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The COVID-19 Whack-a-Mole

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Article

The COVID-19 Whack-a-Mole

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The following article is an opinion piece written by Michael S Kinch. The views and opinions expressed in this article are those of the author and do not necessarily reflect the official position of Technology Networks.

The vaccines are a medical miracle, but mutations are changing the game.

The year 2020 witnessed both terrible suffering and an unprecedented medical miracle. As a deadly pandemic spread across the globe, the medical and scientific communities sprang into action. In the span of weeks, they identified the virus responsible and began clinical vaccine trials — a process typically measured in decades. 

Now, through a blend of scientific and technological prowess, sprinkled with more than a bit of luck, nations around the world have begun deploying safe and efficacious vaccines. Virtually no vaccine expert, including myself, dreamed we’d be so successful.

Yet, as the pandemic enters its second year, the case for optimism has grown shakier. SARS-CoV-2 has been mutating. New variants have arisen in the United Kingdom, Brazil and South Africa, and seem intent on evading our remarkable new vaccines before we’ve even fully rolled them out.

To be clear, it is entirely natural for viruses to mutate as they spread. This is classic Darwinian evolution. The more a virus proliferates, the more mutations it accumulates, and the faster scientists must work to formulate vaccines that are effective against mutated forms of the virus.

It’s as if we’re all playing a collective round of whack-a-mole, the old arcade game. No matter how quickly we move, no matter how hard we struggle, the enemy always pops back up at an increasingly frenzied pace.

Thankfully, no vaccine is likely to lose efficacy all at once, and the same amazing mRNA technologies that allowed us to rapidly create the first generation of COVID-19 vaccines also will allow us to target new variants with follow-up boosters. Yet, creating, manufacturing and distributing these new vaccines will take time.

And so, the cycle continues. The whack-a-mole never ends — until we either eradicate the virus or adopt a different strategy.

For example, rather than fighting mutations individually, we might simultaneously target groups of viral proteins that are unique to coronaviruses. Indeed, we know from considerable experience that while viruses might dodge one form of attack, they are far less capable of escaping concurrent assaults. The introduction of so-called “cocktail” therapies, which target multiple virus-encoded molecules at the same time, helped render HIV infection from an inevitable killer to a more manageable, chronic disease.

An even more old-school approach would be to develop vaccines using whole viruses that have been killed or weakened. Such approaches have largely been upstaged by the more glamorous mRNA and viral vectored vaccines, but they’ve worked for centuries, and could allow the body’s immune system to target as many viral proteins as its defenses find necessary.

Think of our vaccine portfolio as akin to a personal financial portfolio. Picking individual winners is chancy (GameStop, anyone?). The key to success is hedging your bets and emphasizing diversity.

But we must act now. Vaccine whack-a-mole is accelerating, and the virus’s lead is further lengthening. We must begin tilting the game in our favor. Or, to use another arcade analogy: we’re like a character in Mario Kart, racing against a rapid mutation rate. As in the video game, we have some powerful boosts that can help propel us forward.

The first boost is to work for more efficient vaccine distribution and uptake — not only in the United States but worldwide. This is not mere charity. From a selfish standpoint, when it comes to viruses, protecting others has the positive side-effect of protecting ourselves.

In particular, private and government support for organizations such as GAVI, the Vaccine Alliance that helps to vaccinate children around the world, and COVAX, an initiative that helps to procure and distribute COVID-19 vaccines, could pay outsized dividends.

In the meantime, arguably the most powerful boost available to individuals is also the most old-fashioned: wear your mask and maintain social distancing.

Yes, the successful push to create COVID-19 vaccines has enabled us all, after a difficult year, to begin imagining a return to some degree of pre-pandemic normality. But we’re not there yet. One strong, final and consistent push to curtail the rate of viral spread will not only save lives in the weeks and months to come — it will extend the lifetime and efficacy of the very vaccines that at last could end the pandemic.

About the author

Michael S. Kinch is associate vice chancellor, professor of biochemistry and molecular biophysics, and director of the Centers for Research Innovation in Biotechnology and Drug Discovery at Washington University in St. Louis. He is the author of Between Hope and Fear: A History of Vaccines and Human Immunity, The End of the Beginning: Cancer, Immunity and the Future of a Cure and A Prescription for Change: The Looming Crisis in Drug Development.

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