Vaccines go back a long time. Edward Jenner created the first vaccine in 1798, against smallpox. He noticed that milkmaids who’d been exposed to cowpox previously were immune against smallpox. The world was never the same afterwards. A new weapon had been discovered against an invisible and formidable adversary that was impossible to defend against. In present times, with the world in the grip of the COVID-19 pandemic, the science behind developing effective vaccines is more relevant than ever.
HOW WAS THE FIRST VACCINE CREATED?
The basic idea behind vaccines is to immunize the human body. The practice of immunization is hundreds of years old. Buddhist monks used to ingest snake venom in small doses to train the body’s defenses against it. The pioneer of vaccination in the west was Edward Jenner, who founded vaccinology in the year 1796. When apprenticed to a country surgeon and apothecary in Sodbury in 1762, the 13-year old Jenner was intrigued when he heard milkmaids say that they will never catch smallpox, as they have already survived cowpox. It was a common belief during that time – milkmaids were considered to be immune to smallpox.
A portrait of Edward Jenner
It was much later, in the year 1796, that he would finally work on developing the world’s first vaccine. Jenner came across a milkmaid who had suffered from cowpox, and had developed lesions on her skin as a symptom of the disease. He extracted some matter from these lesions and injected an 8-year old boy, James Phipps. Subsequently, the boy developed mild fever and discomfort in the axillae. Nine days after the procedure he felt cold and had lost his appetite, but on the next day he was much better. In July 1796, Jenner inoculated the boy again, this time with matter from a fresh smallpox lesion. Phipps showed no symptoms and no disease developed. Jenner concluded that the cowpox infection helped fortify the body’s immune system protected against smallpox. In 1798, he privately published a small booklet entitled ”An Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire and Known by the Name of Cow Pox”. Things took off after this – by 1800, vaccination spread rapidly in England and to other European countries as well. Smallpox, a disease that is estimated to have been around since 10,000 B.C., was eradicated completely from the world by 1979.
THE COVID-19 PANDEMIC
The first human cases of COVID-19, the disease caused by the novel coronavirus causing COVID-19 were first reported by officials in Wuhan City, China, in December 2019. While some of the earliest known cases had a link to a wholesale food market in Wuhan, some did not. Many of the initial patients were either stall owners, market employees, or regular visitors to this market. Environmental samples taken from this market as early as December 2019 tested positive for COVID-19, further suggesting that the market in Wuhan City was the source of this outbreak or played a role in the initial amplification of the outbreak. The market was closed on 1 January 2020. But the disease had spread to dozens of countries by this time. On 30 January 2020, following the recommendations of the Emergency Committee, the WHO Director-General declared that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC). World scientists on COVID-19 met at the World Health Organization’s Geneva headquarters on 11–12 February 2020 to assess the current level of knowledge about the new virus, agree on critical research questions that need to be answered urgently, and to find ways to work together to accelerate and fund priority research to curtail this outbreak and prepare for those in the future.
Wuhan City, China – Where it all began
What makes this disease so dangerous is it’s high infection rate. Initially it was thought that it did not spread through contaminated air, but now it has been proven otherwise. The presence of different strains of the virus further complicates the development of an effective vaccine.
DEVELOPMENT OF A VACCINE AGAINST COVID-19
Building on the response to recent outbreaks of Ebola virus disease, SARS-CoV and MERS-CoV, the R&D Blueprint facilitated a coordinated and accelerated response to COVID-19, including a program to develop a vaccine, research into potential pharmaceutical treatments and strengthened channels for information sharing between countries.
The current COVID-19 pandemic is unprecedented, but the global response draws on the lessons learned from other disease outbreaks over the past several decades. As part of WHO’s response, the discussions were activated to accelerate diagnostics, vaccines and therapeutics for this novel coronavirus. The Blueprint aims to improve coordination between scientists and global health professionals, accelerate the research and development process, and develop new norms and standards to learn from and improve upon with regards to the global response. Experts estimate that a fast-tracked vaccine development process could speed a successful candidate to market in approximately 12-18 months – if the process goes smoothly from conception to market availability.
To date, just one coronavirus vaccine has been approved. Sputnik V – formerly known as Gam-COVID-Vac and developed by the Gamaleya Research Institute in Moscow – was approved by the Ministry of Health of the Russian Federation on 11 August. Experts have raised considerable concern about the vaccine’s safety and efficacy given it has not yet entered Phase 3 clinical trials.
The Oxford vaccine, called ChAdOx1 nCoV-19, is being developed at unprecedented speed. It is made from a genetically engineered virus that causes the common cold in chimpanzees. It has been heavily modified, first so it cannot cause infections in people and also to make it “look” more like coronavirus. Scientists did this by transferring the genetic instructions for the coronavirus’s “spike protein” – the crucial tool it uses to invade our cells – to the vaccine they were developing. This means the vaccine resembles the coronavirus and the immune system can learn how to attack it. Trials involving 1,077 people showed the injection led to them making antibodies and T-cells that can fight coronavirus. The findings are hugely promising, but it is still too soon to know if this is enough to offer protection and larger trials are under way. The UK has already ordered 100 million doses of the vaccine.
The different vaccines in development – Sputnik V, ChAdOx1 nCoV-19, mRNA-1273
The US government has chosen three vaccine candidates to fund for Phase 3 trials under Operation Warp Speed: Moderna’s mRNA-1273, The University of Oxford and AstraZeneca’s AZD1222, and Pfizer and BioNTech’s BNT162. Members of ACTIV have suggested developing safe controlled human infection models (CHIMs) for human trials could take 1-2 years. A sponsor would need to provide data from placebo-controlled trials indicating their vaccine is at least 50% effective against COVID-19 in order to be authorized for use, according to FDA guidance issued on 30 June.
India is currently awaiting trial data from the Russian vaccine, which became the first vaccine against COVID-19 to be approved in the world. At present, there are 29 vaccines in clinical trials – a multi-step process to establish safety and efficacy of a shot. There are 138 more that are in pre-clinical phases, which includes development and animal trials. Currently, two Indian vaccines are in phase II of clinical trials. While Covaxin, which has been produced by Bharat BioTech in collaboration with Indian Council of Medical Research (ICMR) and National Institute of Virology (NIV), Pune was one of the first to be launched, another contender is ZyCOV-D, which has been developed by Ahmedabad based Zydus Cadila, using a DNA and recombinant measles virus strain. Both the vaccines, which started trials in early July entered phase II trials in August, making them the quickest vaccines to reach the mid-scale phase of testing. In trials conducted so far, both the vaccines have been found to be safe and eliciting a required immune response. As per reports, both Covaxin and ZyCOV-D are expected to be launched in 2021. Blueprints for vaccine trials and distribution are being worked on by PM Narendra Modi, who also announced the launch of National Health Mission for the public and discussed plans for how the vaccines will be distributed in the country. In the past week, authorities conducted meetings with experts from different fields so as to ensure how and when would the vaccines, once deployed, be made available for the public.
IN CONCLUSION…
The world still has some way to go before a fully functional vaccine is developed and deployed. It’s not easy to develop a vaccine within one or two years. Historically, it took years before a perfect vaccine was fully developed. There’s still a lot we don’t know about this virus and disease, including who will fall seriously ill or die from COVID-19. People can’t know the risks of participating in the vaccine trials, so they wouldn’t be able to give high-quality informed consent. This is an essential part of modern clinical trials.
There are a few alternatives in the meanwhile, before a vaccine for this disease is successfully developed. Clinical trials are underway in Israel, the Netherlands, and Australia to see whether existing vaccines for tuberculosis might also protect against SARS-CoV-2. The polio vaccine is another possible option. Scientists think these vaccines might boost the immune system just enough to fight off the new coronavirus, although there’s no evidence yet to confirm this theory. Like drugs, potential vaccines have to pass through the same clinical trial stages. This is especially important when it comes to safety, even during a pandemic. As of now, the only option is to wait for more information before coming to any kind of logical conclusion. This is a new disease, and the world was not prepared to handle a pandemic of this scale. The best we can do right now is to take proper precautions to slow down the infection rate. As long as each and every one of us steps up to do our bit, we can beat the pandemic.
