The vaccination race for COVID-19: A marathon update.
by Lisa Short
The development of a safe, effective and widely available Vaccine for COVID-19 as a tool which can contribute to the control of its spread and ultimately enable lifting of social and economic restrictions that have crippled globalisation has been called a race against time by many of the leading scientific communities around the world1. In reality it is more of a marathon with over 120 vaccines proposed across the world and 6 currently in clinical trial, another about to start and just on 70 in pre-evaluation stages2. The incredible speed and resources attributed to achieve this marathon start must be recognised in association with the time it would normally take a vaccine to reach this stage which can be 2 to 4 years3.
The unprecedented public health emergency created as a result of COVID-19 is clear. What is still not clear is the conclusive source and the origin of the virus, how it transferred from its host [also not conclusive] and why the world wasn’t prepared with robust pandemic planning on the back of a flu like pandemic being known as the greatest single global threat for more than 10 years. These issues do not change the fact that conducting research and vaccination development even under these trying times is still linked to “a moral obligation to learn as much as possible, as quickly as possible”1. Patience as they say is a virtue, but with the global catastrophic impact of COVID-19 it is also in very short supply. The CSIRO states this is a very complex task, and ‘we really are pushing our science to the limits of global knowledge’7.
Some of the Scientific Challenges
Scientists face are overcoming a number of key challenges in this marathon of Olympic proportions, under extreme pressure of demand by a world wanting life as the once expected it to be.
The first relates to how the virus that causes COVID-19, SARS-CoV-2 gains entry into the cells of a person. This entry door occurs via the angiotensin converting enzyme (ACE)-2 receptor. Put simply the virus attaches itself to a particular enzyme that converts a protein in the blood and enters much like a guest to an uninvited party. However, the real problem occurs when it comes to testing a proposed vaccine, because the two animals usually involved in the trial process – rats and mice – lack the ACE-2 receptors that virus attaches to.
Another challenge to be overcome of vaccine development in general lies in identifying a standardised neutralising antibody titre, which is designed to test whether being vaccinated against an infection will neutralise exogenous exposure to a virus, and thus offer seroprotection. And in that mix of ‘challenge’ is that the virus being tested hasn’t gone through generic change. In the case of SARS-CoV-2 there has been evolution, but fortunately not in the manner in which it enters cells through the ACE-2 receptors.
Who’s winning the marathon and where are the other runners placed?
US based company Moderna, based in Massachusetts, is the current front runner leading Phase 1 trials in conjunction with the National Institute of Allergy and Infectious Diseases. On 18th May 2020 Moderna released the first findings of its trial for mRNA-1273 the first SARS-CoV-2 vaccine to be tested in people. Findings indicate the vaccine seems to be safe, and stimulated an immune response against the virus where antibodies were generated in the trial volunteers, and were also able to stop the virus from replicating in human cells in the laboratory. The levels of antibodies in the blood of the trial volunteers were similar to those previously detected in recovered COVID-19 patients. These successes pave the way for the larger Phase 2 and Phase 3 [July] stages of the vaccine development. Tal Zaks of Moderna has cautiously indicated said that if these stages go well, the vaccine could be widely available by the end of this year or early next year.
Running second in the marathon is the University of Oxford. It has found its recent trial was not effective in stopping six rhesus macaque monkeys from becoming infected with the coronavirus. albeit none of the vaccinated monkeys developed pneumonia. This is good news in that it suggests the trial may offer some protection against severe symptoms of COVID-194. The progress of this trail continues, for the Oxford vaccine candidate just three months after the genetic sequence of the coronavirus was released for study.
In Australia the Coalition for Epidemic Preparedness Innovations (CEPI), which has funded four consortia one of which is led by The University of Queensland (UQ) in conjunction with the CSIRO are looking to move to Phase 1 dosing in June 2020. This follows Melbourne researchers from the Doherty Institute mapping immune responses from one of Australia’s first novel COVID-19 patients, showing the body’s ability to fight the virus and recover from the infection7.
Congratulations and accolades must go to the University of Queensland (UQ) who in 3 weeks created this vaccine candidate for SARS-CoV-2 , in part because of excellence in pre-existing knowledge and research.
Other universities including the Imperial College London and companies like Johnson & Johnson, Pfizer and GSK (GlaxoSmithKline) are discussing starting phase one trials in September 2020.
Once efficacy and safety is finalised the race to the finish line must also include the final impetus to ensure the world has sufficient facilities to produce the vaccine. Pharmaceutical company AstraZeneca has announced it will develop, manufacture and distribute the successful vaccine around the world. However, to do this they will need to ensure scaled production without critically affecting the supply of other vital vaccines. Oxford Biomedica and Cobra Biologics are conducting similar approaches to scaling their capacity.
In this regard the he UK government is powering ahead launching a vaccine taskforce to coordinate scale-up efforts and has funded a £14 million industry-led vaccine manufacturing group with a fast-tracked a £65 million Vaccines Manufacturing and Innovation Centre (VMIC). Australia to the contrary lacks the physical facility capacity to produce the vaccine numbers required and may need to look to overseas to conduct the task.
Other Interesting Developments
No Olympic marathon would ever be complete without a few surprise delights and contributing factors. The development of treatments for COVID-19 will occur quicker than a vaccine, mainly because they are based on what scientists and medical staff already know. For these reasons scientists from the United Kingdom have called for wider screening of existing drugs to see if they might work against SARS-CoV-2. Many of these being developed and the drugs already approved for use fall into a group of drugs called antivirals and target virus’s in people who already have an infection. Healthline10 publishes a good account of those approved already for use or under consideration.
Cardiff University in Wales has also led the world in antibody transfusion treatments for severe COVID-19 symptoms. Through transfusion of antibodies from plasma patients can increase their capacity to fight the infection themselves.
In another research paper produced in Canada on 2 May 2020, by the University of British Columbia it has been observed that by the time SARS-CoV-2 was first detected in late 2019, it was already pre-adapted to human transmission and there is a lack of definitive evidence to verify or rule out adaptation of the virus in an intermediate host species11.
What does all this mean?
There is still so much we don’t know about SARS-CoV-2, including its origin, source and exact time of appearance in humans. We do know it’s very new to its human host and for that reason only we don’t know yet how it will behave. A vaccine is still at best months away. Whilst a lot of criticism has been directed globally at the World Health Organisation and governments around the world in their responses to the management of the pandemic, and even in their pandemic preparedness, rightly or wrongly it will take a globally collaborative approach to develop a vaccine and treatments for COVID-19. Political banter does not achieve this end goal. Working together in the fastest and most efficient way does. Concurrently, new processes and infrastructures that develop ways for the people of the world to live, work, travel and enjoy life with resilience to any pandemic are paramount.
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