Bio-Engineered Plant-produced Antigens, Self-Administered for Oral Vaccination: A Cottage Industry for Vaccines for Less Affluent Nations?

Background

Introduction

PROPOSAL

EVIDENCE

[A] EXPRESSION OF ANTIGENS IN TRANSGENIC PLANTS

Mason et al. (1992) expressed hepatitis B surface antigen (HBsAg) by genetically transforming tobacco (Nicotania tabacum; not an edible plant) plants with the gene encoding hepatitis B surface antigen linked to a nominally constitutive promoter (Figure 1). The gene encoding HBsAg was integrated into the plant genomic DNA via Agrobacterium tumefaciens-mediated transformation.

Enzyme-linked immunoassays using a monoclonal antibody directed against human serum-derived HBsAg revealed presence of HBsAg in extracts of transformed tobacco leaves (correlated with presence of recombinant HBsAg mRNA in tobacco leaves). Therefore, expression of foreign antigens (e.g., Ebola virus surface antigen, EBOV; SARS-CoV-2 surface antigen, S [Spike] protein, bacterial toxins) in plants, may not suffer from any limitations of transcription or translation in plants.

Intramuscular injection with rHBsAg (recombinant HBsAg) produced in yeast[18] resulted in effective immunization[19] and protection from viral infection (agnostic of potential for any variation in post-translational modifications in yeast, Saccharomyces cerevisiae). Each subject received a 10-μg dose of HBsAg at 0, 1, and 6 months. By one month, 27% to 40% of the vaccinees had antibody to HBsAg, and by three months 80% to 100% were antibody positive (Skolnick et al., 1984).

Levels of rHBsAg (Figure 2) in transgenic tobacco leaves appear to be less than 0.01% (maximal levels are closer to 0.006%). Assuming rHBsAg concentration of 0.005% (50ng/mg protein), it will require ~200mg of soluble protein (extracted from tobacco leaves) to deliver a single 10-μg dose of rHBsAg. How many leaves of a plant are necessary to deliver an adequate dose is an open question with respect to sublingual administration in the form of raw leaf-paste (only from edible plants, not tobacco).

[B] IMMUNOGENICITY IN HUMANS

The ability of the body to differentiate between the “edible” plant proteins (e.g., should not produce an immune response to lettuce leaves, potatoes, watercress) and the foreign antigen in the transgenic plant product (e.g., edible lettuce leaves, potatoes or watercress expressing foreign antigen) lies at the heart of the anticipated specificity of antigen-induced immunogenicity in humans. Induction of immunity by foreign antigens (sufficient to protect from infection) in healthy individuals is the ultimate “litmus” test for recombinant antigens produced in edible plants. The choice of edible plant products (oral “edible” products or sublingual administration for rapid absorption in the blood stream) may influence the intensity and duration of the immune response. We re-present a few seminal but old experimental results demonstrating that unpurified edible plant-based oral vaccines can induce immunity in humans.

Kapusta et al., 1999, fed lettuce containing 0.1μg – 0.5μg of HBsAg (per 100g leaf) to volunteers (initial 200g of lettuce leaves; after 2 months, 150g). Blood samples were collected before (pre-immune) and 2 week and 4 week after first 200g lettuce and then 2 week, 4 week and 12 week after 150g of lettuce.

Figure 3. Titer of antibodies in three individuals [A] immunized orally with transgenic lettuce engineered to express HBsAg. [B] Control (two individuals fed with edible lettuce without HBsAg). Two of the three volunteers developed immunity potentially capable of preventing infection (bottom). Kapusta et al., 1999.

Figure 3. Titer of antibodies in three individuals [A] immunized orally with transgenic lettuce engineered to express HBsAg. [B] Control (two individuals fed with edible lettuce without HBsAg). Two of the three volunteers developed immunity potentially capable of preventing infection (bottom). Kapusta et al., 1999.

Tacket et al., 1998, fed volunteers with genetically modified raw (uncooked, unpurified) potatoes expressing the enterotoxigenic Escherichia coli LT-B (B subunit of the E. coli enterotoxin is non-toxic and related to the B subunit of cholera toxin). Adult volunteers (n=14) ingested either 100 g of transgenic potato, 50 g of transgenic potato, or 50 g of wild-type potato. E. coli enterotoxin LT-B subunit protein in the potato was estimated to be 3.7-15.7 µg per gram. The amount of E. coli enterotoxin LT-B subunit protein ingested per 50g or 100 g dose ranged from 0.4mg to 1.1mg per dose (mean 0.75 mg/dose). Tacket et al., 2004, reaped similar success in delivering LT-B orally to humans via transgenic corn[20].

Figure 4. Geometric mean LT-B neutralizing antibody titers in volunteers who ingested transgenic potatoes (n = 11) or wild-type potatoes (n = 3). Potatoes were ingested on days 0, 7 and 21 (arrows). Tacket et al., 1998.

Figure 4. Geometric mean LT-B neutralizing antibody titers in volunteers who ingested transgenic potatoes (n = 11) or wild-type potatoes (n = 3). Potatoes were ingested on days 0, 7 and 21 (arrows). Tacket et al., 1998.

Tacket et al., 2000, explored immunization against Norovirus (causative agent for gastroenteritis, commonly referred to as stomach flu) using plant-based oral vaccine (POV). The first norovirus outbreak occurred in Norwalk, Ohio, USA, in a school in 1968. For this reason, the first strain of norovirus is also known as the Norwalk virus[21]. Tacket et al., 2000, used “Norwalk virus capsid protein (NVCP), assembled into virus-like particles (VLP), as a test antigen, to determine immune response in volunteers who had ingested transgenic potatoes (uncooked, unpurified). Healthy adult volunteers (n = 24) received 2 or 3 doses of transgenic potato (n=20) or 3 doses of wild-type potato (n=4). Each dose consisted of 150g of uncooked, raw, peeled, diced potato (unpurified) that contained 215–751mg of NVCP. 19 (95%) of 20 volunteers who ingested transgenic potatoes developed significant increases in the numbers of specific IgA antibody–secreting cells (ASC). 4 (20%) of 20 volunteers developed specific serum IgG, and 6 (30%) of 20 volunteers developed specific stool IgA. Overall, 19 of 20 volunteers (95%) developed an immune response of some kind, although the level of serum antibody increases were modest.”

The significance of edible potatoes for oral vaccination (POV) is simplicity of delivery, as a food lifestyle for immunization. Potatoes can be grown from potatoes, potatoes can grow anywhere, potatoes can be grown indoors, potatoes can be grown in tires, potatoes can be grown in cardboard boxes or any container and potatoes are suitable for hydroponic growth[22]. In addition to potatoes, edible leaves (thale cress, watercress, mustard greens) may be suitable for sublingual administration as “leaf paste” for rapid absorption in the bloodstream. Thus, these edible global vaccination solutions will benefit poor people.

Table 2. Immune response to Norovirus – unpurified potatoes expressing Norwalk virus capsid protein (NVCP) vs control (wild-type potatoes). Tacket et al., 2000. Can we increase the level of serum antibody?

Table 2. Immune response to Norovirus – unpurified potatoes expressing Norwalk virus capsid protein (NVCP) vs control (wild-type potatoes). Tacket et al., 2000. Can we increase the level of serum antibody?

DISCUSSION

STEPS: GLOBAL HEALTH SOLUTION IN 7 STEPS FOR ~7 BILLION PEOPLE?

The vision of BEPASA is half century old. Several vaccine[31] efforts are in progress[32]. But, we are still waiting to build the ramp to transform POV into reality to lift ~7 billion lives. It may not happen by committee. We need commitment from a few committed individuals who will provide the leadership.

TRANSLATIONAL SCIENCE

Translating these 7 steps into a production phase (when/where end users can obtain plants and know-how and how much to self-administer at what frequency) calls for establishing baselines, ranges and a skeleton of standard operating procedures. Errors due to estimating the immunogenicity of the plant-derived antigen (PDA) and improper tests to establish the level of circulating immunoglobulins (mainly IgG but IgA, too, for mucosal membranes[33]) in response to the recombinant antigen introduced orally (PDA) could be harmful. IgG antibody (to antigen) serves as an accessible quantitative biomarker of post-vaccination protection because T-cell responses (umbrella response of CDn+ cells) are important but difficult to quantify. IgG titer and its duration is salient to “sterilizing” immunity which is the desired post-vaccination outcome for complete clinical protection from contracting infection (dose dependent). Viruses/bacteria invading the mucosal surfaces complicates the “sterilizing” immunity scenario because the number of invading infectious particles (e.g., virions) will influence (may overwhelm) the outcome.

Establishing threshold values for IgG antibody response to antigen (PDA) is confounded by the immune status of (test) individuals, pattern of cytokine response to antigen, pre-existing conditions, sex, age, race, ethnicity (population genetics) and per capita income level (proxy for nutritional status). In addition, the quest for a protective titer[34] may/will be influenced by [i] type of expression vector used in creating the transgenic plant (source of PDA) [ii] expression level of protein (antigen in ng/mg of soluble protein) in plants (leaves) [iii] ingested vs absorbed amount of PDA [iv] individual (gut) microbiomes[35] in the interplay between immune health and nutrition[36] [v] testing/monitoring constraints [vi] others.

Figure 5. Couples selected from a homogeneous background (race, ethnicity, economic status) respond differently to SARS-CoV-2 mRNA vaccine[37]. What is the protective titer for “sterilizing” immunity?

Figure 5. Couples selected from a homogeneous background (race, ethnicity, economic status) respond differently to SARS-CoV-2 mRNA vaccine[37]. What is the protective titer for “sterilizing” immunity?

Identification of thresholds for the IgG antibody levels for sterilizing immunity (collect titer data for different infections, globally) is the translational science data for POV to inform the transition from the lab to locals. Establishing a “green zone” threshold of circulating IgG levels in response to PDA is the “target” that individuals want to know to assess (from self-testing) acquisition of immune protection. To arrive at this “target” the users must ingest a minimum weight of plant product to absorb PDA in their body (blood) within a specific period. Declaring the “green zone” threshold target for IgG antibody levels must take into account risk mitigation strategies. The latter must make room for high fault tolerance due to mis-steps, mis-information, and mis-calculations, inevitable from the self-administration of PDA.

The bridge of translational science knowledge from the lab to locals (LTL) holds the potential to save ~7 billion lives. But, the path to global vaccination will be non-linear even if the science of POV may be summarized in 6 (not 7) relatively simple sequential steps. There is a non-zero probability “new” lies will be manufactured to transform saving lives into a dying art. Scientists must be cognizant of their own hubris and desist from their desire to pursue perfection in determining the titer for “sterilizing” immunity. The latter is our penchant to understand immunological dynamics. If we are challenging uninfected humans with a live dose of a potentially fatal virus (Ebola, Lyssa, Marburg) then we should know the IgG levels for “sterilizing” immunity and adhere to safety measures advocated by the US FDA.

Steps 1-6 must proceed without any delay due to translational science related efforts. We must implement POV. The risk from exposure to deadly viruses far outweigh the risks due to ingestion of potatoes or watercress or mustard greens as a source of PDA even without any standard protocol or dietary guide to induction of immunity (IgG titers in blood). While we work in labs, the locals must not be kept waiting for this proven solution (steps 1-6) in hand. Even low levels of IgG may reduce fatalities and dampen the severity/acuity of infection. Should the luxury of pursuing translational science prevent us from the urgent implementation of POV and deliver potential death sentences for billions of people?

COMMENTARY

TEMPORARY CONCLUSION

Based on published papers, it is a fact that foreign antigens can be produced in transgenic plants. Table 3 (below) indicates that that outcome is largely ignored by the nations[50] preparing for pandemic regulatory capacity. Oral (sublingual) administration of plant-produced unpurified antigens are capable of inducing immunogenicity in humans. Step 7 may prove that the immune response to plant-produced antigens are adequate to induce sterilizing immunity (i.e., protects from and prevents infection). The use of edible Arabidopsis thaliana (thale cress) and/or Brassica rapa (“fast” plants) may be palatable as transgenic plants of choice. Exploring the use of watercress (Nasturtium officinale) may offer an even more “tasty” option. Further explorations using potyviruses as vectors to deliver the recombinant antigen may lead to use of flowers (rose, tulips) to serve as vehicles for oral administration of foreign antigens (edible flowers are used in Eastern foods and tulips[51] represent the world’s first financial bubble).

US and EU may balk at Step 7 but most nations in Asia and Africa will embrace the opportunity for mass adoption of low cost vaccination solutions to mitigate risks due to public health catastrophes. POV represents a lifestyle practice similar to use of neem tree twigs for cleaning teeth (Azadirachta[52] indica). Instead of the elusive quest for alms, developing nations with ~7 billion people may prefer bold approaches rather than waiting for ‘blessings’ from FDA, CDC, ECDC for POV solutions for healthcare.

Cartoon: Genetically Modified, Bio-Engineered and Transgenic are elephant in the room[53] terms preventing global adoption of useful plants and crops. Phobia, resistance and irrationality even among rational humans are holding ~7 billion people hostage by depriving them of access to health/healthcare.

The global need for vaccines is the fuel to pursue plant-based oral vaccines (POV). But one must add and admit that there will be errors and missteps in the process, even if the benefits vastly outweigh the problems. Almost nothing in science is always absolutely perfect, even the best solutions may present unexplained problems which may temporarily plunge the effort in a quandary, agnostic of how precisely it was planned, executed and/or implemented. POV may not be a panacea for all ills, it is expected to experience growing pains and it will expose gaps in our multi-disciplinary knowledge or even overwhelm us with unknown unknowns. Are these sufficient reasons to asphyxiate the pursuit of scientific solutions?

Despite the anticipated and unanticipated shortcomings of POV, let us use the Pareto principle and proceed to hypothesize that POV may be effective in preventing healthcare disasters 80% of the time for 80% of the ~7 billion people in less affluent nations. Is saving 80% of the world not worth the effort?

If the positivism of the 80% optimism is too sugary for Pareto pessimists, let us consider what if POV may be effective in preventing healthcare disasters for only 20% of the ~7 billion poor people. The pessimists of POV should reflect whether we can discard or bypass or scoff at the ability of POV to help 1.4 billion people (i.e., current population of India [~1.4 billion] or China [~1.4 billion]). In other words, are the nay-sayers of POV prefer to ignore scientific rationale and choose to be oblivious of the preventive health of ~1.4 billion poor people? Do POV pessimists “believe” that they are “protecting” poor people by their opposition? In reality, inaction about POV makes living a dying art.

The 20th century scientific research results, re-presented in this discussion, may become catalytic to save the world from public health cataclysms in the 22nd century. How common is resistance to reason?

In the 18th century, for sailors, disease during long sea voyages was often more dangerous than enemy action. One British expedition to raid Spanish holdings in the Pacific Ocean in the 1740’s lost 1,300 of an original complement of 2,000 men to illness. That illness was scurvy. In 1747, on board HMS Salisbury, James Lind (1716-1794) carried out the first controlled clinical trial in medical science[54]. He took 12 men suffering from similar symptoms of scurvy, divided them into six pairs and treated them with remedies suggested by previous observers/writers (in 1622, explorer Richard Hawkins[55] recorded that “sower lemons and oranges” were “most fruitful”). In 1747, the results from James Lind’s “clinical trial” demonstrated that oranges and lemons were indeed a cure for scurvy. “Treatise of the Scurvy” appeared[56] in 1753, but it was not until 1795 (42 years later) that the British Admiralty issued an order for distribution of lemon juice to sailors. Apparently, James Lind did not possess sufficient clout.

In the 19th century, John Snow (1813-1858), an anesthesiologist in London, conducted an epidemiological study of water supply from the Broad Street Pump in 1854. Results indicated that cholera was a water-borne disease. But, the “germ” theory were ignored by the Miasma theorists. It was not until the epidemic of cholera in Egypt in 1883 that Snow’s findings were re-discovered. The germ theory gained acceptance based on Snow’s observation[57] that cholera was a water-borne disease. The means to prevent cholera had been identified by Snow ~30 years before the cholera epidemic. It wasn’t used as a preventive solution to save lives due to prevalent scientific ignorance which failed to grasp Snow’s scientific thinking and scientific insight, at least three decades ahead of the cholera epidemic, which was preventable.

In the 19th century, Ignaz Semmelweis (1818-1865) made a discovery by comparing a highly qualified clinic (death rate ~10%) with a clinic operated by midwifes (~2.5% death rate). Semmelweis observed[58] that simply by washing hands, the death rates dropped (to ~2.5%). The news spread. Doctors thought it was too mystic, despite the results. Semmelweis, in his next job, did the same thing. Dropped the death rate just by washing hands and equipment. Semmelweis pioneered the habit of washing hands in hospitals, published[59] papers about it but was rejected, had a mental breakdown and was sent to an asylum where he was beaten to death by the guards, in 1865. Merely two decades later, Louis Pasteur[60] proved Ignaz Semmelweis was correct. In the 21st century, the medical profession may perish if sepsis[61] was uncontrolled and medicine may struggle to exist without hand hygiene[62].

POV will remain a bright light obscured behind a bushel unless the less affluent nations are bold (audentes fortuna iuvat [63]) enough to focus on science as a service to society and people in need, first, of course with caution, but not excessive caution resulting in paralysis due to analyses. The interpretation of the “bold” (fortune favors the bold) approach advocated for POV means acknowledging that perfect is the enemy of good, rapid acceptance of promising results to save lives must take precedence over need for more data/results from the next experiment (in praise of imperfection) and prioritizing common sense of science that serves the people in that community. The “bold” approach does not exclude being careful to do no harm (primum non nocere). The “bold” approach is less enthusiastic about trend of repetitive studies fueled by bureaucratic buffering to re-consider, re-evaluate and re-validate (with even more platitudes) the initial results to re-confirm what we already know or wait for adverse effects to surface, sometime, somewhere, to placate politicians. Less affluent nations must not blindly mimic (but adapt) the protocols, procedures and processes in US/EU but find leaders who may possess the humility, knowledge and wisdom to inspire trust and responsibly shoulder the challenge of renewing that golden braid[64] of choice, chance, and character with civilization (even in face of constraints and consternation).

The “hidden” 20th century science, re-presented in this discussion as POV (plant-based oral vaccines), may become catalytic to save the world from public health cataclysms in the 22nd century. If one must profit from “cottage industry of vaccines” then we suggest 1% net profit limit. For example, a charge of $10 or $100 / year / person (for all vaccines) for 80% and 20%, respectively, of the 7 billion market, generates $196 billion per annum (pa) revenue from less affluent (poor) nations. Charging the affluent 1 billion people $1,000 or $10,000 / year / person, for 80% and 20%, respectively, translates to $2.8 trillion pa. 1% net profit from $3 trillion from a market of 8 billion is $30 billion pa. Even if this naïve optimistic what if scenario is 1% true, the net business profit from POV could be about $0.3 billion or $300 million pa (“enough for human need but not enough for human greed” – M. K. Gandhi[65]).

In the short-term, creating and implementing the distribution of fast growing transgenic plants for rapid immunization from known culprits with pandemic potential (Ebola, Marburg, Lassa, etc.) is a wise path, as discussed thus far, in this call for action. The key elements in this approach is removal of the purification protocols and the cold supply chain logistics. These two elements are rooted in the industrial complex of affluent nations and are holding the less affluent world hostage.

In the long term, plant-based oral vaccines may explore tools from the food industry to convert the plant material (e.g., leaves from the transgenic plants producing the antigen in their leaves for oral immunization) into a dry packed form factor in dose-adjusted supplements (e.g., turmeric[66] ) or sachets (e.g., dehydrated[67] seaweed or vegetables included with Ramen[68] and Miso[69] as shown in Figure 6) with a long shelf life at room temperature to facilitate rapid distribution, in case of a public health emergency.

Molecular immunologists must address whether food technology processed (post-FTP) antigen conserves sufficient number of epitopes to remain viable as an antigen (efficacy of immunogenicity). Food technologists must explore post-processing dosage issues which could differ between the untreated transgenic leaves and post-FTP leaves in sachets, after periods of storage (low efficacy due to degradation during storage). We must investigate if expressing the whole antigen (e.g., EBOV-1, SARS-CoV-2 Spike) is necessary or do we create GMO/transgenic plants expressing a number of epitopes[70] for each antigen? Natural changes in epitopes due to genetics of virulence[71] and antigenic drift[72] may make universal[73] epitopes useful. A “first” dose of “universal” epitope may induce immunization to decrease the acuity of infection from specific variants if new epitopes not covered by the “universal” dose. Research on epitope integrity, structure, function and post-FTP immunogenicity will transform GMO/ transgenic plant-based oral vaccines as effective, efficient, safe, and accessible preventive public health solution. Food industries could grow to reap ~$30 billion in annual net profit as a POV supplier if it focused on PAPPU[74], i.e., earning 1 penny / day / person (1 US penny as net profit / day / person) from ~8 billion global users.

EPILOGUE – ANALYSES OF SCIENTIFIC FACTS IN SCIENTIFIC RESEARCH PUBLICATIONS

The anti-GM (genetically modified / transgenic / bioengineered) movement and its anti-science propaganda ignores pre-existing scientific knowledge and is responsible (albeit, partly) for the trials and tribulations of ~7 billion people who are deprived of global public goods and shares an increasing burden of healthcare due to their inability to access affordable preventive public health measures (vaccination).

What if we knew that a plant or crop may resemble canonical cancer or a cancerous form (if the same criteria were applied to humans and animals)? Should we eat “cancerous” plants or plant products?

The truth, hidden (deliberately?) in plain sight, is that we eat, we crave and we will be in trouble without that specific plant. Acknowledging the science (genetics) of our daily bread[75] made from wheat (Triticum-Aegilops group) reveals that chromosomal multiplication (polyploidy) in wheat is a fact known to science[76] for ~100 years. Chromosomal aberrations (ploidy[77]) are a natural phenomenon in many edible plants. Genomic[78] changes and ploidy are associated with cancer[79] in humans (pathological somatic aneuploidy[80]) or indicates risk[81] of cancer[82] (neosis[83] leading to PGCC[84] or polyploid giant cancer cells). Hence, it appears that human cancer related chromosomal aberrations also occur in wheat. The obstreperous raconteurs (anti-GM / anti-science cults) are unconcerned about the state resembling “cancer” of the wheat in our daily bread-basket. Is it willful ignorance or just garden variety hypocrisy?

Therefore, the science of genetic modifications behind the evolution of wheat “cancer” is of no consequence (required edible food) for the anti-GM and anti-science aficionados. But, the same “anti” socialists are up in arms to burn, kill, and prevent access to healthcare, if transgenic plants (e.g., golden rice) may serve as vaccines for the ~7 billion poor people, who are forgotten and often down-trodden.

Evolutionary[85] dynamics[86] uses many tools to address “fit” with chaotic[87] non-binary outcomes due to punctuated equilibria[88]. Ploidy-based “cancer” of the wheat is a positivism quintessential for our civilization. Exploring[89] ploidy in humans reveal ploidy as a diagnostic[90] tool for cancer prognosis but it also offers certain protective[91] functions and may help in stress response for plants[92] and humans[93].

The ill-informed pseudo-science driving the anti-GMO collusion is laden with misgivings and replete with incomplete information arbitrage designed to selectively suppress scientific facts. Transgenic plants created by humans use tools which mimic natural genetic processes to insert/delete/amplify genetic material (e.g., discovery of transposons[94] by Barbara[95] McClintock[96] in the 1920’s and restriction endonucleases by Werner Arber, Daisy Dussoix[97] and Ham Smith[98] in the 1960’s as well as “cut and paste” application of restriction endonucleases by Kathleen Danna[99] and Dan Nathans[100]). Plants, naturally, amplify/alter/exchange genetic material with foreign (non-plant) genes (see APPENDIX). It will be an irremediable and egregious error of leadership if we fail to overcome the obstructionists. Science must serve societies and communities chronically underserved and under severe economic constraints. One tiny contribution in this context is this science-based solution for preventive global health, but only if we can implement the proven value of plant-based oral vaccination (POV) to improve the health of nations.

The potential of plant-based antibodies was unleashed 30 years ago[101] but its promise[102] for global health was muted[103] by diabolical[104] groups[105] and inhuman individuals[106] who would not even help to prevent blindness[107] in children (due to lack or reduced dietary intake of Vitamin A). Scientists[108] genetically supplemented Oryza sativa (rice) with phytoene synthase, an enzyme from daffodils (Narcissus pseudonarcissus), which leads to the accumulation of phytoene, a precursor in the pathway of Vitamin A biosynthesis. Consumption of golden rice[109] provided phytoene, the precursor for Vitamin A, as a measure[110] to reduce preventable morbidities due to xerophthalmia. But, asphyxiation of science[111] reduced adoption[112] and implementation[113] (but increased fake rice products instead of Golden rice[114]). It remains to be seen whether plant-based oral vaccines can chart a better path to global implementation.

Figure 7. Moving the boy[115] on the L to the state of boy on the R takes a massive amount of preparation.

Figure 7. Moving the boy[115] on the L to the state of boy on the R takes a massive amount of preparation.

• AMAT VICTORIA CURAM - Is this the message?

Could you and your scientific network help to convert the suggestion in this article (in principle, proven. published) into practice? Can you be a leader-catalyst-scientist to create and help implement plant-based oral/sublingual vaccination? Seven steps (outlined here) could help 7 billion people. Do you think you can be the “hand” and the “brains” that can transform this idea into reality? Scientists can help to source recombinant antigens (plasmids) to transfect and produce the transgenic plants.

Do you have what it takes to drive this science for social good? It requires convergence. It will be difficult to accomplish. It can save ~7 billion people. Can you become an instrument of global goodwill to usher hope for billions who are hopeless about their ability to access preventive public health and global public goods in terms of healthcare? You and your effort can empower ~7 billion people, forgotten and downtrodden, to find a reason to believe, that they, too, can be a constructive economic contributor to the wealth and health of nations. You and your effort can give voice to ~7 billion voiceless people. You and your effort, should you decide to pursue the opportunity, requires you to possess that moral, ethical and visceral fiber which represents an eternal braid of chance, choice and character.

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