Month: January 2021

Bridging the Chasm: From Vaccines to Vaccinations

8 months ago when I started this PBH blog, my underlying premise was that scientific breakthroughs and science alone, while necessary, are not sufficient, for solving many of the health-related challenges facing our society. I believe that nowhere is this more true than in bridging the chasm from the discovery and development of the COVID-19 vaccines, to the vaccinations in large numbers sufficient to achieve herd immunity. Effectively addressing significant challenges, such as the COVID-19 pandemic, requires multi-faceted solutions that include considerations across Science, Ethics, Policy & Law, and Economics. 

In my last blog, I shared my excitement about the tremendous accomplishment of utilizing novel mRNA technology to develop safe and effective COVID-19 vaccines in record time. Recent headlines have tempered that excitement. It has been disheartening to see the recent reports about vaccines not being used, sitting in freezers, or even going to waste. As of mid-January, on average across the US, only 35% of the distributed vaccines have been administered (CBS News). California, which according to the John Hopkins Covid Tracker has nearly 40,000 new daily cases and over 700 daily deaths, has only administered 26% of the vaccines they have received. Georgia has only administered 20% of the vaccines received. How is this acceptable in our country, one of the richest and most developed in the world? 

Many other countries are doing a lot better at vaccinating their citizens (OurWorldData). As of mid-January, Israel, for example, has vaccinated approximately 25.8% of their population, as compared to 3.7% in the United States! Even the United Kingdom is doing much better, at 5.9% of their population. 

 More people are dying in the US, in a single day, than died from the terrorist attacks on 9/11. That day transformed the way the US deals with intelligence gathering and terrorism threats. This pandemic must be the crisis that transforms healthcare in the US. Clearly just scientific and technological advances, such as mRNA vaccines, are not sufficient. My hypothesis is that we need a multifaceted approach. We need continued contributions from science and technology to now develop effective, 1-dose vaccines that are more stable and easier to store and distribute. 

From a Policy & Law Lense, short-term, I think that the United States needs to develop a much stronger and more streamlined vaccination plan. Currently, there is little coordination between federal and state governments on the most effective method for COVID-19 vaccinations. Each state is responsible for administering their allocated vaccines, developing priority groups, maintaining lock-downs, and scheduling the second-dose appointments. Developing a national plan that’s congruent across all states and territories, developed by heads at the HHS, FDA and CDC, and consistently implemented using say the national guard in each state would provide the structure needed to maximize the timely use of all available vaccine doses. Looking at learnings from countries like Israel and the UK, both the countries seem to have benefited from a national health system. Perhaps it is time for the US to establish an effective national health system. 

From an Ethical Lense, we need to continue to make sure that the vaccines for this pandemic are available for free to all citizens. Some recent reports claim that elite medical schools have received an excessive number of vaccines, and people socially well-connected and rich have found ways to receive the vaccine early. Could the HHS or CDC establish a special office, not just to provide consistent ethical guidelines for vaccine distribution, but also to track their implementation, and, through the influence of the federal government that is supplying these vaccines, ensure compliance to these fair and ethical vaccination policies across all states? Beyond the US, the world must come together to make it easier for all countries to have the option to manufacture the COVID-19 vaccines in their own country, at a lower cost. An important step will be to make a one-time ethical and humanitarian exception for the IP associated with the COVID-19 vaccines. 

From an Economics Lense, it is good that this first round of vaccines is being given for free in the United States. Given the shared public health implications of this pandemic, we need to ensure that the COVID-19 vaccines will continue to be available for free even if we find out that our entire population needs to be vaccinated for multiple years to come. Governments need to budget for this while also working with pharmaceutical companies to reduce the cost to manufacture the vaccines and the price the governments have to pay for them. Hopefully, economies of scale and increased competition with multiple safe and effective vaccines will help reduce the price over time.

These are my early thoughts based on reactions to recent news headlines. The COVID-19 pandemic has given us a real-life view into why focusing solely on scientific and technological innovations doesn’t automatically solve our greatest health challenges. By looking at all four of my PBH lenses – Science, Ethics, Policy & Law, and Economics – I am optimistic that with time and dedication, the United States and the world can bridge the chasm from vaccines to vaccinations, and a safer, healthier society.

The Miracle of mRNA Technology

As a highschool student with a strong interest in genetics and immunology, the developments of the past few weeks have been exciting and provided much needed hope. Biological sciences to the rescue of humanity – YES! The first two vaccines to receive emergency use authorization by the FDA are both mRNA vaccines. I hope that this marks the beginning of the end of this pandemic that has had such a devastating impact on all of our lives across the globe. For this PBH (philosophy of biology and health) blog post, I want to focus on the Scientific Lens to explain the cause of my excitement. Also, as I zoom out and think about these developments from a broader, multidimensional PBH perspective, I want to share some new questions that have come up.  

On December 11, 2020, the FDA authorized for use the Pfizer and BioNTech’s mRNA COVID-19 Vaccine (FDA). The first doses were administered to healthcare workers from December 14, 2020. Just the following week, on December 18th, 2020, Moderna’s mRNA vaccine also received FDA emergency use authorization (FDA). The mRNA vaccines were developed in record time and faster than the traditional vaccines that are yet to be approved by the FDA.  

Both of these vaccines have gone through extensive trials, proven to be safe and highly efficacious after two doses. However, many people are still wary about what the new mRNA vaccine entails. A recent survey (WebMD) found that only 60% of the American population are “certain” or “probably certain” they will get the vaccine. To achieve herd immunity, professionals believe 75%-85% of the population will need to be vaccinated. What’s causing this reluctance and lack of faith in modern medicine? Yes, wild conspiracies and fear mongers influence this opinion. However, I think one of the primary causes for this uncertainty is a lack of knowledge about this new vaccine technology. So, what really is the mRNA vaccine, and how does it differ from a conventional vaccine?  

Conventional vaccines have been utilized since 1796, when english doctor Edward Jenner produced the first vaccine for the Smallpox disease. This primal vaccine was used by introducing cowpox into a young boy. As cowpox doesn’t produce symptoms for humans, the boy’s immune system was able to learn and fight off the non-threatening virus. When introduced to smallpox, the boy was not affected as now his body had the antibodies to fight off the disease. This was a huge breakthrough for the scientific field, and for over the last 200 years this method has been used to some extent. Now, common vaccinations for diseases such as Chickenpox, measles, and the flu use various forms of this method. Overarchingly, they work by introducing a harmless, denatured version of the virus into the body, allowing the immune system to build the proper antibodies and immune response to fight it off. Then, when exposed to the pathogen in the real world, the body already has it’s defense system built up and prepared to effectively stop the spread of the disease. 

mRNA stands for messenger RNA, and it is an important part of the DNA replication process. In DNA replication, the first stage is called transcription. An enzyme called DNA helicase “unzips” the double-stranded DNA, leaving one side of the genetic material exposed. mRNA reads the genetic code of nucleotides A, T, G, and C, creating a complementary strand of mRNA utilizing the nucleotides T, U, C, and G respectively. This strand of mRNA leaves the nucleus and nuclear envelope, carrying the new RNA codes to the cell’s ribosomes. These ribosomes read the mRNA instructions, build the corresponding amino-acid chains, thus producing the specific proteins. Scientists are now able to leverage the role of mRNA to develop new medications and treatments. Synthetic mRNA, precoded for a specific protein, can be distributed to many cells in the body. From there, human biology takes over. The synthetic mRNA is taken up by the ribosomes, continually building up the amino acids and proteins, allowing them to be expressed in the body. This technology has the potential to be applied for many different medical uses, with the most current and notable one being the COVID-19 mRNA vaccines (Moderna). 

Early in the outbreak, scientists sequenced the COVID-19 virus and published its genetic code. Scientists discovered that this virus is characterized by “spike proteins” on its surface. Scientists used these protein spikes as the target for vaccines and treatment, as opposed to injecting a fully-structured denatured virus. While BioNTech and Moderna worked on their vaccines separately, there are a lot of similarities in the underlying science. Using the genetic code of the COVID-19 virus, scientists use complementary RNA base-pairs to build strands of synthetic mRNA, with the instructions to build the specific viral spike proteins. The synthetic mRNA strands are delicate, and need assistance entering human cells. They are packaged in a specially designed oily coating, created with lipid nanoparticles. Once injected into the body, these oily capsules bind to some cells and break apart, inserting the mRNA material into the cytoplasm. These mRNA strands make their way to the cell’s ribosomes, where the mRNA sequence is read repeatedly to produce the viral spikes. These viral spikes are then pushed to the surface, protruding from the cell membrane as either displayed fragments or full spikes.

Once the cell ultimately dies, the mRNA is destroyed, disallowing it from spreading and taking over other cell functions. This acts as a safety feature for the vaccine, ensuring that only a select few cells are taken over. Upon the individual cells’ destruction, the protein spikes and debris float throughout the body, unable to do real harm. However, the foreign material attracts the attention of the body’s immune system – specifically antigen-presenting cells and T-cells. The antigen-presenting cells take in the spikes and present at its surface, while helper T-cells can send a signal to the rest of the immune system. This calls another type of immune cell: B-cells. These B-cells can hit and lock into the protein spikes, and with activation from helper T-cells can begin forming antibodies to identify the virus. Lastly, killer T-cells are activated, and trained to recognize and kill the virus upon contact. Memory B and T-cells store this information, offering protection in the long term. This shortens the reaction time of the immune system upon exposure to the virus, allowing it to utilize the “alarm” system and its antibodies to destroy the virus before it can continue to replicate. In this way, the vaccine utilizes the new mRNA technology to protect the vaccinated individual and break the chain of transmission.

These two COVID-19 vaccines are the first ever mRNA based product to be approved by the FDA. This miracle of being able to use the human body as a factory to custom manufacture targeted proteins has the potential to protect humans from other infectious diseases and genetic disorders. I am  very excited about the potential this new genetic technology has to do so much good for human health! 

From a PBH perspective, as I zoom out beyond the Scientific lense, these promising new scientific developments also raise some important questions and considerations: 

  • What are some of the other most promising applications of this new mRNA technology? 
  • How can we make these new, promising mRNA vaccines cheaper and more accessible beyond the rich, developed countries? 
  • Should the intellectual property (IP) associated with the COVID-19 mRNA vaccines be made freely available to developing and poor countries, at least until this pandemic ends?

There will be other opportunities to address these questions. But for now, I want to take a moment to marvel at this miracle of science!