30 years of hard work and dedication and then, suddenly…overnight success.
It’s tempting to think of mRNA vaccines as a ‘new’ technology. 12 months ago, most people had never heard of them, now they are in the headlines and in demand.
Until December 2020, no mRNA vaccine had ever been approved. Today more than 1 billion people have received an mRNA vaccine, with experts declaring a new era in vaccination.
But, like a pop group suddenly catapulted to stardom, the story stretches back further than it may appear – and features painstaking labour as well as flashes of invention.
It is also a story of collaboration across continents and between different kinds of science.
And, to ensure vaccines could be made and distributed at a scale unparalleled in human history, unprecedented partnerships between governments, companies and regulators were formed.
A brief history of mRNA
There is no single ‘inventor’ of mRNA technology. In the late 1980s, US researchers at the Salk Institute (named after the developer of an early polio vaccine) began studying how mRNA could be injected into cells.
In the 1990s, the persistence of Hungarian biochemist Katalin Karik helped scientists to see the potential of injecting mRNA, parcelled in tiny blobs of fat, to trigger an immune response. The field was inching forward.
There were several landmark moments along the way. In the year 2000, Ingmar Hoerr, then a German PhD student, published his thesis on mRNA-based vaccines. He co-founded a university spin-out company called Curevac with his supervisors to attract the investment needed to take this technology from the lab to the clinic.
When we caught up with Dr Hoerr for a video interview in 2014, he had just collected a cheque for €2 million for winning the first EU innovation prize. For a research-based company with no products on the market, it was a welcome boost and helped them continue to develop their science. Meanwhile, on the other side of the Atlantic, the US government was also supporting mRNA technology in the hope that it could one day be used against future pandemics.
All of this meant that when COVID-19 struck, researchers had a head start: rather than starting from scratch, they were building on decades of basic science and clinical testing. But there was still much work to do before a vaccine could be approved by regulators.
That’s where CEPI (the Coalition for Epidemic Preparedness Innovation) comes in. Founded in 2017 to respond to a global pandemic, it was ready to work on the tricky questions around accelerating clinical trials, expanding manufacturing capacity and clearing regulatory hurdles.
Here, again, they were standing on the shoulders of giants. GAVI, the vaccine alliance, has more than 20 years’ experience supporting immunisation in the developing world by building public-private partnerships. It has helped to immunise over 760 million children, prevented more than 13 million deaths, and halved child mortality in countries where it works.
As GAVI chief Dr Seth Berkley told us in 2012, this has considerable knock-on positive effects on families and communities. ‘Healthy children lead to healthy societies,’ he said. ‘The power of vaccines is almost equivalent to that of primary education in terms of cost-benefit ratio.’
Rewind a little further and you’ll find the WHO’s successful 10-year campaign to eradicate smallpox which began in 1967. In 1977, the Organisation launched the Expanded Program Immunization (EPI) which significantly increased vaccination against diphtheria, whooping cough, tetanus, measles, TB and polio.
One hit wonder?
As we dare to look to the post-COVID era, attention is turning to the legacy of the pandemic. New collaborations sprung up very quickly to develop vaccines, manufacture and distribute vaccines, and ensure regulatory hurdles were cleared without compromising on safety.
Were these part of a one-off response to a one-in-a-lifetime challenge, or should some of the best bits become a feature of the future?
The world will emerge from the crisis with new technologies and more vaccine manufacturing capacity than ever before. Companies, academics, regulators, international agencies and governments have experienced new collaborations.
There are more vaccinators and supply chains than could have been imagined, and people of all ages have been vaccinated for the first time in decades.
As Anuradha Gupta, Gavi Deputy CEO, told us earlier this year, there is a unique opportunity ahead to reach the 20 million ‘zero dose’ children who have never received a vaccine.
The push to wipe out polio, stalled during the pandemic, would benefit from renewed momentum. And regional campaigns to drive down cases of measles and other preventable illnesses could be reignited.
Over the past decade, Vaccines Today has followed closely the global drive for polio eradication. There have been ups and downs, but the virus is now endemic in two countries: Pakistan and Afghanistan.
The number of polio cases has fallen by 99% since 1988 and experts are keen to finish the job, making polio only the second human disease to be eradicated (after smallpox).
The infrastructure, personnel and funding used for polio eradication played a vital role in responding to the COVID-19 pandemic. As the COVID-19 pandemic spread, staff and resources from some polio immunisation programmes were diverted to help fight COVID-19. In addition, lab capacity was largely taken over for COVID-19 testing.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, says the ability to harness polio eradication infrastructure was crucial to low-resource countries. ‘The wisdom of investing in polio eradication and sustaining its legacy is clear,’ he said.
In June, the World Health Assembly backed a new Global Polio Eradication Initiative Strategic Plan 2022-2026, highlighting the importance of collective action in achieving success. The introduction of novel oral polio vaccine 2 (nOPV2) will be central to responding to outbreaks. (Read a draft of the plan here)
Professor David Salisbury, Chair of the Global Commission on Certification of Polio Eradication, says success will depend on the capacity of countries to implement their national polio elimination plans.
‘With nOPV2 now coming on stream, we can hope to see an impact on vaccine-derived type2 virus outbreaks,’ said Prof Salisbury, who is a member of the Vaccines Today editorial board. ‘If Pakistan and Afghanistan can implement the plans that they have developed, in theory they should be able to stop transmission and be sure that they have indeed done so. When that will happen is entirely in their hands. If they are successful, polio will be eradicated.’
Go far, go together
Partnerships have rapidly delivered vaccines during a global crisis, developing new technologies with the potential to address several diseases. Global collaborations have eradicated smallpox and pushed polio out of almost every country in the world.
Together, governments, international organisations, NGOs and companies have ensured that the benefits of vaccination reach people in low-resource countries – and in marginalised communities in rich countries.
Now, the challenge is to reach the millions of children who still do not have access to routine immunisation. Building on the experience of the pandemic, the global community has an opportunity to end polio and ensure the world is better prepared for future pandemics.
In the next of our ‘10 @ 10’ articles, we ask what can be done to ensure a better, more coordinated response to the next public health crisis.