20 Aug 2020

Covid-19: Lessons from the last big vaccine race

6:18 am on 20 August 2020

For Russell Basser, the pressure was immense. It was 2009. Swine flu had arrived - the last global pandemic before coronavirus.

CSL distributed its swine flu vaccine worldwide in 2009.

CSL distributed its swine flu vaccine worldwide in 2009. Photo: AFP

Though it was far removed from the devastating impact of Covid-19 - there were no lockdowns and life in Australia remained relatively normal - the virus was killing people. Healthy young people.

Like today, the race was on to find a vaccine.

And Dr Basser - a top executive at research firm CSL's clinical and regulatory arm - was in charge of finding it.

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"It [swine flu] was actually hitting kids and pregnant women," Dr Basser said.

"We were worried this was going to be something akin to the Spanish flu.

"We were racing. We put our full body and soul commitment into getting that vaccine developed. And there was pressure, as there is now."

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The pressure is real. Across the world, more than 115 coronavirus vaccines are in development. Eight human trials are underway - five in China.

It is a global race between nations, and the subject of US espionage claims against China.

Billions are being poured into development, with big pharmaceutical companies teaming up to speed up the process. But the prize - if it comes - will become a powerful political tool, potentially freeing the citizens of the country that produces it from the shackles of life under the threat of the coronavirus.

And though the stakes may not have been as high in 2009, lessons have been learnt to help with the response today.

The H1N1 vaccine was rolled out around the world in 2009.

The H1N1 vaccine was rolled out around the world in 2009. Photo: AFP

CSL, today the most valuable company in the country, is Australia's biosecurity partner and manufacturer of the seasonal flu jab.

As it is focused on influenza vaccines, it is not actively involved in the search for a coronavirus vaccine, apart from supporting others in their efforts, like the University of Queensland.

But back in 2009, it was at the forefront. And it achieved its goal.

Dr Basser's Australian-based team was the first to carry out human trials of a swine flu vaccine.

CSL then received approval in September 2009 with the Australian government kicking off its immunisation program the same month. A Chinese firm working on similar timeframes kicked off its program days later.

"It was a bit of a relief more than anything," Dr Basser told the ABC.

"A relief that we could develop a vaccine with the volumes required for the Australian population, much more efficiently and much quicker than we might have been able to.

"We were very efficient in what we did."

But what happened next is the issue that has some in the global health community worried.

By the end of 2009, about 37,000 Australians were diagnosed with swine flu and 190 people died. Yet Australia came out of the swine flu pandemic relatively unscathed because of CSL's swift response.

CSL had agreements with a number of countries: Australia, New Zealand, Singapore, the US and Canada to hand over the vaccine, in turn producing a healthy windfall for the company.

Yet, the governments of those countries determined how it got used.

An employee of vaccine manufacturer CSL, works on the production for the swine flu vaccine in Australia.

An employee of vaccine manufacturer CSL, works on the production for the swine flu vaccine in Australia. Photo: AFP

These countries entered into contracts with big pharmaceutical companies, effectively monopolising the H1N1 swine flu vaccine at the expense of poorer nations, who were pushed to the back of the queue.

Looking back, Dr Basser said the mistakes made more a decade ago were informing today's decisions.

"As a global ecosystem of vaccine developers, not only do we need to look out for our own communities, but we also do need to look after the rest of the world," he said.

"And one of the big learnings from swine flu was that the system and network wasn't as well set up as what it could have been. The world's had a wake-up call."

Evening out the playing field

Tony Cunningham, an adviser to the Australian Government coronavirus vaccine response, consulted with CSL and the global vaccine company that distributed it across the world back in 2009.

The founding director of the Westmead Institute for Medical Research's virus research centre said the fact that countries would "often look after their own populations first" was relevant to the Covid-19 response, and that issue remains a "major concern" for the World Health Organization.

CEPI Deputy Director Frederik Kristensen.

CEPI Deputy Director Frederik Kristensen. Photo: AFP

But since the swine flu experience, there has been a global push to level the playing field.

The Switzerland-based Coalition for Epidemic Preparedness Innovations (CEPI), founded in 2016 by the Bill and Melinda Gates Foundation, was established to coordinate the development of new vaccines to prevent and contain infectious disease epidemics.

It is in the midst of negotiations with a range of companies, research arms and state-backed organisations for a coronavirus vaccine.

Last week it granted American vaccine development company Novavax US $384 million (NZ$578 million) for its push to find a coronavirus vaccine - CEPI's biggest-ever funding boost.

Will history repeat?

There are still concerns that if a vaccine is successful what happened in 2009 could happen again.

The concerns are centred on countries such as the US - a leader in pharmaceutical research - being hit so hard by coronavirus that if one is produced in-country it will not be shared worldwide for months or even years.

And the political games are already taking place. Over the weekend, France's government summoned the chief executive of French pharmaceutical giant Sanofi for talks, after he suggested the US may have first rights to a pre-order of a vaccine in development, because it had "invested in taking the risk".

The ABC understands CEPI's negotiations with companies in the US and the Trump administration have been sensitive, with work still to be done in locking down agreements.

The concerns have also spread to China. Although some commentators suggest China is keen to use the development of a vaccine to reboot its global standing on the back of coronavirus, others fear a state-backed firm may not be as generous with its intellectual property.

Professor Cunningham said the speed at which companies and researchers were racing towards a vaccine was exciting - but also concerning.

"It generally takes us eight to 18 years to produce a vaccine, the shortest is about four years," he said.

"We're seeking to do this, which everyone is saying, within 12 to 18 months. We have got to be careful - we can't short change the checks on safety.

"But this is going to require alliances, and I see a lot of collaboration happening around the world; people are energised by the emergency."

A scientist studying coronavirus.

A scientist studying coronavirus. Photo: AFP

Collaborations big and swift

Pharmaceutical giants Sanofi and GSK joined forces last month to look at developing a vaccine.

Pfizer, another global pharmaceutical leader, is collaborating with a German biotech, while Johnson and Johnson, the biggest pharmaceutical company in the world, has committed US$1 billion (NZ$1.5 billion) in collaboration with the US Government to try to find a vaccine.

While it is not unusual to see collaborations in the sector, big pharma intellectual property expert and Herbert Smith Freehills partner Rebekah Gay said the speed at which these agreements were moving was "extraordinary".

"There's been a willingness on the part of companies to just get in and start working without being caught up in legal intricacies or arguments about intellectual property ownership," she said.

"And what that means is we're seeing vaccine candidates in a timeline that we've never seen before."

In Australia, CSL is the manufacturing or "industrial" partner of the University of Queensland's vaccine push - which is being part-funded by CEPI - and would produce it locally.

But if a locally produced vaccine did not eventuate, CSL would work with the Australian Government in its negotiations with foreign governments, CEPI, other companies and research groups to bring the successful vaccine to Australia.

Some experts predict any vaccine would need two doses, meaning manufacturers would have to work together to produce the near 15 billion doses to protect the world.

View of a Coronavirus Covid-19 background - 3d rendering

A 3D rendering of the coronavirus that causes Covid-19. Photo: 123rf.com

Dr Basser, now senior vice-president of CSL vaccine arm Seqirus, said in the 11 years since swine flu the research community had woken up.

And although there were still many uncertainties, he said the response to the Covid-19 threat so far had shown its development over the past decade.

"This is not about a commercial return," he said.

"This is about overcoming a threat to everybody. And that we could share appropriately if only one or two vaccines were successful.

"And given the way the global vaccine ecosystem has behaved up until now, I am cautiously optimistic we'll find a solution."


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