Vaccine development toolkit needs to be optimized to counter infectious disease threat: CPHI webinar

While there have been some huge advances in vaccine technology, more still needs to be done to counter the threat that infectious diseases pose, particularly to poorer countries.

“When we look at vaccine R&D in general, it depends on the geography - in low and middle income countries, five out of ten causes of death are infectious diseases, but that is not the case in high income countries, where less than 7% of deaths are from infectious diseases,” said Ana Cespedes, COO, International AIDS Vaccine Initiative (IAVI). “There is still some way to go.”

She added that the issue of inequality required more global collaboration and public/private partnerships and made the point that the problems of tuberculosis and HIV continue to be very present, with millions of people dying from these diseases every year.

“It’s not only about COVID,” she said.

Mike Whelan, project leader, Coalition for Epidemic Preparedness Innovations (CEPI) said that the COVID-19 pandemic presented an opportunity for the world to “’level up” in terms of equal distribution of vaccines.

“COVID-19 is somewhat unusual, it doesn’t tell the difference between rich and poor countries, whereas those that are dying up till now have primarily been in low to middle income countries,” he said. “There’s lots of excellent new technologies out there but they’re not fully licensed and now is maybe the time where we can actually do that. If anything good is to come out of this pandemic, it may be licensing technologies – doing it properly and safely of course – and developing new techniques and cheaper cost of goods that can actually be used by people who need them.”

Marie-Liesse Le Corfec, global portfolio marketing head, Pharmaceutical Systems, BD, said she had seen a trend whereby a number of the company’s customers were asking for a nasal spray as the drug delivery device for a vaccine.

“With COVID, it has really boomed, and you can see all these small companies who had an idea and the right technology and now the world is opening for them,” she said. “Part of the silver lining to this terrible crisis is that it has really accelerated the opportunities for more creativity in R&D.”

Diverse toolkit

Gunnveig Grødeland, research group leader, University of Oslo, told the audience that while the ongoing pandemic has demonstrated a diverse toolkit of vaccine formats and technologies can be used both against normal diseases and pandemic relief, a better understanding of the premises for immune formation and how it can be shaped is needed.

“So why does a particular vaccine work in some individuals and not in others? What’s the most relevant type of immunity for protection? I think we’re scratching the surface still when it comes to these questions, but we have the toolkit as a starting point,” she said. “The key question for the future is how can we design vaccines that specifically raise the most relevant type of immunity against the particular virus and in a diverse population.”

She said that currently, the two main strategies in vaccine developments were stockpiling, which is only effective if the pathogen has little variation and a low mutation rate, such as Ebola, and rapid development at the emergence of a new virus, which has been employed for the present pandemic.

“What happens if the next virus X emerges?” she said. “A situation where we do not know a relevant correlate of protection and we are really starting blindfolded.”

She suggested that in this event, a third strategy of in-depth immunology, or immunological fingerprinting, needed to come into play.

“We need to know how individuals will respond to a different antigen in terms of immune information and we need to couple that with increased understanding of which regions of a pathogen are more likely to dominate formation of immunity,” she said. “We are presently scratching the surface for this strategy, but efficient future pandemic management is entirely dependent on an increased understanding of the interaction between a virus, bacteria and its host. My advice for the future vaccine development would be to carefully select what you want to achieve in relation to which pathogen it is that you are actually trying to stop.”

However, Whelan at CEPI questioned whether an “upfront” correlate of protection was essential given that scientists had not found one for COVID-19 and nevertheless, vaccine development was well underway.

“It goes very much in parallel, it can’t go one ahead of the other,” he said “For influenza or a COVID, you have to go down the platform technology route so you can do something very quickly; you can’t wait for the correlate of protection.”