The Nobel prize in physiology or medicine for 2023 is significant.
The prize has been awarded jointly to Katalin Karikó and Drew Weissman, scientists whose work fundamentally changed our understanding of how mRNA — messenger RNA — interacts with the immune system.
This recognition was for their work in the late 1990s. That is almost three decades ago.
So, what is it that they discovered which got them the Nobel now?
In our cells, genetic information is stored in DNA. This information is crucial for the production of proteins, which are essential for various cellular functions.
The process of transferring this information from DNA to proteins involves an intermediary molecule known as messenger RNA (mRNA).
The mRNA transcribes the information from the DNA, a process akin to taking notes from a lecture. These ‘notes’ or transcriptions are then translated into proteins.
This fundamental mechanism in molecular biology is known as the ‘central dogma’. It was proposed by Dr Francis Crick, the English scientist renowned for discovering the double helical structure of DNA.
Simultaneously, our innate immune system has evolved to identify certain molecular patterns associated with pathogens, which are disease-causing foreign organisms.
These recognisable patterns are referred to as pathogen-associated molecular patterns (PAMPs).
Karikó and Weissman observed that dendritic cells, which are part of our innate immune system, identified mRNA transcribed in a lab environment as a foreign substance; in other words, potentially a PAMP.
Interestingly, mRNA from mammalian cells did not trigger any immune response. This observation suggests that our immune system can distinguish between self and non-self mRNA. And this has a very specific chemical correlate.
The new medicine laureates discovered that the components of mRNA, known as nucleosides, are modified when they are inside the cell.
When these nucleosides are unmodified, they can trigger an immune response, leading to inflammation.
However, when these nucleosides are modified, they do not trigger an immune response. Instead, they allow the mRNA to produce proteins without being detected by the immune system.
The August 2005 paper ‘Suppression of RNA Recognition by Toll-like Receptors', published in the journal Immunity, as well as subsequent research that showed a way to prevent the immune system from destroying mRNA have been important in developing mRNA technology, leading to vaccines to combat the coronavirus SARS-CoV-2.
So, here is research which later became relevant in developing vaccines quickly against a pandemic that threatened the world with a global collapse and effected for more than a year a global standstill.
Huge transnational pharmaceutical companies like Pfizer were quick to recognise the potential of this technology and became dominant global players during the pandemic.
Science is one thing and technology, though related, is another. With technology comes politics, power, and profit.
It is well known that transnational pharmaceuticals would have loved India to be a recipient of their vaccines. They could have simultaneously displayed the global north’s magnanimity and charity while, behind the curtains, filled their coffers.
But a new India resisted it all during the pandemic. It relied on an ‘old school’ vaccine, but not without innovation.
Covaxin, developed by Bharat Biotech in collaboration with the Indian Council of Medical Research (ICMR) and the National Institute of Virology (MIV), can be considered 'old school' because it is an 'inactivated vaccine', made from a part of the coronavirus that has been inactivated.
But it is not merely 'old school'. Toll-like receptors (TLR) are a class of proteins that play a key role in the innate immune system. A TLR agonist is a molecule that can bind to and activate a TLR, thereby inducing an immune response.
Covaxin uses such a TLR agonist adsorbed to alum as an adjuvant — to create a stronger immune response. Covaxin, thus, raised the immune memory in its recipients.
What's impressive about the India vaccine story is how the country showed vital technological self-reliance with innovative adaptation as its very base.
The large-scale production and efficient distribution system with network connectivity that made the world’s largest democratic immunisation drive a success is in itself a meeting point of science, technology, and society in the spirit of democracy and increased awareness of citizen-government responsibility.
In terms of adaptability, too, the India vaccine story stands apart.
The vaccine does not need sub-zero temperatures for storage. It just needs an ordinary fridge. That is technology adaptability for society.
Each dose of Covaxin costs Rs 295, which is approximately $3.54. In comparison, the Moderna vaccine costs between $19 and $28 per dose, and the Pfizer/BioNTech vaccine costs around $26.70 per dose.
This makes Covaxin the most affordable vaccine purchased by any country in the world.
The 2023 medicine Nobel story is one of a discovery becoming a commercial technological success, finally entangled in multinational companies' struggle for power and profit.
India’s vaccine story is one of coming together of science and society, technology and democracy, to usher in an empowered, self-reliant society — healthy and disciplined.
It is the story of India becoming the emerging symbol of a self-reliant, scientific nation, coming out successfully from the fire of a pandemic.
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