Will COVID-19 innovations trigger a molecular revolution?
The worldwide impact of COVID-19 is staggering: over 100 million cases, more than 300 million tests performed in the US alone, 2.3 million deaths, 130 million vaccinations and counting. Over the last year, we have witnessed exponential growth of testing capacity, emergency approval of several drugs, and bringing vaccines to market in record time. By all counts, 2020 was a historic year of many records leading to substantial medical improvements. I believe we can leverage these breakthroughs to build a more resilient future – one that starts at the molecular level.
Repurposing PCR machines
One of the biggest developments I observed happened in testing. In many countries, people with suspected COVID-19 symptoms can get tested quickly and accurately thanks to polymerase chain reaction (PCR) machines, which diagnose the presence of viral RNA of SARS-CoV-2. These highly accurate but expensive devices are now the gold standard in diagnosing the infection and a mainstay in the larger fight against COVID-19. But what will happen with all these PCR machines after the pandemic? They can easily be redeployed to tackle other challenges. I believe they are putting us on the precipice of a molecular diagnosis revolution.
Imagine a world where cancer is diagnosed by blood tests, where routine screening for disease is as simple as a finger prick test, where mammogram or CT scan results are considered "late stage" – unlike now where a potential cancer diagnosis typically starts with worrying shadows or lumps. This is the exciting future that PCR offers us: it highlights and quantifies any small DNA change that cancerous and pre-cancerous cells exhibit as they move from regular cells to disease.
Ways of diagnosing this at the molecular level, known as "liquid biopsies," are already available in some countries, and more are scheduled to leave the lab and enter the commercial market in the years to come. I was very excited to see that in the UK, the NHS and healthcare company GRAIL are currently trialling the Galleri blood test, which looks for abnormal DNA in the blood, with 165,000 participants. The trial aims to detect the absolute earliest signs of cancer through next generation sequencing, and large numbers of readily accessible PCR machines can only speed up this process.
The innovative application of mRNA
I can't think of a more celebrated development in the last 12 months than the creation and rollout of multiple vaccines for SARS-CoV-2. For me, it represents the way out of seemingly endless cycles of lockdown and new COVID-19 waves. But these vaccines may hold more promise than "just" beating the pandemic.
The first vaccine approved in the West was made by Pfizer/BioNTech and was revolutionary for another reason: it was the first messenger RNA (mRNA) vaccine approved for human use which was previously only theoretical. Moderna followed soon afterwards.
mRNA COVID-19 vaccines are different than traditional vaccines. They work by carrying instructions – mRNA which codes proteins – to cells to produce harmless proteins of the virus at a molecular level. The immune system then detects these foreign proteins and learns to identify and destroy them. In effect, the body creates an immune response which is fully primed to fight the virus if exposed.
Can mRNA vaccines work for Alzheimer's and cancer?
If the immune system can be trained to fight proteins from a virus, what about teaching it to attack other proteins that cause illnesses? We know that Alzheimer's disease, a form of dementia, is accompanied by the formation of protein plaques which cause the slow and currently irreversible decline of cognitive function. I wonder, in the years to come, whether we will be able to design mRNA vaccines to target the very specific changes on these plaques and stop Alzheimer's?
Maybe we can go one step further and use vaccines to limit the spread of cancer? After all, at the molecular level, cancerous cells are cells that produce incorrect proteins. Immunotherapy is already being trialled for many cancers. With mRNA vaccines, we might be able to stop cancer in its tracks.
However, mRNA vaccines certainly won't be a panacea: two of the major fatal diseases of the 20th century – malaria and HIV – have far too much genetic variation to make such a specific and targeted approach viable with the technology we have now. But if we created multiple COVID-19 vaccines in less than a year, who knows what other progress we're capable of in the future?
Molecular diagnosis will change insurance
Currently, cancer is diagnosed by biopsy or radiography, which is what we consider a formal diagnosis for a Critical Illness insurance claim. If doctors switch to using liquid biopsies to diagnose cancer and begin treatment, then we will have to revisit how we approach cancer diagnosis and insurance claims. If we live to see a world where dementia and cancer are no longer fatal diseases, then I would expect changes to Life and Disability insurance.
Regardless of the medical developments post-COVID-19, one thing is clear: we are about to see a molecular revolution. Maybe this is a silver lining in all the pain, loss and sacrifices COVID-19 brought upon us. I know this new technology will make us more resilient to fight the next pandemic – I hope that it will also help eradicate dementia and cancer.