With an increasing number of confirmed cases in China and 24 other countries, the COVID-19 epidemic caused by the novel coronavirus (now known as SARS-CoV-2) looks concerning to many. As of Feb. 19, the latest numbers listed 74,280 confirmed cases including 2,006 deaths. Four of these deaths have occurred outside of mainland China: one each in the Philippines, Japan, Hong Kong and France. The case in France is the first COVID-19 death outside of Asia.
In light of these events, health experts around the world are now divided as to whether this event will become a pandemic, or whether it will be possible to contain transmission of this virus.
Towards a pandemic?
In a recent New York Times article Dr. Thomas R. Frieden, former director of the Centers for Disease Control and Prevention, said it was “increasingly unlikely that the virus can be contained.” In the same article, Dr. Anthony S. Fauci, director of the U.S. National Institute of Allergy and Infectious Disease (NIAID), said, “It’s very, very transmissible, and it almost certainly is going to be a pandemic.”
On the other hand, the WHO remains optimistic. Its head of emergency responses, Dr. Michael Ryan, told STAT News, “there’s enough evidence to suggest that this virus can still be contained” and that “until [containment] is impossible, we should keep trying.”
This brings us to the scientists and experts who are doing just that, throwing everything they have at this public health issue. Some are focused on treating patients with existing or novel therapeutics, others are focused on stopping transmission between individuals by developing a vaccine. Luckily for scientists, lessons learned during the 2013-16 West African Ebola epidemic are now enabling the fast-track development of vaccines, without compromising their safety and efficacy.
Of course, it is critical to learn more about this specific novel virus, including its source and why transmission appears to be more efficient than with other coronaviruses.
Vaccine development
CEPI, the Coalition for Epidemic Preparedness Innovations, is an international, not-for-profit organization with the mandate of accelerating the development of vaccines against emerging infectious diseases. On Jan. 23, it announced financial support to three institutions for the development of a vaccine against the newly identified coronavirus: Inovio Pharmaceuticals Inc. and its “DNA platform,” the University of Queensland and its “protein clamp platform” and a Moderna Inc. partnership with NIAID using its “mRNA platform.”
On Jan. 31, CEPI also announced an extended partnership with CureVac, a biotechnology company, to adapt its RNA vaccine platform to SARS-CoV-2. Four days later, CEPI launched a call for proposals to develop new vaccines against the novel coronavirus, open to all organizations meeting its criteria and in possession of a readily available platform.
People wearing surgical masks sitting in the Shanghai metro in January 2020. The novel coronavirus that originated in Wuhan has spread to many cities in China. (Robert Wei/Shutterstock)
Johnson & Johnson has also announced its participation in vaccine development, using its “adenovirus platform,” which consists of a virus that is modified to look like SARS-CoV-2, but is unable to cause disease in humans. GlaxoSmithKline, another large pharmaceutical company, recently announced a partnership with CEPI to offer access to anyone who would like to use its adjuvant platform (adjuvants are components that can be added to vaccines to increase the generation of an immune response).
Finally, adding its name to the list, the University of Hong Kong also announced it already had a vaccine, designed from a modified influenza virus vaccine.
Issues and solutions
But what do these platforms mean? Why are so many different organizations working towards the same goal of developing a vaccine against one pathogen? Wouldn’t it be easier if everyone worked together, instead of trying such a wide variety of approaches? The answers to these questions are not so simple.
Vaccine platforms are tools that scientists can use to develop a new vaccine, using a similar system to previously successful approaches. For example, one well-known and straightforward approach is the “inactivated platform,” where the pathogen is safely replicated in laboratories, inactivated and then administered as a vaccine.
Although these platforms use different approaches, they all have the same overall goal of training the immune system of the vaccinated individual to quickly recognize a pathogen inside the body.
So why are there so many different platforms? Well, each platform has its own advantages and disadvantages. Some are easier to mass produce, some are known to induce fewer side effects, and some are just better at training particular aspects of the immune system.
The human immune system is divided into two major arms: innate and adaptive. Our innate immune system is non-specific and provides an immediate, but limited level of protection against a foreign intruder inside the body. The adaptive immune system can target a specific pathogen, but needs time to develop its full effect, about 21 to 28 days following infection, or vaccination. The adaptive side can be further sub-divided into humoral and cellular immunity.
With new pathogens like SARS-CoV-2, scientists don’t know which sub-division of the immune system will provide protection, so they aren’t certain which platform will produce the most successful vaccine.
What are scientists doing then?
Vaccine design looks simple on paper, but making it work all the way to human use is a whole other story.
Currently, scientists are working on identifying which parts of SARS-CoV-2 they can use in their vaccines. These parts have to be carefully selected, because they need to mimic what a real infection would look like to our bodies. This has to be done in conjunction with selection of an appropriate vaccine delivery method: the platform that will be used.
Coronaviruses, like MERS CoV seen here, are named for their appearance under a microscope: projections give the edges of these viruses a characteristic corona, or crown-like shape. (NIAID)
For ethical reasons, once a vaccine candidate is available, it needs to undergo safety and efficacy testing in animals (although exceptions are possible). Not all laboratory animals are susceptible to infection in the same way as humans. This is why scientists are also working to identify an animal model suitable for evaluating candidate vaccines. At this point, many months and tens of thousands of dollars have been invested in vaccine development.
Once animal trials are satisfactory, the vaccine can be administered to humans in a clinical trial to evaluate the vaccine’s safety and efficacy. This means additional months to years (if not decades), and millions of dollars in investment.
The last steps are often out of the scientists’ hands. The vaccine must be registered and receive regulatory approval, produced at large-scale and distributed. Although these steps take only a few lines to list here, they can take years to actually achieve.
On the other hand, health experts tell us over and over again that if we’re lucky and everything goes well, we could have a safe and effective vaccine in about a year. It remains to be seen at what stage of the process we will be in early 2021. If China has managed to build a 1,000-bed hospital in 10 days to counter the spread of the epidemic, who knows what can be achieved in a year on the vaccine side.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
