Fauci ‘cautiously optimistic’ about identifying effective COVID-19 vaccine by end of 2020
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An effective vaccine for the novel coronavirus likely will be identified in the next few months, the nation’s leading infectious disease expert told ESMO Virtual Congress 2020 attendees.
“Favorable data in animal models and in phase 1 clinical trials showed the induction of a very good neutralizing antibody response, making us cautiously optimistic — although you can never guarantee anything with vaccines — ... that we will have an answer by the end of 2020 and will be able to start distributing vaccines in a meaningful way in 2021,” Anthony S. Fauci, MD, director of National Institute of Allergy and Infectious Diseases, said during the meeting’s opening ceremony. “We could get an answer sooner. That is unlikely but not impossible.”
The United States “has taken a strategic approach” to harmonize clinical trials of seven vaccine candidates, Fauci said. This effort includes implementing a common data and safety monitoring board, as well as common primary/secondary endpoints and immunological parameters.
Two nucleic acid-based vaccine candidates — one developed by Moderna, and another by BioNTech and Pfizer — are being evaluated in ongoing phase 2/phase 3 trials.
Three viral vector vaccines are in development, with one — developed by University of Oxford and AstraZeneca — in a phase 2/phase 3 trial. Two other vaccine candidates based on a protein subunit platform are in phase 1/phase 2 trials.
US vs. EU
Fauci’s presentation highlighted the virology, transmission and clinical manifestations of the novel coronavirus.
He also offered insights into the disease patterns in the United States compared with the European Union.
As of Sept. 7, an estimated 27.4 million coronavirus cases had been confirmed worldwide, and 894,480 people had died. On that date, the United States led the world in reported cases (6.3 million) and deaths (188,513).
In the European Union, new cases peaked in late March and early April and declined to a “very low baseline” of less than 10,000 cases per day through early summer, Fauci said. Cases spiked again in August and early September amid efforts to open the EU’s economy, with 7-day rolling averages now suggesting about 20,000 new cases per day.
“This is really very little compared with a situation that is most extraordinary in the United States,” Fauci said.
After a spike in cases in March and April — primarily due to the outbreak in the New York metropolitan area and elsewhere in the Northeast — numbers in the U.S. “never went down to a low baseline,” Fauci said.
Rolling averages of new cases continued to hover around 20,000 cases per day until efforts to open the U.S economy intensified in July. This led to a spike to about 70,000 new cases and approximately 1,000 deaths per day, Fauci said.
“This has now stabilized somewhat at an unacceptably high level of anywhere between 40,000 and 50,000 cases per day,” he said.
Data from Italy and Spain showed “much more diminished” mobility — specifically utilization of parks and outdoor spaces, workplaces, and visits to grocery stores and pharmacies — between early March and early September in the European Union than in the United States, Fauci said.
“The epidemiology was driven by the degree to which the different countries shut down,” he said.
Data by age, race, ethnicity
Fauci summarized updated data about the impact of the novel coronavirus by age and race/ethnicity.
Data through Aug. 29 showed low laboratory-confirmed COVID-19-associated hospitalizations in the United States among children (16 per 100,000 among infants to age 4 years; 9 cases per 100,000 among those aged 5 to 17 years) and young adults (69 cases per 100,000 among those aged 18 to 29 years; 108 cases per 100,000 among those aged 30 to 39 years), but considerably higher rates among older individuals (328 cases per 100,000 among those aged 65 to 74 years; 516 cases per 100,000 among those aged 75 to 84 years; and 793 cases per 100,000 among those aged 85 years or older).
Age-adjusted COVID-19-associated hospitalization rates by race and ethnicity from March 1 through Aug. 29 showed much lower rates among non-Hispanic whites (71 per 100,000) and Asian/Pacific-Islanders (95 per 100,000) than American Indian/Alaska natives (328 per 100,000), Hispanic/Latino individuals (331 per 100,000) and non-Hispanic Black individuals (333 per 100,000).
Fauci also touted a “living document” online, developed by NIH, that provides continually updated COVID-19 treatment guidelines for health care providers.
“[The site] gives real-time updates on data from clinical trials that have been published, as well as those in prepublication, to give clinicians an up-to-date real-time capability of knowing the best clinical practices,” Fauci said.
The site is accessible at covid19treatmentguidelines.nih.gov.
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Fauci AS. COVID-19: Public health and scientific challenges. Presented at ESMO Virtual Congress 2020; Sept. 19-21, 2020.
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