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Thursday, December 3, 2020

The West might invent Covid vaccine, but it may well hand the baton to India for the last mile

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It has been a year since the first case of the coronavirus was discovered in China. The dark humour of the Internet reminded us of this as ‘Happy birthday, Covid’ messages flew around social media a couple of days ago.

The one-year-old virus has infected nearly sixty million people and killed nearly 1.4 million worldwide. But its deadly effect has also spurred the worldwide search for a vaccine at unprecedented speeds. We’re almost there.

The two worst-affected countries, the USA and India, will likely play a crucial role in healing the world when the vaccine arrives. While a widely accepted vaccine may well be invented in the West, India’s part in delivering it to the world will be the key.

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The New York Times reports that there are as many as 54 vaccines in clinical trials around the world. At the head of the pack are the vaccines under development at Moderna, a small Boston-based company, in collaboration with the National Institutes of Health. The US government-funded Moderna’s efforts, and last week, it reported that its vaccine was 95 per cent effective.

Days earlier, the New York-based pharma company Pfizer, in collaboration with Germany’s BioNTech had just announced that their vaccine was over 90 per cent effective.

The findings came after initial Phase 3 trials — the phase which determines whether a vaccine is effective or not. To be approved by the US FDA, the makers need to demonstrate that the vaccine has been tested on a large sample of people (in the thousands); that it is safe; and that it effectively prevents the disease in at least 50 per cent of those tested.

By those measures, both Moderna and Pfizer have come through, and full-scale approval is just a matter of weeks by most estimates.

These two companies are developing messenger RNA (mRNA)-based vaccines. These are armed with a gene that produces the spike protein that protrudes from the coronavirus. As these genes enter human cells, they begin to multiply and move to the outside of the cells. This triggers our immune system, preventing invasions from the virus which recognises the spike protein as a threat.

While mRNA vaccines are easier to manufacture in large volumes, they are much more difficult to store and deliver. They spoil, much the way milk or food does unless kept in temperatures that are at least -20 degrees Celsius; the Pfizer vaccine needs even more extreme temperatures.

The Indian firm Zydus Cadilla began testing a different type of vaccine. It is DNA-based and could be delivered by a skin patch. Its phase 3 trials are slated to begin in December. The company is among five that are trying to develop a DNA-based vaccine, reports the New Scientist. In this type of vaccine, the spike protein that alerts the immune system is delivered in the form of DNA, rather than mRNA. But the publication notes that “special equipment and training is needed to dose people with DNA vaccines”, which might pose a challenge.

A third line of attack in the fight against Covid has also shown a lot of promise. These are the adenovirus vaccines.

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These vaccines use the shell of a virus with the spike protein inside and deliver a package that activates the immune system.

The Russians claimed that their SputnikV vaccine is 92 per cent effective, but experts remain skeptical. India, has, however, booked a large batch of the Russian vaccine which has already been approved for early use in that country.

The Chinese company CanSino Biologics has developed its adenovirus vaccine, Ad5, which has been approved for limited use in China. Phase 3 trials for this vaccine are being run in countries like Saudi Arabia and Pakistan, among others.

The most promising of the adenovirus vaccines seems to be the one being developed by the British-Swedish company AstraZeneca in collaboration with the University of Oxford. In India, this vaccine is known as Covishield, and it is already in Phase 2/3 trials.

At a factory in Maharashtra, the Serum Institute of India is already manufacturing the vaccine at a speed and scale that few other facilities can match anywhere in the world. As NBC News put it: “Each of the 500 vials hurtling off conveyor belts every minute holds a world of hope: the prospect of protecting someone from Covid-19.”

The adenovirus vaccines are less delicate than those that use mRNA, which is why they can be transported to parts of the world without much infrastructure but needs that are just as real as those in more advanced countries.

Manufacturing the vaccines now — before formal approval comes –ensures that millions of doses are ready to ship immediately. This improves the chances of battling the virus significantly.

Another aspect of the Serum Institute’s effort is equitable distribution. Studies have already found that wealthier nations are attempting to corner the supplies of a vaccine by just paying more to please constituencies at home.

“Vaccine nationalism” is just as dangerous (and much less clever) than the virus itself. In a pandemic, protecting just one’s own country is short-sighted. If the virus is around elsewhere, it will find its way back into every country in the world. This is why half the vaccines the Serum Institute produces will be distributed in India, while the other half is shipped to developing countries.

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