Spread of COVID-19 caused by a new coronavirus, SARS-CoV-2, has resulted in an unprecedented public health crisis and a devastating economic situation globally. COVID-19, declared a pandemic by the WHO, quickly shifted its epicentre from China to Europe and North America. Today the world over, we have more than 3.5 million confirmed cases and over 245,000 deaths, most reported from some of the highly advanced countries in the world.
With no clinically confirmed drug therapies and vaccines against COVID-19, the control and containment mantra has been to test and treat infected individuals, trace contacts and isolate them, implement social distancing, impose lockdowns and continuously monitor the ever-changing situations.
Medical professionals and scientists from China, United States, Italy and other countries rapidly shared reports of repurposing of existing drugs with a degree of success. These are understandably based on findings from small trials and currently there is limited data. Randomised controlled trials will provide the answers and are being conducted with several drugs therapies in many countries in a highly co-ordinated manner. One such drug, Remdesivir has shown promise in reducing the recovery period and death rate in COVID-19 patients and has received a fast-tracked FDA approval. As more data emerges from Remdesivir and other drug therapies, it will help policy makers make well informed decisions.
Ultimately, we need an efficacious vaccine to stop the spread of the virus.
A Lot's Happening on the Vaccine Front
All vaccines work through inducing protective immune responses by using full or some parts of the virus, using suitable vaccines formulation. While most traditional vaccines use live, killed or attenuated forms of viruses, many new vaccine technologies use genetic engineering methods to deliver genetic materials to generate protective immunity. As of now more than hundred vaccine candidates are being developed in many countries.
Given that the genetic information of SARS-CoV2 became available in mid-January 2020, this is incredible and unprecedented, that at least seven vaccine candidates have moved to phase 1 safety trials in humans.
Given the desperate urgency, almost all possible vaccine platforms are being used including many new ones. While several candidate vaccines are being developed in private industry, other candidates are also under development in academia and small, new enterprises with relatively less experience of making a vaccine. Many candidates under clinical development are based on new vaccines platforms that have not been licenced for any human vaccine. All these are being evaluated by the best scientific minds in the world for safety and finally, efficacy.
At the same time, SARS-CoV-2 is a new virus and many questions relevant for vaccine development are yet to be addressed. For example, does infection with SARS-2 provide protective immunity, and how long lasting this immunity will be? Will those who recover from the disease, and the asymptomatic carriers, remain susceptible to reinfection by the virus? What is the true nature and fine specificity of immune responses to SARS-CoV2 infection? Some of these questions can only be answered as research progresses and we learn more about this new virus.
In parallel to a fast-tracked, development of an anti COVID-19 vaccine, other challenges will need to be addressed. Even in normal circumstances, the development process, clinical trials, vaccine manufacturing and distribution are inherently complex issues. Given the urgency and huge demand of anti COVID-19 vaccines worldwide, these issues will be many times more complex.
Access to Vaccines Must For All
About two third of all candidates are currently being developed in two countries namely USA & China. Many countries, particularly where candidate vaccines have already entered phase I trials have allocated extra funds for seamless development of anti COVID-19 vaccines. These countries may expect preferential access to vaccines developed in their countries.
An efficacious vaccine, once developed, must be made available almost simultaneously in multiple locations. Manufacturing of such vaccines at the scale needed will be another big challenge as billions of doses will be needed in a very short period of time. Vaccine companies in countries like India, which produce more than half of the world supply of vaccines, will play a major role in providing anti COVID-19 vaccines in large quantities.
International collaborations, co-ordination and strong leadership will be needed to ensure that all aspects of vaccine development are vigorously supported. Robust mechanisms need to be put in place now for making these vaccines available worldwide.
Lessons learnt from non-availability of anti-HIV drugs in resource compromised countries should not be forgotten.
All stakeholders including vaccine developers in academia and industry, regulatory authorities, funding agencies and government bodies need to jointly ensure that most promising vaccines are developed and manufactured in sufficient quantities.
Fortunately, some of these issues are already being addressed. Agencies like the Coalition for Epidemic Preparedness Innovations (CEPI) with several other funding agencies are supporting and coordinating anti COVID-19 vaccine development efforts. CEPI has already appealed and has received commitments from multiple donors to support up to three candidates to large scale manufacturing and making them available worldwide. At a virtual meeting organised by the WHO, the coming together of many heads of state, leaders of international global health organisations and vaccine industry, and philanthropies to show their serious intent and commitment for making anti COVID-19 vaccine accessible to all is unprecedented and highly commendable. This coming together for a common good will need to continue for a long time to win the fight with this virus.
(Prof Virander Chauhan is the former Director of the International Centre for Genetic Engineering and Biotechnology where he currently holds the Arturo Falaschi Chair, and Anjali Nayyar is Executive Vice-President, Global Health Strategies.)
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