By Richard Kessin

It takes gall to channel Churchill’s World War II phrase, especially when we could be looking forward to the beginning of the end. But let’s keep our attention on the development of SARS-CoV-2 vaccines. 

All of the vaccines are designed to present a SARS-CoV-2 Spike protein to the human immune system and provoke the production of circulating antibodies and T-cells that kill lung or other cells infected with the virus. After a vaccination or illness, the immune response subsides, but many antibody-producing B cells and cell-killing T cells are banked. When infection occurs, thousands or millions of lymphocytes leap into action and block or minimize the infection. With some vaccines the banked cells last a long time, with others, only a few months

The Spike protein is a string of about 400 amino acids in a unique order. During its synthesis, the protein folds into a spike shape and is assembled into the SARS-CoV-2. The tip of the spike protein grasps a protruding protein on the surface of human cells and the attached virus is pulled inside, where it unfolds and starts the production of much more virus. 

The genome sequence of the SARS-Cov-2 virus was deposited on a National Institute of Health server on January 10, 2020. Within days scientists all over the world used the sequence to make vaccines. Two vaccines are now approved for limited use; 8 vaccines are in large-scale phase-3 clinical trials; 13 are in expanded phase-2 safety trials; 21 are moving through phase-1 safety testing. More than 135 vaccines are at earlier stages of development. These numbers are being curated by The New York Times and were updated on Aug. 21. Search for the paper’s Coronavirus Vaccine Tracker; The Times will not fail to keep you updated. 

All clinical trials must register with an organization at the National Library of Medicine at the NIH. Anyone can find the list of clinical trials for a disease or condition at ClinicalTrials.gov. If you are interested in joining a SARS-Cov-2 clinical trial, you will find medical centers involved in the trials at ClinicalTrials.gov. Being a participant requires commitment because the people running a trial want to know if you produce antibody and new T-cells in response to a vaccination and how long it lasts, which means occasional blood tests. They want to know about side effects of inoculation. They are eager and are required to have participants of all ages and ethnicities. 

In the Northeast, there are few sites because there is a relatively low level of disease. If we want to test a vaccine, we have to go where disease rates are high—in the United States that means Texas, Alabama, Arizona, Missouri and California.

The vaccines in Phase-3 testing are all products of genetic manipulation. In one approach, scientists inserted the gene that carries the information for the Spike protein into an attenuated animal virus. The Oxford-AstraZeneca group uses a weakened chimpanzee adenovirus with an inserted Spike protein gene. They are testing in Arizona for phase 3. The Chinese have four vaccines completing phase 3 and starting general use. 

The method that is most intriguing to me is purely chemical. Recipients get no live or dead virus, which is reassuring for some people. The new method makes the messenger RNA in a test tube that provides instructions for the synthesis of Spike protein. The scientists wrap the coding mRNA in lipid and inject it into macaques or humans, where it enters cells and uses their protein synthesis capacity to make Spike protein. In macaques, the mRNA-1273 vaccine successfully defends the host from coronavirus. This novel vaccine is the product of Tony Fauci’s National Institute of Arthritis and Infectious Disease and a company called Moderna that specializes in RNA-based defenses against infectious disease. The vaccine is in phase-3 trials on 30,000 people. The study is recruiting volunteers; find it on ClinicalTrials.gov. Enter code identifier NCT04470427. 

These new techniques are effective and fast, but we have to know what virus may appear. They will not do us much good if we ignore pandemic preparedness plans, eliminate virus surveillance programs, leave the WHO, disparage the CDC and denigrate scientists and physicians who are trying to keep us alive.