第一代疫苗并非新冠疫情初期人們所期待的萬能藥。群體免疫這一抗疫模式也未能力挽狂瀾,結(jié)束疫情。
一款所謂的“泛冠狀病毒”疫苗能否成為萬眾期待的靈丹妙藥,它是否能夠終結(jié)本次疫情和未來疫情?
答案是:情況很復雜。
約翰斯·霍普金斯大學(Johns Hopkins University)的醫(yī)學系(Department of Medicine)的數(shù)據(jù)完整性與分析醫(yī)學副主任斯圖爾特·雷伊告訴《財富》雜志:“所謂泛冠狀病毒疫苗,后面需要加星號標注。”
這種疫苗可以對所有冠狀病毒形成免疫。冠狀病毒因為其在顯微鏡下外形類似于皇冠而得名。這款疫苗將新冠病毒及其混合變種作為重點防護對象。它甚至能夠應(yīng)對以普通感冒形式長期存在的四種冠狀病毒。
它還可以對2002年出現(xiàn)的SARS(嚴重急性呼吸道綜合癥)和2012年出現(xiàn)的MERS(中東呼吸綜合征)產(chǎn)生抗體。這兩種病毒均造成了數(shù)百人死亡。
除了可能結(jié)束當前的新冠疫情,它甚至有可能將下一次疫情盡早扼殺在搖籃中。
哈佛醫(yī)學院(Harvard Medical School)的教授、布里格姆和婦女醫(yī)院(Brigham and Women’s Hospital)的風濕病學、免疫學與過敏科(Division of Rheumatology, Immunology, and Allergy)的首席研究員杜安·威瑟曼博士表示:“冠狀病毒直接進入人際傳播?!蓖且粋€泛冠狀病毒疫苗研究團隊的負責人,該團隊得到了美國國立衛(wèi)生研究院(U.S. National Institutes of Health)的資助。
“我不知道[下一次疫情將在什么時候爆發(fā)]?;蛟S我有生之年都不會發(fā)生。但未來某個時間肯定會發(fā)生。有沒有辦法開發(fā)一款能夠應(yīng)對SARS-CoV-3的疫苗?”
拉貢研究所(Ragon Institute of MGH, MIT, and Harvard)的主任、馬薩諸塞州病原體應(yīng)對協(xié)會(Massachusetts Consortium on Pathogen Readiness)的負責人之一布魯斯·沃克博士告訴《財富》雜志,無論這種疫苗會是什么形式,開發(fā)這樣一款疫苗都是值得我們?nèi)ヅΦ哪繕?。拉貢研究所致力于根除各類疾病?/p>
但它可能永遠都只是一個目標而已。
沃克警告稱:“我認為我們要有開發(fā)一款泛冠狀病毒疫苗的雄心,但這將是一項艱難的任務(wù)。因為我們尚不清楚如何開發(fā)?!?/p>
研究工作正在進行中,但可能需要花費數(shù)年時間
要想開發(fā)出一款泛冠狀病毒疫苗,或許希望渺茫,但已經(jīng)有人著手為實現(xiàn)這個目標而努力?!蹲匀弧罚∟ature)今年4月發(fā)布的一篇文章顯示,一款通用冠狀病毒疫苗成為非營利組織、政府機構(gòu)和疫苗生產(chǎn)商的研究重點。
正在開發(fā)通用疫苗的實體包括Moderna、杜克大學(Duke University)和綜合生物科技公司。
約翰斯·霍普金斯衛(wèi)生安全中心(Johns Hopkins Center for Health Security)的高級學者阿梅什·阿達爾佳博士對《財富》雜志表示,美國陸軍(U.S. Army)和加州理工學院(CalTech)正在準備進行臨床試驗。
他表示,這樣一款疫苗可能成為“靈丹妙藥,有望消滅所有威脅,不只是新冠病毒,而是所有冠狀病毒的威脅?!睂⑵胀ǜ忻皽p少30%確實是好事?!?/p>
但他表示,研究工作需要時間。一個很好的例子就是流感疫苗。
他說:“雖然很長時間以來一直有人在研究通用流感疫苗,但至今沒有一款疫苗真正獲得成功。有一款通用流感疫苗的多個版本正在進行臨床測試,但這款疫苗在不同病毒株導致的多個流感季中的療效不盡如人意,并未成功發(fā)揮效果?!?/p>
另外一個例子是HIV。
威瑟曼表示:“數(shù)十年來,我們一直在研究針對HIV等病原體的疫苗。幾十年前,有科學家曾經(jīng)認為:‘用不了幾年,我們就會有一款HIV疫苗。’但幾十年過去了,我們發(fā)現(xiàn)對這種病毒依舊不夠了解。”
威瑟曼稱,他更看好泛冠狀病毒疫苗的開發(fā)前景,“但我們從其他病原體那里已經(jīng)學會了保持謙遜。”
他說:“我們對人體免疫系統(tǒng)的了解,并沒有達到可以坐下來設(shè)計一款最佳疫苗的程度。”
哈佛醫(yī)學院的醫(yī)學教授、病毒學和疫苗研究中心(Center for Virology and Vaccine Research)的主任丹·巴魯什博士對《財富》雜志表示,開發(fā)一款可供大眾施打的通用冠狀病毒疫苗,需要額外研究、動物試驗和早期人體試驗,這些環(huán)節(jié)可能要花費多年時間。
巴魯什稱,“曲速行動”(Operation Warp Speed)制定了加快開發(fā)初始新冠疫苗的時間表,但通用冠狀病毒疫苗的研發(fā)過程并不在其中。
巴魯什說:“泛冠狀病毒疫苗向公眾開放施打可能還需要等待一段時間。我認為今年秋天在CVS還買不到這樣一款疫苗?!?/p>
前景光明,風險猶在
專家提醒稱,通用新冠疫苗什么時候上市或者能否上市?這個問題沒有確定答案。
布里格姆和婦女醫(yī)院的傳染病科主任、哈佛醫(yī)學院的醫(yī)學教授丹尼爾·庫里茨克斯博士表示,雖然一款泛冠狀病毒疫苗有望“幫助結(jié)束疫情”,至少能夠減少重癥和死亡,但它能否成功將取決于全世界是否有足夠的人接種疫苗。
否則,即使有通用冠狀病毒疫苗,病毒也可能學會免疫逃脫。
庫里茨克斯表示:“這種情況當然有可能發(fā)生?!?/p>
他補充道:“只要病毒繼續(xù)在大批人當中傳播,它就有機會持續(xù)適應(yīng)。如果一種變種病毒發(fā)生突變,可以逃脫泛冠狀病毒疫苗所產(chǎn)生的免疫反應(yīng),病毒就會向已經(jīng)接種疫苗的人群傳播,再次流行?!?/p>
雷伊表示,疫苗能夠?qū)崿F(xiàn)兩個目標:徹底阻止病毒傳播,或者像現(xiàn)有的新冠疫苗一樣阻止重癥的發(fā)生和對人體器官的破壞。
泛冠狀病毒疫苗有可能防止因所有新冠病毒變異株和亞變異株導致的重癥和對人體器官的破壞,理論上可以讓人們免于接種加強針。
但專家警告,就像現(xiàn)有的疫苗一樣,這樣一款疫苗可能依舊無法避免病毒傳播。
威瑟曼稱:“據(jù)我猜測,如果我們設(shè)計一款覆蓋范圍足夠?qū)挿旱囊呙?,我們就將不得不在療效方面做出一些犧牲?!?/p>
雷伊警告稱,泛冠狀病毒疫苗概念可能過于美好,不可能實現(xiàn),但他還是希望有這樣一款疫苗“在防護力和持久性方面達成最佳平衡?!?/p>
他說:“讓我們輾轉(zhuǎn)反側(cè)的是,如果我們所做的工作無法控制病毒傳播,病毒就會繼續(xù)進化,并找出我們的防御漏洞?!?/p>
有一個潛在的缺口是可能令人失去行動能力的長期新冠。據(jù)聯(lián)邦官員表示,可能有多達2300萬曾經(jīng)感染新冠病毒的美國人,正在經(jīng)受這種病癥的折磨。
雷伊表示,研究顯示“即使感染新冠出現(xiàn)輕癥或中癥,也可能在心血管和精神健康方面產(chǎn)生長期影響。我們可能會發(fā)現(xiàn),雖然我們能夠阻止在感染后的前兩周出現(xiàn)重癥,但相對溫和的感染卻造成了日積月累的傷害?!保ㄘ敻恢形木W(wǎng))
譯者:劉進龍
審校:汪皓
第一代疫苗并非新冠疫情初期人們所期待的萬能藥。群體免疫這一抗疫模式也未能力挽狂瀾,結(jié)束疫情。
一款所謂的“泛冠狀病毒”疫苗能否成為萬眾期待的靈丹妙藥,它是否能夠終結(jié)本次疫情和未來疫情?
答案是:情況很復雜。
約翰斯·霍普金斯大學(Johns Hopkins University)的醫(yī)學系(Department of Medicine)的數(shù)據(jù)完整性與分析醫(yī)學副主任斯圖爾特·雷伊告訴《財富》雜志:“所謂泛冠狀病毒疫苗,后面需要加星號標注?!?/p>
這種疫苗可以對所有冠狀病毒形成免疫。冠狀病毒因為其在顯微鏡下外形類似于皇冠而得名。這款疫苗將新冠病毒及其混合變種作為重點防護對象。它甚至能夠應(yīng)對以普通感冒形式長期存在的四種冠狀病毒。
它還可以對2002年出現(xiàn)的SARS(嚴重急性呼吸道綜合癥)和2012年出現(xiàn)的MERS(中東呼吸綜合征)產(chǎn)生抗體。這兩種病毒均造成了數(shù)百人死亡。
除了可能結(jié)束當前的新冠疫情,它甚至有可能將下一次疫情盡早扼殺在搖籃中。
哈佛醫(yī)學院(Harvard Medical School)的教授、布里格姆和婦女醫(yī)院(Brigham and Women’s Hospital)的風濕病學、免疫學與過敏科(Division of Rheumatology, Immunology, and Allergy)的首席研究員杜安·威瑟曼博士表示:“冠狀病毒直接進入人際傳播?!蓖且粋€泛冠狀病毒疫苗研究團隊的負責人,該團隊得到了美國國立衛(wèi)生研究院(U.S. National Institutes of Health)的資助。
“我不知道[下一次疫情將在什么時候爆發(fā)]?;蛟S我有生之年都不會發(fā)生。但未來某個時間肯定會發(fā)生。有沒有辦法開發(fā)一款能夠應(yīng)對SARS-CoV-3的疫苗?”
拉貢研究所(Ragon Institute of MGH, MIT, and Harvard)的主任、馬薩諸塞州病原體應(yīng)對協(xié)會(Massachusetts Consortium on Pathogen Readiness)的負責人之一布魯斯·沃克博士告訴《財富》雜志,無論這種疫苗會是什么形式,開發(fā)這樣一款疫苗都是值得我們?nèi)ヅΦ哪繕?。拉貢研究所致力于根除各類疾病?/p>
但它可能永遠都只是一個目標而已。
沃克警告稱:“我認為我們要有開發(fā)一款泛冠狀病毒疫苗的雄心,但這將是一項艱難的任務(wù)。因為我們尚不清楚如何開發(fā)。”
研究工作正在進行中,但可能需要花費數(shù)年時間
要想開發(fā)出一款泛冠狀病毒疫苗,或許希望渺茫,但已經(jīng)有人著手為實現(xiàn)這個目標而努力?!蹲匀弧罚∟ature)今年4月發(fā)布的一篇文章顯示,一款通用冠狀病毒疫苗成為非營利組織、政府機構(gòu)和疫苗生產(chǎn)商的研究重點。
正在開發(fā)通用疫苗的實體包括Moderna、杜克大學(Duke University)和綜合生物科技公司。
約翰斯·霍普金斯衛(wèi)生安全中心(Johns Hopkins Center for Health Security)的高級學者阿梅什·阿達爾佳博士對《財富》雜志表示,美國陸軍(U.S. Army)和加州理工學院(CalTech)正在準備進行臨床試驗。
他表示,這樣一款疫苗可能成為“靈丹妙藥,有望消滅所有威脅,不只是新冠病毒,而是所有冠狀病毒的威脅?!睂⑵胀ǜ忻皽p少30%確實是好事。”
但他表示,研究工作需要時間。一個很好的例子就是流感疫苗。
他說:“雖然很長時間以來一直有人在研究通用流感疫苗,但至今沒有一款疫苗真正獲得成功。有一款通用流感疫苗的多個版本正在進行臨床測試,但這款疫苗在不同病毒株導致的多個流感季中的療效不盡如人意,并未成功發(fā)揮效果?!?/p>
另外一個例子是HIV。
威瑟曼表示:“數(shù)十年來,我們一直在研究針對HIV等病原體的疫苗。幾十年前,有科學家曾經(jīng)認為:‘用不了幾年,我們就會有一款HIV疫苗。’但幾十年過去了,我們發(fā)現(xiàn)對這種病毒依舊不夠了解?!?/p>
威瑟曼稱,他更看好泛冠狀病毒疫苗的開發(fā)前景,“但我們從其他病原體那里已經(jīng)學會了保持謙遜?!?/p>
他說:“我們對人體免疫系統(tǒng)的了解,并沒有達到可以坐下來設(shè)計一款最佳疫苗的程度。”
哈佛醫(yī)學院的醫(yī)學教授、病毒學和疫苗研究中心(Center for Virology and Vaccine Research)的主任丹·巴魯什博士對《財富》雜志表示,開發(fā)一款可供大眾施打的通用冠狀病毒疫苗,需要額外研究、動物試驗和早期人體試驗,這些環(huán)節(jié)可能要花費多年時間。
巴魯什稱,“曲速行動”(Operation Warp Speed)制定了加快開發(fā)初始新冠疫苗的時間表,但通用冠狀病毒疫苗的研發(fā)過程并不在其中。
巴魯什說:“泛冠狀病毒疫苗向公眾開放施打可能還需要等待一段時間。我認為今年秋天在CVS還買不到這樣一款疫苗?!?/p>
前景光明,風險猶在
專家提醒稱,通用新冠疫苗什么時候上市或者能否上市?這個問題沒有確定答案。
布里格姆和婦女醫(yī)院的傳染病科主任、哈佛醫(yī)學院的醫(yī)學教授丹尼爾·庫里茨克斯博士表示,雖然一款泛冠狀病毒疫苗有望“幫助結(jié)束疫情”,至少能夠減少重癥和死亡,但它能否成功將取決于全世界是否有足夠的人接種疫苗。
否則,即使有通用冠狀病毒疫苗,病毒也可能學會免疫逃脫。
庫里茨克斯表示:“這種情況當然有可能發(fā)生?!?/p>
他補充道:“只要病毒繼續(xù)在大批人當中傳播,它就有機會持續(xù)適應(yīng)。如果一種變種病毒發(fā)生突變,可以逃脫泛冠狀病毒疫苗所產(chǎn)生的免疫反應(yīng),病毒就會向已經(jīng)接種疫苗的人群傳播,再次流行?!?/p>
雷伊表示,疫苗能夠?qū)崿F(xiàn)兩個目標:徹底阻止病毒傳播,或者像現(xiàn)有的新冠疫苗一樣阻止重癥的發(fā)生和對人體器官的破壞。
泛冠狀病毒疫苗有可能防止因所有新冠病毒變異株和亞變異株導致的重癥和對人體器官的破壞,理論上可以讓人們免于接種加強針。
但專家警告,就像現(xiàn)有的疫苗一樣,這樣一款疫苗可能依舊無法避免病毒傳播。
威瑟曼稱:“據(jù)我猜測,如果我們設(shè)計一款覆蓋范圍足夠?qū)挿旱囊呙纾覀兙蛯⒉坏貌辉诏熜Х矫孀龀鲆恍奚?。?/p>
雷伊警告稱,泛冠狀病毒疫苗概念可能過于美好,不可能實現(xiàn),但他還是希望有這樣一款疫苗“在防護力和持久性方面達成最佳平衡?!?/p>
他說:“讓我們輾轉(zhuǎn)反側(cè)的是,如果我們所做的工作無法控制病毒傳播,病毒就會繼續(xù)進化,并找出我們的防御漏洞。”
有一個潛在的缺口是可能令人失去行動能力的長期新冠。據(jù)聯(lián)邦官員表示,可能有多達2300萬曾經(jīng)感染新冠病毒的美國人,正在經(jīng)受這種病癥的折磨。
雷伊表示,研究顯示“即使感染新冠出現(xiàn)輕癥或中癥,也可能在心血管和精神健康方面產(chǎn)生長期影響。我們可能會發(fā)現(xiàn),雖然我們能夠阻止在感染后的前兩周出現(xiàn)重癥,但相對溫和的感染卻造成了日積月累的傷害?!保ㄘ敻恢形木W(wǎng))
譯者:劉進龍
審校:汪皓
First-generation vaccines were not the panacea hoped for in COVID-19’s early days. Nor did herd immunity swoop in and save the day.
Could a so-called “pan-coronavirus” vaccine be the long-awaited silver bullet that ends the COVID pandemic—and the next one, too?
Answer: It’s complicated.
“The term pan-coronavirus vaccine needs an asterisk next to it,” Dr. Stuart Ray, vice chair of medicine for data integrity and analytics at Johns Hopkins’ Department of Medicine, told Fortune.
Such a vaccine could tackle all coronaviruses, named for their crown-like appearance under a microscope. It could focus on COVID-19 and its myriad variants. And it could even tackle the four longstanding coronaviruses that circulate as common colds.
It could also protect against SARS (Severe Acute Respiratory Syndrome), a coronavirus that emerged in 2002 and killed hundreds, and MERS (Middle Eastern respiratory syndrome), another coronavirus that emerged in 2012 and killed hundreds.
Aside from the possibility of concluding the current coronavirus pandemic, it might even be able to squash the next as soon as it starts.
“Coronaviruses jump over to the human population,” said Dr. Duane Wesemann, a professor at Harvard Medical School and a principal investigator in the Division of Rheumatology, Immunology, and Allergy at Brigham and Women’s Hospital. He’s leading a team of researchers working on a pan-coronavirus vaccine with funding from the U.S. National Institutes of Health.
“I don’t know when [the next will]. Maybe not in our lifetime. But it will probably happen sometime. Is there a way to develop a vaccine that will be available for us in the setting of SARS-CoV-3?”
Whatever form such a vaccine might take, it’s a worthy goal, Dr. Bruce Walker—director of the Ragon Institute of MGH, MIT, and Harvard, a medical institute focused on eradicating disease, and co-leader of the Massachusetts Consortium on Pathogen Readiness—told Fortune.
But it may forever remain just that: a goal.
“I think we have to be aspirational in terms of aiming to make a pan-coronavirus vaccine, but it will not be an easy task,” Walker cautioned. “There’s not an obvious path forward.”
Work underway—and potentially years of work ahead
However pie-in-the-sky the goal may be, there’s no shortage of work being done to accomplish it. A universal coronavirus vaccine is a top research priority for nonprofits, government agencies, and vaccine-makers, according to an April article in Nature.
Among entities with a version in development: Moderna, Duke University, and myriad biotech companies.
Clinical trials are underway for attempts by the U.S. Army and CalTech, Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told Fortune.
Such a vaccine could indeed serve as a “silver bullet,” he said: “That would be the way you take this threat off the table—not just SARS-CoV-2, but all coronaviruses. And to knock off 30% of common colds would be a really good thing.”
But these things take time, he said. An apt illustration: the flu vaccine.
“We don’t yet have a universal flu vaccine though people have been working on that for some time,” he said. “There are some versions of a universal flu vaccine in clinical testing, but it’s not something that’s been deemed to have efficacy and hold up over multiple influenza seasons with multiple strains.”
Yet another: HIV.
“We’ve been working on vaccines for some pathogens like HIV for decades,” Wesemann said. “Some scientists several decades ago were thinking, ‘Gosh, it’s only going to be a few years until we have an HIV vaccination,’ but many decades later, we’re still figuring out we have more to learn about how to do this.”
Wesemann said he’s more optimistic about the development of a pan-coronavirus vaccine, “but we learned a lot of humility from other pathogens.”
“We don’t understand our immune system as much as we need to, to sit down and design the best vaccine.,” he said.
Making a universal coronavirus vaccine available to the general public will require additional research, animal studies, and early-phase human studies, all of which can take years, Dr. Dan Barouch—a professor of medicine at Harvard Medical School and the director of the Center for Virology and Vaccine Research—told Fortune.
And the process is not occurring on the accelerated Operation Warp Speed timeline the original COVID vaccines were on, Adalja noted.
“It will likely still be a while before a pan-coronavirus vaccine will be available to the general public,” Barouch said. “I don’t think anyone will be going this fall to get this at CVS.”
Promising, but not impervious
Even when—or if—a universal coronavirus vaccine is available, it likely won’t be bulletproof, experts caution.
While a pan-coronavirus vaccine has the potential to “help end the pandemic”—at least in the way of halting severe disease and death—its success would hinge on enough individuals around the world to get the jab, said Dr. Daniel Kuritzkes, chief of the Division of Infectious Diseases at Brighman and Women’s Hospital and professor of medicine at Harvard Medical School.
Otherwise, the virus could learn to evade even a universal COVID vaccine.
“That’s certainly a possibility,” Kuritzkes said.
“So long as the virus continues to circulate in a significant number of people, there’s an opportunity for continued adaptations of the virus,” he added. “Were there to be a variant that emerged that had acquired mutations that were able to evade immune response from the supposed pan-coronavirus vaccine, the virus could leap into the vaccinated population and emerge again.”
There are two goals vaccines can aspire to, Ray said: to prevent infection altogether, or to merely prevent severe disease and disruption, as current COVID vaccines do.
A pan-coronavirus vaccine might prevent severe disease and disruption from all variants and subvariants of COVID-19, theoretically eliminating the need for boosters.
But such a vaccine may still allow the spread of infection, as current vaccines do, experts warn.
“My guess is if we design a vaccine that’s meant to be as broad as possible, we’re going to have to give up some potency,” Wesemann said.
The pan-coronavirus vaccine concept may simply be too good to ever become reality, Ray cautioned—but he holds out hope that such a development could “hit that sweet spot of really being protective and durable.”
“One of the things that keeps us awake at night is if we do things that don’t control the spread, that it will continue to evolve and find a gap in our armor,” he said.
One potential gap: long COVID, a potentially disabling condition federal officials say could affect up to 23 million Americans who’ve survived infection.
Research shows that “even mild to moderate COVID can have long-term consequences for cardiovascular and mental health outcomes,” Ray said. “We might find we prevent the severe first couple of weeks of disease but see an accumulation of damage from relatively mild infections.”