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VACCINATION FACTS

When human coronaviruses were first studied in a laboratory in the 1960s the distinctive spikey appearance looked, to scientists, like the crown shaped outer atmosphere of the sun known as the corona. [i]

Studies of the virus in the 60s and 80s showed that some people had antibodies against coronavirus, suggesting that the virus had already been circulating in humans. However, the usual mild symptoms of infection with coronaviruses in the 20^th century meant the spread was undetected.

It wasn’t until 2003 that a new coronavirus that caused Severe Acute Respiratory Syndrome (SARS-CoV-1 or SARS), that the virus started to behave differently. In some people the disease was severe. It spread to 29 countries and infected 8096 people, of which 774 died, accounting for about 10% of those infected.[ii] The virus was contained with concerted efforts and by 2004 there were no further cases reported.

In the last ten years there have been more coronavirus cases. In 2012, the Middle East Respiratory Syndrome Coronavirus (MERS-CoV or MERS) emerged in Saudi Arabia. While not highly transmissible like other coronaviruses, it caused the death of about 35% of those infected. Between 2012 and 2021, there were 2580 cases of MERS reported in 27 countries [iii] [iv]

MERS is a zoonotic virus, which means transmission is possible from animals to humans. In the transmission is through contact with infected dromedary camels, though exactly how it occurs is still unknown. The virus is not easily transmissible from human to human. [v]

The latest coronavirus, that began with an outbreak of pneumonia in Wuhan, was announced on 9 January 2020 by state media in China, sending warning bells around the world. [vi] The new or “novel” coronavirus became known as COVID-19 with the shortening of “Corona Virus Disease” timestamped with its emergence in “2019”.

By 30 January 2020, the International Health Regulations (2005) Emergency Committee, advised the World Health Organization (WHO) Director-General that the situation constituted a Public Health Emergency of International Concern (PHEIC). At that time there were 7711 confirmed and 12,167 unconfirmed cases in China with 170 deaths. There were 83 cases in 18 other countries.

Only 41 days later, on 11 March 2020 WHO Director-General, Dr Tedros Adhanom Ghebreyesus, announced worldwide spread of COVID-19. There were, “118,000 cases in 114 countries, and 4,291 people have lost their lives.” He declared the fast-moving infection from COVID-19 a pandemic. In summary of the recommendations he said, “First, prepare and be ready. Second, detect, protect and treat. Third, reduce transmission. Fourth, innovate and learn.”[vii]

Vaccinology around the world took on a critical new challenge; produce vaccines and create immunity to COVID-19 worldwide. Until then, no vaccines had ever been produced for a coronavirus, but MERS and SARS research and development would soon play a critical role in the ability to rapidly produce effective vaccines for COVID-19. [viii]

In December 2020, less than a year after the announcement of COVID-19 in China, vaccines had been developed, trialled, and granted Emergency Use Approval (EUA) by regulatory authorities in the US, UK and China. [i] Weeks later, in January 2021, the world recorded two million deaths from COVID-19. [ii]

If nothing else, 2020 became the year the world learned what science, industry and government collaboration could produce if all the necessary elements were made available at once. The result was staggering. It was a deft response to the crisis and a demonstration of how far vaccinology had progressed. The COVID-19 pandemic trajectory looked set to improve and not mimic the last pandemic, the Great Influenza epidemic of 1918, or Spanish Flu as it was better known, that killed 50 million people. [iii]

The technology that created the first COVID-19 vaccine candidates was made possible by knowledge accumulated over 200 years of vaccinology and learnings from SARS and MERS coronavirus outbreaks and vaccine development over the last two decades. [iv] [v] But it was in the last one hundred years of scientific research and development and investment in technology that manufacturers became capable of producing large quantities of vaccine in relatively short time ready to combat global health emergencies.

Faced with the COVID-19 crisis, finding the right vaccine technology would fix one part of the problem. The next was how to scale up production, bring approved vaccines to people around world and slow the worsening impact of the pandemic.

Before vaccines can be granted approval by regulatory authorities, they go through multiple human trials to ensure safety and effectiveness. These critical steps can be lengthy and cause considerable delays before mass production can start. In the case of the first COVID-19 vaccines, researchers enrolled more participants in large-scale clinical trials which generated the necessary data in shorter time. Then, to shorten the delivery time, the vaccine manufacturers began production and stockpiling vaccines in warehouses, at their own risk, while the regulatory approvals were sought. All the approaches dramatically reduced the time to bring the vaccines to the market.[vi]

Perhaps most remarkable were the result of the trials in 2020. Pfizer-BioNTech trials reported above 95% protection against symptomatic COVID-19. Moderna reported 94% and in the UK, Oxford-AstraZeneca vaccine was seeing similar results, reporting 79% protection at that time and much higher on prevention of hospitalisation. [vii] [viii] [ix]

As more vaccines developed across the world, a familiar logistical challenge loomed. It was the same challenge World Health Organization (WHO) had faced for decades; how to supply and administer vaccinations to every community in the world and ensure high levels of vaccination among those eligible.

The Coalition of Epidemic Preparedness Innovations (CEPI) leads the COVAX initiative with WHO, GAVI Alliance and UNICEF.  COVAX is coordinating global resources to provide access to COVID-19 vaccine to every country, including those least able to afford the necessary supply for their population. [x] [xi]

Logistical problems have plagued the global effort. By late 2021, only 2.3% of populations in low-income countries had received a vaccination while some wealthier countries had achieved levels above 80%. [xii]

It seems that key to unlocking local access is local production and distribution. To enable that, vaccine technology sharing is adding to new capability to help development and distribution of vaccines where supply has been low. [xiii]

By September 2021, there were almost 300 [xiv] new COVID-19 vaccines in development worldwide. While only a fraction of these will reach the approval stage, the capacity to locally mass produce vaccines remains the real challenge.