How scientists are racing to end the pandemic

News Feature | John Rafael Ambag

Graphics by Christian Robic Hermosa

COVID-19 continues to sweep the globe with each passing day with over two million cases recorded worldwide as of April 17. Countries, including the Philippines have adopted drastic measures such as lockdowns and quarantines. However, these measures do not guarantee an end to the virus; cases can still spike and cause a rebound outbreak once these measures are lifted after a few months. The final blow to the coronavirus crisis will be a vaccine.

Humanity was already given a head start to find this vaccine for SARS-CoV-2, the virus that causes the COVID-19 disease. As early as January 12, less than a month after the first reports of the disease, China already shared the genetic sequence of SARS-CoV-2 to the public, signaling the start of the vaccine race.

Vaccine development starts by finding a formulation that introduces the virus to a person’s body in a weakened form, triggering the person’s immune system to create antibodies that protect them from future infections. Companies and institutions use different technologies to create these formulas.

Once the vaccine formula is finalized, scientists then test the vaccine on animals. Researchers can proceed with human trials if vaccinated animals recognize the virus and defend themselves from infection. However, this step is skipped by some developers or implemented in parallel with human trials in order to save time.

According to the Centers for Disease Control and Prevention (CDC), human trials proceed in three phases. Phase 1 checks the vaccine’s safety by introducing it to a small group of healthy patients. Developers can only proceed further if there are no adverse side effects observed in the small group. Phases 2 and 3 aim to determine how effective the vaccine is.

The difference between the two latter phases is the number of participants and the time involved; Phase 2 involves hundreds of people and can last from months to years. It expands the target group as it introduces the vaccine to people with similar age and characteristics to the intended patients. Meanwhile, Phase 3 determines if the vaccine is safe and effective. It involves thousands of people and can take years. This shows how the SARS-CoV-2 vaccine development is an incredible challenge as researchers try to shorten a process that usually takes years.

Once Phase 3 is successful, regulatory bodies such as the Food and Drug Administration (FDA) can review the vaccine and determine whether to license its distribution. Once approved, companies can then beef up the scale of the vaccine production and introduce the vaccine to the market.

The candidate vaccines, in spite of their fast development, vary extensively on how they work. Platforms include the use of encapsulated genetic material, which differentiates one virus from another, from vaccine developer Moderna to the use of other non-infective viruses bearing the coronavirus protein from CanSino Biologicals. Other developers opted to use other platforms such as virus-like particles, recombinant proteins, and more.

The difference in platform also leads to difference in performance. New platforms such as wrapping genetic material inside very small lipid particles, as used by Moderna, have the potential to make vaccinated people immune to the virus in a short amount of time. Meanwhile, vaccines using non-infective viral vectors such as that of CanSino Biologicals are known for their long-term stability coupled with a strong immune response of the patients.

The extensive array of vaccine platforms is also coupled with an extensive profile of vaccine developers. Of the five leading vaccine candidates, three are from the industry whereas two are from the public sector. Overall, researchers from the Coalition for Epidemic Preparedness Innovations (CEPI) report that there are 78 vaccine candidates undergoing development as of April 8, wherein 56 are from private or industry developers while the remaining 22 are from the academia, the public sector, and nonprofit organizations. The developers of these vaccine candidates mostly come from North America, which houses 36 developers. The rest of the developers come from China, the rest of Asia and Australia, and Europe with 14 developers each.

In spite of the presence of big-time multinational developers such as Janssen, Pfizer, GlaxoSmithKline, and even Sanofi in the competition, the vaccine race is currently dominated by small developers that lack experience with large-scale manufacturing. To meet the expected high demand, vaccine developers are expected to fully coordinate with each other in manufacturing as well as supply capability and capacity.

Vaccine development for previous outbreaks have no specific trend. The previous H1N1 influenza pandemic in 2009 is remembered for the fast response of health agencies leading to a short vaccine development time. This can be attributed to scientists’ solid background in influenza-vaccine technology. In contrast, non-influenza viruses such as those of COVID-19 prove to be more elusive. Previous outbreaks of severe acute respiratory syndrome (SARS) and Zika currently do not have a vaccine. The SARS and Zika epidemic diffused before a vaccine was developed.

There is hope however. Vaccine efforts for COVID-19 are being pushed at an unprecedented pace. Amid the saturation of conservative estimates for the vaccine development duration ranging from 12 months to 18 months, some companies are confident that they are miles ahead.

Sarah Gilbert, head of a vaccine-development team at the University of Oxford told the New York Times that she is “80 percent confident” that her team’s vaccine is effective and will be ready by September. Her estimate slashes the usual projection in half. The team’s vaccine, currently set to enter Phase 1 and Phase 2 in parallel, uses Chimp adenovirus ChAdOx1 as a non-infective viral vector to introduce the SARS-CoV-2 spike S protein, which is the protein used by the coronavirus to attach to a host cell’s surface.

Gilbert and her team find themselves in the thick of the race currently led by CanSino Biologicals in partnership with the Beijing Institute of Biotechnology, currently at Phase 2 and Phase 1 of the clinical trial according to the WHO draft of landscape of COVID-19 candidate vaccines published last April 11. Two US companies follow: Inovio Pharmaceuticals and Moderna, which are both at Phase 1 of the clinical trials. Rounding out the candidates that already entered clinical trials are two candidate vaccines from Shenzhen Geno-Immune Medical Institute from China. Meanwhile, the majority of vaccine developers are still at the exploratory stage of vaccine development.

Before the COVID-19 pandemic, the Philippines had just gone through a “Dengvaxia scare,” sparking anti-vaccine sentiments from its citizens. Vaccine confidence in the country severely waned; it boasted a vaccine confidence level of 93 percent “strongly agreeing” that vaccines are important in 2015 that dropped to a meager 32 percent in 2018 according to the Vaccine Confidence ProjectTM. Preventing the Dengvaxia situation to repeat itself requires government officials to be more prudent and cautious with their decisions.

The Philippines currently follows a bidding system for the procurement of vaccines. Experts advocate for more competitive bidding in order to gain back the confidence of the people to accept the purchases made by the government. In theory, bidding allows governments to get the same quality from a product for a lower price.

The scientific community has stepped up big time in the face of a great pandemic, providing possible solutions to the crisis in a pace previously unimagined. The outlook is positive as an approved vaccine may be on its way by early 2021 through emergency protocols.

However, experts have warned that speed, albeit needed, also leads to compromise. This unheralded pace must also be taken with a grain of salt, pushing agencies and institutions to place more stringent measures for evaluating and assessing the efficacy and safety of all vaccine candidates.

Taking the vaccine from the lab to the human population is the final challenge. Succeeding in this final step requires an all-out coordination and cooperation between vaccine developers, regulating agencies, funding agencies, governments, policy makers, and the people.

The official student publication of the College of Science, UP Diliman.