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Last updated October 19, 2020. 5 minute read

COVID-19 vaccines in development: what can we expect and when?

Around the world, scientists are working hard to develop a COVID-19 vaccine rapidly. Many of the vaccine candidates are ones that were initially designed to treat other diseases, like Ebola, SARS, and influenza, but are being modified for use against COVID-19. The World Health Organization (WHO) reports that 25 vaccine candidates are currently in clinical trials, and there are 139 additional preclinical evaluations for other potential vaccines (WHO, 2020).

Dr Chimene Richa Md Written by Dr. Chimene Richa, MD
Reviewed by Dr. Mike Bohl, MD, MPH

Since its start in Wuhan, China at the end of 2019, the new coronavirus disease 2019 (COVID-19) has become a global pandemic affecting over 40 million people worldwide and over 8.1 million people in the United States (as of October 19, 2020) (ArcGis, 2020). Many people with COVID-19 infections have no symptoms or only mild symptoms. Unfortunately, this contributes to the spread because it is possible to transmit the virus to others even if you don’t feel sick. When symptoms do occur, they tend to start around 2–14 days after COVID-19 exposure, according to the Centers for Disease Control and Prevention (CDC, 2020). COVID-19 symptoms include (CDC, 2020):

  • Cough
  • Fever or chills
  • Muscle pain (myalgias)
  • Headache
  • Shortness of breath (dyspnea)
  • Coughing up mucus
  • Sore throat
  • Diarrhea
  • Nausea/vomiting
  • Loss of smell (anosmia)
  • Change in the sense of taste (dysgeusia)
  • Stomach pain
  • Runny nose

Vitals

  • COVID-19, caused by the novel coronavirus SARS-CoV-2, is a global pandemic affecting millions of people.
  • No COVID-19 vaccine exists to date, but there are over 40 vaccine candidates in clinical trials.
  • Using the “pandemic paradigm” of vaccine development, researchers aim to develop an effective vaccine by early 2021.
  • Other treatments being tried include remdesivir, favipiravir, dexamethasone, and immunomodulators.

Older people or those with chronic medical conditions, like heart disease, diabetes, obesity, and lung disease, are at higher risk of developing severe disease. Severe symptoms may require hospitalization, admission to the intensive care unit (ICU), oxygen support, or mechanical ventilation (intubation). In the worst cases, COVID-19 has led to death in over 190,000 people in the U.S. and over 900,000 worldwide (ArcGis, 2020).

COVID-19 vaccines

Around the world, scientists are working hard to develop a COVID-19 vaccine rapidly. Many of the vaccine candidates are ones that were initially designed to treat other diseases, like Ebola, SARS, and influenza, but are being modified for use against COVID-19. The World Health Organization (WHO) reports that 42 vaccine candidates are currently in clinical trials, and there are 139 additional preclinical evaluations for other potential vaccines (WHO, 2020). 

Pharmaceutical companies and institutions globally are working on developing an effective SARS-Cov-2 vaccine. The vaccine candidates that are the farthest along in development and trials are made by the following (WHO, 2020):

  • University of Oxford/AstraZeneca 
  • Wuhan Institute of Biological Products/Sinopharm 
  • Beijing Institute of Biological Products/Sinopharm 
  • Moderna/National Institute of Allergy and Infectious Diseases (NIAID)
  • BioNTech/Fosun Pharma/Pfizer 
  • CanSino Biologics/Beijing Institute of Biotechnology
  • Anhui Zhifei Longcom Biopharmaceutical/Institute of Microbiology, Chinese Academy of Sciences

Vaccine development usually takes a long time—around ten years on average (Pronker, 2013). Typically, after spending many years in the preclinical testing arena, a vaccine may be tested in a small group of people to observe side effects and figure out the best dose—these are phase 1 clinical trials. Phase 2 involves more people to look at how well it works and any additional side effects. 

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Lastly, there are phase 3 trials that test the vaccine on thousands of people for more extended periods. After phase 3, then you can have licensure and large-scale manufacturing of the vaccine. Because each stage of vaccine trials has to be completed and the data analyzed before the next phase can begin, this process takes years.

However, in light of the global pandemic caused by SARS-Cov2, new strategies have to be used. The Coalition for Epidemic Preparedness Innovation (CEPI), an international nongovernmental organization, supports vaccine development for epidemic diseases, like COVID-19. The “pandemic paradigm” allows researchers to decrease the time from laboratory vaccine research to clinical trials from the traditional 3–4 years down to 16 weeks (Lurie, 2020). 

For example, in the case of COVID-19 vaccines, phase 1 clinical trials may be started at the same time as animal studies. Most of the vaccines in development act against the spike protein of the outer shell (the “corona”) of the virus particle, but the details vary by the developer (Thanh Le, 2020). The candidate vaccines use different platforms to affect the coronavirus particles—there are DNA vaccines, inactivated virus vaccines, mRNA vaccines, and non-replicating viral vector vaccines.

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The U.S. Department of Health and Human Services (HHS) is hoping to have an effective vaccine available for emergency use in the United States by early 2021, a plan they are calling Operation Warp Speed (HHS, 2020). In an interview with CNN, Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, stated that “To go from not even knowing what the virus was in early January to a phase 3 trial [in July] is really record time.”

Other treatments being explored

Scientists all over the world are not only working on a COVID-19 vaccine. They are also researching potential treatments to alleviate the symptoms of SARS-CoV-2. Possible treatments include antivirals, convalescent plasma, and immunomodulators (NIH, 2020). Hydroxychloroquine was a potential treatment option early on, but it has since fallen out of favor because of concerns over the risk of heart rhythm problems and death in some people (ISDA, 2020).

Antiviral drugs interfere with a virus’ ability to replicate. The antiviral medication remdesivir has already been given an emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA). It is reserved for hospitalized COVID-19 patients who are not on high-flow oxygen (NIH, 2020). Clinical trials have already begun on favipiravir, an antiviral that was initially developed to treat influenza (Stanford, 2020). This medication is being tested not only on hospitalized COVID-19 patients but also on people whose symptoms do not warrant hospitalization.

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Convalescent plasma is blood plasma taken from people who have recovered from SARS-CoV-2 infection. This plasma may contain antibodies against the virus and, if given early enough to a patient with a severe COVID-19 infection, could help them fight off the disease quicker and more effectively. This treatment is still considered experimental, and, according to the National Institutes of Health, there is not enough information to recommend for or against the use of convalescent plasma (NIH, 2020).

Immunomodulators, like dexamethasone, help to regulate your immune response. COVID-19 can cause your body’s immune system to overreact, leading to severe symptoms (like ARDS) and can damage your lungs and other organs (leading to death in the worst cases). By keeping your immune system in check, these types of medications may improve mortality and overall outcomes.

Dexamethasone is being used in COVID-19 patients who are hospitalized and require supplemental oxygen or mechanical ventilation (intubation) (NIH, 2020). Other immunomodulators under investigation are interleukin-6 (IL-6) inhibitors (e.g., tocilizumab, sarilumab, and siltuximab), and “antibody cocktails,” like REGN-COV2 (UpToDate, 2020).

What can you do now?

While we are all waiting for an effective vaccine or treatment for this novel coronavirus, you can take steps to protect yourself, your family, and your community. Remember to practice social distancing when you are out of the house—avoid large groups of people and stay at least six feet away from others. Wear a face mask in public and wash your hands frequently.