Viruses, Vaccines, and Antivirals: Why Politics Matters

Raj Chari, Isabel Rozas

• Publisher: De Gruyter
• Year: 2021
• eBook ISBN: 9783110743722
• Edition: 1
• Topic: Social Sciences
• Subtopic: Epidemiology
• Index: Social Sciences

This short book brings together novel cross-interdisciplinary investigation from both natural and social science, representing a true hybrid across disciplines examining the 'politics' and 'science' of COVID-19. Viruses, Vaccines, and Antivirals: Why Politics Matters considers the dynamics surrounding viruses, proposed vaccines, and antiviral therapies, contextualizing what governments have done during the COVID-19 crisis.

The four basic phases of a pandemic are considered with a strong focus on COVID-19, namely the anticipating and early virus detection, containment strategies, policies to control and mitigate the spread of the virus and policies aimed at opening up society. Viruses, Vaccines, and Antivirals: Why Politics Matters examines policy developments throughout these phases in key nations worldwide and puts forward a blueprint for countries developing public policies to deal with a pandemic.

Chapter 1 Introduction

On January 7, 2020 the SARS-CoV-2 coronavirus was identified in workers of the ‘wet market’ in Wuhan as the infective agent responsible for the unusual pneumonias detected since December 2019. This was only the beginning of one of the most uncertain periods for humanity since the Second World War: the COVID-19 pandemic.

On that date, there was no indication that the virus was spreading easily because some infected people were asymptomatic. Soon, the infection had moved to nearby countries such as Thailand, South Korea and Japan. Before it was contained, it had already spread as far as the US, Australia, Italy and Spain. The World Health Organization (WHO), previously accused of being alarmist when dealing with the 2003 SARS coronavirus outbreak, cautiously declared this viral infection a Public Health Emergency of International Concern on January 30, 2020. Soon after, all around the world, cities became empty while people died alone in hospitals and, beyond the human tragedy, the global economy suffered a tremendous blow.

Despite earnest criticisms made against many governments and international institutions, nobody saw this coming and nobody was ready for it. For that reason, this book aims to give guidance to governments to be ready for future pandemics, since this is neither the first one, nor will it be the last. Based on natural science concepts around viruses, viral infection prevention (i. e. vaccines) and antiviral treatments, and considering the different stages of the pandemic seen in different countries, we propose a typology that can serve as a blueprint for states to deal with future health crises.

Thus, in Chapter 2 we offer an overview of the ‘natural science’ side of our investigation by first considering what a virus is and outlining key terms and nomenclature. We then examine previous pandemics, including the plague, smallpox, malaria, cholera, tuberculosis, and AIDS. Next, we turn to the present pandemic, focusing on coronaviruses, viral replication, COVID-19 and SARS-CoV-2 variants. In the rest of the chapter, attention is then paid to putting a drug on the market, antiviral therapies to treat COVID-19, and vaccines to prevent it.

Given the importance of governments in developing public policies when there is no immediate anti-viral treatment or vaccine during a pandemic, the public policies they formulate are paramount. Hence, Chapter 3 starts with the ‘social science’ side of our research by first looking at the historical role of the state during pandemics. We then explain why over time the WHO has not been pivotal in shaping how countries have responded. This has resulted in states largely ‘going it alone’ and rather blindly developing public policy responses, which was particularly evident during COVID-19. The second part of the chapter thus develops a typology of four phases of policy responses to guide states during a pandemic: anticipating the virus, containing it, controlling it, and then opening up society. Here we outline the empirical indicators that signal the start of the phases and the policies that are expected to be found in each of the phases. The strength of our classification scheme is that it can be used to understand developments in any country, anytime, during any pandemic.

Next, Chapter 4 demonstrates the strength of this typology by examining public policies pursued in key countries during the COVID-19 pandemic against the expectations in our typology. In the first part of the chapter we justify the countries examined and explain the mixed methods approach relying on both qualitative and quantitative methodologies used for our country analysis. We then examine developments in these countries as follows: New Zealand, Ireland, Germany, Canada, the United States, India, South Africa and Chile. The chapter closes with comparative examination of the COVID-19 vaccination rollout in these states.

Finally, Chapter 5 closes by highlighting the main findings of the book. It also outlines significant lessons to be taken from this study, from both the ‘natural science’ and ‘social science’ vantages.

It is our overall objective that this book represents an incremental, as opposed to a step, change in scholarship because it examines a key global crisis in the last century for a broad group of readers. Those interested in social science will better understand the science behind viral infections, how to treat and prevent them, and why evidence-based policy is important when evaluating policy-makers’ decisions. Those more oriented towards natural science and medicine will better understand what governments are doing (or not doing) to deal with health crises. While there are many books and papers on COVID-19, we believe that this book represents a novel attempt to fruitfully bring both the natural and social scientific communities together, serving as a strong foundation for more interdisciplinary research.

Chapter 2 Viruses, antivirals and vaccines

In this chapter we offer an essential overview of viruses, pandemics, vaccines, and antiviral treatments and development, situating the importance of this in contextualizing political decisions. Our view is that while the world has watched what has happened during the COVID-19 crisis, there is a lack of information on the basic facts about the ‘science’ side. Examining this will be particularly useful for social scientists seeking to situate where governments find themselves during any viral pandemic.

So … What is a virus?

Viruses are not animals or plants, and they are also different to bacteria; however, they are the most amazing parasites. They are the simplest entities and their existence as ‘living’ beings has been questioned. Basic requisites for an entity to be considered ‘alive’ are to be able to reproduce by itself, to move by itself and to store energy (adenosine triphosphate – ATP – in biological terms). Viruses do not comply with any of these requisites; they need an animal or plant cell, the host, to reproduce themselves, they do not store any ATP, and they are entirely dependent on external physical factors for movement and propagation. They also parasitize the cell to obtain basic materials such as amino acids and nucleotides, which are needed to build more viruses. Without a host, viruses cannot exist.

The structure of a virus is fascinating. Viruses consist exclusively of two types of macromolecules: nucleic acids (deoxyribonucleic acid – DNA – or ribonucleic acid – RNA) and proteins (Figure 2.1

Figure 2.1: Schematic representation of the elements comprising a virus and how they form the viral structure.

).

Nucleic acids store all genetic information, the genome, which contains all the ‘instructions’ to build future viruses. Proteins can play two different roles, surround and protect the genome (structural proteins) or help with the viral reproduction (enzymes). The core of a virus is formed by the corresponding nucleic acid (DNA or RNA, but never both) closely folded and tightly covered by a layer of protein units (capsomers) that form the ‘(nucleo)capsid’ to protect the viral genome (Figure 2.1).

Curiously, these capsids can adopt icosahedral or helical shapes. Many viruses have also a roughly spherical lipidic ‘envelope’ that protects the capsid. Embedded in the capsid or in the envelope there are other types of proteins (glycoproteins), known as ‘spikes’, that help the virus to attach to the host cells (Figure 2.2

Figure 2.2: Microscope images of three examples of viruses with different capsids’ structures, from left to right, helical (Ebola – CDC/ Cynthia Goldsmith, Courtesy: Public Health Image Library), icosahedral (adenovirus – CDC/ Dr. G. William Gary, Jr., Courtesy: Public Health Image Library) and enveloped (influenza – CDC/ C. S. Goldsmith and A. Balish, Courtesy: Public Health Image Library).

).

The most common virus classification system is the Baltimore classification (Figure 2.3) which groups viruses into seven families depending on

1. the type of nucleic acid (DNA or RNA) that they contain,
2. number of strands of the nucleic acid: double-stranded (ds) DNA or RNA or single-stranded (ss) RNA with a positive or negative ‘sense’, and
3. by their method of replication (i. e. retroviruses that require reverse transcription to DNA before replication can take place).

Some examples of viruses belonging to the different families in the Baltimore classification are human herpes virus (class I), parvovirus (class II), rotavirus – childhood gastroenteritis (class III), coronavirus (class IV), Ebola virus (class V), human immunodeficiency virus (class VI), hepatitis B (class VII).

Figure 2.3: Baltimore classification of viruses based on their nucleic acid (DNA or RNA), single or double strand (ss or ds) and positive or negative sense single strand.

As mentioned, coronaviruses (CoV) belong to class IV, which includes single stranded RNA viruses with a positive sense strand (represented by the notation (+)ssRNA) such as picornavirus (e. g. hepatitis A), togavirus/matonavirus (e. g. rubella) or flavivirus (e. g. zika). There are several viruses that belong to the CoV family, but those that have raised more concern to humans in the recent years are

• the ‘severe acute respiratory syndrome coronavirus’ (SARS-CoV) which caused an epidemic in 2002 – 03,
• the ‘Middle East respiratory syndrome-related coronavirus’ (MERS-CoV) that became a threat in 2012 and
• the ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2), which is the cause of the present 2019 – 20 COVID-19 ‘pandemic’.

A bit of nomenclature

Before going ahead with this chapter, several terms need to be clearly defined. According to the Principles of Epidemiology in Public Health Practice an ‘epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area’ while ‘pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.’¹ Other related terms, that will be used in the following chapters, are outbreak that is defined as an epidemic in ‘a more limited geographic area’ and cluster that ‘refers to an aggregation of cases grouped in place and time that are suspected to be greater than the number expected.’²

At the beginning of the present pandemic there was an extensive discussion on the origin of the viral infection and the term zoonotic appeared in the news. Thus, zoonotic refers to the spread of germs between animals and people due to daily interactions of humans with animals at work or at home.

Throughout this chapter we will be talking about the spread of the infection that occurs because of the viral replication cycle involving the transcription and translation of the viral genome. Thus, we will explain how once inside the host cell, SARS-CoV-2 takes over the host machinery to transcribe and translate its (+)ss-RNA genome into structural and functional proteins before the new viruses are assembled, encapsulated, and budded out of the cell. This will be discussed in detail later on in this chapter and here we will only explain what the terms transcription and translation mean. The process of transcription consists of transforming the viral genome into messenger RNA (mRNA) and this is performed by enzymes named polymerases, whereas translation consists of producing proteins based on the information provided by the mRNA and making use of another nucleic acid, the transfer RNA or tRNA (Figure 2.4

Figure 2.4: Scheme of the processes of transcription, which is the production of the messenger RNA (mRNA) in the case of class IV viruses (i. e. containing (+)ssRNA) and translation, which is the transformation of the genetic information of mRNA into amino acids carried by the transfer RNA (tRNA) to form the corresponding protein.

).

Recently, the appearance of variants has increased the number of cases and severity of the pandemic. It is important then to define what a mutation is and to distinguish between variants and strains (Figure 2.5

Figure 2.5: Viruses with mutations become variants and when variants show different properties to the original virus, they are named a new strain.

). A mutation is defined as the changing of the structure of a gene (DNA or RNA) in the reproductive step and results from an error in the replication of that particular nucleic acid (Figure 2.5). After translation of the gene to produce the corresponding proteins, this change produces a modification in the resulting protein. Thus, mutations are usually identified by a letter, a number, and another letter, where the first letter represents the amino acid in the position indicated by the ‘number’ (starting from the N-terminal) of the original protein and the last letter represents the new amino acid that appears in that position as a consequence of the gene mutation. Thus, the E484K mutation (important in many SARS-CoV-2 variants) indicates the substitution of a glutamic acid (E), that was in the position 484 of the original spike protein, by a lysine (K) in the mutated protein.

When a virus multiplies by making copies of itself, it sometimes makes small mistakes that are called mutations, and a virus with a small numbe...

Table of contents

• Title Page
• Copyright
• Contents
• Acknowledgements
• List of figures
• List of graphs
• Chapter 1 Introduction
• Chapter 2 Viruses, antivirals and vaccines
• Chapter 3 Conceptualizing the four phases of a state’s public policy responses during a pandemic: anticipating, containing, controlling and opening-up
• Chapter 4 Demonstrating the strength of the typology: examining key countries globally
• Chapter 5 Conclusions