Scientists predict progress against COVID-19, cancer in 2021

Just as the COVID-19 pandemic dominated our lives in 2020, it was a huge focus for many researchers at Fred Hutchinson Cancer Research Center and around the world. That focus is likely to continue in 2021, but the increasing availability of vaccines means our experts forecast a positive shift in the course of the pandemic in the coming year.  

With that hopeful outlook as a foundation, we talked to researchers across Fred Hutch about what they are expecting in 2021 — not only in COVID-19, but also in the diseases that we’ve been facing  year after year. 

COVID-19 vaccines will have a positive impact 

It has been a momentous year for former Fred Hutch President and Director Dr. Larry Corey. In February the acclaimed virologist was tapped by his friend Dr. Tony Fauci to help shape plans for clinical trials of potential COVID-19 vaccines. 

That effort led to the formation in April of the COVID-19 Prevention Network, or CoVPN, which was formally launched in July to run the large-scale Phase 3 clinical trials of vaccines seen as the world’s best hope of controlling the pandemic. The CoVPN operations center is directed by Corey and based at Fred Hutch, which was chosen for its decades of expertise in designing and running international HIV vaccine studies. 

The early success of the Moderna vaccine, tested through the CoVPN, underscores the urgency of that mission and delivered rare bright moments in a bleak year. Moderna’s vaccine received an emergency use authorization from the Food and Drug Administration on Dec. 18, on the heels of the FDA’s authorization of Pfizer’s independently tested vaccine a week earlier. 

Looking ahead, Corey believes that the coronavirus vaccines will change the course of the pandemic, allowing all of us to return to something resembling normal life a year from now: “I am optimistic that I will be able to ski with my grandkids for their winter break in December 2021,” he said.

For the stressed U.S. medical system, Corey also predicts the vaccines will have a marked impact in reducing deaths and severe illness. “I think we will see the percent of people who go on ventilators for COVID-19 be reduced by 60% by September 2021,” he said. 

As for research at the Hutch itself, he is hopeful that laboratories will attain a fully immunized workforce during the year, enabling operations at close to full capacity. “But we will still be wearing masks,” Corey said.

Dr. Parth Shah, a pharmacist and behavioral scientist with the Hutchinson Institute for Cancer Outcomes Research, expects that an initially hesitant public will become increasingly willing to get the new vaccines over the course of 2021.  

“There’s a lot of ‘wait and see’ going on; people waiting to see what the data are going to show: Is the vaccine as effective as people say? Are we seeing weird side effects that weren’t reported in the trials? I can understand not being the first to get a vaccine,” said Shah, who studies how to improve the delivery of vaccination services and other medical care. “As more and more front line and health care workers get vaccinated — that’s going to be a strong signal of confidence in these vaccines to the general public.”

Another nudge toward high vaccination rates: pandemic fatigue. 

“A lot of people look at these vaccines as a way to get back to normal — to go out and spend time with family members. It’s been distressing for everyone,” he said. “I can’t wait to see my friends, travel again, and do the things I love to do locally like go to concerts and out to eat. The vaccine is one of the very, very tangible ways we can do that again.”

But some people will still refuse to be vaccinated, often fueled by misinformation they get from their social networks and websites peddling conspiracies. And, unfortunately, he predicted that will stay with us through 2021 and beyond. 

“Conspiracy theories and misinformation won’t go away,” Shah said. “It will be a continued nuisance for public health practitioners and providers, and we have to be continually vigilant for it.”

Advances against other viral diseases, including HIV and herpes 

Dr. Julie McElrath, senior vice president and director of the Hutch’s Vaccine and Infectious Disease Division and holder of the Joel D. Meyers Endowed Chair, has been living at the center of the COVID-19 whirlwind since reports first surfaced about a novel coronavirus sickening people in Wuhan, China one year ago.

The pandemic vaccine research of the last year, however harrowing, may set the stage for speedier efforts to find ways to block other viral diseases. “There’s potential to accelerate the process for producing vaccines, conducting clinical trials, obtaining efficacy results and vaccine distribution,” she said. 

Corey, who has been leading HIV prevention trials for decades, predicts some encouraging news in 2021 in that field. With a predicted rollout of injectable antiviral drugs like cabotegravir that block HIV transmission, Corey said, “We will see a reduction in new HIV infections in the U.S. at the end of next year.”

He also foresees progress in the use of monoclonal antibody combinations for the treatment and prevention of HIV. “It will take a couple of more years to get licensed, but the research focus on monoclonals will increase,” he said.  

Like Corey, Fred Hutch virologist Dr. Keith Jerome is looking forward to widespread availability of COVID-19 vaccines and life returning to a more normal state. Jerome is also director of the Molecular Virology Laboratory at the University of Washington, which played a pivotal role in identifying early community spread of the coronavirus in February, and by December was processing 10,000 COVID-19 tests per day covering the Puget Sound region.

In the midst of that pandemic work, Jerome and his colleagues published in the journal Nature Communications results of pathbreaking research on using gene therapy to eliminate up to 95% of herpes simplex virus-1 in mouse experiments. In the coming year he anticipates progress using similar techniques to target HSV in guinea pigs, a prelude to human trials, still a few years away.

“We’re really excited to see how our therapy reduces — or hopefully eliminates — recurrent HSV lesions,” he said.  “We also hope to generate data this coming year for HSV-2 elimination to add to our HSV-1 work.”

Advances in precision medicine for cancers

Dr. Andrew Cowan, who specializes in multiple myeloma research and treatment, anticipates the first FDA approvals for immunotherapies for this cancer in 2021. Multiple myeloma is largely incurable, and new targeted, immune-based therapies have made headlines at industry meetings — including immune-activating drugs called bispecific antibodies and genetically engineered immune effector cell treatments, called CAR T-cell therapies. A Phase 1 clinical trial led by Cowan and based on research by the Hutch’s Dr. Damian Green combines an experimental CAR T-cell therapy for multiple myeloma with a drug that keeps the cancer cells from shedding the target the T cells see, potentially resulting in a stronger therapy. 

Cowan is also hopeful that the new year will bring greater accessibility of treatments to patients. An analysis he presented at this month’s annual meeting of the American Society of Hematology with colleagues in HICOR showed that multiple myeloma patients had better outcomes when treated in Alberta, Canada, compared with people in Western Washington in the SEER-Medicare database from 2007-2013, and had differing upfront patterns of treatment..

“New therapies for multiple myeloma give me hope that we will someday be able to cure this disease,” Cowan said. “But we still will need to work on health care policies that enable patients to receive the best treatment, regardless of where they live.”

Dr. Amanda Paulovich develops new technologies and tests to measure proteins, the workhorse molecules of the cell that are critical both as targets and tools in cancer therapy. She, too, looks forward to advances in precision medicine in 2021. In 2020 she published a first-of-its-kind study in the journal Cell with the National Cancer Institute and other collaborators to identify protein patterns in pediatric brain tumors.

“Our lab processed more than two hundred pediatric brain samples, which was an emotional undertaking knowing what these tissues represent on the human level,” said Paulovich, who holds the Aven Foundation Endowed Chair at Fred Hutch. “The study results are being looked at for a new clinical trial, which I hope makes progress toward the clinic in 2021. I hope it brings comfort to patients and their families who have suffered from this terrible disease.” 

She and her team are working on a similar approach for breast and other cancers. 

Progress toward equity 

This year has been notable not only for the coronavirus pandemic, but also for a renewed national antiracism movement. This push for equity has been a part of research and medical care as well. For example, building off longstanding equity work in HIV vaccine trials, the CoVPN’s massive efforts to recruit tens of thousands of participants into coronavirus vaccine trials includes extensive work to ensure that the trials are diverse and inclusive.  

In 2021, Fred Hutch will complete a faculty “cluster hire” announced in 2020 to bring to the center a cohort of researchers in a range of scientific disciplines who actively demonstrate a commitment to diversity, antiracism and inclusion. 

Shah envisions more progress next year in health equity at institutions around the country and locally as well. 

“The pandemic revealed a lot of structural problems with the way we do research, the way we provide health care,” Shah said. “I’m really happy our leadership at Fred Hutch recognizes that and is trying to make tangible changes in the immediate and forthcoming future with regard to equity in research.”