As we embarked on the one-year anniversary of the COVID-19 pandemic in Alabama, we asked people from across the School of Medicine to take part in conversations about what they had learned from the past year, and what they see when they look ahead to the future. The following are excerpts of those conversations, which have been edited for clarity.
Fran Lund, Ph.D., is the Charles H. McCauley Professor and chair of the Department of Microbiology. In 2020, Lund led UAB’s preclinical testing of AdCOVID, a novel, single-dose, intranasal COVID-19 vaccine candidate developed by Altimmune Inc., which started Phase 1 clinical trials this year. Ellen Eaton, M.D., is assistant professor of Infectious Diseases and creator of the “Dr. Ellen Eaton Coronavirus Updates” Facebook page, which promotes evidence-informed updates on COVID prevention and treatment and amplifies best practices from experts. We asked them to discuss COVID vaccine development and combating misinformation around the virus and vaccines.
Eaton: Dr. Lund, I’m curious how scientists were able to identify the spike protein that we now know is the hallmark of COVID-19, and develop COVID vaccines that target those spike proteins so quickly.
Lund: It seems like it was very quick because a lot of things were already ready to go. First, in the last decade, our capacity to sequence viruses cheaply and quickly has gotten much better, so we already have a large database of viruses that have been sequenced. And second, when the virus infection was first recognized in China, they swabbed people’s noses and sequenced everything they could find, and recognized it very quickly as a coronavirus. Moreover, it looked a lot like a coronavirus that had an epidemic in 2003, which was the SARS-1 epidemic. We knew from that earlier outbreak that the spike protein in the SARS-1 virus was important for it to get into cells.
Because this new virus looked a lot like that one, immediately scientists made the assumption that the spike protein in the new virus was probably doing the same thing. And scientists were able to sequence it really quickly, and start generating reagents to it. That turned out to be really important because in the SARS-1 outbreak in 2003, a bunch of vaccines were made because we didn’t know whether it would come back.
When SARS-CoV-2 came along, we knew what we needed to do right away, and that was a huge advantage that jump-started us by months. But it all came from a lot of basic knowledge about coronaviruses, and our prior experience with a virus that had caused an epidemic but not a pandemic.
Eaton: I think some people are hesitant to get the vaccine because we haven’t done a great job messaging all the stepping stones that you outlined that were key to the vaccines. Yes, it is groundbreaking how quickly we identified COVID and developed effective vaccines. But if you take it in context, you realize that there have been millions of dollars and many, many years spent in poring over similar viruses and vaccines that predated COVID, that really put us in the sweet spot where we were able to rapidly identify and respond to COVID-19.
Lund: A question I get asked is, are mRNA vaccines really novel? No, they’re not—we’ve been working on mRNA vaccines for 30 years, but this is the first time we’ve managed to deploy them so quickly.
mRNA is really unstable, so one problem we had to overcome is keeping it stable long enough to make a protein in a cell. So for almost 20 years, people have been working on how to make it so it doesn’t immediately fall apart. We also had to figure out a way to get it into cells such that your immune system didn’t see it until it was in the cell. And that is why we put lipids around it, or fat, so it could be absorbed into cells and not be recognized by the immune system. Those were the two biggest hurdles: making it stable and getting it past the immune system. That technology really blossomed in the last five years, so it’s just amazing that it was available and that we, as a country, were able to deploy it so quickly.
Eaton: It really is amazing. So how we can chip away at mistrust of the vaccines? I think first we have to understand the roots. There’s been a lot in the lay press on mistrust in the medical establishment among racial and ethnic minorities, especially African Americans, and certainly there are valid reasons for that. But I’m also seeing data that, when offered a vaccine, African Americans are not more likely to turn away than their white counterparts. I think a lot of the disparities in vaccine uptake in African Americans is access, not willingness.
But if you look at groups that are consistently coming up as hesitant in polls, what’s coming out now is along party lines, rurality, and even faith. I’m concerned because in rural states like Alabama we have a lot of those intersecting factors that put people at risk for vaccine hesitancy. If we have slow vaccine uptake, it could potentially be the perfect storm— we dropped our statewide our mask mandate April 9, people are returning to normal, they’re getting more mobile. And we should assume we have virus variants here in Alabama, just due to travel proximity to places that we know have them.
But I should say those polls are also consistently showing that vaccine willingness is going up as we normalize vaccination and as the CDC starts loosening policy for fully vaccinated Americans. So now they’re saying, if you’re vaccinated, you don’t have to quarantine if exposed, you can go visit elderly family members who are fully vaccinated, that kind of thing. I’m hoping we’ll see vaccine willingness trends continue to rise so that by the fall we can send our kids back to school, and maybe we won’t be required to wear a mask for all activities, just some high-risk activities.
That’s why I felt this moral obligation to respond to people sharing misinformation on social media. I’m from a small town in South Alabama, and I bring that up not to paint South Alabama as misinformed, but I think it represents a lot of towns where there’s a huge variation in terms of health literacy. And with that there’s sometimes a mistrust of big institutions and the “big city.” So that’s why I started the Dr. Ellen Eaton Coronavirus Updates Facebook page, because at that point I was getting texts and calls at all hours answering questions from friends and family about, what really is going on, how scared should we be? I started it because I felt an obligation to fill this void of uncertainty with facts and evidence.