“Can you patent the sun?” Scientist Jonas Salk reacted like this in an interview when asked who would reap the benefits of marketing the polio vaccine, which he had just discovered. “He saw it as a natural advance of science and its result must belong to the people,” his son recalled in a documentary years later. A reasoning that today sounds like a Martian when a race between countries and companies is taking place to get the covid-19 vaccine. Salk became something of a rock star when he presented the remedy for the most feared illness at the time. A mysterious ailment that paralyzed each year or killed thousands of people.
In all this time, that formula is the one that has almost annihilated the disease. In 2018, 33 cases were registered worldwide. The last step to eradication, a milestone that humanity has only achieved with smallpox, is resisting. Raúl Andino, an Argentine who emigrated to the United States in the 1980s, is at the forefront of the team that has given birth to the first polio vaccine in 60 years. It is called nOPV2 and represents a new weapon to try to crush this virus once and for all.
What has happened between Salk and Andino? As progress was slow, the World Health Organization created in 1988 a special program to eradicate this disease. Today it is still the ailment to which the highest percentage of its budget dedicates the entity. Ongoing immunization campaigns have reduced cases by 99% in the past 30 years, but there are still four countries where transmission has not been completely eliminated: Afghanistan, Pakistan, Nigeria and India. Some territories in Southeast Asia also have sporadic cases.
“It is the silent disease, in 80 or 90% of cases it does not cause symptoms, but it is transmitted very quickly,” Andino said by videoconference. Its ease of contagion and the fact that it is often kept hidden is one of its similarities with covid-19. “The current vaccine protects against the disease, but even so an immunized subject can transmit it to one who is not”, Andino explains. Here is the problem: within a vaccinated person, the virus mutates and becomes more robust and penetrates the new host, which has not received immunization, with more ferocity. This is what has happened in Africa, where a new type of polio has been developed over the years. “What we have done is introduce changes in the virus genome to prevent it from mutating,” says the researcher.
The team that has investigated this new vaccine. Loaned by Raúl Andino.
“This is a breakthrough in the global fight against the disease,” says Akhil Iyer, senior health adviser for UNICEF, bluntly. “Until now, clinical trials have shown that the new vaccine provides protection against the mutated polio virus and is also more genetically stable compared to the one currently in use,” he adds. The first clinical trial was carried out in Belgium in a group of 150 adult patients. The results were positive. In April, a second phase was carried out in Panama, in more than 900 children from a few months to five years. “Now we are analyzing the results, but it went wonderfully well, the transmission chain is broken,” summarizes Andino.
It took seven years for researchers to come up with this result, the same time it took Salk to get his discovery. There is optimism. “We hope that this finding will help overcome some of the final obstacles to eradication; it will add to the tools that already exist ”, explains Ananda Bandyopadhyay, researcher at the Bill and Melinda Gates Foundation and co-author of the study. The money from this entity is what has allowed the development of this new formula. Eradicating polio has become almost an obsession for the Gates.
The mutation would never have occurred if the vaccine had reached everyone equally. To understand where there are gaps in immunization processes, one must step on the ground where the virus continues to wreak havoc. Militias like Boko Haram, which operates Nigeria, or extremist religious groups in Afghanistan or Pakistan, see a threat throughout the west. This includes medicine. That is why they prevent prophylaxis from reaching broad layers of the population and fill their heads with hoaxes as the immunization will leave them sterile. “Health workers travel from house to house during campaigns,” explains Iyer of UNICEF. “Many of them live in remote, fragile and conflict-affected areas, making it very difficult to reach them. Massive migrant and refugee populations, challenging geographic terrain, and vaccine disinformation are other key obstacles,” he adds. the expert. The teams are exposed to great risks and have even been killed.
Raúl Andino, when he was taking his first steps in the fight against polio. Loaned by Raúl Andino
Not to mention the situation caused by the coronavirus pandemic, which causes the population to fear leaving their homes, cut supply chains or prohibit the movement of health workers. Gavi, the international alliance tasked with ensuring the provision of vaccines in the most vulnerable settings, said last week that campaigns against measles and polio are being hit hardest. 38 countries have suspended distribution in the case of the second, a situation that harms at least 24 million people. “We do not know what the effects of three or four months without campaigns may be,” Andino acknowledges.
The next step is manufacturing and distribution, almost as tricky as the research itself. “The manufacturer BioFarma has just submitted the available data from clinical trials to regulatory authorities. Right now, the probability of deploying it under an emergency procedure planned by the WHO is being studied. Preparations are already underway to ensure that the proper doses are ready to be implemented immediately if permits are obtained, ”Bandyopadhyay details.
Then work with the communities will come, as Iyer explains: “The introduction of any new vaccine to the population is not an easy process, from identifying the most suitable countries, reaching consensus among local politicians, to working with people to generate trust and acceptance. “
Andino came to Boston in 1986 to work alongside Nobel Prize winner David Baltimore. It was in that laboratory that his long-standing relationship with polio began. “It was like Al Pacino in El Padrino: every time I wanted to get out, they would put me back in,” he jokes. Now, like almost everyone in science, he has slowed down everything he was doing before covid-19 and has been involved in researching the new virus. “I just hope that this coronavirus does not also become a disease of the poor.”
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