- Covishield, the Oxford vaccine will be a two dose vaccine: Mr Poonawalla
- During trials, a gap of 1 month is being given between 2 doses of vaccine
- Mr Poonawalla said the Oxford vaccine will be affordable
New Delhi: The race for the COVID-19 vaccine is on with numerous vaccine candidates at different stages of trials across the world. In India, three plausible vaccines against the Novel Coronavirus (SARS-CoV-2) are in different stages of trials. One of the frontrunners in the global race for a COVID-19 vaccine is British-Swedish pharma company AstraZeneca which is developing a vaccine in collaboration with the University of Oxford. The Serum Institute of India (SII), the world’s largest vaccine maker by the number of doses produced, had partnered with AstraZeneca to conduct the trials in India and manufacture AZD1222, which will be called ‘Covishield’ in the country. So far, the progress has been good but the billions of people around the world, waiting for a vaccine, have numerous questions like, what will be the cost, when will it be available, and about access criteria. In an exclusive interview with NDTV, Adar Poonawalla, CEO, SII answers all these questions.
NDTV: When does the Serum Institute of India intend to rollout the Covishield vaccine?
Adar Poonawalla: It’s now directly related to the UK trials that are on the verge of completion currently. If the UK goes in for an emergency license; we heard some reports recently about some hospitals that are going to get the vaccine in the first or second week of November then it will be down to our regulators and the government of India to finally decide whether we also go down the emergency license route. Having said that, we will have to look at the data available both in the UK and India. We have some good news, as per the UK reports from AstraZeneca and Oxford, the vaccine is working in the elderly and vulnerable population which was a concern as well. If we look back in April and May, I would have never dreamt that we would come to this stage so quickly. Our trials are also going very well in India. We have injected more than 1,000 people with the vaccine.
NDTV: In terms of acceptance over here in India, what were the processes assuming there is an emergency permission which is granted in the UK?
Adar Poonawalla: You will have to check that with the government of India on their decision to go ahead and do that. It is still a bit early for that. Maybe in a few weeks we can look at the data, analyse it and see whether it is worth giving to a limited population – elderly, healthcare workers, and the most vulnerable people. It is definitely giving an immune response; both the antibody response and t-cell response which is for long term immunity. We need vaccines that will give you long term immunity. A lot of people today get the disease and feel they will be protected forever. That is not the case sadly. After four or five months you can still get the disease again and have long-term side effects. It is better to take the vaccine and also we hope that these vaccines will give long term protection that we all need.
NDTV: You said, in the next few weeks, there needs to be a decision on whether you would perhaps use this on a trial basis on the elderly and amongst certain other groups. Is that what you are looking at? Assuming there are permissions, in India, you would be able to start a limited process of vaccinating people?
Adar Poonawalla: That’s for the government of India and health ministry to answer because they would have to be confident and decide. I can’t say, look, use this vaccine under an emergency license. This conversation would have to happen of course after the UK, which has done extensive trials in thousands of patients, licenses the vaccine in the UK. It’s only after that, in a few weeks, we can have that conversation with the government of India, health ministry and experts here to see whether it makes sense to look at doing something similar in India as well.
NDTV: People want to know about time. You have mentioned it is not in your hands, the government has to decide and trials need to finish. Let’s talk about that peer-reviewed data in the U.K., how long will that take?
Adar Poonawalla: Firstly, if we don’t go for an emergency license our trials should be over by December and then we can maybe launch in India in January subject to the U.K. trial also being completed which is on the verge of being completed. It could still take two months for widespread availability. Secondly, if the U.K. in the next two weeks were to unblind their study and share the data and be confident that it’s safe then we can after 2-3 weeks apply to the Indian regulator to look at a possible emergency license if that’s what the government of India wants. That review could take another 2-3 weeks I imagine and then you can have a vaccine by December. But all these would have to happen and I don’t want to venture a guess whether that would happen or not happen because it’s not my place to do so, that’s for the health ministry officials to decide.
NDTV: Are there any reasons to be concerned about the pause this month in stage 3 trials?
Adar Poonawalla: No, not at all. In fact, we didn’t really need to pause even the first time around because the vaccine was never causing an issue. It was a non-vaccine related event which was investigated and we paused it rightly so like the Drug Controller General of India (DCGI) requested us to and then we continued as soon as we shared the data that the patient overseas had neurological issues which had nothing to do with the vaccine. The vaccine is very safe. Thousands of people have had it in India and abroad. We are on track with no safety concerns.
NDTV: How effective do you believe the first-generation of COVID vaccines will be and for how long?
Adar Poonawalla: The t-cell response is an indicator of how you will develop your long term immunity and have immunity after your antibodies drain of in three or four months. It’s your T-cell, CD8 response which will give you that immunity if you are under an attack after a couple of months. Now, whilst that indication is strong and good with the Oxford candidate and some of the others we are working on. Not all the other candidates in clinical trials have shown that. And having said that, it is still not a guarantee so I must make that clear, it is only after a year or two when we actually see vaccinated people or patients being protected if they are exposed to the virus we will know that vaccine has given you that long term immunity. We will have to wait for a year or two to really know that beyond a reasonable doubt. But the indicators are all positive. Science is all positive to indicate that you will have that long term immune response.
NDTV: Would there be a requirement for booster dose after a few months even initially?
Adar Poonawalla: Absolutely. The Oxford vaccine is going to be a two dose vaccine. All the other candidates are going to be two dose vaccines. In fact, if you look at all the other vaccines that have been given to children, they are three dose vaccines. Pneumonia, measles, and even the HPV given to adolescent girls is two to three dose vaccines. So, most vaccines need the second and third dose to give you that boost and long term immunity going forward.
NDTV: Do we know when that booster dose, the first one, would need to be administered?
Adar Poonawalla: At the moment, as it is being done in trials, it’s a 28 day or a month you can call it the gap between the first and the second dose.
NDTV: Will Covishield impact different age groups differently?
Adar Poonawalla: Well, of course, all vaccines give a different immune response. If you are young, fit and healthy and your immune system is robust, you will probably respond better to a vaccine. I assume the same will hold true even for this vaccine. Having said that, the concern was that will the elderly be protected? We added the older generation also to our trial here in India to prove just that. The UK has done that also and shared the data publically to say that it does give an immune response to the elderly which is good news. It will give a slightly different response but it seems at the moment that we are going to get a response both in the young and healthy and also the elderly.
NDTV: How much will a single dose of Covishield cost?
Adar Poonawalla: That’s one thing I won’t comment on because we are talking to the highest levels of the governments and that’s sensitive. When they announce it, everyone will hear about it. But it is going to be very affordable. It is going to be a few hundred rupees. It is going to be way cheaper than RT-PCR test. It’s going to be affordable and the government will take most of the load financially. All the departments have been very helpful and proactive in that.
NDTV: Where else will you export Covishield?
Adar Poonawalla: Mainly to the African countries, a little bit to South America and of course, our neighbors Bangladesh, and Nepal. At the moment, the tie-ups that we have between Novavax and the Oxford AstraZeneca product, we have rights in about 68 countries with Oxford and 92 countries with Noxavax. Mainly, it’s Africa, India and some parts of Asia. When our own candidates come in about year and year and a half, we will go to Europe and the United States with our own candidates.
NDTV: How would they be priced outside India?
Adar Poonawalla: They will be priced at a substantially higher price. I will definitely subsidise the price for my country because that’s what I can do. Especially because our population is so large, it will need a huge budget. We are doing our best to keep the prices absolute lowest in India.
NDTV: Where does India stand currently in terms of potentially distributing millions of doses in a small period of time?
Adar Poonawalla: Traditionally, we have relied on the universal immunisation programme that’s geared up to have vaccines go out to the mothers and children in these clinics all over the country. We will be largely relying on that. We will be augmenting and enhancing those facilities in those locations to have more cold storage and better cold storage condition.
NDTV: How will the vaccine be distributed once it’s ready?
Adar Poonawalla: We are going to leave that to the decision making at the centre. They are going to decide the most vulnerable areas and people that it should be given to in terms of healthcare workers, and the elderly. How they distribute it in the states also will be decided by them.
NDTV: How long will it take you to ramp up production to 200 million doses per month?
Adar Poonawalla: The target was always 100 million doses per month. By the third or fourth quarter of 2021, we will get there. At the moment, we are at a capacity of 40-50 million doses per month, we have started production and stock piling already. As we ramp that up, we will get to 100 million doses per month. Which I think will be more than enough given that there are other candidates and other manufacturers also who will start supplying from the second or third quarter of next year. That’s when you will see a really lot of supply coming into.
NDTV: Would patients or people need to vaccinate themselves using different drugs for the best solution?
Adar Poonawalla: What the health experts have recommended is that take whatever the safe and efficacious vaccines are available at the moment because getting the disease is far worse than getting that 50-70 per cent protection. Wait to take another shot and a booster and I must clarify, we are going to have to do some trials to show that it is okay for you to take another vaccine maybe a year later. There is already talk of some studies where they are going to do a trial with multiple vaccines being taken over a period of time by the same patient and there should be no safety complication on that. May be yes, in a year you could try out and take second vaccine as a booster shot depending on whatever is the best thing at that time. Certainly not wait for those vaccines to come about because that could be six months or a year.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.