The development of a COVID-19 vaccine may feel like it should be just as accessible as your friendly, annual flu shot. But what we don’t see behind the scenes are the years of research and testing to ensure the safety and efficacy of influenza and COVID-19 vaccines alike. With the global spread of coronavirus, a vaccine may be our best shot at stopping the spread of the virus and returning to full social normalcy. [1,2]
If you’ve been hearing a whirlwind of terms in the news - from vaccine, to antibody test, to drug treatment options - here is a quick tl;dr on the difference between these terms and what each one means in terms of addressing COVID-19:
Vaccines come in all shapes and sizes - from injections of live attenuated viruses to the use of DNA plasmids. [3] Yet, of the vaccine platforms under development, candidates with the greatest potential for speedy development are DNA and RNA platform vaccines because they do not require culture or fermentation.[4,5]
According to the WHO, 5 vaccines are currently furthest along in development (as of April 27, 2020): [6]
PHASE II Clinical Trial:
Non-replicating Viral Vector platform (Developer: CanSino Biological Inc. and Beijing Institute of Biotechnology)
PHASE I Clinical Trial:
RNA platform (Developer: Moderna/NIAID)
DNA platform (Developer: Inovio Pharmaceuticals)
Inactivated virus (Developer: Beijing Institute of Biological Products/ Wuhan Institute of Biological Products)
Inactivated virus (Developer: Sinovac)
FYI | Additional Resources:
See WHO's compilation of clinical and pre-clinical COVID-19 vaccines here for a comprehensive and updated chart!
Quick Refresher on Clinical Trial Phases, according to the CDC:
The general stages of vaccine development are:
-Exploratory stage
-Pre-clinical stage
-Clinical development*
-Regulatory review and approval
-Manufacturing
-Quality control
*Clinical development is a three-phase process.
Phase I: small groups of people receive the trial vaccine
Phase II: the clinical study is expanded and the vaccine is given to people who are similar in age and health to the intended population receiving the vaccine
Phase III: the vaccine is given to thousands of people and tested for efficacy and safety
Many vaccines undergo Phase IV formal: ongoing studies after the vaccine is approved and licensed.Current research efforts addressing the most recent coronavirus outbreak in terms of vaccine type and spread among the different stages of research, the “COVID-19 Vaccine Development Landscape” is laid out by Le et al.:
Source: Thanh Le T, Andreadakis Z, Kumar A, et al. The COVID-19 vaccine development landscape. Nat Rev Drug Discov. April 2020. doi:10.1038/d41573-020-00073-5
As a byproduct of this current push for vaccine development, millions of vaccines could be developed, which is necessary as attrition rates may be high.[4] Yet, at the end of this massive vaccine development effort, we just need to end up with one viable vaccine. The next question to be addressed following vaccine development is how can we fairly allocate and distribute these vaccines? Vaccines play an undeniably important role in stopping the spread of this coronavirus outbreak. But attention must be equally paid to the economic burdens imposed by quarantine, the importance of testing and tracking regional outbreaks, and improving the protection of our frontline workers.
Collaboration, both domestically and globally, is essential to salvage time throughout the vaccine development and manufacturing processes. To address this, researchers have proposed the formation of a global coalition to fight the spread of COVID-19.[7] As a part of this effort, The Coalition for Epidemic Preparedness Innovations (CEPI) recently announced the initiation of three programs aimed to develop COVID-19 vaccines by utilizing established vaccine platforms.[8] In addition to the work that these organizations have initiated, international collaboration has already been occurring organically. China assisted the state of New York by donating ventilators in early April [9], Taiwan has pledged to donate 100,000 protective face masks per week, [9] and 500,000 COVID-19 tests have been arranged to be purchased from South Korea by the first lady of Maryland.[10]
With the streamlined development of a COVID-19 vaccine, we can only hope the next time we ask “What’s the sitch about COVID-19 vaccine development?” that we can call or beep the international COVID19 research teams and our government leaders who have stepped up to answer the call.
Primary Author:
Minda Liu
B.A. Biology | Carleton College
MPH Candidate | Dartmouth College
Contributors:
Monica Ngyuen, Shruthi Patchava, Arushi Krishnan, Divya Chawla
MPH Candidates | Dartmouth College
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REFERENCESPao M. NIH Launches Effort To Speed Up Development Of COVID-19 Treatments : Coronavirus Live Updates : NPR. https://www.npr.org/sections/coronavirus-live-updates/2020/04/17/837347535/nih-launches-effort-to-speed-up-development-of-covid-19-treatments. Accessed April 19, 2020.
Cetron M, Maloney S, Koppaka R, et al. Isolation and Quarantine: Containment Strategies for SARS 2003. In: Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al., editors. Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington (DC): National Academies Press (US); 2004. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92450/?report=classic
Prompetchara E, Ketloy C, Palaga T. Allergy and Immunology Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. doi:10.12932/AP-200220-0772
Lurie N, Saville M, Hatchett R, Halton J. Developing Covid-19 Vaccines at Pandemic Speed. N Engl J Med. March 2020. doi:10.1056/nejmp2005630
Dhama K, Sharun K, Tiwari R, et al. COVID-19, an emerging coronavirus infection: advances and prospects in designing and developing vaccines, immunotherapeutics, and therapeutics. Hum Vaccines Immunother. 2020. doi:10.1080/21645515.2020.1735227
World Health Organization. Draft landscape of Covid-19 candidate vaccines. March 20, 2020 (https://www.who.int/blueprint/priority-diseases/key-action/novel-coronavirus-landscape-ncov.pdf?ua=1)
COVID-19 Clinical Research Coalition. Global coalition to accelerate COVID-19 clinical research in resource-limited settings. Lancet. 2020;0(0). doi:10.1016/s0140-6736(20)30798-4
CEPI. CEPI to fund three programmes to develop vaccines against the novel coronavirus, nCoV-2019; 2020. Accessed April 23, 2020. https://cepi.net/news_cepi/cepi-to-fund-three-programmes-to-develop-vaccines-against-the-novel-coronavirus-ncov-2019/
Rummler O. China donates 1,000 ventilators to New York - Axios. https://www.axios.com/coronavirus-china-new-york-fd8ffd12-d8fa-4e54-b8f0-4412f65c57e9.html. Accessed April 24, 2020.
Booker B. Maryland Secures Half A Million Coronavirus Test Kits From South Korea : Coronavirus Live Updates : NPR. https://www.npr.org/sections/coronavirus-live-updates/2020/04/21/839919655/maryland-gets-500-000-test-kits-from-south-korea-drawing-criticism-from-trump. Accessed April 24, 2020.