Covid-19

Frontrunners in the vaccine race

How far away are vaccines which could end the pandemic and how many doses can be made quickly? 

Finding a vaccine which protects against the coronavirus which causes Covid-19 is seen as the best way to stop the continued spread of the disease. It's estimated around 70 percent of the world's population - 5.5 billion people - will need immunity to the virus to stop the pandemic.

The race for a vaccine is likely to have more than one winner. Over 150 vaccines are being developed and there's an expectation by mid-to-late 2021 there will be vaccines available. Some companies suggest they may be ready even earlier. 

There's a pipeline of testing that vaccines need to go through before they're licensed for use. The safety bar is set high and they're tested on thousands of people before they're approved by regulators. Some vaccines are now in the final phase of trials before approval.

There's a chance, if interim results from the final phase of trials look positive, some countries may consider allowing emergency use of a vaccine. Vaccine producers are hedging their bets, already manufacturing vaccines, so as soon as approval occurs, there will be doses to ship. 

Already, one vaccine has been approved for use in China for military personnel only despite not completing all three phases of trials. 

Russia is also rushing through a vaccine, saying it will begin a mass vaccination programme in October. The vaccine it's planning to use, made by Gamaleya, has not entered phase three trials yet. 

The vaccine development and testing process

Developing a vaccine is done in phases. This usually takes close to a decade. For this vaccine timelines have been shrunk by running phases simultaneously.

 Tests are done in animals, such as monkeys or mice to see if the vaccine triggers an immune response.

 Tests done on a small number of people to test for an immune response, dosage and safety.

 Tests done on a larger number of people to test for immune response and safety.

 Tests done on thousands of people to see if the vaccine will protect against coronavirus. Traditionally people are split into two groups, some get a vaccine and others get a placebo. After a period of time both groups are checked to see if the vaccine protected against the virus. To get fast results it's best to test vaccines in areas where the virus is common.

 Vaccine approved for general usage. The US Food and Drug Administration has said it wants vaccines to be at least 50 percent effective in protecting against the virus. Comparatively a flu shot is usually 50 to 60 percent effective and the measles vaccine is 99 percent effective. 

The Covid-19 vaccine frontrunners

The following vaccines are the frontrunners. They are either in phase three trials or have limited approval for use.

University of Oxford/AstraZeneca

Country: United Kingdom 
Vaccine platform: Non-Replicating Viral Vector
Doses: One

The much-touted University of Oxford / AstraZeneca ChAdOx1 vaccine has started phase three trials after earlier results showed a four-fold increase in antibodies for 95 percent of recipients after one month. The phase one and two trials were completed simultaneously.

Its phase three trial taking place in Brazil will have 2000 participants with an end date of October 2020. Another trial taking place in South Africa will also have 2000 participants. Early results are expected around November for the South African trial.

AstraZeneca has said its global supply capacity will exceed two billion doses per year by 2021. In June AstraZeneca's chief executive said it was on track to start delivering vaccines as soon as September, if trial results were successful. A vaccine manufacturer in India which is already manufacturing the vaccine said it should have 300 million doses ready by November.

SinoVac

Country: China
Vaccine platform: Inactivated
Doses: Two doses 14 days apart

SinoVac is developing CoronaVac and commenced a phase three trial in Brazil in July. The company said phase one and two trials have produced antibodies in 90 percent of people tested with no severe side effects. There are 8870 participants in the trial. The study completion date is listed as October 2021, but an interim efficacy analysis will be completed after 150 cases.

The private company has used similar technology to produce vaccines for hepatitis, swine flue, avian flu and the virus which causes hand, foot and mouth disease.

It's hoping to produce 300 million doses a year.

Moderna

Country: United States
Vaccine platform: Messenger RNA
Doses: Two doses 28 days apart

The new kid on the block is Moderna. It's never produced an approved vaccine and is using a technology which has never been used in an approved vaccine. One of the advantages to the technology is speed of production, unlike other types of vaccines, there's no need to grow the virus in chicken eggs from which to create a vaccine.

Phase one and two trials showed the vaccine produced an immune response. 

The phase three trial will involve 30,000 participants in the US. The study is due to be complete in October 2022. Early results should be known by November. 

Moderna says it's "on track" to deliver between 500 million and one billion doses per year from 2021.

Sinopharm/Wuhan Institute of Biological Products

Country: China
Vaccine platform: Inactivated
Doses: Two doses either 14 or 21 days apart

Sinopharm is investigating two inactivated virus vaccines. One with the Wuhan Institute of Biological Products and the other with the Beijing Institute of Biological Products. 

The lack of Covid-19 cases in China has meant Chinese companies need to run phase three trials outside China. This trial is being run in the United Arab Emirates. 

The company has said it expects the trial to take around three months and a vaccine could be available by the end of the year. It has the capacity to produce 100 million doses a year.

Sinopharm/Beijing Institute of Biological Products

Country: China
Vaccine platform: Inactivated
Doses: Two doses either 14 or 21 days apart

The second of Sinopharm's vaccines is also going through phase three trials in the United Arab Emirates.

It's been reported if the trial is successful the company has the capacity to produce 120 million doses annually.

Pfizer/BioNTech/Fosun Pharma

Country: Germany
Vaccine platform: RNA
Doses: Two doses 28 days apart

BioNtech have reported good immune response results and tolerable side effects from one of the vaccines it's been trialing. 

 Pfizer will recruit around 30,000 participants for a phase two and three trial from the U.S., Argentina, Germany, and Brazil. If the trials are successful the companies hope to gain emergency use approval by the end of 2020. It aims to produce 1.3 billion doses by the end of 2021.

University of Melbourne/Murdoch Children’s Research Institute

Country: Australia
Vaccine platform: Live-attenuated vaccine
Doses: One

A vaccine developed a century ago is being investigated for use in the pandemic. Initially created for tuberculosis the Bacillus Calmette-Guerins vaccine has been shown to reduce deaths in infants and reduce respiratory disease. It's not thought this vaccine will fully protect against Covid-19 but it may reduce the time a person is unwell. There's also a chance the effects of the vaccine may reduce quickly - possibly within three and 12 months. If it proves helpful against Covid-19 it may be a stop-gap measure which could better protect frontline workers until a targeted vaccine is completed.

A phase three trial is now underway in Australia and the Netherlands with health workers. 

CanSinoBIO
 (Limited approval only)
Country: China
Vaccine platform: Non-replicating viral vector
Doses: One

This is the only vaccine licensed for limited use. It was developed by a private company in partnership with China's Academy of Medical Sciences. In an unusual move, it was approved for emergency use after promising results in phase one and two trials.

It's approved for military use in China only. Any results from this use will not count as completing phase three trials. To get full regulatory approval a phase three trial will still need to take place.

This vaccine looks to be less effective for people older than 55.

Will we be able to make enough vaccine to vaccinate everyone in 2021?

A vaccination campaign this large has never been done before. Meeting the demand is a huge challenge which goes beyond making the vaccine itself. Billions of glass vials, stoppers and syringes will also be needed. A cold chain - refrigerators and refrigerated transport - will be needed if it's a vaccine that needs to be kept chilled.  

At present, the numbers aren't adding up to suggest everybody will be able to get vaccinated by the end of next year.

Hitting a vaccination rate of 70 percent globally, which was an early estimate of the rate needed to end the pandemic, will mean 5.5 billion people will need to be vaccinated. If the only vaccines approved are two dose vaccines, that's 11 billion doses. There's also a chance immunity might be short-lived and regular booster shots will be required. 

Based on the numbers that the above vaccine makers are suggesting they could produce per year, fewer than half the needed population could be vaccinated in the first year. 

A survey of manufacturing capacity conducted by the Coalition for Epidemic Preparedness Innovations (CEPI) found the current global capacity to be between two and four billion doses from October through to the end of 2021. This is based on what can be done without disrupting the production of other vaccines.

Published just days ago with numbers gathered from April to June, CEPI warns its estimate could already be out of date as companies aggressively ramp up manufacturing capacity. 

The big business of vaccines

The overall vaccine industry is estimated by AB Bernstein to be worth around $52 billion a year. Four major players; Sanofi, Merk, Pfizer and GlaxoSmithKline, have 85 percent of the market. The pandemic has seen interest in smaller players, such as Moderna, spike. Despite having no products for sale, its stocks went up from around US$20 in January to around $80 by July.

Globally there's been jockeying for vaccine supplies by countries who are already doing deals with vaccine makers. The United States 'Operation Warp Speed' has sewn up deals with Sanofi, GlaxoSmithKline, AstraZeneca, Johnson & Johnson, Moderna, Novavax and Pfizer.

AstraZeneca and Johnson & Johnson have both said they're not planning to make a profit from the vaccine during the pandemic. AstraZeneca say the vaccine will be sold at cost price, around $5 a dose. Johnson & Johnson's deal with the United States indicates its price is $15 a dose. Once the pandemic has ended, their prices could increase. 

Pfizer's vaccine looks to be around $30 per dose and Moderna's mRNA was initially going to cost between $60 and $90 for a two dose course. For large purchases, it's now dropped its price to between $48 to $56.

It's not just countries splashing cash around that will get a vaccine. The World Health Organisation, CEPI and Global Alliance for Vaccines and Immunisations (GAVI) have launched Covax. It's a programme which aims to distribute two billion doses of vaccine by the end of 2021. The hope is this will end the acute phase of the pandemic. 

Participating countries have pooled money and funded several different vaccines. If any of these are approved, vaccines will be delivered equally to participating countries. The amount is proportional to the population, with health workers at the front of the queue followed by at-risk groups such as the elderly, or people with underlying health conditions.

The goal is for 20 percent of the population of a country to be vaccinated by the end of 2021. 

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