Of over the 300 projects around the world working towards developing a vaccine for SARS-CoV-2, almost a dozen have gone through the first two stages of human testing and results of three projects are likely to be available by the end of the year, , said Dr. Gagandeep Kang, microbiologist and professor at the Christian Medical College, Vellore. This will also bring with it associated challenges like identification of people who need it the most and distribution, she said.
"We have never had a time before when so much work has been done so fast on so many candidates as in the last nine months," said Dr. Kang who is credited with pioneering work on an indigenous rotavirus vaccine. Every platform technology that can be used in developing vaccines is being used against SARS-CoV-2, she said.
"Vaccination programmes in India and developing countries around the world almost never gave vaccines to anyone other than children and pregnant women. If we now need to give vaccines to people identifying the ones who need it the most is going to be a challenge. Reaching out to them is the next challenge. Getting the vaccines made and distributing it is a challenge as well," she said during the virtual inaugaration of the Kerala Sasthra Sahithya Parishad's annual State meeting.
In the haste to make vaccines for SARS-CoV-2, a lot of pressure was put on vaccine companies and researchers to make the vaccines quickly. "Fortunately for us, the researchers and regulators have resisted that pressure. This is very important for building trust in vaccines," said Dr. Kang, who was the first Indian woman to be elected as a fellow to the Royal Society, London.
"We will start with the healthcare workers, and then with the elderly and those with comorbidites,, and then think about the rest of the population."
The Indian vaccine industry has four candidates that are in the stage of human trials. "We are very lucky that India has an outstanding vaccine industry, consisting of private players who despite the fact that they are private players, have been responsible for providing unimaginable service to public health in India because they make high quality and affordable vaccines. India's vaccine manufacturers provide almost 60% of the vaccines that are used for routine childhood immunisation in low and middle income countries," she said.
More studies will have to be done to generate strong evidence on the treatments that can work, she explained. "Two large studies that were done have resulted in clear answers for certain kinds of drugs for treatment. One done in the U.K., called the Recovery Trial, showed us that steroids – dexamethasone - worked in decreasing mortality in patients with severe disease who were hospitalised.”
“However, if we look at other drugs - lopinavir, ritonavir - which were designed for HIV, they do not work as a treatment. Hydroxychloroquine, which was widely recommended as a prophylactic in India, does not prevent severe disease or mortality,” she said.
“We have preliminary evidence on remdesivir showing there may be some effect. But to define the size of that effect, we need more studies," she said. She pointed out that we should no longer be thinking about hydroxychloroquine, lopinavir or ritonavir, being used for patients with severe disease.