Front Burner - The race for a COVID-19 vaccine, explained

Episode Date: July 23, 2020

There's new hope this week in the quest for a COVID-19 vaccine. Trials for two vaccines, one at Oxford University and another being worked on here in Canada, are showing some promising results. And they're just two possible frontrunners from scores of vaccines being tested around the globe. Today, Emily Chung, the creator of CBC's vaccine tracker, tells us where we are on the path to approving vaccines, and what bumps may lie in the road ahead.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Josh Bloch. We do have a possibility of having explosive growth in our outbreak here in B.C. if we're not careful in how we progress over the summer. Dr. Bonnie Henry, B.C.'s provincial health officer, warning of a looming COVID-19 resurgence in her province.

The curve in B.C. continues to rise after over 100 new cases were reported on the weekend. And since the upward trend seems to have a lot to do with life getting closer to normal, it got me thinking about something the prime minister said back in April. Normality, as it was before, will not come back full on until we get a vaccine for this. And as you say, that could be a very long way off. Well, this week, there's new hope on that front. Oxford University's vaccine showed promising results from human testing. So did a vaccine from Chinese company CanSino, which Canada is also working on.

And they're just two possible frontrunners from scores being tested around the globe. Today, I'm joined by one of the creators of CBC's vaccine tracker, Emily Chung. She'll tell us where we are on the path to approving vaccines. This is FrontBurner. Hi, Emily. Hi. All right, so we're four months into this pandemic. It really feels to me like a vaccine is our ticket out of this mess.

And I have to say, I'm pretty heartened to see just how many scientists are all working on this at the same time around the globe, really racing to come up with a vaccine. around the globe really racing to come up with a vaccine. And I was especially interested to see that on Monday, one of these efforts by Oxford University and this company called AstraZeneca saw results from human trials. What were those results? Well, what they found in early stage human trials was two things. One, that the vaccine didn't seem to cause any major side effects, which is good. It looks like it's pretty safe. And the other thing it found was that it seemed to be provoking an immune response, both antibodies and T cells, which is what you're looking for in a vaccine. When we look at the immune responses, they are present in everybody.

We see good neutralizing antibodies. These are the ones that we are looking for that should inhibit the infection of the virus into cells. So really results at the high end of our expectations. And so we're into this human trial stage, but how many more phases does a vaccine have to go through before reaching approval? Well, they've got more stages of human trials. All vaccines need to go through a preclinical evaluation, which is in the lab and tests on animals. And there are 142 vaccine candidates right now that are at that stage around the world. Then they move into phase

one, which is early stage human testing. And the real goal there is to make sure the vaccine is safe. So you pick healthy volunteers up to about 100 and you give them different doses of vaccine and you're looking for side effects. And then that's where you also can try and look for preliminary signs that it's causing an immune response. But the goal of phase one is really safety. Then you move on to phase two, which is a bigger human trial. And this is where you're more looking for an immune response. And you're also trying to figure out, OK, what's the best dose to give? Do we need one shot, two shots?

You know, how far apart should they be? Those kinds of things. And phases one and two are the phases Oxford just saw some results from. After that is when you move on to phase three. And that's when you answer the really key question, which is, well, is this going to stop someone from getting this disease if they're vaccinated? Usually phase three is done on a much larger scale, like thousands, maybe tens of thousands of people. And you're going to go somewhere where you have a very active pandemic to increase the chances that someone will be exposed to the virus. So that's why the companies that are doing phase three trials are doing them in places like Brazil, South Africa, and the US. And phase three can last

years, although presumably, the more severe the pandemic is, and the faster it's spreading and more widespread in the population, the sooner you can see results. Interesting. So in phase three, they give people the vaccine and then they wait for them to encounter COVID in their daily lives. I mean, that's how you test if the vaccine works. How do they decide in phase three if it's working? Like what threshold do they have to meet in phase three? Well, vaccines don't work in everybody. have to meet in phase three? Well, vaccines don't work in everybody. So they're trying to see that in a certain percentage of the population, it will reduce the chance of them getting an infection,

or maybe eliminate the chance of them getting an infection, or at the very least, prevent them from getting a severe infection compared to someone who hasn't had the vaccine. And I think the threshold the WHO is looking for in this case is that it works about 50% of the time at least. But of course, everyone is hoping that it'll be much higher than that, you know, that'll protect most people who get the shot. And I've seen that there's these conversations, in fact, about intentionally exposing volunteers to the virus to kind of help fast track that process. You could guarantee that your volunteer has been exposed to the virus and whether that vaccine is working. But can you explain why that is controversial? It's controversial, especially for COVID-19, because we don't have any treatment or cure

for it. Generally, in the past, people have only done those kinds of studies, which are called challenge studies, for things where we can treat people for it. With COVID-19, I mean, even relatively young, healthy people can potentially see pretty serious effects. But if we do trials like this, they're not going to replace the standard phase one, phase two, phase three, especially since it just wouldn't be feasible to do a trial like this with thousands or tens or thousands of people. So the vaccines we've mentioned so far are the ones that are furthest along, but they're not the only ones that are in development. You were part of a team that made a CBC tracker to follow the many vaccines that are in development right now. Can you tell

me just how big is this effort around the globe to come up with a vaccine? It's huge. I think pretty much anyone who is working on a vaccine for anything has now turned their attention to COVID-19. You know, this includes people who are working on animal vaccines. People are working on vaccines for anything ranging from like Zika to Ebola to flu. And anyone who has any kind of technology that can be used in vaccines, things like, you know, adjuvants that can boost immune response is trying to get involved with this too. So there's obviously the incentive here of, you know, saving the planet from this virus, but I imagine there's also a financial incentive as well. If a company is the first to get a vaccine approved, how can they expect to benefit

from that? Well, I mean, they definitely have a big market for this. In fact, a lot of governments around the world have already secured deals with certain manufacturers that if their vaccine makes it to market, you know, they're committing to buying a certain amount of doses and that's in the, you know, millions. You know, the Trump administration has awarded a $1.9 billion contract to Pfizer and its German partner BioNTech for 100 million doses of the COVID-19 vaccine with the option to buy 500 million more doses. There probably will be more than one vaccine. I mean, we've got more than 100 vaccines under development right now from all over the world. And they are all using different technologies and they all have different pros and cons. So some of them might be suitable, more suitable for some populations than others.

And there's other advantages to that, too. You know, just manufacturing capacity for a particular vaccine. advantages to that too, you know, just manufacturing capacity for a particular vaccine. And if there are different kinds of vaccine, they use different raw materials, they use different factories, that could generate a much bigger supply around the world than the trickle that we would probably get initially from a single vaccine. You're talking about all these different strategies and types of vaccines. I know you can't explain all of it, but can you just tell me a little bit about some of those distinctions? What are some of the most interesting different types of vaccines in the works right now? So, I mean, some of them are

relatively traditional. Like, I think most of us think of vaccines as being either a dead virus or one that's been weakened. And those ones are some of the strategies that are being used. The second main group are ones that don't involve the entire virus. You don't have to grow the whole virus or anything. What they do is focus on one protein. And generally, that's the spike protein so you know this virus is called the coronavirus because it's got this sort of crown of spikes around us and that's the spike protein it's used to bind to cells in order to get inside the cell and there's a number of ways you can get this spike protein in the

body so that your immune cells can learn to recognize it and stop it from infecting cells. So obviously, the simplest method is to just inject the spike protein itself. And there's a lot of companies that are working on that. There's also a variation on that where you've got the spike protein, but you get into a shape that kind of looks like a virus. And that's actually the technology that Medicago, the Canadian company that's in phase one human trials now, is using. The other way is using what's called a viral vector. And what that is, is a carrier virus. So it's a virus that's not coronavirus.

It's a virus that won't harm humans. Oxford and Consino are using versions of a virus called the adenovirus to carry the spike protein into the human body and then make lots of copies of the spike protein inside the body. The third way of getting this spike protein into the body is to just take the gene itself with RNA or DNA, but they're quite similar. Basically what happens is those are the instructions for making the spike protein. Bring those into the body and then your own cells will take those instructions to make copies of the spike protein. In the Dragon's Den, a simple pitch can lead to a life-changing connection.

Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income?

That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. It was interesting to see in the news recently that, you know, there were these initial presumptions that if you got the coronavirus that you would develop an immunity. Now there's some research suggesting that that immunity might only last for a few months. If that's true, does it suggest a vaccine might only work for a few months as well? It depends on the vaccine. Some of them might generate a longer lasting immune response than others, but there's a lot of technology involved.

And you can actually, depending on the type of platform you use, the type of adjuvants, can sometimes be more specific and tailor your immune response to optimize it. There's the potential for a vaccine to be more effective at inducing an immune response than a natural infection. We talked earlier about how the Oxford vaccine seems to be safe. It seems to cause an immune response than a natural infection. We talked earlier about how the Oxford vaccine seems to be safe. It seems to cause an immune response. What other criteria makes a vaccine good for this pandemic? Some of these techniques, you can scale them up and manufacture many doses much more quickly

than others. And some of them might require multiple doses. doses much more quickly than others. And some of them might require multiple doses. Maybe, you know, you can only vaccinate half the number of people with the same number of doses. There's also the distribution, you know, how easy it is to distribute. Some of these vaccines will have to be stored at very cold temperatures. And that might be a problem for distribution in certain parts of the world. So these are, yeah, these are all considerations that might make a difference in the end. What do you think is the earliest we could actually see these vaccines get rolled out for use? There are some people being optimistic, saying as early as the end of this year.

But I mean, that seems really unlikely. We're still just started phase three testing for even the ones that are the furthest ahead. Normally, these things can take an average of 10 years for a vaccine to get from the preclinical development to market registration. That's right. And obviously, you know, everyone's saying to the regulators are all saying, you know, the standard is going to be the same for this one. It's got to be just as safe and effective as any other vaccine that took those 10 years. While they're speeding things up by overlapping some of the phases, they still have to meet all the criteria for those phases. The other thing I've been thinking about is that even once we

get past all those phases and a vaccine is approved, how many people actually need to be vaccinated for this to be effective, for this to really stop the pandemic? Yeah, it's going to be a lot, like billions and billions of people. Because none of us have been exposed to this before. It's a totally new virus. And so nobody has immunity, like even in places where they had very bad waves of this pandemic. You know, when they've looked at the studies to try and test the antibodies of people in the population and see what percentage have been infected. It's very, very small. There definitely isn't anywhere close to herd immunity, which for the coronavirus that causes COVID-19 is thought to be about somewhere between 60 and 70 percent.

You know, vaccines are never 100 percent effective either. If we're in a situation where there's not enough doses for everyone in the world right away, what kind of conversations are happening about who would get the vaccine first? I think in most places, there's two angles to this. One is we need to prioritize globally because obviously this is a pandemic. And so, you know, which countries should be prioritized? And another question is within a country who should be prioritized? You're talking about healthcare workers, you know, frontline healthcare workers, essential workers, and then after that, usually the highest risk groups. On a global scale, it's a little bit trickier. I mean, a lot of countries are saying

that they want to vaccinate their own populations first. But on the other hand, the places where the pandemic is a biggest problem are not necessarily those countries and where a vaccine can make the biggest difference. And where does Canada fit into that mix? Canada has a number of vaccine candidates. So in theory, we might have some say, but most of those would also not be manufactured here, which means we could also have trouble getting enough for our population. You know, obviously the government is trying to make deals and trying to secure doses for our country and trying to boost manufacturing capacity. So this won't all be manufactured overseas. But Canada is also a smaller market, which can also be a bit of a challenge. So obviously these vaccines are incredibly important to public health around the world, but I also wonder about the risks of moving too quickly,

that you have anti-vaccination groups who are already campaigning against vaccines. And I can only imagine that things would get worse if a vaccine was pushed too quickly ahead for approval and there are side effects or they aren't as effective as advertised. Well, everyone is saying, everyone is saying that they will have to meet the same criteria as any other vaccine. When I was talking to one researcher in Canada about this, she said the idea that some people might be hesitant to take these new vaccines won't even be an issue for a while, because at the beginning, when we first get some vaccines, there really will be a huge shortage. There really will be only a fraction

of the doses available compared to the number of people who want and need it. And so anyone who doesn't want it isn't even probably going to have the opportunity to say no. Right. So we're a long way off from having a universal mandate for the vaccine. Well, I will be watching closely as well. Thank you so much for your insights into this. Oh, you're welcome. It's my pleasure. Some news before I say goodbye. A former CBC employee is going public about his experience of hearing two colleagues use the N-word in a staff discussion at the Fifth Estate last year. At the time, Dexter Brown was working as an associate producer there. The N-word was repeatedly used in a documentary about racial issues in the American South.

about racial issues in the American South. Two longtime Fifth Estate employees then used the word in a staff discussion after the screening, either quoting people in the item or when discussing its contents. Brown says he was shocked and then disappointed by the resulting investigation. The public broadcaster confirms that a third-party investigator was called in and that corrective actions were taken as a result,

but CBC says it cannot comment on the details because of confidentiality agreements. I'm Josh Bloch. Thanks for listening to FrontBurner. For more CBC Podcasts, go to cbc.ca slash podcasts.