Preparing for Outbreaks: Q&A with Thomas Rademacher, MD, PhD

Thomas Rademacher, MD, PhD
CO-founder and CEO
Emergex

In the second part of this two-part interview, Rademacher continues his discussion about preparing for outbreaks and pandemics ahead of time. Check out part 1 of this interview.

Pharmaceutical Executive: How is Emergex preparing for potential outbreaks or pandemics?
Thomas Rademacher: At Emergex, we carry the can globally on the preparedness issue. We have a lot of things in our freezers for a lot of viruses, such as potential vaccines that many people have likely never heard of. We can make vast amounts of these things, and make them cheaply, so they can be distributed where they need to be. Before us, there were a few national and international organizations that tried to do this, but they didn’t really take off.

There’s also the potential for bioterrorism. Someone may or may not, within the next 100 years, release viral strain X or Y. So, we have to think about whether we need to have something to treat these potential outbreaks stored in various locations around the world. I think we do, we must do that, because you can’t do human challenge studies. You can’t vaccinate somebody with a potential vaccine and then challenge them with the virus to see if it works.

Instead, you must have the vaccines in a bottle, ready to go, before the pandemic, epidemic, or outbreak. We’re in a unique position in the vaccine world. We work on a cellular immune basis of vaccinations, which is trying to reproduce regular immunity or a live-attenuated vaccine.

PE: How do you approach achieving immunity?
Rademacher: I always ask people how many mosquito bites do you need to catch dengue? You probably need quite a few, but if you’re short of the number needed to catch it, you may become naturally immune to dengue. In people, by the time people are 19, everyone is zero-positive for dengue, because they’ve developed that immunity by catching low-grade infections, which is sub-optimal.

In many ways, the live-attenuated vaccines were mimicking a very low dose of a natural infection.

That’s where the company evolved. We play an important role in the global vaccine world, especially in the tropical diseases. We also focus on first-world viruses as well.

PE: What is your view on universal vaccines?
Rademacher: If you go to part of Brazil and into the Amazon and they have an outbreak, there’s 66 viruses in the flavivirus family. What differs on these different viruses in the family is the surface code, like with COVID-19’s protein spikes. We name viruses by what is on the outside. The insides of these viruses are very similar. Most of the interior proteins in the various SARS viruses are 98-99% similar. Only a true expert could really tell them apart.

The cellular immune system doesn’t recognize the virus but it does recognize the viral infected cell. So, for example, flaviviruses go inside a cell and generate a flavivirus signal. These are pretty similar across the various viruses in the family. When you generate immunity against dengue, you’ve generated immunity against yellow fever to a large extent, and vice versa.

The idea of trying to make 66 flavivirus vaccines is insane. Are you going to give people 66 different shots? Cellular immunity removes that need. It’s similar to the flu. As far as your body is concerned when it generates a response against the flu, it doesn’t care if its H1-N1 or H1-N3, or whatever strain. It simply responds to the virus when it infects the cell. The concept of natural immunity has always been there.

The probably around developing universal vaccines has come from people doing something like trying to make a flu vaccine and making changes to it every year based on new strains. At the level of the cellular immune response, your body looks at the internal signals that come from the virus. Flavivirus produces on set of signals, while influenza viruses produce a different set of signals.

The body knows, probably through evolution, when it’s getting hit with an influenza, a flavivirus, or a different type of virus. From our point of view, anything that we make is, in a sense, universal, because the target is common amongst all of the strains. While it’s hard to test these things, our computer projections tell us that these will hit all 66 flaviviruses.