JACOB EAPEN
Dr Jacob Eapen is a medical director at the Alameda Health System and a member of the board of directors at the Washington Hospital in Fremont, California. The views expressed are his own.
The last time a generation waited on their knees was when the Israelites were making their 40-year exodus to the promised land through the deserts. God blessed them with manna from heaven. Now the world is anxiously waiting for an effective vaccine for Covid-19 and it is like waiting for 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 but they 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 whereas per records provided now 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 like 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 interventions in the modern era, saving three million lives a year. The world has seen similar situations, especially during the paralytic polio epidemic in the 1950s 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 most of the illnesses.
The Covid-19 vaccine discovery has now become a competition between nations, and all want to be like the Sputnik, when the erstwhile 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 (WHO) 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 is about $500 million.
The fastest vaccine developed so far is for mumps which was developed in four years. There are more than 100 companies around the globe currently developing vaccines.
Vaccines fit into two categories: genetic vaccines, which use virus genes to prove a response (Moderna, BioN Tech), and virus vector vaccines that use another virus’s 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 life-saving agency.
The 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 into the Bio N Tech/ Pfizer partnership. It has invested close $1 billion in 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 the OWS and their vaccine is moving into phase-3 trials next month.
Oxford and AstraZeneca are in phase-3 trials in the UK, US, 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. The OWS hopes to shortlist 14 companies, cutting them further to seven companies from whom they intend to sign a contract with.
Sinovac is a Chinese company that also has clinical trials rapidly progressing. Russia is already boasting about being the first country to have a registered vaccine.
To be effective, a vaccine must be produced with the least side effects and with the 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 percent of people hesitant to be vaccinated.
In the United States, a recent survey showed that one-third of respondents and about 47 percent of Republicans declared that they would not vaccinate against COVID. A vaccine with an efficacy of 60 percent could stop the pandemic provided the whole population gets vaccinated.
With fewer people accepting vaccination the efficacy should be 80 percent 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 outbreaks 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 it? No single company will be able to meet 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 affected 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 the early inoculation effort five centuries ago. Finding a vaccine to protect the world is a challenge but if we have learned from history then there is the reason for hope. I can already smell the manna.
