AHEAD OF THE CURVE

As the race intensifies to find vaccines and treatments for Covid-19, researchers in Melbourne are working on a trial of 10,000 healthcare workers to see if an existing vaccine for tuberculosis could hold a key.

buzzword of 2020 is ‘pivot’. It’s been used to explain how individuals, businesses and governments have all shifted course in the wake of Covid-19. For Murdoch Children’s Research Institute (MCRI) in Melbourne, the word offers more than a simple cliché, however. It describes how the organisation has turned valuable knowledge from existing work into something that will possibly be a game changer in the fight against Covid-19.

It started, explains institute director Professor Kathryn North, with research they were already doing around the Bacillus CalmetteGuérin (or BCG) vaccine. While typically given to children in Third World countries to combat tuberculosis, in recent years researchers noticed it also boosts immunity, which continues into adulthood.

“There have been studies looking at adults with influenza and other types of viral infections that have demonstrated that giving BCG can decrease the severity of the infection and can decrease mortality,” explains North. There is also circumstantial evidence, she says: “The countries where BCG is part of the routine vaccination look, so far, like they’re less severely hit [by Covid-19] than other countries.”

SURELY THE BIGGEST

Back in late February, North received a call from researchers at MCRI suggesting to trial the vaccine on healthcare workers at risk of contracting Covid-19. She gave the project, led by Professor Nigel Curtis, the green light and also underwrote it. From there, it took just 20 days for the study to go from the design phase and through the relevant ethics approvals to become ready for healthcare workers to enrol. It also garnered support from the director general of the World Health Organization.

“To put this in context, to set up this sort of complexity of trial at this scale – from idea to getting it through the first enrolment – would usually take a minimum of nine to 12 months,” says North.

The BRACE trial, as it’s now known, was initially planned for local rollout, but having received significant philanthropic investment and a recent $10 million grant from the Bill & Melinda Gates Foundation, can now extend beyond our borders to 10,000 people in Spain and The Netherlands, as well as those in Australia.

“To get the answer more quickly and to also add on studies to look at how it might be affecting the response to the virus, the more the better,” says North.

Hypothetically, if the BCG vaccine is shown to be beneficial, it could eventually be released more widely. Evidence is the goal. “We don’t know the answers, but it’s got biological plausibility … Once you can demonstrate it’s making the difference you can move to much more widespread vaccination if you’ve demonstrated that it’s having a positive effect,” explains North.

The work has been an exercise in both domestic and global solidarity for the research community. “We’ve been in contact with experts all around the world; there’s a huge amount of cooperation,” reveals North. “We’re sharing all the information we learn along the way.”

This is particularly reassuring given how quickly things can change. While it’s understood children generally appear to have mild or no symptoms for Covid-19, there have been recent reports overseas of children presenting with an illness resembling Kawasaki disease and toxic shock syndrome. While some of these (but not all) have tested positive to the virus that causes Covid-19, it’s causing speculation there’s a link between the two. The MCRI say it’s an intriguing but unproven link and however tempting it may be to conclude Covid-19 might trigger Kawasaki disease, it should be met with caution. Its website has proved to be a valuable resource for parents seeking upto-date articles, information and FAQs as reports circulate.

North says she’s never been prouder of her institute’s work. What continues to impress her, she says, is “the ingenuity, the drive, the curiosity, the energy and the dedication” of her staff and colleagues. “Australia has proven itself to be a global leader in flattening the curve and we are pleased to now be in a position to help the rest of the world. We are still in a race against time.”

“Australia has proven itself to be a global leader in flattening the curve and we are pleased to now be in a position to help the rest of the world”