What are the current vaccine candidates?

According to the World Health Organisation (WHO), as of 3 November there are 47 vaccine candidates in clinical evaluation. Of these, ten are currently in the most advanced trials, known as phase 3 clinical trials.

The vaccine in development at the University of Oxford, in partnership with the pharmaceutical company AstraZeneca, is one of the candidates currently in the furthest stage of development. The vaccine is made using a weakened version of the adenovirus from monkeys known as ChAdOx1. This vaccine is being manufactured in the UK. The candidate being developed by Pfizer and BioNTech is also in the furthest stage of development, and has produced early trial results showing 90% effectiveness. All vaccines are yet to pass clinical safety tests, which are required before widespread UK distribution can begin.

The vaccine being developed by Moderna and the National Institute of Allergy and Infectious Diseases in the United States is also in advanced phase 3 clinical trials. Unlike the Oxford vaccine, the Moderna vaccine, as well as the Pfizer vaccine, uses a synthetic mRNA molecule to trick the body into developing the natural viral proteins that spread an infection. Some scientists have claimed that mRNA vaccines are faster, safer and cheaper to produce than traditional vaccines.

On 3 November 2020, Sir Patrick Vallance told the House of Commons Science and Technology Committee:

There are now vaccines that produce good immune responses. It does not mean they are going to work but they are on track. They are in late stage clinical trials and we will get the [data] readouts. Those are all quite concrete things that are pointing in the right direction.

When will the vaccine be ready?

There are differing perspectives on when the first vaccine candidates are expected to be delivered and ready for circulation. Prior to the Pfizer candidate releasing its 90% effectiveness results on 9 November 2020, many scientists predicted early 2021 as the earliest point at which a vaccine would be available. However, on 10 November, the Health Secretary, Matt Hancock, stated that NHS staff will be ready to deliver a vaccine from 1 December 2020, subject to regulatory approval and safety tests. Hancock also stated that “many hurdles” remain until a vaccine is ready for deployment, and that the Government will not deploy a vaccine unless it is fully confident in its clinical safety.

In November 2020, the chief executive of NHS England, Sir Simon Stevens, stated that his expectation was that a vaccine would be available in the first part of 2021. Sir Simon continued:

[…] we want to be ready, just in case [a vaccine] becomes available this side of Christmas. The NHS has reached an agreement with general practice leaders to mobilise now and be ready to start delivering a vaccine to patients in December.

In his evidence given on 4 November 2020, the trial chief investigator on the Oxford vaccine candidate, Andrew Pollard, told the Commons Science and Technology Committee that it was very difficult for scientists to accurately predict when a vaccine will be ready for deployment. He stated that a vaccine would normally take years to develop, but factors including large amounts of government and private funding, and over double the usual number of people participating in clinical trials, mean that it is possible that a successful vaccine will be ready at some point in 2021.

Who will be prioritised for a vaccine?

Sir Simon Stevens has stated that the NHS’s current system for delivering flu vaccinations through GPs and pharmacists will be used to deliver the new Covid-19 vaccine. Initial priority will be given to older people, health workers and care home staff.

The Joint Committee on Vaccination and Immunisation (JCVI) has published recommendations for the prioritisation of groups when a vaccine becomes available. It called for care home residents and staff to have highest priority, followed by people over 80 and then health and social workers. The rest of the population would then receive it in order of age and risk.

The JCVI’s recommendations for who gets priority are predominantly age based. This is due to a number of factors, including:

  • evidence indicating that risk from Covid-19 increases exponentially with age;
  • evidence that risk increases in those with underlying health conditions, of which the older population make up a large number; and
  • simple age-based vaccination programmes are easier to deliver and therefore achieve higher vaccine uptake.

Planning has already started on how to distribute the vaccine in many countries around the world, with the World Health Organisation (WHO) publishing guidance on how vaccines should be allocated and prioritised.

How will poor and middle-income countries get a vaccine?

Scientists and policy makers have raised concerns around vaccine nationalism, and how this will impact poorer states’ access to a successful vaccine candidate. According to research conducted by Oxfam, higher-income states covering 13% of the population have already bought around 51% of the potential vaccine supply. The UK has pre-ordered around 380 million doses from a variety of global manufacturers.

In April 2020, the WHO launched the Access to Covid-19 Tools Accelerator, a “global collaboration to accelerate development, production, and equitable access to Covid-19 tests, treatments, and vaccines”.

The third pillar of this collaboration, the Covid-19 Global Vaccine Access Facility (COVAX), is a major global procurement project attempting to secure vaccine supply for poorer states. Funding from richer member states, as well as from the private sector, will ensure that nine different vaccine candidates, if successful, will be distributed globally through the programme. The aim of COVAX is to deliver 2 billion doses to its member states by the end of 2021.

The UK Government has signed up to the COVAX facility. In a speech on 30 September 2020, the Foreign Secretary, Dominic Raab, stated:

We want to be able to ensure large-scale manufacturing, rapid delivery of the future vaccines globally and on an equitable basis. I’m very proud that the Prime Minister has announced the UK’s participation in the COVAX facility, which demonstrates our commitment to multilateral solutions to the global challenges that we all face.

Cover image by Daniel Schludi on Unsplash.