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  • NATURE PODCAST

Coronapod: An untapped resource

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 news.

In this episode:

02:07 A drive to diagnose

Many research labs are pivoting from their normal work to offer diagnostic testing for COVID-19. We discuss how to go about retooling a lab, the hurdles researchers are facing and why, in some cases, tests are not being taken up.

News: Thousands of coronavirus tests are going unused in US labs

14:18 Masking the issue?

There has been conflicting advice on whether people should wear masks to protect themselves during the pandemic. We look at some of the take home messages from the debate.

Research article: Leung et al.

News: Is the coronavirus airborne? Experts can’t agree

18:36 One good thing this week

Our hosts pick out things they’ve seen that have made them smile in the last 7 days, including a local superhero, and a caring choir who have release their first song.

Reuters: Spider-Man to the rescue! Superhero jogger cheers kids in England

Video: The Isolation Choir sing Wild Mountain Thyme

22:08 Accelerating vaccine development

Around the world, research groups are rushing to create a vaccine against the coronavirus. We hear about one group’s effort, and how vaccine development is being sped up, without sacrificing safety steps.

News: If a coronavirus vaccine arrives, can the world make enough?

Never miss an episode: Subscribe to the Nature Podcast on Apple Podcasts, Google Podcasts, Spotify or your favourite podcast app. Head here for the Nature Podcast RSS feed.

doi: https://doi.org/10.1038/d41586-020-01094-1

Transcript

Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the latest COVID-19 news.

Benjamin Thompson

Welcome to Coronapod.

Noah Baker

In this show, we’re going to bring you Nature’s take on the latest COVID-19 developments.

Benjamin Thompson

And we’ll be speaking to experts around the world about research during the pandemic.

Amy Maxmen

I really don’t know how this plays out. We also don’t know a ton about this virus, so there’s so many open questions. I just have a really hard time making predictions because I don’t know how the outbreak is going to change.

Benjamin Thompson

Hi, I’m Benjamin Thompson. Welcome to episode four of Coronapod. I’m still here in my south London basement. I’ve actually moved the recording studio slightly so I can see a different wall, so a whole new outlook on the world for me, but I’m joined once again by Noah Baker and Amy Maxmen. Noah, how are you doing today?

Noah Baker

Yeah, not too bad. Still in my booth, still recording Coronapod. Pleased to be doing it again.

Benjamin Thompson

And Amy, how’s California?

Amy Maxmen

I’m personally okay. I’m personally doing fine. But what’s happening in the US is extremely upsetting. So, it’s 430,000 cases and, of course, that’s just the one’s confirmed so there’s surely more, and almost 15,000 deaths. With all of the resources that we have in this country, there’s still sort of a lack of a strategy. We’re still not getting on top of this.

Noah Baker

We mentioned at one point in the past that 3.5 million diagnostic tests have supposedly been ordered by the UK, these antibody tests. We’ve recently found out that none of those tests were deemed appropriate so none of them are going to be used. The government is now looking for ways to get their money back.

Amy Maxmen

No, I hope they just donate them to other countries that will need help.

Noah Baker

It seems to me that what the government did was panic bought tests in the way that people have been panic buying toilet paper.

Benjamin Thompson

But in this case, 3.5 million of them.

Amy Maxmen

Yeah, I agree. I mean that’s so nuts. I guess we have a scientific background and we talk to scientists and that’s just sort of like not how they would have gone about it. Just talking to the scientists this week who are like, ‘Yeah, we vet the tests. We go through them.’

Noah Baker

One thing that we’ve been thinking about a lot this week is something that we’ve discussed quite a lot which is how scientific labs could help with the testing effort, which is something that we know is really vitally needed in the States and in the UK, particularly at the moment.

Amy Maxmen

Yeah, so researchers saw this need for testing and they understand that kind of the basic technique goes back to something called PCR, which is identifying genetic sequences. It’s been used for ages, well, okay, maybe a couple of decades, and a lot them have the capability to do this in their lab. The US Food and Drug Administration that looks over diagnostic tests as well as drugs said it’s okay for academic labs to ramp up testing, however they need to make it through these regulatory checks to make sure that they have high standards of quality, which makes sense. You don’t want to give someone the wrong result – that could be life or death. That’s when kind of our top academic labs, especially, really started running towards this, and we’re talking thousands of dollars, getting hundreds of volunteers, and then they went through the different regulations they needed to get through, and it’s not simple. It entailed becoming very creative. Like for example, the Chan Zuckerberg Biohub in San Francisco realised that they could partner with the University of California, San Francisco and kind of extend the certification for clinical testing to them. So, there’s all sorts of things they did to get around this. The sheer administrative burden of having to… let me pause for one second because this chihuahua has crawled on to my desk and is making noises.

Benjamin Thompson

Laughs

Noah Baker

Is that your chihuahua or has It just arrived?

Amy Maxmen

A friend loaned it to me.

Noah Baker

An isolation companion.

Benjamin Thompson

Laughs

Amy Maxmen

Laughs. Yes. Okay, so let me get to sort of where I’m going with this. So, I’ve been talking to these labs about all of the things that they’re doing, but the one that really got under my skin is this. So, now that these big institutes – and I should say, I’m talking to about seven or eight of them and this includes like the Broad Institute of MIT and Harvard and the Innovative Genomics Institute that Jennifer Doudna leads at UC Berkeley, so the top places – they go through all of this, they have a diagnostic that the FDA says it’s okay to use, they do all of this, and then they found that when they approach hospitals that are waiting three to seven days for results, ‘Hey, we have tests for you.’ In some cases, they even say ‘we have free tests because we have philanthropic backing’. The hospitals are actually turning them down, and that is a shock.

Benjamin Thompson

That must be so frustrating for the researchers involved.

Amy Maxmen

So frustrating for the researchers, so frustrating even on my end as I watch my own country desperate for testing. I’ve talked to nurses, I talked to the Nurses Union for this story, and they’re really upset because nurses are being told that they can’t be tested even when they’ve had high exposure to people with COVID without proper protective gear. Of course, they want to have a test both so they can protect their own family, they want to protect themselves, and they want to make sure that if the next person they see is a patient undergoing chemotherapy, that they’re not going to spread the virus to them. But even they can’t get tested.

Noah Baker

And they’re saying no not because the staff, as you’ve said, don’t want the tests or because a test might not be useful, but because there are kind of hurdles in the way that are linked to the way that the healthcare system in the US is set up.

Amy Maxmen

So, the system is that hospitals use electronic health records and each one kind of uses their own piece of software to keep these. So, one thing is, if you want to work with them, you have to be using their software platform, and if these new labs aren’t already using that piece of software, then they say they can’t connect with them. They’re not really willing to work with you.

Benjamin Thompson

So, trying to fit a round peg into a square hole there, maybe?

Amy Maxmen

Yeah, but obviously at a time when this is an emergency, the idea that a piece of software is the problem can be kind of mind-boggling. And just to say that some people have overcome this. So, in some cases, like, say, at UC Berkeley, the student health centre allowed graduate students who study computer science to write some kind of code so that the results from the lab can speak to the software the clinic uses, and the same thing happened at Boston University Medical Center. So, it’s a bottleneck that we could overcome but it takes kind of a hospital that’s willing to do that, and there’s kind of another thing that some researchers brought up that also is kind of in the realm of hospital administration. Some hospitals are saying that they already have contracts with existing commercial diagnostic providers. So, if the hospital is already working, say, a bit one in the US is called LabCorp, another one is called Quest Diagnostics, they have a contract with them, and so they say they can’t go ahead and use someone else because they already have a contract, or it just takes a very long time to take a new diagnostics provider in their system. So, that’s why they’re saying no, and that would almost be fine except for, in the US, we know that the big diagnostic providers such as Quest and LabCorp are way overloaded, so there’s been reports of it taking three to five to seven days to get results back.

Noah Baker

Is there a solution to this? If someone just made a decision at the right level of power, could this be solved?

Amy Maxmen

I think there is a solution, but the solution is we really, desperately need national leadership here. We need to have kind of a taskforce, say, that’s in charge of testing in the US, a body that would give hospitals the leeway to say in this state of emergency, for COVID-19 testing, these are the things you can do. You can work with labs outside of your electronic health records or you can break a contract if that’s required, in this particular emergency situation.

Noah Baker

How big is this chunk of resource that potentially could come from these independent labs? Are we talking doubling the testing capacity if they found a way to work with hospitals, or is this a little addition? What’s the kind of possibilities if these kind of kinks can be worked out?

Amy Maxmen

It’s a great question. So, I don’t have a simple answer for you because there’s more labs coming online and I don’t have a calculation about all of that, but just to give you a sense, the labs I’m talking to, like for example, the Broad Institute, has the capacity to test 2,000 tests a day. Right now, they said they’re working at like half of that, and I talked to a number of other places that are somewhere around the same ball park of 1,000 tests a day. A lot of them are saying that they have this capacity but because they don’t have the samples, they’re working at half of that. So, I don’t have an exact number, but I think it’s clear that they’re quite powerful and it could really assist the response.

Benjamin Thompson

We’ve been talking maybe in sort of abstract about what’s going on here, but what about some of the specifics of actually how you go about doing it because that’s something that I don’t really know much about. Say, it’s not just about PCR, right? It is quite a complex setup. Could you maybe give us or maybe give our listeners just an idea of some of the steps you need to go through to do something like this, right?

Noah Baker

Yeah, I’ve been talking to some labs here in the UK – in particular, the Francis Crick Institute – and I called up a researcher there called Charles Swanton to talk to him about what they’ve been doing and he actually took me through the pipeline to sort of say what was actually required to do a test. In fact, I think we actually have a quote from him.

Charles Swanton

You’ve got an occupational health clinic which swabs medical staff. They’re collected by a courier twice a day. They’re taken up in an isolated coronavirus-specific lift up to the sample reception, which is on the same floor as the category 3 laboratories. There, lightest buffer is added. At that stage, the virus is inactivated and the samples get transferred to the RNA extraction step where they get subjected to the Biomek FX robot and then transferred to the qPCR laboratory. The qPCR machines – we’ve got ten of them running in parallel – and reported through with the CT curves to the online clinician scientists who report back within an hour or two of the assay having been run as to whether the sample is positive, negative or indeterminate, and they then get reported directly back through mobile phones to doctors, medical staff to tell the doctor or nurse to stay at home if they’re infected or to go back to work if they’re not.

Noah Baker

I think it occurred to me when I was listening to this that, similarly to the labs that you’ve been talking to, Amy, the Crick has organised its testing capacity from the bottom up. This is not being centrally controlled. They’ve formed these relationships with motorcycle couriers and healthcare workers and diagnostics labs, and they’re also having to adapt to their reporting systems. This really is a multidisciplinary and quite multi-faceted thing that’s needed here. It’s not a case of just turn on the right PCR machine.

Amy Maxmen

Yes, that is exactly true. I think as shorthand I’ll say, based on PCR, but you’re right. As you heard at what he’s saying, of course, there’s a lot more to it.

Noah Baker

I also put to him the global problem of reagents running out, which is something that we’ve talked about before. He said that that was something that they’ve been thinking about for a long time, so they’re trying to design whole new RNA extraction kits. This is one of their approaches, and I wonder whether or not there are approaches that you’re seeing to try to get around the potential global shortages of reagents.

Amy Maxmen

Yeah, that’s definitely something that everybody is sort of aware of. One lab I talked to specifically chose the test they did because they could be promised some certain set number of supplies from the manufacturing company. The other thing that I’ve heard about is there’s this giant Slack group, I counted at least like 600 people in it – I didn’t count it, Slack told me – where there’s different channels and one of the channels is supplies, and that’s where researchers from around the world are talking about different workarounds that they are not only just coming up with but also just validating so that they can show that this is really a consistent way to do things. So, sure, if the RNA extraction kit from one provider is short, can you use it from somewhere else?

Noah Baker

And that was one thing that Charles also said to me, was even if you’re a lab that doesn’t have all of what you might need to achieve this, he pointed out that his facility is lucky that they have BSL-3 labs, they have qPCR machines, they have an existing reporting system that they use for a cancer study that they’ve been able to adapt. If you don’t have all those things then there are still partnerships. You can still partner with other labs that can do things that you can’t, and it’s a way forward that he was sort of suggesting because going it alone is quite tricky for a lab right now.

Amy Maxmen

One other note that one of the researchers I spoke with, George Murphy at Boston University Medical Center, something that occurs to him as he’s leading his lab is the people who are working with him. They’re a stem cell biology lab, so they’re used to doing kind of fundamental basic research, and one thing that he’s worried about is that he has graduate students and postdocs just throwing themselves at this, but what he worries about is that there’s a lot of emotions involved, sort of the way he put it. They’re not doing fundamental research anymore. They realise that these are real people. When they have a positive, there’s a real person behind that. They know that this is a pregnant woman who came into the hospital or something, so there’s also kind of a lot of weight on their shoulders. What if there is an inaccurate result, and that’s sort of a really heavy reality that unlike medical residents, people who train to be doctors who have learned to sort of detach themselves a little bit, they really don’t have that background. This is totally new to them to sort of be working on the front lines of a thing.

Noah Baker

I think that’s something that’s becoming more and more prominent to a lot of researchers. There’s also been discussion about the research about the spread of the disease in aerosols, for example, and that suddenly seems to be directly informing government policy, and people are saying people will or will not die if this is not taken up straight away. That link between fundamental research and policy is very, very close right now in a way that it hasn’t been in the past.

Amy Maxmen

Yeah.

Noah Baker

So, one thing that has been talked a lot about over the last, well, I guess, month, really, but especially in the last couple of weeks is masks – whether or not people should or shouldn’t be wearing masks. Now, I know there have been differing opinions coming out from research about whether or not the virus can be transmitted in the air, whether or not it can be transmitted in these aerosol particles smaller than 5 microns wide particles which can be breathed out or released when speaking, I’m kind of interested to hear your take because there’s been a bit of a bitter disagreement between researchers and between countries who are giving different advice about whether or not people should or shouldn’t be wearing masks when they travel out.

Amy Maxmen

Yeah, so my take, I think maybe one thing that has shifted is there was this idea, and this has been around for a long time, for weeks, people have said, ‘Okay, the masks aren’t going to really help you from getting infected, but they will stop you from transmitting if you have symptoms.’ Now, it was a little bit clear before and now it’s become really clear that people transmit COVID-19 before they’re symptomatic and also it seems like there’s some amount of people who transmit even when they have no symptoms, so they have an infection but they don’t have symptoms, so in that case, a mask is really going to prevent those people from transmitting it to others. Right now, the CDC is saying you can wear a face mask. They’re advising that people make their own masks at home using heavy fabric. That’s because the reality of the situation is there is a shortage of face masks for healthcare workers and they should be the number one people that we need to protect, and also people hoard masks. So, they say if you can kind of sew your own face mask then that works too.

Benjamin Thompson

A lot of attention is, at the moment, on this Nature Medicine paper that came out not so long ago which has looked at people in Hong Kong, and that showed that maybe in some cases, masks actually do some good, right? So, there’s a lot of messages flying around and I think a lot of confusion.

Noah Baker

In the UK, there was certainly discussion early on that said that wearing a mask could increase your risk because of people’s behaviour. So, people were doing things like putting a mask on, they were going outside, they’re wondering around, then they were taking their masks off with their hands but without washing their hands afterwards and touching the outside of their mask and then risking spreading whatever they’ve kind of captured on what essentially has become a net at that point into their mouths or onto their faces or wherever it’s been.

Amy Maxmen

Yeah, I mean I guess the way that I look at it is this, my feeling is generally risks and benefits to a thing. So, okay, what’s the risk? The risk would be if people wear masks and then stop doing the things like social distancing. So, if I’m hanging out with my friends and we all have bandanas on our faces, that’s cute, but that could be a real problem. Are people going to do that? I actually don’t know, so maybe that’s not even a real risk. Then the benefit, so let’s say one is the benefit that you slow transmission. I think another benefit that I think about is kind of the psychological one. There was this great piece I read in the New Yorker that was written by somebody who was under lockdown in China. He talked about how a lot of people didn’t really wear their face masks well. He talked about how people would kind of loop it under their chin or hang it from one ear. However, he did say that there was a psychological impact, like just by everybody wearing masks and some people having on gloves and booties, he put it as something like, ‘It makes you just want to go within yourself.’ People just sort of stopped socialising so much. It keeps it on your mind that this is happening.

Benjamin Thompson

So, I can speak to that personally, actually. Yeah, I went to the supermarket this weekend and thankfully, they did have food there, but there were maybe, I don’t know, a good percentage of people wearing masks of different sorts, but so many of them were wearing them under the chin, and it was kind of maddening to me for a bit, and then I’m like well actually, are these doing anything anyway and I think it maybe comes back slightly to Noah’s point about people still don’t know yet quite necessarily definitively how this virus is transmitted. It seems like droplets coughing on a surface seems to be super important, but whether it’s aerosolised as well, so it just muddies the waters even more for me.

Amy Maxmen

I guess to me the bottom line is I don’t know if our outbreak is going to pivot on this. I certainly know that health workers and essential workers like those at grocery stores, I really want to see them wearing masks. As far as I have friends that go on bike rides wearing masks, I guess I don’t know if it’s going to be pivotal, I think is my point. I think if people want to wear them, that’s great. Maybe it will slow pre-symptomatic and asymptomatic spread, but I don’t think this is what’s going to really solve our outbreak.

Benjamin Thompson

This time last week, Noah and Amy, we sort of highlighted to the listeners the one thing that stood out to us that we’ve kind of enjoyed, and it’s a very difficult time for a lot of people, but the sort of thing that maybe stood out to us as a little ray of sunshine, and I thought we should do that again this week. And I’m happy to go first, this time, if you don’t mind.

Noah Baker

Please do.

Benjamin Thompson

And the thing that really has brought a smile to my face this week, maybe it’s slightly old but it’s the first time I’ve heard it, so it’s new to me, is the Stockport Spiderman. Now, for people who aren’t from the UK, Stockport is a town in the north of the country, and it’s this gentleman who it turns out is a martial arts teacher who has been going out on his kind of one exercise run a day but dressed as Spiderman, and he runs past the houses and kids rush to the house in their little Spiderman pyjamas and wave at him and he does some flips and some high kicks and that kind of thing, and he just brings a smile to their face, and apparently there’s a Wonder Woman now and an Iron Man and all sorts of people just running around trying to bring a little bit of joy to the kids who are stuck at home.

Amy Maxmen

I love it.

Benjamin Thompson

Noah, what about you? What’s brought a smile to your face this week?

Noah Baker

So, again, it’s a bit of a personal one. I have a friend who teaches community choirs that he’s not been able to run. He’s been quite concerned about that. People that are usually in his choirs are already quite isolated and now they’re even more isolated, and so he decided to start up an isolation choir where he got people to record parts of the song and send it in and he’s put it together and it was published today and it makes me cry every time I listen to it. It’s just marvellous. 57 people and multiple instruments all singing a Gaelic tune, including my mum.

Amy Maxmen

That’s great. I hope we can listen to this.

Noah Baker

Absolutely.

Benjamin Thompson

I’ll put up links again in the show notes just like I did last week to all of those stories. Well, there we have it for another week. My goodness, a lot has happened yet again. Let’s meet up again in seven days, Noah and Amy, and we’ll find out the latest that’s going on with this outbreak in episode five. So, Amy and Noah, thank you both so much for joining me once again.

Amy Maxmen

Thank you. It’s always a good time.

Noah Baker

Thanks.

Benjamin Thompson

More from Noah and Amy next week. Up next on this week’s show, reporter Dan Fox has been looking into vaccine development to see how long it may be before an effective one against COVID-19 exists.

Dan Fox

As we come to the end of our third week in lockdown here in the UK, questions are of course being asked about what the endgame for this outbreak looks like, and how we’ll be able to return to some semblance of normality. And while the short-term focus has been on things like testing and social distancing measures to try to minimise the immediate spread of the virus, for many it seems that the only real long-term answer to protect people from COVID-19 is a vaccine. But how long is it going to take to produce an effective vaccine that offers enough protection? One person aware of the complexity of vaccine development is Marie-Paule Kieny, a virologist and vaccine specialist who works at INSERM, the French national institute for health and medical research. Developing a new vaccine is a multi-step process, as she explains.

Marie-Paule Kieny

You have to start with research to design your vaccine, so It is about knowing whether you want to use proteins, you want to use viral vectors or if you want to use DNA or RNA. So, that’s the first thing.

Dan Fox

Next, researchers will begin testing in the lab. They need to prove that the vaccine candidate could work against the disease they are targeting and that it isn’t toxic. If they can demonstrate its safety, they can be certified to begin clinical trials.

Marie-Paule Kieny

Phase one clinical trial is evaluating in a few dozen people, usually young and in good health, whether your vaccine is safe enough to move forward. Phase two is done with a few hundred people. You want to understand what dose of vaccine you use, but still no efficacy. And then the last step is that you test the efficacy, and this is usually done in a few thousand people, where you vaccinate people and you let them get exposed naturally to a pathogen, and you see how many people are protected in the vaccinated group when compared to the control group.

Dan Fox

Once a vaccine candidate has passed all of these steps, it’s ready to be rolled out in a clinical setting. So, how long does a vaccine typically take to go from the drawing board to completing phase three trials?

Sarah Gilbert

In the past, it’s taken anything up to 20 years to get through all of those stages.

Dan Fox

That’s Sarah Gilbert, a vaccinologist from the University of Oxford in the UK.

Sarah Gilbert

Things have been getting faster recently and particularly with attempts to develop new vaccines against outbreak pathogens, so things like Ebola, for example. It’s come down to more like about five years, but that’s still not fast enough when we have an outbreak with a new pathogen.

Dan Fox

Five years could be a long time to spend in lockdown while the world waits for a COVID-19 vaccine, but progress is being made. Last month, the US pharmaceutical company Moderna became the first to start phase one trials with an RNA-based vaccine candidate. Since then, two more candidates have entered clinical trials and many others are in development. Sarah and her team have also been working on a potential vaccine since the start of the outbreak and have recently received £2.2 millions of funding from the UK government to do so. Sarah hopes that it will be entering phase one soon. Of course, in this pandemic, speed is of the essence. Fortunately, there is a collective effort to accelerate this work without skipping any important safety steps. For example, regulators have smoothed the process by granting conditional approval for the team at Oxford to begin recruiting people for the phase one human trials earlier than usual, while the team completes their quality control analysis.

Sarah Gilbert

And so, we save weeks. Normally, it would take two to three months between having that certificate and being able to start a study.

Dan Fox

Of course, there are many hurdles to overcome between a stage one trial and a completed vaccine, so how long might it be before Sarah’s vaccine candidate is ready for use?

Sarah Gilbert

We don’t yet know when we will have a result on efficacy of the vaccine because in order to get that result, we have to vaccinate a lot of people in the phase three trial and then follow them to see if they get infected, and their chance of being infected is obviously effected by the amount of transmission in the population that’s going on at the time. Now, we have social distancing measures in place, which is very good, to protect the population. The aim of that is to reduce virus transmission and the effect on a vaccine trial is, if we have low virus transmission, it’s going to take longer to determine efficacy.

Dan Fox

So, it seems that efforts put in place to slow down the virus’ progress in the UK might also slow down the testing process for Sarah’s vaccine. One solution being discussed is to hold phase three trials in countries with higher infection rates, potentially demonstrating efficacy faster than could be achieved under lockdown. Around the world, researchers are making similar efforts to speed up development and testing. Here’s Marie-Paule.

Marie-Paule Kieny

It is expected that it will take a good year to 18 months if everything is right in order to see a vaccine which has demonstrated efficacy, which may or may not be available in large quantities at that moment.

Dan Fox

As researchers race to develop a vaccine, they must still remain vigilant to the potential risks involved.

Marie-Paule Kieny

For coronaviruses, there is evidence that a phenomenon called disease enhancement can be possible, which is that if a human being is immunised with a sub-optimal dose of a vaccine, the immune response, instead of being protective, can actually be enhancing the disease. Indeed, even with compressed timelines, the investigators will first test this hypothesis in animal models and then in human trials it will be important to look at any signal that can indicate that this is something which is happening.

Dan Fox

And even if candidate vaccines are safe, there are other, broader pitfalls to be avoided.

Marie-Paule Kieny

One is to put our energy in trying to accelerate each and every candidate vaccine there is because currently the list is very long, so this is about trying not to spread our efforts too thin. The other pitfall would be to go for a vaccine which looks fine, without looking at the same time at potential for scale up and of availability of millions and hundreds of millions of doses as quickly as possible because it would be a disaster also to, after 12-18 months, have a vaccine which is demonstrated to be efficacious and then realise that actually it’s efficacious but there is none of it.

Dan Fox

The lack of stocks is something that Sarah’s also been thinking about, and even though her vaccine candidate is just about to begin phase one trials, her team are already in talks with contract manufacturers about mass production. Their candidate was developed using an approach that they have already used to make a vaccine that targets another coronavirus, MERS. That vaccine has already seen good results in phase one trials, so she is confident, but there are still challenges to overcome.

Sarah Gilbert

We think we will see strong responses here, but nobody knows what level of immune response we need to protect against a coronavirus. So, we can tell that the vaccine is inducing immune responses, but we don’t know if it’s good enough to give protection, which is why we have to do the efficacy trial. But our backup option is to give two doses of the vaccine because then we will get an even stronger immune response, and if one dose doesn’t protect, then it’s quite likely that two doses would.

Dan Fox

So, it’ll be a few months before we find out how Sarah’s vaccine candidate has performed in its trials, and the world is waiting to see how the nearly 50 other potential vaccines in various stages of development fare as well, and with the WHO announcing plans for an initiative to ensure equitable distribution of any future vaccine, thoughts now turn to the next steps – making sure these treatments find their way around the world to the people that need them. Marie-Paule thinks these discussions need to happen as soon as possible

Marie-Paule Kieny

So, the next steps will be to see how you need to roll out this vaccine because it is impossible to think that you will have billions of doses from one day to another. So, the discussion about privation for which population in which kind of countries should take place quite early, so that it’s not my country first or your country first or my generation, the children, the elderly. There needs to be quite a lot of discussion starting as quickly as possible and also relatively urgent to see how a vaccine that will become available in 12-18 months could be rolled out to benefit global public health as much as possible in view of what might be availability of a number of doses.

Benjamin Thompson

For more on vaccine development, head over to nature.com/news, where you’ll find the latest updates and all of our coverage on the ongoing outbreak. We’re back again next Friday with another edition of Coronapod. Look out for us then. In the meantime, if you’ve been changing up your research or if it’s been effected by the ongoing lockdown, why not let us know? You can reach out to us on Twitter – @NaturePodcast – or on email – podcast@nature.com. I’ve been Benjamin Thompson. Thanks for listening. Stay safe

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