Coronavirus: Behind the scenes in the race for a Covid-19 vaccine

Parallel approaches increase chance of finding some form of protection but any solution is months away, researchers say

National Institute of Allergy and Infectious Diseases Director Tony Fauci (L) speaks to US President Donald Trump during a tour of the National Institutes of Health's Vaccine Research Center March 3, 2020, in Bethesda, Maryland. The US Federal Reserve announced an emergency rate cut responding to the growing economic risk posed by the coronavirus epidemic after the UN health agency said the world has entered "uncharted territory" with the outbreak's rapid spread. / AFP / Brendan Smialowski
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A team of scientists jostled for a view of the lab dish, staring impatiently for the first clue that an experimental vaccine against the new coronavirus just might work.

After weeks of round-the-clock research at the National Institutes of Health, it was time for a key test. If the vaccine revs up the immune system, the samples in that dish – blood drawn from immunised mice – would change colour.

Minutes ticked by, and finally they started glowing blue.

“Especially at moments like this, everyone crowds around,” said Kizzmekia Corbett, an NIH research fellow leading the vaccine development. When her team sent word of the positive results, “it was absolutely amazing”.

Dozens of research groups around the world are racing to create a vaccine as Covid-19 cases continue to grow. Importantly, they are pursuing different types of vaccines – shots developed from new technologies that not only are faster to make than traditional inoculations but might prove more potent. Some researchers even aim for temporary vaccines, such as shots that might guard people’s health a month or two at a time while longer-lasting protection is developed.

“Until we test them in humans we have absolutely no idea what the immune response will be,” cautioned vaccine expert Dr Judith O’Donnell, infectious disease chief at Penn Presbyterian Medical Centre. “Having a lot of different vaccines – with a lot of different theories behind the science of generating immunity – all on a parallel track really ultimately gives us the best chance of getting something successful.”

The first stage of testing in small numbers of young, healthy volunteers is set to start soon. There is no risk participants could get infected because the doses do not contain the virus itself. The goal is purely to check that the vaccines show no worrisome side effects, setting the stage for tests of whether they offer protection from the virus.

First in line is the Kaiser Permanente Washington Health Research Institute in Seattle. It is preparing to test 45 volunteers with different doses of shots co-developed by NIH and the biotechnology company Moderna.

Next, Inovio Pharmaceuticals aims to begin safety tests of its vaccine candidate next month in a few dozen volunteers at the University of Pennsylvania and a testing centre in Kansas City, Missouri, followed by a similar study in China and South Korea.

Even if initial safety tests go well, “you’re talking about a year to a year and a half” before any vaccine could be ready for widespread use, said Dr Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases.

That still would be a record-setting pace. But manufacturers know the wait – required because it takes additional studies of thousands of people to tell if a vaccine truly protects and does no harm – is hard for a frightened public.

“I can really genuinely understand everybody’s frustration and maybe even confusion,” said Kate Broderick, Inovio’s research and development chief. “You can do everything as fast as possible, but you can’t circumvent some of these vital processes.”

The new coronavirus is studded with a protein aptly named “spike” that lets the virus burrow into human cells. Block that protein, and people will not get infected. That makes “spike” the target of most vaccine research.

 

Not so long ago, scientists would have had to grow the virus itself to create a vaccine. The NIH is using a new method that skips that step. Researchers instead copy the section of the virus’ genetic code that contains the instructions for cells to create the spike protein, and let the body become a mini-factory.

Inject a vaccine containing that code, called messenger RNA or mRNA, and people’s cells produce some harmless spike protein. Their immune system spots the foreign protein and makes antibodies to attack it. The body would then be primed to react quickly if the real virus enters.

Ms Corbett’s team had a head start. Because they had spent years trying to develop a vaccine against Mers, a cousin of the new virus, they knew how to make spike proteins stable enough for immunisation, and sent that key ingredient to Moderna to brew up doses.

This is the fastest we have gone.

The team grew spike protein in the lab – lots of it – and stored it frozen in vials. Then with the first research doses of vaccine Moderna dubbed “mRNA-1273”, the NIH researchers immunised dozens of mice. Days later, they started collecting blood samples to check if the mice were producing antibodies against that spike protein. One early test: mix the mouse samples with thawed spike protein and various colour-eliciting trackers, and if antibodies are present, they bind to the protein and glow.

Ms Corbett says the work could not have moved so quickly had it not been for years of behind-the-scenes lab testing of a possible Mers vaccine that works the same way.

Inovio’s approach is similar – again using genetic code, in this case packaged inside a piece of synthetic DNA that acts as the vaccine. One advantage Ms Broderick cites for using DNA is that unlike many types of vaccines, it may not need refrigeration.

A Mers vaccine that Inovio designed the same way passed initial safety studies in people, paving the way for testing the new Covid-19 vaccine candidate. Inovio is doing similar animal testing to look for protective antibodies.

While it gets ready for human safety trials, Inovio also is preparing for test – what is called a challenge study. Vaccinated animals will be put in a special high-containment lab and exposed to the new coronavirus to see if they get infected or not.

Regeneron Pharmaceuticals is exploring a different approach: simply injecting people with coronavirus-fighting antibodies instead of teaching the body to make its own. This method could provide temporary protection against infection or work as a treatment for someone already infected.

Regeneron vaccinated mice genetically engineered to make human antibodies. From small blood samples, researchers drew hundreds of different antibodies and now they are teasing out those that seem most potent against the Covid-19 spike protein, said Christos Kyratsous, Regeneron’s chief of infectious disease research.

Regeneron developed this “monoclonal antibody” approach as a life-saving treatment for Ebola. Last year, it performed a successful safety test of experimental antibodies designed to fight Mers.

Low-dose shots in the arm every few months might provide enough antibodies to temporarily ward off infection, while treatment would probably require far higher doses delivered intravenously, Mr Kyratsous said. Regeneron is pursuing both, and hopes to begin first-step safety testing within months.

“The antibodies are the same,” he said. “We would like to have an antibody that is as flexible in administration as possible.”

Whichever of these approaches, or others in the pipeline, pan out, NIH’s Ms Corbett said scientists one day hope to have vaccines on the shelf that could be used against entire families of viruses. One frustration when scientists have to start from scratch is that outbreaks too often are waning by the time vaccine candidates are ready for widespread testing.

“This is the fastest we have gone,” Mr Fauci said of the NIH’s vaccine candidate, although he warned it might not be fast enough.

Still, it was “quite conceivable” that Covid-19 “will go beyond just a season, and come back and recycle next year", he said.

"In that case, we hope to have a vaccine.”