It is no news that we are all looking forward to the COVID-19 vaccine. But to believe that finding one – or several – vaccines will be the panacea and immediately end the pandemic is a mistake. Three fundamental questions explain why the vaccine does not provide an immediate solution. The first and most obvious, the date: when will the vaccine be ready? The second question is the access: how will the community have access to the vaccine? The third question, just as important, is the cost: once ready, what will the price be? In this article, we share the positions and visions of three leading organizations worldwide for the COVID-19 vaccine.
In a webinar organized by the Inter-American Development Bank, the President of the organization, Luis Alberto Moreno, spoke with Dr. Melanie Sabille from CEPI Vaccines (Coalition for Epidemic Preparedness Innovations), who is currently supporting the development of nine vaccines, four of which are in the clinical phase. Also participating was Dr. David Robinson from the Bill and Melinda Gates Foundation, which has raised $8 billion funding for the COVID vaccine so far. Marco Krieger, from Brazil’s Oswaldo Cruz Foundation, provided insight for the LATAM region. Here, we present the main conclusions.
When will the COVID-19 vaccine be ready?
Between 12 and 18 months is the possible horizon that specialists calculate to have a first version of the vaccine. In general, vaccines take years, even decades, to develop. In the case of some diseases like Ebola, it has not yet been possible to find an effective dose, despite decades of research and the high level of funding allocated.
In the case of COVID-19, experts agree that the speed at which the numerous actors are working is unprecedented. Developers are combining new technologies that allow faster advances, with traditional techniques that would enable vaccine production to be scalable, but with slower results. The speed advantage of the new platforms is surprising: Moderna, an mRNA vaccine company, took only 10 weeks from the virus sequence release to testing the vaccine in a human. Typically, this process takes between 3 and 4 years.
The problem with these new platforms is production at scale. For example, mRNA, does not yet have a license for mass production. Furthermore, because this formula has not yet been tested in a wide population, we do not know whether the same antigen response and, consequently, generate the same immunity. Dr. Sabille says that it is very likely that the older technologies will end up “catching up” with the new ones, since the new ones will stagnate in the production process, creating a bottleneck. Both Dr. Krieger and Dr. Robinson agree on the need to use existing facilities (which use traditional technologies), since building new ones can take up to four years.
How to do it? A balance of speed and quality.
Even if processes are accelerated, and financial risks are taken, health risks should be avoided. It’s true that the world needs a vaccine as soon as possible, but the tests that determine its effectiveness and safety cannot be rushed, summarized, or replaced by shorter procedures.
And when will it be available to the public?
Suppose that an effective and safe vaccine is developed, the second question is to ensure access for the entire population, starting with the most exposed groups.
The experts consulted agree that the best approach, and the only way to fight a pandemic, is a global distribution and allocation system. Also, it is the only way to ensure the necessary financing, the high-risk investment, and the offer of a vaccine at a fair price.
How much will the vaccine cost?
One of the most critical issues is high-risk financing. On the one hand, we must consider the development and approval costs of a drug. On the other, the prices of producing a drug on a large scale.
According to Dr. Sabille, to save time, several activities must occur in parallel. This implies that investors must risk financing an early stage of development, before clinical trials in humans, with the possibility that many formulas will fail. Furthermore, investors must have some assurance that the vaccine will be purchased once developed, so the cost cannot be excessive. Although it is impossible today to calculate it, Dr. Robinson cautions that because companies have not had enough time to optimize processes, the cost can initially be higher.
How much financing are we talking about? CEPI estimates that the research and development of three vaccines capable of being licensed and scalable require US$2 billion. It is desirable to reach an agreement between governments, philanthropic organizations, international organizations, and private companies that makes their contribution to accelerating the process. As popular wisdom says: alone, we go faster, but together we go further.
Research in the region: the case of Brazil.
Brazil is currently researching and developing seven vaccines, although all of them are in the preclinical phase. According to Dr. Krieger, developing countries have good experience in vaccine production. For example, of the vaccines used by the Pan American Health Organization, 70% come from developing countries.
Brazil’s has a robust development structure, in part thanks to the tradition of public-private participation. Besides, past outbreaks of yellow fever and measles have ensured the development of a strong vaccination program that reaches the entire population, facilitating future such campaigns.
It is essential to manage expectations and know that the mere development of a vaccine does not end the pandemic. Simultaneously, the importance of collaboration between governments and organizations to fight the virus is evident. In this sense, investment in vaccine research and development must continue once the COVID-19 pandemic is over. While this may sound obvious, the development of the SARS vaccine and the MERS vaccine virtually came to a halt once the outbreaks were controlled. Also, it is necessary to continue with the existing vaccination campaigns. Vaccination rates have fallen in many countries, and this is concerning. COVID-19 is the challenge that currently keeps us awake, but it is not the only one we face.