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We need a strategy that can cope with variations and mutations

Dr. Bonaventura Clotet is the director and president of Fundació Lluita contra la Sida (Fight against AIDS Foundation). We interview Dr. Clotet as part of our #PassTheMic campaign.

Here’s some of what he had to say.

This is a virus that recombines significantly, which is why it became even more contagious. So we need to design a new strategy that can cope with all these variations and mutations.

I think what’s very important these days is that we move forward to set up a vaccine platform that will allow us to cover the different coronavirus that might appear in the future. It’s what we call a “pan coronavirus vaccine.”

Here in Barcelona, we have set up a consortium, where we joined the Barcelona Super Computing Centre and also the Centre for Research in Animals, which has significant expertise in the field of coronavirus.

We come from the HIV field and for more than 30 years we have been focusing on understanding and designing vaccines for HIV. This knowledge has allowed us to generate a platform of vaccines that might be suitable for other viruses, such as COVID-19.

Scientists should push pharmaceutical companies to accept that we should be providing the vaccines for free to the areas of the world that cannot cope with the expenses.

Cross collaboration

So far with coronavirus, we’re trying to fight the disease in its advanced stages. Obviously this makes sense, because we have to treat very ill people. This is like what happened with AIDS: We began at the very end and then we were able to move to provide treatment at the very early stages.

The same should happen here, because the first stage of the disease is viral replication and then it’s inflammation. So if you stop the virus at the very beginning, you will prevent the progression to this sort of inflammation and respiratory distress signal.

I am cross collaborating with many colleagues worldwide. We make our research available for free, because what we want to achieve are vaccines that will work and can be provided free to developing countries.

Unfortunately, I have been fighting for free treatment for AIDS for decades, and the fact is about 40% of patients still don’t have the treatment they need. That should not be repeated.

Scientists should push pharmaceutical companies to accept that we should be providing the vaccines for free to the areas of the world that cannot cope with the expenses that these vaccines represent.

We should also accept a higher price in rich countries so that poorer countries can get them for free. Otherwise we lose the momentum of protecting our world from this disease.

Clinical trials

Our first goal should be to control coronavirus and to avoid its progression to the advanced stages, so that it doesn’t require intensive care units.

Then we should design clinical trials at the very beginning with different compounds, so we could in fact be significantly counteracting the crises that emerge because of COVID-19. For example, influenza kills people every year and there is no economic crisis, so we have to impact the progression of this coronavirus disease. Then if we are creating all the tools that we need to block that progression, we can take a more measured approach to the design and study of the vaccine.

If we are not succeeding with the control of the disease and in reducing the number of deaths, then we have to speed up the vaccine development to find out if the initial designs that will be in clinical phase 1 later this year could work.

Then we have a lot to learn in the animal model and volunteers. How do they react to the vaccine? Next, we have to move to areas with an outbreak to learn how the vaccine responds there, and then we will learn more about which is the ideal one, and which one could protect from recombination strategies of the virus.

What makes me hopeful

What is making me feel optimistic is that the number of deaths has declined significantly, so we can manage our patients properly.

I am aware of clinical trials moving earlier than they used to, and therefore we should expect more efficacy. We should be designing combination strategies. I’m hopeful some of the vaccine designs could in some way control the outbreaks, at least partially in some regions in the world.

We are used to mutations because HIV has a higher rate of mutations than the coronavirus and we can control almost all mutated HIV viruses. So why couldn’t we end up controlling all coronaviruses too?

These excerpts from the interview were edited for length and clarity.

Hear more from experts in our #PassTheMic campaign, where global health experts take over celebrities’ social media channels to share the data, facts, and science we need to know to end COVID-19. Follow us on Instagram, Facebook, and Twitter for more.

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