Tackling the Covid-19 pandemic, a scientist’s opinion
We speak with Professor Giovanni Rezza, MD, Director of the Department of Infectious Diseases at the Istituto Superiore di Sanità, Roma, Italy about the EU’s announcement of funding for research to tackle Covid-19, and current efforts to develop vaccines and antiviral drugs.
How prepared was the EU for the Covid-19 pandemic?
It seems that we were not prepared at all. There has not been a unique response to the outbreak and now pandemic. We diagnosed the first case of the virus in Italy on the 21st January, before flights from Wuhan were blocked. The patient had already been sick for one week and we reckon that the virus had already been circulating for around month. Because the Covid-19 infections were taking place at the peak of the influenza season, they were difficult to diagnose. At first, to contain the epidemic, we identified the towns and villages with high incidence rates and designated them as red zones. But as the infection expanded to nearby areas, the government decided to implement social distancing at a national level.
Despite the health crisis in Lombardy, one of the wealthiest and best organised regions of Europe, the other EU countries didn’t really react or offer much support. This was very sad, now they all seem to be implementing different measures. It is only in the last few days that they have started to apply similar social distancing measures and reducing the movement of people. The EU should be offering more support to countries that are being hit and be more active at implementing consistent policies around Europe to maintain trust between countries.
How long do you think it will take to find an effective vaccine or antiviral?
The NIH has started human trials with an mRNA vaccine and the Chinese are also starting human trials with a candidate vaccine. Here, near Rome there is a company producing simian adenovirus vectors that express a surface protein of Covid-19 (Spike, provided by the Jenner Institute in Oxford, UK). They expect to start human trials at the beginning of the summer. Other big companies are also exploring the use of adenovirus that express Covid-19 surface proteins and are set to start trials even sooner.
However, it will take months to go through the safety (Phase I) trials and at least a year to complete Phase II / III trials, depending on what the regulatory agents accept, to test efficacy.
I think that research into antiviral drugs is likely to yield good results in a shorter period of time. We could learn something from the experience in China. We know that some randomised controlled trials with drug products were carried out and we are eagerly awaiting to hear the results.
At the hospital Lazzaro Spallanzani in Rome we are testing some drugs that have already been used against HIV and Ebola, as well as anti-inflammatory monoclonal antibodies against interleukin 6, that have been used successfully in the treatment of rheumatoid arthritis. We have seen some encouraging results in patients that are in sub-intensive treatment. We are still collecting evidence of the efficacy of these drugs.
Several groups in Europe are focussing their efforts on producing genetically engineered monoclonal antibodies against Covid-19. This is a worthwhile strategy as they are fast to produce if they prove to be effective.
The EU should not just be funding efforts to test these new products as soon as possible, but also, looking at ways to accelerate approval. We need these products; the current social distancing measures to contain the virus can be applied for one, maybe two months, but it is difficult to sustain them indefinitely.
What measures can be taken to ensure equitable access to antivirals and vaccines?
Joint procurement could be one way, and, of course, scaling up production will be necessary to ensure that there are enough doses for everyone. This will not be easy. It is an exceptional time, so state production of vaccines might need to be considered.
Given the natural origin of Covid-19, is there anything we can do to prevent future similar outbreaks?
I am not too worried about this now. I am concerned about fighting the current pandemic. The species passage has already occurred and it is the sustained human to human transmission that we need to stop.
It is not the first time that we have faced this problem of trans-species passage, especially for respiratory infections. This has occurred in China before, with SARS in 2002 and avian influenza H5N1, though fortunately it wasn’t efficiently transmitted from human to human.
We need to deal with the problem of wet markets in China and the Far East and I hope that this is something that the WHO will take it into consideration, and that everyone will take measures to avoid the occurrence of future events like this.