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As part of his work in global health, Bill Gates has warned for years about the potential for an unchecked epidemic to kill millions of people around the world.

“An epidemic, either naturally caused or intentionally caused, is the most likely thing to cause, say, 10 million excess deaths,” the Microsoft co-founder said in 2017. “It’s pretty surprising how little preparedness there is for it.”

The events of the past few weeks may be proving him right. A few weeks ago, as reports were emerging of the novel coronavirus increasingly reaching beyond China, Gates spoke about the issue at the American Association for the Advancement of Science annual meeting in Seattle.

“This is a huge challenge,” he said. “We’ve always known that the potential for a naturally caused or intentionally caused pandemic is one of the things that could disrupt health systems, economies, and cause more than 10 million excess deaths.”

But he also talked about potential long-term solutions, including the promising field of RNA and DNA vaccines — a new generation of cutting-edge techniques that could accelerate the global response to future outbreaks such as the current coronavirus epidemic.

So how do these new vaccines work, how do they differ from current approaches, and how could they improve our response to global health challenges like the current coronavirus outbreak?

On a new episode of GeekWire’s Health Tech Podcast, we go behind the scenes for answers to these questions with two University of Washington scientists pursuing DNA and RNA vaccine breakthroughs, generally known as nucleic acid vaccines: Dr. Deborah Fuller, a professor of microbiology and a vaccinologist at the University of Washington School of Medicine, and Dr. Jesse Erasmus, a molecular virologist working on new RNA vaccine and therapeutic technologies.

In the future, DNA and RNA approaches could lead to vaccines that are available within a few months of an outbreak, rather than the longer turnaround times common for traditional vaccines.

So how does this work? Here’s some Vaccine 101.

The most common form of traditional vaccine is an inactivated vaccine, which Fuller describes as the “shake and bake” approach, in which the virus or pathogen is killed and then injected into the body to stimulate an immune response. This is the case with the annual flu vaccine, for example.

Another current approach is the live attenuated vaccine, in which the pathogen is mutated to slow its growth prior to injection, so it stimulates an immune response without causing disease. The measles vaccine is a common example of this approach.

A third, newer approach is the recombinant vaccine, in which a specific protein or sub-unit of the virus or bacteria is identified, purified and injected to generate an immune response. An example of this is the Hepatitis B vaccine.

Next-generation DNA and RNA vaccines, aka nucleic acid vaccines, are similar in some respects to recombinant vaccines, but instead of purifying and injecting the protein, the approach directly injects the DNA or mRNA coding sequence for the antigen in such a way that human cells themselves produce the protein.

“You’re manufacturing your own vaccine,” Fuller explains. “And that has some really interesting advantages.”

First, with the nucleic acid approach, the body produces antibodies that prevent infections. In addition, it stimulates a cellular immune response that can recognize and clear infected cells.

Scientists including Erasmus have been working for weeks on next-generation vaccines for COVID-19. However, those would still require testing and approval, which means they don’t have implications for the immediate spread of the virus. Currently there are no DNA or RNA vaccines licensed for use in humans.

I have a lot of confidence that we’ll come up with a vaccine, that we’ll have a very effective vaccine for COVID-19. … It’s just a matter of time getting through all the steps that are required.

“For folks who are really worried about this as a pandemic, I have a lot of confidence that we’ll come up with a vaccine, that we’ll have a very effective vaccine for COVID-19,” Fuller said, describing it as “low-hanging fruit, because we now exactly what protein we need to include in our vaccine, we know what kind of immune responses we need to induce, and we have technologies capable of doing that. It’s just a matter of time getting through all the steps that are required.”

Fuller said she hopes the current outbreak will be a “wake-up call” to fund the development of these new vaccine platforms to accelerate the response in the future.

“Even if this particular virus goes away, there’s going to be one in the future,” Fuller explained. “And so one of the ways that we’re looking at our technology is not just to design a vaccine specific for this virus, but could we make a universal vaccine against any sort of coronavirus that may come up in the future.”

With the world suddenly highly interested in this field, Erasmus has been closely watching the public discussion about vaccines and COVID-19. “Particularly nowadays, communication is happening very rapidly on social media platforms, and scientists are particularly vocal on social media,” he said. “I think they’re doing a very good job of communicating to the general public.”

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