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How fast is the development of a Covid-19 vaccine progressing and when will it be ready?
Incredibly fast. Faster than any vaccine that has been developed before, but we will still have to wait a little longer.
Everyone is aware of the urgency. No interview with a scientist trying to develop a Covid-19 vaccine goes without the urgent question: “When will it be ready?”
But the answer is probably not this year. Next spring is much more likely. It is essential that any vaccine is very safe and at least moderately effective. To be sure of both, you need to collect a large amount of data from trials involving tens of thousands of volunteers and then be evaluated and verified by regulators. And volunteers must be in the middle of an outbreak, where people are at risk of infection. Sadly, it’s only when unvaccinated people get sick and vaccinated people don’t know it works.
If that seems like a long time to wait, it’s not much more than a nanosecond in terms of normal vaccine development. A group of scientists who have a brilliant idea for a way to make a vaccine against a virus would spend months or years doing the initial work that involves laboratory tests. If they develop something that they believe will work, they must conduct animal studies to show that their potential vaccine is safe before it is anywhere near a human. Then there are three phases of human clinical trials: Phase 1 is in a small group of healthy volunteers, injected with the vaccine to make sure there are no side effects that did not appear in the animals. Phase 2 are larger trials that involve a group that is vaccinated and a group that is not, to see if there is an effect. These could be in a few hundred people. Phase 3 are large-scale trials, involving tens of thousands, usually in several locations. That will produce the proof that it works, works partially or does not work.
Typically, all of this, associated with a lot of red tape and the necessary ethical approvals, takes a few years. Maybe more. The speed of progress with the Covid vaccine is staggering.
So is it realistic to think that by this time next year we will have a fully approved vaccine?
I’m pretty sure we will have several licensed vaccinations for this time next year. The real question is whether they will work or how well. None of the scientists I have spoken to, including those who develop vaccines, believe that we will have anything that is 100% protective. That does not mean they are not good. Even protecting some people really helps, and it has a knock-on effect, because those people probably won’t pass the virus on to anyone else.
There are vaccines that are not completely protective. The malaria vaccine is a good example. It offers approximately 30% protection against mosquito-borne disease for about four years. That may seem like very little, but it is being given to children in African countries where malaria is endemic because any reduction in the death toll is worth it.
With Covid, we are likely to do better because there are so many vaccines in development. Wellcome says there are more than 300. Some of them will never make it out of the lab, but there are 33 in clinical trials. That means we may be able to use a combination of different vaccines to increase the effect. That might be necessary for adenovector vaccines, of which the Oxford University / AstraZeneca candidate is one of the best known. They deliver the vaccine using a mild cold virus. The immune system may recognize that virus a second time and block it, so theoretically a different vaccine could be used as a booster. Boosters may also be necessary for older people, whose immune systems weaken with age and are most at risk for Covid.
The success rate for vaccines in development is about one in 10. So the numbers are cause for optimism.
What do you think is the most promising vaccine currently in development?
It is impossible to say at this point. It’s too soon. The Oxford vaccine appeared to be progressing, but then stopped for a week because one of the volunteers became ill. It has now rebooted, but it was a reminder not to make assumptions.
There are a number of different technologies that are used to develop these vaccines. Some are old faithful models and some are very new. Moderna, BioNTech and Imperial are each developing a messenger RNA vaccine, which uses a genetic code instead of parts of the virus. But a regulator has yet to approve any mRNA vaccine. Others, like Valneva, are taking the traditional approach of using inactivated viruses, which work in polio vaccines, while big pharmaceutical companies GlaxoSmithKline and Sanofi are priming the immune system to fight the virus with what’s known as an adjuvant.
How could the race for a vaccine influence Trump’s election campaign?
It would be a great card for Trump to play it on the eve of his election. So much has been said that the vaccine is the only way to stop the pandemic that taking one out of the bag before November would nullify all criticism of its handling of the crisis at a stroke. The United States has invested heavily, pledging to buy a third of the first billion doses of the Oxford vaccine, for example, and making deals for others. There was talk of Trump demanding that the Food and Drug Administration should grant a promising vaccine an emergency license for use.
But admittedly, the major vaccine manufacturers got together and signed an ethics statement that said they would not seek emergency approval unless they had definitive proof that their vaccine worked. That means getting straight to the end of Phase 3 testing with no shortcuts.
In recent days, Trump has been saying that the pandemic will come to an end without a vaccine, suggesting rather that he doesn’t expect to be able to make an announcement that he has one before November 3.
Will people be willing to receive it once there is an approved vaccine?
I think most people will queue. I certainly will. But there will be people who will be nervous, because it is a new vaccine and some side effects only appear after millions of people have been immunized (but that would mean they were very rare). Others will be influenced by the anti-vax movement, which is a catch-all term for many people with widely disparate motivations, from anti-science to politics to a penchant for “natural” remedies. But we do not have to vaccinate 100% of the population to bring the virus to low enough levels that normal life can resume.
