Archives April 22, 2020

SARS-CoV-2 Vaccines Not an Easy Shot in the Arm

by Barry P Chaiken, MD

A crisis has a way of focusing the mind. With millions infected and hundreds of thousands of dead from SARS-CoV-2 infections, thousands of life science company and university center researchers from around the world are working tirelessly to develop a COVID-19 vaccine. In normal times, these researchers would work independently and protect their intellectual property. They would limit the release of their findings to patent filings and peer review journal articles. The pandemic has created times that are not normal with researchers, companies, and medical journals responding accordingly.

With these usual barriers to information sharing gone, researchers now freely distribute their findings with colleagues. They are taking a crowd-sourcing approach to vaccine development while bypassing the usual licensing agreements that often hinder collaboration. Academic journals are accelerating the peer review and publishing of COVID-19 research papers and accepting clinical letters that share preliminary research results. For most academic and mainstream media publications, the paywalls that would limit access to COVID-19 information no longer exist.

Perhaps the 12-18-month timeline to develop a vaccine will be achieved and the world will soon be poised to get a shot in the arm in its fight against the pandemic. In the meantime, what should we do while we wait?

There are three major steps in using a vaccine to control the COVID-19 pandemic: 1) Develop a safe and effective vaccine, 2) Ramp up production to billions of doses, and 3) Establish a process to vaccinate large populations. We know that step 1 is already in process and hope that an effective vaccine becomes available soon.

For a vaccine to be useful in the real world (Step 2), it must be of a type that can be produced at scale. Therefore, as researchers develop vaccines, they should pay attention to the effort required to produce billions of doses. How long will it take to produce one dose? Do we have enough fermenting kettles for bacteria that produce the vaccine’s antigens? Can we access enough chicken eggs to be used as a culture? These and many other practical considerations will influence which vaccine we choose to use and how quickly we can distribute it.

The challenge of mobilizing a vaccination force with the correct supplies to vaccinate billions of people (Step 3) is the greatest logistical problem the human raced has ever tackled. Other global vaccination efforts have taken years, not months to complete (e.g., smallpox). How do we vaccinate large populations spread all around the world that live in countries with different levels of medical resources, infrastructure, customs, and laws, and do it in a year or less? While we need a vaccination plan for every country, each plan will be different.

No country will be fully safe until all citizens are vaccinated. Success depends upon rich and poor countries working together towards universal vaccination. This is the only way to achieve a high enough level of heard immunity to halt the spread of the infection.

While we wait for a vaccine to be developed, it is imperative we start our vaccination planning now. We need to anticipate the different ways the vaccine might be manufactured and start preparing facilities for production. We must start stockpiling of the supplies needed to administer the vaccine. All countries need a comprehensive vaccination plan. Only by following these steps can we achieve the “new normal” all of us think about every day.

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