Since the spread of COVID-19, researchers around the world have spent thousands of hours working towards the common goal of improving public health, understanding its spread, and alleviating disease through the development of vaccines and treatments. I did.
Their research has produced amazing results. Currently, multiple vaccines developed at record speeds show the potential to ultimately return to the activities enjoyed before the pandemic. But many Americans remain in conflict about taking them, jeopardizing the progress we have made.
Professor David Pitrak is responsible for Infectious Diseases and Global Health at the University of Chicago School of Medicine. This past fall, he is working with Professor Kathleen Mullane, UCM’s clinical trial director, on the Moderna vaccine trial and trials for a new COVID-19 treatment.
In the next Q & A, Pitrak will explain in context the progress towards COVID-19, from past vaccination campaigns to the fight against HIV. He states that while research provides hope for the disease, spillover effects will continue to be felt. To truly end COVID-19 as a public health threat, providers and communities must work together to reduce vaccine hesitation.
Are there any similarities between past vaccination campaigns (perhaps polio and other illnesses) and current campaigns to protect against COVID-19?
This is the first universal vaccination campaign we have conducted in the United States for a long time. From 2009 to 2010, there was a move to try to vaccinate against H1N1 flu, but such efforts are closest to diseases like polio.
I was vaccinated against polio when I was in kindergarten in 1960. At that time, my classmates were infected with polio and, as a result, suffered from paralytic illness. Since that time, vaccination has really changed the situation. Many illnesses that were important sources of morbidity and mortality have virtually disappeared. Measles, mumps, rubella, and chickenpox are all common, and I was infected with three of these four infections when I was a kid.
Of course, COVID-19 is very different. This is because adults are currently vaccinated and the safety and efficacy of the vaccine for children is still being evaluated. The next group that research is focusing on are people in their early teens. Therefore, while everyone is talking about herd immunity, it may never reach the point that a sufficient number of the entire population is unaffected by vaccination or natural infections in order to significantly reduce community spread. Maybe.
Instead, adults need to opt in. This is a different scenario that most of us have ever experienced. Childhood vaccinations can be requested, but this time it is often up to adults to take this step to protect themselves and those around them.
Has the general perception of vaccines changed completely since the days of polio?
There have always been skeptics, but the acceptance of scientific facts has not been as politicized as in the past. This is a new phenomenon that we need to tackle.
However, at the individual level, people incorporate their own experience and the experience of family and friends into their awareness of vaccines. In the pre-polio vaccine era, people were aware of the risk of serious illness and were afraid for good reason and encouraged them to accept the vaccine when it became available.
For many, the same thing is happening today. It’s easy to be insensitive to COVID-19’s incredible death toll (more than 500,000 lives), but personal stories about families who have lost loved ones bring back the significance of people’s situations. think. They see friends and neighbors vaccinated.
It is also important to recognize that there are subtle differences in vaccine repellent. In the black and Hispanic communities, vaccine hesitation may be rooted in historical distrust of the healthcare system. We need to remain thoughtfully involved in these communities, acknowledging that pandemics are often widening existing inequality.
How have UCM healthcare professionals worked to build public confidence in new vaccines?
Everyone may never be able to vaccinate with confidence. However, in the hope of increasing confidence when the vaccine is approved, we can think of approaches for conducting clinical trials.
For example, UChicago Medicine confirmed that the people enrolled in vaccine clinical trials are diverse and racially and geographically representative of the population. In the Moderna trial, about 30% of the participants came from underrated groups and special attention was paid to achieving a fair level of registration. This ensures that people of different backgrounds respond well to the vaccine and that there is no difference in efficacy between groups.
Also, after the primary endpoint was achieved, the vaccine trial could be unblinded, giving participants who were first given the placebo access to the real vaccine. Not only does this protect people, but it is worth recognizing the risks they have taken by participating and volunteering for clinical trials for others in the future.
You have worked extensively on HIV as both a practitioner and a researcher. What lessons from HIV apply to COVID-19?
HIV is in many ways similar to slow-motion COVID-19. COVID-19 has rapidly overtaken the world. In just one year, there were already more than 100 million cases and 2 million deaths. In contrast, since the HIV epidemic began around 1980, about 75 million people have been infected with HIV worldwide, with far more deaths at 27 million.
Scientists have learned a lot from HIV over the last 40 years, and that knowledge has been applied in important ways to COVID-19 and other infectious diseases. HIV is about the same as the space program for infectious diseases, as it is a field of powerful scientific activity that has brought many new technological approaches to diagnosis, drug development, accelerated clinical trials, and drug approval. is.
For example, when I saw the first HIV patients in 1982, there were no diagnostic tests for HIV, and a combination of three drugs to treat it was not available until 1995. When I give a presentation, I don’t even put them all on one slide.
It’s amazing how much technology has emerged to develop diagnostics, treatments and vaccines. These processes have really improved recently and could be built on the learning curve of COVID-19. Now, better data is available faster than ever before, and effective vaccines are being developed very quickly.
Do you think COVID-19 can eventually be treated with antibodies or other drugs?
UChicago Medicine is also involved in testing the Lily anti-COVID-19 monoclonal antibody. I’m still excited about this possibility of using lab-created versions of neutralizing antibodies that infected individuals produce to treat other patients, but there were challenges.
Antibody treatment appears to be effective only in relatively mild cases, so it mainly treats outpatients. However, it is difficult to take a patient with a highly contagious respiratory illness to the clinic for a single injection. Also, like influenza and many other viruses, there are no direct-acting oral antivirals to treat COVID-19. The only drug approved for treatment is remdesivir. Remdesivir is an intravenous drug for inpatients with moderate to severe illness.
For now, we need to focus on vaccines. They are very effective and for COVID-19, 1 ounce of prophylaxis is really worth a pound of treatment. People who get sick, especially those with immunodeficiency who are less effective with the vaccine, still need the drug, but taking the vaccine is a much safer way than expecting treatment after the onset of symptoms.
What else would you like to emphasize about COVID-19 and the vaccination campaign?
One thing that hasn’t received enough attention is how much COVID-19 has disrupted medical care for other conditions, from HIV to cancer and heart disease. COVID does more than just affect people by infecting them and causing illness. It also has a spillover effect.
Part of my focus was on HIV, with impacts in both treatment and prevention. Acute HIV infection increased dramatically in emergency room screening. Currently, it is 2.5 times that before the pandemic. In some cases, HIV-infected persons may come to the emergency room thinking they are infected with COVID-19. There are similar symptoms such as fever and muscle aches.
But I’m worried that what we’re seeing is actually just the tip of the iceberg. Due to the degree to which HIV care and prevention programs are interrupted, we may take a few steps back. If people are unable to receive regular tests and treatment, or are hesitant to do so, illnesses such as HIV can progress unchecked. As it becomes clear what happened in 2020 and 2021, there may be a fallout from COVID that wipes out years of progress in lowering HIV prevalence and improving disease management in Chicago.
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Courtesy of the University of Chicago
Quote: The combination of scientific progress and personal experience is the COVID-19 vaccine obtained from https://medicalxpress.com/news/2021-03-pairing-scientific-advances-personal- on March 17, 2021. Reasons to help build trust in (March 17, 2021) covid-.html
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Why combining scientific progress and personal experience can help build confidence in the COVID-19 vaccine
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