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APRIL 26, 2020 -- Without equitable access to a vaccine, the COVID-19 pandemic will continue to rage, especially as it begins to hit less developed countries, say prominent public health experts on a panel convened April 25 by the National Academies of Sciences, Engineering, and Medicine (NAS).
"I do have a sense that we still as yet underestimate the true impact of what we face today and what we may face in the coming months and years," said Jeremy Farrar, MD, PhD, director of the UK-based Wellcome Trust, in a video conference held in conjunction with the NAS annual meeting.
He noted that in the 120 days since the first knowledge of the novel coronavirus, it has spread to almost every country on earth.
"My biggest worries next are going to be what happens when this increasingly becomes an issue in central and South America, in Africa, and South Asia," said Farrar.
"The United States is now the country that has suffered most — that does not mean there is not worse ahead, particularly in the southern hemisphere," agreed Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID).
Poor Nations Will Suffer More, Longer
People in marginalized populations in the current epicenters of North America and Europe "will continue to suffer longer." It is inevitable that the impact of COVID-19 marginalized and vulnerable populations will be much larger in developing countries, Farrar added.
Conflict zones, refugee camps and migrant settlements will "prove to be hotbeds of this epidemic," he said.
Social distancing and lockdowns are not going to bring about the end of the pandemic. Similarly, antivirals are not a solution, said Farrar.
"The track record of producing antiviral or immune-modulating drugs in acute viral infections has not been great," he said. The fast-changing dynamics of immunity during a viral infection make it tricky to determine at what point to administer a therapy, he noted.
At some junctures, it might be desirable to increase the immune response, whereas during other times, it might be more important to suppress the response, said Farrar.
Susan R. Weiss, professor of microbiology, University of Pennsylvania School of Medicine, Philadelphia, who has studied the genetics of coronaviruses, agreed that antivirals would likely only be effective early on in the illness.
With COVID-19, the problem is that it's not always clear that people are infected, and early in the course of the virus is when these drugs are needed.
"Vaccine is really going to be the answer," said Weiss.
"We should be realistic about our expectations of antiviral therapy," said Richard J. Hatchett, CEO of the Coalition for Epidemic Preparedeness Innovations (CEPI). "They probably won't be a silver bullet," he said, but added that it was still critically important to test them in COVID-19.
The majority of the 107 vaccine candidates in development are in Europe, North America, and China, said Hatchett.
No Room for "Vaccine Nationalism"
Fauci noted the many vaccines in development in the US, including at NIAID. He said the US agency is also supporting vaccine studies — through its global network of clinical trial programs — at several pharmaceutical companies and academic centers.
"We want multiple successful vaccines," he said. "The only way you're going to do speed, scale-up, and access is to do a lot of shots on goal, and a lot of goals from those shots."
Fauci said the agency's first obligation was to the US. "But we're very sensitive to the fact that as a country that has a big research and development operation that we do have a global responsibility," said Fauci.
He and others on the panel said it will be crucial to ensure that, if a successful vaccine is developed, it will be distributed equitably around the world.
"We want to make sure that the world has access to vaccines, and that access to vaccines is not just concentrated in a few nations," Hatchett stressed.
Hatchett said he was concerned about "vaccine nationalism," which he defined as "the tension elected leaders will feel to protect the lives of their citizens vs the most efficient way that you protect their livelihoods, which is to make sure the epidemic is addressed globally."
It's a small world, said Farrar, noting that COVID-19 spread around the planet in just 60 days. The great challenges of this century — epidemics and climate change among them — "cannot be answered by narrow nationalism."
"If we don't learn from this, and we don't work together, across borders and across political views, then we will face further crises like this in the future," Farrar warned.
Unless the world makes a commitment to bringing science-based solutions to all nations, "then we will not bring this pandemic to an end," he added.