Vaccination of the world against COVID-19
Vaccination of the world against COVID-19

Vaccination of the world against COVID-19

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

The rapid development of vaccines against Covid-19 has been a triumph for science, with more than half of the world population vaccinated since vaccines only became available in late 2020. But that triumph has not been shared equally across the globe, with only 15 percent of people in low-income countries receiving even a single vaccine dose by the end of March 2022.

One reason for this imbalance is that the mRNA vaccines that have been so successful in affluent nations are new, expensive and technologically challenging to manufacture. Only a few companies have the expertise to manufacture them, and high-income countries have hoarded more than 70 percent of the doses.

Efforts to increase the production of mRNA vaccines in middle- and low-income countries are now underway, including in some African countries. However, mRNA is fragile and difficult to handle, requiring some vaccines to be stored at ultra-cold temperatures. This increases the complexity of vaccine manufacturing and to the challenges of distribution in remote areas. Vaccines that use genetically modified viruses to introduce coronavirus proteins, such as the Johnson & Johnson vaccine, are also relatively new and technically challenging to manufacture.

A better option is to turn to more traditional vaccine technologies that do not require as much new infrastructure, says Maria Elena Bottazzi, a vaccine researcher at Baylor College of Medicine in Houston. Bottazzi was the co-author of A Look At Covid-19 vaccines that use more accessible technologies in 2022 Annual review of medication. Such vaccines deliver whole, inactivated viruses or fragments of viral protein to stimulate the immune system to produce antibodies, and they can be more than 90 percent effective in preventing disease, just like the mRNA vaccines.

In contrast to mRNA technology, factories already exist in many middle- and low-income countries to produce these older types of vaccines, which include the well-known hepatitis A and B vaccines and polio vaccines. Such shots also tend to cost less than the new mRNA vaccines: a few dollars per. dose, compared to more than $ 10 per dosage. In collaboration with the Indian company Biological E, Bottazzi and her Baylor colleague and co-author Peter Hotez have developed such a Covid-19 vaccine, Corbevax, using protein fragments, which are now approved for use in India and Botswana.

Knowledge Magazine talked to Bottazzi about what makes a vaccine suitable for global use and some of the barriers that have prevented more widespread vaccination. This conversation has been edited for length and clarity.

What is a “good” vaccine for global use?

You must have a solid technology that is appropriate for the region, including scalability, storage conditions, the characteristics of the product itself. You must have the right infrastructure to make, deliver and regulate vaccines. And you need to have all the supplies needed to make them. We can not have sole sources, because then countries block exports, as we saw with US-made reagents or India-made vaccines.

Why have mRNA vaccines like those manufactured by Pfizer and Moderna not been the solution globally?

We could not make them on a large enough scale. There were not enough production facilities to do this – it was impossible. So even though they did a great job of scaling to the amount they did, it was not enough. We could not distribute them equally. And of course, some countries benefited more than others because there is purchasing power. If you can buy them, stock up on supplies.

Is there a better option?

Protein-based vaccines are well-suited to become a global health vaccine. You have a diversified group of manufacturers who already have all the know-how as well as the previous track record to make them so they do not have to start from scratch. And they are easier to make on a large scale, so you have economies of scale.

But I think the most important thing is social. It really depends on the acceptance of these products. A vaccine should build trust in the user. People are scared – not only because they are in the middle of a pandemic, but they are also scared of all these tools that are new. Some people are obviously early adopters, but there are also many of us who prefer to wait a bit and see what happens before we put ourselves in danger.

At some level, people are always more confident when they know it is a vaccine similar to one they have used for many years. Therefore, a vaccine like the one we have developed can help. People are more familiar with it because protein-based vaccines are a technology they have used before. We get a lot of emails from people asking, “When is your Corbevax vaccine coming to the United States? It’s the vaccine I’ve been waiting for because I’ve used this kind of vaccine before.” And this is not just happening here, but it is happening all over the world.

And how to establish clinical safety and efficacy is important. We want to see more inclusion of different population groups. I think we have that problem now with Covid: Many studies evaluating the vaccines have not been done in the populations where these vaccines are ultimately to be used. We need more studies in countries like Honduras, Ethiopia and Thailand.

Even for well-known vaccine technologies, developing a vaccine against a new disease requires a lot of work. You have argued that this should be done worldwide, locally or regionally, instead of relying on a few nations. Does it not lead to unnecessary effort?

One would think that this is superfluous, but Covid clearly showed us that producers and supply chains are too consolidated in very few regions. When you need to resolve a situation immediately, block access to having these manufacturers concentrated in very few, mostly high-income areas, and rich countries can raise prices or nationalize vaccines. We are not saying that the wheel must be reinvented everywhere – but strategically regions must be able to be self-sufficient so that there can be more equity.

How does your vaccine – which is being developed by an Indian company, Biological E – help achieve this?

We gave BioE the recipe, but in the end they had to develop the vaccine themselves. They had to figure out how to make it industrial. They were supposed to be innovators and now they can teach others to do it so they can all make their own. It’s very different because it does not come from the traditional multinational model with: “I hand it over and you have to do what I tell you.” You encourage and enable native production and creativity.

How would you respond to concerns that some countries may lack the technical expertise to produce high-quality vaccines or the regulatory rigor to evaluate them?

I completely disagree that these producers, especially producers in middle-income countries, are in a smaller category compared to a multinational company. They already produce many vaccines. They have already undergone clinical evaluations by many regulatory agencies. There are quality regulatory agencies in places like Indonesia and India that have been working for years in accordance with international standards. They have already proven themselves.

BioE works for approval from the World Health Organization. They work with the Australian Regulatory Agency because it is one of the strict regulatory bodies that can give an extra stamp of quality on top of what Indian regulators can provide. I think it is wrong to say that just because the vaccines are manufactured in India, they have a different standard than if they were manufactured in the United States or Europe.

Why are Covid vaccines using the older, more well-known technologies only now becoming available? What made them develop so much slower?

It’s not slowness. We had one [protein-based vaccine] technology ready three months into the pandemic. And we handed it in to Biological E in May 2020.

BioE struggled to develop it. They did it as fast as they could – it’s just that they certainly did not receive the financial support, and they did not receive the state support, the political will. Governments said we do not need you – we have to deal with our new technologies so we will not give you the funding. Now they realize that they made a mistake. Now they say, “We want you.”

You have made your vaccine technology available to everyone, patent-free. Should all manufacturers do that?

There are some technologies, like the RNA technologies, which are newer, where there is a logic why they might want to protect it, because they obviously developed it into many other therapeutic agents. They may be more careful to say let’s open it.

We could have patented, but we decided not to. We did not want barriers. We basically said, “Look, you want to try our strategy, you can do it yourself, because it’s all published. But if you want help, we’ll be very interested in doing joint development with you.”

Covid-19 will not be the last pandemic. Are there lessons we need to learn next time?

I think we need to empower countries, especially in the low-middle-income regions – not just with the technology itself, but with regulation, how they create public health systems. We need to empower them to be more self-sufficient, where they can build a solid workforce and avoid brain drain, but then give them the responsibility that they can create their own infrastructure to build it regionally or locally. Not all countries need to be self-sufficient in absolutely everything, but they should complement each other. Our vision is that everyone works together, in the good times and the bad times. But it must come with political will.

Why should people in richer countries worry about global vaccine equity? There is, of course, a humanitarian argument – but is there also a practical reason to invest dollars or doses to vaccinate people elsewhere?

We are a great community. Even diseases that primarily affect another place will ultimately affect us. We see that in Covid. It is clear that the variants arose from the lack of us, which ensures that other regions have equal access to very important tools such as vaccines, medicines and diagnostics. To help others is really to help ourselves.

This article was originally published in Knowable Magazine on April 18, 2022. Knowable Magazine is an independent journalistic effort by Annual Reviews, a nonprofit publisher dedicated to synthesizing and integrating knowledge for the advancement of science and for the benefit of society. Sign up for Knowable Magazine’s newsletter.

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