From left: Florian Krammer, PhD, Adolfo García-Sastre, PhD, and Peter Palese, PhD
Microbiologists at the Icahn School of Medicine at Mount Sinai, who created the first and most reliable test to determine whether an individual has antibodies to SARS-CoV-2, have been monitoring the virus since it began circulating in Wuhan, China, in late 2019.
Now, Peter Palese, PhD, Horace W. Goldsmith Professor and Chair of the Department of Microbiology, and Florian Krammer, PhD, Mount Sinai Professor in Vaccinology— weigh in on the future of SARS-CoV-2 and its place in our lives. They, and their colleague, Adolfo García-Sastre, PhD, the Irene and Dr. Arthur M. Professor of Medicine, recently created a low-cost COVID-19 vaccine that can be manufactured wherever influenza vaccines are made—particularly in low-and-middle-income countries. The scientists are also working on a universal flu vaccine, which would confer immunity without having to be administered annually.
As we move away from this pandemic will SARS-CoV-2 continue to play a large part in our lives?
Dr. Palese: Clearly the future is difficult to predict, but one likely scenario would be similar to the way we manage influenza viruses, which necessitates continuing vaccinations as we go into the future—perhaps once a year or once every two years. In this case, the virus continually changes but the effects can be ameliorated by vaccines, and those vaccines have to be changed. But they reduce fatality and hospitalization and the need for people to stay home.
Dr. Krammer: In this scenario the virus is not going to disappear. It’s just going to stick around and become the fifth coronavirus that circulates in humans. The other four coronaviruses make up about 30 percent of all common colds, and they’re seasonal; they come in the winter like influenza.
Dr. García-Sastre: Some of these common coronaviruses that cause the common cold have been with us for a long time and are very different from SARS-CoV-2. They are happily living with us, rarely cause any major disease, and do not cause a threat.
Dr. Krammer: Now, influenza typically causes more damage than these common coronaviruses which are typically causing mild infection, except in people who have problems with their immune system who are sometimes brought to the intensive care unit. I think SARS-CoV-2 will land somewhere between influenza and human coronaviruses—between those two extremes.
Is it possible that this virus will simply disappear?
Dr. Palese: You can never exclude the possibility that this virus will peter out the way the coronavirus (SARS-CoV-1) did twenty years ago, when it emerged to cause some really high fatalities but disappeared. On the one hand it was a nightmare, but then it was over.
Dr. Krammer: I don’t think the virus will just disappear, but it might. We didn’t think there would be so many variants this quickly, especially not something like Omicron, so there might be surprises. I hope for society’s sake that this fades into the background and we’re not afraid every fall that another wave is coming. The scenario I would like to see in six months is that Peter and I – as virologists – are concerned about it but that the problem is insignificant enough so that the public does not have to be. We’ll see if that happens.
How do we continue to ensure protection from COVID-19?
Dr. Krammer: We have to look at the baseline immunity that exists in the population. If a lot of people have immunity and there is less virus circulating chances are that you either don’t get infected or, if you get infected, your immunity will be protect you against severe outcomes. Then the disease and infections become less relevant. And that is what we hope for. Now, you can get there through vaccinations—that’s the painless way, or you can get there by having had the infections, and that’s the painful way. But both contribute to having higher baseline immunity in the population. Unfortunately, even in this scenario, immunocompromised patients are still at risk of severe outcomes although there risk of getting infected is lower.
Dr. García-Sastre: Vaccinations are still the solution to the problem. We should make sure that as many people as possible are vaccinated and boosted.
Dr. Krammer: I think we need to keep working on vaccines against SARS-CoV-2. Right now we have this situation where the vaccine protects very well against severe disease if you’re not immune compromised. But those vaccines are not protecting very well from infection anymore. They did against the original virus, but not with the variants. That’s why, for example, we need a variant-specific vaccine for Omicron. There are ways to make vaccines differently so you get more sterilizing immunity, which would suppress infections more, in general, and that would make the world safer for those who don’t mount good immune responses.
Dr. Palese: In creating our COVID-19 vaccine at Mount Sinai, we are using the Newcastle-disease virus in a vector-driven approach. If the FDA [U.S. Food and Drug Administration] is agreeable and allows the comprehensive use of genetically modified viruses, such as ours, then we can prevent the emergence of these new variants by vaccinating right away with the correct vaccine against the new variant, and we should be in good shape.
Do you think the public needs a fourth vaccine right now?
Dr. Krammer: For populations that don’t mount optimal responses or their responses disappear quickly, there might be an advantage in getting another dose. But for the general population, I don’t think this is useful right now. If there is a fourth dose, it should be variant-specific, an adapted vaccine that reflects what’s circulating right now.
For immunocompromised individuals, there are already a couple of important therapeutic treatments—including PAXLOVID from Pfizer Inc., operating under the FDA’s emergency use authorization—that can help them to greatly reduce their risk of a severe outcome.
Is it feasible to create a universal coronavirus vaccine—similar to the universal influenza vaccine you are developing?
Dr. Krammer: By universal you mean a variant-proof SARS-CoV-2 vaccine, I assume? One that would protect against all variants? We’ve made a lot of progress with the universal influenza vaccine in the last few years. But vaccine development has just started for coronaviruses and there are a lot of approaches out there. Coronaviruses are very diverse. A truly universal coronavirus vaccine would include protection against SARS-CoV-1 and other viruses in that subgenus and then you have a bigger genus of betacoronaviruses and, in addition, you have alpha-, delta-, and gammacoronaviruses (meant are the coronavirus genera, not the SARS-CoV-2 variants). So developing a universal coronavirus vaccine that would protect against all of them is a very big ask. It might be possible at some point, but it is small steps now and would take a lot of time. Of course, something that protects against variants that are around now or could be developed within the next five years, that’s actually possible.