Vaccines, COVID-19, and passive immunity

Administration of CoVID-19 vaccines is slowly moving forward and treatments for those with severe symptoms from the virus are constantly evolving. But how is the current CoVID-19 vaccine different from vaccines administered in the past? And what exactly are these treatments?

“Vaccines and CoVID-19: Passive Immunity Now and in the Future,” a presentation by Dr. Roger Kobayashi, a clinical professor of pediatrics at the University of California Los Angeles School of Medicine, answered some of those questions during a recent IDF Forum. 

Dr. Kobayashi covered topics including:

• Vaccine history
• Vaccine types, using the flu and CoVID-19 as springboards to explain why they are necessary
• How different vaccines work, particularly the new technology in the CoVID-19 vaccine
• Herd immunity
•  Allocation of the CoVID-19 vaccine
• Implications of passive immunity

“Vaccines are derived from germs or parts of germs – and in the case of CoVID, we are talking about incredible technology which causes your cells to produce a piece of the virus – which results in your immune system making protective antibodies and stimulating protective T cells, while hopefully not making you sick,” explained Dr. Kobayashi.

The origins of vaccines go back a thousand years ago, said Dr. Kobayashi, when the Chinese, and later the Turks and Africans, used fluid from smallpox pustules to inoculate healthy people. This fluid contained live Smallpox virus, which, if it did not kill you or make you very sick, induced protection from the disease. In 1796, Edward Jenner, an English doctor, used pus from Cowpox pustules to vaccinate a 9-year-old boy against smallpox. In fact, the word vaccination comes from the Latin word meaning “cow”. By the late 1800s, Louis Pasteur developed a vaccine for rabies, and later physicians, most notably Emil von Behring and Shibasaburo Kitasato, developed vaccines for diphtheria, tetanus, cholera, typhoid, plague, and anthrax.

Traditional vaccines, or vaccines that are directly from the germ, include the following:

• Live attenuated vaccines (weakened bacteria or virus) like tuberculosis, oral polio, measles, rotavirus, yellow fever
• Whole inactivated vaccines (killed antigen) like whole-cell pertussis and inactivated poliovirus
• Subunit vaccines (purified antigen-part of the bacteria or virus) like acellular pertussis, flu, pneumococcal, Hepatitis B
• Toxoid vaccines (derived from inactivated toxins from bacteria) like tetanus and diphtheria

Recombinant, or synthesized, “reconstructed” vaccines, unlike traditional vaccines, use manufactured parts or “genetic code” technology which delivers instructions to the patient’s cells to make fragments of the virus to elicit an immune response, resulting in protection.

“This genetic code technology is the most exciting advancement. We take the information, part of the genetic instruction blueprint, from the virus or the bacteria that we want to protect against, and deliver that genetic instruction, either mRNA or DNA, to our cells. Amazingly, that causes our cells to make portions of this pathogenic virus or particle, but cannot cause infection and it is harmless. So this is one of the major benefits of the so-called recombinant vaccines of which CoVID is going to be the main prototype,” said Dr. Kobayashi.

A major advantage of recombinant vaccines is that they can be made quickly. It took only 67 days to genetically isolate the CoVID viral genome and raise fragments to manufacture a potential vaccine. Traditional vaccine technology takes 10 to 15 years to produce a vaccine.

The groundwork and technology for recombinant vaccines date back 30 years. The technology was fortunately in place when CoVID struck, an extremely fortuitous occurrence, pointed out Dr. Kobayashi.

“This technology is absolutely amazing. The antigen produced is uniform, standardized, and pure so attenuating the virus or removing impurities from the manufacturing process with all inherent kinds of technological problems, are diminished,” he said.

But there are drawbacks, he said. The application of recombinant technology is new, and challenges associated with mass manufacturing, shipping, and storage are enormous because some vaccines may require special handling such as extremely cold temperatures in order to remain effective. Also, in some instances, the vaccine may elicit a lesser immune response or, conversely, elicit adverse responses. Scientists have worked very hard to mitigate these short-comings.

“Until CoVID, the new recombinant technology has been employed primarily in cancer. It really hasn’t been utilized on a wide scale for infection in the human population. There are experimental HIV vaccines, and Ebola vaccines, but we really have not used it on a wide scale, so the CoVID will be the first one,” said Dr. Kobayashi.

“On the one hand, it is exciting and miraculous. On the other hand, naturally, there are concerns and fears because it is new technology.”

Dr. Kobayashi then detailed the effects of both the flu and CoVID on the human population. While the flu is an avoidable and controllable disease, thanks to vaccines, anti-virals, and acquired immunity, no one had prior immunity to CoVID which caused it to spread unchecked and resulted in a tenacious foothold in the U.S. as is evidenced by the mounting cases and deaths.

Some facts about the flu include:

• It’s a seasonal winter respiratory virus
• There is a vaccination available
• There are approximately 20,000 to 41,000 deaths per year, despite vaccination (which only half the population opts for each year), anti-virals, and frustrating mutations within the flu virus, which, if significant, will evade existing immunity
• Ninety percent of deaths are in the elderly, but increased mortality in pregnant women, infants, and those with chronic diseases
• It’s highly contagious
• The flu tends to hit the children first who then spread it to adults
•  Incubation time is three to four days
•  Most of the population has some herd immunity

Some facts about CoVID-19 include:

• Humans had no prior immunity
• Deaths could exceed 400,000 by the winter
• Contagious
• Surveillance and tracking is very difficult
• Vaccines are just beginning to be administered
• Most patients may have little or no symptoms, yet still carry the virus
• Incubation is five to 14 days, but most stop shedding by day 12
• Attacks the lungs and heart but may affect multiple other organs
• Affects kidneys, blood vessels, clotting and can cause aberrant, catastrophic activation of the immune system including cytokine storm, inflammation of the blood vessels, and Kawasaki-like syndrome in children
• In some individuals, recovery may be prolonged, with a post-viral syndrome resulting in fatigue, headaches, muscle and bone pain, and cognitive dysfunction. Others might experience POTS-like (a blood circulation disorder) symptoms with dizziness, lightheadedness, racing heart, fatigue, and chest pain
• In other patients, the virus may cause the immune system to malfunction, resulting in autoimmunity

“The bad thing is that people may be infectious and not sick, and this issue is causing great concern. The other problem is that our surveillance protocols have been wanting, so we don’t know where clusters of infection are or who is carrying the virus until someone gets sick,” said Dr. Kobayashi.

Dr. Kobayashi said the United States, perhaps the most advanced country in the world, should not have hundreds of thousands of people dying from CoVID.

“In my opinion, we have not done a good job,” he said.

Eventually, commercially available IVIG/SCIG will contain anti-CoVID virus antibodies as a result of plasma donors receiving the vaccine or through immunity acquired from natural infection.

Perhaps also, artificially manufactured monoclonal anti-CoVID antibodies might be added to IVIG/SCIG to insure high-titer products.

“This might be a Star Trek dream, but maybe not,” said Dr. Kobayashi.

A consulting physician with IDF for 40 years, Dr. Kobayashi maintains a positive attitude about the future of our struggle with CoVID.

“While CoVID is worse than the flu, I strongly believe that with the help of our scientists, health professions, and others, and the support of people, we shall overcome,” said Dr. Kobayashi.

Click here to watch to the presentation.