An Optimist’s View of the COVID-19 Outbreak

A quick scan of the headlines admittedly lays low an optimistic view of the world, particularly as it pertains to infectious diseases. COVID-19 is the most prominent example of a rising medical crisis but is joined by less visible but daily reports of Lassa fever, dengue, as well as ongoing Ebola virus infection in central Africa.  Even once-conquered diseases, such as measles and mumps are being reported across the developed world on a daily basis, largely propelled by a misguided, but nonetheless burgeoning, anti-vaccine movement.  

The collective impact of this news recalled a conversation I had years ago with a Brazilian graduate student, which could point the way to a future silver lining to frame the storm clouds of today. 

Amidst a course at Washington University I developed to convey the history of medicines and vaccines, a debate arose about the subject of vaccine hesitancy.  Unlike the visible and destructive mis-information that rightfully has propelled criticism of the anti-vaccine community, this particular debate did not center upon their false claims linking the M-M-R vaccine to autism. Instead, the disagreement focused upon the question of how such myths propagate in a rational and educated society.

The aforementioned South American proclaimed proudly she had never met an anti-vaxxer in  Brazil and had only done so in the United States and Europe. The reason, she contended, was that her compatriots lived with infectious disease on a daily basis. She cited numerous examples of individual family members and friends, who had suffered and (mostly) recovered from dengue fever, Chikungunya infection and a variety of other pathogens. Focusing upon the M-M-R vaccine, she further stated how Brazilians are required to carry a card indicating their immunization history and, if one were to seek medical attention at a doctor’s office, urgent care or hospital, the failure to present evidence of prior immunization would prompt a quick booster shot. She estimated that in her twenty-something years of life, she had received no fewer than five M-M-R boosts, mostly as a result of circumstances, where her records were not readily available.  

Until recently, the American public had largely forgotten the consequences and dread of a myriad diseases that have devastated our species for millennia.  Our enviable position today largely reflects the remarkable progress made in the development of vaccines, sanitary improvements and anti-infective agents. These successes lulled us into a false sense of complacency, which has facilitated the rise of a fringe of na?ve individuals seeking solace in the falsified work of a quack British physician. The anti-vaccine movement continues to accelerate its growth and a brief search of vaccines on your favorite website is likely to reveal the dominance of their messaging in social media. The result is a flood of highly-vocal and often well-presented, but nonetheless inaccurate, views about the perceived dangers of vaccination. 

In this light, the relentless media coverage of the COVID-19 disaster has conveyed an essential reminder of the dangers of the microbial world. As importantly, the world now looks to the scientific and commercial innovators to develop a protective vaccine.  Unlike the fictional features emerging from Hollywood, this process will not occur overnight. The successful deployment of a COVID-19 vaccines will require arduous and expensive work requiring months or years needed for its discovery, development and manufacturing. In the meantime, we will become desensitized by innumerable reports of morbidity and mortality from COVID-19 that will capture headlines for the foreseeable future. 

The inevitable fear and frustration the public will inevitably evince might trigger constructive outcomes. This period will provide an opportunity to convey the importance of the need for greater scientific, medical and commercial interest in infectious diseases and public health. At least two positive outcomes (beyond the development of a new vaccines) can be achieved. First, we can remind the public of the importance of disease prevention and the disingenuous arguments of the anti-vaccine movement. Second, we can recognize and help prevent the decline in our capacity to develop new vaccines. It is crucial we act quickly as the window of opportunity afforded by COVID-19 will be fleeting as other headlines invariably distract our attention to the next political or geopolitical blockbuster. 

As I point out in Between Hope and Fear, abundant evidence of the life-saving benefits of vaccines contrast dramatically with the hollowness and sheer irresponsibility propagated by their critics. The awareness imparted by COVID-19 provides an opportunity for medical professionals, the media and indeed all of society to re-engage in conversations about the importance of preventing disease rather than the far more challenging and expensive strategy (both in terms of dollars and human suffering) to develop new medicines to manage diseases that might otherwise have been contained.

An optimistic outcome of the current crises could be a reassessment of the societal costs and values of vaccines as a means to improve the quantity and quality of life. Prominent examples of the need for this discussion have arisen from analyses of vaccine development by our team at Washington University Center for Research Innovation in Biotechnology. This work has documented that the breadth of the biopharmaceutical industry in general has declines, largely has a result of consolidation. One consequence is that despite the extraordinary increase in our understanding of infectious diseases, the net number of vaccine-preventable diseases has not changed in nearly a half-century.

Many organizations that have historically discovered many of the most effective vaccines have been discouraged from continuing this practice by the fundamentals of risk and reward. As a consequence, many of the most prolific vaccine innovators have abandoned vaccine programs based upon perceptions of low margins and ever-increasing risk. The risks include both scientific and legal given that vaccines are administered to healthy individuals and thus have a low tolerance for side-effects. This sensitivity has only been sharpened by an increasingly visible and vocal anti-vaccine movement.

Solutions to these problems will likely require a fundamental re-thinking of how new vaccines are developed and distributed. Given the common good conveyed by preventing infections from deadly and debilitating infectious agents, the conversation needs to include private, public and charitable organizations. Together, these partners must be guided by a shared desire to reshape the scientific, regulatory and commercial approaches needed to discover, develop and distribute vaccines to those most in need.

In this context, the ongoing COVID-19 outbreak provides a window to discuss the challenges and opportunities for future vaccines to prevent or minimize the harm from future infections. We are amidst a rare period with governments and citizens appropriately focused upon an important issue of public health. We must not lose this opportunity to engage an interested public to regain proper perspective about the value of vaccination and the need to ensure that we can continue to develop new vaccines for both new and existing threats.