Top vaccine scientist Dr Gagandeep Kang on Thursday expressed amazement at how quickly Indian vaccine companies moved during the Covid-19 pandemic. “They were– known for high volume and low-value vaccines and what they did very quickly was partner around the globe for every kind of technology platform and made sure they had multiple shots. So now, Serum Institute of India has four different products and so does Bharat Biotech. “They have made phenomenal efforts to partner for technologies they did not have,” said Dr Kang.
Kang, who is the vice-chair of the Board of Coalition for Epidemic Preparedness Innovations (CEPI), has been speaking of her concerns related to the approval process of the vaccines by the Drugs Controller General of India.
Responding to questions on Covid-19 vaccines during a webinar organised by the National Council of Applied Economic Research that hosted authors Kang, Dr Randeep Guleria, director of AIIMS, and Dr Chandrakant Lahariya on their new book `Till We Win: India’s fight against the Covid-19 pandemic’, Dr Kang, however, tried to drive home the point that none of these vaccines is “innovation that has suddenly came to light because there was a new virus”.
She explained that it was really investments and efforts by scientists around the world over years that made these vaccines possible. “That is why we have the vaccines and these will be a game-changer during the next pandemic. If this time a vaccine was made in 10 months, then next time it will be a matter of asking why not make it in six months. We need to be prepared,” said the scientist.
Kang pointed out that the reason we have mRNA vaccines is because of the investment that then US President Bill Clinton made in the vaccine research centre (VRC) at the National Institutes of Health, USA. “It was set up to make a vaccine against HIV that failed, but what it did was to bring scientists together and the work they did from mid-90s went a long way in helping them figure out why there were problems with certain vaccines and what it takes to induce a durable immune response to vaccines. So, when the sequence of the SARS-CoV2 virus was released on January 10 last year, within two days the VRC was communicating the structure of what needed to be done for an mRNA vaccine to Moderna,” she said.
“The vaccine is based on the spike of the coronavirus and the spike is a sort of a floppy protein that changes shape… They had to decide which shape of the spike really matters and scientists were able to show that it was based on what they had done earlier that it was the prefusion form of spike that was important. They were able to engineer a stabilising mutation to make the vaccine and Pfizer also did the same. These are new technologies and have been around for the last 20-25 years – We did not have a successful mRNA product before for infectious diseases and it is really building on the backbone of everything that has happened around the world that allowed for the vaccines to happen,” Dr Kang said.
“The AstraZeneca vaccine is based on the adenovirus-based platform, where scientists have been working for well over a decade at the Jenner institute. They had an ongoing funded programme for a MERS (MERS is a corona virus as well) vaccine as well. Scientists soon switched the programme to make a SARS coronavirus vaccine and used the same stabilising mutation developed by VRC. The vaccine made by Serum institute of India is essentially an identical composition to the AstraZeneca vaccine,” said Kang.
“With Covaxin, the vaccine is made by a company that is innovative but using technology that is old by making an inactivated vaccine. This is something that Louis Pasteur made 150 years ago when he made the rabies vaccine. Since the 1950s, instead of growing vaccine in animals, vaccines were grown in cell culture. Inactivated polio and inactivated influenza vaccines were the first examples of inactivated vaccines made in cell culture. That is the technology Bharat Biotech has used. They also have an adjuvant which uses molecular approaches to immunology to improve immune response to the inactivated vaccine,” she explained.
Meanwhile, Kang also made a strong case for building clinical research capacities in the country. “The area that bothers me is that the quantum and quality of clinical research and that of public health research has been quite limited. If you look at clinical research and what happened globally, India’s participation in Solidarity trial was really quite limited given the number of cases there were in the country of coronavirus disease. We recruited very tiny numbers and if we are to do better then we need to focus on building clinical research capacities so that large well-powered studies on diagnostics, vaccines and drugs would be useful,” said Kang, a professor at the Wellcome Trust Research Laboratory at the Christian Medical College in Vellore.
Kang, who is also the co-chair of the newly established Lancet Citizens Commission on Reimagining India’s health system, shared her insights about how the pandemic in many ways has been good for us. Despite the heavy toll taken on people and systems, there is an increased recognition of the importance of stronger health systems and of research, she said.
“When we wanted mathematical models for predicting what was likely to happen in the country for the first few months, we had to rely on models that came largely from outside the country that were developed by a lot of mathematicians who had no understanding of infectious disease and frequently got things quite wrong,” she said.
“We do not have a lot of virologists in the country and during the Covid pandemic, what has happened is that a lot of basic science institutes like the Indian Institute of Science in Bangalore, National Centre for Biological Science, and Centre for Cellular and Molecular biology have begun to focus on structural studies of viruses… they earlier had a lot of ability and Indian scientists are really fantastic. So, to see them turning now towards what are really public health problems is really phenomenal, specially in terms of vaccine development, indigenisation of diagnostics and making new equipment via industry and academia partnerships have been excellent,” she said.
Dr Guleria too agreed with Kang on the need to really focus on research. “We have not been able to develop a clinical research cadre… lot of people come to AIIMS and want to do research that has a translational element, which can be useful but they find there is no path for their career growth. Clinicians should have confidence that research can be promoted and that there is a good career in it. There has to be a mechanism that promotes research,” Dr Guleria said. Despite the huge challenges, India has done well, he said.
Preeti Sudan, former Union health secretary and a member of the international panel for pandemic preparedness and response, Dr Devi Prasad Shetty, chairman of the Narayana Health and NCAER Director General Shekhar Shah also spoke on the occasion. The discussion was chaired by N K Singh, chairperson of the 15th Finance Commission.
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