Couples who have been unable to get married because of the coronavirus lockdown have had their wedding insurance claims rejected in some cases despite being assured they were covered before buying their policy.
The Guardian has heard from people who have lost thousands when claims were turned down by provider WeddingPlan Insurance.
Lidia and her partner Adam were due to get married on 4 April, after the lockdown had begun.
They became concerned that their plans would be affected in early March and looked for insurance that would offer cover against cancellation due to coronavirus. After checking with WeddingPlan that they would qualify, they bought a 57 policy and made payments to caterers and other suppliers.
On 21 March the venue told us they would not be able to hold our wedding because they couldnt guarantee the safety of staff, Lidia says. Then on 23 March came lockdown, and everything was officially shut down.
They asked about a new date next summer, but the price will be much higher. The caterers said they had prepared most of the food and they will not survive if they give a refund.
The couple, who marked their planned wedding day with drinks in the garden and a Zoom call with friends and family, made a claim for just under 10,000 to cover costs they cannot recover. Emails seen by Guardian Money show they were told they could make a claim if the wedding had to be cancelled as a result of an infectious disease. The rejection says they wont pay out because the venue was closed as a result of a government act, she says. But the cancellation was made before the legislation went through.
Others have had their claims turned down. Debenhams wedding insurance customers appear to be in the same position, as both brands are operated by UK General. Many bought their policies last year but others paid on the basis that they would get coronavirus cover.
The competition watchdog has warned venues over refusing refunds, but some of those claiming have been told that expenses already accrued cannot be reimbursed.
Screengrabs suggest WeddingPlan changed its advice. In an FAQ section on its website in late March, it said: If the government or relevant body cancels all public gatherings due to coronavirus, would the cancellation or postponement of my wedding be covered?. The response is: Yes, if the venue was closed due to general outbreak of infectious disease, where the government issues a notice, this would fall under closure of the venue by the relevant authority.
Many, like Lidia, had also been reassured by email and phone.
Annie was due to get married on Saturday 21 March before the lockdown began but the day after the government announced pubs and hotels would have to close. The photographer pulled out because he was in the vulnerable group, and the guests were dropping like flies, she says. So they checked with WeddingPlan, and were assured they would be able to claim.
After setting up the venue on the Friday, they watched the press briefing announcing the first round of closures, and at 7pm got a call to say the venue would have to close. The couple had planned a church wedding and, with family gathered for the event, they called the insurer to ask if they could still claim for loss of the reception if they went ahead with the legal part of the day. Thanks to a vicar with a tape measure, they were allowed to marry, but with none of the celebrations.
We arent claiming for a photographer, because we had pictures of the ceremony. We are claiming for flowers for the table, but not for the bouquets. But it was too late to postpone, so we had to pay for the food and the venue.
Their 20,000 claim has also been rejected because the insurer said the venue was forced to close by a government act. They contest that, saying the law did not come into effect until after their wedding date, and that the insurers website initially said it would take claims in these circumstances. We havent had the wedding we planned, and we have paid full price for it.
UK General says it did not underwrite the policies and was a distributor of a number of insurance products so we do not have the final say in whether or not a claim is paid.
It adds: We acknowledge that our customers expect to be able to make a claim on their wedding insurance policy as a result of having to postpone their wedding, and when their claim is turned down it is extremely upsetting ... A pandemic cover, for situations such as for Covid-19, was not written into wedding policies, and policies were thus not priced to cover pandemics. The policy is intended to cover localised issues, such as a local authority closing a specific venue following an outbreak of food poisoning. A government-imposed lockdown is not, and was never intended, to be part of the cover provided under this policy.
UK General says anyone who has had a claim turned down can use its complaints process and the Financial Ombudsman Service.
Couples who put down deposits for weddings that have had to be cancelled due to the lockdown have faced aggressive demands from venues to pay their final bills which can easily be 12,000-17,000 for a wedding that can no longer take place.
Faced with such a demand what should you? James Cronin, a director at the Cheltenham law firm Eight Legal, advises couples against handing over any more money. Instead, he says, they may want to argue that the original contract to provide the wedding venue has been frustrated.
If a contract exists for a wedding or holiday which is now impossible to perform in a way that resembled the original terms agreed between the parties in any meaningful way, a letter arguing that the contract has been frustrated and referring to the Law Reform (Frustrated Contracts) Act 1943 may well help, he says.
Frustration applies when an unforeseeable event would make it impossible to perform the contract at all or on terms which bore any real commercial resemblance to those agreed between the parties. If one party has benefited considerably prior to the frustrating event covid cancellation - a judge is allowed to apportion some or all of the benefits to the other party if this would result in a fair outcome.
Consumer rights group Which? says it has received complaints from couples about wedding venue cancellations.
It is unacceptable that some venues are refusing to provide any refund of couples significant upfront deposits or charging customers extortionate fees, particularly when it is not the couples decision to cancel, said Adam French, consumer rights editor at Which?.
While many businesses will be struggling during this difficult time, it does not seem fair for customers to be charged fees or left thousands of pounds out of pocket for a service the venue cant deliver.
Miles Brignall
"You may," responds a Hong Kong official, who is still wearing his mask.
Moments later, Rana and I exchange rings, sign government documents, and share a brief kiss. Amid the uncertainty of the coronavirus pandemic, Rana and I have just gotten married.
On the other side of the planet, our families and friends in the US, Lebanon and elsewhere watch the little civil ceremony in Hong Kong streamed live on Instagram, sprinkling the video with hearts and emojis and other social media expressions of happiness.
Before leaving the wedding registry, we put on his and hers surgical masks adorned with the titles "Mr." and "Mrs."
This was not what we expected, when I first asked her to marry me on a freezing night in New York City last December.
At the time, we were both jet-lagged after the long flight from Hong Kong, where we live and work. We were also deliriously happy, posing in front of a glowing fountain alongside my sister and brother-in-law, who conspired with me to take surprise photos of the occasion.
Basking in that happy moment, we had little clue that a deadly new strain of pneumonia had just been discovered in a city called Wuhan in China -- and the next four and a half months of our lives became our Engagement with Coronavirus.
Neither of us are strangers to crisis.
Rana grew up in Beirut in a civil war. At a young age, she suffered the loss of her father, one of many tragic victims of that conflict.
While my childhood was much more comfortable, 20 years of reporting overseas exposed me to the grim realities of war, natural disaster and political instability.
Still, neither of us had ever been confronted by a modern-day plague of global proportions.
The wake-up call came at the end of January, when the Hong Kong administration canceled schools, shut down public recreation centers and issued work-from-home orders to civil servants. The coronavirus outbreak in Wuhan had spread across China, and the first cases had been detected in the semi-autonomous cities of Hong Kong and Macau.
Hong Kongers didn't mess around. Immediately, the whole city started wearing masks.
We did too, when we went to the Births, Deaths and Marriages Registrations Office in early February to apply for a date to get married.
Friends and family back home called to express concern about our health. But they spoke about the epidemic as if it was some distant threat, an "Asian" problem that would never reach their shores.
As Rana became more and more worried, I remained naively optimistic -- until a reporting assignment in South Korea at the end of February.
At that stage, South Korea had the most confirmed coronavirus cases outside mainland China. In early March, thousands of Koreans were testing positive on a daily basis. Governments increasingly imposed international flight restrictions. Seemingly overnight, my hotel in Seoul became eerily empty.
On March 10, the only way to get from South Korea back home to Hong Kong was to fly absurdly long distances via London. On the flight from South Korea, CNN cameraman Tom Booth and I were shocked to see British Airways crews operating without any protection. No one checked our temperature during the layover at London's Heathrow Airport. Britain apparently behaved as if this deadly disease wasn't happening.
Upon arrival in Hong Kong, health authorities put me on two-week mandatory medical surveillance. I was to check my temperature twice daily and report immediately if I came down with symptoms. Though authorities advised against it, Rana insisted on staying by my side throughout the 14 days. Fortunately, neither of us got sick.
Making the best of it
Then, throughout March, Covid-19 spread like wildfire across the Middle East, Europe and North America. Suddenly, Rana and I were far more worried about our parents in the US and Lebanon, than we were for ourselves in Hong Kong.
For two people who have lived almost all of our adult lives overseas, a sickening realization set in -- we could no longer count on jumping on a plane to fly home to our loved ones in the event of an emergency.
Yet amid the anxiety and fear, a silver lining emerged.
In this pandemic, we had each other. Social isolation meant a pause in business travel and long work deployments.
With our little rescue cat, our small family settled in for weeks of working from home in pajamas followed by cozy home-cooked dinners.
The coronavirus forced us to stop and count our blessings. The entire world has been taught a giant lesson in humility, a reminder that we are subject to forces and events that we cannot control. Nothing -- neither our health, the roof over our heads, nor the food on our table -- can be taken for granted.
At the same time, life must go on.
"After all, your grandparents got married during World War II," my mom pointed out.
She is very right. My grandparents, two refugees from the civil war in Russia, started a family amid the horrors of Nazi-occupied France.
Compare that to me and Rana, who spent much of our engagement on the couch watching "Tiger King" (among other things).
So far, we have had it so easy. A week before the wedding, however, disaster struck. Rana's 84-year old grandmother suffered a stroke. She was taken to intensive care in Beirut and had brain surgery.
There was nothing we could do. Even if there was some way to fly to Lebanon, Rana would not dare exposing her family if she picked up an illness on the plane.
Thankfully, Rana's teta stabilized after the operation. She's a tough lady.
Finally, our wedding day arrived in May. We wore surgical masks with "bride" and "groom" written on them in marker to the registry.
The city's coronavirus guidelines allow up to 20 guests at a wedding. We had eight.
There is no time for vows to be exchanged during the 15-minute civil ceremony -- although in some ways, we didn't need them.
After our engagement with coronavirus, we know we will be there for each other, no matter what the future may bring.
Written by Amitabh Sinha, Edited by Explained Desk | Pune | Updated: May 9, 2020 2:22:04 pm Fridays Coronavirus count of new cases was a little less than the previous day, and it is now the first time in two weeks that the daily count has declined for two consecutive days.
Odisha saw its highest single-day surge of Coronavirus cases so far, reporting as many as 78 new cases on Friday to take its tally to 287. The state had been reporting low numbers of Coronavirus infections till now, but in the last two days 107 cases have been discovered, mainly amongst the migrant workers returning from other states, triggering an alarm in Bhubaneswar.
More than 80 per cent of the states cases, 240 of the 287, are concentrated in the five districts of Ganjam, Khurda, Jajpur, Bhadrak and Baleshwar. These are the areas that have received maximum number of returning migrant workers. About 8000 workers have returned to Ganjam in the last few days, and suddenly, the districts Coronavirus count has shot up. 79 of the 83 cases in Ganjam, now the worst affected district in Odisha, were discovered in the last three days.
In the country as a whole, 3340 new cases were discovered on Friday, taking the total count of confirmed Coronavirus infections to 59,564. Fridays count of new cases was a little less than the previous day, and it is now the first time in two weeks that the daily count has declined for two consecutive days, even though by a small amount. On Thursday, India had added 3355 new cases, which was 175 less than the previous day, and Fridays count was 15 less than Thursday. Coronavirus LIVE Updates
Kerala discovered its first case in three days, just one patient in Ernakulam. The state now has 503 confirmed cases, 484 of whom have already recovered.
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Tamil Nadu continued to add new cases in large numbers. On Friday, the state discovered 600 new cases to take its tally to 6009. The number of cases has tripled in the last ten days, from 2058 on April 28 to 6009 now, thanks to the discovery of the Koyambedu market cluster in Chennai, and the states aggressive testing in the last few days. Tamil Nadu overtook Maharashtra on Thursday to emerge as the state that has conducted the most number of tests in the country. On Friday, it consolidated its lead further, carrying out 13,980 tests to Maharashtras 10,245. Tamil Nadu has now done 2.16 lakh tests, while Maharashtra, which has three times greater caseload, has done 2.12 lakh.
At least 95 deaths were reported from the country on Friday, 39 of them from Maharashtra and 24 from Gujarat. The death toll in the country has now crossed 1950. Some doubts have been raised about the number of deaths being reported by Delhi, after a few hospitals in the Capital reported many more deaths than officially acknowledged so far. According to data put out by Delhi government, there have been 68 deaths in the Capital so far. But the total of the numbers reported from five of the biggest COVID hospitals in Delhi add up to at least 116. Delhi government bulletins have reported only 33 deaths from these hospitals. Delhi government officials maintained that a death audit committee set up by it was investigating every death, and was reporting the data accurately and transparently.
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Ventilators have become the single most important piece of medical equipment for critically ill coronavirus patients whose damaged lungs prevent them from getting enough oxygen to vital organs. The machines work by forcing air deep into the lungs, dislodging the fluid and accumulated pus that interfere with the exchange of oxygen, a process orchestrated by tiny air sacs known as alveoli.
Lungs are complex organs that deliver oxygen to the bloodstream and keep organs functioning.
Human lungs are spongy vessels made up of millions of microscopic, balloon-shaped air sacs called alveoli, the workhorse of the respiratory system where the exchange of gases takes place.
A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.
A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.
A single alveolus, no bigger than the width of a human hair, is ringed by a mesh of tiny capillaries that transport oxygen to the bloodstream.
Ventilators are not a cure for Covid-19 patients, but mechanical breathing assistance can keep patients alive while they battle the infection.
Critical care ventilators are more than just air pumps. They are finely tuned machines with software that must be constantly adjusted by skilled medical workers to ensure that patients receive the right combination of oxygen level, pressure, breath volume and breathing rate.
Non-coronavirus patients on ventilators have about a 50 percent survival rate. The mortality rate for coronavirus patients on ventilators is not yet clear in part because, with no proven method of treatment for the virus, coronavirus patients are often being kept on these machines for weeks in order to keep them breathing long enough to give their lungs a chance to heal.
Exhaled air is filtered for viral particles
Air supplied to the patient
contains 21-100% oxygen
Air supplied to the patient
contains 21-100% oxygen
Exhaled air
is filtered
for viral particles
Intubation is fraught. Patients must be heavily sedated to allow doctors to insert a breathing tube into the lungs and to prevent them from waking up and pulling out the tubes. Because too much air pressure can damage the lungs, intubated patients must be constantly monitored.
Fears of a ventilator shortage in New York and the poor prognosis for intubated patients have helped spur innovations for sustaining patients without relying on critical care ventilators.
Health care providers have embraced a maneuver that has long been used for ventilated patients periodically turning them on their stomach to increase lung capacity. Proning, as its called, opens up areas of the lungs that are normally compressed by the weight of the heart when lying on ones back. Doctors are currently studying whether using proning for some patients in respiratory distress can allow them to recover without being placed on ventilators.
Flipping over patients in acute respiratory distress, doctors have discovered, can markedly increase oxygenation. The process can be labor-intensive, however, requiring staff to turn over patients several times a day.
Medical workers have increasingly turned to CPAP and BiPAP machines, inexpensive air pumps used by millions of Americans with sleep apnea, chronic obstructive pulmonary disease and other breathing disorders. Hospitals have been repurposing unused machines and using them both with or without intubation to send pressurized air into the lungs of coronavirus patients.
Soft and transparent plastic helmet
holds positive pressure inside
Room oxygen
supply option
Soft collar
seals helmet at the neck
Plastic helmet
holds positive
pressure inside
Room oxygen
supply option
To reduce the risk of infection for hospital workers, doctors have also been fitting patients with jury-rigged helmets that deliver oxygen via CPAP machines while filtering out exhaled viral particles. The helmets were pioneered by Italian doctors forced to improvise because of a shortage of intensive care ventilators.
Poll worker Patty Piek-Groth, left, helps fellow poll worker Jerry Moore, center, put on a mask to prevent the spread of coronavirus, as the polls open for the presidential primary election at the Janesville Mall in Janesville, Wis., on Tuesday, April 7, 2020. Hundreds of voters in Wisconsin are waiting in line to cast ballots at polling places for the state's presidential primary election, ignoring a stay-at-home order over the coronavirus threat. (Angela Major/The Janesville Gazette via AP)
Its been four months since researchers in China sequenced the novel coronavirus now known as SARS-CoV-2. In those four months, at least 3.8 million people around the world have been diagnosed with Covid-19, the deadly respiratory disease it causes. As of Friday morning, more than 267,000 people have died. Doctors have been trying lots of existing drugsfrom malaria medications to anti-influenza pills to Ebola treatmentsin an effort to save patients from the ravages of the disease, which can damage the heart, kidneys, brain, and lungs. But so far, no blockbusters have emerged. Researchers are still testing hundreds of potential candidates in search of a cure.
Here's all the WIRED coverage in one place, from how to keep your children entertained to how this outbreak is affecting the economy.
A vaccine, which would teach peoples immune systems to recognize and fend off the virus before an infection can take hold, would be even better. An inoculated public could get back to work, stop sheltering in place, resume normal life. Developing a safe, effective vaccine against a new pathogen typically takes years, if not decades. Thats because, unlike with experimental treatments, its impossible to know right away if a vaccine has worked. During testing, researchers have to wait for participants to encounter the real virus in the wild, which if people are sheltering in place or an outbreak has ended, can take a very long time.
Clinical testing generally has three stages: Phase I involves a few dozen healthy volunteers, Phase II expands to several hundred in an outbreak area, and Phase III repeats the experiment with several thousand. Then US Food and Drug Administration officials must review the data and decide if the shot is safe and effective enough to approve.
But in the face of the current global pandemic, scientists, pharmaceutical companies, and regulators are sprinting at record-shattering speeds to test hundreds of vaccine candidates. Without clinical trial data, its impossible to predict which contenders will emerge from the onslaught of experiments as the most successful. For the front-runners, that information could arrive as early as this fall. Heres what you need to know:
Phase II candidates: Moderna gets the green light, joining Oxford group and CanSino Biologics
On Thursday, Boston biopharma company Moderna announced that its vaccine candidate, mRNA-1273, had been cleared by the FDA to move into a Phase II trial. The study, which will begin enrolling 600 participants in the coming weeks, is designed to begin assessing whether or not the potential vaccine can induce a persons immune system to produce antibodies that recognize SARS-CoV-2.
With the news, Moderna pulls neck and neck with the current coronavirus vaccine leader: Oxford Universitys Jenner Institute. Scientists there had a head start, as The New York Times reported last month. Having already acquired safety data from human trials of similar vaccines for the related coronavirus that causes MERS, Oxford researchers convinced British regulators to push forward with a large Phase II study involving 6,000 people while the outbreak in the UK is still raging. The vaccine is based on a technology that involves genetically modifying a harmless virus to create a SARS-CoV-2 look-alike that doesnt cause disease but does trigger an immune response.
Modernas vaccine candidate, which was developed in collaboration with scientists at the National Institutes of Allergy and Infectious Disease, is made out of messenger RNA, hence the phrase mRNA in the vaccines name. This molecule is responsible for carrying the genetic recipes for making different proteins to a cells protein production factories. The version inside Modernas vaccine carries the instructions for making a little bit of the spike protein that SARS-CoV-2 uses to infect human tissues. The idea is that a vaccine recipients cells will produce this partial spike protein, which will train their bodies immune systems to recognize the virus and attack it the next time it shows up.
Similarities, differences between 1918 and 2020 pandemics
In many ways, 2020 is looking like 1918, the year the great influenza pandemic raged. Like then, science is unable to crush an insidious yet avoidable infectious disease before hundreds of thousands die from it.
The availability of a vaccine for the novel coronavirus willlikely playakey rolein determining when Americans can return to life as usual. Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, on April 30 announced that a vaccine could even beavailable by January 2021.
Whether a vaccine can end this pandemic successfully, however, depends on more than its effectiveness at providing immunity against the virus, or how quickly it can be produced in mass quantities. Americans also must choose to receive the vaccine.
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According tosomeestimates, 50% to 70% of Americans would need to develop immunity to COVID-19 either naturally, or via a vaccine in order to thwart the spread of the virus. If these estimates are correct, that could mean that nearly twice as many Americans would need to elect to receive a COVID-19 vaccine than those who currently opt to be vaccinated against seasonal influenza.Just 37%of American adults did so in 2017-2018, even in the midst of ahistorically severeflu season.
Making matters more complicated is the possibility that people who hold skeptical views about vaccine safety sometimes referred to as anti-vaxxers will not opt to receive the coronavirus vaccine. According to some estimates, aboutone-fifthtotwo-fifthsof Americans express reservations about vaccine safety. If most of these individuals forego receiving a COVID-19 vaccine, they could potentially jeopardize the recovery process.
RELATED:COVID-19 shutdowns are clearing the air, but pollution will return as economies reopen
One of us is adoctoral candidate, and the other is aprofessor, who both study vaccine resistance. We conducted a study, which is currently undergoing peer review, where we estimate the number of Americans who report being willing to receive a COVID-19 vaccine, once it becomes available. We also investigate the reasons some Americans might refuse the vaccine.
We found that about one-fifth of Americans, and more than half of people who hold skeptical views toward vaccine safety, may be unwilling to pursue vaccination. Although most Americans do plan to get vaccinated, noncompliance rates may be high enough to pose a threat to collective immunity.
Is coronavirus changing minds about vaccine safety?
On the one hand, a pandemic may be encouraging anti-vaxxers tochange their minds. One reason so many Americans doubt vaccine safety is due tocomplacency the idea that, because high rates of vaccine compliance have kept us safe from diseases thatonce reachedepidemic proportions in the U.S., segments of the population can hold anti-vaccine views without endangering public health.
Consistent with this view, research finds that when people are concerned that once nearly eradicated diseases might reemerge to reach epidemic levels, people aremore likely to trust recommendationsfrom public health experts. Additionally,cross-national survey researchsuggests that people who live in parts of the world where the threat of epidemics is more likely tend to hold more positive views toward vaccines than the rest of the world.
Studies based on in-depth interviews with parents further suggest that parents who chose not to vaccinate their children are often willing to accept treatments for children withlife-threatening illnesses.
On the other hand, however, it could be the case that anti-vaxxers remain suspicious of a COVID-19 vaccine, when it becomes available.Prominent anti-vaccine websiteshave already begun circulating misinformation about the COVID-19 vaccine such as the idea that a vaccine has existed for years and has been kept from public consumption. Additionally, recent research suggests that anti-vaccine views are tied to deeply heldpsychological and moral aversionsto inoculation, implying that attitudes may be difficult to change.
Exercising and eating right are vital.
What do anti-vaxxers say now?
We set out to investigate this important question. In a demographically representative survey of 493 U.S. adults conducted on April 15, 2020, we investigated whether people who hold skeptical views toward vaccine safety plan to receive a vaccine against COVID-19.
Specifically, we asked respondents whether they would be willing to get vaccinated against COVID-19 once a vaccine becomes available. Nearly a quarter (23%) of respondents said that they would not.
Additionally, and consistent with the view that even a global pandemic may not persuade anti-vaxxers to get vaccinated, we find that 62% of people who are skeptical of vaccines said that they will forego COVID-19 vaccination.
To assess this, we measured vaccine skepticism by asking respondents three questions about whether they find vaccines to be safe, effective and/or important which is how vaccine skepticism istypically measured. Respondents indicated whether they thought each characteristic described vaccines quite a bit, a moderate amount, a little bit or not at all. We then averaged the score across the three to create a scale of vaccine skepticism.
Nearly one-fifth (19%) of respondents were more vaccine skeptical than not. Among vaccine skeptics, 62% stated that they would not get vaccinated against COVID-19. By contrast, just 15% of those more supportive of vaccines than skeptical said that they would not get the COVID-19 vaccine.
We also asked respondents if they self-identified as anti-vaxxers, and nearly 16% said they did. For those that identified as anti-vaxxers, 44% said they would not vaccinate against COVID-19, compared to 19% of people who did not identify as anti-vaxxers.
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A threat to collective immunity?
We believe that these findings, although preliminary, suggest that many people who hold anti-vaccine beliefs may jeopardize the effectiveness of a COVID-19 vaccine once its available, due to issues of noncompliance. Furthermore, it appears that anti-vaccine sentiment is at least as widespread as it was before the pandemic began.
We caution that a drawback of this study is that it doesnt directly measure changes in vaccine sentiment over time. However, the levels of anti-vaccine sentiment found in this data are comparable to similar levels of anti-vaccine sentiment in the American public before the pandemic, according topreviousstudies. Tracking public attitudes toward a COVID-19 vaccine can help public health agencies better understand who plans to receive the vaccine, and why some people might choose to refuse it.
This article is republished from The Conversation under a Creative Commons license. Read the original article here:https://theconversation.com/a-majority-of-vaccine-skeptics-plan-to-refuse-a-covid-19-vaccine-a-study-suggests-and-that-could-be-a-big-problem-137559.
Right now, the best bridge to a new normal is a successful vaccine against Covid-19. Scientists are racing to develop one on an unprecedented timeline, but it could still take a year to 18 monthspossibly longer.
Vaccines are harder to make than ordinary pharmaceuticals. Typical drugs carry out a specific process in the body, and they only have to work only until the kidneys and liver filter them out. Vaccines, though, have to do a bit of biological catfishing: They dupe certain cells in our blood, called B-cells, into responding to a pathogenic threat that doesnt actually exist.
Tricking those cells into producing antibodies against a disease it hasnt yet faced is a difficult process. Scientists need help from benign viruses and bacteria, gene editing tools, and even copies of the infectious pathogen itselfand sometimes combinations of all three. And right now, scientists are throwing all of these strategies at Covid-19 to see what sticks.
At the time of writing, there are 123 vaccine candidates in various stages in the research pipeline. In a best-case scenario, multiple kinds of vaccines would be found safe and effective, so there would be several options for drug manufacturers and distributers to make and ship across the globe. Heres your guide to understanding the different approaches.
The most effective way (pdf) to generate antibodies against an infection is to actually get sick. The next best option? Show your B-cells a copy of the same pathogenbut genetically modified or kneecapped with a chemical like formaldehyde so it cant cause an infection. These vaccines cancause a minor infection if the virus is merely weakened and still capable of replicating, but its not nearly as dangerous as if it were at full-strength.
Scientists have developed inactivated or weakened vaccines for illnesses like measles, chicken pox, and polio. These vaccines are tried and true, but finding a new one requires a delicate balance: It has to be as close to the actual virus as possible, but not capable of replicating like it normally would.
If for some reason, the virus does start replicating, a perfectly healthy person would become sick. This is why safety testing is so critical for these vaccines. Currently, only two vaccine candidates in this category are in early clinical trials: one being developed by the Wuhan Institute of Biological Products, and one by Sinovac Biotech, which is also based in China.
Instead of showing B-cells the entire pathogen, protein subunit vaccines only show the body partsof the virus. For Covid-19, most developers are going after the spike protein that SARS-CoV-2 uses to enter our cells. The hope is that by showing B-cells that characteristic protein, theyll be able to recognize it on the pathogen itself, too. Itd be like showing your B-cells a novelty bedazzled bowling hat, and telling them to watch out for any invader wearing it in the future.
Protein subunits arent able to turn into a full-blown infection. But the immune responses they produce get weaker over time, which means that a person may require boosters throughout their life. Some annual flu vaccines take the form of protein subunits, as does the HPV vaccine. So far, none of the protein subunit vaccines have made it to testing in humans.
Protein subunit vaccines require manufacturers to genetically modify a microbe, like the bacteria E. coli, to produce the desired protein. Then these proteins have to be purified and mixed with adjuvants, which signal to B-cells to pay attention to them. So to speed up the process, scientists have worked out a way to get the body to produce these desired subunit proteins themselves.
Nucleic acid vaccines use either double-stranded DNA (the same genetic material stored in each of our cells nuclei), or messenger RNA (mRNA). These forms of genetic material contain the recipe for the desired proteins, just like our DNA does (mRNA is genetic material that is just a little farther along in the process). Cells within the body translate this foreign genetic material into target proteins, which B-cells then create antibodies against.
The advantage of this approach is that its relatively fast; once scientists have genetically sequenced a novel pathogen, they can isolate target proteins for the body to recreate. The challenge, though, is getting the body to actually respond to them.
Nucleic acid vaccines made with DNA have to get through the cell membrane and the cells nucleic membrane, which protects your DNA.Those with mRNA only have to get through the cell membrane, but theres still an additional hurdle: Even if the cells make the desired protein, they have to fold it into a shape that resembles the actual viral protein. Its like the difference between using a boxed cake mix to make 12 cupcakes versus two round cakes.
A nucleic acid vaccine has never been approved for use. But one of the leading vaccine candidates for Covid-19 uses this approach. Its an mRNA vaccine created by the Cambridge-based company Moderna, and the US government has already invested millions in it, even though its still in early clinical testing.
Another way to get around B-cells failure to respond to subunit vaccines or nucleic acid vaccinesis to try a hybrid approach: using otherweakened or inoculated viruses to transport genetic material that codes for bits of SARS-CoV-2, the coronavirus that causes Covid-19. The carrier virus can make its way into our cells like other infectious diseases wouldbut once it gets there, it produces SARS-CoV-2 proteins that generate the correct antibody response.
Some of these carrier viruses, called viral vectors, are capable of reproducing to a small degree, while others dont at all. Either way, they shouldnt cause an actual illness. The only reason these vaccines would be ineffective is if the recipient already has some form of immunity against the knocked-out vectormaking it impossible for the virus to enter our cells. One virus that scientists like to use is an adenovirus, for example, which often causes the common cold.
The newly-minted Ebola vaccine, which the US Food and Drug Administration approved in December 2019, is a viral vector vaccine. There are two promising vaccine approaches for Covid-19 using this platform, one by researchers at Oxford University, and one from the drug company Johnson and Johnson.
The last main tactic that developers are exploring is another variation of subunit vaccines. Instead of getting B-cells to recognize only certain viral proteins, virus-like particle vaccines introduce all the proteins on the outer shell of SARS-CoV-2. Its like showing B-cells only the menacing trench coat of a potential pathogen. Underneath the trench coat, though, theres nothingno genetic machinery to reproduce and destroy cells.
Currently, there are no virus-like particle vaccines in human trialsbut Medicago Inc., a company based in Quebec City in Canada, is hoping to start theirs in July.
Donald Trump may be very confident we will have a vaccine for COVID-19 by the end of the year, but the rest of us should be more cautious. Billions of dollars are being spent trying to develop vaccines and treatments as a more permanent solution to the crisis than the lockdowns currently being enforced around the world.
As of May 2020 there are 182 treatments and 99 different vaccines being developed globally. But, based on recent history, only one or two are likely to be transformative, a couple may be partially helpful, some will be shown as downright dangerous, and the majority will have conflicting evidence as to their effectiveness.
This is because medical research is a slow and painstaking process. It is also very complicated and easy to come to the wrong conclusions.
One good thing to have come out of the coronavirus pandemic seems to be a renewed trust in experts. The routine presence of scientists at government briefings seems to recognize that rather than deserving our suspicion, we need these people to beat the virus.
But more trust in experts means more scrutiny of science as it happens the latest studies showing promising results are now headline news. This can be worrying because, while there is no doubt that treatments for COVID-19 will eventually be found, it is easy for enthusiasm to turn into cynicism if expectations are not met as quickly as the public and politicians may hope.
Read: [Will a coronavirus vaccine change the minds of anti-vaxxers?]
There seems to be little recognition that, while thousands of drugs have shown promise in early animal or clinical tests for example, the vaccine trials at the University of Oxford the vast majority that show early promise will never make it into routine clinical use. On average it takes 12 years and over US$1 billion (805 million) to get a drug to market.
I chair research ethics committees. Over the last few years I have reviewed thousands of research protocols representing the very best, and occasionally some quite poor, examples of medical research.
Good research is defined as rigorous and reliable, producing results that are not only interesting but are practical, useful, and in some cases transformative. They are also reported clearly, transparently, and in the context of previous studies. This is precisely the type of research we need to address the COVID-19 crisis.
But such good research comes at a cost. Much of society think of thecost in terms of dollars and pounds, and indeed mindful of our own survival, scientists and researchers are of course always going to lobby for more investment. While it is very helpful to have the funds to order any chemical that is needed, access highly specialized equipment, or pay others to conduct experiments and analyze results quickly, we must take care never to underestimate the importance of taking time to think carefully about what results actually mean.
It is only once researchers have taken the time to understand the context of results that they can start turning them into effective applications or treatments. The real cost of good research is therefore time.
The frustrating truth about medical research is that the majority of experiments appear not to work because the subject being studied is so horrendously complex. In fact, rather than not working, many experiments are simply inconclusive. To make progress you have to slow down, look at the evidence , and take time to think very carefully about what the results might mean.
Positive results in animals often dont translate to scientific breakthroughs for humans. Credits: Shuttershock
The thinking needed for this takes years. I was involved with one project that was delayed for almost ten years while the team tried to work out why a single animal showed cardiovascular complications. Another project I worked on showed promise reducing an Alzheimer-like pathology in mice, yet 18 years later similar effects have yet to be conclusively shown in humans. Commendably, the team is still working on it.
The reality is that the long road to a vaccine or drug for any disease is littered with trials that did not lead to expected results. Even when a study is successful, it takes a long time to go from the lab to the general public.
One worrying aspect of the current situation is the pressure on researchers to work quickly and come up with solutions for COVID-19 almost immediately. For perhaps the first time, financial resources are not a limiting factor, and so politicians and the public are expecting researchers to take the cash and provide the answers. This has been coupled with significant pressure on regulators to streamline or even suspend some of the normal processes so that treatments can get to the clinic as quickly as possible.
Lured by promises of unlimited funding, and perhaps fame should their chosen idea work, some researchers may be tempted to engage in questionable research practices. History shows that whenever a large amount of money is involved, the temptation to commit, fraud, misconduct, or other questionable practices increase. The UK spent more than 400 million during the 2009 swine flu outbreak stockpiling a drug whose effectiveness had been inflated by the manufacturers due to publication bias where negative or inconclusive results from a trial are not published in scientific journals, but positive results are.
Without appropriate scrutiny, there is a real risk that ineffective, or even harmful, treatments begin to get used. This may be considered an acceptable risk in the current crisis, but if so, it is important that any new treatments are monitored very closely and withdrawn without hesitation if the harms mount up.
Given time maybe two, three or perhaps even ten years researchers will be able to take stock of the evidence from experiments and trials, perform a meta-analysis and systematic review, hold international conferences, and then, following careful thought, tell the world what the best treatment for COVID-19 is.
The world clearly needs scientific and medical answers to the current pandemic as soon as possible, but we need to recognize that initially, we may only find partial or tentative answers. Instead of a quick vaccine that completely prevents COVID-19, a variety of partial successes will be combined until eventually a full solution is found.
There may even be some blind alleys with promising, but ultimately futile, treatment ideas. This is not a failure of research, or misuse of resources. Above all, researchers need to be supported to work with integrity, and not be made scapegoats for the challenges that undoubtedly lie ahead.
This article is republished from The ConversationbySimon Kolstoe, Senior Lecturer in Evidence Based Healthcare and University Ethics Advisor, University of Portsmouthunder a Creative Commons license. Read the original article.
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