The technology used to develop the Pfizer vaccine could be used to tackle illnesses such as cancer and other infectious diseases similar to Covid-19, leading health experts have said, raising hopes that humanity can take a major scientific “leap forward” in the wake of the coronavirus pandemic.
Oncologists, vaccinologists, biomedical engineers and doctors have all told The Independent that the technological advancements seen throughout 2020 could come to have a “profound” impact on the future provision of care for patients suffering from a variety of conditions.
The developments made in diagnostics, therapeutics, vaccine manufacturing and medical telecommunications are expected to leave a transformative legacy that will endure beyond the pandemic, experts say.
From RNA-based technology that trains the body to fight cancer, to the so-called “factory in a box” – which aims to manufacture 600 vaccine doses in as little as 60 seconds – the pandemic has helped fuel the creation of new and exciting technologies that were thought to be out of reach before the outbreak of Covid-19.
Sir Jeremy Farrar, director of the Wellcome Trust, said: “I think we'll look back on the advances made in 2020 and say that was a moment when science really did make a leap forward, which we will come to celebrate in due course.”
The technology behind the Pfizer/BioNTech vaccine is seen as a notable game-changer.
The jab makes uses of genetic material called RNA which, when injected into human muscle cells, delivers a series of instructions to produce the “spike” protein found on the surface of Sars-Cov-2.
Spotting what appears to be foreign invaders within the body, the immune system springs into action to produce the necessary antibodies and T cells. This process leaves behind a protective memory that enables the body to build up immunity against the coronavirus.
The apparent success of the vaccine, which is said to be 90 per cent effective in preventing the disease, demonstrates that this RNA platform could be used in a similar way in cancer treatments.
“I’m very excited by the power and potential of vaccines, the immune system and cell therapies to prevent cancer, or block its progression when it's been diagnosed,” Professor Charles Swanton, chief clinician at Cancer Research UK, told The Independent.
Research into this treatment has been ongoing for a number of years, while a Nature paper published in August showed that an RNA vaccine was capable of training the immune system in patients with advanced melanoma to tackle cancerous cells.
Prof Swanton said this study remained in progress and that “real efficacy is still to be proven”, but he insisted that the effectiveness of Pfizer’s RNA vaccine was confirmation that the technology works in theory.
He was sceptical that this platform could be used to manufacture enough T cells in the body to overcome late-stage cancer, adding that the “diversification” of the disease over time “outwits” these patients’ immune systems.
However, he suggested that RNA vaccines could potentially be utilised as a prevention strategy.
“There’s also the possibility of using an RNA vaccine to prevent cancer,” he said. “If you stimulate the immune system in advance of the cancer emerging, the patient automatically has an advantage as there are many more T cells.
“Let’s say you’d focus on high-risk smokers. There are 20 or so common mutations in lung cancer. From the patient's genetic coding, you could develop an RNA vaccine that could potentially eradicate cells that are emerging in very small numbers.
“Or, you might able to give the immune system a boost to eradicate those tumour cells before they've got time to evolve further and cause trouble.”
At this stage, he said, it was only speculation. “There is some evidence for this,” Prof Swanton added. “But we’re testing it.”
Zoltan Kis, a research associate at Imperial College London’s Future Vaccine Manufacturing Hub, said the adaptability of the RNA technology meant it could be tweaked and tailored to produce a vaccine candidate for “virtually any disease – including unknown future ones”.
He explained that the process for manufacturing doses of an RNA vaccine is also much simpler compared with conventional technologies.
“The reactors, the purification process, the formulation – everything stays the same, no matter what vaccine is produced,” Prof Kis told The Independent. “Traditionally, you would have to develop a new production line every time you made a new vaccine.”
Although well-suited for provoking an immune response against infections, questions have been raised over the technology’s suitability in treating sick people, because of the fact that the RNA degrades once injected into human cells.
“It's active for some time but then it decomposes,” said Prof Kis. This essentially stops the production of the proteins needed to tackle whatever illness the body is facing, he added.
Nonetheless, the huge leaps in vaccine technology that have been taken throughout 2020 have also forced scientists to revolutionise the ways they produce and distribute large quantities of doses.
Professor Harris Makatsoris, from King’s College London, leads a team that has developed a device they call a “factory in a box” which could provide a new way to manufacture the next generation of vaccines on a massive scale.
The device, which is smaller than a shoebox, uses flow chemistry that recreates the mechanisms in the body to produce any type of RNA vaccine molecule.
Using this technology, it could produce up to 600 doses in one minute, and at a significantly lower cost than a traditional vaccine factory.
“We have shown that it works,” Prof Makatsoris told The Independent. “We can actually produce the RNA. We are mimicking a natural process that happens in the body but in a way that is a larger volume, and the result of that is we can have sufficient production volume to serve the needs of patients.
“The strategy is to have a number of these in a stack to scale up, essentially, to make the quantities that are required.”
He added that the device would be simple to use and could be deployed in GP surgeries or supermarkets with minimal training.
The team are hoping to publish their findings in February and are aiming to apply soon afterwards to the MHRA, the UK’s medical devices regulator, for authorisation that would allow the device to be used.
Across the vaccine industry as a whole, the collaborative response to Covid-19 has helped to streamline the design, testing and production of vaccines – typically time-consuming processes that have now been condensed into a matter of months.
“By doing things at the same time – the discovery work, the manufacturing scale-up, the clinical trials done at pace, rolling reviews from the regulators, thinking about distribution and engagement with health systems – this shows there is the potential to transform these pathways,” Steve Bates, CEO of the UK BioIndustry Association, told The Independent.
“Without the impact of the pandemic, it would have taken many years to unblock. Let me give you one of my favourite quotes: there are decades when nothing happens and weekends when decades happens. We have to carry this legacy forward now.”
Beyond the world of vaccinology, clinicians are hopeful that the shift to online consultation could usher in a new period of medical telecommunications that improves the experience of patients.
Because of the risk of Covid transmission, checkups with GPs and other outpatient services have been moved online, forcing people and their doctors to rely on the likes of Zoom and other virtual platforms.
Despite initial resistance to such a setup prior to the pandemic, the response to this transition seems to be largely positive.
“The trend towards telemedicine where patients are dialled and called up at home – that's made a profound difference to the way we run outpatients now,” said Prof Swanton.
“For well over half of our patients, the follow-up has been done by phone call during the Covid crisis.
“It's not a very efficient way of running a clinic. You can think of a situation where instead of waiting in a waiting room for 40 minutes, patients are at home in the safety of their homes. It'll be much more efficient, much safer and cause less frustration for patients.
“I don’t think there'll be a reversion to previous outpatient practices.”
John Geddes, professor of epidemiological psychiatry at the University of Oxford, said that online consultation was “so much more efficient” but admitted this arrangement would need further evaluation.
“I’m not sure to what extent online sessions do everything that face-to-face consultations do,” he told The Independent. “But just about everyone sees huge benefits. It's about getting it right.”
Despite the advancements that have been made throughout 2020, some have warned against viewing the new emerging technologies as “the panacea” to all diseases.
“We have to be careful that technology doesn’t widen gaps,” Dr Amitava Banerjee, an honorary consultant cardiologist at UCL, told The Independent.
“In my field, we often hear about new drugs or treatments [and] we have to make sure that they're available for all the people who need them. Even within the UK, we still struggle with that.
“With Covid we have found out there are inequalities – whether it's by deprivation or ethnicity – and we've found problems of how to get a vaccine to everyone who needs it.
“Whatever the disease or condition, we still have to figure out how we make sure we understand the underlying causes and make sure the treatments we already have are available and are being taken by the right people.”
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