Research design

The future of vaccine research and learning lessons from COVID-19

Dr Owen Seddon, consultant in infectious diseases and medical microbiology at the University Hospital of Wales, explains how successes in developing the coronavirus vaccine should be used in the fight against other vaccine-preventable diseases .

The global effort to produce a vaccine for COVID-19 has been rightly hailed as one of the greatest scientific achievements of the past century.

The speed at which the process moved from the production of the first viral genetic sequence to the global deployment of effective vaccines was all the more impressive when one remembers that the fastest any vaccine had been developed before was d about four years, for mumps in the 1960s, and most vaccine production times were a decade or more.1

A number of factors – including a wealth of funding, regulatory flexibility and scientific expertise – were on our side, not surprisingly given that the problem at hand was the worst global health crisis in a generation.

While we should rightly applaud this endeavour, it is important that this moment is seen not just as a one-time achievement, but as a real breakthrough in future vaccine R&D.

Through a combination of the lessons that have been learned and a new global focus on the threat of infectious disease, the international scientific community now has the opportunity to promote a new appreciation of vaccination as a powerful weapon in the arsenal of public health.

An opportunity seized, after many failures

Compare the COVID-19 pandemic with the 2014/15 Ebola outbreak in West Africa. Ebola vaccination research had been underway for over a decade before the outbreak, but an effective vaccine could not be deployed for over a year and 11,000 lives were lost.2

ebola virus (long thin filament) in red on dark blue background

This prompted the creation of the Coalition for Epidemic Preparedness Innovations (CEPI) in Davos in 2017 to attempt a coordinated, international and intergovernmental plan to develop and deploy new vaccines.

CEPI was an example of the heightened profile that vaccine science had begun to enjoy even before COVID, with key achievements in unlocking the potential of messenger RNA (mRNA) vaccines, for example, having taken place in the years before COVID-19. pandemic3 and Middle East respiratory syndrome coronavirus (MERS-CoV) research giving scientists a ‘head start’ in the fight against a new coronavirus like severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 the cause of COVID-19).

Looking to the future, vaccine development must be directed against the triple threat of infectious diseases of the coming years. These include infectious diseases with epidemic or pandemic potential, including influenza and coronaviruses, infectious diseases with severe consequences and high mortality, including viral hemorrhagic fevers, and perhaps most importantly the threat of antimicrobial resistance (RAM), which is expected to result in 10 million deaths by 2050.4

The World Health Organization (WHO) action plan highlights the importance of vaccination as a key action in the fight against AMR, through its ability to target both infectious diseases requiring antimicrobials and infections respiratory viruses, which are often inappropriately treated with antibiotics – and which can also give rise to secondary infections that require antibiotic treatment.4

Obstacles removed

Prior to COVID-19, vaccine development faced a major hurdle related to funding from the pharmaceutical industry. Long and arduous development with high chances of failure and limited perceived profitability has led to the reluctance of the private sector to fund research into vaccine candidates.

But during COVID-19, we have seen huge public sector and philanthropic investment in vaccine research, reducing the financial risk for pharmaceutical companies and enabling their involvement.

It is a misconception that it was only the removal of regulatory barriers that allowed the development of COVID-19 vaccines to occur at such a pace.”

From another perspective, the pharmaceutical industry has been able to provide the public sector with expertise in conducting efficacy trials and scaling up manufacturing, and the involvement of multiple agencies has helped develop several candidate vaccines in parallel, thus increasing the chances of success.

It may be unrealistic to think that this scale of development can be replicated in the face of what are perceived as ‘lesser threats’, but here we have a responsibility as a scientific community to exert pressure on governments and industry to recognize that less dramatic dangers than COVID-19 still deserve attention and that prevention efforts against diseases already listed are of clear economic interest.

It has been widely publicized that emergency regulatory mechanisms have been used to considerable effect to expedite the process of COVID-19 vaccine development,5 without compromising the scrutiny candidate vaccines have faced during their regulatory review. These processes were based on emergency use and, like the financial aspects discussed above, can therefore be considered inappropriate in less extreme circumstances.

However, a return to pre-COVID mechanisms is also not appropriate. Vaccine research should be prioritized for review by ethics committees, regulators and reviewers to ensure the process is as streamlined as possible outside of emergency conditions.

Vaccines are not synonymous with vaccination

It is also important that the congratulatory atmosphere around the deployment of the vaccine does not overshadow the problems encountered. Producing a vaccine means nothing if it does not result in the successful vaccination of an individual.

global immunization programs or global vaccine development concept - hand holding syringe in front of globe

While the previous record for vaccine development was four years, the previous record for reaching 40% vaccine coverage was 14 years.6 The roll-out of vaccines in the lowest income countries has been appallingly slow and at a time when 60% were fully immunized in OECD (Organisation for Economic Co-operation and Development) countries, only 6.4% of the population from sub-Saharan Africa had been fully vaccinated.7

Thus, future immunization efforts must focus not only on development, but also on the logistics of vaccine deployment, as well as vaccine equity, regardless of socioeconomic status. Infectious diseases do not respect borders and the burden is therefore disproportionately distributed.

Along with the moral duty to ensure access to vaccines for the poorest, there is an economic incentive to prevent the poorest nations from being left behind. It is also beneficial for all to stop the development of RAM, which exploits the main drivers found in low- and middle-income countries (LMICs) to develop, but can then become a threat to all nations, regardless their country of origin.

Finally, vaccine hesitancy needs to be addressed. Accelerating development timelines has been accompanied by strong public health messages about vaccine safety, but that hasn’t stopped misinformation and vaccine hesitancy from spreading among the population. Ongoing public health information campaigns, education, and engagement with hard-to-reach communities are paramount to turning an effective vaccine into an effective vaccination.

Conclusion

It is a misconception that only the removal of regulatory barriers has allowed COVID-19 vaccine development to occur at such a pace, and the use of emergency regulatory powers may not be appropriate for less extreme threats. , but nonetheless important. .

Finding the balance between public and private funding, working on multiple targets in parallel, as well as accelerating key steps in the approval process are all critical lessons to consider in future vaccine research. Learning lessons from vaccine administration and resisting vaccine nationalism is also essential to ensure that an effective vaccine turns into an effective vaccination.

These lessons must be learned because the threats of infectious diseases and antimicrobial resistance have never been more prominent in public discourse and represent a huge opportunity to advance the cause of vaccine-preventable diseases.

About the Author

Dr Owen Seddon is Head of the Masters Program in Infectious Diseases at Learna, a postgraduate training provider, as well as a consultant in infectious diseases and medical microbiology for Public Health Wales, based at the University Hospital of Wales, Cardiff .

Having been trained in Wales and New Zealand, Dr Seddon contributes to a busy clinical infection service covering the region, runs the OPAT (outpatient parenteral antibiotic therapy) service for Cardiff and the Vale, and has been instrumental in the COVID-19 response both clinically and strategically.

References

  1. Plotkin S. History of vaccine development. New York: Springers; 2011.
  2. Henao-Restrepo A, Camacho A, Longini I, et al. Efficacy and efficacy of an rVSV vector vaccine in the prevention of Ebola virus disease: final results of Guinea ring vaccination, an open-label, cluster-randomised trial (Ebola That’s enough!). The Lancet. 2017;389(10068):505-518.
  3. Pardi N, Hogan M, Porter F, Weissman D. mRNA vaccines—a new era in vaccinology. Nature examines drug discovery. 2018;17(4):261-279.
  4. World Health Organization. Global Action Plan on Antimicrobial Resistance. 2015. Available at: https://apps.who.int/iris/handle/10665/193736
  5. Singh J, Upshur R. Granting emergency use designation to COVID-19 vaccine candidates: implications for COVID-19 vaccine trials. The Lancet Infectious Diseases. 2021;21(4):e103-e109.
  6. Abou Nader, Sauer M, Steele A, et al. Global Rotavirus Vaccine Introductions and Coverage: 2006 – 2016. Human vaccines and immunotherapies. 2018;14(9):2281-2296.
  7. Glassman A, Kenny C, Yang G. Development and deployment of the Covid-19 vaccine in historical perspective. Center for Global Development. Feb. 2022 Feb.