The Great Vaccine Race

Despite arguably being one of humanity's most prolific scientific inventions, it is hard to say that the humble vaccine has ever enjoyed as much attention and general curiosity as it does now. The reason for such widespread curiosity and concern is clear, it is our 'way back'. Soon after the leaders of the world realised that they cannot dismiss COVID-19 as a problem of one or a few nations, they changed tact and chose instead to focus on the transient nature of this contagion in the face of 'advanced' technology that was the product of the long struggle of human civilisation. For many, the idea was simple. If we can go to the moon, split the atom and attempt to decode the human genome, surely we can take care of a virus or ten. This idea became so deeply rooted in the COVID-19 pandemic that we can no longer imagine a beyond COVID scenario that isn't brought about by a vaccine. And thus, vaccine development has become a global obsession. In a way, if one were too positive, such enthusiasm for vaccine development is a good sign that the world is coming together for a monumental effort that will test human perseverance. But change the angle or the viewpoint and what emerges is a global race that seems less concerned with ending a pandemic and more interested in playing yet another game of political one-upmanship that nations and leaders engage in all the time. The Great Vaccine Race has come and much like any other race or game of nations, the stakes are high and the potential collateral damage even higher.

A historic effort

But before continuing with the grim narrative of a potentially reckless race to an uncertain finish line, it is important to acknowledge just how extraordinary the global vaccine effort already is. Despite growing agitations and impatience, the effort to develop the COVID-19 vaccine is the single largest and most expedited initiative of its kind ever undertaken by man. By every known scientific and expert assessment, the pace of development is fast, blazingly so.

At the very onset of this pandemic, most experts were reluctant to give any deadline on when a possible vaccine may be available. Indeed, as many political leaders made reckless claims of the pandemic have a fast-approaching deadline, experts such as Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases warned that such hollow assurances had no scientific backing. Such experts also made sure to mention that it was hard to give an accurate assessment of when (or even if) vaccines would be available given the lack of information regarding this virus. Historical precedents did not offer an encouraging timeline either with the fastest vaccine development in history still clocking in at around four years. But, historical precedents are not an entirely accurate yardstick in such a scenario. Leaving aside the lack of information regarding the virus, we have, in fact, the benefit of new technologies that are helping to expedite many of the tedious aspects of vaccine development. Furthermore, the growing threat to our ways of life and more importantly, the economy has resulted in a level of scientific zeal that has scarcely been witnessed in history.

This astonishing speed is also helped along by the speed at which vaccine makers are now able to navigate through the truly monumental amount of red tape that normally ties up any vaccine development effort. The process that is involved in developing and finally bringing a vaccine to the market is lengthy and even moving a development project past initial lab work into animal testing can take months or even years. Then, there is a possibility that human clinical trials may begin.

Phase one is a trial with a small group of healthy volunteers, undertaken to ascertain that there are no additional side effects other than those already noted in the animal trials. Typically, this phase may last around six months. Next, phase two trials are carried out to ascertain the strength of the immune response in volunteers. This phase may last around a year. Finally, phase three is a longer more complicated version of phase two and factors in conditions like location, exposure to the pathogen, etc. This phase can take around three years. This phase is further complicated by the fact that different side-effects may once again show up in a more diverse volunteer group. While the former phase may have several hundred volunteers, the latter has several thousand across a number of locations. Along the way regulator approvals, peer reviews, etc., add to the effort. Even after all this, there is no guarantee that a vaccine can be brought to the market at a cost that offsets the significant development expenses.

All this points to an uncertain effort that may take years and lead to no tangible results. This is a significant fact to understand in order to appreciate how decisive and swift COVID-19 vaccine development has been. From the time Chinese researchers shared the genome of the Coronavirus, multiple vaccine projects have taken only six to seven months to reach phase three of the vaccine trials. Given the extreme political interest in bringing a working vaccine to the market, it is only natural the process would be fast-tracked. But for certain political leaders across the world, the vaccines aren't coming fast enough and that is where the matter becomes problematic.

Haste makes for…

Unmitigated disaster in this case. Vaccine development is already a complex enough process and expedited processes and corners cut usually have a heavy cost. One of the classical examples for this is the disastrous vaccination campaign carried out in the United States in 1976 against a potential swine flu epidemic. When two military recruits were found to have swine flu in early 1976, researchers noted with alarm that the symptoms appeared similar to the virus that caused the 1918 Spanish Flu pandemic. This fact alone notably triggered a panicked response by the authorities that rushed out an immunisation programme despite calls for caution from WHO. 45 million Americans were vaccinated within ten months. But the speed and neglect of the hassled programme left significant gaps. There were manufacturers who produced the incorrect strain of the virus for the vaccine. This vaccine tested poorly with children with many developing adverse side effects like high fever. It was also noted that the 1976 vaccination drive may have resulted in a small percentage of those inoculated being more susceptible to the Guillain-Barré syndrome, which can cause muscle weakness or paralysis. It was also discovered later that the swine flu virus was not related to the 1918 pandemic at all and ultimately the vaccination campaign was brought to a halt. But the damage was done. Some of it was not physical in nature. Medical experts have attributed the 1976 vaccination drive debacle as being one of the primary reasons for growing distrust of vaccines in general by the American populace. Critics have since noted that it was possible the hasty campaign was put together with political motives as President Gerald R Ford was up for re-election that same year.

In August, Russia became the first country in the world to approve a Coronavirus vaccine. Developed by the Gamaleya Institute, the vaccine has been, aspirationally perhaps, named Sputnik V. Blazing past an already breakneck global vaccine development speed, it was announced that mass vaccinations could be underway by October. Furthermore, Russian medical workers would be given the vaccine within the same month. Indeed, President Vladimir Putin claimed that his own daughter had already been inoculated. Since then, Putin has also made the offer to provide WHO officials with free vaccines. Many scientists across the world have expressed deep concern over the rushed vaccine schedule or the fact that the vaccine was approved before phase three testing. Even the early stage trial findings published by Gamaleya have been questioned. But the Russians have rebuffed all criticism and countries like Saudi Arabia, Egypt, Brazil. Even India has expressed the intent to hold trials for the vaccine. This, commentators fear, will embolden more world governments to start recklessly pushing ahead with deadlines in order to gain...something? National prestige perhaps? To push back unfavourable media coverage? It is hard to say. What is clear is that the scientific community is increasingly at odds with the political leaders on the issue of when it's safe to release the vaccine. In some cases the motives of such leaders are even less ambiguous. Trump has constantly promised to have a vaccine ready before the November Presidential Elections despite pushback from the US science and health community. But this game is already plenty convoluted already with a new disturbing term being coined to describe this odd competition to end a global pandemic — vaccine nationalism.

To share or not to share

In March, it was reported by many outlets that Trump had approached the German firm, CureVac for exclusive rights for their vaccine development in return for a large monetary contribution. The firm denied the offer but the trend stuck around. Reports of vaccine espionage, under the table deals, etc., have become more common in recent times. The EU, the US, Britain and many other countries have already struck deals with vaccine makers, deals that may end up threatening the global initiative. There is a real concern that rich nations will buy up all the early supplies of vaccines, leaving poorer nations with empty hands.

And thus, a WHO-led initiative has been put into effect to secure a large number of vaccines from approved candidates. The initiative, called COVAX, aims to provide equitable access to safe and effective vaccines. 172 nations are presently engaged in the initiative and nine candidate vaccines are already on the portfolio with a further nine to follow. Even India is in talks to possibly join the initiative. The US and China have notably opted to stay out.

What vaccine nationalism discounts is the fact that in the present scenario, no one is safe until everyone is safe. What proportion of the world's population needs to be inoculated for herd immunity to carry the rest of the way — still remains unclear. Most estimates range around 80 per cent, making the whole effort the largest of its kind. The significant logistical challenge is only further heightened when countries try to jump the queue or make side deals. Otherwise there is little meaning to the many international health bodies that are attempting to coordinate efforts. Indeed, vaccine nationalism seems to be yet another failure of multilateralism in this context.

But it would be unfair to simply blame the leaders for these absurd vaccine games. Whether society accepts it or not, politicians are often a mirror of society itself. How accurate that reflection turns out to be is debatable. The panic over the Oxford vaccine trial halt did send AstraZeneca stocks tumbling immediately afterwards even as the medical community itself saw the halt as a positive sign of due scientific process. Ultimately, a global pandemic can only be met with sharing and cooperation, whether this be at the level of individuals or nations. But above all, let us vow to not let our expectations run

wild. Let us vow to not offer false hopes to those who are ignorant. It is realistic to expect that a vaccine will eventually help fix the situation but is foolish to expect it to be a godsent rescue, immediate and perfect like some kind of deus ex machina.