Fast, effective and ethically distributed — what we need from a COVID vaccine

The rise in COVID-19 case numbers across Canada is a stark reminder that we are still living amidst a smouldering global pandemic, and likely will be until a COVID vaccine is ready.

Around the world, vaccine development is happening at a blistering pace, with more than 170 vaccine candidates in the works, with at least 35 of them currently being tested on humans. But, considering that 94 percent of vaccine candidates fail during clinical trials, it's still anyone's guess as to when we'll have the first safe and proven, COVID vaccine.

"There's a lot of adrenaline and hard work going into this. I can't think of a more important project to be working on right now, so I take that very seriously," virologist Dr. Alyson Kelvin told Quirks & Quarks host Bob McDonald. 

At VIDO-InterVac in Saskatoon, Kelvin is not only working to develop a vaccine, but she's also testing different vaccine platforms being used by other institutions across Canada. Some candidates are traditional, others are more experimental. 

According to Kelvin, it's important to have many different options, because we don't know what will ultimately work, and also because multiple options could help get useful vaccines to people faster.

"It's obvious that one vaccine will not cover the global population or even the population of our country. So we need multiple candidates, not only because at this point we haven't fully evaluated all of the candidates, but also because that helps with our resources... having multiple candidates that are using different resources will likely give us more vaccine doses to go around."

Kelvin adds that it's also important to look at how each candidate will affect the disease in different ways — because that could determine whether the vaccine just weakens symptoms, or stops transmission altogether.

"For example, the Novavax vaccine has been shown to decrease your infection and the amount of virus you have," said Kelvin. "Some of the vaccines, for example, the AstraZeneca vaccine, some of the pre-clinical studies have shown that even though you're vaccinated, you're still able to be infected by the SARS-CoV-2 virus. But you have decreased disease at this point."

Fast — but also, safe

No vaccine has never been produced from scratch in less than four years, and timelines like a decade from start to finish are more typical. But for a COVID vaccine, that timeline has been shortened drastically.

To speed up the lengthy, three-phase clinical trial process, some manufacturers are overlapping the different phases instead of doing them one at a time. 

Some vaccine makers are speeding up the process in more controversial ways. One group of scientists, called RaDVaC — or Rapid Deployment Vaccine Collaborative — is using themselves as test subjects instead of animal models, in order to accelerate their research and development phases.

"Self experimentation means being able to adapt our work very quickly without some of the regulatory structures that govern what scientists can ask of human subjects," said Alexander Hoekstra, one of the scientists involved in the work.

No matter the approach, vaccine developers will still have to prove that their vaccines work, and that they're safe, before they can get wide distribution. Agencies, including Health Canada and the World Health Organization, have reassured the public that while they will be fast tracking the regulation process, no steps will be skipped. 

Of course, there are notable exceptions. In August, Russian leader Vladimir Putin announced their vaccine was being pushed into development after only two incomplete phase one trials, raising serious concern among scientists, including Kelvin.

"A couple of countries are skipping certain steps, including the phase three clinical trials, and moving right to approval of these vaccines in their public. I'm not seeing that from Health Canada, which is actually a great sign," said Kelvin.

"Of course, we want a vaccine as soon as possible, but we also want to do it and make these vaccines to the highest quality and know that they're safe and effective in people."

Fast, safe — but what about fair?

A vaccine won't be widely available right away. Billions of doses need to be manufactured which involves building factories to produce vaccines on an unprecedented scale. Some scientists say it could take until 2024 to make enough vaccines for every human on earth. 

"There are 7.8 billion people in the world. Even under optimistic circumstances, by the end of 2021, we might have enough vaccine for a billion people," said bioethicist Dr. Ezekiel Emanuel. "And the question is, who should be at the top of that list?"

Emanuel is a former Obama White House Health Policy Adviser and the Vice Provost of Global Initiatives at the University of Pennsylvania. He and 18 other health experts recently published a paper in the journal Science, laying out what they call a Fair Priority Model for a COVID vaccine distribution plan. 

"The primary focus initially out of the box is to reduce premature deaths," he said. "Once that's under control, we shift to minimizing the economic and social deprivations, things like unemployment, poverty, suspension of educational opportunities."

After those two priorities are met, he adds, then the focus should be on attaining herd immunity.

Vaccine nationalism is probably going to play a role... You just can't take all your vaccine and hoard it.- Dr. Ezekiel Emanuel

These priorities are significantly distinct from the WHO's recommendations to distribute vaccines to countries based on population size. 

"The people who are really sick, who we can help with a vaccine, they ought to take priority. Places like New Zealand or Singapore or Taiwan are doing extremely well. A low number of cases, a low number of deaths. Putting vaccine there is not going to do a lot in terms of limiting harm," he said. 

"On the other hand, countries that have a high rate like India or Brazil or even the United States, those countries, the vaccine is going to do much more in terms of limiting harm and benefiting people. And it does seem intuitive that those countries ought to get top priority."

Emanuel is cautiously optimistic that a vaccine can be distributed in a way that's fair and equitable - even considering vaccine nationalism, the idea that the government of a country that develops the first vaccine will keep it all for domestic use.

"We in our paper recognize vaccine nationalism is probably going to play a role. One of the things we say is it can lead to giving preference to citizens of the country, but it's not absolute preference. You just can't take all your vaccine and hoard it." 

"Extra vaccine needs to be let out to the world so that other countries can address the problem… We're not going to be able to open up international trade, international travel and lots of the economy unless all countries have a vaccine and actually have herd immunity."

Despite all of this, Emanuel has hope that it can be done. 

"Before we wrote our paper, I don't think anyone had any idea what fair and equitable looked like. And so I think offering a coherent plan helps."

Produced and written by Amanda Buckiewicz