By Courtney Wright, PharmD
As the COVID-19 pandemic continues to progress, so does the research of vaccines and treatments to eradicate the elusive virus. Billions of dollars are being spent on research and development efforts to create effective immunity, particularly in elderly adults. As we age, chronic diseases, combined with treatments and immune response, greatly affect how we respond to vaccines and infectious diseases such as this coronavirus. The SARS-CoV-2 is the virus that causes COVID-19, manifesting through the Angiotensin Converting Enzyme 2 (ACE-2) receptor. The levels of ACE-2 have been shown to vary in younger vs. older patients, with older patients succumbing to the virus at higher rates. There is a vital urgency to understand the effect of COVID-19 upon older patients, especially in those with chronic medical conditions.
Based on the confirmed cases thus far, there is a marked vulnerability in the elderly population. This poses a big challenge in the development of vaccines and immunotherapeutic agents. Several studies have shown a decreased efficacy of vaccines in elderly patients, likely due to the decline of the innate and adaptive immune responses as we age. However, some vaccines are very effective in protecting elderly patients, such as the herpes zoster vaccine. Are there variables in the immune response from one elderly patient to another? How can we use the understanding of this variability to develop new vaccines and therapeutics?
The effects of COVID-19 on the elderly population have shed some light on the upcoming challenges the world is facing. The United Nations has reported that by the year 2050, there will be twice as many individuals over the age of 65 years old as there are under age 5, and this cohort will surpass people in the age range of 15-24 years old. Additionally, by 2050, the number of deaths from antimicrobial resistance is expected to reach 10 million, which will exceed the cancer mortality rate. Climate change from tropical vector-borne disease and more potential pandemic diseases will put an additional billion people at risk. Protecting the aging population will be a very important goal in maintaining global health and biosecurity.
Numerous recent technological advances in biomedical and computer science provide opportunities to decode the human immune system. Innovations in systems biology, specifically in clinical immunology, have allowed for detailed measurements of human transcriptomic, proteomic, immune, and metabolic responses. These new advances have led to an improved understanding of human responses in different populations, leading to new immune therapeutic strategies and potential novel vaccines. Innovations in bioinformatics, causal inference, and artificial intelligence can all potentially differentiate people who develop immunity to a disease or explain why some people respond to vaccines and some do not. These advancements will inform research for accelerating discoveries of COVID-19 vaccines and other future vaccinations.
The tools needed to develop therapeutics and vaccines to be effective in the aging population are available. Over time, a new generation of multidisciplinary scientists trained in biomedical, informatics, and computer sciences are warranted to develop these and to prepare for the next wave of infectious diseases. In the long run, the medical community will have to shift our focus from disease-specific research and therapy to targeting how to decode the human immune system, particularly in the elderly population.
References:
- Koff WC, Williams MA. Covid-19 and Immunity in Aging Populations. NEJM. 2020 April 17.
