Combating coronavirus: Covid-19 vaccine could be here sooner than you think
Right now, there are over 100 approaches known to be underway and many think that there are twice that number.
Dr Seth Berkley is a renowned epidemiologist and CEO of Gavi, the global vaccine alliance. In an interview to Khaleej Times, he says an experimental vaccine for use in emergency situations could be ready in 12-18 months, thanks to improved data-sharing and enhanced collaboration between countries and institutions. Dr Berkley also lauded the UAE's role in making vaccines available to poor communities across the world.
Realistically, how soon can a vaccine for Covid-19 be developed? Human trials take a long time.
Developing vaccines is a time-consuming and intensive process that normally takes 10-15 years. With Ebola, for example, despite having a number of promising vaccine candidates when the 2014 outbreak occurred, it took extraordinary collaboration between many stakeholders to get to an approved vaccine in five years. Given current unprecedented levels of data sharing and global collaboration, with a full-scale push, we could potentially have a Covid-19 vaccine -- at least an investigational one for use in emergency situations -- within 12-18 months. That would be an incredibly short amount of time compared to any previous historical experience, and it would require luck and many factors to go our way.
A race is on to develop the vaccine. Do you think this could delay the process? Labs may have the same objectives but are working in different directions.
Since we cannot predict which efforts and approaches will be successful, it is good to have every scientist in the game and competition is helpful. The more chances to get it right, the better. Right now, there are over 100 approaches known to be underway and many think that there are twice that number. However, we cannot take 200 approaches to expanded clinical trials and accelerated manufacturing. So, we will need to downsize the field using standardised and transparent scientific criteria: a target product profile, animal models and standardised assays. This is when we need to use a big science collaborative approach. Gavi is working closely with its international partners to create optimal conditions for the identification of priority candidate vaccines, with specific focus on potential to scale and equitable access.
Does Gavi support all such vaccine initiatives or are you selective? How is the alliance contributing in the search for a common vaccine?
There are currently over 100 vaccine candidates at various stages of development. The Gavi Alliance has a unique role to play a key role in each phase of the development and delivery of a SARS-CoV-2 vaccine: first, by working with our partners to help identify the best candidates based on effectiveness and scalability. Then, by using our experience and resources to facilitate their later stage development, manufacturing and delivery so that they come onstream -- in the right volumes -- as quickly as possible. This is what we did with the Ebola vaccine, and we will continue to leverage that experience delivering affordable vaccines at scale and to the most vulnerable in order to help address the current pandemic.
Mass rollout of such vaccines would be expensive as every country would want it. How does it work?
It will be important to have an agreement on global access agreed to now, before there are any viable vaccines. We need to make sure that vaccines are available for public health needs, to control any out-of-control epidemics at the time we have an efficacious vaccine. We will also need to prioritise use, with from my perspective to be first healthcare workers who are at risk of infection and can infect others. Then high risk, including the elderly and those with risk factors, and then finally the general population. As this will require strong political commitment, we should start discussions and get agreement now. The cost of vaccines pales into insignificance when compared to the cost to the global economy from a prolonged outbreak. Past experience has taught us that innovative finance mechanisms - such as vaccine bonds and advance market commitments - potentially have a critical role to play in enabling governments and industry to invest in the high costs of vaccine development when funds are needed most. Gavi's innovative financing instruments, such as its International Finance Facility for Immunisation (IFFIm) and Advance Market Commitment, have been used to accelerate vaccine development and access in the past, and are potential tools for the current pandemic.
How do poorer countries procure/afford these vaccines?
Gavi, which procures and distributes vaccines to 60% of the world's children at affordable prices, pools demand from the poorest countries and guarantees long-term, predictable funding - sending a clear signal to manufacturers that there is a large and viable market. It further regularly employs innovative mechanisms (see answer above) to encourage vaccine production and delivery at affordable prices. When pneumococcal vaccines for pneumonia, the largest killer of children, were quite expensive in industrialised countries Gavi pioneered an Advanced Market Commitment to get a vaccine appropriate for developing countries at an affordable price. Today, it has been introduced in more than 60 countries and immunised 180 million children at about 2% of the market costs in the wealthy countries. We can use such experiences to incentivize equitable global distribution of a vaccine for Covid-19 as well.
Does the UAE support your initiative for more accessible vaccines?
The UAE was the first Gavi donor from the Middle East and North Africa region, and is a strong supporter of Gavi's work across a wide range of areas, including polio and innovation for vaccine delivery. For example, in 2017 the UAE contributed US$ 5 million to Gavi's Innovation for Uptake, Scale and Equity in Immunisation (INFUSE) programme, which incubates tried and tested innovations that have potential to improve vaccine delivery and help reach the most remote and vulnerable communities.
Furthermore, the UAE hosted Gavi's mid-term review in Abu Dhabi in December 2018. This event gave Gavi an important opportunity to reflect on our results in the past years and shape the future of Gavi's innovative model as forces such as climate change and urbanization combine to increase the risk of infectious disease outbreaks - a reality the world is currently confronting. This was vital in shaping our next five-year strategy, which aims to protect a new generation of 300 million children, saving a further eight million lives.
What impact is Covid-19 having on countries where Gavi is active?
We've seen the postponement of Gavi-supported vaccination campaigns against polio, measles, cholera, HPV, yellow fever and meningitis as well as national vaccine introductions - threatening further disease outbreaks. A Gavi analysis of Imperial College modelling suggests that without any mitigation strategies, Covid-19 could lead to 12.9 million deaths in the 73 Gavi-supported countries, compared with 0.9 million deaths if suppression measures are taken. The latter will be a huge challenge to implement in impoverished communities which cannot afford long periods at home.
What must the international community do, apart from finding a vaccine, to defeat Covid-19 once and for all?
What we have seen in recent days is the immense pressure countries are under to secure scarce supplies and the pressure this is placing on our ability at the international level to foster collaboration and partnership. We see this with testing today: we have the time to ensure it doesn't happen in the future when vaccines do become available. That is why we must act now to get a global agreement based on public health principles, i.e. that vaccines are delivered to whoever needs them most irrespective of wealth.
Furthermore, we need urgent action to support and strengthen health systems to fight Covid-19 and minimize the risk of having to fight two or more epidemics at the same time. This means doing whatever is necessary to avoid a situation like the recent Ebola outbreak in DRC, where many times more people died of measles than Ebola itself, something that had huge social and economic as well as human costs.
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