| A health worker takes a sample for a test on coronavirus COVID-19 infection at a Seoul hospital. Yonhap |
By Oh Young-jin
Dr. Hakim Djaballah, a New York-based virology expert, told The Korea Times of the possibility of the second wave of novel coronavirus, or COVID-19, if Korea becomes complacent as its current viral crisis is being tamped down.
"Most politicians have the tendency to do [so] as the elections are approaching, and with a very short recollection of events; then there would be a much higher risk for a second wave of attack," he warned in his interview with The Korea Times.
The second wave could be even more difficult if the virus comes from Europe, the former head of the Institute Pasteur Korea said Wednesday by phone. "It is a different generation of the same virus ... due to its enhanced virulence," he said, adding that with closer monitoring on its perimeter and tighter border controls, South Korea could transform from the "patient of Asia" to the healthiest country in Asia.
Regarding talks of ongoing efforts to develop vaccines, he was not supportive for a variety of reasons, ranging from the unreliability of vaccines in their early stages and difficulty in producing large doses for those in need, to the history regarding the SARS crisis in the early 2000s, when the government and pharmaceutical firms put themselves in a kind of a futile race against time for a vaccine.
"Even if we had a vaccine today, it will be a 50:50 chance of either making some people even sicker with potentially high lethality rates, especially for the most vulnerable groups such as the elderly communities," he said.
He cited two drugs that at least ― anecdotally ― have proved effective. The first is a chloroquine derivative sold under the brand name “plaquenil.” It has been extensively used since the 1950s to fight malaria and inflammation.
The second is the experimental drug “remdesivir,” being developed by the U.S.-based company Gilead, to target the machinery helping the coronavirus divide and increase to cause the COVID-19 disease. Remdesivir, which is in clinical tests in China and soon to be in Korea, was administered to the first American COVID-19 patient, who was then cleared of the virus and recovered.
Dr. Djaballah is not convinced of Korean firms' drug development efforts, saying, "… at least for Celltrion, I found their chairman's comments rather surprising since they have been quite good at producing biosimilars, but the company has never developed an innovative antibody based therapeutic ever."
He said he has not seen signs that worry him about the situation in the U.S., saying that there are not large clusters like in Wuhan, the original epicenter in China, Daegu, Korea and Italy. "The recent outbreaks on the East Coast of the U.S., especially in New York and Massachusetts, are linked to travelers returning from other infected countries or infected foreign travelers coming to the U.S.; some of the cases are not directly linked to China, though some of these travelers could have visited China during the past two to three months."
About recent reports in the U.S. that Korea's testing methods are not reliable, he said that it is "unprecedented" as neither China nor the U.S. has been able to match what Korea has done.
"The methods developed by South Korea have been proven beyond any shadow of doubt not only for their reliability in the field for sample collection and preservation, sample preparation, and sample evaluation for the presence of viral genetic material, but also the very high throughput and the turnaround time for results," he said.
| Lee Nak-yeon, former prime minister standing in the April 15 general elections, is on a campaigning trail with face mask on and a promotional board in front. Yonhap |
The following is the written text of the interview with Dr. Djaballah.
Q: What is the chance of a second wave of coronavirus hitting Korea as the ongoing one is coming under control?
A) I believe the country is now contained at 90 percent and stabilizing with fewer newly confirmed cases reported in the past several days. I remain concerned with the stigmatization of the church followers and how this will impact the ongoing efforts to curb the virus. A healing dialogue should be starting soon with church leaders.
The Moon administration must continue the message on hygiene, stricter entry controls at the borders and, of course, they must keep up with monitoring the country for any signs of outbreak. If these measures continue to be in place, there is little or no chance for a second wave of this virus attacking South Korea. However, if the Moon government becomes complacent, as most politicians have the tendency to do as the elections are approaching, and with very short recollection of events, then there would be a much higher risk for a second wave of attack.
Q) Would it be a different virus or a mutated one?
A) Most likely, it will be a different generation of the same coronavirus, depending on where it is coming from. If it is coming from Europe, as an example, it would be a real serious situation due to its enhanced virulence, which we are seeing across much of the European Union.
Q) Would Korea need to keep border controls or travel restrictions after it is brought under control?
A) If there is a mouse in your home and you catch it, it does not mean that it is the only one as its relatives are close by; and the best remedy is always to check the outside perimeter of the home and block all potential entry points, which can be advantageous to the mice to re-enter your home. By analogy, the government must check and recheck the perimeter of its home, South Korea, through stricter border controls and travel restrictions.
Geopolitics and diplomacy aside, it is their opportunity to change the status quo from “South Korea being the patient of Asia” to “South Korea becoming the healthiest country in Asia.” The Moon administration cannot afford to let their guards down and let another mouse into their home.
| Americans arriving from Spain wait in lines for a coronavirus test in O'Hare airport in Chicago. AP-Yonhap |
Q) Do we need vaccines for COVID-19?
A) I am of the opinion that now is not the time for a vaccine; we have at hand many other realistic options to fight this virus and a vaccine, unfortunately, is not one of them. Vaccine development is a complicated process with a very high rate of failure, especially for this family of coronaviruses. There is no one who can guarantee success of the vaccine, not only to alleviate symptoms in the short term but also protect the individual from future infections.
Even if we had a vaccine today, it will be a 50:50 chance of either making some people even sicker with potentially high lethality rates, especially for the most vulnerable groups such as the elderly communities; or the vaccine would simply help alleviate symptoms, without any protective benefits to the patient and even to help stop the virus' continuous colonization of the same patient and spread. I do not foresee the vaccine benefits, except perhaps to give us a false sense of hope that we are winning the war against the SARS-CoV2 virus.
Q) Is it plausible to think that we will make one on time to help fight its spread now?
A) This is wishful thinking! I am aware of many concerned parties around the world thinking along the same lines, but we must be realistic and do not confuse a wish versus what we can accomplish in a relatively short period of time, and under immense pressure to succeed.
I am fully aware of an increasing number of companies joining this COVID-19 vaccine bandwagon, and with new platforms and sexy technologies; it is not time to reinvent the wheel and call it “innovation.” I am also aware that many of these companies in the vaccine rave do not have a track record in producing highly-quality and protective vaccines for immunization. They are in uncharted territory with a high risk to benefit ratios.
The reality of the matter is that there is no vaccine company today that can produce billions of doses in the next three to six months; even if they magically could do produce billions of doses needed, there are many additional hurdles and limitations, from distribution of the vaccine requiring temperature-controlled vessels, to inoculation of the general population around the world. This is a logistical nightmare that many seem to be ignoring.
Because of the dire situation we are in globally, these vaccine advocates are not thinking through the whole process ― from raw material acquisition, manufacturing and production, to temperature-controlled distribution and inoculation. This is a very tough cycle to crack and I cannot think of a single company which can successfully lead this enormous task.
In essence, we do not want to end up in a situation where we must decide who gets the shot and who does not, unless you produce enough vaccine doses for everyone. It is better not to raise people's hopes only to find yourself unable to deliver the promise. The echoes of a broken promise can live with you forever and ever.
| U.S. President Donald J. Trump (C) meets with bankers including Chairman of the Board and CEO Bank of America Brian Moynihan, left, and others at the White House. |
Q) What happened to efforts to develop anti-SARS vaccines following that epidemic?
A) It is not as much as a failure to make the SARS-CoV vaccine, but rather a lack of accountability, follow-ups, changing government priorities and a lack of preparedness. For academic researchers, as soon as the SARS-CoV outbreak ended back in 2003, the funding earmarked for research on the coronavirus ended up being reprioritized to other research topics, leaving SARS-CoV researchers struggling to finish their work and to save their professional careers. These are very common practices within many governmental funding agencies around the world.
The irony in that is these researchers shifted their work to help their governments with critical research toward a better understanding of the coronavirus at the molecular level as well as all associated vectors and reservoirs that this virus uses to survive and propagate. They answered a call to help, only to be forgotten once the outbreak ended.
For companies, their efforts to produce a SARS-CoV vaccine must have a market where they can sell the vaccine and recover their research and development costs and, of course, make huge profits in return; it is also a huge risk for them to undertake unless the government will sponsor their research efforts, and pay them in advance.
The urgency to make the vaccine will also fade away as the outbreak ends, leaving these companies either with a product that no one wants to purchase or with a huge loss if they did not receive any government funding, or simply shelve the project.
These companies answer to their investors and shareholders and are in the business to make money, they are not a charity. The only customer left for them is the government, as it is the only institution which can purchase millions of vaccine doses as part of their global health preparedness.
If these governments feel that there is no need to stockpile SARS-CoV vaccines because the virus threat is no longer there; and at the same time, their advisers would present them with good projection numbers as an example that no new cases of SARS-CoV infections were reported in 2004, one year after the end of the outbreak, would support the notion that SARS-CoV is in the past and no longer requires a vaccine.
Then, these companies would have a vaccine which no one wants to purchase; so they would always opt not to continue the project as they do not have to give back the government/taxpayer money.
Q) Explain the drugs that are already on the market and are seriously tested for the COVID-19. Are they working?
A) Unlike for the MERS-CoV outbreak, we are in a fortunate situation that several drugs exist on the market or they are in their late phase of clinical trials that can be used either therapeutically to treat infected patients or prophylactically to prevent the COVID-19 disease. I am strongly advising the use of these two drugs in combination:
The first drug is a chloroquine derivative and sold under the brand name “plaquenil”. It has been extensively used since the 1950s to fight malaria as its initial indication and with more research, it was found to be useful for other indications such as the immune system and inflammation.
It is one of the cheapest drugs to manufacture and could easily be made available to everyone concerned worldwide. The only problem with this drug class is that they are not protected by patent so companies will feel less excited about them since they cannot corner the market and make huge profits.
The second one is the experimental drug “remdesivir,” being developed by the U.S.-based company Gilead, to target the machinery helping the coronavirus to divide and increase its population to cause the COVID-19 disease.
It is currently undergoing a few clinical trials around the world including soon in South Korea. It was given to the first American infected with the virus and the patient has survived and seems to have cleared the SARS-CoV2 virus. Since then, this drug has been made available by its maker Gilead for use as a compassionate treatment, and it has been used on additional patients with good responses and positive outcomes.
Combining these two drugs would block the virus from infecting the lungs and dividing to make more viruses, leading to the COVID-19 symptoms and death. Both drugs are safe, available today, or can be manufactured. There is growing supporting scientific evidence and positive clinical trial results to make these drugs the ultimate treatment for the SARS-CoV2 virus and the COVID-19 disease.
Q) So you think that some of the pharmas that claim they are making vaccines or drugs are carpetbaggers trying to take advantage of the current situation?
A) Whenever a for-profit pharma company can be paid in advance for making a drug or a vaccine, they will take advantage of any situation. They are for-profit and profit margins are the language they speak.
Social responsibility is secondary to many and the current situation not only provides them with money but also free publicity. I have seen some reports on Korean pharma companies joining this COVID-19 race, and at least for Celltrion, I found their chairman's comments rather surprising since they have been quiet good at producing biosimilars, but the company has never developed an innovative antibody based therapeutic ever.
Q) You correctly predicted the peaking of the virus in Korea and exponential growth of new cases in Italy and Europe. What is the outlook in Europe?
A) I remain pessimistic and very concerned about the situation in Europe. Some governments have taken drastic measures to slow the spread, and we will know in the next two to three weeks if these measures are working.
I also find it disturbing that many keep comparing South Korea to what is going on in Europe, the Middle East and North America. Each country has its own challenges when it comes to fighting this cryptic virus. I wish these comparisons would stop.
| PSG's supporters celebrate after Paris Saint-Germain's Spanish defender Juan Bernat scored the second goal during the UEFA Champions League round of 16 second leg football match. AP-Yonhap |
Q) Why are you not worried about the U.S.?
A) I have not seen any data which would worry me yet; the reported cases in the U.S. are typical cross-over resulting from relaxed border controls. If you allow a plane full of passengers from Italy, as an example, to land in New York and allow all of the passengers to leave the airport without any scrutiny, then you are not only asking for trouble but also allowing the virus to enter the U.S. unchecked.
The recent outbreaks on the East Coast of the U.S., especially in New York and Massachusetts, are linked to travelers returning from other infected countries or infected foreign travelers coming to the U.S.; some of the cases are not directly linked to China, though some of these travelers could have visited China during the past two-three months.
The thing that worries me most, however, is not the coronavirus or the lack of tests, but rather this wave of indescribable panic and uncertainty with a relaxed attitude from the Trump administration toward this crisis. The psychology of the pandemic has sunk in and it is hitting the population hard.
Q) Can you explain to me claims by U.S. officials that Korea's testing methods are not reliable so shouldn't be imported?
A) It is always a huge challenge to explain to any government official, who does not have basic scientific knowledge, how a method works and why it is better or worse than other methods. I have personally experienced this challenge both in the U.S. and in South Korea.
The unfortunate situation is that when this official tries to explain or comment on the method to others, it becomes a slippery slope situation as they always want to look smarter than they really are, and would end up making those classical ill-advised comments.
Media outlets would pick on the topic and again bring in their “experts” who really do not have a clue on how the method or testing process works, to add more oil on the burning fire. For me, personally, it is a shame when such an expert is a senior medical doctor without basic common sense and knowledge and comments and fuels more confusion on the issue at hand.
The U.S. C.D.C. (Centers for Disease Control) had to overcome issues with their own methods; it is an embarrassment for a federally funded research laboratory not to be able to provide hospitals and testing facilities with the most sensitive and accurate methods. The methods developed by South Korea have been proven beyond any shadow of doubt not only for their reliability in the field for sample collection and preservation, sample preparation, and sample evaluation for the presence of viral genetic material, but also the very high throughput and the turnaround time for results.
This is unprecedented, especially that during the SARS-CoV outbreak of 2002, China struggled with such methods and could only perform fewer tests per day; South Korea is doing tens of thousands per day. For those criticizing the Korean methods, as they say the proof is always in the pudding and South Korea seems to have their pudding in that they have contained the outbreak much better than other developed countries, including the U.S. I urge the Moon government to share the methods and data analysis software capabilities with other countries, even with the U.S., to help with containing viral spread. Several diagnostic companies in South Korea seem to be ready and eager to join the fight and help other countries.