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Polio as a backdrop

Peter Salk: “When my father and his research team at the 51��Ʒ��Ƶ developed the first effective polio vaccine (65 years ago), a great fear was lifted. In this country, as well as around the world, people were terrified. This went on for decades. There were about 58,000 cases of polio in the United States at polio’s peak in 1952, and around the world about 600,000 cases.

“My father and his team took great care to ensure that their vaccine would be safe. They started with a dangerous live-poliovirus that was inactivated by a chemical. And all the conditions were set so it could be a reproducibly safe vaccine. Nevertheless, when the vaccine moved into manufacturing for use after the field trials ... a huge mistake took place. One of the new manufacturers that came onboard did not pay adequate attention to the procedures. Kids were injected with batches that contained the live poliovirus. As a result, 159 individuals were left paralyzed, and 10 people died. This was a great tragedy.

“Procedures were put in place by the government to make sure that never happened again, and it did not. Those procedures are still in place.

“It’s really important, with coronavirus vaccines in research now, that corners not be cut. We want to assure that the vaccines are safe and effective.”

Making a vaccine for COVID-19

Duprex:��"In 2020 we can make vaccines in ways that Jonas Salk could only have dreamed of.” And though scientists have more tools today, “this process would be very, very familiar to Jonas Salk."

Duprex's team is working with a company in India that manufactures vaccines for two-thirds of the world’s children.

“Is it a race? Yes, we are pushing it forward.��Participating in that race is important. We need a number of vaccines, and there will be no ‘one’ COVID-19 vaccine for the world. We don't know which approach will work best and there may be differences between groups in society, the old, young and pregnant.”

“Optimistically, it would be wonderful if we could license a vaccine by the end of the year or early next year. Remember though, it’s only a vaccine once we have millions of doses.��Manufacturing, distribution, etc., collectively takes time. We’re not rushing.

“Do not equate ‘speed’—(as in Operation Warp Speed)—with ‘rush.’”

Sequencing and testing

Anantha Shekhar: “The virus was sequenced very quickly. On Jan. 10, a Shanghai institute released it. And today, we have more than 160 vaccine candidates—because of global collaboration and sharing of information. The idea that some of these highly anticipated trials are being halted means science is actually preventing people from rushing things that aren’t ready yet.

“As we see vaccines halted, it means science is holding court.” 

Trust and vaccine hesitancy

Duprex: “The success of getting the vaccine into the population will ultimately rest on the public’s willingness to be vaccinated.” He’s studied measles his whole career. Because of unfounded claims that the vaccine causes autism or other disorders, the UK saw a change from more than 90 percent of the population immunized to pockets where only 74 percent were vaccinated.

“There are viruses in my freezer isolated from a small child who was not vaccinated from measles who died due to the infection.��We need to champion these products (vaccines). It’s important not to forget what the diseases did in the past.

“It is good to ask questions. It’s good to have trusted messengers to answer the questions.”

Rahul Gupta: “We have not succeeded—whether it's mask wearing or social distancing—if the health officials say one thing, and the leaders say something else. No vaccine will immunize us if we stay on this path.”

Lisa Waddell: “Leadership matters. If we have a consistency of message, yes, that builds trust.��

“Ultimately, it still matters who the messenger is. Providers will play a big role early on.”

She notes it will be crucial to have culturally appropriate messaging with different populations.

Inequity and access

Waddell: “Hesitancy to vaccines is not the only barrier. People may not have insurance, or insurance may not cover a vaccine. Policy plays a role.

“The pandemic has laid bare significant inequities.

“We should be outraged. ​We need to address the underlying inequities—(those) avoidable, unfair and unjust differences in health. Nationally, Black Americans account for 13% of the U.S.  population but 24% of COVID deaths.”

Distribution of a vaccine

Gupta:��"Once we have a safe and effective vaccine … there will be a need to distribute to high risk groups first. ... The first phase may include front-line health workers. Many of those are already people with high risk conditions, including those who are pregnant as well as lactating. This could be expanded to include transportation and environmental service workers and others who are exposed to bodily fluids and aerosols.

“Next would include folks who are at significantly high risk . The Americans across the nation that are older than 65 but they are living in congregate or overcrowded settings, in addition to people suffering with serious medical conditions that make them high risk.

“Phase 2 would include those who are moderately high risk: This includes pregnant women, teachers, school staff, childcare workers. This also includes people like workers in food-supply systems and public transit. Also: people who are experiencing homeless or in group homes, people who have disabilities or are in recovery. It’s also important to include in this population people who are often overlooked: people in jails, prisons and detention centers.

“It will also be important to monitor, not just the vaccine and distribution, but also supplies, like syringes and swabs.”

Long-term protection

A viewer asked: It seems that people who’ve had COVID-19 can become reinfected. In light of that, how will manufacturers assure long-term protection?

Ruth Karron: “With respect to reinfection (cases documented recently in the medical literature), it’s not surprising to those of us who work on respiratory viruses that reinfection can take place. Nor do I expect that COVID vaccines will necessarily protect against reinfection. The purpose of these vaccines is to prevent severe COVID disease.”

An opportunity

���������Dz�:��“As of today, the U.S. leads the world in COVID-19 related cases and deaths.

“As the editors of the New England Journal of Medicine have stated, ‘We've taken a crisis and turned it into a tragedy.’ But we have an opportunity now to lead in a way that benefits people in our country and all over the world.”

​“The building blocks to support and sustain rigorous, careful and ethical evaluation, regulation and deployment of COVID-19 vaccines are all in place—as long as we don’t allow political considerations to derail the process.” And, she adds, we can start laying the groundwork for equitable access.

“I’m an optimist at heart. We have before us a national and global teachable moment that could stand us in good stead not only for COVID-19, but for vaccine uptake in general. Because we develop, regulate and deploy vaccines many times over, but we don't generally do it on center stage. This is a time when we can educate the public.

“If we do this right, we could not only increase confidence in COVID-19, but increase confidence in all the vaccines we deploy.”

Closing thoughts on parallel challenges

Shekhar: “This is a historic moment in our world, in human history and modern medicine.

“Polio was such a killer. Dr. Salk’s work was part of that solution. Much has changed in the world. The whole field of virology and vaccinology has changed so much, and yet the same principles are still challenging us.��I feel the world will be a better place in 2021. I’m very proud that 51��Ʒ��Ƶsburgh will be a contributor to this outcome.”