What if we can't think of a COVID-19 vaccine or cure? Then what?

Pizz's picture
Rank: Neanderthal | 2,238

What's with the idea that the world will eventuallyhave a vaccine or other therapeutic medicine in 12-18 months--we still don't have a vaccine for HIV after 30 years. If there isn't a cure or vaccine in 12-18 months, the world will surely go into depression, no?

https://www.bloomberg.com/news/articles/2020-03-31...
THoughts?

Comments (24)

Apr 1, 2020

The idea stems from the fact there are numerous companies working on separate vaccines that are in clinical trials. For no vaccine to develop, all of these clinical trials would have to fail which is pretty unlikely. it's more the process of trials and proving one is effective and safe, rather than actually finding one.

Array

Apr 1, 2020

Then how come we don't have a vaccine for HIV after 30 years??

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  • Incoming Analyst in IB - Gen
Apr 1, 2020

bc nobody gives a shit about hiv- sorry its just not profitable enough as coming up with a cure t something that affects EVERYBODY involuntarily. HIV is extremely preventable and therefore most people dont really care about it- besides the fact that its mostly a problem in Africa so most work towards it would essentially be charity since there are very few resources in Africa to pay for cures

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  • Associate 1 in IB-M&A
Apr 3, 2020

This isn't to be insensitive, but is just a fact:

We know, with 100% certainty, that HIV spread could be eliminated in one generation purely through stopping a few voluntary behaviors, the ask of which would be considered by many to be of a minimal burden. (Obviously there are involuntary actions post-original diagnosis, but at some point down the line a behavior took place that spread)

Viral spread through everyday activities puts far more pressure on those to find a stop so that "normal" life will resume.

This isn't to take anything but a sympathetic view towards HIV, but it's a wholly different set of preventative measures.

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Apr 1, 2020

Because we already have flu vaccines and coronavirus is theorized to be more similar in nature to that than HIV.

But to get to your point, more people will die and get infected on a recurring basis. I already expect "coronavirus season" to be a yearly threat unless we come up with a banger vaccine

Apr 1, 2020

But they couldn't get a SARs vaccine from the 2000 epedimkc

Apr 1, 2020

You're right, and it's very possible a vaccine is delayed (though I don't think we will give up any time soon given the international magnitude of who's being affected). Hopefully people can build some degree of immunity or resistance to it over time, even if it means a lot of deaths.

  • Incoming Analyst in IB - Ind
Apr 1, 2020

Very possible. There was never a vaccine developed for SARS from early 2000s, despite China setting up a virology lab afterwards to study one, and COVID is essentially SARS v2.

Apr 1, 2020

So in that case, a depression is not out of the question

  • Incoming Analyst in IB - Ind
Apr 1, 2020

Dr. Fauci, Dr. Birx, and Scott Gottlieb (former FDA head) have all said to expect a second wave (as early as this fall) and a third wave (sometime next year), which doesn't leave me too optimistic. However, they have said we should be far better prepared in terms of testing capability so that we can better and earlier quarantine those that catch it. Also, hopefully those that have already caught COVID may build immunity.

Apr 1, 2020

Good luck keeping your IB job. With no deals happening, banks are going to start cutting

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  • Incoming Analyst in IB - Ind
Apr 1, 2020

I'm in RX

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  • Intern in IB - Ind
Apr 2, 2020

@Pizz says the kid in ER as we're about to enter a recession. I'm sure your sell-side research saved investors a lot of money. You should be worried about the pandemic of AI that's been killing and will kill your industry.

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Most Helpful
Apr 2, 2020

@Pizz the reaosn why the belief is that in 12-18 month's here will be some theraputic treatment is due to the fact that, even forgetting the R&D side of things, clinical trials take time to run, analyze, and ensure both efficacy and human safety. First, just about every other clinical trial has been put on hold for now. So it's easier to get Covid-19 trials out the door and into legitimate studies. Second, given the massive number of patients with the Wuhan Virus (we're talking nearly 1MM cases glonbally, ~700K active cases, and 250K closed (of which 202K have recovered and 48K have died) as of April 2nd according to Worldmeter. The growth rate on this is clearly logtrithmic.) we have a significant "Study ready" population. Additionally, this is getting top priority in terms of being studied around the globe. So new research on Covid-19 is getting published at a fast pace and is being reviewed by researchers, virulogists, epidemiologists, and the FDA in order to help shape response. Plus, there's a ton of research on SARS and MERS that is being levered to help with this.

Typically, drug trials take 6-7 years and go across three phases. Phase 1 trials are small, maybe 10 to 100 people, to look at safety, dosage, and identify side effects. If a company wants, it can do a Phase 0 Trial, but those are often part of Phase 1 and are even smaller. They basically test Pharmacodynamics and Pharmakenetics in humans to see that the drugs "Work". Phase 2 trials are between 100 and 500 people, and are used to determine the initial efficacy. Phase 3 studies are 1000 to 5000 people and are used to confirm the results of Phase 1 and Phase 2 studies. What we're seeing now, besides what looks like a moratorium on R&D and trials for other treatments, is that the FDA is using all of it's available paths to approval (fast track, accellerated, break through status, and priority review) to expedite the process because the Coronavirus meets multiple guidelines that qualify. The two advantages of these statuses is that it allows for review to happen concurrently as the trials are progressing, and alternative trial design can get employed to make it easier to clear some hurdles.

Now, here's the thing. the process for single therapy treatments - using a singular drug to help treat a disease - is going to go faster than a combination therapy. For treatments like Remdesivir (Gilead's ART for HIV) or Kevzara (Regeneron and Sanofi's RA product) which are already on the market, doing a Phase II/Phase III trial isn't that hard to get set up. Both of these products are already approved by the FDA, so going into new trials for a new indication isn't as hard since the majority of the Phase 1 and Phase 2 data is already there for side effects, dosage, dynamics, etc. The big thing is efficacy and modifications to dosage, etc. for treating this.

Combination Therapy requires more work. So it will have a longer process. The French doctor who treated with a combination of Chloroquine and Azythromicin treated a small cohort. Forgetting that the cohort study wasn't done in any regular fashion (not randomized, no control, etc.), Usually more of those studies need to be done in order to confirm the safety of the combination before moving onto larger studies.

For new treatments though, assuming that all resources are being directed for this and assuming that a new treatment can be developd in 6 months that can fight the disease, even on an accellerated timetime, we're still looking at 12 months for testing and review before it gets approved for widespread use.

Here's the thing - all of these studies are going to take time. IT's just the nature of studying drug interaction. We can't assume that what shows promise won't actually kill us. I'd rather run the risk of having Covid-19 than I would take a Chloroquine/Z-Pak combo when I don't know how strong the interaction between those two drugs can be. Chloroquine already has serious side effects and Z-Pak can have an adverse reaction with Anti-Malarials like Chloroquine. If I have to take Remdesivir (which is a daily use medication) or Kevzara (which is used every other week to treat RA), how long does the treatment last and does it become a daily/regular treatment or am I only treated for a short period of time and transitioned off the drug? What happens when you come off the medication? What's the risk of getting Cronoavirus again?

Now, comparing this to HIV is an entirely different question and it's nto a fair one to ask. HIV medication has come a very long way since the 80s. Additionally, HIV treatment is a post-infection treatment. There is a relatively low population in the US (the US Gov't - via HIV.Gov - is suggesting 1.1MM people in the US have HIV) and the I've read reports suggesting the global population is approximately 40MM. Given the current state of treatment, the ability for the virus to mutute, etc., pretreating patients with a vaccine could cause more harm than good when you consider how HIV is transmitted. Compare that to what we're seeing with 1MM people with this virus in ~4 Months, and you can see why people are focusing so much on getting a treatment out in a 12-18 month window.

As far as the depression question goes, even if we come out of this in 6 months, we're still looking at an economic depression and downturn given how fast everything has happened and the odds of certain industries recovering quickly.

Apr 2, 2020

If there is no vaccine then we just have to press on. People will die. Civilization, however, will have to press on and people will need to adjust their behavior. But we can't shelter in place for years on end.

  • Analyst 2 in RE - Comm
Apr 3, 2020

Yea, it is an angry and unforgiving Economy. To repent we must stop frivolous spending! Instead of paying for cable, let us watch clouds! Instead of buying clothes, wear but sheets from thine beds! Cut spending to only the bare essentials! Water and bread and margaritas, yea...

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Apr 3, 2020

Lmao Randyyyy!!

Apr 3, 2020
real_Skankhunt42:

If there is no vaccine then we just have to press on. People will die. Civilization, however, will have to press on and people will need to adjust their behavior. But we can't shelter in place for years on end.

You're right, we can't, and we won't shelter in place for years. But we will have to adopt some kind of intermediate containment measures to prevent another outbreak. Whether that's broad testing and targeted quarantines or local lockdowns, something will need to be done as we have seen what happens if you just let this virus spread unchecked.

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Apr 3, 2020

Totally agree. What I find funny is that everyone will have to adopt my lifestyle, which means fastidious cleanliness. COVID-19 is going to turn everyone into me.

  • Analyst 1 in Other
Apr 3, 2020
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Apr 3, 2020