How Seattle’s Fred Hutchinson Cancer Research Center Became a Global Leader in Testing COVID-19 Vaccines

 

When COVID-19 first made landfall in the U.S. last year, it made its grand entrance in Snohomish County, Washington, and eventually turned Seattle into the country’s “coronavirus capital” for some months. So, in a way, it’s only fitting that the institution at the center of the vaccine development campaign to end the pandemic is based in Seattle, as well.

On the face of it, Fred Hutchinson Cancer Research Center may sound like an unlikely candidate to coordinate COVID-19 vaccine clinical trials. But “Fred Hutch” or “the Hutch” as it’s known, was actually an obvious choice, after having worked for more than 20 years on a vaccine to end another pandemic: HIV/AIDS.

Fred Hutch was founded in 1975 as a center dedicated to studying cancer – and that work continues. But it soon became renowned for its work on other diseases, too, especially HIV (which also causes a type of cancer called Kaposi sarcoma).

It was through HIV research that the center’s former president and director, Dr. Larry Corey, became friends and colleagues with Dr. Anthony Fauci in the 1980s. In fact, it was Fauci who encouraged Corey in 1998 to co-found what became the HIV Vaccine Trials Network (HVTN), the world’s largest publicly funded international collaboration conducting clinical trials of HIV vaccines. The HVTN is headquartered at Fred Hutch and supported by the National Institute of Allergy and Infectious Diseases (NIAID), which is headed by Fauci.

So, when COVID-19 hit, it was no surprise that Fauci tapped Corey, along with the global network and expertise of Fred Hutch and the HVTN, to coordinate vaccine trials through a newly-formed clinical trials network: the COVID-19 Prevention Network (CoVPN). The plan was to “harmonize” trials of various vaccines so they could be compared to each other by asking a common set of questions, setting a common set of goals, and measuring success with a common set of tests, carried out by independent laboratories. And it needed to be done as quickly as possible.

CoVPN manages more than 100 clinical trial sites in the U.S. and around the world, including in Mexico, Peru, Brazil, Argentina, South Africa, Kenya, Uganda, Tanzania, Zimbabwe, Zambia and Malawi. So far it has tested, and is still evaluating, vaccines from Moderna, AstraZeneca, Johnson & Johnson, Novavax, and Sanofi.

“Our large network, which is very connected across different disciplines, was a really obvious choice to move forward these COVID-19 vaccines,” says Dr. Michele Andrasik, a senior staff scientist in the Vaccine and Infectious Disease Division of Fred Hutch and director of Social & Behavioral Sciences and Community Engagement at HVTN and CoVPN.

The HVTN’s three core areas — operations/leadership, statistical, and laboratory — are all housed at Fred Hutch. Additionally, with clinical trial sites spread across the country and around the world, the Hutch had all the mechanisms and processes in place to ensure that COVID-19 vaccines could get through trials safely, effectively, and relatively quickly.

“We’ve been incredibly successful at shepherding through HIV vaccine trials, so for us, it was a seamless shift,” says Andrasik of taking on the responsibilities of the CoVPN.

“It’s always been our opinion that vaccines are what is going to get us out of this,” says Andrasik, but testing and developing vaccines that work is only the first step. Vaccinating people – enough people – is the goal.

Doing so requires building people’s confidence in vaccines. So, Fred Hutch did what it has always done. Its external relations team reached out to community partners in Washington and around the world – in Asia, in the Pacific Islands, in Indigenous communities, in the Latin American diaspora, in the Black diaspora – to learn how the disease was impacting their communities. They asked leaders what their communities needed to know about the vaccines and what was needed to not only enroll people in vaccine trials, but to increase the number of people getting vaccinated.

According to Dr. Stephaun Wallace, a Fred Hutch staff scientist and HVTN and CoVPN’s director of external relations, skepticism about the trial process or of the vaccines usually falls into four main categories: questions about the benefits, safety and side effects; concerns about the speed with which the vaccines have been developed and whether they work on people “like me;” distrust in the political and economic motivations of the governments and companies involved; and belief in misinformation or conspiracy theories.

Fred Hutch is working especially hard to ensure representation of Black, Indigenous, and people of color (BIPOC) communities in vaccine trials, because diversity is important for finding a vaccine that works in all kinds of people, and it is necessary for building vaccine confidence. People are more likely to take a vaccine that they know worked on someone who looks like them, says Andrasik.

Again, community engagement is key to increasing BIPOC representation in trials. Fred Hutch’s clinical trial sites have always been in the communities where they work, says Andrasik, and the people who work at those sites are members of the community themselves. Wallace says the team works hard to acknowledge community concerns, provide accurate information, and ensure the ethical conduct of research.

Vaccine confidence isn’t as great of an issue outside of North America and Western Europe, says Andrasik. Instead, the challenge in many low- and middle-income countries is just getting the vaccines there. Besides an inequitable global supply of vaccines, inconsistent pricing is also part of the problem, as well as inadequate public health infrastructure that limits the types of vaccines that are viable in areas without sufficient cold storage capacity, according to Raquel Sanchez, the managing director of Global Oncology at Fred Hutch.

Andrasik says Fred Hutch’s approach is to let global partners take the lead. “They’ll let you know what they need in terms of support,” she says, but ensuring that the trials go through as quickly as possible – without bypassing any safety procedures – is one way they’re helping low- and middle-income countries get vaccines sooner.

As vaccines are now being rolled out, community engagement is still key. According to Andrasik, some of the most successful places in the country that are distributing vaccines are doing so in collaboration with faith-based organizations, community organizations, and long-standing institutions that have earned the trust of the communities they’re in. Locally, Fred Hutch is working with the Washington Department of Health and Seattle and King County Public Health to further that effort.

But it’s always a learning process. For example, early on, Seattle – and other cities – thought that mass vaccination sites in BIPOC communities were the answer to administering vaccines equitably. Instead, it quickly became clear that the people who were accessing the sites were not the people who lived in those communities. Instead, it was mostly people who had the ability to chase down appointments, as they worked from home on their computers, who then drove into BIPOC communities to get their vaccinations.

In response, Andrasik says there has been a “massive effort” by the city, local, and state government to deploy pop-up and mobile sites that go directly into BIPOC communities. In some situations, unique URLs have been created for community-based organizations to give to their clients in order to ensure that vaccination appointments are actually being filled by BIPOC individuals.

Although there’s still a lot of work to do to ensure equity as we move closer to ending this pandemic, Andrasik is optimistic: “This is by far the greatest and most concerted effort toward equity that I’ve ever seen in my life, and it’s really amazing to be a part of it.”