The Race for the Coronavirus Vaccine Is On, Who Will be Left Behind?

On July 20, 2020, the world embraced the news that a joint COVID-19 vaccine development effort by the British-Swedish pharmaceutical giant AstraZeneca and the University of Oxford has shown promising preliminary results in phase I/2 trials. The results published in The Lancet hint at a robust cellular and antibody-mediated immune response after administration of the adenovirus-vectored vaccine that is augmented after delivery of a second booster dose. In addition to showing signs of efficacy, the results have so far also indicated that this vaccine has a tolerable safety profile.[2]

While encouraging, the data is far from conclusive. Eliciting an immune response does not necessarily imply an enduring immunity to SARS-CoV-2. For this to be established, longer-term follow up is needed comparing the infectivity rate of volunteers who have received the vaccine with the rate of those who have received placebo. There are also other caveats to consider. The median age of trial participants is 35, considerably younger than the population that is most vulnerable to severe Covid-19 infection. Similarly, the trial included healthy volunteers who do not suffer from the comorbidities known to increase the risk of a complicated disease course. Additionally, there is growing evidence that ethnicity may be an independent risk factor for adverse outcomes from Covid-19 infection[3] and 90% of participants in this UK-based trial were white. Results from the ongoing phase III trials of this vaccine in South America and Africa are needed to improve generalizability concerning more ethnically and geographically diverse populations.

Despite these limitations, this piece of good news has improved the prospect that we could have a vaccine by this year’s end and has lifted markets from Tokyo to New York. This reflects growing hope that there may after all be light at the end of the tunnel and we may yet get there sooner rather than later. The Astrazenica/Oxford vaccine is not the only candidate making headway. There are currently two vaccines developed by Chinese companies  also in ongoing phase III trials and they will soon be joined by several more hopefuls as the race for what will undoubtedly be the fastest vaccine in history heats up.[4]

Vaccine distribution can be as challenging as development and nations are already jockeying to secure supplies and, consequently, a geopolitical edge. For example, the U.S. government will provide AstraZeneca with up to $1.2 billion to fund a U.S. based trial and expand manufacturing capacity in exchange for 300 million doses of their vaccine.[5] The U.S. has also arranged similar agreements with other vaccine developers as part of the federal program Operation Warp Speed.[6] This reflects the U.S. government’s nationalistic ‘America first’ approach to vaccine distribution, especially when taken in the context of the administration’s decision to end funding for the World Health Organization. Meanwhile, the U.K. has reserved 100 million doses of the AstraZeneca/Oxford vaccine and a deal for this vaccine have also been signed with Europe’s Inclusive Vaccines Alliance which will provide participating countries with up to 400 million doses.[7]^,[8]

Maneuvers by the world’s wealthy nations to insure their vaccine supply leaves many questions unanswered regarding where this leaves the rest of the world. The broad and equitable distribution of vaccines globally has been, and remains a challenge. The Global Alliance for Vaccines and Immunizations, backed by institutions such as the World Health Organization and the Bill and Melinda Gates Foundation, has raised $8.8 billion towards funding for vaccine purchases for lower income countries. They, along with the Coalition for Epidemic Preparedness Innovations have secured procurement of 300 million doses of the approximately 2 billion AstraZeneca/Oxford vaccine doses planed for production, but it remains to be seen how exactly these doses will be allocated.[9]^,[10]

Paying for the procurement of vaccines, however, is not the only obstacle facing poorer countries. Resources are also needed to allow these nations to develop the infrastructure needed to insure that vaccines are disseminated in a reliable manner. This necessitates the availability of accurate and thorough medical records databases and robust primary healthcare services that prioritize disease prevention. Establishment of reliable supply chains in the global south for the coming coronavirus vaccine also requires temperature-controlled vaccine storage units, transport and delivery processes in urban and rural settings, and, eventually, the capacity to manufacture vaccines locally. More also needs to be done to raise awareness in parts of the world where a lack of knowledge about the importance of immunization may impede vaccination efforts, and this is a challenge shared with developed nations.

The Coronavirus pandemic is exerting a heavy toll in developing and underdeveloped nations where governments have limited latitude to impose lockdowns due to their punishing economic effects. Around the globe, the virus has overwhelmed the capabilities of healthcare systems of poor nations to test, trace, isolate and treat. The world must insure that a vaccine and other advancements in the fight against COVID-19 do not increase the already existing inequities in global health.

The Global Health Institute at the American University of Beirut addresses an array of health concerns amid COVID-19. More information is available, here: COVID-19

Filters: COVID-19, Vaccine

Contributors

[1] Doctor of Medicine Graduate, American University of Beirut Faculty of Medicine Class of 2020, Lebanon

References

[2] Folegatti, P. M., Ewer, K. J., Aley, P. K., Angus, B., Becker, S., Belij-Rammerstorfer, S., . . . Yau, Y. Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. The Lancet. doi:10.1016/S0140-6736(20)31604-4

[3]  Pareek, M., Bangash, M. N., Pareek, N., Pan, D., Sze, S., Minhas, J. S., . . . Khunti, K. (2020). Ethnicity and COVID-19: an urgent public health research priority. The Lancet, 395(10234), 1421-1422. doi:10.1016/S0140-6736(20)30922-3

[4] Jonathan Corum, D. G., Sui-Lee Wee and Carl Zimmer (2020). Coronavirus Vaccine Tracker. The New York Times Retrieved from https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

[5] Roland, D. (2020). U.S. to Invest $1.2 Billion to Secure Potential Coronavirus Vaccine From AstraZeneca, Oxford University. The Wallstreet Journal Retrieved from https://www.wsj.com/articles/u-s-to-invest-1-2-billion-to-secure-potential-coronavirus-vaccine-from-astrazeneca-oxford-university-11590063053

[6] Fact Sheet: Explaining Operation Warp Speed. (2020). Retrieved from https://www.hhs.gov/about/news/2020/06/16/fact-sheet-explaining-operation-warp-speed.html

[7] Loftus, S. W. a. P. (2020). Coronavirus Vaccine Data Raises Hope for Trio of Candidates

. The Wallstreet Journal. Retrieved from https://www.wsj.com/articles/oxford-university-astrazeneca-covid-19-vaccine-front-runner-shows-promise-in-trials-11595254222

[8] Stearns, J. (2020). AstraZeneca Reaches Vaccine Supply Deal With Four EU Nations. Bloomberg. Retrieved from https://www.bloomberg.com/news/articles/2020-06-13/astrazeneca-reaches-vaccine-supply-deal-with-four-eu-nations

[9] AstraZenica. (2020). AstraZeneca takes next steps towards broad and equitable access to Oxford University’s COVID-19 vaccine. Retrieved from https://www.astrazeneca.com/media-centre/press-releases/2020/astrazeneca-takes-next-steps-towards-broad-and-equitable-access-to-oxford-universitys-covid-19-vaccine.html

[10] Taylor, C. (2020). Bill Gates-backed vaccine alliance raises $8.8 billion from world leaders and businesses. CNBC. Retrieved from https://www.cnbc.com/2020/06/04/bill-gates-backed-vaccine-alliance-looks-to-raise-7point4-billion.html