Offline: Preparing for a vaccine against COVID-19

Abstract

The results of two randomised trials reported this week in The Lancet give great encouragement to the view that a vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be produced within the next 18 months. There are no guarantees. But the evidence is hopeful. Pedro Folegatti and colleagues from The Jenner Institute at the University of Oxford used a chimpanzee adenovirus viral vector expressing SARS-CoV-2 spike protein to create a vaccine given by a single intramuscular injection. The ChAdOx1 nCoV-19 vaccine, tested in five trial sites in the UK, was safe and well tolerated, and led to striking findings of both humoral and cellular immune responses. This candidate vaccine is now undergoing phase 3 trials in Brazil, South Africa, and the UK. Feng-Cai Zhu and colleagues completed a single-centre phase 2 randomised trial in Wuhan, China, using a recombinant adenovirus type-5-vectored COVID-19 vaccine. They found rapid onset of an immune response within 14 days, with evidence of humoral and cellular immune responses by day 28. This vaccine was also safe and well tolerated. There were signs that it produced a poorer immune response in older recipients. As the vaccine enters phase 3 trials, a second dose will be considered for this group to boost their immunity. These results are unquestionable breakthroughs in the global response to the COVID-19 pandemic. But there are reasons for anxiety. Anti-vaccine campaigners are mobilising to challenge the introduction of a vaccine to protect the public against COVID-19. Opinion polls suggest that in some countries, such as the USA, as little as half the eligible population would be willing to receive a vaccine against SARS-CoV-2. The arguments cover familiar ground—ranging from claims that the pharmaceutical industry is trying to profit from the pandemic to the notion that the virus poses little danger to human health. The context of urgency is also strengthening the anti-vaccination movement. President Trump has called the US vaccine programme Operation Warp Speed. This designation has led some anti-vaccine activists to claim that corners are being cut in safety testing. When questioned recently by the US House Committee on Energy and Commerce, Anthony Fauci, a member of the White House Coronavirus Task Force, noted that it usually takes 7 years to develop a vaccine. If a COVID-19 vaccine is developed far sooner, some anti-vaccination campaigners will allege that safety tests have not been properly conducted. Convincing vaccine sceptics will not be easy. Bill Gates explained the challenge during an interview on BBC television: “...there will be a trade-off. We'll have less safety testing than we typically would have and so governments will have to decide. Do they indemnify the companies and really say let's go out with this when we just don't have the time to do what we normally do?” These comments were seized upon by those who believe the science of COVID-19 vaccines is being compromised to favour speed over public welfare. The work to prepare the public for a vaccine to control this pandemic needs to start now. Policy makers and scientists must partner with communities to understand their concerns. Advocacy for a COVID-19 vaccine should ideally be led by local communities and local community champions. The availability of a vaccine should be transparently prioritised for those at greatest risk. Access to a vaccine should be through familiar settings—for example, high-street pharmacies and supermarkets—and not only health clinics and hospitals. Public information campaigns should be considered, including campaigns to challenge growing disinformation. Finally, at a time of widespread populist anti-elitism, the leadership of national vaccine programmes should be shared beyond government and public health agencies. The current debate over masks—and “mask Nazis”, as one commentator wrote last weekend—gives clues as to how a vaccine might be received. Anti-government voices will argue that politicians are using the pandemic to, as another critic noted, “distil fear into power”. A COVID-19 vaccination strategy demands a whole-of-society response—incorporating business, trade unions, faith communities, charities, media, entertainment, and sports. A vaccine to protect the public against SARS-CoV-2 is the most important and immediate technical challenge humanity has ever faced—at a moment when public trust in science and government is alarmingly brittle.