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This brief article is a first early warning about possible uncertainty regarding vaccines against the COVID-19 and mass vaccination for the pandemic. Despite multiple ‘good news’ announcements invading media, business and policy-makers circles, and governments’ establishment, some indications that could lead to dangerous evolutions multiply and deserve further and more in-depth analysis and monitoring.
As the COVID-19 pandemic developed, vaccination and related variables became fundamental key factors. We thus immediately added them on our watch list of indicators to monitor. Indeed, vaccination – alongside treatment – critically determines the timeframe for the pandemic. In other words, until a successful mass vaccination campaign has taken place (or the virus magically disappears), we shall have to live with the COVID-19 and its stringent rules (see The COVID-19 Pandemic, Surviving and Reconstructing).
To date, 22 June 2020, we have seen an accumulation of indications and signals according to which hurdles may exist for the COVID-19 mass vaccination needed to end the pandemic. We identified four types of challenge, and focus here on three of them, namely
- possible mutations of the SARS-CoV-2 that could affect the efficiency of some candidate vaccines;
- possible bottlenecks in the vaccine manufacturing supply chain that could impact delivery of doses;
- possible distrust of COVID-19 vaccination and thus difficulty to reach herd immunity.
The last challenge the “competition and race for future COVID-19 mass vaccination”, as expected, has also started and must also be closely monitored. We shall not focus on that particular aspect of the issue here.
We thus estimate that a renewed uncertainty regarding the future COVID-19 mass vaccination campaign must be added on the watchlist of possible challenges to monitor. It warrants in-depth strategic foresight and warning analysis at global and country levels, especially if one also wants to address the race to vaccination. The very high impact that such challenge would have, were it to materialise substantially across countries, is sufficient to pay attention to the issue.
Below, we share with members and readers some early indications of the rise of the issue. We then highlight some points that must be considered in the framework of a strategic foresight and warning or risk analysis. These points should also help with monitoring. Finally, we provide a couple of useful online resources and background explanations.
Nota Bene: Starting to monitor the rise of a possible danger or threat does not mean that the threat will materialise with absolute certainty. It means that the possibility to see that threat becoming a reality increases. Thus the evolution must be followed closely. Actors may start thinking about developing answers and responses accordingly. They may also think about steering policies in a way that will mitigate as much as possible the materialisation of the threat.
Some early indications and signals
1- Could some mutations of the SARS-CoV-2 affect the efficiency of some candidate vaccines?
Independent scientific analysis including by neuropharmacologists, specialists of genomic virology etc., would be required to assess and then monitor in detail the potential risk to each candidate vaccine.
SARS-CoV-2 mutations in general
CGTN, “China releases gene sequence data of Beijing COVID-19 strain“, 19 June 2020.
L. van Dorp, M. Acman, D. Richard, L.P. Shaw, C.E. Ford., L. Ormond, C.J. Owen, J. Pang, C.C.S. Tan, F.A.T. Boshier, A.T. Ortiz, F. Balloux, “Emergence of genomic diversity and recurrent mutations in SARS-CoV-2″, Infection, Genetics and Evolution, Volume 83, September 2020, https://doi.org/10.1016/j.meegid.2020.104351
Jody Phelan, Wouter Deelder, Daniel Ward, Susana Campino, Martin L. Hibberd, Taane G Clark, “Controlling the SARS-CoV-2 outbreak, insights from large scale whole genome sequences generated across the world“, bioRxiv 2020.04.28.066977; doi: https://doi.org/10.1101/2020.04.28.066977 This article is a preprint and has not been certified by peer review.
SARS CoV-2 Mutation and vaccination
London School of Hygiene & Tropical Medicine, “Coronavirus evolving: How SARS-CoV-2 mutations could delay vaccine development“, 12.05.2020.
Elyse Hope, “Virus evolution: what do viral mutations mean for vaccine efficacy?“, Genome British Columbia, 20 April 2020.
Zharko Daniloski, Xinyi Guo, Neville E. Sanjana, “The D614G mutation in SARS-CoV-2 Spike increases transduction of multiple human cell types,” bioRxiv 2020.06.14.151357; doi: https://doi.org/10.1101/2020.06.14.151357 – This article is a preprint and has not been certified by peer review.
B Korber, WM Fischer, S Gnanakaran, H Yoon, J Theiler, W Abfalterer, B Foley, EE Giorgi, T Bhattacharya, MD Parker, DG Partridge, CM Evans, TM Freeman, TI de Silva, on behalf of the Sheffield COVID-19 Genomics Group, CC LaBranche, DC Montefiori, “Spike mutation pipeline reveals the emergence of a more transmissible form of SARS-CoV-2“, bioRxiv 2020.04.29.069054; doi: https://doi.org/10.1101/2020.04.29.069054 – This article is a preprint and has not been certified by peer review – It has been criticised methodologically: see, for a review of criticisms through twitter – which is highly unorthodox – Alan Boyle, “Studies of coronavirus evolution stir up a controversy for scientists on social media”, Geekwire, 5 May 2020
2- Bottlenecks in the vaccine manufacturing supply chain
It is not only that vaccines must be developed, they must also be produced in sufficient quantities. This implies that all components necessary be also produced in sufficient quantities. Some tensions and bottlenecks may exist on part of the supply chain. Each of them need to be closely monitored.
New – Julie Steenhuysen, “Exclusive: Vaccine alliance finds manufacturing capacity for 4 billion doses of coronavirus vaccines“, Reuters, 25 June 2020.
Roxanne Khamsi, “If a coronavirus vaccine arrives, can the world make enough?“, Nature, 9 April 2020.
Ludwig Burger, Matthias Blamont, “Exclusive: Bottlenecks? Glass vial makers prepare for COVID-19 vaccine,”, Reuters, 12 June 2020.
Ned Pagliarulo, “Facing vial shortage, pharmas explore workarounds for coronavirus vaccines“, Biopharma dive, 28 May 2020.
3- Possible distrust of COVID-19 vaccination and thus difficulty to achieve herd immunity
Developing an efficient vaccine is a crucial step for immunisation. However, if it is done in such a way that an insufficient part of the population accepts the vaccine, then mass immunisation – the famous herd immunity – will not be achieved.
A video by the Wall Street Journal interestingly summarises some possibly worrying points and challenges regarding the current way the SARS-CoV2 vaccines are developed. Considering that the WSJ is widely read and respected, this video may also increase caution among the population.
Speed, efficiency, safety and ethics
Note that a related uncertainty emerges here, regarding the safety of the future vaccine.
Shayan Sharif and Byram W. Bridle, “Fast COVID-19 vaccine timelines are unrealistic and put the integrity of scientists at risk“, The Conversation, 15 June 2020.
Jonathan Lambert, “Infecting people with COVID-19 could speed vaccine trials. Is it worth it?“, Science News, 27 May 2020
Tim Lahey, “An Unproven Vaccine Is Too Risky“, The New York Times, 16 April 2020
Totally new ways to create vaccines
As with the previous factor, another related uncertainty emerges regarding the unknown possible consequences of inoculating totally new types of vaccines. In other words, what effect could such novel types of vaccines have on the human body? On the virus? On other viruses? At medium and long term? Could we see variations in terms of impact according to the quantity of people being immunised with such vaccines?
Video The Promise and Peril of Fast-Tracking the Coronavirus Vaccine | WSJ – 3 June 2020 – see above
Charles Schmidt, “Genetic Engineering Could Make a COVID-19 Vaccine in Months Rather Than Years,” Scientific American, 1 June 2020.
Ifeoma Ajunwa, Forrest Briscoe, “The Answer to a COVID-19 Vaccine May Lie in Our Genes, But …“, Scientific American, May 13, 2020
Legitimacy challenges for political and scientific authorities
This factor needs to be addressed at both global and country level. Indeed, some countries and societies may be largely opposed to vaccination while others may not be. Besides pre-existing constituted and organised anti-vaccination movement, as in the articles below, one should also consider all severe discontent with governments, states and scientific authorities. This discontent may have increased and accumulated since the start of the COVID-19 pandemic. It may also have preexisted and reached a critical level with the pandemic. Detailed country analysis will be necessary. Possibly, distrust promoted in the framework of international tension – “propaganda” – will likely play its part.
Nicholas Bogel-Burroughs, “Antivaccination Activists Are Growing Force at Virus Protests“, The New York Times, 2 May 2020.
Steve P Calandrillo, “Vanishing Vaccinations: Why Are So Many Americans Opting Out of Vaccinating Their Children?“, Univ Mich J Law Reform. Winter 2004;37(2):353-440
Adam Gabbatt, “US anti-vaxxers aim to spread fear over future coronavirus vaccine“, The Guardian, 29 May 2020.
Some important points to consider
A successful mass vaccination will allow a society to consider the pandemic is over. Thus, a safe and efficient vaccine and related mass vaccination campaign determine the timeframe of the pandemic. We need to learn to live with the COVID-19 until successful mass vaccination takes place.
Each delay or failure in the development of a vaccine means that we must be ready to live longer with the COVID-19.
We initially estimated that a full vaccination campaign, following proper trials, could start at the end of 2022. However, since then, vaccination companies and labs have rivalled to promise vaccines much earlier. For example, Astrazeneca (vaccine developed by Oxford University lab) states that delivery (but we do not know how many doses) will start “by the end of 2020” (Astrazeneca Media, 13 June 2020).
We should nonetheless remember first, that, to date, no candidate vaccine has successfully finished all trial phases. Then, the dates given by manufacturing companies do not correspond to full immunisation and thus to the end of the global pandemic. Finally, considering the uncertainties highlighted above, the dates found in press releases appear even more remote and uncertain as far as full immunisation for the whole world is concerned.
Variations of the factors identified above, in terms of countries, will have severe consequences in terms of international relations and new emerging international order.
Estimates and analyses need to also be assessed according to the stakes of the actors in the vaccination process. Because the stakes are very high here, ideological polarisation is likely to be very strong too. For example, actors with a high stake in a return to the previous type of world, even if they have no link whatsoever to the vaccination industry, may tend to be more optimistic than others. On the contrary, seasoned vaccines manufacturers with a highly ethical company culture may be more cautious in their assessment. Critical thinking – as always – is thus extremely important.
Other unrelated factors may impact the whole vaccination process (climate change, emergence of another pandemic, other diseases that also demand vaccination, food insecurity, transportation upheavals, communitarianism and related riots, more largely civil disorders, etc.)
Some further resources
WHO – Draft landscape of COVID-19 candidate vaccines – regularly updated.
Wang, Fuzhou et al. “An Evidence Based Perspective on mRNA-SARS-CoV-2 Vaccine Development.” Medical science monitor : international medical journal of experimental and clinical research vol. 26 e924700. 5 May. 2020, doi:10.12659/MSM.924700
“Oxford COVID-19 vaccine to begin phase II/III human trials“, 22 May 2020.
Ben Adams, “With hard cash from U.K., Imperial to kick-start next-gen COVID-19 vaccine trials this month“, Fierce Biotech, 16 June 2020
GISAID – Genomic epidemiology of hCoV-19
Nextstrain – Real-time tracking of pathogen evolution
Los Alamos National Laboratory and Edge Bioinformatics: COVID-19 Genome Analytics
Featured image: Image par Alfonso Cerezo de Pixabay [Public Domain].