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It's September ... why don't we have a vaccine yet?





The past 5 months have been a whirlwind . The seemingly race/ sprint for a vaccine is a thing of the past. It's now September, no vaccine but there are promising candidates. To date of writing this post there are more than 170 vaccine candidates being developed all at various stages and in different countries. 50 + of these vaccines are in human trials.



There a few things I want to address in this post - feel free to skip to bits you find most relevant


  1. The Vaccine frontrunners

  2. Fair distribution of vaccines

  3. My thoughts: September to December Outlook






You can look at the front runners in a few ways: their viral mechanisms, the institutions behind them or the pharmaceutical companies funding their development. Their mechanisms of action may be interesting for science enthusiasts but many people just want a vaccine that works.



Europe


Oxford Vaccine


The oxford vaccine trials in humans was officially announced in April. I explain in an IGTV video the full mechanisms behind the vaccine in a simple way but you can also listen to the team talk about it .The oxford vaccine has gone through animal trials and now is at the point of large scale clinical trials across several countries: UK, USA, Brazil and South Africa. Their studies in healthy volunteers have shown no harmful side effects. The true test of protection is still unknown and the animal studies have shown to reduce the effects/ damage of Covid-19 infection but not completely prevent symptoms. The oxford vaccine is backed by AstraZeneca, and trials in South Africa were also supported by the Bill and Melinda gates foundation.


Imperial Vaccine


The Imperial vaccine is the second runner in the UK and hasn’t had an ambitious expectant date like the Oxford vaccine .In June 300 people had been recruited with a conservative date of spring 2021, so perhaps i'll be asking more questions again if a vaccine hasn’t already been shown successful. The trials are still in the early days and its studies are currently only being tested in the UK. This vaccine does not seem to be funded by a Pharma but instead university money and donations. Like the oxford vaccine it is also backed by the Bill and Melinda gates foundation.




Russian Vaccine


Now lets take the focus away from the UK. The Russian vaccine named “ Gam-COVID-Vac” has entered phase 3 trials and is not the only vaccine being developed in the country - It is quite a “controversial vaccine” as per reports and lack of data regarding efficacy and safety being published. The team have recently published results of a small study of 76 patients. They report it to be safe, but as it is in the very early stages larger trials are still needed. A second candidate “EpiVacCorona” is also in early trials. “Gam-COvid Vac” has had a quite interesting development with small phase one trials of less than 100 participants and now phase 3 with hopeful enrollment of 40,000 people. It has also been approved by the government being the “first” in that case. It is also planned to go for testing in the UAE and Saudi Arabia with requests being made from other countries.



America


The Moderna vaccine / mRNA-1273 is being developed in the US has been perfectly summarised - its last updates state larger clinical trials should have started in July. Early studies have shown it to also be “safe” . BioNtech and Pfizer BNT162 mRNA vaccine candidate is being trialed in Argentina, Brazil and Germany. The trials have also been extended to turkey to begin in september. These trials have shown to produce an immune response after giving two doses of the vaccine. This means the vaccine causes production of antibodies but it is still unknown if it provides protection.


In summary, all the front runners are safe in not causing adverse reactions in heathy volunteers from phase 1 and 2 trials but investigators are still looking to see how many doses will be needed and how long protection if any actually lasts in humans and what type of protection is provided.


Africa


Africa has been in the news but never for developments of a vaccine. The world is more centered on how the continent has dealt relatively “well” with the pandemic. On the continent, South Africa has the highest number of cases with more than 500,000 reported. Other countries such as Algeria, Egypt , Ghana, Morocco and Nigeria have cases exceeding 20,000.Currently there are no vaccines to my knowledge being developed on the contitnent.


In terms of vaccines, South Africa- the worst affected has trials being conducted using candidates from Europe such as the oxford vaccine . To date of this post South Africa seems to be the only country participating in clinical trials. The African Union is building a framework to get more vaccines trialed in Africa to ensure the vaccine candidate that does “win” is also effective in african populations.


In an interesting turn, some African countries are exploring other means of testing and “antibody” testing has gained some interest in countries like Sierra Leone. The purpose of these tests are to see what percentage of the population have been infected with coronavirus. The antibody testing procedure is quite controversial with scientists not fully aware of their true benefits. The potential useful window of opportunity is unknown as antibody levels vary after time following an infection. Antibody tests will not replace the standard PCR test ( that uncomfortable nose and throat swab) but results will add to the pool of knowledge needed.








There are loads of candidates but most in early stage phase 1 where results are to see if an immune response is generated and look for potential side effects. I have written posts on vaccine basics and trials that explain the whole process quickly including things you should consider if you want to take the vaccine .



Who will be given the vaccine ?


The “race “ for the vaccine has brought about a lot of concern.The hope of the World Health Organisation( WHO) was that vaccine access would be a fair and just process but as some countries come closer to the possible breakthrough, it will be naive to assume that governments wont give access to their nations first.


It may seem dramatic to say but from the beginning, the UK saw large amounts of people fight over toilet roll and also the US buying out stock of Remdesivr a Covid-19 medication doesn’t leave you with much hope.


The WHO are still trying and have set up a COVAX initiative to ensure the equitable access of vaccines. It aims to ensure low and middle income countries have access. It relies on governments doing the good things and is supported by vaccine candidates at different stages with Oxford/Astrazeneca and Moderna vaccine the furthest along.







With all these trials in place there are many concerns around its accessibility and making sure it works for everyone. It is no surprise that the lack of diversity in science does not only span the structure itself but research rarely reflects global populations especially when the west is leading. When looking at the majority of vaccine candidates, there is a concern that the data may not be useful for those most affected in western countries i.e "BAME" in the UK. The candidates part of the COVAC initiative are all being developed outside Africa, at bare minimum data will be needed to test adverse effects and safety based on african populations.


I don't want to end this in a gloomy way. The science is moving along and each day we get new data. The lack of data for black populations may be concerning but there are scientists and people working very hard to ensure that research done is representative and furthermore holding funding bodies accountable.


As for the next few months, I think it would be VERY optimistic to think that the general population would be given the vaccine by december. At the very least, in line with reports healthcare workers will probably be offered it first to further test the effectiveness of the vaccine. The next few months will be what the past months have been... learning each day and adapting according to the situation in individual countries.




To support fair and open research. Read the letter written by amazing scientist in relation to £0 of funding from the UKRI going to black academic leads for their " Covid-19 and BAME" fund.

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