A vaccine might not be enough – we need Covid-19 treatments that work

With every jab in the arm, Britain moves a step closer to defeating Covid-19. That was the message from the prime minister as he imposed another lockdown. It’s a hopeful line - but will vaccines alone truly be sufficient to put an end to this pandemic? I think not.

In the run-up to Christmas, it gave us all a lift to see images of older people, and key workers, smiling with relief as they received pioneering vaccine jabs. The weight off their shoulders is palpable – a burden of worry removed.

Nevertheless, for many scientists, a sense of foreboding remains. Covid-19 has proven to be a nimble, wily virus. Put that together with the fickle nature of human behaviour, the complexity of modern society and experience from medical history and all of my instincts suggest that we need better treatments, as well as vaccines.

We’re all too aware that the mutated form of Covid-19 is more contagious than its predecessor. A further variant in South Africa demonstrates that changes are happening to the virus’s spike protein – the method by which it gains entry to human cells. There is no evidence that either will make vaccines less effective, but there are concerns. This is a wake-up call that this is a living, evolving virus. Future mutations may well require adaptations of the vaccines to keep pace with the changes. That will naturally take time and new cases will continue to require treatment.

We must also recognise the limitations of what government can achieve. The supply of the vaccine is finite, the logistics of a roll-out are complex and costly. And even those who are vaccinated will occasionally get the virus. Hence the need for alternative treatments is even more important.  

Simply stated, the SARS CoV-2 virus has taken advantage of human susceptibility and simultaneously has evolved to evade protective immunity. We need new treatments that can handle this. With drugs narrowly targeted at a specific virus, Covid-19 will inevitably mutate to bypass their blocking effects just as has happened with selective antibacterial treatments in the emergence of antimicrobial resistance.

As an example, work at the University of Southampton has identified a naturally occurring protein, interferon beta, as a potential game-changer targeting the very molecular pathway this coronavirus is trying to evade. When delivered via an inhaler, interferon beta, a well-known and safe drug already used to treat multiple sclerosis patients, prevents SARS CoV-2 from damaging the lung and creating the cascade towards severe disease, no matter which mutant variant shape the virus is taking.  

Initial clinical trials suggested the odds of patients developing serious disease were reduced by between 72 per cent and 82 per cent, and that those admitted to hospital were more than twice as likely to recover. Inhaled interferon beta could markedly cut the number of patients admitted to NHS hospitals. It could be helpful in care homes too.  

Scientists from around the world have contacted Synairgen, a company I co-founded from Southampton University, to find out more – but in Britain, these developments have been overshadowed by excitement over vaccines, with novel treatments still struggling to make progress in clinical trials.

The government is focusing a lot of its efforts on a hospital trial called Recovery, which has 21,000 patients so far across 176 NHS hospitals and is looking at a handful of prospective, mostly “off the shelf” treatments.  

The Recovery study identified last year that dexamethasone, a steroid treatment, could cut deaths by as much as a third in intensive care. A number of other concepts, including use of blood plasma from convalescent patients and aspirin, are being assessed. Recovery is a tremendous platform – but we need an ecumenical approach.

Britain has one of the finest drug development industries in the world. We’ve proven that we can be a global leader in creating and deploying novel approaches in the life sciences. There’s a real opportunity to show global leadership in potential Covid-19 breakthrough treatments too.

Great strategies often disintegrate when confronted with reality, and who knows, the aim of controlling the virus by the spring using vaccines alone might yet come unstuck. Not much, to date, has gone to plan in this crisis.

It is absolutely essential that, as a nation, we prioritise research into helping sick people get better, as well as preventing them from getting ill in the first place. Covid-19, in one form or another, is with us to stay. All of us recognise the real human suffering in front of our eyes, so we really do need proven better treatments than those being currently offered.

Sir Stephen Holgate is a professor of immunopharmacology at the University of Southampton. He chaired the Academy of Medical Science’s advisory group which prepared a report for the government, “Preparing for a challenging winter, 2020/1”.