What If There's No Vaccine To Fight COVID-19?

No Vaccine

We are all hoping for a vaccine in 2021. But what do we do in the meantime? And more importantly, what if no vaccine emerges?

Humanity will have to live with the threat of coronavirus “for the foreseeable future” and adapt accordingly because there is no guarantee that a vaccine can be successfully developed, one of the world’s leading experts on the disease has warned.

The stark message was delivered by David Nabarro, professor of global health at Imperial College, London, and an envoy for the World Health Organisation on Covid-19, as the number of hospital deaths from the virus passed 250,000.

Hopes for a return to normal life after the coronavirus hinge on the development of a vaccine. But there’s no guarantee, experts say, that a fully effective COVID-19 vaccine is possible.

Remember Dengvaxia in the Philippines?

In a worse-case scenario, a phenomenon called “immune enhancement” can cause vaccines to make the symptoms of infections worse. Instead of preventing the virus from entering healthy cells, the antibodies actually help them to do so. In 2016, after some 800,000 Filipino schoolchildren were given a dengue-fever vaccine called Dengvaxia, officials realized that some of them had been put at increased risk of life-threatening complications. Investigators wound up looking into the deaths of some 600 children who’d taken part.

Back during the SARS outbreak, researchers were unable to test their SARS vaccine candidates for effectiveness in humans. To do so, they would have had to inoculate a population that was exposed to SARS, and the disease was effectively wiped out using public-health measures before that could happen.

Remember HIV… well that didn’t work

In 1984, the US Secretary of Health and Human Services announced that scientists had successfully identified the virus that later became known as HIV — and predicted that a preventative vaccine would be ready for testing in two years.

Nearly four decades and 32 million deaths later, the world is still waiting for an HIV vaccine.

For many years, a positive diagnosis was not only a death sentence; it ensured a person would spend their final months abandoned by their communities, while doctors debated in medical journals whether HIV patients were even worth saving.

In 1997, President Bill Clinton challenged the US to come up with a vaccine within a decade… that was fourteen years ago.

The difficulties in finding a vaccine began with the very nature of HIV/AIDS itself.

Outbreak Every Year

Treatments may be developed — but outbreaks of the disease could still occur each year, and the global death toll would continue to tick upwards.

It’s a path rarely publicly countenanced by politicians, who are speaking optimistically about human trials already underway to find a vaccine.

But the possibility is taken very seriously by many experts — because it’s happened before. Several times.

“There are some viruses that we still do not have vaccines against,” says Dr. David Nabarro.

“We can’t make an absolute assumption that a vaccine will appear at all, or if it does appear, whether it will pass all the tests of efficacy and safety.

“It’s absolutely essential that all societies everywhere get themselves into a position where they are able to defend against the coronavirus as a constant threat, and to be able to go about social life and economic activity with the virus in our midst,” Nabarro tells CNN.

Not Achievable

But even if a vaccine is developed, bringing it to fruition in any of those timeframes would be a feat never achieved before.

“We’ve never accelerated a vaccine in a year to 18 months,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, tells CNN.

“It doesn’t mean it’s impossible, but it will be quite a heroic achievement.

“We need plan A, and a plan B,” he says.

What’s Our Plan B?

We all hope the massive global effort to develop a vaccine or drug treatment for COVID-19 is successful. But many experts, including Ian Frazer, who developed Australia’s HPV vaccine, think it will not be easy or quick.

If an effective vaccine or drug doesn’t materialise, we will need a Plan B that uses only non-drug interventions.

That’s why we need high-quality research to find out which ones work and how to do them as effectively as possible.

To prepare for the future and Plan B, the case where a vaccine doesn’t arrive, we need to conduct randomised trials into non-drug interventions to prevent the spread of respiratory viruses.

The current pandemic is presenting us with a rare opportunity to rapidly conduct trials to answer many of the unknowns about this set of non-drug interventions.

Concentrating all our funding, efforts, and resources into vaccine and drug research may turn out to be a devastating and costly mistake in both healthcare and economic terms. The results will be felt not only in this pandemic, but also in future ones.

If the same fate befalls a COVID-19 vaccine, the virus could remain with us for many years. But the medical response to HIV/AIDS still provides a framework for living with a disease we can’t stamp out.

“In HIV, we’ve been able to make that a chronic disease with antivirals. We’ve done what we’ve always hoped to do with cancer,” Offit says. “It’s not the death sentence it was in the 1980s.”

The groundbreaking development of a daily preventative pill — pre-exposure prophylaxis, or PrEP — has since led to hundreds of thousands of people at risk of contracting HIV being protected from the disease.

A number of treatments are likewise being tested for COVID-19, as scientists hunt for a Plan B in parallel to the ongoing vaccine trials, but all of those trials are in very early stages.

How the world looks like without a vaccine?

If a vaccine can’t be produced, life will not remain as it is now. It just might not go back to normal quickly.

“The lockdown is not sustainable economically, and possibly not politically,” says Neal. “So we need other things to control it.”

That means that, as countries start to creep out of their paralyses, experts would push governments to implement an awkward new way of living and interacting to buy the world time in the months, years or decades until COVID-19 can be eliminated by a vaccine.

“It is absolutely essential to work on being COVID-ready,” Nabarro says.

What Can We Do Now?

There’s no guarantee a coronavirus vaccine will arrive, so we need research to understand the best ways to use facemasks, hand hygiene, and other interventions to control the spread of the disease.

We are being saved by non-drug interventions such as quarantine, social distancing, handwashing, and – for health-care workers – masks and other protective equipment.