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verely sick Covid-19 patients, who are experienc-
ing a “cytokine storm,” in which the immune sys-
tem overreacts. Small-scale studies have suggest-
ed this might be an effective treatment, and sev-
eral companies, including Melbourne, Australia–
based Mesoblast, are already in late-stage clinical
trials for severe Covid-19 patients. Soon-Shiong’s
companies are working with hospitals to recruit
patients for human trials.
f Soon-Shiong’s approaches to
Covid-19 bear fruit in clinical tri-
als, the next step may prove hard-
er still: getting those treatments
to needy patients. This is espe-
cially so for the vaccine, because at the moment
neither NantKwest nor ImmunityBio has the re-
sources to scale up manufacturing. “I’m now be-
hind the eight ball,” Soon-Shiong admits, “be-
cause there’s no way I could have 100 million
doses unless somebody supports me. Maybe I
have a million doses or 2 million doses.” He ex-
presses some frustration at the government: “Bil-
lions of dollars are going to companies that have
billions [in] revenues.” He’s not wrong about
that. In July, pharma giant Pfizer (2019 revenue:
$51.8 billion) received a $2 billion federal con-
tract to manufacture a vaccine it’s developing.
Things are brighter for the companies’ N-803
and NK-92 products, as NantKwest has the abil-
ity to manufacture at scale, but these treatments
will face certain competition from others being
developed by a number of pharmaceutical com-
panies. “I think there are a lot of alternatives that
are more practical than a cellular therapy for an
acute infectious disease,” Marasco says, though
he does acknowledge that the companies’ plans
to use stem cells against the more severe cases of
disease have potential.
Despite his frustrations, Soon-Shiong appears
determined to do his part in the health-care
industry’s war against the coronavirus. “This is
the crisis of our time,” he says. “It’s almost ex-
istential. The United States could have 20 to
30 million infected. You could have a million
deaths—this is not a joke.”
I
“My timeline is now dependent
on the FDA. I’M IN THE GATE, THE
BELL HASN’T RUNG and the
racehorse is frothing at the mouth.”
als, Soon-Shiong says he’s ready to go. “My timeline
is now dependent on the FDA letting me get out of
the gate,” he says. “I’m in the gate, the bell hasn’t
rung and the racehorse is frothing at the mouth.”
This vaccine is delivered to the body in a com-
mon cold virus called an adenovirus that has
been stripped of all the parts that can cause
harm to people or trigger the body to attack it.
That modified virus contains two individual seg-
ments of the Covid-19 coronavirus: the spike
protein, the surface protein on the virus that
triggers an antibody response; and a nucleo-
capsid protein, which is found in the center of
the virus. Most of the more than 100 vaccines
that are currently in clinical development for
Covid-19 focus on the spike protein to generate
an immune response. Soon-Shiong thinks that
won’t be enough, though, which is why he’s in-
cluding the nucleocapsid protein. “My concern is
that the spike protein mutates,” he says. “It’s mu-
tated even through this pandemic.”
Beyond potential mutations, another concern
about merely eliciting an antibody response is
that from the data seen so far, antibodies to the
Covid-19 virus just don’t last very long. Levels of
antibodies in the blood are “really low after a few
months,” says Marasco, who’s not associated with
Soon-Shiong’s companies or their vaccine re-
search. “I think it’s uncertain how long immuni-
ty will remain after successful vaccination.” Using
the nucleocapsid protein “couldn’t hurt,” he adds,
and it could elicit not only antibodies but virus-
killing T-cells as well.
The second weapon is the application of
NantKwest’s NK-92 and ImmunityBio’s N-803
against Covid-19. NK-92 is being adapted to
directly attack virus-infected cells, while the
N-803 stimulates the patient’s immune system
to produce its own natural killer cells against
the virus. The treatments might be used either
together or separately depending on the partic-
ular patient, Soon-Shiong says. Human trials
of these treatments have already begun. “It’s a
fantastic thing that they’re applying them to in-
fectious disease to see how patients fare,” says
Gigi Gronvall, an immunologist at Johns Hop-
kins Center for Health Security, who is not in-
volved in the research. “The concept is great,”
she adds, cautiously, “but we need to see what
the data says.”
The third weapon NantKwest and Immunity-
Bio are developing to combat Covid-19 involves
the use of mesenchymal stem cells, which are de-
rived from bone marrow. This type of stem cell
has been investigated over the past decade for dis-
eases—like Covid-19—that can cause the body’s
immune system to go into overdrive and attack
itself. This treatment would be for the most se-