“I am not part of the age risk category, nor am I immunocompromised, but I as a member of society have a responsibility to slow down or stop the transmission by not going out there and thinking “I don’t have any symptoms, I’m not infected.”
Last weekend I met with Dr. Indah AndiLolo, a vaccine developer for the Bill and Melinda Gates foundation, over the phone to discuss the current situation. Dr. AndiLolo had been self-quarantining in her home for almost 20 days, with her husband and children for 8. She agreed to speak with me about vaccine development and how she feels the world is reacting to the virus. I asked her some questions over email as well as a short phone interview and compiled the answers she gave me below.
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We develop a vaccine using a certain part of the virus or a bacteria, [depending on] if the disease is caused by a virus or a bacteria. So [we] take part of that pathogen and make it not disease-causing. So if you have this vaccine in your body, the vaccine is developed in such a way so that it mimics the behavior of the actual virus or bacteria, but it doesn’t actually make you sick from it. Once a vaccine is developed, you’ve tested it, it’s safe and it works, you go through registration, you know, the regulatory bodies, like FDA for example, [they review] the data to prove it. But then, that’s not the end of it, there’s something called effectiveness meaning your vaccine only works if people actually use it.
I am currently not directly involved in the COVID-19 vaccine development. I am leading a project to develop a vaccine against another virus which is considered a pandemic threat called Nipah. It is a partnership between PATH, CEPI and AURO VACCINE.
Moderna and NIH have started a Phase 1 COVID-19 vaccine clinical trial here in Seattle. I believe it is the most advanced vaccine development. It would also be a paradigm shift in how vaccines are made. Normally vaccines are inactivated forms of the virus or parts (proteins) of the virus that are most immunogenic. This one carries some of the genetic code of the virus (mRNA) and the immunogenic parts (proteins) are made using this genetic material in the body after vaccination. This approach allows very rapid design and manufacturing of a new vaccine against a newly emerging virus.
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So the principle of vaccination is always prevention, not treatment. So you will hear vaccines tend to be linked to prophylactic, meaning you get it before you actually have the disease. So for folks who have actually encountered the disease, those who [have] tested positive, getting the vaccine, if we were to have the vaccine today, would not help them. You have to treat the symptoms that [are] caused by the virus. But for you and I, for example, [assuming] you and I don’t have the virus, then it would be good to have the vaccine so that we do not get the disease and therefore we do not transmit the virus to other people.
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The concepts I have trained on is that the vaccine should be given to a large proportion of the population to establish herd immunity and prevent the spread of the virus. Intuitively with COVID-19 I would think that the populations most at risk would be those prioritized for vaccination, but there could be other factors. The issue would be, now this is in the early days of the clinical trial, so if the data that comes out of this clinical trial for some reason shows that the vaccine currently being tested does not work well in [the older and immunocompromised] population because the whole immune system needs to be able to respond to this vaccine.
So if it doesn’t work in the elderly population because they cannot show a good immune response to the vaccine, perhaps the best way to do it is to create this herd immunity and give it to the younger population. So to [make sure] people your age, the young adults, don’t end up carrying the virus and [this] slows down or stops the transmission. So that the elderly population and those that are vulnerable are protected by this herd. So when you hear about, for example, flu vaccination, seasonal flu, there’s a vaccine for it and people are always advised to get the vaccine on an annual basis. So not everyone can get the vaccine for certain reasons, if you are immunocompromised, for example. If you are going through treatment for cancer, chemotherapy, sometimes you would not be a candidate to get the seasonal flu vaccine. Or if there is a 2-month-old infant in the house, they do not meet the criteria for getting the flu vaccine. But they can still contract the disease, so therefore it’s always advised that the mom, the dad, any people around that vulnerable group gets vaccinated so we don’t end up being carriers of the virus and transmit it to people who can’t get the vaccine and protect themselves.
That’s always the challenge in the end, so I develop and manage projects funded by the Gates Foundation. So the Gates Foundation, their aim is to be able to help countries that are underdeveloped, they don’t have good health infrastructure. They are nowhere as rich as America and therefore cannot afford these vaccines. So through the Bill and Melinda Gates Foundation, and the Global Alliance for Vaccines, what they’re doing for general vaccines, so not necessarily for COVID-19 at this moment, but generally what they do is they provide funding support so they can supply vaccines to these countries. Basically the government can have these vaccines at an affordable rate so that they can give them to their population.
Now when we talk about America, the health infrastructure here is quite different. In parts of Europe, we know that they have more of a universal healthcare system. So you don’t necessarily have this private insurance: you go to the clinic, you get what you need. Sure you pay a lot of taxes, but that the same time, the flip side of things, you have universal health coverage. I don’t know how the COVID-19 vaccine will be distributed here in America, how that’s going to be. I assume somewhere along the line there will be discussions about how the insurance [companies] will be covering these things. Does that mean that your premium, as someone who has insurance will increase so that you can have [the vaccine]? Or, because this is an emergency situation, will there be a special [measure] from the government requiring everyone who meets criteria to get [the vaccine], whether you have health insurance or not? That is not an area that, to be honest I know. Because going back to what I mentioned earlier about vaccine development, you start from the basics, you take it all the way through the animal tests, take it through the clinical testing in humans, have those data reviewed by the regulators.
If it gets approved, there’s the next part, how do you get it to the people? That’s what they call the delivery side of things. Meaning that, are you going to be providing it through your healthcare channel? Can you go in there and have it through your usual insurance or your insurance pays part of it and you have to pay another part of it? But then, what happens to people who don’t have insurance? That’s something that I have not heard how it’s really going to be distributed because [it’s] the early days.
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I find it crazy that people are stocking up a 2-week supply in one day and that’s [putting] a stress on the supply system. I think if leaders don’t take the time to explain things, that’s where the chaos starts. The fear of the unknown. Is there a shortage of [supplies]? And that’s where people start feeling afraid and they don’t know [so] they end up hoarding.
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If leadership doesn’t provide enough context, I think there’s a tendency [for] people to run with their own understanding. So there’s been a lot of talk [about this being] a Chinese virus. Well, it’s a virus that was first detected in China. It came from bats, it’s called a zoonotic virus, so it used to live in animals but then it mutated and moved to humans. [And] I don’t think animals have a race. That’s where leadership [comes in], if we’re talking about the level of government or each of us, where we need to take the time and explain “No this is not a Chinese virus.” Everyone’s getting infected and it’s not a virus that is caused by Chinese.
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In my view, the pandemic preparedness was not sufficient. When the case first broke in China, testing capacity should have been ramped up, so that we can Test – Identify – Treat. Trace contact is also not established. At the moment, we must assume that anyone we encounter is carrying the virus without necessarily having symptoms.
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I find it crazy, and I’m still wrapping my head around it that the pandemic preparedness, here in the US, is not as good as I assumed it would be, America being a country that is always seen as being a country that is leading, at the forefront of fighting infectious diseases. They’re leading in the science, they’re leasing in everything. But for this [form] of preparedness, they’re not prepared. I’m still wrapping my head around it, I’m just surprised.
When all these things were happening in China, back in January, one [should’ve] assumed that that’s not going to stay in China. This thing is going to travel. So if it hits, and when it hits the US, we [should've] already had testing capacity that is at that level of Korea or even more, considering America is America. It appears that China and Korea did incredibly well. China to stop the spread of the virus and Korea to contain it and “flatten the curve.” Italy [is] current the worst hit country globally (as of March 2020, now America is the worst hit), especially since they have a high aging population. They made an unprecedented decision to lock down a country which appeared crazy at the time, but appears very brave and proactive as time passes.
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I think [people think it’s like the flu because they look at the symptoms. [Compared] to the Covid-19 symptoms, yea it’s kind of like the flu; you’ve got this respiratory infection, fever, cough. So the transmission rate is high, meaning that it can infect a lot of people [at] quite a fast rate. But the mortality rate, the rate of it killing people, is not as high as Ebola, for example. [Also], rabies. Rabies is usually carried in infected dogs, and it has a very short window. If you don’t get vaccinated and don’t get [medical help], it kills within 72 hours. People say “well, yeah it’s kind of like the flu” because the symptoms are similar, the incubation period is only 14 days so it doesn’t kill you right away. And if you get it, for some people who are lucky it’s mild. For others, who are not lucky, it’s pretty severe and then they recover. Now, the issue is, it’s not necessarily about those people who are not in the age-risk category, so the young adults, the millennials, the teens, the kids my childrens’ age.
The issue is about the vulnerable, the immunocompromised and the elderly and, in my view, it’s a social responsibility. I am not part of the age risk category, nor am I immunocompromised, but I as a member of society have a responsibility to slow down or stop the transmission by not going out there and thinking “I don’t have any symptoms, I’m not infected.” The other part of my responsibility is to ensure that my vaccinations and my childrens’ vaccinations are up to date because I am a member of the community that can help create herd immunity. But I alone, my family, that’s not enough. So, for folks who say “it’s just like the flu,” sure, it’s like the flu. But the thing is, it’s not just about yourself, who’s going to be getting the “flu.” Other people, who may be more vulnerable than ourselves, these flu symptoms can actually get worse, and kill them.