The COVID-19 Vaccine Race

The Covid-19 pandemic continues to run rampant globally with over 22m confirmed cases and nearly 800,000 deaths globally. Many countries that successfully fought off a first wave – particularly in Europe – are seeing spikes that threaten to become a full-blown, uncontrolled second wave of infection. Social distancing, lockdowns and limits on public events have been deployed globally as tactics to control the pace of infection in the population. However, when it comes to an endgame for the pandemic most experts and political leaders have placed their hopes on a having a vaccine available within the next 12 months.

Developing a vaccine in 12 months is no small feat of scientific achievement. Typically, vaccines take a decade to develop and thoroughly test before they are approved for widespread use. The global scientific community has rallied and accepted the challenge. There are now over 160 different vaccine candidates in various stages of being tested. Some are expected to be available for use as early as the end of this year.

AstraZeneca / Oxford University

Moderna Therapeutics

  • Type of Vaccine: A messenger RNA vaccine developed by the company.
  • Stage of Testing: Phase 3 testing in the United States involving 30,000 subjects.
  • Early Results: Antibodies detected in phase 1/2 trials for 8 out of the 45 subjects initially tested.
  • Pre-orders: The US government has ordered 100m doses.
  • Production Capacity: The company has stated they can scale production to 500m doses annually.

Novavax

  • Type of Vaccine: Protein-based vaccine developed in-house.
  • Stage of Testing: Phase 3 trials beginning in the United Kingdom in September with 9000 subjects.
  • Early Results: Antibodies detected in phase 1/2 trials for all 131 subjects tested.
  • Pre-orders: The UK has ordered 6m doses.
  • Production Capacity:

Johnson & Johnson

  • Type of Vaccine: A vector-based vaccine developed in-house.
  • Stage of Testing: Phase 3 testing beginning in Brazil in September with 6000 subjects.
  • Early Results: In a study of seven vaccine prototypes tested, the Johnson & Johnson vaccine (Ad26.COV2.S, referred to in the Nature article as Ad26-S.PP), elicited the highest levels of neutralizing antibodies to SARS-CoV-2.
  • Pre-orders: The European Union is planning to order 200m doses, the UK has ordered 30m doses, US government has ordered 100m doses.
  • Production Capacity: The company aims to supply 1 billion doses of the vaccine in 2021.

Gamaleya Research Institute

  • Type of Vaccine: A viral-vector vaccine.
  • Stage of Testing: Launched phase 1 in June but was approved for use by the Russian health regulator on August 11th. Russia is planning a mass vaccination program in the fall.
  • Early Results: Antibodies detected in phase 1/2 trials.
  • Pre-orders: Vietnam has agreed to order between 50 – 150m doses.
  • Production Capacity: Starting production of 1.5m doses per year.

Sinopharm

  • Type of Vaccine: Sinopharm is testing two whole-virus vaccine candidates.
  • Stage of Testing: The company launched phase 3 trials for both candidates in the United Arab Emirates in July and has stated the vaccine will be available in market by December of this year.
  • Early Results: Antibodies detected in phase 1/2 trials.
  • Pre-orders: Unknown
  • Production Capacity: 220m doses per year.

Sinovac

  • Type of Vaccine: Whole-virus vaccine.
  • Stage of Testing: Phase 3 testing begin in Brazil in July.
  • Early Results: Antibodies detected in phase 1/2 trials on 743 subjects.
  • Pre-orders: Unknown
  • Production Capacity: Unkown

BiontechPfizerFosun Pharma

  • Type of Vaccine: Messenger RNA vaccine.
  • Stage of Testing: Phase 3 tests begin on July 27th involving 44,000 subjects
  • Early Results: Antibodies detected in phase 1/2 trials with minimal side effects.
  • Pre-orders: Japan has ordered 120m doses, US government has ordered 100m doses
  • Production Capacity: Pfizer expects to manufacture 1.3 billion doses by the end of 2021.

CanSinoBio

  • Type of Vaccine: Viral-vector business.
  • Stage of Testing: Starting phase 3 trials in Saudi Arabia. The Chinese military has already given emergency authorization to the vaccine for use for one year.
  • Early Results: Antibodies detected in phase 1/2 trials.
  • Pre-orders: Unknown
  • Production Capacity: Unknown

Scaling and Distributing a Vaccine

The true challenges begin after an effective vaccine is successfully identified. It typically takes 6 – 36 months to produce, package and deliver a high-quality vaccine. About 70% of this time is spent testing batches of vaccine at every stage of the journey to ensure quality. Producing enough doses of the vaccine to vaccinate the global population is nearly impossible. The maximum global vaccine production capacity estimate as 6.4bn a year and this is based on single dose flu vaccine whereas most covid-19 vaccine candidates require at least 2 doses. As production scales many experts worry that the inputs used in the process – from reagents to lipids – will run short and these shortages will further bottleneck the production process. Even more importantly, correctly storing vaccines is critical. Annually a shocking 50% of vaccines are wasted every year due to improper refrigeration.

Graphic from Sanofi.

Aside from production, the question of distribution is potentially the thorniest challenge. Due to a vacuum of global leadership or consensus, there is no organized global plan on how to distribute the eventual vaccine around the world. Instead, every country is in a mad dash to supply enough vaccine for themselves and rich countries are already hoarding much of the available production capacity. Even within countries the question of who gets vaccinated first is a sensitive issue. Should it be the young? The elderly? First-line responders?

The Covid-19 pandemic has proved to be a once in a century pandemic. It has been met by an unprecedented surge in scientific research to identify an effective vaccine and produce it as soon as possible. One or more of the over 160 candidates will eventually be approved for general use in the population. Then the true challenge begins of producing enough of the vaccine and ensuring those most in need get it. Well-planned and targeted vaccination campaigns can quickly snuff out the virus. The alternative is an “every man for himself” rush by countries competing for vaccine doses. This will allow some countries to eliminate the pandemic domestically while others continue to be ravaged by it – a sad and unequal ending to a global problem.

This piece was originally published here.

 

Mikal

 

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