What if there is no COVID-19 vaccine?

Dr. Catherine Hankins is used to taking on deadly viruses. In the late 1980s, as a member of Montreal’s public health department, she became an unexpected hero in the fight against AIDS. One of the first researchers to link intravenous drug use to the epidemic, she also defied her own government and the Catholic lobby and launched a rogue campaign promoting safe-sex education (which included a secret press conference where she handed out communications to reporters). “At that time, public-health professionals had very little sway,” she says. How things have changed.

Today, Dr. Hankins co-chairs Canada’s COVID-19 Immunity Task Force, part of a $1.1-billion strategy guiding the country’s research and development of treatments, clinical trials and testing. And while Dr. Hankins says she is heartened by the scientific progress being made at home and abroad, she’s confident that this war on COVID-19 will be a long one.

We spoke with her about how the unknown nature of this coronavirus (SARS-CoV-2) and human immunity continues to confound scientists; the danger of short-term thinking; and the sobering possibility that there may never be a vaccine.

What makes the coronavirus so challenging to deal with?

There is still so much uncertainty surrounding it. Some of the infected have no symptoms while others have been crippled; most patients are dealing with respiratory issues, while others’ organs have been attacked. Now studies are suggesting people are contracting COVID-19 more than once, but we need to make sure that’s true. We know how immunity works in more common coronaviruses, but at this point, it’s irresponsible to say, “once you’ve had it, you’re protected.” And immunity does wane, so what happens if it disappears in someone after only a few months? All of this to say, we just don’t know enough about the virus. So, while we’re waiting on the data, we must be hyper-vigilant — educate ourselves, wear masks, wash hands and maintain physical distance.

But do you think a COVID-19 vaccine is actually coming?

I do. Creating one is not the kind of problem we’ve had with HIV, which mutates so quickly that it escapes our antibody responses. HIV isn’t intelligent, it’s just a really sloppy copier of itself.

COVID-19  is the kind of virus for which we have a better chance of getting a vaccine, because it doesn’t change as fast. Researchers are trying to see if humans have the necessary neutralizing antibodies, ones that are specific to a vaccine. It’s a humongous effort. I think it has a lot of promise. How long will it take? That, I don’t know.

What strategies can governments implement in the meantime?

It’s all about accepting protections for the short- and long-term. As we begin to reopen, one strategy involves being on top of every new case with contact tracing apps. A number of countries already have them, and we’re waiting to approve a national program in Canada. The more people that agree to participate, the more data we have, the better. I’d love for us to reach New Zealand’s level of progress: not a single case. But they are not easing up. Prime Minister Jacinda Ardern expects new cases to emerge, and when they do, her administration can use contact tracing to jump on them right away. There are, of course, issues of privacy. What kind of personal information should the government collect and for how long? That’s something Canadians will have to grapple with.

Another approach involves virus-proofing settings where people are most vulnerable — which environments have a higher risk of spread if the virus gets in? We’ve already identified several workplaces like meatpacking plants that fit the bill. There have to be whole strategies to tackle this, lots of public-private partnerships. A hotel in Whistler, for example, is conducting temperature checks for every single person entering the building. So, extrapolate such a measure and you get a clearer picture of what governments, corporations and other organizations will have to do in the service of safety. Again, there are so many questions. How far apart should people sit in an office? How much working from home will we continue to do? Perhaps most importantly, how much face-to-face contact do we need to foster good mental health? It’s anybody’s guess. What we’re trying to do now is adjust policy to prepare for these unknowns and react to the latest science.

Is there anything we can glean from the HIV/AIDS crisis if a vaccine fails to surface?

For me, there are three major learnings. First, people have to accept changing their behaviours — and we are changing, what with our embrace of physical distancing, greater hygiene, etc. With HIV, my colleagues and I understood the importance of creating enabling environments. In 1989, we set up needle and syringe programs, the first of their kind in Montreal. We also have supervised injecting facilities now for harm reduction. An analogous initiative today might look like handing out masks to passengers before getting on the Metro. Establishing new social norms can and will protect us.

Second, we need to discover novel treatments and therapies. Combination treatment changed the whole HIV/AIDS paradigm, since it meant the disease was no longer a death sentence. But we had to wait until 1996 for that. Then a big advancement came in 2010 with the Undetectable Equals Untransmittable campaign. By then, if a patient took their drugs and worked on their health, they did not have to worry about transmission.

And this is the hardest takeaway from the HIV/AIDS journey: getting here came at a terrible cost. We’re still plugging away at creating a vaccine. The disease has killed more than 32 million people since the beginning of the epidemic. I’m hopeful we can get the coronavirus under control much faster. So, yes, we need a COVID-19 vaccine, but we need to discover effective treatments too, as many as we can. Doing that will make waiting for a vaccine easier to tolerate.

There’s also the threat of a coronavirus cure being monopolized for profit.

Any attempt at that should be blocked. We need global solidarity on this. And should a successful vaccine be created, we must then determine where vaccines should be deployed first, for whom, and at what price. I’m glad Canadian scientists are contributing to vaccine development, because it gives us a place at the table for those kinds of decisions. To overcome such a crisis, all actors need to see themselves as global citizens, not competitors in some nationalistic or corporate race.

How should Canadians engage with the COVID-19 Immunity Task Force?

I encourage everyone to visit our website and stay up-to-date. We’ve just had a third antibody test, approved by Health Canada on June 5. The task force also has a big study that’s set to be announced across the country, allowing us to cross-validate assays and see which one is working best. And there’s the SeroTracker, an antibody hub that visualizes worldwide testing efforts. Every single study in Canada, as well as many international ones, will be posted there. This will be the go-to site for learning about the virus’s prevalence across the country.

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