COVID-19 has already caused catastrophic consequences for social, economic and public health, with more than 107 million documented cases and 2.3 million deaths. Although this pandemic is far from over, we now have the tools to end it, with the largest and fastest worldwide deployment of vaccines. That we got here so quickly is remarkable, but we may not be so happy again. More virulent and deadly coronaviruses are waiting in the wings. The world therefore needs a universal vaccine against coronavirus.
The rate at which safe and effective COVID-19 vaccines are developed and made available is unprecedented, and it takes less than a year. However, if you are confronted with a more virulent strain with a higher mortality rate than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), even this rapid time span may not be enough to cause a death toll on the 1918 scale does not prevent flu pandemic, which has killed more than 50 million. In addition, there is a continuing risk that the virus will mutate in ways that make existing COVID-19 vaccines less effective – as we have already seen for the B.1.351 variant first identified in South Africa – or even ineffective.
As with flu, this is the case for a vaccine that protects all people against all forms of coronavirus. SARS-CoV-2 belongs to a diverse group of viruses of which there are thousands that can infect a wide range of animals, from bats and pangolins to pigs and mink. SARS-CoV-1, which originated in 2002, had a mortality rate of 10%; Coronavirus (MERS-CoV) in Middle Eastern respiratory syndrome was 34% lethal.
The potential is increasing for other coronaviruses to jump species and cause more pandemics. The reasons are many. The animals that are infected with the viruses are animals that people come into regular contact with. Modern agricultural practices, viral evolution and relentless human encroachment on the natural environment mean that there is an increasing risk of humans encountering previously isolated animal populations containing new strains with pandemic potential. As human migration, population growth, urbanization, rapid global travel, and climate change accelerate the spread, it has never been so easy for outbreaks to become epidemic and escalate into pandemics.
At the same time, the recent convergence of technological advances in biomedical, computer and engineering sciences ushered in a new era in the discovery of antigen and vaccine. High-performance supercomputers and machine learning, coupled with structural modeling, have the potential to greatly accelerate the identification of common antigenic targets shared by coronaviruses. Databases of genetic sequences of animal isolates of coronaviruses can be used to model the evolution of the viruses. Continuous efforts to decode the principles of immunity in older populations may improve the effectiveness of vaccines for those most vulnerable. Collectively, studies now suggest that the development of a universal coronavirus vaccine is scientifically feasible.
It must be a global effort. A roadmap is needed to set out the core scientific issues, as well as a framework for funding and sharing information, data and resources. Early on, it will be necessary to set up a global monitoring network for zoonotic coronaviruses, such as the World Health Organization’s Global Influenza Surveillance and Response System or the US Agency for International Development’s PREDICT program (which was repaid last year). In addition, a worldwide effort is needed to identify antibodies that specifically neutralize coronavirus specifically to facilitate cross-reactive coronavirus antigen discovery.
None of this can happen until all stakeholders across industry, academia and non-governmental organizations recognize it as a global public health priority. With COVID-19, much of the foundation has been laid. Waiting until this crisis passes can be a missed opportunity. It is estimated that the current pandemic worldwide costs between US $ 8 and 16 trillion, about 500 times more than would be necessary to prevent the next pandemic.
This is not to say that it will be easy, and a step-by-step approach from COVID-19 to pan-coronavirus to universal coronavirus vaccines may be needed. SARS-CoV-2 is rapidly adapting to humans, and other new coronaviruses are changing, recombining, and replicating in bats and other animal species, and this is the place to jump species in the future. If we choose to wait until the next coronavirus appears, it may be too late, as with COVID-19. Creating tools to prevent the next coronavirus pandemic is within our capabilities and should be considered a global health priority. We can invest now or pay significantly more later.