How to make a faster COVID-19 vaccine

First, life may not return to full normality until an effective vaccine is developed, mass-produced, and distributed worldwide. Other than a careful resumption of the economy for the time being, it will likely result in a significant second wave and a new physical distance. There is no substitute for herd immunity.

Second, despite recent scientific advances and courageous efforts to accelerate the market introduction of vaccines, the 12- to 18-month timeline that public health authorities continue to mention is not It is a desire. Although private and government laboratories are rushing to test vaccine candidates, there is no guarantee that they will be safe, effective, and easily scalable. The world has not made the long-term investments of the kind needed for pandemic vaccines.

Emergency funding, hard work and ingenuity can result in a relatively quick vaccine. However, the resulting amount of uncertainty and increasing death toll, even in the best scenarios, suggests the need for much more ambitious intervention.

Making a vaccine is difficult and, at best, expensive. It usually takes years to get a candidate to market. In addition to scientific difficulties, vaccines need to meet very high safety standards. Unlike most other treatments, vaccines are given in large quantities to otherwise healthy people. Significant side effects can have disastrous consequences and require long and careful testing to avoid harm. Roughly, a single infectious disease vaccine from preclinical to large-scale testing can be obtained for $ 319 million to $ 469 million.

These costs and risks are even higher in a pandemic. This is because there is no time for the usual time-consuming and careful process. For example, while researchers are still looking for which animals to use to test potential vaccines, preclinical trials, dose selection, and human trials have been performed at warp speeds in dozens of laboratories. I am going. This increases the possibility of mistakes that can be overlooked later. To be able to use something in a reasonable timeline, you need to build your manufacturing capacity before it is validated and safe. On the other side of this very costly process is a series of significant market failures. Long vaccine timelines mean that communicable diseases often disappear and there is no demand for products. This is unlikely in this case, but the companies that challenged to develop SARS and Zika vaccines were running out of commitment and funding, and their work was stagnant. In a March Congressional testimony, Texas-based researcher Peter Hotes said he could not find public or private funding to bring promising SARS vaccines to trials after the disease had stopped transmitting. Was. As a result, he was not alone and the world lacks valuable insights into vaccines against similar coronaviruses.

Even if an effective vaccine emerges on time, there is no guarantee that the costs will be recovered, not to mention making money. Infections often occur in developing countries with limited solvency. Covid-19 is a rare exception that has destroyed even richer nations. But that doesn’t guarantee profit. The German parliament has recently expanded its authority to allow the government to suspend patent rights in response to the crisis. The same is allowed under Canadian emergency legislation. If countries don’t like the price of vaccines or don’t have enough, they just make it themselves.

Despite this difficult situation, it is encouraging that there are already 12 or more vaccine candidates under development. That diversity increases the likelihood of at least one success. However, few applicants have successfully developed vaccines and scaled them worldwide. No new pathogens have been targeted within 18 months.

The world needs far more sophisticated efforts to create incentives and keep companies investing in the face of significant risks.

An important step in that direction is to provide a big award, or a better but well-guaranteed purchase order, for Covid-19 vaccines that meet reasonable standards of efficacy and safety. Guaranteed payments help reduce concerns about intellectual property foreclosure and commercial viability. A variety of awards have been proposed and offered, but bigger issues need more incentives.

Center for Global Development recently issued a thoughtful report pointing out that there should also be reward for better and slower options to advance science. This promotes sustainable investment and avoids late-stage failures. The award must also include a value rating. The safer and better the vaccine, the bigger the prize. Ideally, this would be an international effort to increase the size and sustainability of the prize money and reduce the financial burden.

But getting a workable vaccine is only the first step. Manufacturing and distribution will require an additional coordinated open source international approach. Generating significant manufacturing capacity for some candidates, sometimes using novel technology, is a highly costly task, some of which are likely to fail. Choosing the wrong winner or waiting too long can have unacceptable consequences. It is a definition of global projects and public goods.

Leaving production to individual countries or companies can lead to missing goods and unequal sales. It is too easy to imagine that richer nations are vaccinating massively due to the high needs of poor countries and weak health systems. Significant, coordinated investments in both adapting existing manufacturing capabilities and creating new lines solve some of the problems. The CDG report proposes that prizes be made subject to providing low-cost licenses to low-income countries.

These measures need to be implemented sooner rather than later to get the vaccine to market faster. There are also long-term benefits. The collective support of the Covid-19 vaccine is the basis for improving long-term disease readiness. The world needs a financing system that plays a consistent role from discovery to manufacturing and distribution. In the current crisis, groups such as the World Health Organization and the Alliance for Disease Prevention can manage and implement these programs quickly. In the long run, we need to be careful and create a new global agency to fund this issue. A more well-established organization and a permanent prize system should generate enough stable demand for companies to encourage investing in infectious diseases as a business offer, not as a charity.

Such a system also creates a better environment for so-called vaccine platforms. This is a technology that allows the creation of vaccines against multiple pathogens with the same basic formula. New approaches, such as the mRNA vaccine being developed by Moderna Therapeutics Inc., offer the potential for a faster response than was possible in previous epidemics. However, these efforts have not yet been tested, especially in situations where rapid response is required. Enabling a new platform to deliver safe and effective vaccines quickly may require years of ongoing support.

A new vaccine development paradigm will not appear overnight. But the current crisis is an opportunity to start with badly needed corrections.