How to immunize 7 billion people?

We hope to return to some normality in the global pandemic fog of developing some COVID-19 vaccines. More than 100 kinds Vaccines at different stages of development Probably the most consistent message we hear constantly is the “12-18 months” mantra.

This somewhat abstract time frame has been echoed by politicians and researchers around the world, but what exactly does it mean?

Ah 2013 survey A Dutch researcher investigating the timeline of vaccine development suggests that it takes an average of 10.71 years to move a vaccine from preclinical stage to market registration. It may not be impossible to compress this to 12-18 months, but it’s certainly ambitious.

But perhaps most importantly, these estimates generally refer only to the time frame of clinical development. It is not the end of the process when the vaccine is determined to be successful enough to be delivered to the general public. No, that is just the beginning. Especially when the global pandemic shows the need to vaccinate people all over the world.

What if a team of researchers somewhere in the world banned the vaccine and said, “I have something that works, so let’s get started!”?

How long does it take to vaccinate 7 billion people?

How do you manufacture such a large quantity of vaccines?

And … who got it first?

When is there enough clinical evidence to move forward?

For over 30 years, Professor Kim Mulholland has been researching vaccine development and evaluating ways to introduce new vaccines to the local population. He worked for several years with the World Health Organization in Geneva and spent some time at the London Hygiene and Tropical College after establishing a pneumococcal vaccine trial in Africa. Currently based at the Murdoch Children’s Institute in Melbourne, Australia, he leads numerous ongoing vaccine field studies.

Professor Mulholland says that if one of the vaccines is working and there is a positive sign that it will work after at least 6 months, the first question to ask is to move to mass distribution. Is there enough information in.

“Although more information is always provided, the question is at what point more information is provided, and we are moving on,” he says. “This was traditionally an obstacle to vaccine development.”

Look at the Oxford University COVID-19 One example is the vaccine currently in development, its primary trial cohort is between 20 and 50 years old. In general, vaccine trials will initially demonstrate safety and efficacy and then expand to include broader demographics. But at such an unprecedented time, Professor Malholland hopes for a faster rollout, without the traditional delays from the market approval agencies, which usually require extended demographic data.

“If they decided that the vaccine was safe and effective, [in the initial demographic trialed], And then they will probably go into an early phased rollout that will depend on the amount of vaccine available, “says Mulholland.

At this point, we face two basic questions that cover this entire fictional scenario. Who gets the first wave of vaccines? And how quickly can production ramp up to produce the large quantities of vaccine needed to treat billions of people?

Rich vs poor

Ses Berkeley Vaccine Alliance, Gavi, An organization founded in 2000, will help developing countries access and purchase the same life-saving vaccines available in richer countries. recently New York Times editorial Berkeley has put together a huge hurdle that we would face if we had a relatively effective vaccine.

“It is dangerous to prevent exports of vaccines developed within national borders, as rich countries buy their own supplies and compete in competition to protect citizens and stockpiles in case of future outbreaks. “, Says Berkeley. “Another concern is that manufacturers may limit sales to the winning bidder.”

Both of these concerns were also reflected in Professor Mulholland, suggesting that initial vaccine distribution may depend on which vaccine was successful and where it was developed. Again, focusing on the Oxford vaccine as a hypothesis, the first rollout into the community could be the UK community in this case, depending on the amount of vaccine available at that time. .

Oxford Group paves the way for future manufacturing and distribution Recently participated With world-class pharmaceutical giant AstraZeneca. Collaborative research is aimed at accelerating the global distribution and production of vaccines, of course depending on the ultimate success of the trial.

Professor Mulholland, however, notes that there may be many of the political issues surrounding their distribution if other vaccines present successful trials. For example, the pharmaceutical company Moderna Currently working US National Institutes of Health to accelerate trials on its new RNA-based COVID-19 vaccine. If that particular vaccine turns out to be effective, the US government does not seem to prioritize the first hundreds of millions of vaccinations for its own people.

Pharmaceutical giant Pfizer also threw its hat on the COVID-19 vaccine ring, Cooperation with German company BioNtech Accelerate manufacturing capacity ahead of clinical trial results. Pfizer expects RNA-based BioNtech’s vaccine to be successful later this year, suggesting that 10–20 million doses will be available by the end of 2020.

“However, [efficacy] Since the end of this year, we have a rush to launch manufacturing and plan to administer about 10 to 20 million doses, which is of course expected to be used in an emergency type environment. ” explained Nanette Cocero, Pfizer Global Head of Vaccines.

Again, it’s unclear who gets the first 10-20 million vaccines …

If one works, the other users

There is 100+ vaccines Currently under development, Not all of them are novel. In fact, many vaccines in development are variations on a similar hypothesis. Therefore, when one vaccine proves successful, it drives many other similar vaccines.

For example, the Oxford vaccine uses a method that helps the body develop an immune response to spike proteins that the new coronavirus uses to enter human cells. Mulholland said that many other vaccines targeting the coronavirus spike protein could succeed if the early signs of the accelerated Oxford test later this year began to show the technique to be safe and effective. I believe that This means that the world can ultimately manufacture and administer many different but somewhat similar vaccines worldwide at the same time, rather than relying on a single vaccine.

“If [targeting the spike protein] Professor Mulholland proves that this method is an effective strategy, and the series of vaccines is likely to succeed. “That may be the best result. If I’m going to bet on something, I’ll bet on it. There are multiple successes and they are based on spike proteins.”

Scale up

Thus, a successful vaccine could potentially be produced and delivered millions of times, but how can it scale up to the billions of doses needed to fairly immunize everyone? Is it okay?

Coordination for innovation and preparation for the trend, or CEPIFounded in 2017, we have developed a plan for exactly this scenario. CEPI is not only funding many COVID-19 vaccine trials around the world, but is also working on ways to ensure that the distribution of potential vaccines is spread fairly. Seth Berkley says there are many challenges to overcome to achieve this goal.

“It’s unclear exactly how this will be accomplished, and for dozens of other vaccines in development through other efforts, whether the mechanism will be followed by others who make the vaccine.” Berkeley writes. “We also don’t know how poor countries will pay them. But in the global health crisis, where emergency vaccines are a global public good that keeps us all safe, the answer is mainly public funding. Must be done through. “

A multi-billion dollar manufacturing and distribution strategy must necessarily span multiple facilities in multiple countries. This cannot be done by a single company or nation, but instead requires an unmatched global collaborative effort.

Recently released ACT (Access to COVID-19 toolsThe accelerator program is hoping to become the primary plan for this massive collaboration. This groundbreaking program brings together CEPI, Gavi, WHO, Wellcome Trust, and numerous other private and commercial stakeholders to centrally coordinate the successful global rollout of the vaccine.

“The establishment of the ACT Accelerator is a turning point in the world gathering to develop a global exit strategy from the COVID-19 pandemic.” CEPI CEO Richard Hatchett says. “We need everyone to have access to tools and measures, including vaccines, that we develop through ACT Accelerators. There is hope today. By bringing together the collective strengths, resources and expertise of the institutions that contribute to ACT Accelerators We can end the pandemic together. CEPI is proud to be part of this global collaboration. “

Other entities like Bill and Melinda Gates Foundation Have already spent Hundreds of millions of dollars to build the expected vaccine manufacturing facility. The plan is to establish a vaccine manufacturing facility that is ready to go as soon as a particular candidate leaves the herd.

“We can start by building a facility where these vaccines will be manufactured,” writes Bill Gates. Washington Post. “You need to build equipment for each candidate, knowing that many of the top candidates are made with their own equipment, so some are not used.”

“I hope we can work together.”

After all, there is still great uncertainty as to whether any of these vaccine candidates will work effectively with this new coronavirus, but whether the world can come together to provide vaccines to 7 billion people. There is also uncertainty.

Professor Mulholland is somewhat optimistic and points out that, despite some nationalist divisions of the world today, there is enough goodwill to do this. He suggests that the key to achieving this incredible feat is bringing together many organizations that have been deeply fragmented over the last few decades.

In particular, he points out that the World Health Organization has been underfunded for many years. Other organizations such as CEPI and Gavi have also intervened to fill this void, but as a result there is a lack of a single global inclusive entity to effectively coordinate everything. Professor Mulholland believes that in this unprecedented global pandemic, WHO and other core institutions are more needed than ever to be well-funded.

“This is an opportunity to change the situation. We hope our actions are internationally tied …”