Developing Covid-19 vaccines in less than a year came from repurposing multiple, decade-old vaccine research platforms, but too many lives were lost, and a new goal of developing vaccines in 100 days is needed to counter the next global pathogen.

This is according to Dr Nicole Lurie, a Strategic Advisor to the UK-based Coalition for Epidemic Preparedness Innovations (CEPI), and an advisor to the World Bank and the World Health Organization, (WHO).

She was addressing a virtual global forum on tuberculosis (TB) vaccines on Thursday, 22 April, in a session on how to use lessons from Covid-19 to accelerate responses to the TB burden and antimicrobial resistance worldwide.

“There are amazing centres of excellence and a lot of synergy between them. When Covid-19 first showed up, I was struck by how these pockets of research sprung into action. But it’s a bit like a conductor-less orchestra. It’s not clear whose responsibility it is to do something specific, whose role it is to collect samples from patients at different levels of illness — and to share,” she said. “We need to know what our preparedness system looks like and invest more in that. There are terrific individual players. For us, it was great to see a Covid vaccine developed in less than a year, but an awful lot of people died. That’s way too long. We need to have a moon-shot aspiration to do this in 100 days, so the system has to be tuned, ready, and pre-deployed.”

Lurie said vaccine development platforms should be improved to enable the easy manufacturing of clinically approved products while keeping prices low to enable access and equity. She backed a proposal to create equity-based global science hubs made by Professor Gordon Dougan, Head of Pathogen Research at the Wellcome Trust Sanger Institute (WTSI) in Cambridge.

AU gets TB research boost

Lurie said CEPI had just signed a Memorandum of Understanding with the African Union probing TB vaccine manufacturing capacity to enable innovation, ease of access, and, cost-efficacy.

“It will have to co-exist with clinical trial networks and laboratories and scientific and community engagement capacity. Those networks need to be where the disease is – which is sometimes hard to predict,” she cautioned.

She urged building on previous pandemics, transforming these lessons into a day-to-day function between outbreaks via training and constant scientific advances. She cited the Ebola outbreak as an example of innovative, adaptive clinical trial design in therapeutics.

“We have not done that in vaccines. It’s been one trial at a time… with no great sense of how different vaccines compare to one another. This is now an area ripe for innovation,” she stressed.

‘Tremendous burden’

Dr Jim Kublin, Executive Director of the HIV Vaccine Trials Network, based at the Fred Hutchinson Cancer Research Centre in the US, said Covid-19 merely highlighted the tremendous burden of TB that existed globally.

“It’s a critical point for us – the huge boost Covid-19 vaccine research has given to the method and practice of teaching over the last year has been thrilling, especially for future generations of researchers. We’ll need an even stronger workforce as the HIV, TB, and Covid epidemics could stay with us for decades. There’ll be new pandemics that emerge – it’s very exciting and the global community needs to continue the momentum of scientific interest and enthusiasm,” he said.

Resurgence of research interest

Dr Erica Andersen-Nissen, Laboratory Director at the Cape Town HVTN Immunology Laboratory, told the forum that the Covid lockdown, requiring travel permits, social distancing, and shift work demanded unique methods of staff motivation.

“For those working with live viruses, social distancing is extremely important. The other big challenges are acquiring reagents and supplies so critical to developing these assays. We’re used to long lead times, but now labs around the world are also struggling to procure personal protective equipment. For those of us in the molecular space, there’s also big competition with diagnostic labs for PCR reagents. These are all barriers. However, getting specimens from C-19 individuals early on was easy for us, but for others with less infected cohorts, not so. Many of our labs could pivot quickly – but we needed funding quickly too! That was critical to our success.”

She agreed with Kublin about the tremendous boost Covid-19 had afforded scientific teaching. “To get assays up and running we’ve formed new collaborations that will endure beyond Covid for working on other diseases – one colleague in our SA Variant Consortium estimates she has twenty more collaborations than six months ago, just sharing data and information,” she said.

From high-level data to small details and shared protocols, this was saving her and her staff months of work and accelerating research. Virtual meetings also allowed the global sharing of scientific information and cutting-edge data.

“Everyone is waking up to the pace of research being too slow. We have to keep this momentum going. There are great opportunities to publish and to get early and mid-term investigators to take on leadership roles. Many have really stepped up to the plate. The new pathogen has reignited people’s interest and that can translate into other pathogens. We’re working in a time of trial and tribulation, but also one of amazing successes,” she said.

Dougan said Wellcome was busy reorganising its strategy when Covid-19 first struck last year, to focus on impact and knowledge translation in Climate Change, Mental Health, and Epidemics.

We were involved in the formation of CEPI on epidemics, but now we’re more interested in diseases that have the potential to escape therapy like TB, he said.

Wellcome’s genomics funding and open access data had borne rich fruit in the United Kingdom where 500,000 SARS-COV-2genomes had been sequenced. This also allowed investigators in low-to-middle-income countries to remotely access informatics and data — with a new global surveillance network being built around genomics. Many sustainable research hubs would be situated in high TB, HIV, Dengue, and Covid-19 prevalence countries, building on phenotyping — a type of screening used in biological research and drug discovery to identify substances such as small molecules, peptides, or RNAi that alter the phenotype of a cell or an organism in a desired manner. These could result in high-efficacy drugs or antibiotics.

When it came to TB, Wellcome was keen on backing just one or two promising, affordable vaccine candidates. “We want to use our funding power in a more targeted, scientific, investigation-driven way globally and TB is very much on the agenda,” he concluded. DM/MC

*This article was produced by Spotlight – health journalism in the public interest.