TrialSite reported recently that a number of countries were reporting growing so-called breakthrough infections due primarily to the Delta variant surge, but also perhaps associated with the increasingly questionable efficacy of vaccine products developed in China, such as those from both Sinopharm and Sinovac. Thus the trend of mixing and matching a first Chinese vaccine dose with a second Western dose (e.g. AstraZeneca, Janssen/Johnson & Johnson, Moderna, or Pfizer-BioNTech) emerged over the past several weeks in some Asian nations. For example, Malaysia’s health minister announced that this nation would cease to use the Sinovac product once the supply ran out. Then the southeast Asian nation, having secured 45 million doses, will switch to the mRNA vaccine produced by Pfizer-BioNTech. TrialSite also reported that Thailand would drop Sinovac in exchange for AstraZeneca’s vaccine. Perhaps based on a mutating pathogen combined with subpar vaccine products, even in some of the most vaccinated nations, a noticeable surge in cases is reported. And what about early treatment to protect low-and middle-income countries (LMICs) with extremely low vaccination rates? That most certainly would have been an important component of any public health strategy.
In regards to the global market, government buyers for the most part now have their research institutes as well as industry looking into more flexibility as to how to vaccinate the world’s population. Due primarily to the Delta variant, but spurred on by both emerging as well as potentially emerging variants, the concern that these pathogens become ever more transmissible while evading existing vaccines becomes a topic of intensified discussion.
What is a national public health authority to do if existing vaccines don’t prove strong enough to overcome select variants such as Delta? Even in the West, in the highly vaccinated country of Israel, concern mounts with calls for a third booster as the efficacy of the Pfizer-BioNTech mRNA vaccine waned from 97% down to 64%. That’s why that nation suggested a booster shot, but in America, the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) are resisting such a move, at least for the time being.
But clearly, from market demands for a third booster to calls to mix and match different vaccines (again, against the World Health Organization’s accordance), government buyers seek out more efficacious solutions. But other approaches are possible as well. From compressing the duration from first and second dose to what TrialSite has suggested, that is, using only one dose and sharing more of the supply around the world, the pandemic moves into its next phase of solution discovery.
Early Intervention—the Price of Having a Pervasive Embrace
The other challenge in all of this, of course, is the global pushback made by the World Health Organization (WHO) and national regulatory authorities—perhaps encouraged behind the scenes by industry—against low-cost, economical, generic, possible early-treatment options. TrialSite won’t go into that particular discourse in this piece, that is, that part of any comprehensive, holistic public health fight against COVID-19 includes a diversified range of tools, including A) vaccines, B) branded novel therapeutics, C) generic low-cost drugs, and D) appropriate public health measures at the local level.
WHO Declaration…then the Market
While undoubtedly, WHO declared emergency use authorization (EUA) for vaccines from both Sinovac and Sinopharm due to scarcity of vaccine supply in poorer countries also known as low-to middle-income countries (LMICs), undoubtedly knowing that the more efficacious Western products wouldn’t be available en masse in these places anytime soon. But a combination of the Delta variant and inferior efficacy appear to be overwhelming the WHO strategy of using the Chinese vaccines to overcome a market dynamic. That is, the rich nations first secure the overwhelming supply of the superior mRNA vaccines. But could the Delta variants overcome even the best Western vaccine products?
As reported across many different media from all corners of the globe, rising cases among vaccinated populations indicate a combination of questionable vaccine efficacy and more virulent strains of SARS-CoV-2, such as the Delta variant.
In Malaysia, for example, The Edge Markets reports that that nation’s Drug Control Authority authorized AstraZeneca plus Johnson & Johnson but also Sinopharm. TrialSite reported that even with material delays in production associated with the AstraZeneca product, Thailand would mix and match a Chinese product with a Western vaccine. This elicited a strong response on July 12 from the WHO while TrialSite reported that Canada has, for quite some time, been studying the mixing and matching of COVID-19 vaccines. We, of course, informed the reader why Canada was in such a bind, due to a failed early on vaccine strategy involving the selection of China’s CanSino Biologics.
University of Oxford Study Shows Potential for 1-2 combinations
The University of Oxford recently released a study, for example, demonstrating that a more potent response was generated from mixing the mRNA-based BNT162b2, that is the Pfizer-BioNTech vaccine as a second dose, on top of a first dose of AstraZeneca’s vaccine developed by the University of Oxford.
As it turns out, these results directly contradict the WHO when they declared there was no legitimate science behind the mixing and matching of vaccine products. In fact, the University of Oxford study indicates that such mixing and matching of vaccines can actually outperform two shots of the same vaccine. Moreover, as reported recently by Nature, a couple of German studies show similar results.
Demand for Third Boosters
Israel’s Ministry of Health reported that the Pfizer-BioNTech vaccine declined in effectiveness from 97% in May to 64%, hence the recent call there for a booster shot.
While WHO called out the equity challenges associated with drug companies moving ahead with third booster shots, national government buyers, which form the market for vaccines, are already driving the industry in that direction. Israel put out an interest for a third booster while the world’s fourth-most populous nation, Indonesia, recently suggested diversification away from Chinese-made vaccines based on an intense COVID-19 surge there. A Western booster shot would be in demand there as well.
A study by the University of Hong Kong and published in the journal Lancet Microbe suggests consideration for “alternative strategies” for individuals inoculated with the Sinovac vaccine. In Hong Kong, the other product in use is BNT162b2 developed by Pfizer-BioNTech. Hong Kong adopted both these vaccine products and, for the most part, has contained the pathogen.
Meanwhile, recently TrialSite’s shared the thoughts of a top immunologist in Israel. Potentially countering the immediate impulse for a third booster dose, Cyrille Cohen from Bar Ilan University declared that the Delta variant could be overcome by cutting transmission rates or the “R-value.” That equates to the average number an individual carrier of the virus actually goes on to infect. The expert commented, “You don’t need a lockdown, you just need to get the R and 1 and it’s not too much effort.”
Top Vaccinated Places & COVID-19 Trends
As can be predicted, rich developed economies demanded, and paid, for large shipments of the superior Western vaccine products while a majority of the low-and-middle-income countries (LMICs) await secondary and tertiary orders or depend on the WHO’s COVAX facility. China and Russia supplied much of the developed world with vaccine products.
|Gibraltar||99%||Up since July 9|
|Malta||70.8%||Up since July 10|
|Seychelles||69.8%||Up but Flattening|
|UAE||68.9%||Deaths up since June|
|Isle of Man||63.6%||Massive Spike since early July|
As depicted in the table, these nations are the most vaccinated places in the world. A disturbing trend manifests in a number of them. For example, in Gibraltar, Malta, Seychelles, UAE, and Isle of Man, COVID-19 cases are considerably up, including deaths in some of these nations. This is despite overwhelming vaccinated numbers.
Of course, there are a number of explanations that can be attributed to this trend. In places such as Seychelles, we have suggested the trend probably results from a combination of the Delta variant and dependence on a subpar vaccine product produced in China.
But what about the Isle of Man experiencing a dramatic increase? As reported by the BBC, this place depended on the AstraZeneca vaccine yet experienced a large spike in cases. Of course, it’s relative in that the population is very small but nonetheless, this kind of trend should be monitored.
Call to Action: More granular data needs to be collected on why some highly vaccinated nations are faring so much better than others.