With pressure growing, competition intensifies
WASHINGTON » Four months after a mysterious new virus began its deadly march around the globe, the search for a vaccine has taken on an intensity never before seen in medical research, with huge implications for public health, the world economy and politics.
Seven of the roughly 90 projects being pursued by governments, pharmaceutical makers, biotech innovators and academic laboratories have reached the stage of clinical trials. With political leaders — not least President Donald Trump — increasingly pressing for progress, and with big potential profits at stake for the industry, drugmakers and researchers have signaled that they are moving ahead at unheard-of speeds.
But the whole enterprise remains dogged by uncertainty about whether any coronavirus vaccine will prove effective, how fast it could be made available to millions or billions of people and whether the rush — compressing a process that can take 10 years into 10 months — will sacrifice safety.
Some experts say the more immediately promising field might be the development of treatments to speed recovery from COVID-19, an approach that has generated some optimism in the past week through initially encouraging research results on remdesivir, an antiviral drug previously tried in fighting Ebola.
In an era of intense nationalism, the geopolitics of the vaccine race are growing as complex as the medicine. The months of mutual vilification between the United States and China over the origins of the virus have poisoned most efforts at cooperation between them. The U.S. government is already warning that American innovations must be protected from theft — chiefly from Beijing.
“Biomedical research has long been a focus of theft, especially by the Chinese government, and vaccines and treatments for the coronavirus are today’s holy grail,” John Demers, the assistant attorney general for national security, said on Friday. “Putting aside the commercial value, there would be great geopolitical significance to being the first to develop a treatment or vaccine. We will use all the tools we have to safeguard American research.”
The intensity of the global research effort is such that governments and companies are building production lines before they have anything to produce.
“We are going to start ramping up production with the companies involved,” Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and the federal government’s top expert on infectious diseases, said on NBC last week. “You don’t wait until you get an answer before you start manufacturing.”
Two of the leading entrants in the United States, Johnson & Johnson and Moderna, have announced partnerships with manufacturing firms, with Johnson & Johnson promising 1 billion doses of an as-yet-undeveloped vaccine by the end of next year.
Not to be left behind, the Britain-based pharmaceutical giant Astrazeneca said this week that it was working with a vaccine development project at the University of Oxford to manufacture tens of millions of doses by the end of this year.
With the demand for a vaccine so intense, there are escalating calls for “human-challenge trials” to speed the process: tests in which volunteers are injected with a potential vaccine and then deliberately exposed to the coronavirus.
Because the approach involves exposing participants to a potentially deadly disease, challenge trials are ethically fraught. But they could be faster than simply inoculating human subjects and waiting for them to be exposed along with everyone else, especially as the pandemic is brought under control in big countries.
Even when promising solutions are found, there are big challenges to scaling up production and distribution. Bill Gates, the Microsoft founder, whose foundation is spending $250 million to help spur vaccine development, has warned about a critical shortage of a mundane but vital component: medical glass.
Without sufficient supplies of the glass, there will be too few vials to transport the billions of doses that ultimately will be needed.
The scale of the problem and the demand for a quick solution are bound to create tensions between the profit motives of the pharmaceutical industry, which typically fights hard to wring the most out of their investments in new drugs, and the public’s need for quick action to get any effective vaccines to as many people as possible.
So far, much of the research and development has been supported by governments and foundations. And much remains to be worked out when it comes to patents and what national governments will claim in return for their support and pledges of quick regulatory approval.
Given the stakes, it is no surprise that while scientists and doctors talk about finding a “global vaccine,” national leaders emphasize immunizing their own populations first. Trump said he was personally in charge of Operation Warp Speed to get 300 million doses into American arms by January.
Already, the administration has identified 14 vaccine projects it intends to focus on, a senior administration official said, with the idea of further narrowing the group to a handful that could go on, with government financial help and accelerated regulatory review, to meet Trump’s goal.
The winnowing of the projects to 14 was reported Friday by NBC News.
But other countries are also signaling their intention to nationalize their approaches. The most promising clinical trial in China is financed by the government. And in India, the chief executive of the Serum Institute of India — the world’s largest producer of vaccine doses — said that most of its vaccine “would have to go to our countrymen before it goes abroad.”
George Daley, the dean of Harvard Medical School, said thinking in country-by-country rather than global terms would be foolhardy since it “would involve squandering the early doses of vaccine on a large number of individuals at low risk, rather than covering as many high-risk individuals globally” — health care workers and older adults — “to stop the spread” around the world.
Given the proliferation of vaccine projects, the best outcome may be none of them emerging as a clear winner.
“Let’s say we get one vaccine quickly but we can only get 2 million doses of it at the end of next year,” said Anita Zaidi, who directs the Bill and Melinda Gates Foundation’s vaccine development program. “And another vaccine, just as effective, comes three months later but we can make a billion doses. Who won that race?”
The answer, she said, “is we will need many different vaccines to cross the finish line.”
Speed versus safety
At 1 a.m. on March 21, 1963, a 5-year-old girl named Jeryl Lynn Hilleman woke up her father. She had come down with the mumps, which had made her miserable with a swollen jaw.
It just so happened that her father, Maurice, was a vaccine designer. So he told Jeryl Lynn to go back to bed, drove to his lab at Merck to pick up some equipment and returned to swab her throat. Hilleman refrigerated her sample back at his lab and soon got to work weakening her viruses until they could serve as a mumps vaccine. In 1967, it was approved by the FDA.
To vaccine makers, this story is the stuff of legend. Hilleman still holds the record for the quickest delivery of a vaccine from the lab to the clinic. Vaccines typically take 10-15 years of research and testing. And only 6% of the projects that scientists launch reach the finish line.
For a world in the grips of COVID-19, on the other hand, this story is the stuff of nightmares. No one wants to wait four years for a vaccine while millions die and economies remain paralyzed.
Some of the leading contenders for a coronavirus vaccine are now promising to have the first batches ready in record time, by the start of next year. They have accelerated their schedules by collapsing the standard vaccine timeline.
They are combining trials that used to be carried out one after the other. They are pushing their formulations into production, despite the risk that the trials will fail, leaving them with millions of useless doses.
But some experts want to do even more to speed up the conveyor belt. Writing last month in the journal Vaccines, the vaccine developer Dr. Stanley Plotkin and Dr. Arthur Caplan, a bioethicist at NYU Langone Medical Center, proposed infecting vaccinated volunteers with the coronavirus — the method known as challenge trials. The procedure might cut months or years off the development but would put test subjects at risk.
Even without challenge trials, accelerated testing may run the risk of missing potential side effects. A vaccine for dengue fever, and one for SARS that never reached the market, were abandoned after making some people more susceptible to severe forms of the diseases, not less.
“It will be extremely important to determine that does not happen,” said Michel De Wilde, a former senior vice president of research and development at Sanofi Pasteur, a vaccine maker in France.