The race for a vaccine against the Covid-19 accelerates. If the hopes are many, the pitfalls are all the same. And, as for the treatments, you should learn to be wary of the effects of ad junk on the booming success of such or such formula vaccine still in the experimental stage. Interview with Marie-Paule Kieny, a former deputy director-general of WHO, responsible for the deployment of pandemic vaccines at the time of the H1N1 flu epidemic and a member of the Committee on analysis of research and expertise (CARE), consisting of 12 scientists who advise the government on the treatments, tests and vaccines.
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The Point : just Four months after the start of the pandemic, one has the impression that the vaccine against the Sars-CoV-2 is already on rails ?
Marie-Paule Kieny has been deputy director-general of WHO. © MARTIAL TREZZINI / KEYSTONE / EPA Marie-Paule Kieny : When you listen to some of the laboratories started in the race, one could have this impression, indeed. But this is not so simple. The case of the u.s. laboratory Moderna is in this respect emblematic. His statement, widely reported Monday, may 18, announced positive interim results in phase I, one that corresponds to the first step of tests on the man, with the appearance of an immune response in participants. But this ad is advertising, not the publication of scientific data in good and due form. Moreover, if Stock prices have immediately jumped on Monday about the actions of Moderna, there was eventually a backlash with the publication of articles and expert advice which, in detail, show that the vaccine Moderna has, in fact, not at all proven. Moreover, it should be noted that the NIH, the american institute of health care, which financially supports this trial, has not said a word about these preliminary results.
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Are you sure you can be vaccinated against the coronavirus ?
No, there is no certainty of being able to develop an effective vaccine against the Sars-CoV-2, despite the ads very affirmative of various governments around the world. But there are clues to be reassuring. Before the emergence of Sars-CoV-2, had already begun to develop vaccines against two other coronavirus pandemic, the Sars-CoV-1, which is responsible for the pandemic of 2003, and Mers-CoV, which is rampant in the Middle East since 2012. These vaccines have not been successful due to lack of funding or a flow sufficient of the virus to measure their level of real protection. Nevertheless, the concepts have been laid and now serve as a basis for some of the teams to develop their vaccine against the Sars-CoV-2. Other scientists have embarked on tracks from the vaccination against the Ebola virus, which depends for example on the use of adenoviruses of chimpanzee or attenuated virus to trigger an immune reaction. But course, one must not sell the skin of the bear before having killed him ! We are at the first stage of the research, one which requires to explore so many trails – over 120 at the moment – up to their potential failure... or until their success, hopefully, for some of them.
should not be confused, a new time, communication, and science, especially when we see the eagerness of some politicians...
The goal of a vaccine available by the end of the year is it achievable ?
outside of health emergencies, like today, it normally takes from 5 to 6 years to complete the entire series of clinical trials necessary. For the vaccine to Ebola, the last example of a vaccine developed in the emergency, the time of clinical trials has been considerably reduced : it took just over a year and a half, and that the vaccine passes all of the steps and begins to be administered in 2015. This acceleration was made possible by conducting in parallel the clinical studies of phases I and II. The first checking the safety and the second to assess the doses of vaccine needed. Phase III also immediately resulted in permissions to use the so-called "compassionate" for people who are directly exposed to the Ebola virus in epidemic areas. The official registration of the vaccine took place only in December 2019 ; to this date, more than 500 000 people had been vaccinated in an emergency. It is also what we plan on doing for the Covid-19, in time even faster. But to be sure that the vaccine being tested is effective, it's going to take the test at a time when the virus is circulating actively. This will be the case if the virus causes a second wave in Europe in the fall. We could then have phase III results towards the end of the year. But it is important not to confuse, once again, communication, and science, especially when we see the eagerness of some politicians...
What do you mean by that ?
We have already been able to see the NIH, for example, make state results more than partial, even before all the publications of solid data on treatment : the remdesivir. Since this announcement, we are still waiting ! One could therefore fear that the american authorities be tempted by an aggressive communication of the same type for a vaccine this fall... And this, even if it is only for intermediate results of phase III with poor fire protection 20 to 30 %. It is absolutely necessary to keep it reasonable ! Of all the ways, at the beginning, it will not be necessary to vaccinate the entire earth, it will be necessary to proceed step by step.
So who will book the first vaccines ?
This is an essential question because if we have the vaccine in a few months, it's now time to define the strategy to use. The health authorities of all countries must rapidly agree on the persons who must receive the first vaccination campaigns and ensure equitable access to vaccine doses. If one refers to the 2009 influenza pandemic, we should protect as a priority 2 % of the world population, or the whole of the health workforce and the professionals in the front line, to turn the society and the States. For the Sars-CoV-2, the elderly persons may be the second target population, since they are most at risk of severe forms. Only, they are also respond less effectively to vaccines. To work around this problem, vaccination may be extended to younger populations to limit their ability to transmit the virus. And, by ricochet, the most vulnerable will be protected.
