Wack: Vaccine not just game-changer for COVID-19; technology will be vital in fighting other diseases | COMMENTARY

Editor’s note: This is the second of three Community Voices pieces on COVID-19 from Dr. Robert Wack.

The delivery of the Pfizer and Moderna COVID-19 vaccines is fantastic news not just because it signals the beginning of the end of the pandemic. The technology they use is as big a leap forward as the discovery of antibiotics.

These innovations didn’t happen overnight. Operation Warp Speed was the final push for work that began back in the 1980s, and came to fruition because of the publicly funded, long-term investment in the persistent, brilliant, hard work of hundreds of scientists around the world. They also demonstrate that the pay off of decades of public funding for basic research arrives in ways, and at times, that are hard to predict.

The first big breakthrough compresses years of tedious research into weeks. Instead of test tubes and Petri dishes, researchers can now use supercomputers and big data analytics to understand the structure and operations of a virus, then rebuild it virtually, allowing detailed analysis of the parts that could be important for immunity.

The second important breakthrough is exactly how the new vaccines work. On it’s own, the immune system is both extremely complex, but in some ways, very inefficient. It has three general phases: destroy, amplify, and remember.

The first step in the immune response, destroy, occurs through inflammation. The cellular damage caused by a virus triggers an indiscriminate attack like you’d get using a flamethrower and carpet bombing, causing as much damage from friendly fire as it destroys the invader. That leads to the more prominent symptoms of illness: fever, aches, and congestion.

For the body to develop a more specific response from the immune system, a process of random sifting through the wreckage occurs. It’s like trying to find an important email message by examining each little piece after someone has smashed your computer with a sledgehammer.

The sifting process involves a lock and key mechanism, where specific antibodies and receptors on immune cells bump around against the debris caused by inflammation. If a viral protein fits into a matching receptor, the next phase of the immune response is triggered, amplification. Matching immune cells rapidly reproduce, churning out more matching antibody. These antibodies bind to the invader, flagging it for destruction by other immune cells. This amplification continues until there is no more virus to bind and destroy.

The last, long-term phase of immunity is memory. Once the invader is wiped out, the immune cells quiet down, but now there are antibodies floating around, along with memory immune cells to produce more antibody if the immune cells are stimulated by the binding of the specific protein key into their receptor locks from a repeat infection.

The Pfizer and Moderna vaccines use techniques to stimulate immunity that are quicker and simpler compared to older methods. This bypasses most of the inflammation older techniques generated. Early vaccines caused an actual infection with either a low dose of the target microbe, or something very similar. This would induce immunity, but it would also cause extensive inflammation. Sometimes that inflammation could be as bad as the actual disease.

Over the years, researchers figured out how to produce effective immunity, with less inflammation, by using killed viruses, then parts of viruses, and now just individual viral proteins.

This is where the Pfizer and Moderna vaccines really change the game. Instead of stimulating the immune system directly by injecting viral proteins, the new vaccines reprogram the cellular protein manufacturing machinery to make those viral proteins, which the immune system then detects and reacts to, but without all the indiscriminate damage of inflammation.

That programming uses something called messenger RNA (mRNA). It can tell the cell to produce viral proteins, but getting inside the cell was impossible until researchers gradually developed techniques to sneak it in. That was another breakthrough. Through decades of painstaking trial and error, researchers developed fragile tiny bubbles that did the job. These bubbles break down easily if mishandled, which is why the Pfizer and Moderna vaccines require deep cold storage and transport.

There is a local connection as well. A UMBC virologist now at NIH, Dr. Kizzie Corbett did important early work on the protein spikes of the coronavirus, and worked with the team on the essential last steps for developing an effective vaccine.

The biggest news is how this technology can be used to treat other diseases. Reprogramming cells to produce proteins for the immune system to react to can now create treatments for cancer, autoimmune diseases, metabolic diseases, and pretty much any other infection. It is truly transformational, and we’ll continue benefiting from many other new treatments in addition to the COVID-19 vaccine.

Dr. Robert Wack is a physician who writes from Westminster. He can be reached at Robert.p.wack@gmail.com.