Reinventing Vaccines To Save Lives And The Economy

Pfizer Inc. PFE and BioNTech SE BNTX were the first to deliver good news regarding the efficiency of their coronavirus vaccine candidate. Moderna Inc MRNA had its turn last week delivering even better news with U.S. stocks hitting a new record. This Monday, stocks also rejoiced as the University of Oxford and AstraZeneca plc AZN delivered the third major breakthrough in stopping people from developing COVID-19 symptoms. A process that usually takes a decade was shortened to just 10 months, with drugmakers providing a glimpse of light at the end of the global pandemic tunnel.

mRNA Vaccines By Pfizer & BioNTech And Moderna

Last week, Pfizer announced that early data show its vaccine is more than 90% effective. Moderna went a step further as it revealed 94.5% effectiveness of its candidate, making it the second vaccine in the U.S. to have a stunningly high success rate. Both companies reported that there were no serious side effects with only a small percentage of participants experiencing mild ache symptoms such as headaches.

Pfizer's and Moderna's vaccines have similar results because they use the same technique to activate the body's immune system as they inject the virus's genetic code for the immune system to create antibodies. This genetic code is the messenger RNA or mRNA, that mimics what the virus does without causing the disease. If a vaccinated person is later actually exposed to the coronavirus, those antibodies should be ready to attack and defend. Although this new technology is not found in any vaccine currently on the market, these impressive results seen in both trials seem to validate its efficiency.

Similarities & Differences

Both vaccines need to be taken in two doses. Besides the identical dosage, they have a similar rate of protection and safety. But, Moderna has the lead due to two significant advantages over Pfizer. Unlike any other vaccine in the US, Pfizer's vaccine has to be kept at minus 75 degrees Celsius, whereas Moderna requires only 20 degrees Celsius. Doctors' offices and pharmacies do not have freezers to store Pfizer's vaccine. The second advantage is the expiration date, as Moderna's can be kept for 30 days whereas Pfizer's can only last five days.

A Viral-Vectored Vaccine By Astrazeneca

AstraZeneca and Oxford University's candidate demonstrated the efficacy of 70.4% in two large-scale trials. Most importantly, nobody who received the actual vaccine developed any severe symptoms or needed hospital treatment. If a lower dose is used, followed by a second full dose the efficacy is up to 90%.

Despite being less than Pfizer and Moderna's protection level, Oxford's candidate is far cheaper and is easier to store and distribute across the globe, if it gets approved. However, AstraZeneca's stock tumbled after Wall Street analyst Geoffrey Porges raised questions about whether it would receive U.S. regulatory approval. But Oxford technology is more established, so the vaccine is easier to mass-produce cheaply which can play a significant role in tackling the pandemic.

A Traditional Approach

This candidate uses a traditional approach that is completely different from that of Pfizer and Moderna. A viral-vectored vaccine uses an adenovirus, a common cold virus, that has been genetically modified to include genetic material from the SARS-CoV-2 virus. With a purified signature protein of the virus that is much weaker than the ‘original', it trains the immune system to recognize the disease-causing part of a virus. Therefore, if the immune system actually comes into contact with the virus, it will know exactly what to do. This approach prevents the patient from developing severe symptoms, complications, and hospital treatment.

Why the low dose first? There are two answers. One is that if the initial dose is too big, the immune system might reject the vaccine which is built around a common cold virus. The other is that a low then high shot may do a better job at mimicking an actual coronavirus infection and therefore, lead to a better immune response.

The ‘Contest'

After Pfizer and Moderna's above 90% protection, 70% might be seen as disappointing. But this is still a vaccine that can save lives and play a role in containing the pandemic. It also has crucial advantages such as more convenient storage and a smaller price. As AstraZeneca has also made a "no-profit pledge," its candidate will cost about $4, which is far less than Pfizer's $20 and especially Moderna's $37 per dose.

Too Early To Claim Victory

The FDA requires two months of follow-up data when vaccine developers submit the application for emergency use. Most side-effects appear within 60 days of receiving the vaccine so this is a necessary safety measure. But it does not mean that rare issues can't crop up later. The risk is even greater for mRNA candidates as they will be the first to use this technology. This means the FDA will need to weigh the potential benefits over the known risks before granting emergency use authorization. We all need to accept that there will be risks but the FDA has the hard task of finding the balance between taming the pandemic as soon as possible and having the perfect data. Meanwhile, the U.S. is all set to roll out Regeneron Pharmaceuticals Inc REGN antibody cocktail. Therefore, positive developments are there, but the battle is far from over as all three vaccines still need to prove they are safe.

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