Deepak Bhatt, MD, MPH: We are talking about mutation of the virus. What does that mean in terms of vaccine development? Of course, vaccines have to target areas that are largely conserved. If they're not, then 1 particular vaccine won't be that effective. It varies from year to year with the influenza vaccine, for example, whereas the measles vaccine is pretty good. Of course, a lot of it depends on how much a virus mutates. We don't yet know about COVID-19 [coronavirus disease 2019]. We know that it's not like the measles virus; it's mutating more quickly than that. We don't know that it's like influenza. What do you think we can safely assume right now in terms of probability of developing a vaccine and an effective vaccine? Would it be 100% effective, or would it be like the flu vaccine, where it gets a lot of strains but not every one?
C. Michael Gibson, MS, MD: Like you, I'm optimistic. The most knowledgeable person in this field is Anthony Fauci, [MD], and he said that he hopes—I think it's an aspirational goal—that by the end of the year, we will have a vaccine. That's hopeful, and I'm hopeful that it does happen. I wouldn't be surprised if it's not until 2021, to be honest. That's why many of us were so concerned about the rate of mutations early on and were reassured that the surface wasn't mutating, but the spread of this latest mutant makes some of us a little concerned that this thing might have some changes to the surface protein that happen more often than we might expect.
I'm sure the audience knows that the vaccine is directed against those surface proteins and the spike proteins of the coronavirus. If those change, then you're right, Deepak. We could be looking at an A strain, B strain, C strain kind of situation here that changes.
It's a little up in the air for all of us. When you look at a lot of the antibody testing, what has been disconcerting in 2 Nature papers is that people often didn't have antibodies. If they did, by 2 months, they had started to go away, particularly in asymptomatic people. This is the fine print: that was for the neutralizing antibodies.
Now, what one paper made very clear is that, if you look specifically at a highly conserved region with the spike protein, everyone had an antibody to that spike protein. That was incredibly important because that says that we're making the right choice in terms of the target. I did meet with some vaccine scientists and manufacturers churning in this field, and one of them was very pleased because they were targeting that highly conserved spike protein region that was mentioned in the Nature article.
I'm hopeful. I'm optimistic. The next big challenge will be just like it is in all the trials. The science is tough, but people are tougher. What we've learned in this is that we can have the scientific solutions, but it won’t matter unless we get organized, unless we can stop fighting, and unless we can collaborate and work toward common goals. You can have all the science in the world, but if you can't do a trial, and you can have all the science in the world, but if you can't deliver the drug to the 7 billion people who need it, then you're still between a rock and a hard place. We can treat a lot of people, but until we eliminate the virus and get the numbers down worldwide; it's not a US solution. This has to be a worldwide solution, so it's going to be a challenge. It's going to be a real challenge.
Deepak Bhatt, MD, MPH: I agree. It calls for cooperation between people locally, regionally, nationally, and internationally in a way that I don't think we've ever done, at least that I can recall.
Transciprt Edited for Clarity