Concerted effort holds the key to fighting off coronavirus

Everyone, from US President Donald Trump to a common man, wants to know how close we are to finding a cure to Covid-19 and how long this lockdown is going to last. All our questions are best answered only by trials and researches currently going on around the world.

Virology is an interesting part of microbiology. Viruses can mutate so rapidly that continued research is mandatory to know them in-depth in order for us to find a treatment and to stem its spread. Since its first mapping in January 2020, this virus genome is sequenced more than 3,000 times to learn about newer mutations. And when proteins that help these viruses adhere to human cells were identified, it was considered a huge step towards finding a cure against these viruses.

Gene sequencing of the first infected case of Nepal was carried out at a WHO-designated laboratory in Hong Kong and was submitted for free access to the world under Global Initiative on Submitting All Influenza Data (GSAID).

Further, gene sequencing of recently isolated viruses, which are mostly found in people crossing the border into Nepal from India, should also be done and submitted. Not only these steps help us secure our access to vaccines—if vaccines are available sometime in future, but we may also know its effectiveness against the recent virus strains that are spreading in our local environment.

Openness is another factor that will help us reach a conclusion. Any information regarding Covid-19 patients should be published and made accessible to the world. The pace of the pandemic is so rapid that publishing this information in a peer-reviewed journal will be a lengthy process. So, it is logical to create medical ‘hive minds’ on social media for faster dissemination of knowledge. One such group ‘PMG Covid-19 Sub-group’ has more than 35,000 scientists as members worldwide. It is our duty to disseminate any useful and authentic information as widely and quickly as possible during this pandemic.

From Smallpox to Ebola, what the world has understood is that without international collaboration, no country can beat any contagious virus. Nepal has associated itself with the WHO-led Solidarity Clinical Trial comparing four different treatment modalities, including a treatment arm which consists of the most famous malaria drug Hydroxychloroquine. This trial is going on in more than 70 countries simultaneously.

The Norwegian health minister published a statement and expressed pride in being the first country to provide the first case in this trial. Similarly, Nepal should cooperate and lend its Covid-19 cases for this trial and be part of this historic trial.

Everybody is puzzled regarding the time frame needed to develop a vaccine. So far, no vaccine has been made ready for widespread use in less than four years. Usually, it takes a decade for a vaccine to be available for a country like Nepal. Late 2021 or early 2022 will be the most realistic time frame when manufacturers could start mass production of Covid-19 vaccines.

Trial phase might begin before that. In the case of Covoid-19, only a few trials have entered the second phase where a large number of human trials are conducted and adverse effects are seen for about six months.

In the context of more than 100 different manufacturers racing to investigate effective vaccine in different parts of the world, we can say scientists all over the world are doing quite good having ‘maximum attempts in the goal post’. Among them, few promising trials like Oxford university vaccine trial are showing encouraging results in rhesus monkeys and a widespread human trial is expected in the near future.

American Wall Street went into transient recovery mode when Moderna, an American manufacturer announced good results in a small human trial. On May 22, Lancet published encouraging results of different doses of Chinese vaccine when tried in human. Hence, if a global trial of vaccines against Covid-19 starts, Nepal should participate in it wholeheartedly. If the current trend of spread of the virus is observed, we can make out that by the time vaccine is available, most of the disease burden will be in highly populated third world countries and countries like India is likely to be a new epicentre of this global pandemic.

Amid the good news, there are some areas of concern too. Though manufacturers have promised mass production of these vaccines once the trials are over, there will certainly be an outrageous application of force by richer nations to maintain ‘my-country-first’ kind of monopoly for vaccines. The growing tussle between the world’s two economic giants over this pandemic fans the fear of ‘vaccine cold-war’. These nationalist feelings might delay access to vaccines to people living in poor countries like ours. Hence, Nepal should join growing voices condemning ‘vaccine nationalism’ which might possibly surface in the coming days.

Leading manufacturers like AstraZeneca is bound with the UK because of its commitments secondary to the funds it received from the UK. Sanofi has announced that the US has the right for a largest pre-order of vaccines. Serum Institute of India has dismissed the plan of vaccine export. European nations are backing Wellcome Trust for the Covid-19 related technologies. Such news makes one smell upcoming tussle in between the disparate nations when vaccines are available.

A similar situation had happened in 2009 when the vaccine for Swine Flu was developed. Richer countries made sure that vaccine donation to be carried out only when their own nationals were fully covered. Such vaccine distribution based on the country’s purchasing power, not on the risk of transmission, should be abolished.

Hence, pinning our hopes on ongoing researches and adopting international collaboration in a positive way is the only way we can end this pandemic. More importantly, equitable global access to the vaccine, not a nationalistic stance, will shorten the duration of this pandemic.

Dr Joshi is a consultant surgeon at B & B Hospital in Gwarko, Lalitpur and editor of the journal of the Nepal Health Research Council.

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