Vaccines have been a routine part of preventive healthcare throughout modern history, so much so that up until about two years ago, many people in the developed world took them for granted. Babies were vaccinated against diseases like diphtheria, tetanus and whooping cough. School-age kids got jabs to guard against measles, mumps and chickenpox. Travelers got shots to prevent yellow fever or typhoid before venturing far afield.
But in the wake of a pandemic that’s upended life as we know it, vaccines have taken on a new role – a leading one – in the larger conversation about public health. Words and phrases like “spike protein”, “mRNA”, “viral vector” and “herd immunity” have become part of the global vernacular. And that’s vital, because increased vaccine awareness and action are critical to overcoming the current pandemic.
This understanding is translating into action. As of early October 2021, approximately 67% of the UK and 57% of the US was fully vaccinated against Covid-19. But there is more work to be done: while 6.4bn doses have been distributed globally as of early October 2021, in some countries, less than 0.1% of the population has been fully vaccinated. More help is needed, and quickly, to help mitigate what the World Health Organization (WHO) calls a “two-track pandemic”, in which high-income countries are achieving higher levels of immunity via vaccination, while lower-income nations are left behind.
With this significant need, it’s not just one vaccine, company or country that will end the global pandemic. It will require the vaccines that are approved – as well as those currently going through regulatory processes – to accomplish the ambitious task at hand, in addition to ongoing safety and mitigation measures.
“The progress in vaccine development so far has been extraordinary, but we are in a complex phase of the pandemic,” says Dr Nicholas Jackson, head of programs and innovative technology at the Coalition for Epidemic Preparedness Innovations (Cepi). “Vaccines are now saving lives around the world, but the scarcity of existing vaccine supply is exacerbating global inequities. More approved vaccines are urgently needed to help protect the most vulnerable, wherever they are in the world.”
A collaborative effort to combat a global crisis
In the face of threats like new variants of SARS-CoV-2, the virus that causes Covid-19, it’s critical that global organizations – including public corporations, private companies and non-governmental organizations (NGOs) – work together.
Since the early stages of the pandemic, biotechnology and pharmaceutical companies around the globe have been developing new technologies in collaboration with public sector entities. Organizations including Cepi, Gavi, the Vaccine Alliance and the WHO, who co-lead Covax, support research, development, manufacturing and equitable distribution of Covid-19 vaccines.
“It’s always been Cepi’s goal to build a large and diverse portfolio of Covid-19 vaccine candidates to maximize chances of success,” says Jackson.
To date, Covax has delivered over 300m shots in arms, with more on the way. Novavax, a biotechnology company developing what is expected to be the first protein subunit Covid-19 vaccine available to the European Union, has committed, with its partner Serum Institute of India, 1.1bn doses to Covax.
“We know that no one is safe until everyone is safe,” says Stanley C Erck, president and chief executive officer of Novavax. “If we have learned anything over the last year and a half, it’s that ensuring that there are as many weapons as possible in the arsenal against future infectious diseases is critical to ending pandemics.”
How vaccines could help prevent the next pandemic
Here’s the simple truth: vaccines work. A study published earlier this year examining vaccination efforts against 10 different pathogens found that vaccines saved more than 36 million lives globally between 2000 and 2019. And this number is projected to nearly double by 2030. Furthermore, vaccines have largely eradicated diseases like measles, a disease that primarily impacts young children.
Robust vaccination programs offer economic benefits as well. One recent analysis of 10 vaccines among 94 low- and middle-income countries resulted in a $586bn reduction in illness-associated expenses, as well as $1.53tn saved in the context of broader economic benefits.
Beyond the current crisis, there are long-term opportunities for vaccines that have risen in prominence during the pandemic. Vaccine research and development (R&D) has accelerated significantly since the onset of the pandemic, along with a higher awareness of the threat that infectious viruses present.
While there have been new developments over the past 18 months, including widespread use of messenger RNA (mRNA) vaccines, some vaccine makers are innovating more traditional technology to combat the pandemic. Protein subunit vaccines take a distinct approach that differs from the mRNA and DNA Covid-19 vaccines. This technology stimulates the immune system by presenting it with a part of the virus that is incapable of causing disease to encourage the body to develop an immune response. In recent clinical trials, protein subunit vaccines have demonstrated high levels of efficacy in protecting against Covid-19. They are also typically more stable under normal refrigerated temperatures, making them easier to distribute among hard-to-reach communities around the globe.
Advances in adjuvants – substances added to vaccines to enhance the body’s immune response – are another differentiating factor that may improve the efficacy of future vaccines. Adjuvants help generate a robust immune response, typically allowing the use of less protein to generate the same level of protection, potentially. This ultimately increases the number of doses that can be made – something that is particularly critical when the entire world needs vaccines to fight the same virus at the same time.
Beyond the monumental effort to combat Covid-19, the scientific community is also working to determine how pandemic learnings can be applied to other infectious diseases. For example, some companies, including Novavax, are currently developing combination Covid-19 and influenza vaccines, which could potentially decrease the number of times one needs to head to the general practitioner or local pharmacy for a jab.
Ongoing R&D is also under way to combat other devastating diseases such as malaria, which the WHO estimates killed approximately 409,000 people – including around 274,000 children – in 2019. The ability to tailor vaccines to key components of pathogens that enhance functional immunity may help lead to better protection against infection for a wide range of illnesses around the world. For example, recombinant nanoparticle technology may play a role in combatting diseases like malaria and Middle East Respiratory Syndrome (Mers).
Organizations like Cepi are already preparing for future threats, with plans that involve producing a library of prototype vaccines, working to compress vaccine development timelines and supporting low- and middle-income countries via infrastructure initiatives, manufacturing facilities and epidemiological expertise.
“Covid-19 has demonstrated that pandemics represent an existential threat to our way of life, and vaccines can be our most effective exit strategy,” says Dr Jackson. He notes that the 1918 influenza pandemic killed as many as 50 million people at a time when the population was less than a quarter of today’s.
He warns: “We need to seize this window of opportunity when pandemic preparedness is at the top of the political agenda.”