We need a bolder approach to next generation vaccines

At the risk of sounding like a newlywed offering my wife a list of pointers for improvement, the once-miraculous Covid vaccines could do even better. It wasn’t long ago that I celebrated the anniversary of being fully vaccinated, but the first surge of immunity started to fade very quickly. I was even kidding with some exciting new variants.

I shouldn’t be joking. The vaccines were already astonishingly effective, as well as as safe as one might hope. But the virus has adapted so quickly that it is in danger of being left behind. Current vaccines have been tuned to induce immunity against early strains of SARS-CoV-2, but recent variants have proven to be adept at vaccine evasion and immunity from previous infections.

Vaccines still significantly reduce the risk of severe symptoms. But it does not eliminate the risk of infection, disease, or lasting side effects. In the UK infection rates may be higher today than they have ever been. The outcome: short-term illness, risk of long-term illness and, unfortunately, hospitalization or death.

We can deal with that, if we have to. But there is clearly a danger of something more sinister going down the right track. The UK has been exposed to three successive waves of Omicron variants, each one appearing within weeks. If one of the future variables turns out to be more dangerous, we won’t have much time to prepare for impact.

So what can be done? The answer: Better vaccines are being developed. The simplest approach, as with influenza, is to try to predict where the virus will be four to six months in advance, and do booster doses accordingly. It seems possible. After expanding to meet demand for vaccines in 2021, the world has “unprecedented production capacity,” says Rasmus Beck Hansen, founder of Airfinity, a health analytics company — enough to produce another 8 billion doses this year.

But even better, if we can figure out how to do that, is to make a vaccine that targets all variants of SARS-CoV-2, or a broader family of coronaviruses including SARS, or even more ambitiously all coronaviruses.

“It’s a riskier, more aggressive approach,” says Prashant Yadav, a vaccine supply chain expert at the Center for Global Development, a Washington-based think tank. There are several such vaccines in development; If one of them succeeds, this is a huge step forward.

Another method that has been highlighted recently is the use of a nasal booster. Akiko Iwasaki, an immunologist at Yale University, leads one of several laboratories working on such an approach, which she calls “the prime and the spike.” The nasal spray promises to produce antibodies in the nose, thus preventing infection before it starts and breaking the chain of transmission. But this vaccine is still at an early stage.

Other delivery mechanisms include patches and pills. It will be much easier to store and distribute the vaccine in tablet form, and many people prefer to swallow a pill of the vaccine. A final consideration, Yadav says, is the development of new ways to manufacture vaccines — for example, growing them in plant or yeast cultures. Having such alternatives available would avoid bottlenecks the next time a vaccine is urgently needed.

This is all very exciting, and Bech Hansen says there are about 400 different vaccines for Covid in various stages of development, along with more than 100 new flu vaccines and more than 250 vaccines for other diseases. There is a lot more urgency than there was before Covid, but less urgency than we need. Given the risk of another dangerous variant (not small) and the social benefit of an effective vaccine against it (huge), governments should invest significantly more to accelerate the next generation of vaccines.

In 2020, government programs such as Operation Warp Speed ​​in the United States were intended to support research, testing, and production of candidate vaccines, as well as to significantly speed up the regulatory approval process. The idea was that governments, not private companies, would accept the risks of failure. This made sense, since it would be society as a whole that would enjoy the most rewards.

Sure, a vaccine manufacturer benefits from a successful vaccine, but those profits dwarf the broader benefits. By accelerating vaccine development and production, “Operation Warp Speed ​​saved hundreds of thousands of lives and trillions of dollars,” says Alex Tabaruk, an economist at George Mason University.

The stakes are lower now but still worryingly high. While there is a lot of interesting science going on in the vaccine pipeline, it won’t be fast enough if we’re not so lucky with the next variant. To move next-generation vaccines beyond promising studies into clinical trials, large-scale production requires money, as well as a greater sense of regulatory urgency. All of these new vaccines can fail or work, but they provide only a modest benefit.

or it may be necessary. Investing more money in the next Covid vaccine is not only likely to have scientific implications for other vaccines, but it is the best way we have to reduce disaster risk. This insurance is worth paying for. Politicians have been keen to declare the epidemic over, but the virus does not care about such statements. We need better vaccines. We must be willing to pay for it.

Written for and first published in the Financial Times on July 15, 2022.

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