A tipping point in the fight against Covid-19

Ten days ago we had no Covid-19 vaccines. Now we have two, the latest from Moderna (after the one from Pfizer/BioNTech). Sure, the first statement may be a bit of an exaggeration — there were 12 vaccines in late stage trials, some with more than an even chance of succeeding and what we were witnessing is just that. The two that have cleared the first hurdle — an adequate success rate in an interim analysis of early results — are both messenger RNA or mRNA vaccines, which use a genetic messenger code to instruct the body’s own cells to make a protein found on the shell of the SARS-CoV 2 virus that causes Covid-19, thereby provoking an immune reaction, resulting in protection from the virus. 

There’s every chance that another candidate, perhaps the one being developed by Johnson & Johnson or AstraZeneca/Oxford could join the ones from Pfizer and Moderna before the end of the year (to end 2020 with three successful vaccines would be something). And there is every chance that both will be approved for use and available, at least to those whose needs are the highest, before the end of the year. Wider commercial availability will follow next year, perhaps by early spring. 

Pfizer will make 50 million doses available this year (once approved) and Moderna, 20 million. Both are two-dose vaccines which means 25 million and 10 million people, respectively, can be vaccinated. Next year, Pfizer plans to boost production up to 1.3 billion units, and Moderna up to between 500 million and a billion. That should be enough to vaccinate around 15% of the world’s population, which is a start. The other successful vaccines will add to the number. It’s entirely possible that if two more vaccines are successful, around 40% of the world’s population could get a vaccine next year. But that’s on paper, because supply won’t just be a function of availability — it will be driven by pre-existing deals between countries and vaccine makers. The US, for instance, has deals with both Pfizer and Moderna. The UK has a deal with Pfizer and five other vaccine makers, in all accounting for 350 million doses. Its population is 66 million, so even if some vaccines entail multiple doses, its population is covered. The country was scrambling to strike a deal with Moderna before the company announced the interim analysis of the preliminary results of its Phase 3 clinical trials. And the EU has deals with both Moderna and Pfizer/BioNTech. 

Pharma analytics company Airfinity said in September that rich countries accounted for at least 50% of the 5.3 billion doses for which deals had been struck at the time. That number is likely to increase. Indeed, the announcements by Pfizer and Moderna are both likely to result in some frenzied deal-striking — and they should. A vaccine is the best investment a country can make at this point in time. The origins of the ongoing global economic crisis are not really economic, several experts have said (correctly) that a vaccine is the best stimulus/cure for an ailing economy. 

Now comes the tough part of managing the acquisition, logistics, and administration of the vaccine -- and there too Moderna had some good news; its vaccine lasts longer in the refrigerator than previously believed (it still needs to be frozen), and even lasts 12 hours at room temperature. 

But what of the science behind the results announced by Moderna on Monday and Pfizer/BioNTech last week? Both involved waiting for a certain number of test subjects (some were given the vaccine and others a placebo) to get infected -- and then see who got what. In Pfizer’s case, based on 94 people who got infected, and in Moderna’s case, based on 95, the vaccines were found to be over 90% and 94.5% effective. While there is safety data to be reviewed, and the studies themselves (both clinical trials cover tens of thousands of subjects) will have to run their course, it is unlikely that these results will change. 

I believe this is a tipping point in the fight against the virus -- it reduces, by a significant amount, the uncertainty surrounding a vaccine, and offers a tentative timeline on when one could be available commercially.

Government and public health responses may have faltered in the face of Covid-19, but the pace and progress of the scientific response to the pandemic has been revolutionary and unprecedented. It is, like many other things that have come before, another triumph of human ingenuity.