A Diversified Vaccination Strategy Needs to be our Plan A

The fact that the SARS-CoV-2 coronavirus causes asymptomatic infection means it is very unlikely that we will be able to eradicate it without a combination of vaccines and therapeutics. While border closures can help us feel safe, it is not reality. We have to start living with this virus and hence we have to implement a diversified vaccination strategy. In addition, new therapeutics will be available in due course that should also be part of the strategy to combat the virus, given that it is unlikely that the vaccines will offer 100% protection in everyone. 

European countries have realised that life has to go on despite rising infections. Governments in Europe are favouring regional restrictions depending on infection rates. Wearing a mask has become second nature, as has carrying sanitiser. At the same time, governments are also diversifying their vaccine options and in time, we may also see a similar strategy when it comes to therapeutics. 

What worries us, is the limited transparency here in Australia. We are in a bubble if we think that we can eradicate the virus forever. That should not be our Plan A. 

So far, the Australian government has secured dosages of the AstraZeneca/Oxford University vaccine candidate (with manufacturing support from CSL) and has also supported the University of Queensland’s vaccine candidate^[1]. As we have seen in recent weeks, the side-effect profile of the vaccines in development can vary, and in the future, we may also see protective immunity differ between the young and the old, as well as those who are immunocompromised. We believe, it would be prudent to also secure access to additional vaccines that are based on different technologies, such as mRNA-based vaccines^[2] and protein subunit vaccines that are combined with an adjuvant (an agent that may be added to a vaccine to boost the immune response).

The supply of any of these vaccines will be tight and in addition, we expect there will be several waves of vaccines: 

• The first wave are the “rapid response” vaccines, which are based on the first generation of mRNA vaccines that were designed within days of the viral sequence becoming available. These may be called the prototypes, where manufacturing can be scaled up quickly and the product is a bit “rough around  the edges”.
• The second wave will likely be the next-generation mRNA vaccines as well as vaccines based on other technologies (e.g. adenovirus and protein subunits, combined with adjuvant technology). These vaccines are more refined, should be more effective, elicit longer immunity and potentially be better formulated for easier storage and transport. These vaccines are expected to become available in mid- to late 2021 and we believe they should be part of any country-wide vaccination strategy. 
• Then, there are the third wave of vaccines, which will be about seasonality as well as combining it, for example, with flu vaccination.

To us, a sound strategy to combat coronavirus would be to have access to several of these vaccines, like the UK government has done (illustrated in the diagram below), as well as considering local manufacturing as part of a longer-term pandemic preparedness plan. We applaud CSL for stepping up to the task and supporting the manufacturing of the AstraZeneca/Oxford University vaccine candidate. However, we also see a very reasonable case for establishing a local mRNA manufacturing footprint, potentially in partnership with relevant companies. This would secure access to mRNA SARS-CoV-2 vaccines as well as future mRNA-based combination vaccines, such as personalised cancer vaccines. In June 2020, the German government invested €300 million in CureVac^[3], while in mid-September, another €375 million was given to BioNTech^[4]. Manufacturing mRNA has cost advantages and could be an interesting future industry, not just for vaccines but also for mRNA therapeutics.

In our view, combating the virus is a multi-phase battle that requires different generations of vaccines as well as therapeutic approaches. Hence, we would encourage the Australian government to have a multi-phase response. We do not want to find ourselves in a situation where other countries are well ahead with vaccination while we watch from afar having not established a solid Plan A. 

UK Government’s Progress on Vaccines 


_{Source: Press conference slides used by Sir Patrick Vallance and Professor Chris Whitty at the Downing Street Coronavirus Data Briefing (21 September 2020), https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/919548/20200921_Briefing.pdf}

^{[1] Source: Australian government, 19 August 2020, https://www.pm.gov.au/media/new-deal-secures-potential-covid-19-vaccine-every-australian
[2] Messenger RNA (mRNA) is a molecule that functions naturally in our bodies as an intermediary between our genes and our proteins. It is the blueprint for our proteins and essentially a copy of the gene encoding the protein. If designed and delivered correctly, cells will recognise the mRNA and start making the protein. For vaccines and therapeutics alike, the mRNA can be quickly designed (by the right team of scientists) in the lab once the scientists know which is the correct viral particle to make. Usually, several mRNAs are made and scientists quickly assess which one is the most suitable. Manufacturing these chemical molecules (or information molecules, as Moderna calls them) can be done with a much smaller manufacturing footprint and also at a fraction of the cost of making traditional vaccines or protein therapeutics, as it is not a protein, it is the information to make the end product. In the end, the 'active’ product, the vaccine or the therapeutic protein, is made by the person who receives the mRNA injection. Humans essentially function as the manufacturing site for the mRNA vaccine. More information can be found here: https://www.platinum.com.au/the-journal/covid-19-demystifying-this-frightening-disease
[3] Source: CureVac, 15 June 2020, https://www.curevac.com/en/2020/06/15/bundesregierung-beteiligt-sich-mit-300-millionen-euro-an-curevac/
[4] Source: BioNTech, 15 September 2020, https://investors.biontech.de/news-releases/news-release-details/biontech-receive-eu375m-funding-german-federal-ministry}

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