Evening Standard

Vaccine arms race: How the competition for a Covid jab is heating up

You wait a year for a Covid vaccine, then three come along at once. Well, hopefully. Until last month, pharmaceutical giant AstraZeneca, which is developing a vaccine with University of Oxford, was widely considered as the frontrunner in the global race for a coronavirus vaccine, but recent developments have raised the game.

A fortnight ago, US drugmaker Pfizer and German partner BioNTech announced its vaccine, developed by husband and wife Dr Ugur Sahin and Dr Ozlem Tureci, was 90 per cent effective in preventing symptoms of the disease (it has since upped this to 95 per cent). Days later, a second US company, Moderna, confirmed over 94.5 per cent effectiveness of its vaccine in trials and a third, Russia’s Sputnik V, has also reported positive preliminary data from phase three trials (the final stage before regulatory approval).

Now, the homegrown Oxford-AstraZeneca has been found to be up to 90 per cent effective, with the first Britons set to receive it by the end of the year (the trial leaders say it has shown an “encouraging” response in over-70s - a gamechanger for those groups most at risk). Competition to be the first to succeed with a vaccine is intense, which is good because more than one vaccine will be necessary to meet global demand.

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So far, the news is promising with talk of a vaccine before Christmas, but we are far from the finish line. Finding a successful shot is only half the battle. There are logistical hurdles, from sourcing rare ingredients to how we’ll actually administer the injections. Questions of fairness and security are already upping tensions: who will take the vaccine first? How will we make sure it gets to lower-income nations? Would the UK take a vaccine made by Russia?

From the current state of the competition to how we solve the world’s shortage of glass vials, this is a guide to the most high stakes global competition in a generation.  

The frontrunners

This is a fast moving arms race – worldwide, 12 vaccine candidates are currently in phase three trials. But current scores on the doors show five countries currently in the lead: the US, the UK, China, Russia and India.

Pfizer, Moderna and now Oxford-AstraZeneca are neck-and-neck in their scramble to offer a vaccine by Christmas. The Coalition for Epidemic Preparedness Innovation and Dolly Parton are among donors to have supported Moderna’s breakthrough, while Pfizer’s has been funded by the German government and Oxford by the UK government.

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The UK has secured 40 million doses of Pfizer’s vaccine and five million of Moderna’s, with Pfizer being the more complicated candidate. The German/US collaboration was pitched at a price of £15 a dose over the summer and must be kept at minus 70 degrees Celsius - “a logistical nightmare”, according to pharmacists - while American candidate Moderna is more expensive, at £28 a shot, but can be kept at more accessible temperatures. It lasts for up to 30 days in household fridges, at room temperature for 12 hours, and remains stable at minus 20 degrees Celsius - equal to most household freezers - for up to six months. 

As of yesterday, the University of Oxford-Astrazeneca candidate, AZD-1222, has now joined the leading trio, despite being halted last month after the death of a trial volunteer in Brazil. Details around the death are being kept confidential but it is understood the volunteer did not receive the vaccine and an independent review revealed no safety concerns. 

Clinical testing is currently underway in India, South Africa and parts of the USA and leaders announced this morning its vaccine was found to be up to 90 per cent effective in preventing people falling seriously ill with coronavirus. It also appears to prevent infected people without symptoms from transmitting it to others. “It means we have a vaccine for the world. I think this is an incredibly exciting moment for human health," says trial leader Professor Andrew Pollard.

The runners up

There are nine other vaccines that have also reached the final phase of trials – many are still potentially in the running to be ready by Christmas.  

Among them are Canada-based Medicago, which uses a species of tobacco to make its vaccines, and two from the US: Maryland-based Novavax, which has been awarded $1.6bn of funding by the US government, and American drug giant Johnson & Johnson, a late entrant to the race and one of the four drugmakers backed by Trump’s Operation Warp Speed programme (it has been given $456 million of US state funds). Its team successfully developed a vaccine for Ebola and say they’re currently on track to deliver results of its Covid vaccine candidate before the end of the year.

China has also quickly emerged as a vaccine powerhouse. Of the 12 global candidates to have reached phase three, four are from China, with at least two approved for early use and the most promising, Wuhan-based Sinopharm, already being given to frontline workers in the UAE.

India, long known as the “pharmacy of the world”, is also at the heart of global vaccine efforts - not just as a production hub, but development, too. Alongside being the producer of 60 per cent of the world’s vaccines and confirming more than 1.5 billion Covid dose purchases (more than the EU or US), its Bharat BioTech’s Covaxin has also reached the critical phase three trial.  

Russian roulette

Two days after the Pfizer news, developers of the Russian vaccine Sputnik V announced that their candidate had a 92 per cent efficacy rate. The development could be promising if true - the Sputnik vaccine only needs to be stored at minus 18 degrees compared to Pfizer’s minus 70, making it easier to distribute - but there is growing scepticism.  

AP

Russia was heavily criticised for giving Sputnik V regulatory approval in August, despite failing to complete advanced testing, and the trial that deemed the vaccine to be 92 effective was based on a much lower number of infections (20 compared to Pfizer’s 94). “How can we draw conclusions about 92 per cent efficacy, based on [analysis of just 20 cases]?” Svetlana Zavidova, executive director at Russia’s association of clinical trials organisations, asked in response. “Maybe they looked at Pfizer’s results and just added 2 per cent.”  

Putin is keen to dispel rumours about dangers. When he announced the Sputnik registration in August, his first words were about trying the vaccine on his daughter and he has already made deals with Brazil and India to put it into production.

Power struggle

That same summit saw the BRICS nations vow that they would “work to ensure” that when a vaccine becomes available, “it is disseminated in a fair, equitable and affordable basis.” But there are fears countries will use the vaccine to lever geopolitical power, as nuclear weapons and oil are now.  

Suerie Moon, co-director of the Global Health Centre at the Graduate of Institute of Geneva, calls the unfair advantage that countries with more resources will have to get the vaccine the “rule of the jungle”. She has warned that low-income countries will suffer and recommended a set of arrangements to ensure priority access for health workers, people with underlying medical conditions and older people.

One positive step is that most countries have signed up to COVAX, the WHO-led Covid-19 vaccine alliance that aims to provide two billion doses of vaccines to high-risk populations by the end of 2021. Moon has called the alliance a “ray of sunshine” but warns that while it might be well-intentioned, she doesn’t expect more than 10-15 per cent of the population in developing countries to access a vaccine through the alliance. As a result, countries will need to work together independently of COVAX, says WHO director-general Tedros Adhanom Ghebreyesus. “Solutions must be shared as global public goods on the basis of equitable and affordable access for all.”  

The logistics 

While drugmakers compete to develop the vaccine itself, a second race is running alongside. How will we actually administer these shots once we (hopefully) have them? The logistics are complex and according to the Royal Society, the “most important bottleneck” is giving the injections. Professor Nilay Shah, head of chemical engineering at Imperial College London, estimates that even if 500,000 shots are given a day, it could take up to a year to vaccinate the UK’s more than 50 million adults. To put it in context, pharmacists administered just 1.7 million flu jabs across England over the whole of last winter.  

Getty Images/Cultura RF

Then there is the question of supply. South American tree bark and an oil found in shark liver are among some of the more obscure raw ingredients for potential vaccines and there are concerns over supply chains being disrupted by the pandemic.  

Concerns have been raised over a global shortage of glass vials, the bottles used to hold the vaccine before it is injected. Analysts have warned of a shortage of the sand containing the type of ‘angular’ grain required for making Pyrex and immunologists have estimated there are only 200 million vials left in the world. Possible solutions include storing more than one dose inside each vial.  

Supply issues affect transport. Experts estimate it would take 8,000 jumbo jets to carry enough vaccines for the world’s almost five million adults to have a single dose - the “mission of the century,” according to the International Air Transport Association.

Cool runnings

Another hurdle is temperature. To be effective, Pfizer’s vaccine must be stored at minus 70 degrees Celsius, meaning dry ice is needed to transport it, for which there is limited infrastructure in place. Medical freezer suppliers are currently scrambling to meet demand and Pfizer has already designed a GPS-tracked “suitcase” containing dry ice to store up to 5,000 doses for 10 days.

Even so, administering shots at this temperature would be an unprecedented task. According to leaked Pfizer documents, the suitcases containing the doses can only be opened for a minute at a time and not more than twice a day. Currently, “nowhere on the planet does the logistical capacity exist to distribute vaccines at this temperature and volume without massive investment”, warns Toby Peters, a professor of cold economy at Birmingham University.  

AFP via Getty Images

But would you take it?

Of course, posing the vaccine challenge as a race has its dangers. Many are nervous of taking a shot developed over months rather than years (vaccines typically take 10-15 years before approval) and some are concerned that the rushed rhetoric around names such as Trump’s Operation Warp Speed is further damaging public confidence. Latest polls suggest 76 per cent of the British public would take a vaccine - down from 78 per cent in June, but still higher than the 66 per cent rate among Americans. 

To boost general confidence in a vaccine, experts have been addressing safety concerns on sites like Twitter and TikTok while government advisor Professor Heidi Larson has suggested calling on the Queen to dispel misinformation and persuade Brits to get the jab. The race for a vaccine is barely past the starting gun.  

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