With an estimated 15.5 million cases, daily increasing, the world is in search for a vaccine for covid19.
Clinical trials are ongoing in the US, which leads the global count with more than four million cases, and China, where the coronavirus is said to have originated. The UK is also doing extensive research, with experts at Oxford University leading the way.
Caribbean and Latin American countries are being supported by the Pan American Health Organization (PAHO) to ensure they have a fair chance to access treatment and vaccines.
TT is assured of being on the list, PAHO director Dr Carissa Etienne told the Prime Minister earlier this month, the Health Minister revealed when he read letters between the two during a clinical briefing on July 15. Their exchange spoke of “a safe, reliable vaccine” regardless of the economic position of participating countries.
Despite the speed at which vaccines for covid19 are being developed, they will still be safe to take when finally distributed assured professor in veterinary virology at UWI, Christopher Oura.
And when they are developed, every country in the world will initially receive enough for 20 per cent of the population, said PAHO/WHO representative, Dr Erica Wheeler.
Oura said vaccines usually take years, sometimes up to a decade, before being released for public use, mainly because of the various phases of clinical trials. However, because of the rate of spread and the potential for fatalities, the world is desperate for a covid19 vaccine and scientists are trying their best to develop some as soon as possible.
Why a vaccine?
Medical scientists use a small, safe part of a virus, or an inactivated virus and introduce it to the body. This primes the body’s immune response to think that the actual virus is in the system.
“When, at a later stage, we see the virus itself, our body remembers from the vaccine that we’ve already seen it, and it produces a memory response, a very efficient immune response, and gets rid of the virus.”
So while the development of a covid19 vaccine is urgent, Oura said it is not a rushed process.
“Rather than saying it’s being rushed, I think what is happening at the moment is that they are doing many of the stages of clinical trials in parallel. So rather than doing an early stage and then looking at, and assessing the results and then moving on to the next, they are actually overlapping them, which is not a bad thing. It doesn’t mean there’s any more chance the vaccine will not be safe.”
He said the vaccines that are furthest along are already in the later phases of clinical trials, which involves putting people into two groups – those who are vaccinated for covid19 and a control group which consists of people who get a different vaccine for another virus.
“You’re looking to see whether the vaccine is proving to be efficacious. Is it stopping the virus from infecting the people who are vaccinated? Whereas, at the same time, you would expect to see viral infections in the control group that aren’t vaccinated with the covid19 vaccine.”
Phases one, two, and three of clinical trials are being done at the same time, and the rigours of the process, the safety and ethics, are not being compromised in any way.
In phase three trials, thousands of people of different age groups, people with underlying health conditions, pregnant people, and others of various backgrounds should be included.
At the end of the process, he said there will be a safe and effective vaccine.
“I wouldn’t worry at the moment. The same level of rigour is being applied to the vaccine and at the end of the day, if regulators say it is safe and effective we can be sure of that.”
It is doubtful, however, that TT will be able to participate in any clinical trials.
Oura said clinical trials have to occur in places with as much community spread as possible, to see the differences in the two groups, if people become infected and the levels of infection.
With TT having no community spread as yet, it would not be a good candidate for testing.
What to expect?
Around the world there are many vaccines at various stages of development but there have been some positive results from the team at Oxford.
Oura said it has shown good levels of neutralising antibodies, and a good T-cell response, which usually means good protection against a virus or disease. However, everyone has to wait and watch for the results on the vaccine’s safety and effectiveness, which may be available in the next two or three months.
“Most people are thinking that, hopefully we will get some kind of vaccination that might not be a perfectly efficacious vaccine, but it might be partially effective. But at least that would stop severe clinical signs.
“We’re hoping we will get something into the first six months of next year.”
He explained that some vaccines are more effective than others. Some allow some virus replication but limit the spread within the body so it would stop the severe disease “so you get a cold rather than dying of it.”
Some vaccines stop transmission, and others produce sterile immunity, which stops the virus completely so there is no replication.
The aim is for sterile immunity, but no one knows what will be the final result of tests.
Realistically, he said it could take another nine-12 months before a vaccine can be administered in TT. Even with that estimated time frame, everything will depend on the results from the vaccines.
Oura recognised some people are concerned about the safety of a covid19 vaccine and that some would want to “wait and see,” but he discouraged that.
“I wouldn’t wait for a few years. We need to get herd immunity across the world. We need to stop this virus. We need to get back to normality. We need to get tourists back into the Caribbean. We need to get our economies back on track.
“And the only way we will do that is if we get 70-80 per cent of people across the world protected, and that protection will likely be through vaccination.”
Children too should be immunised, as long as test results determine the vaccine is safe for them.
He said most people believe covid19 will be around for many years, and so people will likely have to be vaccinated for years to come. Depending on the length of the immune response, it may become an annual vaccine like the flu, so it will be important for the vaccine to be added to the mandatory list of vaccines for children.
He said while younger people are not affected as severely by covid19, they can still transmit it, especially to older people, who are more susceptible to severe symptoms.
“It’s important that we stop the virus circulating, so in the end we get herd immunity, and that will include the kids being immunised and not transmitting the virus.”
Wheeler told Sunday Newsday there are 140 potential vaccines in the pre-clinical phase and 23 in clinical trial phases. However only three are in phase three, including the one from Oxford.
She said there is a global agreement that 20 per cent of the population of each country in the world will get the first set of vaccines at the same time. Those will cover health and care workers, as they were most at risk by interacting with covid19-positive people, and high-risk people with underlying health factors.
Governments will decide who will make up the 20 per cent and how they will be distributed. PAHO will help Latin America and the Caribbean governments develop plans and logistics for transporting and distributing the vaccine, making sure regulations are in place, and provide technical assistance.
WHO, which will assist the rest of the world, will also help with funding.
For phase two there will be an assessment of who will be the next set of people to get the vaccines, based on the threat to individuals and communities and their vulnerability.
“In tier two the government has a more active role in identifying who they want to vaccinate next. It’s not going to be a matter of PAHO telling the government, but the government will have to have data and information in place to be able to tell us, ‘These are the people who need the next tier.’ Countries with higher risk would receive the dosage they need in this phase faster than others.”
She said PAHO/WHO, through the PAHO Revolving Fund for buying vaccines, are trying to put mechanisms in place now to make sure that as soon as vaccines become available they will be able to negotiate a price countries can afford.
One way is via the Covid19 Vaccine Global Access (Covax) Facility, which is funding the development of nine vaccines. The Covax facility is a partnership between WHO and Gavi, the Vaccine Alliance (formally the Global Alliance for Vaccines and Immunization) to ensure vaccines can be delivered once manufactured. It is funded by money raised to help work on developing diagnostics, treatments, and vaccines. US$2.2 billion has already been invested in the facility.
She said Gavi usually provides assistance to low-income countries to get vaccines at “a reasonable cost.” Ten countries in the region fall in that category, but TT is not among them. Instead, TT, 22 members states and nine territories, are considered self-financing.
“What PAHO is doing is engaging with the IDB and Gavi on the possibility of getting financial assistance to countries who are classified as high- and middle-income countries.”
She said TT had already agreed to be part of the Covax facility which will give countries the opportunity to access vaccines at a reduced cost. The more countries that sign up with Covax, the better the rate at which they could get vaccines, and that would be much better than one country trying to negotiate with a manufacturer. And if Covax develops a vaccine, it will be even less costly.
Manufacturers that are part of the facility and whose products show the most promise are being given money to help them continue developing nine potential vaccines, in the hopes that at least two or three will become viable as vaccines. And if a vaccine is developed they have to be able to produce a large number.
“That’s why we have started to fund them (manufacturers) and work with Gavi from now. Gavi is the global body with the best expertise in working with the vaccine manufacturers, because that’s their everyday business. They work with the manufacturers to produce millions on millions of vaccines. That’s how we have World Immunization Week in every country of the world.”
No one knows what the cost of vaccines will be, but once they know, PAHO can bargain as a bloc to get them below market rate.
However, she pointed out that vaccines will become available at different times and at different costs from different manufacturers.
Wheeler stressed that there were still a lot of unknowns with this pandemic. It’s not known if all the vaccines will behave in the same way – level of immunity, for how long people will be immune – how the virus will change in the next few years, or the period between the phases. She added that there will be “risk communication,” or people who refuse to take the vaccine may reinfect others.
However, she said everyone is moving as fast as possible.
Would you get vaccinated?
Priya Ganness said she was ready for the vaccine for herself and her four-year-old son. She said millions of people have been infected and hundreds of thousands have died from covid19, and she did not want herself or her son to be one of those people.
“I would like to look back on this day, years from now, when my son is grown and I am old. I want to tell stories of the pandemic of 2020. To do that, we must both survive. I am willing to be vaccinated to increase our chances of longevity.”
Ian Cox said his inclination is to be vaccinates, but he is cautious about it.
“I will review any available literature along with the prevailing rate of infection and the governmental stipulations as it pertains to school, the workplace, travel, etc. If I am not confident I will defer vaccination.
“But vaccination will make for safe participation (in various activities) and I suspect inclusion in the new normal of society.”
However, others were reluctant to be immunised against covid19. Amanda Espinet said she preferred to wait for a few years to pass before taking the vaccine so the long-term effects could be known.
Amie Soumaré was unsure. She expressed suspicion of foreign authorities, especially the US, believing they would either use black people as test subjects or use the vaccine to harm them in some way.
However, like Oura, Wheeler was certain of the safety of any vaccine produced.
She said, “In order to have a vaccine in the first place it has to be tested on thousands of people to make sure it is safe. It’s not possible to have a vaccine that you put out in the world for people without clinical trials. It’s the same methods, the same safety measures – everything will be put in place.”
She admitted that there would always be a small percentage of the population that reacts badly to vaccines, or people in whom the vaccine may not be as effective. But, she said, there was never an occasion where a vaccine gave thousands of people a disease, or they got the disease after vaccination.
In addition, she said there would be time between testing and putting the vaccine on the market to notice side effects, so people should feel confident in any vaccine in the public sphere.