- A vaccine against COVID-19 should be ready in 12-18 months: Experts
- The world has 70 vaccine candidates; three have moved to human trial stage
- In the absence of COVID-19 vaccine, Delhi to begin trials of plasma therapy
New Delhi: On March 17, US National Institutes of Health (NIH) announced that a Phase 1 clinical trial evaluating an investigational vaccine designed to protect against coronavirus disease 2019 (COVID-19) has begun at Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle. Though the trials for the vaccine called mRNA-1273 begin a month ago and raised hopes, it was clearly stated that it may take another year to 18 months before the vaccine becomes available. In India also six companies are working on a vaccine for COVID-19. Across the world, there are 70 vaccine candidates.
While some believe that a vaccine against COVID-19 will be available by September 2020 and some are of the opinion that nothing until 2021. NDTV spoke to experts to know about the status of the vaccine and understand the dynamics of developing a vaccine.
Speaking about by when we can expect a vaccine, Saad Omer, Director of the Yale Institute for Global Health (YIGH), said,
We have some really promising candidates for the vaccine but there is a lot of uncertainty. You don’t know how a vaccine will behave in the human population so it’s reasonable to expect something in 2021. There may be outliners that we get unexpected news. We should be realistic about our expectation specifically from a policy planning perspective.
Talking about the complex process of developing a vaccine and why can’t we expect a vaccine anytime soon, Dr Rommel Tickoo, Associate Director of Internal Medicine at Max Healthcare said,
Normally it takes 10-15 years to develop a vaccine and you need lots of funds for that but in this case, we are hopeful that it’ll take 1-1.5 years for us to develop a vaccine against COVID-19 because lots of researchers and scientists all over the world are working on it. Having said that, vaccine has its own stages of development like there is a pre-clinical stage, clinical stage which has phase 1, phase 2, phase 3 trials, regulatory review, approvals, manufacturing, and quality control. So, you have to go through all that. We also have to see how efficacious it is, the safety profile and how long will the immunity last. As of now, there are 70 vaccine candidates all over the world out of which three have moved to human trial stage. Two are from America which are in the first phase of trial and one is from China which is in the second phase of trial.
The vaccine development will indeed take time and meanwhile, the Delhi government has announced the trials of plasma therapy. On Thursday (April 16), Delhi Chief Minister Arvind Kejriwal said the city has got the Centre’s approval to carry out clinical trials of plasma therapy to help critically ill coronavirus patients. The Chief Minister said,
Trial of Plasma Enrichment technique will begin in the next three or four days. If successful, we can save the lives of serious COVID-19 patients.
Plasma Therapy involves transfusion of plasma from a convalescent coronavirus patient to a critical patient. The blood of a convalescent patient is rich in antibodies that are expected to help the critical patient recover. Other countries like China, South Korea are also using this technique to save lives of people suffering from COVID-19.
Talking about whether or not India can depend on plasma therapy in the absence of a vaccine, Mr Omer said it’s promising but with a note of caution. He added,
There are two broad approaches of doing it – first, to throw the kitchen sink at the problem and try everything that exists; second, which seems to be happening with increasing frequency – which is to say, okay, these are the potential options based on the biology, based on the history from other infections, diseases and treatments and we are going to try out things systematically in trials, collect data, randomise people in certain situations. There can be non-randomised trials as well depending on the risk benefit calculus in a given situation and then we will improve our clinical practice. We will change our clinical repertoire based on those data. So using plasma has increasing evidence that’s been done the right way – generating evidence, quickly improving practice, broadening the use, looking at it again, so on and so forth.
Sharing his opinion on plasma therapy and how successful it can be, Dr Guido Vanham, Virologist said,
Plasma therapy has been successfully used in Hepatitis B and unsuccessfully in HIV and Hepatitis C. There is data from china that about 30 per cent of people who have recovered do not develop neutralising anti-bodies that can block the virus. If that is the case, therapy will not be universally successful but you can expect 60-70 per cent success.
In Delhi, Max Hospital is the first one to perform plasma therapy and the results have been promising. Sharing the insights of the same, Dr Tickoo said,
Though the evidence is anecdotal, we need randomised large scale trials on this but again having said that, in Max, we used it on a patient on compassionate grounds called off-label indications. The family wanted us to do something to save the patient and anyway he was not doing well. After taking the family into confidence, taking consent, and considering ICMR guidelines, we sued plasma. The patient is doing well and we plan to wean him off the ventilator in the next few days but again we need more trials, there is a need for more evidence. Whatever evidence we have in this case, plasma has been used in the past as well with Ebola, Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). I think we can use it on compassionate grounds.
Further talking about whether India needs to ramp up testing, experts in unison nodded and said ‘yes’. Dr Omer believes that in order to control the spread of the virus, it was necessary to impose a lockdown but while we are in it, testing needs to be ramped up. He said,
Testing should be paired with mass contact tracing, early isolation and quarantine even if it’s at home. There is a possibility to ramp up testing within India to much more – may be not to the ideal level – but increase it especially during the period where you are buying social distancing.
Sharing the same thoughts, Dr Tickoo informed that ICMR is doing about 30,000 tests a day and plans to take the number to 1 lakh in next few weeks. He added,
ICMR is also doing rapid antibody test. Though it has its own limitations; it’s not a confirmatory test and can give false negatives in the first week. Also, since the last three days, the numbers are going down which is a good sign. With the lockdown, ramping up of the testing and healthcare facilities, and tracing the contacts and quarantining them, I think we will be able to contain it by the end of the month.
Countries like Italy have started releasing restrictions and lockdown. Sharing his views on whether it’s the right step especially at this juncture, Dr Guido Vanham said,
It depends on how fast and in what way restrictions are removed. We have to maintain certain number of measures to slow down and mitigate the pandemic. The main thing is social distancing and hand hygiene – washing hands with soap. Tests are not 100 per cent sensitive. There are a lot of asymptomatic people that can spread the disease.
Dr Vanhma also noted that the infectious disease will stay with the world for a long time and meanwhile regular handwashing and social distancing might become the normal thing. COVID-19 might turn out to be a seasonal issue but we don’t know yet.
With India under a lockdown, new cases and stories of the spread of the virus are turning up. Like on Thursday (April 16), in Delhi, a food delivery guy was tested COVID-19 positive following which 72 families have been quarantined. The case raises a safety concern especially when ordering food and groceries online. Taking about whether it’s safe to receive a package or order food online, Dr Tickoo said,
Yes, it’s okay to receive food but we have to take precautions like clean the outer surface of whatever package we are receiving, wear a mask, and maintain distance while accepting the package. In the case of food, warm it which will kill the virus. Simultaneously, employers should screen their employees.