Securing C-19 vaccine to move from new normal to new future

Which vaccine candidates Bangladesh SHOULD and SHOULD NOT target?
The COVID-19 vaccines under development could be categorized based on the technology platforms utilized namely mRNA technology, adenoviral vector technology, protein subunit and inactivated vaccines (see Table 1).

mRNA vaccines: Using this technology, the vaccines of BioNtech-Pfizer and Moderna-NIAID have so far proven to show acceptable efficacy and safety profiles. However, the storage temperatures for BioNtech-Pfizer and Moderna-NIAID are (minus) -70�C and (minus) -20�C respectively. Such (ultra)cold-storage is expected to be a huge logistic challenge ever faced by the vaccination program of Bangladesh. Importantly, according to WHO estimates, over 50% of vaccines are wasted globally just because of not maintaining proper regular temperature (2-8�C).  This is why, proper planning is important, especially to cover most vulnerable group. It is simply to open few locations in the major cities where COVID-19 hit very hard.  In the next phase, Bangladesh may consider another mRNA technology that CureVac is developing, which is expected to receive emergency use authorization during summer 2021 and can be stored in standard 2-8�C. Bangladesh should pre-order the vaccine of CureVac ASAP.
Adenoviral vaccine: This vaccine technology has proven to be successful in receiving FDA and EMA approvals. For instance, the technology used by Janssen Pharmaceutical (Johnson and Johnson) has received EMA approval for the Ebola vaccine in 2020 (see Table 1). Moreover, due to standard storage temperature, relatively cheap price and capability of manufacturing in huge doses, Bangladesh must consider the pre-order of Janssen vaccine in addition to pre-ordering of more doses of Oxford-AstraZeneca vaccine. Sputnik-V vaccine of Gamaleya Institute (Russia) could be considered but need to be cautious about their Phase III data once available to public.

Protein subunit vaccines: This vaccine technology also has proven to be successful in receiving FDA and EMA approvals. More importantly, the vaccine candidate of Novavax so far has shown acceptable efficacy and safety profiles. In addition, Novavax vaccine is relatively cheap and due to standard storage temperature, Bangladesh mayconsider pre-ordering of this vaccine too but need to check by the experts for the preclinical and clinical data critically.

Inactivated vaccines: It is remarkable that none of the scientifically advanced countries in the EU and countries like the USA, UK, Australia and Japan has chosen and has not invested their money in inactivated vaccines (see Figure 1). Similarly, Bangladesh should stay away from inactivated vaccines of Bharat Biotech, Sinovac, Sinopharm, and Institute of Medical Biology of Chinese Academy of Medical Sciences, Research Institute for Biological Safety Problems of the Republic of Kazakhstan, Shenzhen Kangtai Biological Products Co., Ltd. among others. Other than the scientifically questionable efficacy of inactivated vaccines, such vaccines like the vaccine of Sinovac are very costly, US $60 per person.

How Bangladesh must act immediately to secure enough vaccines?

1. Pre-order frontline vaccine candidates suitable for Bangladesh: The Government must start pre-ordering of frontline vaccine candidates without any delay. In choosing the scientifically solid vaccine candidates, Bangladesh should also follow those vaccines pre-ordered by the developed countries. The vaccine candidate of Janssen Pharmaceutica (Johnson and Johnson) should be given the priority as the vaccine technology has proven to be successful in receiving the recent EU approval for Ebola vaccine. Moreover, Janssen vaccine is affordable, storage temperature is suitable for Bangladesh and the vaccine will be manufactured over 1 billion per year, therefore, the chance of getting that vaccine in Bangladesh is relatively high. Bangladesh should also pre-order the vaccine candidates of Novavax and CureVac. Sputnik V could also be an interesting candidate for Bangladesh as Gamaleya Institute has already permitted India and Latin America to produce 100 million doses each.

2. Promote private initiatives to secure vaccines: The whole population of Bangladesh should not wait to receive COVID-19 vaccines through a government funded vaccination program. Studies have shown that nearly 70% of the patients seek healthcare service in private hospitals/clinics and therefore, a significant proportion of the population can effort vaccination from private initiatives. Therefore, the government should promote reputed pharmaceutical companies to make deals with vaccine developers to ensure that Bangladesh gets priority access to suitable vaccines and secure more doses of Oxford-AstraZeneca vaccine through Serum Institute.

3. Efforts to acquire bulk lots of vaccines for fill-finish in Bangladesh: Bangladesh could also ask Russia and other vaccine developing companies to utilize the internationally-recognized, high-quality vaccine fill-finish platform available in pharmaceutical company(s) in Bangladesh. This will help tremendously to secure enough doses of vaccines within short-time.

4. Take an active role in the movement of equitable distribution of vaccines: People of developing countries like Bangladesh must not leave behind for vaccination. Bangladesh should raise voice and start lobbying for equitable distribution of vaccines.
Dr Rezaul Karim is an immunologist and former project lead at WHO-Utrecht Centre of Excellence for Affordable Biotherapeutics, The Netherlands.
Dr M Shamsul Alam, Immunologist working at the National Institutes of Health, USA.
Dr Jubayer Rahman. Immunologist working at the National Institutes of Health, USA.
Dr Md Anwar Hossain, Vice-Chancellor, Jessore
University of Science and Technology, Researcher
on vaccine development.
Dr Mohammad Sorowar Hossain, Former Senior Manager (R&D), Biotech Division, Incepta Pharmaceutical Ltd; Associate Professor, Independent University, Bangladesh; Executive Director, Biomedical Research Foundation, Bangladesh