A year and a quarter into the pandemic, where do we stand in our fight against Sars-Cov-2?
Currently, cases stand at 180 million with close to four million COVID-associated deaths. The toll the virus has been demanding is high. On the plus side, almost three billion vaccine doses have been administered to date (according to John Hopkin’s University Coronavirus Resource Centre). Many countries vaccinated their vulnerable populations preferentially, thereby decreasing the number of deaths significantly. The front runners in vaccinating their population are Chile, Israel, the UK, Iceland, and Hungary. Speaking in general, Western, Northern and Central Eastern European as well as North American countries show a high percentage of vaccinated inhabitants, as does mainland China and, interestingly, Mongolia (source: New York Times Vaccination Tracker). Unfortunately, the situation is not as positive in many other countries around the world, particularly those with low- or middle incomes.
What can you tell us about the role of the so-called variants of concern?
The delta variant, discovered for the first time in India, threw us back once again in our attempts to ultimately eliminate COVID-19. This strain is about 50-60% more contagious than the alfa variant (first found in the UK) that was about 50-60% more contagious than the wild type. It has spread to 80 countries and is now the predominant strain in the UK and Israel, and already accounts for 20% of cases in the US, where it is likely to become the dominant variant shortly (source: Anthony Fauci, US news). The higher transmission rate has several undesirable consequences: In order to contain the delta variant, measures would need to be tightened again or loosening of measures would need to be postponed. Moreover, herd immunity, i.e., the percentage of the population that needs to be immune to the virus in order to break the transmission chains has now gone up to around 90%.
In this and other contexts vaccination of children is being discussed and first vaccines for children will be available soon.
Fortunately, it has been shown that two doses of both the BioNTech/Pfizer or the University of Oxford/AstraZeneca vaccines are efficient in combating the delta strain (PHE, www.uk.gov). This data also shows the importance of getting fully vaccinated, as one shot only did not provide sufficient protection.
What about the development of new vaccine candidates?
There are yet again many new vaccine candidates in Phase III of clinical testing: Sanofi Pasteur and GSK with their adjuvanted recombinant S protein vaccine, Walvax Bio with the third mRNA-based vaccine, and candidates developed by Shenzhen Kangtai Bio, Nanogen, Shifa Pharma and the West China Hospital. Most of the new vaccine candidates are recombinant versions of the spike protein (data: WHO).
Once these vaccine candidates have successfully passed the Ph III testing phase and gained regulatory approval, the additional production capacities can help with the vaccination efforts, particularly in low- and middle-income countries most of which have so far not yet received large numbers of doses to administer to the public. In this context, it is also noteworthy that the BioNTech/ Pfizer vaccine may now be stored at -25 to -15°C for two weeks instead of the formerly required dry ice storage. Also, an unopened thawed vial may now be used for a full month instead of five days. These improvements will dramatically aid when distributing this vaccine to low- and middle-income countries (data: EMA).
It is also good news that Novavax' adjuvanted recombinant spike glycoprotein nanoparticle vaccine just demonstrated 90% overall efficacy and 100% protection against moderate and severe disease. After a successful regulatory filing, they plan to produce 100 million doses per month by the end of September and 150 million doses per months by the end of the year.
Vaccination as a means of preventing the outbreak of a disease is certainly a success story. However, that doesn’t mean that the development and production of a vaccine is a straightforward task. Several prospective COVID-19 vaccine manufacturers had to end their development projects after first clinical testing, mostly when efficacy was not up to expectations. Also issues during production and upscaling have been reported repeatedly, and for some vaccines the populations to receive the jab had to be more narrowly defined in order to avoid side effects.
What does this mean for vaccine logistics?
First of all, the pandemic isn’t over. There will be a continuous need for vaccines and vaccine logistic services probably for the next two years or even beyond. Moreover, as long as the virus can spread in a more or less uncontrolled fashion in many countries, mutations will continue to emerge, some of which will likely again lead to variants of concern. As it is difficult to completely restrict travel from affected countries in today’s global world, these mutants will most probably spread widely, thereby potentially necessitating containing measures again, even in areas where the virus appeared to have been beat. For this reason, it is important to vaccinate as many people as possible as quickly as possible. The combined expected production capacities of the approved vaccines developed by BioNTech/ Pfizer, University of Oxford/ AstraZeneca, J&J/ Janssen and Moderna amount to total of 5-6 Bn doses per year in 2022. As time is of the essence, additional production capacities will be very welcome, keeping in mind that the predominant majority of the vaccines require two jabs to be efficient.
What are the plans to achieve buy-in of the population to get vaccinated?
Once enough doses of vaccines become available the goal will be to achieve herd immunity. At this time, willingness to get vaccinated may become a limiting factor. Studies had shown that in many Western countries, only about 60% of the population actually planned to take the jab.
Fortunately, now that vaccination is under way, concerns about side effects or rare reactions are decreasing as there are only few reports of negative occurrences after getting inoculated. A recent study in the US revealed that vaccination willingness is at ~ 80%. Another survey in German citizens allowed the conclusion that willingness is increasing rapidly after having reached an all-time low in December.
Campaigns and, most importantly, information on how vaccines work and how to assess the (very small) risk of side effects need to be disseminated by authorities, doctors and health insurances.
In many countries on all continents the vaccinations have started, aiming on delivering the jab to 20% of the population in a first step with those who work in (health)care, the elderly and those with underlying health conditions as a priority. It is expected that the vaccination willingness of the general population will further increase once it has seen the positive results and impact of the first 20% that received a vaccination.
About the author: Dr. Anne Stolle has conducted postdoctoral research in the spread of infectious diseases at leading UK universities. At Berlinger & Co. AG, Anne is the Global Key Account Manager for Clinical Trials.
Looking at the COVID-19 situation from a Global Health perspective, what have you observed in recent weeks?
The relaxation of measures in some countries and sports events like the Euro 2020 and soon the Olympics might give the impression that the pandemic is almost over. Yet in reality, we are still in the first half.
Sufficient vaccines are available in some countries, but some people are reluctant to take the jab. Most countries, however, simply do not have enough vaccines equally available, and that is particularly true for low- and middle-income countries (LMIC).
The recent pledges at the G7 to donate more vaccines are encouraging and a first step towards higher degrees of vaccinations. Yet, there is a long way to go. Meanwhile, new variants like the delta strain are concerning health workers and governments across the world. Aside from the headlines in media about the crisis in India and the beginning of a recovery in the US and Europe, South America is in the midst of “a silent decimation by COVID unlike that anywhere else in the world”, according to a recent report in The Guardian. The region, home to just 5% of the world’s population, accounts for almost a quarter of all COVID-19 deaths. And while we write this blog, COVID-19 cases are skyrocketing across Indonesia, fueled by the Delta variant which is now fast becoming the world’s dominant strain, according to The Economist news.
What do we have to consider now in order to overcome this pandemic?
Berlinger echoes the call for Vaccine Equity ‘No one is safe until everyone is safe’ that organizations such as WHO and GAVI keep underlining. Front line health workers are doing a heroic job in LMIC, but without increasing the vaccination level, they face an uphill battle.
The longer the virus can spread, the more variants will appear. These variants can occur anywhere in the world and that is exactly why it is so important to acknowledge that globally we are all in this together – and we need to act together accordingly.
With the mantra ‘No one is safe until everyone is safe’ we want to emphasize that vaccines must be available to everyone, regardless of who they are and where there are. Increasing the vaccinations rates is essential to fight this pandemic. In the words of the EuroCup 2020 football: At the moment, we are only at half-time. There is still a second half to play. And in order to win the second half, more vaccine equity will be needed.
About the author: Hendrik Harbers joined Berlinger & Co. AG a year and a half ago as Global Health Business Development Director with a strong background in Global Health.