March 27, 2021
T.The first virus whose genome was read was an obscure little creature called MS2. The 3,569 RNA letters it contained were published in 1976, the hard-won product of ten years of work in a well-staffed Belgian laboratory. The almost nine times longer SARS-CoV-2 genome was released just weeks after doctors in Wuhan first became concerned about a new pneumonia. That feat has since been repeated, devastating 1 million different samples of SARS-CoV-2 in search of terrifying variants like the one in Brazil. Within weeks of its publication, the original genome sequence became the basis for the vaccines that inhibit the virus today, wherever supply, policy and public confidence allow.
It is hardly noticeable that medical science has advanced since 1976. But the Covid-19 pandemic has brought the keen joy of seeing decades of cumulative scientific advancement in sudden, concerted action. The deluge of data, experimentation, and intelligence had a profound impact on the pandemic – and indeed the future of medicine. It’s an inspiration too. Scientists around the world have put their own work aside in order to do their part against a common enemy. Jealously guarded laboratory space was devoted to the grunt work of processing tests. Covid-19 has resulted in around 350,000 research papers, many of them on preprint servers, making results available almost instantly.
All of this is based on the systematic and transformative application of genetics to medicine – not just to understand the pathology of diseases, but to track their spread, cure and prevent them. This approach could underpin so-called “natural security” – the task of making societies resilient to the risks posed by their connection to the living world, whether from disease, food insecurity, biological warfare or environmental degradation.
The application of genetics in medicine partly reflects enormous, rapid gains in efficiency. Reading the DNA in a human genome cost $ 10 million in 2007, now it’s less than $ 1,000 and a fraction of the time. Combined with ever better methods of synthesizing and manipulating genes, this has made possible a wisdom that is hardly miraculous. Before the pandemic, there wasn’t much talk about these breakthrough techniques outside of the laboratory. After proving themselves against a brand new disease, they got out into the open.
Take the vaccination technology quickly developed by Moderna of America and BioNTech of Germany, which is based on years of patient and often unsung work on RNA, a repository of genetic information. It is noteworthy that you can simply tell the body’s cells to make the viral protein that you designed to help boost the immune system. The RNA vaccines are evidence of comedian Eddie Cantor’s realization that it takes 20 years to become an overnight success.
With this proof of concept, the investments made by companies that have worked hard on RNA can now pay off. To some extent, RNA medicine divorces form from function. An RNA vaccine against any disease is a message written in genetic code: a vaccine against malaria or any form of cancer can be made in the same way and with the same equipment as a SARS-CoV-2 vaccine. When this provides a platform to get cells to do all sorts of specific things and distance themselves from others as it promises, medicine becomes both more powerful and more personal. Therapies that target rare, even one-time, genetic abnormalities should become routine.
The pandemic has also shown the value of gene sequencing technologies. Monitoring SARS-CoV-2 while it is mutating is important if the world is to understand and defend against dangerous variants. Should Covid-19 become likely to become endemic, sequencing will become the basis for developing regular booster vaccinations. In a broader sense, routine sequencing is one of the best ways to know what’s out there. Companies have excelled in making high-performance sequencing systems for trained technicians. Now the world needs cheap, ubiquitous and reliable systems that can be deployed in the prison hospital or rural health center, farm or urban sewage plant to act as early warning systems for the spread of pathogens.
Another area of work is that the pandemic has uncovered a loophole. Even with today’s advances, low molecular weight antivirals still need to be produced to combat SARS-CoV-2. A natural safety focus should be drugs that target the virus families most likely to cause problems in the future. The market alone will not support this. New mechanisms involving governments will be required, such as funding for research and development and studies, and for buying supplies of medicines. Similar approaches should also be used for the impending threat from antibiotic-resistant bacteria.
These innovations will have major consequences. All-purpose RNA medicine is placing new demands on businesses and regulators – as are other platforms, including some forms of gene therapy. Regulators need to capitalize on the fact that a malaria vaccine and a SARS-CoV-2 vaccine, for example, are manufactured on the same platform by optimizing approval for them while ensuring safety.
Drug companies are having to adapt as some chronic diseases can actually be cured. Many are used to focusing on the long-lasting ailments that worry the rich world most: heart disease, cancer, metabolic disorders, neurodegenerative diseases, and the like. When drug development is aimed at telling cells what to do rather than finding new molecules against certain proteins, some of the know-how on which old-style pharma is based is less relevant. Companies need new pricing models and a new research focus.
Technology in itself will not thwart pandemics. This goal also requires systems and institutions that use technology broadly and wisely. Without good systems, great technology often produces mediocre results, as is the case with many Covid-19 test-and-trace programs. But the pandemic has shown that biomedical science has the tools and the enthusiasm to make the world a better place. The world must now build on both. ■
All of our stories about the pandemic and the vaccines can be found on our coronavirus hub. You can also listen to The Jab, our new podcast on the race between injections and infections, and find trackers that showcase the global adoption of vaccines, excessive deaths by country, and the spread of the virus in Europe and America.
This article appeared in the Leaders section of the print edition under the heading Post-Pandemic Science.