“The richer the country, the more cases of this disease in it”
– Can you name the reasons why there are so many cases in the United States?
– Firstly, the population is quite active, the country is open. Before the pandemic, there were a lot of international connections, and the pandemic immediately began in several places, because the virus was introduced to both the west coast and the east coast, to New York, Seattle, San Francisco … We also did not have and there is no serious quarantine, unlike, for example, Russia. In China and in Europe, simply draconian measures were introduced, up to the police persecution of people who do not observe the regime of self-isolation and social distancing.
This is not the case in the United States. The majority of the population adheres to the mask regime, mass gatherings are not encouraged, for some time some institutions, such as hairdressers and beauty salons, have been closed, which can be done without. But now restaurants are open in most states, not at full capacity, of course, kindergartens are opening … It is not clear about schools yet. They will most likely work at least the first time at the beginning of the school year in remote learning mode.
How the number of people who recovered and died from coronavirus is changing in the world
Recovered (new cases)
Deceased (new cases)
As a result, the epidemic here is more intense, more intense, so to speak. In addition, there is a striking pattern – the richer the country, the more cases of this disease in it. The pandemic is milder in middle- and low-income countries.
– What could it be connected with?
– I think there are many reasons. First, in countries with higher incomes, the age structure of the population is different, there are more elderly people, the population is more mobile. People more often go to various places of entertainment, for example, to restaurants, and the concentration of the population is greater.
– Can we talk about a steady trend in the United States to reduce the number of new cases?
– Of course, the decline is real. But, you see, this decline, if you are talking about the situation all over the world, is the total incidence curve that is made up of many individual curves. Just like, for example, the incidence curve in the United States is made up of many curves for each state. And, for example, in New England, New York, New Hampshire, Massachusetts, this pandemic broke out much earlier. It was April-May. Now the situation there has returned to normal, not to zero, of course, but a fairly acceptable incidence rate. And in California, Florida, Texas, the epidemic has just begun. So when you look at the curve in the United States, you see two waves. This does not mean at all that these two waves are real, it is just that different states began to get sick at different times in time. Although in some places there is a real second wave. For example, in the central part of the east coast, Maryland and Virginia, there are indeed two waves.
– Is the third wave expected in the USA?
– It may well be. You see, here again everything is made up of many components. If the second wave subsides and cold weather sets in, then, as many scientists assume, respiratory diseases will worsen with the onset of the autumn and winter seasons. We know this from the example of the flu. Using this analogy, some predict that there will be another rise in the incidence in the fall and winter, but this again, so to speak, is a guess.
“A person decides for himself whether to get vaccinated or not”
– In Russia recently registered the vaccine… What is the situation in this sense in the United States? Is there a lead developer?
– There is one such thing. In the US, there is a so-called Warp Speed program, which can be translated into Russian as “compressed time” or “bent time”. It was launched by the US government, a collaboration program between the Department of Health and the Department of Defense, which have devoted all their efforts to the development of several vaccines. They are now supporting the development of six vaccines that are being developed and tested in parallel with each other in the hope that at least one of them will be effective.
In particular, one of the vaccines currently being tested in the United States was developed at the National Institutes of Health, a government agency, but for production it was transferred to Moderna, which is already manufacturing and testing it. The state, of course, helps a lot both financially and in terms of the logistics of the entire process. But private capital investment is involved, because you can imagine that it will be a fairly profitable venture: if someone starts producing an effective vaccine, a lot of money can be made.
– Are there any ways to speed up vaccine production?
– There is definitely a way to do it faster. It usually takes years and sometimes even decades to develop a vaccine. You can speed up it in different ways. Usually, a vaccine is first developed conceptually, then laboratory tests are carried out, then experiments on animals begin, then they move on to the first phase of clinical trials, they look at safety, then the second phase – they look at immunogenicity, the ability to stimulate immunity; then the third, when they are already testing for efficiency.
Usually, no one moves to the next step until the previous one has successfully completed. In this case, of course, bearing in mind the significance of the problem and the economic damage that this virus inflicted, it was decided to take risks, that is, move to the next phase, not yet waiting for the results of the previous one, and start preparing for mass production, not yet making sure that the vaccine is effective. In the worst case, you lose money and wasted effort, but, apparently, this is justified, given the importance of the problem.
Another way to speed up the process is to use so-called platform technologies. When some schemes for the production of a vaccine against a similar virus have been developed, and you simply replace one antigen, roughly speaking, with another. Both methods are now, of course, used quite actively.
– When we talk about viruses, coronavirus or others, one of the main ones is the topic of mutations. Could COVID-19 mutations be more dangerous than the current virus, and is there a scenario in which vaccination will protect against future mutations?
– You know, mutations can be of different types. If you are talking about a mutation in the sense in which we are talking about the influenza virus, which adapts very quickly and tries to dodge the immune response, which after a couple of years leads to the fact that the immune system does not help, this is one thing. For this coronavirus and for other coronaviruses, no such phenomenon has been described.
In fact, what is happening with the flu virus is a unique situation. So I don’t think that there will be problems of this kind associated with mutations of antigenic properties, so to speak. But the fact that mutations occur with this virus is certain; the virus that is now circulating is not the one that circulated, say, at the beginning of the year. Because in almost all countries, the population of the virus has changed. Some mutations have emerged that have changed the properties of the virus, and now there are reports that the virus now circulating is less dangerous and less lethal than the one that circulated at the beginning of the year.
– Could the vaccine be dangerous for humans or contraindicated for a certain population group?
– Unfortunately yes. Because the fact that a vaccine triggers immune responses does not mean that it will protect. The immune response comes in a variety of ways. For example, allergy is also an immune response, but allergy triggers a different mechanism, and therefore a pathological process occurs in the body. Sometimes, unfortunately, vaccines can cause increased infections. If immunity is induced, not one that protects, but one that causes an increased abnormal response of the body, then there may be an intensified disease.
There is some reason to think that this may be the case here. There is no direct data yet. But since there is indirect evidence – with other viruses, that this is possible, then you need to be very careful here. Especially when immunizing vulnerable populations. And just because a vaccine protects young people doesn’t always mean that it will protect older people as well. Therefore, one must move here rather carefully. You need to be prepared that even after the vaccine is introduced, complications may emerge and, perhaps, some vaccines will have to be removed from use.
– Now it is being discussed that in some countries there will be compulsory vaccination… In your opinion, such a scenario is possible and will this measure be effective?
– Mandatory vaccination? I don’t know … In North Korea it can, but I think that in normal countries this is simply impossible. Each person decides for himself whether to get vaccinated or not. So I don’t think this scenario is possible anywhere. Perhaps, the mandatory vaccination of children upon admission to school, perhaps, vaccination will be required for those who travel … And so, in a broad sense, of course, everyone decides for himself.
– Recently it became known about the registration of the Russian vaccine against coronavirus infection. Is it possible that the United States will buy this drug, and what should Russian manufacturers do for this?
– I don’t think this is a real opportunity. There are a huge number of vaccines being developed in the United States. As I said, at least six are already in advanced stages of testing. I am not aware of any facts that would say that the Russian vaccine is unique. She’s probably good. I think that it must be no worse than others. But somehow I do not see that the United States and some other countries would buy the Russian vaccine. And first of all, because it does not pass trials in the United States, and without the data obtained there on its effectiveness and safety, this is hardly possible.
– You spoke in other interviews about plans to test an oral polio vaccine in America, about which they say that it can help in the fight against the pandemic. Tell me, can the polio vaccine generally replace the COVID vaccine as an effective means of protecting against coronavirus?
– Completely, of course, cannot replace. When we discussed this, we were talking about the use of this vaccine as an emergency measure to protect against any virus by nonspecific stimulation of immunity for a while. Unfortunately, trials of the polio vaccine have not begun in our country, simply because all efforts were devoted to creating specific vaccines. The focus was on vaccines that will protect for a longer time.
I know that polio vaccine trials have already begun or are planned in some countries. Therefore, I think this is a very promising area. It can help for the coronavirus too, because again we don’t know what happens with specific vaccines. Maybe the polio vaccine will come in handy here too. And then, of course, this is a universal remedy in the fight against any new virus: against a virus that is changing, and in general with the influenza virus. But this is a long-term development that requires, so to speak, additional research.
Konstantin Chumakov – Vaccine specialist, graduate of the Moscow State University. M.V. Lomonosov, Doctor of Biological Sciences. He is with the US Department of Health and Human Services and is the Deputy Director of Science for the Vaccines Division of the Food and Drug Administration (FDA).
In an interview with RBC, Konstantin Chumakov expressed exclusively his personal point of view.
He is a member of the Global Virology Network (GVN), Advisor to the World Health Organization, Adjunct Professor at George Washington University.