Question

On January 13, less than a week after COVID-19 was identified as the virus behind the outbreak in Wuhan, researchers at Cambridge-based biotech company Moderna proposed a vaccine to fight it. A little over two months later, on Monday morning, a pharmacist in Seattle injected Rebecca Sirull with that vaccine, making her the third person to be injected in a 45-person clinical trial, the first human trial in the country. To rush the vaccine to clinical trial, Moderna skipped animal testing, a somewhat extraordinary measure. Sirull, a healthy 25-year-old editorial coordinator at a research institute, will receive a second injection in a month and have her blood drawn regularly for more than a year. Should the test be successful, the more optimistic estimates suggest that a vaccine could be available in 12 to 18 months. Intelligencer spoke with Sirull about her decision to take part.

How did you hear about the trial?

I got a letter in the mail about a month ago saying they were putting together a registry for people who might potentially be interested if they were to go ahead with the trial. It said “email this address and we’ll add you to our list.” So I sent them a message just because I thought it was interesting and wanted to hear more and I got a call that same day or the day after that they were going ahead with the trial.

Why did you ultimately decide to participate?

I signed the consent last week. At that point the news around coronavirus, and the policies around it, had escalated a lot. Initially, when I answered the letter last month, it was just a curiosity. By last week, when I could choose yes or no, I realized this situation is actually pretty dire and it’s a really important thing to be a part of.

Did you discuss it with anyone beforehand?

I didn’t tell anyone until I’d actually decided to do it. I told my parents and a couple of friends after I signed up and it was set in stone that I would be doing it.

What happened on Monday?

I got to the clinic at 8 a.m. They have you fill out a questionnaire — it was the third time that we filled that out. It asked if you were feeling any symptoms of the flu or virus; if any of our behaviors have changed that would not allow us to be in the study. We did a drug test, a pregnancy test, a few different blood-draw tests for other things to make sure that we were still eligible. Then the pharmacist came in and gave the injection. The whole thing happened in 30 seconds or less, quick and painless. They sent us home with a form to fill out and a thermometer to record our temperature daily. They call every day to make sure we’re doing ok. I’ll go back for a follow-up visit on Monday.

What did they tell you about the vaccine?

They’ve been very transparent and open to answering any questions that I have. What they told us is that it’s not a live virus. We don’t actually get exposed to the coronavirus itself. The vaccine is made out of a messenger RNA sequence that teaches your body to produce a protein with a similar shape to the coronavirus and then they check and see if you’re able to produce antibodies that would be able to fight that protein if it were to come in contact with it in the future.

Did they give you any indication about the probability of this vaccine working?

I think they’re very hopeful, but I haven’t gotten a lot of detail about the exact percentages or probability that it will work.

You’re working from home in Seattle, under self-quarantine. It seems sort of counterintuitive to put someone who is testing a vaccine into self-quarantine and not coming in contact with the virus.

The test is not whether or not I get coronavirus. They do that with some types of vaccines, but for this one, the way they’re testing is by drawing my blood every week and looking at the number of antibodies that are in it. That’s what fights off the infection. If my body starts producing more antibodies, then they’ll know that it’s effective. So, the goal is not to give me the coronavirus.

Aha, I’m glad that’s not the goal, for your sake.

Pretty neat …

Did they mention any potential side effects?

It’s not a live virus, so most of the risks that they discussed have to do more with the site of injection itself (like redness or swelling). I’m monitoring myself for fever, cough, nausea, headache. All of the symptoms of the virus.

Did they tell you anything about how the vaccine was developed?

They didn’t do animal testing, which is usually part of vaccine trials. That step was skipped. That’s because they have made other vaccines that use this same technique as opposed to a live virus. Those other types of vaccines were shown to be either successful or not have huge risks to the participants. I believe that’s why they skipped the animal portion, since they had already done a similar concept for the flu. They had been experimenting using that same mRNA sequence, as opposed to live virus. It’s just applying that same theory to a new shape.

1. Which type of antigen preparation was she given?

2. What protein antigen of the coronavirus do you most suspect her cells will be expressing?

3. Think about how the antigen will ‘look’ to her immune system. What specific lymphocytes will be the primary response to this type of antigen preparation?

4. Edward Jenner tested his vaccine by challenging his gardener’s son with actual smallpox. Thankfully, that is not the way the success of this vaccine will be tested. How will they know if the vaccine is effective? What does that mean is happening in her body?

Answer 1

ANSWER 1 :-

The RNA vaccine is based on the mRNA which is isolated from the antigen (protein on the surface) of the microorganism and in case of the coronavirus, the spike (S) proteins are the ones that elicit an immune response and hence the mRNA isolated from these proteins might have been provided in the form of a vaccine to the patient.

ANSWER 2 :-

If the antigen protein is being taken up by the cells, the antigen presenting cells will locate them and will present the already mentioned protein complex to undergo the process of signal transduction to mediate synthesis of antibodies or activation of T-lymphocytes. The protein that will be exposed is the S-protein (spike).

ANSWER 3 :-

The presence of spike proteins on the surface of the cell will trigger the pathway to synthesize the B-lymphocytes which will be associated with the production of the plasma cells and the memory B-cells which in turn will be formed in a long term aspect to ensure immunogenic response is mediated even during reinfection with the viral agent.

ANSWER 4 :-

This process is basically evaluating the clinical trials. In such instance, the nasal swab can be used for testing of presence of the microbial antigen. The antibodies can be tested in a number of ways. Antibody testing is used to identify if a particular antibody is being synthesized in response to the target antigen. and this testing is also called as serum testing. Apart from this, the various symptoms of the condition should also be evaluated. So, if antibodies are being produced in the patient's body, they will neutralize the antigens of the virus thereby making them ineffective.