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The world has been through interesting times in the past 24 months, and many books have been written for local and global consumption that describe the identification, tracking and response to SARS-CoV2, and there are going to be many more that document this incredible time in our history. Gregory Zuckerman’s A Shot to Save the World approaches the development of SARS-CoV2 vaccines from a different viewpoint.
The 19 chronologically organised chapters start with HIV in 1979-1987 and end in Winter 2020 to Summer 2021 as vaccines were rolled out, to create the recent history of virology and vaccines, reaching Wuhan and the first description of the outbreak and the sequencing of the SARS-CoV2 virus only in Chapter 14. This organisation of the chapters creates a sense of anticipation, and each chapter establishes a milestone in the history of viral infections, the science that informed vaccine development and the creation of companies and the people that made it all possible.
The stories are mainly of the vaccines developed or planned for testing under Operation Warp Speed, the Moderna and PfizerBioNTech mRNA vaccines, the Astra Zeneca chimpanzee adenovirus vectored vaccine, the Johnson & Johnson human adenovirus vectored vaccine and the Novavax protein vaccine. Other vaccines developed in the US that ultimately were not taken forward or developed elsewhere do not find a mention. There is also nothing on the many inactivated vaccines in China, India and other parts of the world or the newer technologies still being evaluated.
Intimate moments
The tales that are told are gripping, and the details that Zuckerman incorporates in the telling, provides intimacy with the cast of characters. Gale Smith, the North Dakota farm boy, whose PhD in Texas leads to a protein expression system used decades later to make the Novavax vaccine, celebrates the US trial results with a dinner with his wife at The Inn at Little Washington. Adrian Hill, whose passion for vaccines led to the establishment of the Jenner Institute at Oxford, is faced down by Joana Carneiro da Silva at a scientific meeting, an unusual occurrence for a scientist described as brilliant but savage and derisive. Dan Barouch, the wunderkind, who writes a paper in a weekend, never watches television and practises the violin for an hour a day since the age of four, also teaches his young daughters to play.
The science that led to the insect cell expression of proteins, the modifications of mRNA that allowed it to be used to produce proteins in humans, the structure based approach to stabilising a shape-shifting protein, the development of viral vectors that could be safely and effectively used in humans are laid out in the accounts of the people who worked on them and the places where the work was done, sometimes over decades. Scientists who work on viral vaccines are few, and the same individuals appear as the narratives evolve. Barney Graham of the Vaccine Research Center at the National Institute of Health (NIH) advises Jason McLellan to work on coronaviruses when he gets his faculty position and cannot get funding. He then calls him to collaborate when the SARS-CoV2 sequence becomes available. The story of the weekend slog of Nianshuang Wang in McLellan’s lab that resulted in potential candidates sent to Kizzmekia Corbett, who worked with Barney Graham, will go down in the annals of vaccinology.
Many combine to make vaccines
The scientists and the science take centre-stage, but vaccines are not made by scientists alone. The investors, the executives and the manufacturing experts that make the companies that make the vaccines, or try to, are included in descriptions that detail how large companies like Pfizer built on existing partnerships with BioNTech to switch from influenza to SARS-CoV2, and Novavax and Moderna as small companies, struggled to survive while continuing to push their science forward without any licensed products at the time they started to work on Covid-19 vaccines.
The insights into the decision making of investors, NoubarAfeyan and the Strungmann brothers, who took risks with Moderna and BioNTech, and the descriptions of the comparisons of Theranos with Moderna, because of the personalities and projections of Elizabeth Holmes and Stephane Bancel as CEOs, are unusual and provide some understanding of the evolution of the companies.
The book builds a foundation of science to describe the development of some vaccines that have begun to be used around the world. The portrayals of interesting characters and the interesting situations they found themselves in add value to the accounts of scientific advances. Luigi Warren, a software engineer who chose a second career, struggles to make stem-like cells and get them to produce protein using mRNA, building on the work of Katalin Kariko and Drew Weismann. Kerry Benenato is asked to ‘solve delivery’ for Moderna experiments to find the perfect packaging for mRNA and find solutions in simplicity. There are successes and failures, struggles and triumphs, interesting characters and an arc of discovery and development that capture attention.
If there is a fault, it is limited to a US perspective of vaccines. Even with that, this is a true adventure story for our times.
(Gagandeep Kang is Professor, The Wellcome Trust Research Laboratory, Christian Medical College, Vellore)
A Shot to Save the World: The Remarkable Race and Ground-Breaking Science Behind the Covid-19 Vaccines
By Gregory Zuckerman
Pages: 358
Publisher: Penguin
Price: ₹650
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