Trajectory #18: The Vaccine Race
Vaccines, antibodies and the race to immunity
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The High-Level This Week: A global arms race to identify, test and manufacture an effective vaccine for Covid-19 is bringing the brightest minds in medicine, public health, manufacturing and supply-chain around one goal. From the Brazil to Russia and the United States to China over 179 vaccine candidates are being tested. This week we’ll look at the vaccine candidates that are showing the most promise.
Read on and share your thoughts in the comments below!
This Week in Data
In 2012, designer Leon Farrant used data from the Center for Disease Control in the United States to illustrate the tremendous impact that a century of vaccination has had on the US population. This graphic pre-dated much of the rise of the anti-vaccination movement, the implications of which we have not fully grasped yet.
Intellectual Sparks
Effects of physical attractiveness on political beliefs: Unfortunately this research study is behind a paywall, but the abstract is available and leaves us all with something to chew on.
The mystery of the Timurid Qur’an: Auction house recently sold a stunning 15th century Quran with few known peers. The great mystery is - we have no idea where it came from.
Sunscreen Chemicals Accumulate in Body at High Levels: More worrying questions about the cosmetics and skincare industry.
The Damage We’re Not Attending To: A great read on how complexity science is a critical tool in our fight against the Covid-19 pandemic.
America and China Are Entering the Dark Forest: A nuanced analysis of the state of US and Chinese relations.
The risks of a Russian intervention in Belarus: Will Belarus 2020 resemble Ukraine 2014? The geopolitical dance is underway. We will find out soon.
Editor’s Letter: The Vaccine Arms 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
Type of Vaccine: A recombinant viral-vector vaccine developed Oxford University
Stage of Testing: Phase 3 testing in Brazil, South Africa, India and the United States
Early Results: Has shown that a single dose of the vaccine led to a four-fold increase in antibodies to the SARS-CoV-2 spike protein in 95% of participants one month following vaccination. In addition, a T-cell response that peaked by day 14 and maintained two months after injection was observed in all subjects.
Pre-orders: Australia has ordered 25m doses, the European Union has ordered 400m doses
Production Capacity: AstraZeneca has stated that their maximum production capacity will be 2 billion doses a year
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
Biontech, Pfizer, Fosun 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.