By Sara Frueh

Anthony Fauci and other panelists explored the status of the pandemic, research underway, and the key role of vaccines in bringing the pandemic to an end

Scientists and medical researchers around the world have mobilized to help solve the international COVID-19 crisis — by working to understand the novel virus causing this disease, test therapies, and develop vaccines. Their efforts were explored in an online panel discussion Saturday during the annual meeting of the National Academy of Sciences, as was the status of the pandemic, national and international responses to it, and lessons learned so far.

Only about 120 days have passed since the world learned of the emergence of this new virus, which has now affected essentially every country on Earth, said Jeremy Farrar, director of the Wellcome Trust.

To date, there have been roughly 3 million reported cases of COVID-19 around the world and about 200,000 deaths, including over 50,000 in the U.S. and over 20,000 in the U.K. — “horrendous numbers for something that we didn’t even know about three months ago,” said Farrar, who added that the true numbers are going to be much higher given the existence of undetected cases.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, offered an update on the pandemic in the U.S., where the number of reported COVID-19 cases is nearing 1 million. A number of cities have peaked, while others have not yet peaked, he said. “This is such a large country, and the dynamics of the outbreak differ from state to state, from region to region, and even from city to city.”

The nation got off to a difficult start with regard to testing for the virus, but the situation is much better today and is improving week by week, Fauci said. “Right now we’re doing about 1.5 to 2 million [tests] per week,” he added later. “We probably should get up to twice that as we get into the next several weeks, and I think we will.”

Fauci noted that a range of drugs are being explored as treatment options, some of which are now being tested in clinical trials. “The only way that you’re going to get an answer that is not just perpetual ambiguity is by doing a randomized controlled trial.”

He also pointed to the value of steps taken to slow the spread of the disease. “Mitigation that we did by essentially shutting down the country…was the reason why we’re turning the corner.” A member of the White House Coronavirus Task Force, Fauci described its program to guide states in slowly and carefully reducing the mitigation practices, step-by-step, over three phases. “Any attempt to leapfrog over these almost certainly will result in a rebound, and then we could set ourselves back,” he warned.

An overview of China’s response to the virus was offered by panelist George Gao, director-general of the Chinese Center for Disease Control and Prevention. China developed a plan that categorized different regions of the country into low-risk, medium-risk, and high-risk areas, and that allowed response protocols to be readjusted over time. “Early and active case detection is very important, especially at the community level,” he said. Asked whether China is expecting a second wave, Gao said they would have to wait and see, later noting prevention strategies the country is taking as it resumes business and social activity. “We’ve got to ‘dance’ with the virus, there’s no choice,” he said.

In providing an overview of the virus’s biology, microbiologist Susan Weiss from the University of Pennsylvania explained that the genome of the virus — and the way it replicates in the body — is very similar to the virus that caused SARS. She identified points in the virus’s life cycle that might be good targets for antiviral therapies, such as when it enters the cell and during the translation of the virus’s proteins.

Sanjay Gupta, chief medical correspondent for CNN, offered lessons from his experience reporting on COVID-19 — first among them the need for humility in speaking about the virus, given the many remaining unknowns. Gupta also cautioned scientists to remember not to use words like “cases” too often as they speak about the disease, keeping in the mind the real people affected by it. “It starts to sound like an amalgamation of numbers rather than real lives,” he said.

The Key Role of Vaccines

The only way to ultimately stop the virus from spreading and to prevent its future resurgence is with a vaccine, said National Academy of Medicine President and panel moderator Victor Dzau, an assessment echoed by multiple other panelists.

Richard Hatchett of the Coalition for Epidemic Preparedness Innovations (CEPI) offered an overview of global vaccine development. As of today, CEPI has confirmed the existence of 107 active programs to develop COVID-19 vaccines around the globe. Currently, one vaccine has been approved for Phase 2 clinical trials in China, a number of vaccines are in Phase 1 clinical trials, and many others are speeding toward Phase 1 trials, he said.

CEPI has evaluated a little under half of the known vaccine candidates and announced a portfolio of eight — soon to be 10 — candidates that it will support, choosing them based on three criteria: the speed with which the vaccine can be developed, the ability to scale to meet global needs, and the ability to ensure broad access. “We want to make sure that the world has access to those vaccines, and that access to vaccines is not just concentrated in a few nations,” said Hatchett.

One way CEPI is speeding readiness is by scaling up manufacturing and beginning to build inventory of vaccines even as they wait for data on whether the vaccines work — which means that they will build inventory of some vaccines that data subsequently show are ineffective. “That will increase the cost of the program, but if we want to deliver vaccine at scale within our stipulated target of 12-18 months from initiation of the program, we’re going to have to be comfortable with those risks.”

Fauci seconded the importance of pursuing many vaccine candidates. “You need more shots on goal for a chance of getting a safe and effective vaccine,” he said. As NIH develops its vaccine, which is in Phase 1 clinical trials, it is also directly or indirectly supporting — mostly through access to its global network of clinical trial programs — a number of pharmaceutical companies that are working on vaccines, he added. “What we really do want is multiple successful vaccines,” he said.

At a scientific level, these various initiatives — whether work happening in China or at NIH — are all linked, and that’s crucial, said Farrar. The critical element is not where the best treatment or vaccine comes from, but whether we share them when they are available and commit to making the manufacturing work, he said. “That’s at the heart of the scientific endeavor…. As scientists, we do need to commit to that. We do live in a tense world, and we live in a slightly polarized world, and our job as scientists is to bring people together.”

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