Inside The Race For A Vaccine
THE WINNERS & LOSERS IN PURSUIT OF A CURE
Forget the new normal: an effective coronavirus vaccine could herald a return to life as we knew it. Scientists around the world are in an epic race to be first, with more than 200 projects under way. But will everyone want to take it? And can we really put national interest aside for the greater, global good? Anjana Ahuja investigates
Ewan Birney has given up guessing whether he might be immune to coronavirus.
“Nine vaccine projects are in the final stage of testing”
“I did try a little bit,” he confesses, of trying to deduce whether he’d been injected with an experimental coronavirus vaccine or a placebo, a dummy that feels like a real jab but offers no protection.
Birney is one of around 10,000 volunteers on a coronavirus vaccine trial being run in the UK by Oxford University and the pharmaceutical company AstraZeneca. Half of the volunteers have been given the experimental vaccine, code-named AZD1222; the other half a standard meningitis jab.
Neither volunteer nor researcher will know who got which until the end of the trial, when rates of infection and disease in the two groups will be compared. Birney is more qualified than most to play scientific detective: he is a professor and deputy director-general of the European Molecular Biology Laboratory, near Cambridge. And he is impressed by how the researchers have managed to keep everyone in the dark: “They’ve been clever about having [the dummy] act like a vaccine that has many similar effects in the first 24 hours.”
The world can only hope that their ingenuity pays off. The Oxford/ AstraZeneca vaccine is a front-runner in what is arguably the most ambitious challenge in medical history: to develop, at lightning speed, a vaccine that is capable of shutting down the worst global pandemic in a century. Researchers in the UK, China, India, Russia, Germany and the US, among other countries, have rallied to the cause. Universities, drug companies and even military laboratories have united against a common enemy.
The pandemic, which shows no sign of fizzling out, is more than just a health catastrophe. It has severed global supply chains and ravaged vast industries such as aviation, hospitality and entertainment, sparking the biggest economic downturn since the 1930s.
It is costing the global economy an estimated £290bn per month.
It is also stoking geopolitical tensions and rivalries, as countries barter over limited stocks of unproven vaccines in the hope that their economies will be the first to reopen.
Back to the Start
It has been a year since a mysterious killer pneumonia was first reported in Wuhan, China. Since December 2019, the disease – caused by a virus named SARS-CoV-2 that probably originated in bats and then jumped species – has swept across every continent except Antarctica. As of mid-October, the World Health Organisation (WHO) has recorded more than one million deaths and around 40 million infections. Due to test shortages, both are likely to be substantial undercounts.
Humans are a social species, thriving on close contact. Unfortunately, close contact also allows this respiratory virus to jump from person to person. An infected person, who might not show symptoms, will spread it to two or three others. That exponential spread means that a small outbreak can quickly spiral out of control.
National and local lockdowns help to cut chains of transmission, but they inflict other miseries, including unemployment, social isolation and lost education. They disrupt non-COVID health care and childhood vaccination. All of this makes COVID-19 the most serious pandemic since the Spanish flu of 1918, which resulted in the deaths of at least 50 million people worldwide.
Yet, despite the constant comparison, COVID-19 is not just a “bad flu”. The
coronavirus attacks multiple organs including the brain, causing blood clots that can trigger strokes and heart attacks. The aged are the most at risk. The science journal Nature reported in August that, of 1,000 infected people aged under 50, almost nobody will die, but that rises to 116 deaths out of 1,000 among those who are in their mid-seventies or older. Existing conditions such as diabetes and heart disease magnify the danger. These differential risks are reflected in the UK’s national vaccination strategy: citizens are likely to be vaccinated in age order, with the oldest first. Front-line health and care workers will also be early recipients.
Infected men are almost twice as likely to die than infected women, a disparity ascribed to biological immune differences (which may also explain why women generally outlive men). Black, Asian and minority ethnic communities are also disproportionately affected, possibly due, in part, to riskier jobs and crowded housing. Thankfully, children rarely fall ill with COVID-19, though their role in transmitting the virus remains unclear.
But deaths do not tell the whole story. In the UK, up to 300,000 adults, many in their thirties and forties and never hospitalised, have reported COVID-like symptoms persisting for more than a month, including fatigue and breathlessness. The syndrome is informally known as “long COVID”; the Royal College of GPs is now calling for a network of dedicated clinics to tend to this growing army of under-documented coronavirus casualties.
The Old Normal
The road back to normality, both for human health and the global economy, lies in an effective vaccine that allows people to mingle again without spreading the disease or falling seriously ill. There are more than 300 vaccine projects under way, according to the WHO; at least nine, including AZD1222, are at the final stage of testing before approval and roll-out. It is a phenomenal strike-back against a disease that has been with us for less than a year.
For Dr Zania Stamataki, a viral immunologist at the University of Birmingham who has been assisting the UK testing effort, the response has been an example of “humanity at its best”. To her, a vaccine spells freedom. “I can’t wait for vaccines to become available to my two boys who enjoy contact sports, to my husband who is a front-line clinician, and to our parents, who are tired of isolating.”
The great ambition of the global vaccine race has drawn comparisons with the space race. The Russians have even named their vaccine Sputnik-V, after the first artificial satellite that went into orbit in 1957. The US has been similarly hyperbolic in christening its procurement effort: Operation
Warp Speed is financially backing a handful of vaccines, including those from Oxford/AstraZeneca, Pfizer and Moderna, to secure 300 million doses for Americans.
There are also controversial plans to speed up testing. In January, paid volunteers will be sent to a secure facility in east London to be vaccinated, and then deliberately infected with coronavirus. Deliberate infection means researchers won’t have to wait until a person becomes infected in their everyday life to see whether the vaccine makes a difference. So-called human challenge trials are quick but not danger-free: death or serious disease is a slim possibility (though volunteers are hand-picked to be low risk, and
there is now a cheap treatment, dexamethasone, that reduces the likelihood of death).
If all goes well, carefully regulated short cuts such as this could help scientists identify a winning formula within months. That, in itself, would be a staggering achievement: vaccine development usually takes a decade or more. But that is only the end of the beginning. The next steps involve manufacturing, distribution and the fearsome logistics of getting a vaccine into the arms of billions of people, some of whom might not even want it.
Troubleshooting
Professor Danny Altmann, an immunologist at Imperial College London, believes that we will be well into 2021 before most people are vaccinated. He does not underplay the practical battles ahead, even in an affluent, well-organised country such as the UK. “Up to now, some quite small public health logistical operations, like virus testing and antibody testing, have defeated us,” Altmann says. “Working out how to administer doses of a new vaccine to the whole population, especially if we need monitoring and a booster jab, may really test us.”
Then there’s the issue of the minority of people who show “vaccine hesitancy”, doubting whether they are necessary, safe or effective. “To get on top of this pandemic, we need a population with at least 80% immunity,” Altmann says, meaning that four out of five people will need to be jabbed to make a difference. “Some surveys put vaccine hesitancy at above 20%.” Factor in the people for whom vaccines sometimes do not induce a strong immune response, such as the elderly, and the odds of defeating the viral enemy seem dispiritingly long.
Vaccine hesitancy worries public health officials, as do the conspiratorial narratives that fuel it. The WHO has warned of an “infodemic” – an outbreak of misinformation, such as the unsubstantiated rumours of COVID-19’s connection with 5G phone masts.
Professor Neil Johnson of George Washington University in Washington, DC, who specialises in complex networks, has studied how anti-vaccination groups push their messages on social
media. Facebook seems especially efficient at channelling misinformation through communities focused on unrelated topics, such as male fitness, parenting or pets. “It’s all about online communities,” Johnson says. “You trust people in your community, so you listen to their concerns when they talk about other things, like vaccines.”
He identifies four tactics in the vaccine misinformation playbook: questioning the safety of a vaccine; questioning the need for it; suggesting that governments and Big Pharma have hidden agendas, often mixed in with conspiracy theories; and exploiting uncertainties in the science.
Would Johnson take a coronavirus vaccine? “Yes, but maybe after everyone else in the street has had it,” he says, with disarming honesty. “And I suspect, in that, I’m like nearly everyone. I feel that much more work needs to be done in laying out what is known and what is not known from the vaccine trials as they progress.” Simply telling people that it is safe, he says, won’t cut it.
Recent revelations don’t help: the Oxford/ AstraZeneca vaccine trial was paused twice after two participants reportedly fell ill with a disease resembling multiple sclerosis. The researchers say that no link with the vaccine has been proven. The trial has since restarted in the UK.
Vaccine manufacturers, too, are wary of losing public confidence. In the summer, Donald Trump suggested that a vaccine could be fast-tracked and licensed ahead of the US election. In response, nine top drug companies joined forces to combat perceived political interference, issuing a pledge not to rush the safety trials. If any more evidence were needed that COVID-19 has turned the world upside-down, it is the unprecedented spectacle of the world’s biggest drug companies fighting the White House to get their products to market more slowly.
A Global Solution
The US has already lost the vaccine race, in a sense. Russia approved Sputnik-V in August. China has also approved a vaccine, developed by CanSino Biologics, and started immunising its military. Both were approved before going through the full testing regime usually demanded of new vaccines, which must meet a higher safety bar than medicines, because they are given to healthy people.
Countries have also been frantically cutting deals to secure limited supplies for their own citizens. The UK boasts one of the biggest vaccine portfolios of any country, pre-ordering enough doses of six different candidates to vaccinate the whole population several times over. Betting on multiple vaccines is an insurance policy: the development process is notoriously unpredictable, with promising candidates frequently falling at the final hurdle.
The WHO has warned that if lowand middle-income countries miss out in the great vaccine scramble, the virus will continue to circulate. The WHO has joined forces with Gavi, a body that supports global access to vaccines, and the Coalition for Epidemic Preparedness Innovations, to earmark two billion vaccine doses for countries that might be left wanting. All played key roles in tackling the world’s worst Ebola outbreak, in West Africa in 2014. Encouragingly, more than 170 countries, including the UK and China, have joined the “Covax” initiative.
The WHO plans to give every country enough doses to initially immunise 3% of the population, then up to 20%, depending on supply. After that, doses will go to countries on the basis of risk.
The characteristics of the vaccines – side effects, how long immunity lasts, whether they work in all age groups – will determine how widely they are given. They might cut disease but not transmission, so COVID-19 could become a permanent feature of life, like seasonal flu.
But, if nothing else, the race to find a vaccine is a practice run for a future of viral outbreaks. “More viruses will jump to people as the planet’s human population expands,” warns Stamataki. We can only hope that the world is better prepared next time.
“Vaccine development usually takes a decade”