Why can't medical advances always be this quick?
The Chinese released the genetic sequence of the coronavirus on January 12th. The Medicines and Healthcare products Regulatory Agency (MHRA) approved the use of a vaccine against the virus 11 months later. Preliminary evidence suggests that it is safe and will protect more than 9 out 10 people against an infection which has a 10% mortality rate in vulnerable people. People with other life-threatening conditions, including some with rare cancers, may well be asking- why can’t medical advances be as quick as this for me?
I think there are 3 main factors which have helped to ensure the delivery of a safe and effective vaccine in such a short time.
Viruses are very simple things – a short bit of genetic code wrapped in some protein. They have been around for a long time and our bodies have evolved very sophisticated ways of dealing with them. Our immune system recognises that they are foreign and will mount a response which, in most people, will kill viruses before they cause too much damage. Vaccines prepare this system so that the body already has antibodies and specialised cells primed to fight an infection before it can become established. This can be critical in people who, because of their age or an underlying medical condition, are more susceptible to becoming very ill with a coronavirus infection.
The situation with cancer is very different. Cancer cells “look” very similar to the normal cells in the body and are therefore generally ignored by the immune system- which is why simple vaccines do not work in this case. By their very nature vaccines against infections are always likely to be very effective. Dealing with “an enemy within” like cancer is much more challenging.
Like it or not all companies have an obligation to look after the interests of their shareholders. As vaccines are normally either no longer protected by patents or have very small markets- often in countries unable to pay high prices- drug companies have not usually regarded them as a profitable area for investment. A pandemic affecting rich countries such as the US and the UK is a very different proposition. The rapid development of a new vaccine has required a considerable up-front investment but the return on that investment, particularly in the case of the Pfizer/BioNTech and Moderna vaccines, is likely to be considerable.
The business model for the development of anti-cancer drugs is very different. It is now generally accepted that the days of dreaming of a “blockbuster” drug, active in large numbers of cases, have come to an end with the realisation that cancer is not a single disease but a huge range of diseases- requiring many different treatments. This means that the size of the market is much smaller and as a consequence, by the law of supply and demand, the price is much higher if there is to be any return on investment. Contrast this with a Covid-19 vaccine where the target market is every living person.
The administration of drugs can have very serious consequences and as a result governments have developed a stringent set of measures to ensure that the chances of this happening are minimised. Companies have to produce a large amount of safety data before a drug or vaccine can be used on people and this usually takes a long time to produce and a long time to evaluate. Why has this process happened so quickly in the case of coronavirus vaccines? Have corners been cut? All the evidence suggests that this has not been the case. The vaccines have been approved quickly because the level of investment allowed large clinical trials and studies to be set up and submitted for ethical approval in a matter of weeks rather than months. In the UK, ethics committees have changed the way that they work to turn around applications for research involving coronavirus infection in a matter of days rather than weeks. Finding people willing to take part in the trials was relatively easy because the infection is so common. Finally- the MHRA were in contact with the manufacturers early on in the process so that they were very well prepared before the final documentation arrived. This has been likened to driving across London with all the traffic cleared from the roads and the traffic lights on green.
What can be learnt from this breath-taking experience? A number of measures could speed up the development of new ways of treating rare cancer:
- Making it easier for researchers to access samples from people affected by rare cancer so that they can see if new drugs are likely to be effective
- Making it easier for drug companies to undertake clinical trials by developing a register of people with rare cancer willing to take part
- Encouraging ethics committees to allow people affected by rare cancer accept greater risks based on well-informed decision
- Streamlining and injecting a greater sense of urgency into the approvals process.
Someone is diagnosed with a rare cancer every 8 minutes in this country. For them finding a cure is as important, if not more important, than the introduction of a coronavirus vaccine.