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Pharmacist Michael Witte, left, gives Neal Browning an injection in the first-stage safety study clinical trial of a potential vaccine for the COVID-19 coronavirus on Monday at the Kaiser Permanente Washington Health Research Institute in Seattle in the US. Ted S Warren/PA Images

Here are the potential Covid-19 vaccine and treatment options being developed

The World Health Organization has said it could take 12 to 18 months for a vaccine to be developed and approved for use.

PHARMACEUTICAL AND RESEARCH labs across the world are racing to find vaccines and treatments for the coronavirus Covid-19, using a variety of different technologies.

Ursula von der Leyen, the president of the European Commission, after speaking to a German biotech firm, yesterday said she hopes a vaccine against the novel coronavirus strain will be available this year.

However, the World Health Organization (WHO) previously said it could take 12 to 18 months for a vaccine to be developed and approved for use. Dr Colm Henry from the HSE echoed this yesterday, saying the “prospect of a widely available vaccine is at least 12 to 18 months off”.

Von der Leyen made her comments after holding talks with executives from CureVac, a German biotech company that has received an offer of €80 million euros in EU financial support for its research.

“They are working on a promising technology to develop a vaccine against the coronavirus,” von der Leyen said in an online video message shortly before she was to join talks with the 27 EU leaders.

“The European Union is providing them up to €80 million and I hope that with this support we can have a vaccine on the market, perhaps before autumn. This could save lives in Europe and in the rest of the world too,” the former German defence minister added.

On Monday, CureVac denied newspaper reports that US President Donald Trump had offered to pay for exclusive rights to a coronavirus vaccine.

Benjamin Neuman, a virologist at Texas A&M University-Texarkana, immunising against the pathogen is a long shot as there has never been a very successful human vaccine against any member of the coronavirus family.

“This is going to be a lot of trial, a lot of error, but we have a lot of options to try,” Neuman said.

Treatment could come sooner than a vaccine, with antiviral drug remdesivir – which was originally developed by Gilead Sciences as a treatment for Ebola virus – showing early promise and already being used on an ad-hoc basis before regulatory approval.

Trump has urged his scientists and drug companies to speed up the process of finding a treatment or vaccine – but experts say fundamental constraints mean the process could be lengthy.

“A vaccine has to have a fundamental scientific basis. It has to be manufacturable. It has to be safe. This could take a year and a half – or much longer,” H Holden Thorp, the editor-in-chief of the journal Science wrote in response to Trump’s calls.

“Pharmaceutical executives have every incentive to get there quickly – they will be selling the vaccine after all – but thankfully, they also know that you can’t break the laws of nature to get there.”

The United States is funding several companies through the Department of Health and Human Services (HHS) and National Institutes of Health (NIH).

The Coalition for Epidemic Preparedness Innovations (CEPI), a global organisation based in Oslo, is also helping to fund many companies, mostly smaller partners that would lack the capacity to scale-up mass production. It has so far provided about $24 million (about €22 million).

There are now over 200,000 confirmed cases worldwide and more than 7,600 deaths. There are 292 confirmed cases in the Republic of Ireland and there have been two deaths here to date.

Here is a breakdown of the ongoing global attempts to find a treatment and/or vaccine for Covid-19:

Firm: Gilead Science

What it is: Treatment

When it might come: Later this year

Of all the drugs linked to the virus that causes Covid-19, Gilead’s remdesivir could be the closest to market launch. It’s actually not new per se but was developed to fight other viruses including Ebola (where it was shown to be ineffective) and it hasn’t yet been approved for anything.

Still, it has shown early promise in treating some coronavirus patients in China, according to doctors, and Gilead is moving ahead with final-stage clinical trials in Asia (known as “Phase 3″). It has also been used to treat at least one US patient so far.

NIH’s Anthony Fauci, one of the top government scientists overseeing the coronavirus response, has said it could be available in the next “several months”.

“There’s only one drug right now that we think may have real efficacy. And that’s remdesivir,” Bruce Aylward, a WHO official, said at a recent press conference in China.

Remdesivir gets modified inside the human body to become similar to one of the four building blocks of DNA, called nucleotides.

Neuman told AFP that when viruses copy themselves, they do it “quickly and a bit sloppily”, meaning they might incorporate remdevisir into their structure — though human cells, which are more fastidious, won’t make the same mistake.

If the virus incorporates the remdesivir into itself, the drug adds unwanted mutations that can destroy the virus.

Firm: Moderna

What it is: Vaccine

When it might come: 12-18 months

Within weeks of Chinese researchers making the genome of the virus public, a team at the University of Texas at Austin was able to create a replica model of its spike protein, the part which attaches to and infects human cells, and image it using a cryogenic (cooled) electron microscope.

This replica itself is now the basis for a vaccine candidate because it may provoke an immune response in the human body without causing harm – the classical method for developing vaccines based on principles dating back to smallpox vaccine in 1796.

NIH is also working with Moderna, a relatively new firm founded in 2010, to make a vaccine using the protein’s genetic information to grow it inside human muscle tissue, rather than having to inject it in.

This information is stored in an intermediary transient substance called “messenger RNA” that carries genetic code from DNA to cells.

“The advantage is that it’s really fast,” explained Jason McLellan, who led the UT Austin team, whereas the traditional approach of creating the protein outside is difficult to scale and takes a long time.

The vaccine began its first human trial on March 16 after being proven effective in mice.

If all goes to plan, it could be available on the market in about a year and a half, ready in case the coronavirus outbreak continues until the next flu season, according to Fauci.

Firm: Regeneron 

What it is: Treatment and vaccine

When it might come: Unclear

Regeneron last year developed an intravenous drug that was shown to significantly boost survival rates among Ebola patients using what are known as “monoclonal antibodies”. 

To do this, they genetically-modified mice to give them human-like immune systems. The mice are exposed to viruses, or weakened forms of them, in order to produce human antibodies, Christos Kyratsous, the company’s vice president of research told AFP.

These antibodies are then isolated and screened to find the most potent ones, which are grown in labs, purified and given to humans intravenously.

“If everything goes well, we should know what our best antibodies are within the next few weeks,” with human trials to begin by summer, Kyratsous said.

The drug could work as both a treatment and as a vaccine, by dosing up people before they are exposed – though these effects would be only temporary.

In the short term, they are also trying to repurpose another of their drugs devised using the same platform called Kevzara, which is approved to treat inflammation caused by arthritis.

This could help fight the lung inflammation seen in the severe forms of the COVID-19 disease – in other words fighting a symptom as opposed to the virus itself.

Firm: Sanofi 

What it is: Vaccine

When it might come: Unclear

The French drugmaker is partnering with the US government to use a so-called “recombinant DNA platform” to produce a vaccine candidate.

It takes the virus’ DNA and combines it with DNA from a harmless virus, creating a chimera that can provoke an immune response.

The antigens it produces can then be scaled up.

The technology is already the basis of Sanofi’s influenza vaccine, and believes it has a head start due to a SARS vaccine it developed that offered partial protection in animals.

David Loew, the company’s head of vaccines, is reported to have said Sanofi expects to have a research candidate ready for lab testing within six months and for clinical study within 18 months. 

Firm: Inovio Pharmaceuticals 

What it is: Vaccine

When it might come: Emergency supplies may be available by end of year

Inovio, another US biopharmaceutical, has since its founding in the 1980s worked on DNA vaccines — which work in a similar way to RNA vaccines explained above but work at an earlier link of the chain.

As an analogy, DNA can be thought of as a reference book in a library, while RNA is like a photocopy of a page from that book containing instructions to carry out a task.

“We plan to begin human clinical trials in the US in April and soon thereafter in China and South Korea, where the outbreak is impacting the most people,” J Joseph Kim, Inovio’s president and CEO, said in a statement.

“We plan on delivering one million doses by year-end with existing resources and capacity.”

Other notable efforts

British drugmaker GlaxoSmithKline has teamed up with a Chinese biotech firm, providing adjuvant platform technology.

An adjuvant is added to some vaccines to enhance the immune response, thereby creating a stronger and longer-lasting immunity against infections than the vaccine alone.

Like Moderna, CureVac is working with the University of Queensland on a messenger RNA vaccine. Its CEO Daniel Menichella met with the White House earlier this month and announced the company expects to have a candidate within a few months.

American pharma Johnson & Johnson is looking at repurposing some of its existing drugs to see how they might help treat the symptoms of patients already infected with the virus.

It’s also working on developing a vaccine involving a deactivated version of the pathogen.

US drugmaker Pfizer has signed a deal with Germany’s BioNTech SE to co-develop a potential vaccine. The drugmakers have signed a letter of intent for the vaccine’s distribution outside China, they said in a joint statement.

California-based Vir biotechnology has isolated antibodies from SARS survivors and is looking to see if these can treat the new coronavirus. Its platform has previously developed treatments for Ebola and other diseases.

Even the likes of chloroquine – the synthetic form of quinine, used to treat malaria, may have some properties that fight the virus and scientists are calling for more work to investigate.

Russian scientists have also begun to test vaccine prototypes, and plan to present the most effective one by June, a laboratory chief at a state biotech institute said.

“The prototypes have been created. We are starting laboratory testing on animals, to ensure effectiveness and safety,” Ilnaz Imatdinov of the Vector Institute in Siberia told the Vesti Novosibirsk television channel on Monday.

“In June we will present one or two showing the best results.”

Vector Institute is a state virology and biotechnology centre in Novosibirsk, which previously worked on vaccines for the Ebola virus.

© AFP 2020, with reporting by Órla Ryan

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