Being framed like the space race:

Very clear on the current state of development of vaccines and possible treatments, @ New York Mag this evening, by James D. Walsh Q & A with this guy: As a clinician working on the Ebola outbreak on the border of Uganda and the Democratic Republic of Congo in 2018, Dr. Nahid Bhadelia was injected with an experimental vaccine which was going through an open-label trial, but had not yet been approved by the FDA. Intelligencer spoke to Dr. Bhadelia, who is the medical director of the Special Pathogens Unit at Boston University’s National Emerging Infectious Diseases Laboratories

[....]

What are you following closest right now in vaccine news? 
Last I checked, there were six vaccine candidates at phase-one trials. U.S.-based companies have two: Moderna is doing the RNA-based vaccine, and Inovio is doing the DNA-based vaccine. There are three now from China, including one that showed pretty good promise in animal models that I saw the results of at the end of last week. And there is one in Oxford, which uses a platform that reviews for other diseases called chimp adenoviruses. The lag time for figuring out if vaccines work or not is because you have to see their efficacy in animal models before you take them into healthy humans, which is phase one. The phase-two and phase-three trials are meant to show you efficacy, because you’re vaccinating a certain portion of the population and not vaccinating another portion — you’re letting natural infections happen. That gives you an idea of whether or not it’s safe in a larger group of people, because it’s bigger than the phase-one trials and it gives you a sense over time if they are at a greater or lesser risk than the control arm of this disease. That’s what takes time.

I think you’re going to see multiple vaccines move on to the next phase. That was the case with Ebola. In that case, an emergency vaccine was deployed before it was FDA approved. It was the middle of a crisis in the Democratic Republic of Congo and Uganda and elsewhere. I got that vaccine because I was volunteering on the border of Uganda and DRC. It was not FDA approved, but it had gone through a phase-three trial already in Guinea. As people talk about emergency deployment, I think you still need a certain amount of human data to feel comfortable deploying it in the emergency setting.

It looks as if Japan is considering deploying remdesivir before the U.S. has approved it. Could that provide the sort of human data that moves it closer to use in the U.S.? 
I think it’s worth going into what viral diseases generally do. Viral diseases are generally a one-two hit on your body. The first hit is basically the damage the virus itself does to the body. The second wreaks havoc on your immune system and activates your immune system in an uncontrolled fashion, in such a way that your own soldiers are attacking your body. The secondary damage of inflammation comes from that. You have to think about those two phases as you think about what might work in those scenarios. One presumes that most of the antivirals will work if you’re early enough in the disease — once you have the virus but its level is not very high.

I say this because we’ve had these conversations in the press about whether or not the remdesivir trial is going to be successful. There are signals now that say it’s not going to be successful in severely ill patients, but we still have to wait and see what the data is going to be for moderately ill patients. That’s going to be important data. And what will that mean for the U.S.? If we don’t have enough doses, it won’t matter; it’s a downstream problem.

Anything else you’re following closely this week? 
You might have seen there’s an interim French study that just came out on tocilizumab, which is a drug that’s used in autoimmune diseases, an IL-6 blocker — it calms down your immune system. It’s something that is going into trials. The French trial that just came out is a randomized-control trial that shows efficacy. I haven’t seen the data itself, but it was 65 patients in placebo and 65 patients in tocilizumab, and it showed improvement in people who got tocilizumab. We’re just starting a trial on it at Boston Medical Center, and other places have been doing trials on it as well.

The thing I’m really holding out for is a whole other class of drugs that I think will move forward: monoclonal antibodies. With Ebola, there was a four-armed study in DRC that compared an antiviral, which is remdesivir, against three monoclonal antibodies. With monoclonals, you look at a survivor’s body, you take their blood, you find those antibodies that are very good at blocking virus activity, and then you clone those antibodies and try them out in animals and humans. Monoclonal antibodies ended up being the most successful therapy in Ebola because they serve this function of blocking all viral activity earlier or later in disease.

On Thursday, there was a study from China that showed that they have identified two very effective monoclonal antibodies. It was just bloodwork. Nothing else has been done — it hasn’t been tested in animals, hasn’t been tested in humans. But Regeneron, a company that has been working on other things, is working on a model for those monoclonal antibodies, and there might be other companies that pick it up. I’m hoping that is the third kind of treatment, aside from convalescent plasma, that will provide some answers. We have a long way to go on that, though.

earlier in article talks about NYC herd immunity, contact tracing. (Though I have hit the paywall with them, I found that I could read the full article if I stopped the loading of the page in time before the popup notice.)