Never before has humankind waited in such anticipation for a medical shield against a disease. COVID-19 has claimed more than a million lives and infected 40 million people. In mid-August, more people around the world searched for “vaccine” on Google than they did for “wine.” Now we might finally be weeks away from tested and approved vaccines. Today’s Daily Dose takes you to the front lines of modern medicine’s biggest test, from the companies and individuals who’ll decide when we get the vaccine, and who gets it, to the history that has brought us to this pivotal moment.
Charu Sudan Kasturi, Senior Editor
These companies and individuals will determine how soon the world can immunize itself against a pandemic that has claimed more than a million lives.
1. Leading the Pack
Developing a new vaccine has historically been a yearslong marathon. For COVID-19, scientists have turned it into a record sprint. And as we enter the final stretch, American firms Pfizer and Moderna are at the front of the pack. They’re hoping to seek emergency authorization for their vaccines in November and December, respectively, if data from their most comprehensive clinical trials remain positive. But it might still be several months before the vaccines are widely available.
2. Slow and Steady
Behind the front-runners, but also strong contenders, are vaccine candidates from India’s Bharat Biotech, British-Swedish pharma giant AstraZeneca (which is partnering with the University of Oxford) and American multinational Johnson & Johnson. AstraZeneca and Johnson & Johnson have stumbled a bit midrace, and had to put their trials on pause after volunteers fell sick from unexplained illnesses. Still, these three could have approved vaccines by the spring if they don’t trip up from here.
3. Taking a Shortcut
They’ve already won the race, if you believe them — by breaking the rules and cutting across the field to reach the finishing line before the others. Russia approved its Sputnik-V vaccine — a nod to the Soviet Union’s success as the world’s first space-faring nation — in August, while clinical trials were still on. This month, it cleared a second vaccine, also undergoing trials, for use. China has administered its Sinopharm vaccine — also still in trial stage — to hundreds of thousands of its citizens. So far, the gamble hasn’t backfired for either Moscow or Beijing — data from Sputnik-V trials has been largely positive — but they’ve set a dangerous precedent others might be tempted to follow.
4. The Referee
For years, the U.S. Food and Drug Administration (FDA) has been a global standard, its nod to pharma products a stamp of approval trusted by people around the world. That reputation has taken a beating in recent months, with the agency approving drugs like hydroxychloroquine, endorsed by President Donald Trump but mired in controversy over its level of efficacy for COVID-19 patients. The FDA then revoked that approval. Now its boss, Commissioner Stephen Hahn, is trying to shore up confidence in the regulator. Hahn has promised that vaccine approvals won’t be influenced by politics and has increasingly been willing to lock horns with the White House, including by issuing tougher rules for vaccine candidates to meet for emergency authorization. Will a safe vaccine be his FDA legacy?
5. The Naysayer
Carrie Madejis convinced the game is rigged — no matter what the scientists or the FDA say.The Georgia physician is among America’s most prominent anti-vaxxers, with a YouTube channel platform that could shape broader public opinion against vaccines in the U.S. A June video falsely claimed that vaccines would alter our DNA: “The COVID-19 vaccines are designed to make us genetically modified organisms,” Madej stated.
China’s president, Xi Jinping, has more clout than any other global leader in shaping the future of COVID-19 vaccination. Apart from China’s 1.4 billion people, Xi has promised the country’s vaccines to Southeast Asian nations, Africa and Latin America, offering them loans to purchase the doses. At a time when the U.S. under President Trump has kept mum on support to other nations, Beijing’s assurances are finding ready takers.
President Trump has accused him of turning the World Health Organization into China’s “puppet.” Secretary of State Mike Pompeo has gone personal, accusing him of being “bought” by Beijing. Ignoring those unsubstantiated slights, Tedros Adhanom Ghebreyesus, the Ethiopian chief of the WHO, has remained firm in insisting on a global response to the pandemic. Now he’s driving what is the world’s largest-ever collaborative vaccine project — COVAX — that aims to provide affordable COVID-19 vaccines to 20 percent of the world’s population. His allies include billionaire philanthropist Bill Gates, another target of conspiracy theories. Ghebreyesus’ success — or failure — will determine how fast the world builds immunity.
8. The Broadcaster
If the top vaccine candidates are like elite athletes in competition, Adar Poonawalla is the man who’ll bring them to billions of people around the world. Without his Serum Institute of India, the world’s largest manufacturer of vaccines, all the science in the world won’t save us. So when Poonawalla cautioned last month that there might not be enough COVID-19 doses for everyone until 2024, it was a reality check on what the frenzied vaccine timelines you’ll hear really mean. Five major pharma firms, including AstraZeneca, are counting on the Serum Institute for their vaccine supplies.
9. The Problem Solver
A key reason for Poonawalla’s timeline is the assumption that each person will need to take two doses — as they do for rotavirus or measles. But what if a single dose could release half the vaccine at a later, preprogrammed date? That’s the technology Jacob Becraft is pioneering. It could cut the number of vaccine doses the world needs by half, and reduce the risk of poorer nations — and the underprivileged in those nations — remaining at the back of the queue for vaccines.
It’s been successfully used in a rabies vaccine. Now leading pharma giants are relying on messenger RNA — or mRNA — technology to propel their COVID-19 vaccine ambitions. The Moderna and Pfizer vaccines both use mRNA as the delivery mechanism. No, it does not alter your DNA. It cannot. What it can change is the future of our fight against viruses. The mRNA mechanism does not need to be tweaked for each new virus, meaning that success now could make it easier to battle the next coronavirus.
It could save your life. While other major vaccine contenders plan to deliver their shots through injections, Bharat Biotech and the Serum Institute of India are testing an intranasal delivery system for vaccines. Nasal vaccines are already common for the flu, and the mechanism has the advantage of requiring less specialized training to deliver than a jab into muscle — making it effective for counties with a shortage of trained medical professionals.
3. Dead or Alive
Most major COVID-19 shots will be what are known as live attenuated vaccines: They carry a living, reproducing virus that rapidly builds antibodies, protecting you when you’re actually faced with the coronavirus. China is developing what are called inactivated vaccines, which carry viruses that are effectively in hibernation and incapable of reproducing. This makes inactivated vaccines safer — but also less effective.
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Not one of the multiple experimental vaccines has cleared phase three trials yet, with both AstraZeneca and Johnson & Johnson halting trials recently because participants got sick. Until a successful phase three trial is complete, we won’t know whether any of these vaccines work on large populations — and even if they do, the vaccine may only be 50 percent effective.
2. The Cold Supply Chain
Vaccines need to be kept cold as they’re shipped around the world, but new technologies such as mRNA require cold-storing doses at temperatures that most shipping containers simply can’t manage. Think minus 112 degrees Fahrenheit — or the temperature for shipping steaks and ice cream to supermarkets — but on the scale of billions around the globe. It’s prompting a scramble among hospitals to buy specialized freezers, and logistics companies to set up “freezer farms,” buildings to house hundreds of mobile cold-storage units.
3. Warped Outcome?
The Trump administration’s Operation Warp Speed has helped accelerate the timetable for mass vaccine distribution beyond any previous effort. China and Russia are also moving with unprecedented speed. But could that speed lead to disastrous errors? Look no further than the early days of the polio vaccine, which caused 260 symptomatic cases of the disease and 11 deaths of first and second graders before it was pulled back.
Half of Americans in a recent Pew survey said they wouldn’t take the vaccine if it were available. Anti-vaxx sentiments are high in different parts of Europe too, while religious communities — whether conservative Muslims in Malaysia and Indonesia or Orthodox Jews in Brooklyn and Israel — could prove a stumbling block.
OZY first told you back in April that the pandemic could pave the way for a reputational boost for the pharmaceutical industry. There’s increasing evidence that it’s happening, with surveys showing the American public looking more kindly on the industry as it sells itself as charging into the great vaccine race. Look no further than Johnson & Johnson, which has been hit with a $465 million judgment for its role in the opioid crisis but now is behind a leading vaccine candidate and is seeing a reputational boost.
2. The Bottom Line
A successful vaccine could produce a windfall in the tens of billions of dollars — and drugmakers are making varied claims about how much they’d profit from it. Johnson & Johnson and AstraZeneca say they will not produce a vaccine for profit during the pandemic, while Pfizer’s CEO says it will make a “marginal profit” and others are even less clear.
3. Stock Boom
The companies making leading vaccines and coronavirus therapies have soared this year as advances have continued. Novavax stock, for example, is up nearly 2,500 percent since the start of the year. But there’s reason to be skeptical that these companies will enjoy a huge windfall: Any vaccine will come with government-negotiated distribution contracts that will limit price, and investors are likely betting on headlines rather than fundamentals.
1. The Earliest Vaccines
It killed 3 out of 10, scarring many survivors for life, and while smallpox is believed to date back to ancient Egypt, it plagued the world for centuries. Finally, in the late 1790s, an English doctor noticed that milkmaids who’d contracted cowpox didn’t appear to contract smallpox. This commonly held inspiration story has been challenged in recent years, but what we do know is the doctor tested his theory by taking fluid from a cowpox sore on a milkmaid and injecting it into a young boy to immunize him against the deadlier smallpox. This led to more tests and, ultimately, eradication of the disease.
2. TB or Not TB
Your great-grandparents likely knew someone who died from it. Between 1870 and 1920, tuberculosis was the single biggest killer in the U.S., but the vaccine is not typically given in America these days because the bacterial infection is less frequent — and because the vaccine is not as effective for adults who are exposed. This lung disease, however, remains one of the deadliest internationally.
3. Did You Get Yours Yet?
Every August, the signs start cropping up to remind us about our annual flu jabs. And for good reason. A century ago, the Spanish Flu hit 500 million people, killing as many as 100 million. Doctors tried everything, but only one thing seemed to help: blood transfusions from recovered patients. By the 1940s, we had a field-tested vaccine in place, approved for use by the U.S. military.
4. And the March Continues
Since then, vaccines have rolled out to halt everything from polio and chickenpox to the human papillomavirus, or HPV. The polio vaccine, introduced in 1955, has saved countless millions from paralysis, while vaccines for chickenpox — though not required by all countries — help children avoid scarring. Avoiding HPV, which is often harmless, can mean avoiding some types of cancer and genital warts.
With hundreds of vaccines being tested around the world, using diverse technologies and the best brains from the world’s nations, the odds of at least one or a few vaccines working are good — as long as we’re patient. While some have pointed to the possibility of failure, research shows that vaccines making it to phase three of trials have a nearly a 50 percent chance of success.
2. Countries Betting Big
From the U.S. and Japan, to Mexico and the U.K., countries are betting on the success of a COVID-19 vaccine. That’s why they’re putting billions of dollars into research, development and even preorders. The U.S. federal government alone has dedicated more than $9 billion for developing vaccine candidates.
Modern technology allows rapid medical intervention in ways that simply were not possible in earlier generations. Take Bangladesh, one of the world’s fastest-growing economies, and one that’s also juggling a refugee crisis and poverty. Using a platform called Aspire to Innovate (a2i), the country has used phone calls and mobility data to institute targeted lockdowns and telemedicine to treat remote COVID-19 patients. Such innovations could also prove helpful in delivering vaccines to the most vulnerable populations.
Globalization in trade might have been hit by COVID-19, but in public health, the crisis has accelerated globalization. The hunt for a successful vaccine has forced global medical cooperation at an unprecedented speed and scale. Russia’s vaccines are being tested in India; China’s in Brazil, the Middle East and Southeast Asia; America’s in half a dozen Latin American nations and Europe; the Oxford vaccine in South Africa. More than 170 countries — notably not the U.S. — are also teaming up as a part of the COVAX initiative.
5. Path to the Future
Any successful COVID-19 vaccine could also give scientists crucial tools to modify it for the next coronavirus. This won’t be the last pandemic we’ll face, but it could help ensure that we’re better prepared for the next one.