TIT’S THE FIRST the virus to read its genome was an obscure little creature called MRS2; 3,569 th most common RNA the letters it contained were published in 1976, a hard-earned product of ten years of work in a well-employed Belgian laboratory. The SARS–CoVGenome-2, nearly nine times longer, was released just weeks after doctors in Wuhan first became concerned about new pneumonia. That feat, meanwhile, was repeated by obtaining a million different samples SARS–CoV-2 in the hunt for terrifying variants like the one ravaging Brazil. Within weeks of its publication, the original genome sequence became the basis for vaccines that today stop the virus wherever stocks, policies and public confidence allow.
It’s not hard to notice that medical science has moved on since 1976. But the covid-19 pandemic brought sharp joy at seeing decades of cumulative scientific progress in sudden, coordinated action. A series of data, experiments and insights have had profound effects on the pandemic – and indeed on the future of medicine. It is also an inspiration. Around the world, scientists have set aside their own work to do their part against a common enemy. The jealously guarded laboratory space is dedicated to the grumpy work of processing tests. Covid-19 has led to about 350,000 bits of research, many of which are found on the preprint servers they find available almost instantly.
The basis of all this is the application of genetics to medicine in a systematic and transformative way – not only in understanding the pathology of the disease, but in monitoring their spread and treatment and prevention. This approach could support what is becoming known as “natural security” – the task of making societies vulnerable 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 to medicine partly reflects huge, rapid gains in efficacy. Reading DNA in the human genome in 2007 it cost $ 10 million, today it takes less than $ 1,000 and a fraction of the time. Coupled with ever-improving ways of synthesizing and editing genes, this has made the mind’s mind a little miraculous. Prior to the pandemic, these monitoring techniques were not much talked about outside the lab. Demonstrating their ability against a completely new disease, they broke out in the open.
Take the vaccination technology quickly developed by Modern from America and BioNTech from Germany, building on years of patient and often unsung work on RNA, a storehouse of genetic information. It is amazing that you can easily instruct the body’s cells to make a viral protein that you designed to prepare the immune system. The RNA vaccines are proof of the insight of Eddie Cantor, a comedian, that it takes 20 years to become an overnight success.
With this proof of concept, the investments of companies that have worked hard RNA maybe it pays off now. To some extent, RNA medicine is divorcing from function. An RNA vaccine against any disease the message is written with a genetic code: a vaccine against malaria or some form of cancer can be made in the same way and with the same equipment as SARS-CoV-2 vaccine. If this provides a platform to guide cells to do all sorts of certain things and to give up others, as promised, medicine will become both more powerful and more personal. Therapies tailored to rare, even one-off genetic abnormalities should become routine.
The pandemic has also shown the value of gene sequencing technologies. Observation SARS-CoV-2 because it mutates is essential if the world wants to understand and defend itself against dangerous variants. If covid-19 becomes endemic, as is likely, sequencing will become the basis for the development of regular amplified images. Broadly speaking, routine sequencing is one of the best ways to find out what’s out there. The companies have done a great job in producing powerful sequencing systems for trained technicians. The world now needs cheap, ubiquitous and reliable systems that can be used in a prison hospital or in a rural health center, on a farm or in city sewage plants, to act as early warning systems for the spread of pathogens.
The second area of work is where the pandemic has revealed a gap. Even today’s progress has not yet produced antivirals with small molecules to fight SARS-CoV-2. The focus for natural safety should be on drugs targeting viral families that are likely to create problems in the future. This is not something that the market will support on its own. New mechanisms involving governments will be needed, such as funding for R&D testing and for the purchase of stockpiles of medicines. Similar approaches should also be used to threaten antibiotic-resistant bacteria.
These innovations will have major consequences. General purpose RNA medicine is asking new things from companies and regulators – as well as other platforms, including some forms of gene therapy. Regulators will have to take advantage of the fact that, say, a malaria vaccine ia SARS-CoV-2 vaccines are developed on the same platform, simplifying their approval, while ensuring safety.
Drug companies will have to adjust, because some chronic conditions can actually be cured. Many are accustomed to concentrating on the long-term troubles that plague the rich world the most: heart disease, cancer, metabolic disorders, neurodegenerative conditions, and the like. If drug development is more focused on teaching cells what to do, rather than finding new molecules against specific proteins, some of the knowledge on which the old pharmaceutical industry is based will be less relevant. Firms will need new pricing models and a new focus on their research.
Technology alone will not prevent a pandemic. This goal also requires systems and institutions that use technology widely and smartly. Without good systems, great technology will often provide only mediocre results, as is the case in many covid-19 testing and monitoring programs. But the pandemic has shown that biomedical science has the tools and enthusiasm to improve the world. The world must now build on both. ■
This article appeared in the Leaders section of the print edition entitled “Science after the Pandemic.”