As I write this, I’m finishing A Shot to Save the World, the new book about the hunt for a Covid vaccine.
Which - surprisingly - I don’t hate. Written by Gregory Zuckerman of the Wall Street Journal, the book is a serious look at the decades of scientific work that helped produce the mRNA and DNA/AAV Covid vaccines.
Even better, it contains this line about Stephane Bancel, Moderna’s chief executive, from Derrick Rossi: “He was asking me to steal from a hospital that treats children. Stephane is someone without a moral compass.”
Who’s Derrick Rossi? Some crazy ivermectin-loving anti-vaxxer, no doubt!
Cofounder of Moderna? Oh, that was my second guess. Meantime, Stephane has $10 billion in Moderna stock to buy a new moral compass.
But to read this book is to see that these new biotechnologies are to ordinary small-molecule drug development as a manned mission to Mars is to a cross-country road trip. They are so complicated that even explaining them coherently is hard.
Old-school small-molecule drugs like aspirin are usually relatively simple chemicals with atomic structures that can be sketched out on a napkin.
Aspirin:
In general, these drugs work in straightforward ways, by attaching to receptors on the surface of our cells and either activating them or blocking them from being activated.
The body then breaks them down, usually quite fast, and their cellular effects wear off. They must be dosed again after a few hours or a day. At this point, after generations of developing them, scientists and physicians understand how they work quite well. Even so they need to be carefully tested because they can have off-target effects or be toxic in unexpected ways.
But we’re pretty good at making them. In fact even 20 years ago we were so good at making them that we had hit most of the obvious targets for them, like cholesterol and blood pressure and diabetes.
Unfortunately, fiddling with cell receptors can only do so much. Most cancers, brain diseases, autoimmune diseases, and genetic disorders are simply not amenable to small-molecule treatments. Treating them requires larger and more complicated proteins and enzymes that mimic the body’s existing proteins, attach to specific parts of deranged cells (cancer or other), or have other effects.
For decades, those proteins were generally grown outside the body and then injected into it.
Artificially produced erythropoietin, or EPO - a molecule our own kidneys make to help stimulate the production of red blood cells - is a relatively simple example of such a treatment.
