It has been 11 harrowing months since the dawn of COVID-19, a disease caused by the novel SARS-Cov-2 virus which has swept across the globe at wildfire speed and thrusted the entire planet into sheer distress and indecision. Truth be told, humanity has been shaken to its core! COVID-19 has crippled economies and changed daily life, as we know it, for the foreseeable future.

For medical professionals, these past 11 months have been nothing short of a nightmare! Positioned at the front lines of this pandemic, we have had to combat this invisible enemy, that we had little information about, SARS-Cov-2 virus. Since the first news about the initial outbreak in Wuhan, China, we have grown to learn more about the virus and its myriad disease presentations. Consequently, we have also witnessed a series of vaccine candidates enter the accelerated pipeline — serving as the hope and potential of a saving grace for a world that is aching for immediate relief. Unfortunately, even with the accelerated pace, vaccine development is not an overnight process.

In fact, vaccine development is a trial and error series; a long process that comes with many fundamental phases where scientists and specialists, known as vaccinologists, must first successfully test for safety even before determining the true efficacy of a candidate vaccine for clinical trials. Then, even after successfully launching a trial and finding an effective vaccine, the challenges for getting a vaccine approved and distributed do not end there. As a Virologist and Vaccine Biologist, I am the first to admit that this is the biggest challenge that we face, as we look ahead to the next 11 months of the COVID-19 pandemic.

As of this writing, more than 150 COVID-19 vaccines are in development across the world. At the same time, the World Health Organization is also actively working on coordinating global efforts for vaccine development; with an intention to deliver two billion vaccine doses by the end of 2021. Mind you, there are almost 8 billion human lives on this planet and in order to effectively create herd immunity, or close to it, we will need to vaccinate at least sixty percent (4.8 billion people) of earth’s population and ideally, vaccinate over eighty percent in high-risk populations. Without knowing these detailed figures, the public’s hope in advancing a tangible vaccine solution in the near future is high, as everyone is thinking it would immediately alleviate the ongoing global crisis. Yet, on the other hand, multiple large studies suggest that no more than 50% of people are really interested in getting the SARS-Cov-2 vaccine, if one were to become available today. What a conundrum!

To better educate the public, it is imperative to consider the key challenge in designing vaccines for this newly discovered virus, where we are still learning about its full pathogenicity and mechanisms for how it infects cells and provokes different immune responses in different people. Truth be told, the vaccine design process normally takes between six and ten years because the majority of viral vaccines are produced from scratch to address the unique pathogenic factors which are discovered as the virus is better understood. However, 6 years at our current levels of SARS-Cov-2 infection, morbidity and mortality, while also not having effective early treatments, will be catastrophic, if we were to apply this usual timeline to a COVID-19 vaccine. Therefore, vaccine design efforts have been focused on creating a first generation vaccine to, at the very least, help to mitigate disease severity amongst those at highest risk for severe COVID-19 disease and prevent infection/spread in those with more robust immune profiles; while we refine the candidates for future and more long lasting vaccines.

This first generation of COVID-19 vaccines is anticipated to get a nod before 2020 concludes or by early 2021. Multiple vaccines are already currently in phase 3 trials with efficacy in most trials assessed as prevention of virologically confirmed disease. This is progress that the public desperately wants to hear but just like with other vaccine development stories of the past, things can go south and may even require rerouting as evidenced by the recent halt of a couple of trials and recent realigning of the messaging to emphasize the benefits of therapeutic vaccines such as Regeneron’s monoclonal antibody cocktail candidate and not just preventive vaccines. 

In conclusion, despite the ongoing race to develop the right vaccine, it is important that we impress upon ourselves that the goal here is not to produce one winner. We have to recognize that in the early stages of release, different vaccines will target different aspects of this virus’s biological profile and as medical professionals who understand that COVID-19 affects different organ systems and patient groups in various ways, we also need to start tempering the public’s expectation that this will be a one and done process. Vaccinologists are hard at work identifying and accelerating vaccine candidates into production but their work is really only truly just beginning. In the meantime, and for the foreseeable next 18 to 36 months, we also need to continue to emphasize the importance of the basics: handwashing, wearing a mask and physical distancing.

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