“Without ifs, ands, or buts” – What needs to be done and what needs to change to effectively contain pandemics
Prof. Hufert, we are currently developing a new understanding of time when it comes to delaying the spread of the coronavirus. You are considered an expert in rapid diagnostics. Which testing methods can help to effectively contain a pandemic like the one we are currently experiencing?
Broad testing for the direct molecular detection of viruses via PCR (polymerase chain reaction) or RPA (recombinase polymerase amplification technology) as well as the determination of antibodies for the detection of past infections. The latter applies in particular to medical staff and to all people working in the health and nursing services, as well as to persons whose work is necessary for the continuation of fundamental functions in society. Those immune can then get back to working in their professions without danger.
In your institute you are investigating the viral pathogenesis mechanisms, i.e. the development and course of viral diseases. How does this knowledge help in concrete applications given that viruses are constantly changing and, like the coronavirus, appear in ever new forms and with new mechanisms?
Molecular biological investigations can be used to characterize pathogenicity factors and define the relationships between viruses, which can also indicate a cross-species transmission. Continuous genetic characterization of virus variations also helps us to constantly adapt genetic detection methods and thus avoid false negative results.
The development and approval of a vaccine will take up to one more year. Are there concerns that the virus may already have mutated by then?
Mutations occur continuously in RNA viruses. Nevertheless, coronaviruses have a very large RNA genome with a RNA polymerase that works very precisely, which alone makes up two thirds of the genome, so that the genetic variation possibilities are not as great as in influenza viruses. In my opinion, the best vaccine approach is to create a viral chimera based on the vesicular stomatitis virus (VSV), which carries the viral coat protein S of SARS-CoV-2. This type of vaccine has already been approved for the Ebola virus and is very successful. Animal models have also shown evidence of protection against MERS-CoV, which is very similar to SARS-CoV-2, and this chimeric live vaccine was very immunogenic in a monkey model. For this reason, I consider this option to be the best vaccine approach, which could also be produced very quickly and for which approval already exists for another virus. This course of action should be immediately promoted by the German government without bureaucratic hurdles. In Germany, the technology for this approach is available at the German Primate Center, where immunogenicity could also be quickly analyzed in the monkey model.
Which of the currently discussed treatment methods do you consider most promising and why?
The studies are still ongoing and there is not yet a treatment scheme that can and should be used optimally. I personally consider an early simultaneous administration of two antiviral drugs such as the combination of hydroxychloroquine and remdesivir or the combination of hydroxychloroquine and favipiravir to be promising. Combinations of favipiravir and remdesivir or of remdesivir and foipan would also be very promising therapeutic options. How effective the treatment is in the clinical setting can and must be shown in clinical trials. Early administration of the drugs seems to me to be particularly important in order to minimize the damage caused by the virus. If administered late, a large part of the tissue is already damaged by the virus replication and therefore the therapy can be expected to be significantly less effective. One example of this is the influenza drug Tamiflu, which works best when given prophylactically. The following applies to all therapy options for COVID-19 patients: These drugs have not been approved for this application.
Has networking with virologists and epidemiologists in Germany and abroad changed for you due to the crisis? How are you cooperating and on what?
No, that hasn’t changed due to the crisis. We work in an international network, especially with colleagues from Great Britain, Egypt, Senegal and other countries as we have introduced molecular point-of-care diagnostics in the field in some countries together with colleagues from Stirrling, UK and Göttingen, for example during the outbreak of the Ebola virus in West Africa.
Experts around the world have consistently pointed out that economic globalization, the environmental and social distortions it brings with it and rapid population growth favor the occurrence of new infectious diseases and their rapid spread. What would have to be done from a medical and epidemiological point of view to avert this danger?
Sentinel systems would have to be set up, random samplings that could very quickly reveal new outbreaks of infectious diseases. This also includes the possibility of having reliable mobile diagnostics available in remote regions, which will then be applied by outbreak teams. Despite the interconnections of world trade, the production of medicines, medical devices and personal protective equipment must always be made available at national level. We also have to be able to, for example, produce independently without China. Countries that do not have their own production facilities, such as many countries in Africa, would have to be supplied through the World Health Organization (WHO). Vaccines must also be developed for rare pathogens and vaccination campaigns must be carried out. For example, the number of measles and yellow fever cases is still increasing, despite the availability of vaccines offering life-long protection.
Last but not least, states must be able to close the borders. A central mistake made by Europe and Germany was not to issue strict entry bans despite the threat of the outbreak in China, thus opening the door to virus importation.
What needs to change in this country?
Public awareness of infectious diseases and outbreaks must be raised and integrated into education systems. An outbreak like the one we are now experiencing is a natural phenomenon and requires early and immediate targeted government action to protect the population, without constant protracted discussions with ifs, ands, or buts. Natural phenomena do not take human interests and different kinds of fantasy worlds into account. This early action was unfortunately not taken. Existing pandemic plans must be applied and constantly updated. Our system could also be improved by abolishing the Länder’s competences in epidemic matters. A uniform, centrally controlled structure must be created here, because we do not resort to the individual armies of the federal states either in the case of defense of the Federal Republic, for example.
What about the healthcare system?
The public healthcare system must be reinforced again. And our hospitals must receive adequate funding. Many things are in disarray here, from small rural hospitals to large university clinics. For years, there has been a lack of financial resources everywhere, which the state was not prepared to invest. Here, among other things, the remuneration modalities must also change. Despite years of high tax revenues, these long-standing problems have always been ignored by politicians. I also see an urgent need for action in this area to prepare us for a healthcare system that can also cushion major global emergencies such as the one we are now experiencing.