How We Can Wage a Smarter Defense Against Future Pandemics

COVID-19 is not going away, and it is the latest in the world’s pandemics. Undoubtedly, another one will come, and what can scientists and medical professionals do to prepare vaccines for the next pandemic?

Seth Lederman, MD, the CEO of Tonix Pharmaceuticals, a biopharmaceutical company developing new vaccines for COVID-19, smallpox, and mpox (previously known as “monkeypox”), answered that question for Infection Control Today^® (ICT^®). He is well versed in vaccine creation, and his research led to the discovery of the CD40 ligand and its role in T-cell helper function.

ICT^®: In a new age of pandemics, how can we wage a smarter defense?

Seth Lederman, MD: Our daily news is crowded with updates on overlapping health emergencies in America. Researchers are modeling a winter COVID-19 wave fueled by new subvariants as cases climb in Europe and mpox outbreaks reach more than 100 locations where it is not endemic. There is no shortage of speculation about the next pandemic, and we still can’t shake COVID-19. If sluggish uptake of new boosters continues, projections suggest the United States could average up to 4,500 weekly deaths or more this winter.

As we look ahead to the next public health threat, there’s a great deal that we’ve learned since SARS-CoV-2 swept the world almost 3 years ago. Indeed, we also have lessons dating back to the fight against HIV/AIDS, which is when my work in molecular virology began. It’s a mix of hard-earned reality about immunity, vaccines, and long-term consequences we would be foolish to ignore.

ICT^®: Why isn’t immunity easier to achieve?

SL: There are 2 primary ways our immune systems protect us—antibodies and T cells—and the most effective vaccines rely on both. Our first-generation mRNA vaccines recruit antibodies to ward off COVID-19 infection, but only for a few months. The problem is we need T cells to achieve more durable protection, recognize variants, and block forward transmission. Hence, the pandemic is not over, hundreds of Americans are still dying every day, and the virus continues to strike with more immune-evasive variants constantly gaining ground. Our “whack-a-mole” approach has given way to a motley soup of variants spreading exponentially as hospitalizations rise once again.

We all may have pandemic fatigue, yet SARS-CoV-2 is still busy mutating. People keeping up with the guidelines have now had at least 4 shots since vaccines became available. And even the well-vaccinated are getting infected and reinfected. While current COVID-19 vaccines gave us breathing room and saved many lives, they have not landed a definitive knock-out punch. If we continue relying on perpetual boosters, we will remain in a forever war against COVID-19. If we instead apply our ingenuity and resources to make better vaccines, we can truly end this pandemic—and critically, build the platforms that prepare us for the next one.

ICT^®: What do we need vaccines to do to better protect those who receive them?

SL: We must be smarter about the limitations of some vaccines. For instance, the World Health Organization has warned our mpox vaccine is not “a silver bullet,” in part because it doesn’t block forward transmission. Similarly, it was premature to stop developing more robust COVID-19 vaccines after releasing mRNA shots. But it’s not too late to send COVID-19 into retreat. The possibilities include live-virus vaccines like the ones that eradicated smallpox and protect us from measles, mumps, and rubella; intranasal and oral delivery routes are also being considered. One promising technology is a “chimeric” approach combining a SARS-CoV-2 antigen to target the spike protein with a live-virus backbone that produces T-cell immunity.

What matters most is following the science further. There is no herd immunity from COVID-19, either from natural infection or current vaccines. In fact, contracting COVID-19 confers only short-term immunity to those individuals who recover, similar to the protective benefits from current vaccines. This is why we see people getting second and third cases of COVID-19 only weeks after their last bout. The bottom line is to battle any virus successfully, we need vaccines that do 3 things: block forward transmission, provide long-term protection, and protect more broadly against variants.

ICT^®: What should we do now?

SL: Complacency has unrelenting long-term consequences. The history of HIV/AIDS is replete with the tragic results of inaction. We’ve known about mpox since the 1950s, yet outbreaks are surging because countries like ours largely ignored the potential threat, just as we did with Ebola and Zika. And now we have a trailing epidemic of long COVID-19, a disabling syndrome that warrants its own government research agenda. As many as 23 million people in the US are suffering from long COVID-19, a number that potentially increases with every COVID-19 infection.

Once we build a lasting infrastructure for next-generation COVID-19 vaccines and large-scale production, we will have it to defend against other infectious diseases. We may be on the right track with a 2023 federal budget proposal that includes bolstered funding for pandemic preparedness. There’s also the successful elevation of the U.S. Department of Health and Human Services Administration for Strategic Preparedness and Response to a standalone agency empowered to mobilize against public health emergencies. Along with a recent White House executive order to ramp up biodefense, these steps could significantly increase our capacity for anticipating lethal viruses and deploying life-saving solutions – but only if we leverage the very tough lessons learned from COVID-19.

From more durable COVID-19 vaccines to prevention and treatment for diseases that strike next, it’s time to take urgent action. We need smarter, longer-lasting, and scalable virus-fighting weapons on the front lines for today’s public health crises and those just ahead.