There has been much discussion around the development of a vaccination for COVID-19, making for a fascinating area of research. Typically, vaccination development takes around 10-20 years, but vaccine development for COVID-19 is occurring at a rapid pace and is featured almost daily in the news.
We are fortunate that advances in technology have been able to contribute to the speed of COVID-19 vaccine development, for example, we have already rapidly sequenced the SARS-CoV-2 genome. To develop a COVID-19 vaccine, most researchers have been investigating the spike proteins which allow the virus to attach and replicate. The spike proteins also generate a strong neutralising antibody immune response in humans – an effect important for vaccination efficacy. A strong T cell immune response is also associated with the spike protein and this may be another avenue for vaccination development.
One of the new technologies being investigated for a COVID-19 vaccine is nucleic acid vaccinations. This involves vaccinating the host with the spike protein’s genetic material (RNA or DNA) that encode the antigen. Once administered, the host then creates the antigens, and this stimulates an immune response.
Although nucleic acid vaccination technologies are cost effective compared to other vaccine technologies, it is a new vaccine technology that appears to have issues with its stability and has not been licensed for use in humans before.
Other technologies for COVD-19 vaccinations include viral vectors whereby the spike protein is administered to the host using a harmless animal or human virus, such as adenovirus or poxviruses. There are also other viral vaccine development technologies already available for use, such as inactivated virus (used in whooping cough vaccine) and proteins (used in Gardasil 9®).
As of May this year, ten COVID-19 vaccines were undergoing phase I and II clinical trials, with many more vaccines (some of which are Australian) still being researched or in preclinical trials. Of the ten trials: four are using viral technology, four are using nucleic acid technology and two are using inactivated viruses (one of these with an alum adjuvant).
It must be acknowledged that there are challenges with regards to development of a COVID-19 vaccine: this vaccine might possibly exacerbate disease, COVID-19 may mutate over time, and patients may have a poor response to vaccines due to circulating neutralising antibodies from previous coronavirus infections (e.g. common cold).
This year has seen an increase in influenza vaccination rates largely driven by the COVID-19 pandemic. From Jan-June there was also a twelve-fold drop in recorded flu cases, compared to 2019. AMA NSW vice-president Andrew Zuschmann said, "What it's telling us is that many of the measures that are working to contain the spread of COVID-19 within the community are also very effective at reducing transmission of influenza.”
As of the end of May, more than 7.3 million influenza vaccines had been recorded to the Australian Immunisation Register, compared to 4.5 million in 2019. It is worth noting that this region has the lowest rates of vaccination in the country.
This pandemic and the rise in people seeking influenza vaccinations offers health care workers the opportunity to encourage vaccinations and ensure vaccination status is up to date, whilst perhaps discussing potential future COVID-19 vaccinations. We must remember to acknowledge concerns that patients may have regarding vaccination safety and efficacy in a manner that does not overwhelm or dismiss them.
Supportive material may be useful and the National Centre for Immunisation Research and Surveillance has a helpful website to assist with addressing these concerns and accessing accurate safety data
Alannah Mann is a pharmacist in Alstonville.