Sun Tsu, in The art of war, speaks of a skilful general who can subdue his enemy without any fighting. This principle constitutes the ultimate triumph. Today, we would need one such with the corona vaccine. Over the past two decades, three human coronaviruses (SARS-CoV, MERS-CoV, and SARS-CoV-2) emerged worldwide. However, there is still no approved vaccines for human coronaviruses. Research groups are using various approaches to develop vaccines. Vaccinations remain the best way to stop the spread of infectious diseases, reducing morbidity without longlasting effects.
Vaccine development starts with animal testing, followed by three phases of human clinical trials. However, faced with an unusual circumstance of a pandemic, some companies have attempted skipping this step. Even after the approval of a vaccine, challenges before us would include effectiveness in all populations and different strains of the mutating virus. The most legitimate concern is that it will be less successful in older people, who are the most vulnerable.
This ineffectiveness is not because of the vaccine itself, but the aged immune systems which generally do not respond as well to immunisation. Intensified efforts would be needed to develop a vaccine for this age group. Healthcare workers who come into contact with COVID-19 patients would also be at the top of the list to receive the vaccine. Until the development of vaccines to prevent infections, our best option is to prevent our body from being the host for the virus by maintaining social distancing and hygiene.
Most people infected by a coronavirus show mild symptoms and can be treated at home with bed rest, paracetamol and plenty of fluids. Some patients may develop a more severe disease and need hospital treatment. A vaccine is usually prepared by using weakened versions of those viruses that cannot cause a full-blown infection. With the genetic code of the coronavirus known, some of the new approaches being adopted is the “plug and play” vaccines.
Some other vaccines are being engineered by lifting small sections of the coronavirus’ genetic code and putting it into other, completely harmless, viruses. By infecting someone with the harmless bug, we can give them immunity against the infection. A few other groups have used pieces of raw genetic code that can be injected into the body. These would start producing bits of viral proteins to assist the immune system fight the virus. The Coalition for Epidemic Preparedness Innovations (CEPI) has provided funding to develop COVID vaccines using platform technology such as Curevac Inc, Moderna, Inc, University of Queensland, Novavax, University of Oxford, University of Hong Kong, and Institute of Pasteur.
The aim is to accelerate development of vaccines and enable equitable access to people. CEPI also links academics and pharmaceutical companies and provides financial support for the development of vaccines. A global vaccine research development pipeline for infectious diseases has been established. Nearly 70 ‘vaccine candidates’ are being tested globally and at least three have moved to the clinical trial stage, but are unlikely to be ready for mass use before 2021.
DR VISHAL RAO
Regional Director - Head Neck Surgical Oncology &
Robotic Surgery; Associate Dean - Centre of Academic
Research , HCG Cancer Centre