting over vaccines that won’t arrive, and we’ll be doing so over a ‘minor’ detail: there isn’t enough manufacturing capacity.

In the meantime, the virus will run its course and mutate. Let us hope and pray that the changes are minor, and that both the vaccines currently in production prove effective and that the new mutations do not give rise to new strains capable of infecting even those who have already been immunised.