The last time a generation prayed on their knees were when the Israelites were making their 40-year exodus to the promised land through the deserts. They were crying for food. God blessed them with manna from heaven. Now the world is frantically waiting for an effective vaccine for Covid-19, similar to the waiting for the manna.
Covid-19 has shown its strength and aggressiveness after it first appeared in Wuhan nine months ago. The Northern and Southern hemisphere have passed through the cycles of weather and temperature had no effect on the virus. It has killed nearly 750,000 people around the Globe, no country spared. According to the American Academy of Pediatrics, in the last two weeks 97,000 American children have tested positive for the virus. The pandemic has started spreading its wings into the African continent where more than a million people are affected. Nigeria, Ghana, Algeria and Egypt along with South Africa had the worst of it.
All modes of treatment have pretty much shown to be ineffective. Voodoo medicine men and alternative medicines have self-claimed success in treating Covid, but the virus has ignored them all. Even diagnostic testing cannot catch up with this viral storm and even the most developed countries, including the US, are waving the white flag.
Now the only hope is for people to look up to the heavens and wait for an effective vaccine for Covid. Vaccination is the world’s most successful health intervention in modern era saving 3 million lives a year. The world has seen similar situations especially during the paralytic polio epidemic in 1950’s when kids were not allowed to play outside nor use swimming pools.
All these have erased from our hard drive as science discovered preventive vaccines for most of the illnesses. The vaccine discovery has now become a competition between nations, and all want to be like the Sputnik, when USSR managed to put the first satellite in to space in 1957. In all this, the fundamental rule should not be to ignore the basic principles of medical ethics. The World Health Organization wants all vaccine candidates to go through full stages of testing before being rolled out. But has WHO now become a lame duck? Have they lost their authority and power to monitor and enforce protocols in these countries?
To facilitate in the race many countries have started agencies to facilitate the production of vaccines. The average time interval to develop a vaccine and be in the market is about 15 years and cost about 500 million dollars. The fastest vaccine developed so far is for Mumps which was developed in 4 years. There are more than 100 companies around the globe currently developing vaccines.
Vaccines fit into 2 categories: genetic vaccines which use virus genes to prove a response (Moderna, BioN Tech) and virus vector vaccines which use another virus’ gene to deliver entry into a cell to prove a response (Oxford, Johnson and Jonson). The American administration has formed a task force, Operation Warp Speed (OWS), a name more fitting for a military operation in war than a lifesaving agency. OWS is a partnership between the Directorate of Health and the Defense department. This is a national, private-public partnership intended to accelerate the development, manufacturing and distribution of COVID 19 vaccines.
It has invested about 2 billion dollars into the Bio N Tech/ Pfizer partnership. It has invested close to a billion dollars into Moderna whose vaccine is in phase 3 trials and is expected to enroll 30,000 volunteers. Johnson and Johnson and Novavax along with Mount Sinai have $450 million from OWS and their vaccine is moving into phase 3 trials next month. Oxford and Astra Zeneca are in phase 3 trials in The UK, USA and Brazil. Then there is Bharath Bio Tech, in India, which has clinical trials in 12 centers in different parts of India currently ongoing. Many of these trials have shown promising results. OWS hope to shortlist 14 companies, cutting them further to 7 companies from whom they intend to contract with. Sinovac is a Chinese company which also has clinical trials rapidly progressing. Russia boasts about the being first country to have an approved vaccine by October.
To be effective, a vaccine must be produced with the least side effects and with greatest immunological response. It must also be cost effective for global access. The number of doses is also critical as we go into corners of the world where logistics are an issue. Johnson and Johnson are the only one with a single dose vaccine. Being a pediatrician, I have been the strongest proponent of vaccines as my life has taken me to Tanzania, Nigeria, India and the Philippines. I was a speaker for most of the vaccine manufacturers. I have seen the ill effects of these vaccine preventable illnesses and the lives the vaccines have saved. I am now troubled by this race to “Be the first”. Will countries be cutting corners at the cost of human lives? Will politics win over science? Will the virus be politicized, this a year with many elections looming?
A vaccine is only as effective as society is accepting of it. Prior to Covid, there was already a group hesitant of vaccines. France has the lowest level of trust with 33% of people hesitant to be vaccinated. In the United States, a recent survey showed that one third of respondents and about 47% of Republicans declared that they would not vaccinate against Covid. A vaccine with an efficacy of 60% could stop the pandemic provided the whole population gets vaccinated.
With fewer people accepting vaccination the efficacy should be 80% to stop the pandemic. Science cannot take a chance and cannot afford to make any mistakes. The counter group is watching for any missed step. The world has eradicated smallpox and almost polio. Any shrinkage in the heard immunity will bring back all those pandemics from the past. The rate of childhood normal vaccination all around the globe is down now because of Covid.
We will have to keep up our guard and remain vigilant. Cholera and typhoid out breaks are already happening around the world. We cannot afford to have polio, tetanus and diphtheria be wiped out only to have them return as well. These diseases are still endemic around the globe. So, science and approving agencies have to be absolutely sure about the actions and reactions of these vaccines before it is approved and rolled out in the market.
When we finally have a vaccine who gets them? No single company will be able to meet the global demand. An effective, safe and affordable vaccine will be the key for acceptance. The virus has affected certain ethnic groups more than others. It has also effected people who are marginalized. It is an irony that it is this population whose voices are not heard and are always last in line.. I sincerely hope that the demographics of the affected are given a priority. There is a saying “survival of the fittest” and I hope it is not “the survival of the richest and influential”. There is some good news too. Serum institute of India (SII) is in contract to manufacture Covid vaccines for Oxford and Novavax.
They have the capacity to make about 3,000 vials in a minute. They have just announced that it will offer 100 million doses at a price capped at $3 for 92 low- and middle-income countries. There are saving graces in the midst of all these rat races and greed. We have come a long way from early inoculation effort 5 centuries ago. Finding a vaccine to protect the world is a challenge but if we have learned from history then there is reason for hope. I can already smell the Manna..