COVID-19 vaccines were developed so fast, it seemed like a miracle to some. Although it typically takes five to ten years to bring a new vaccine to the clinic, more than half a dozen COVID-19 vaccines have entered the clinic in just over a year. What’s not clear is whether that success is repeatable—and whether vaccines can not only cut pandemics short, but also prevent them.
The stakes are especially high for influenza since past contagions, including the 1918 pandemic, have claimed tens of millions of lives, and even a normal flu season can have a global death toll of hundreds of thousands. Next-generation influenza vaccines could dramatically boost protection against both seasonal and pandemic strains — and they’ll arrive much faster if the world heeds the lessons from the successful quest to develop COVID-19 vaccines.
Know your enemy. Although technically a new pathogen, SARS-CoV-2 was also a familiar foe—a coronavirus that jumped from animal hosts to humans. And recent battles with its cousins—SARS in 2003 and MERS in 2012—gave scientists a fundamental understanding of these pathogens, such as the key role in infection played by the now-familiar spike protein that studs the coronavirus. “Had this been an entirely different class of viruses, we would likely have been much further behind,” says Kathleen Neuzil, a vaccine researcher at the University of Maryland School of Medicine.
Influenza is also a familiar foe, and scientists have gathered a good deal of intel. For example, they understand broadly how the immune system must respond to prevent serious illness, as well as vaccine design strategies that could spur an immune response that protects against diverse strains, says Gregory Poland, a vaccine specialist at the Mayo Clinic. But researchers also have much to learn about this virus. “We still need to understand how to modulate the immune system towards flu more effectively before we are able to talk about a universal vaccine,” says Luciana Borio, vice president of technical staff at In-Q-Tel and a former assistant FDA commissioner.
Invest for the long term. COVID-19 offered a high-profile launch for mRNA vaccines, one regarded as a resounding success. Yet mRNA vaccines have been in clinical development for over a decade. Moderna’s mRNA vaccine emerged from an earlier US National Institutes of Health (NIH) effort to fend off MERS, and AstraZeneca’s vaccine draws on extensive Oxford University research into chimpanzee adenovirus-based vaccines. “They’ve been working on this for 30 years, and it wasn’t until two years ago that they finally got a product for Ebola,” says Gerald Keusch, an infectious disease specialist at Boston University.
Such stories show that advance preparation has far more impact on a crisis than a sudden influx of emergency funding. This includes building the infrastructure to turn innovations into clinic-ready treatments. “We need to systematically think about better planning for surge capacity for manufacturing vaccines and other products,” Keusch says. Poland highlights the urgency of training and maintaining a skilled workforce of vaccine experts. “The majority of PhD scientists that I train end up not going into academia, because they see how hard it is to get funding to do this kind of science,” he says.
Collaboration is key. Traditionally, industry developed vaccines by taking discoveries from government and academic research and shepherding them into the clinic and the market. These lines blurred during COVID-19, when all sectors collaborated closely to accelerate vaccine development. In addition to the AstraZeneca–Oxford and Moderna-NIH partnerships, Merck agreed to manufacture the newly approved vaccine of Johnson & Johnson, its direct competitor.
Top-down coordination can catalyze collaboration. The NIH’s Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) effort helped leading figures from a host of government agencies, pharma and biotech companies, and other R&D sectors forge partnerships, pool resources and develop sensible, evidence-based strategies for vaccine design, testing, and manufacturing. Similarly, the Coalition for Epidemic Preparedness Innovations (CEPI) has assembled public- and private-sector stakeholders from around the world to enable rapid response to pandemics.
Spending billions can save trillions. The $13.8 billion invested by the US in vaccine programs is a huge sum. But it is orders of magnitude less than the global economic damage wrought by COVID-19, which one study placed at $3.8 trillion. It was also essential for accelerating COVID-19 vaccine development. In the past, vaccines were developed in a linear, step-by-step process. “You make a funding decision at each step, and don’t invest in a product that’s not going to make it,” Keusch says. But for COVID-19, companies worked on multiple steps simultaneously, including designing vaccines, coordinating manufacturing processes, and planning clinical trials, while governments underwrote the risk. “Those resources made a huge difference,” Neuzil says.
Developing a universal influenza vaccine will also require sizeable investments from governments, including funding for early-stage vaccine development that makes subsequent investment opportunities more attractive for private-sector investors, says Marissa Malchione, senior associate for influenza vaccine innovation at the Sabin Vaccine Institute. These private-sector funding sources will also be critical, she adds, and COVID-19 has led private-sector newcomers to invest in vaccine development.
It takes a global effort. Scientists worldwide shared data and insights to develop COVID-19 vaccines. For example, the initial release of viral genome data by Chinese scientists guided subsequent vaccine design, and vigorous viral surveillance in the UK identified the first clinically relevant variant of SARS-CoV-2—an important red flag for vaccine development efforts. Such teamwork will be invaluable in fending off emerging pandemic flu strains. To further it, funding for several global efforts to detect emerging pandemic viruses that were stopped in recent years, including the US Agency for International Development (USAID) PREDICT project, should be restored, Keusch says.
COVID-19 also laid bare vaccine nationalism and inequity, says John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC). For example, only about 1% of Africa’s population is vaccinated to date, and low- and middle-income countries worldwide still lack broad vaccine access. To help Africans protect themselves from pandemic influenza or other future outbreaks, Africa CDC is focused on building out scientific and vaccine manufacturing capacity on the continent.
A new strategic partnership with the Coalition for Epidemic Preparedness Innovations represents an important step in this direction. “We really need to look at how much can be done globally and centralized [versus] how much can be done regionally, so that everybody has a voice in ensuring their own health security,” says Nkengasong.
Explore how Sabin Vaccine Institute’s Influenzer campaign is driving development of a universal influenza vaccine here.