Why we shouldn’t pin our hopes on a coronavirus vaccine
The race to find a vaccine for the coronavirus outbreak is well underway. On February 3, health secretary Matt Hancock announced that the government would donate £20 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to help fast-track a vaccine to counter the novel coronavirus that has spread widely in China.
CEPI – a Norway-based coalition of vaccine makers and health agencies – wants to have a coronavirus vaccine ready within six to eight months. The coalition is joined by a handful of global pharmaceutical companies sprinting towards the development of a vaccine, and they’re all touting similarly ambitious timescales. Johnson & Johnson, for example, says that it hopes to have a vaccine out in eight to 12 months, while China-based Clover Biopharmaceuticals says it wants to begin preclinical trials within six to eight weeks. Other companies such as Novavax and Inovio Pharmaceuticals have confirmed that they are working on vaccines but have not announced timescales. Biopharmaceutical company Gilead, which has partnered with Chinese authorities to develop and market a vaccine is repurposing its failed Ebola drug for use against coronavirus.But while the flurry of vaccine announcements has been met with enthusiasm – and soaring stock prices – getting an effective coronavirus vaccine out there in the world might not be as easy as it seems.Creating a vaccine is a slow, arduous process. Vaccines go through multiple stages of development – from discovery to animal trials all the way through to multiple different human trials. And that’s not including all the regulatory hoops the vaccine needs to pass through to reach the market. These final steps often create the bottlenecks of vaccine development. Registration, regulatory approval and large-scale manufacturing take time.So, are the timescales that CEPI and the other biotech firms gunning for realistic? “To make a vaccine conventionally – to test it and actually get it on the market – can take a decade, and has done,” explains Nicola Stonehouse, professor in molecular virology at the University of Leeds. “In fact, it’s taken several decades for some vaccines in the past.”The Ebola vaccine is a good example of the long path that vaccine development is forced to travel down. The disease had been on the radar of authorities and scientists since 1976, yet when it hit Western Africa on a devastating scale in early 2014, a vaccine had not yet been developed. Biotech companies decided to fast-track the path to a vaccine at the height of the outbreak.But an experimental vaccine for Ebola wasn’t used in Western Africa until a year into the outbreak when thousands of people in Guinea received a clinical trial version of the vaccine. By the time Ebola had been brought under control through public health interventions in the summer of 2016, the disease had already infected 28,000 people. That experimental vaccine, called rVSV ZEBOV, was finally certified as fit to use by the World Health Organisation in November 2019.Things can go much faster than this, Stonehouse says, but it all depends on the stage that the research is at. As we aren’t starting from scratch, scientists are finding themselves in a slightly different position with this current coronavirus outbreak. Since we already have experience with other coronavirus outbreaks – Sars and Mers were both from the same group of diseases – data from those diseases could help accelerate the development of a new vaccine.“We know from the Sars vaccine that what we really need to target is that spike protein,” says Florian Krammer, professor in microbiology at the Icahn School of Medicine. “That was demonstrated nicely with Sars and later on with Mers. We are way better prepared for this now.”The coronavirus relies on this protein in order to ‘spike’ through cells’ defences and cause the infection. As with Sars and Mers, the vaccine will need to target this spike protein to stop it from entering the cell. The speed at which Chinese authorities uploaded the genome sequence online will mean researchers can get off to a quick start. It took scientists six months, from November 2002 to April 2003, to release the sequence for the Sars genome, while it took scientists just ten days after alerting the WHO of the coronavirus to upload its genome sequence to Virological, an open access repository. In a study published on February 3 in the journal Nature, scientists at the Wuhan Institute of Virology identified that this coronavirus was 80 per cent identical to Sars and 96 per cent identical to a form of coronavirus seen in bats. The scientists also discovered that the coronavirus targets the same cell receptors that Sars did, going on to recommend using an unproduced Sars vaccine as a temporary solution.In the Sars outbreak, vaccines were never deployed, as by the time scientists had developed a vaccine – 20 months after the release of the virus genome – the outbreak was already under control and drug firms were no longer willing to manufacturer the vaccine. In June 2004, Berna Biotech announced that it had stopped trials of a Sars vaccine because it was no longer seen as a priority. “It had gone so fast that no one wanted the vaccine anymore,” says Polly Roy, professor of virology at the London School of Hygiene and Tropical Medicine. “If there’s no profit, then manufacturers don’t want it anymore.”That might be the problem with creating vaccines in the height of an outbreak. As Chris Smith, consultant virologist at Cambridge University explains, vaccines work best when they're well ahead of the game. “So basically, you prepare everyone in advance, and then they're ready to meet the onslaught. They're not so useful when you're playing catch up,” he says. “If you add the several months to up to a year of testing to the picture, it may well be that this has gone so far, so quickly, that actually the expense, the risk, the timing, it’s just not going to be in the favour of making this a viable prospect.”By the time a vaccine goes through the regulatory process, the virus may have already waned, as happened with Sars. Krammr points out that it can cost almost £400 million to bring a vaccine to market and a phase one clinical trial could cost £7.7m. “Pharmaceutical companies generally don’t make lots of money out of vaccines because you’re offering them to a large amount of people, so you have to make them very cheap,” says Stonehouse. “There has to be some governmental, or NGO pressure in order to promote the manufacture and distribution of vaccines.” And that’s ultimately what the government’s injection of money into CEPI could help achieve. A report from the US Institute of Medicine says that the revenue from vaccines make up only 1.5 per cent of global pharmaceutical sales, but putting money into a vaccine now could prove useful later on.With the length of time that it takes to produce a vaccine, it’s almost certain that it will not be used to control this current outbreak, says Stonehouse. “What it might do is help control future outbreaks,” she says. “The principles of doing the research and what you find out along the way can be applied to future projects. Even if it's not used for this outbreak, it could be used for the next outbreak and that is surely a good thing.”Alex Lee is a writer for WIRED. He tweets from @1AlexLMore great stories from WIRED