The Vaccine Race
Retractable Industries
Moderna. Pfizer. AstraZeneca. For those following the news about the Coronavirus vaccination efforts, these names will be very familiar. These companies have shown incredibly promising vaccine efficacy rates in their clinical trials; a piece of good news after a year into the pandemic. However, fears of a rushed and improperly tested vaccine may erode confidence in medical institutions worldwide, crippling efforts against Covid-19. In addition, key differences in the rival booster shots and logistical inefficiencies may further hinder their distribution and application.
Pharmaceutical Shmarmaceutical
Current vaccines’ inability to combat the virus has no doubt exacerbated the global death toll, necessitating a rush in development that far outpaces conventional development timelines for such treatments. It is precisely this rush that is driving mistrust in any potential vaccines coming within the next year or so.
On 12th November, the World Health Organisation released a landscape report highlighting more than 170 companies currently engaging in vaccine trials, both clinical and preclinical. 164 of these companies aan re producing vaccines that are undergoing preclinical evaluation, and 48 are undergoing clinical evaluation. (Editor’s note: preclinical evaluations refer to the stage of research not involving human testing, while clinical evaluation involve testing on people.) Moderna, AstraZeneca, and Pfizer all fall within the 48 companies undergoing clinical evaluation and have produced positive results.
Despite such promising results, misinformation and mistrust in scientific institutions threaten to undermine these efforts. A report by the Royal Society, released in October 2020, indicated that deployment of any vaccine could be hampered by skepticism over the efficacy of vaccines. In the words of WHO Director-General, Tedros Adhanom Ghebreyesus, at the Munich Security Conference earlier this year, “We’re not just fighting an epidemic; we’re fighting an infodemic.” Some prominent anti-vaccination (anti-vaxx) activists have condemned the lack of peer review and safety data on the vaccine, alongside its alleged ties to the Bill and Melinda Gates Foundation – yet another lightning rod for conspiracy theorists worldwide.
Vaccination 101
The current iteration of vaccines that have been touted by AstraZeneca, Pfizer, and Moderna as successful deviate from traditional vaccine implementation methods. Putting conspiracy theories aside, there have been concerns raised regarding any potential side effects that may arise without proper testing and long-term monitoring. Breaking down and acknowledging such concerns is thus key to the fight against Covid-19, and may likely contribute to an improvement in safety standards for these vaccines.
Traditional vaccines involve the manufacturing of viral proteins in external laboratories and injecting them into patients. Such viral proteins usually contained weakened or harmless variations of the virus that prime the patient’s body for fighting the actual virus – the immune system would recognise the stronger virus from its previous interaction with the weaker variation and efficiently combat the virus. Both AstraZeneca and the Gamaleya Center for Epidemiology and Microbiology in Moscow, the developers of the Sputnik V vaccine, utilise this traditional approach to vaccine development. The AstraZeneca trials currently demonstrate up to 90% efficacy and the Sputnik V vaccine shows an interim efficacy of 95%; both appear incredibly promising.
On the other hand, Pfizer and Moderna have utilised the MRNA route of vaccine development. This involves injecting genetic material derived from viruses directly into the body, triggering production of viral proteins which the immune system then targets. The main difference between this and traditional vaccines is that for MRNA vaccines, the body itself is producing the proteins that the immune system targets, in comparison to the artificial insertion of viral proteins via the traditional route. And similarly to AstraZeneca and Gamaleya, the results shown by Pfizer and Moderna bode well.
The concern here is the lack of sufficient testing and monitoring of possible side-effects. The use of MRNA in vaccines has not been as extensively researched and documented as traditional vaccine implementation has. As such, critical data like efficacy period, side effects, or ideal dosages appear to be missing. Having said that, the development of mRNA vaccine technology has ramped up in recent years, perhaps in anticipation of such a pandemic. With tens of thousands of volunteers worldwide signing up for trials, precautions and rigorous safety procedures would have been undertaken to prevent negative side-effects.
1 cold-brew vaxxpresso to go, please
Developing the vaccine is half the work, unfortunately. Distribution and administering treatments to as much of the population as possible is just as important. Thankfully (or worryingly, depending on your views), distribution efforts will be largely spearheaded by the governments of their respective countries. While more developed countries will have other logistical problems of their own, the bigger issue appears to be transporting the vaccine to more rural populations.
The Pfizer vaccine requires transport and storage temperatures of -70 degrees Celsius. Involving a secure supply chain from production facility to distribution centres, the vaccine needs to be kept at an incredibly low temperature throughout to ensure maximum efficacy – a feat that may be harder to pull off for less developed countries with larger rural populations. The reason for such low temperatures is due to the unstable nature of the mRNA vaccine. Temperatures above -70 degrees Celsius could cause the mRNA in the vaccine to degrade and lose its efficacy. It is important to note that while the Pfizer vaccine currently requires such low temperatures, with further research a stable shelf life may be achieved at higher temperatures, easing the storage and transport requirements. Nevertheless, this hurdle will be harder to clear if the required infrastructure has not already been implemented – towns in South America will find it harder to receive the Pfizer vaccine than say, London or New York. Reports indicate that wealthier hospitals are also buying up specialised freezers, leaving lesser stocks for poorer and more rural healthcare centres
So why does the Moderna vaccine, which also utilises a similar mRNA backbone, only require regular freezer temperatures of -20 degrees Celsius? There appears not to be a clear answer to this question, as the numbers here stem from research and development by both companies. Margaret Liu, a vaccine researcher chairing the International Society for Vaccines, highlights that as both the Moderna and Pfizer vaccine formulations are secret, it is impossible to know the specifics constituting the differences between the two. Perhaps stress-testing for the vaccines’ thermal stabilities will allow Pfizer to ship out vaccines with less strict requirements, but for now the reported temperature will have to be adhered to to ensure its efficacy. And if both Moderna and Pfizer have their treatments approved at similar times, then governments will find it useful to apply demography-based distribution schedules for each vaccine.
To trust or not to trust?
Ultimately, the vaccine trials have been fast-tracked beyond standard development times. But this is no cause to be concerned; delays caused usually stem from red-tape bureaucracy, which is usual for any governmental processes. But the Covid-19 pandemic is anything but, and the sooner a vaccine is approved for widespread usage, the better.
by Ronald Poh