Covid Chronicles XVII

More than a bit of confusion prevailed over one vaccine and one line of treatment for patients laid low by Covid-19 even as the global tally of confirmed coronavirus cases hit 60 million on Wednesday, with the pace of new infections accelerating and the United States reporting record numbers of hospitalisations, according to Reuters. Globally, infections stood at 60.005 million and deaths at 1.4 million.

The vaccine that first elated and then deflated somewhat during the week is the product being developed by Oxford University and its partner drugmaker AstraZeneca. Some trial participants only got a partial dose of AstraZeneca's vaccine. Experts said the company's spotty disclosures have eroded confidence.

AstraZeneca is likely to run an additional global trial to assess the efficacy of its Covid-19 vaccine, its chief executive Pascal Soriot was quoted as saying on Thursday after questions over the results of its late-stage study. Instead of adding the trial arm to an ongoing U.S. process, a new study would be run to evaluate a lower dosage that performed better than a full amount in AstraZeneca's studies, Soriot was quoted as saying in a Bloomberg News report. "Now that we've found what looks like a better efficacy, we have to validate this, so we need to do an additional study," Soriot was quoted as saying. 

Earlier, AstraZeneca and the University of Oxford had added their vaccine candidate to a growing list of shots showing promising effectiveness against Covid-19 - setting in motion disparate regulatory and distribution tracks that executive and researchers hope will result in the start of widespread vaccinations by the end of the year. AstraZeneca and Oxford said their vaccine was as much as 90% effective in preventing the infection without serious side effects in large clinical trials. 

The line of treatment under question is remdesivir. The US Food and Drug Administration has granted emergency authorisation to the experimental antibody treatment. The drug, made by Regeneron Pharmaceuticals, is designed to prevent infected people from developing severe illness. Instead of waiting for the body to develop its own protective immune response, the drug imitates the body's natural defenses. It is the second drug of this type - called a monoclonal antibody - to be cleared for treating Covid-19. The FDA authorised Eli Lilly's drug on November 9. 

Remdesivir, one of the drugs Donald Trump took when he developed Covid-19, should not be used in hospitals because there is no evidence it works, the World Health Organisation has advised. The US President was an enthusiastic proponent of the drug, to the point where he boasted in July that he had bought up the world's entire stock for Americans. The WHO's guidelines committee, however, has said Covid patients may be better off without it. The WHO issued what it calls a "living guideline", which can be updated as evidence comes in, largely as a result of a Solidarity trial it led in several countries. Solidarity allocated patients randomly to several drugs including remdesivir and found that those who took it were no more likely to survive severe Covid than those who did not.

Meanwhile another controversial vaccine candidate was back in focus during the week with its Russian makers claiming that Sputnik V is up to 95% effective at stopping people developing Covid-19 symptoms. Second interim data from the Sputnik V vaccine appears to provide 91.4% protection 28 days after the first dose and the researchers say the figure is as high as 95% 42 days after the first dose. 

President Vladimir Putin told fellow world leaders last week that both of Russia's Covid-19 vaccines, including one he championed as the world's first inoculation against the disease, are safe and effective. That doesn't mean he's taken a jab. "We have not yet begun widespread vaccination and the head of state can't take part in vaccination as a volunteer. It's impossible," Kremlin spokesman Dmitry Peskov told reporters Tuesday, in response to a question on whether Putin had been inoculated. "The president can't use an uncertified vaccine." Russia has the world's fifth-highest number of cases globally, passing 2 million last week. Putin had declared the vaccine an unqualified success earlier without having gone through the niceties of essential stage 3 trials. 

The UK will be the first country to begin clinical trials of a new coronavirus antibody treatment developed by drug giant AstraZeneca aimed at people with a weakened immune system who cannot be vaccinated. A participant in Wakefield, West Yorkshire, will be the first in the world to receive the pharmaceutical company's new "antibody cocktail", as part of the trial to test whether it will prevent Covid-19 for up to a year. The aim of the trial is to evaluate the safety and effectiveness of a combination of two long-acting monoclonal antibodies - man-made proteins that act like natural human antibodies in the immune system. 

When it comes to vaccine-making, India is a powerhouse. It runs a massive immunisation programme, makes 60% of the world's vaccines, and is home to half a dozen major manufacturers, including Serum Institute of India - the largest in the world. Not surprinsingly, there's no lack of ambition when it comes to vaccinating a billion people against Covid-19. India plans to receive and utilise some 500 million doses of vaccines against the disease and immunise up to 250 million people by July next year. 

Even as the race for an effective vaccine (or two or three) approaches the finishing line, there is a feeding frenzy among the better-off countries to corner the market in as many vaccines as possible. A word of caution here for the prospects of some countries and some people being left out in the cold: a pandemic requires as many people as possible to be vaccinated or protected against the disease otherwise it can always begin spreading again from those left out. Early results indicate that at least two vaccines are highly effective, several others have reached late-stage trials, and many more are at some stage of development. None of these vaccines have been approved yet, but that hasn't stopped countries purchasing doses in advance. A key research centre in the U.S. - Duke University in North Carolina - is trying to keep tabs on all the deals being done. It estimates that 6.4 billion doses of potential vaccines have already been bought, and another 3.2 billion are either under negotiation or reserved as "optional expansions of existing deals." The process of advance purchasing is well established in the pharmaceutical industry, as it can help to incentivise the development of products and fund trials, according to Clare Wenham, assistant professor of global health policy at the London School of Economics. 

And after weeks of celebrating the end of Covid-19, China where it all began a year ago has lapsed into a more introspective phase. Chinese health authorities have imposed lockdowns and shut down schools in Tianjin, Shanghai, and Manzhouli, and are testing millions of citizens after discovering multiple locally transmitted coronavirus cases in the cities. The number of cases in the country remain low, especially when compared to the U.S. and European nations, but the recent spikes in cases have indicated that the virus is still a risk despite having been largely controlled in China.

Lalita Panicker is Consulting Editor, Views, Hindustan Times, New Delhi