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COVID-19 vaccines in the Philippine context

Several months and over 400,000 COVID-19 cases later, the Philippines has begun its long-awaited and promised process of acquiring vaccines as a means to end the pandemic. As early as April, President Duterte spoke optimistically of the prospects of a vaccine. Realistically, however, we must be aware of the realities of vaccination in the recent past in order to truly ensure its success.

Before looking at the advances of COVID-19 vaccine technology, it is important to look at the role immunization has played in the Philippine health care system. Indeed, this has been one of the cornerstones of preventive care for disease not just of childhood (mumps, chickenpox) but eventual adult concerns (HPV, pneumonia) as well. Yet despite the government’s Expanded Program on Immunization (EPI) and the National Immunization Program (NIP), the country has seen a drop in population coverage, leading to the resurgence of vaccine-preventable illnesses such as measles, diphtheria, and even poliomyelitis in the past decade. The Philippines’ circulating vaccine-derived polio cases in 2019-2020 placed us on a list with African countries struggling to end the transmission of this disease.

Many attribute the dismal immunization coverage to the dengue vaccine scandal, but while it doubtless eroded vaccines confidence in the Philippines, our immunization programs have actually been problematic long before Dengvaxia, failing to reach the coverage goal of 95 percent for many years now. The scandal only represented the nadir of what’s already been an alarming trend.

In fact, when it comes to timeliness of vaccination, the 2017 National Demographic and Health Survey showed only a 10.6 percent rate for all vaccines (ranging from 38 to 67 percent per vaccine). The gaps in delivery boil down to the quality and accessibility of our public health system, which, during the recent polio vaccinations, for instance, relied heavily on private sector support. It also faces a lot of challenges when it comes to maintaining the cold chain.

Looking forward to the COVID-19 vaccines, there have been major breakthroughs, the speed and complexity of which have never been encountered before. Of those nearing approval, there are two mRNA vaccines from Moderna and Pfizer—both requiring negative temperatures in their delicate handling. There are also the vector-based vaccines from Astra-

Zeneca and Gamaleya’s Sputnik V, as well as China’s inactivated vaccines developed by Sinopharm and Sinovac, all of which will only need normal refrigerated temperature.

Beyond the vaccine type, its corresponding handling, and the limitations of our health infrastructure, a major concern is the potential politicization of the acquisition, prioritization, and distribution protocols that will be put in place. There have been conflicting reports on who will be vaccinated first—health workers, vulnerable individuals, the poor, and uniformed personnel—according to different government agencies. There is also a need to address people’s concerns about the vaccines, from fears of being made “guinea pigs” to misconceptions about side effects and efficacy.

Surprisingly, there are reports of politicians having already received the vaccine, even if no emergency use authorizations have been granted by the local FDA. The vaccine “czar,” Gen. Carlito Galvez Jr., also mentioned that equitable access to the vaccine will only be achieved by 2022—an election year, which may bring about a predicament not unlike that of Dengvaxia in 2016, which some quarters allege was funded and launched for political considerations. These issues once again raise the danger of politicizing vaccination, especially if the process for prioritization will have potential interference from vested interests. With the urgency called for by the still uncontrolled pandemic, the success of not just the COVID-19 vaccine, but also of the entire vaccination institution in our country, hangs in the balance.

In the end, however, the solution for COVID-19 goes beyond vaccination. The World Health Organization reminds governments of the continuous need to strengthen their countries’ health system to provide for adequate testing, tracing, quarantine, treatment, and monitoring, aside from the provision of essential services. States must invest in public health to strengthen the infrastructure for pandemic preparedness, and to ensure the well-being of all, now more than ever.

Joshua San Pedro, MD, and Gideon Lasco, MD, PhD, are both physicians and anthropologists.

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Delivering COVID-19 Vaccines to the Last Mile in the Philippines

For Vilma Campos , a mother of five from Quezon City, the Philippines, life has been better since her family received their vaccinations. “My daughter and my husband have gone back to work,” she said. “Life is no longer as hard (as it was at the beginning of the pandemic). I really hope we can all get through this pandemic.” 

Vilma worked as a child caregiver before COVID-19 hit the country in early 2020. With quarantine restrictions forcing everyone to stay home, her employer did not need her to watch their children anymore. Her husband and daughter had also lost their jobs because of the community quarantine restrictions imposed by local authorities. It was a trying time, they often did not know where the next meal would come from. The arrival of vaccines gave them hope.

For  Marjunell Mendoza , resident of Cavite, access to vaccines has given her and her family a sense of safety and security. She brought her children to a vaccination center so they too could have greater mobility.  “If all the children are vaccinated, we feel that that the risk of them getting infected or having severe symptoms is significantly less.”

“Some of our relatives are medical practitioners, they made us realize that we should protect, not only ourselves, but also our kids. At the height of pandemic, we really prayed hard for vaccines,”  Marjunell added. 

“I got my child vaccinated against COVID-19 so that he can attend face-to-face classes,”  said  Bernadette Usog,  a resident of Metro Manila.

Vilma, Marjunell, and Bernadette are among the millions of Filipinos whose lives have started to return to normal because of greater access to vaccines.

Ezra Acayan/World Bank

Vaccines administered

Over 15 months, the Philippine government had administered more than 153 million doses of vaccines, including more than 14.8 million booster doses to frontline workers, senior citizens, and the immunocompromised.  

The World Bank is supporting the country’s vaccination program and overall COVID-19 response through the  Philippines Emergency COVID-19 Response Project  (PCERP), which helped scale up national vaccination, strengthen the country’s health systems, and overcome the impact of the pandemic especially on the poor and the most vulnerable.

World Bank financing covered the procurement and deployment of 33 million doses of COVID-19 vaccines across the country. The project also supported pediatric vaccination for 7.5 million children.

The Philippine Department of Health (DOH) has reported that with 70 million doses, the Philippines had achieved 77.8% of its target vaccination rate by the end of June 2022. Ramping up vaccination has helped the country manage the spread of COVID-19, and allowed the country to open more economic activities, which is fueling recovery. By the end of 2021, the country’s  economy grew by 5.6% , a rebound from a –9.5% contraction in 2020.

The employment picture has also started to improve, with the  unemployment rate  dropping to 6.4% in January this year from 8.8% in January in 2021, and 17.6% in April 2020 at the height of enhanced community quarantine (ECQ), the strictest mobility restriction. These numbers indicate that Filipinos have started to regain jobs after a long period of limited mobility and limited operational capacity among businesses.

Following a rapid surge in cases that peaked January 2022, the Philippine government lowered the quarantine restrictions in Metro Manila and several other provinces to  Alert Level 1  beginning in March 2022, allowing greater mobility among citizens and allowing business and other establishments to operate at full capacity subject to minimum public health measures including masking, handwashing, and social distancing.

Reaching the “last mile”  

To achieve the goal of inoculating 80% of the population (or 90 million Filipinos), the government set its sights on ensuring people in the most geographically isolated and disadvantaged areas (GIDA) had access to vaccines.

Despite having many hard-to-reach areas, Tarlac province has already vaccinated 80% of its target population, but the province is trying to raise this number to 85%, focusing on senior citizens and residents in remote villages.

For Mayor Romeo Capitulo of San Jose, Tarlac, the physical difficulty of delivering vaccines to these areas is just one of the many challenges in extending vaccine coverage in remote locations.

“To get to our area, you have to be persistent and ford rivers,”  Mayor Capitulo  said.  “We received help from different agencies—the DOH, the army, Department of Education. They all worked together to help us. There was even an instance when the vaccines had arrived but the people in the community were not around; they were hiding in the creek. We had to convince the people that this (COVID-19) is a different kind of a disease—that it is time to follow the DOH vaccination program.”

Apple Joy Capiral  is a rural health midwife assigned to the national vaccination program in Tarlac province.  “As early as 5:00 am, we prepare the vaccines and then start transporting them by foot,”  said Apple.  “We traverse rivers and hills with the heavy vaccine carriers. The impassable roads and bad weather are also a challenge. The journey may be difficult, but we enjoy it.”   

Apple also said,  “It is a joy for health care workers to help the community. It feels great when the people in the community welcome us when we arrive. We feel happy and fulfilled when they accept the vaccination program and no one gets sick in the community.”

“I am grateful to our health workers and the DOH. Despite the difficulties, having to cross rivers, they are always there, untiringly doing their work,”  Mayor Capitulo added. 

Department of Health Development Management Officer  Maria Noel Borneo-Lim  said,  “We see the number of cases going down, and this is because of collaborative efforts... Let’s push on and not lose hope.”

Going forward, the World Bank will be supporting the coverage of booster doses to vulnerable groups and the rollout of primary vaccination in the Bangsamoro Autonomous Region in Muslim Mindanao.

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Vaccination in the Philippines: experiences from history and lessons for the future

Affiliations.

• 1 Duke-NUS Graduate Medical School, Singapore, Singapore.
• 2 Harvard Medical School, Boston, MA, USA.
• 3 Department of Health, Health Promotion and Communication Service, Philippines.
• PMID: 33357156
• PMCID: PMC8115747
• DOI: 10.1080/21645515.2020.1841541

In anticipation of a potential vaccine for COVID-19, vaccine uptake may be critical in overcoming the pandemic, especially in countries like the Philippines, which has among the highest rates of infection in the region. Looking at the progress of vaccination in the country - its promises, pitfalls, and challenges - may provide insight for public health professionals and the public. The history of vaccination in the Philippines is marked by strong achievements, such as the establishment and growth of a national programme for immunization, and importantly, the eradication of poliomyelitis and maternal and neonatal tetanus. It is also marred by critical challenges which provide a springboard for improvement across all sectors - vaccine stock-outs,strong opposition from certain advocacy groups, and the widely publicized Dengvaxia controversy. Moving forward, with recent surveys having shown that vaccine confidence has begun to improve, these experiences may inform the approaches taken to address vaccine uptake. These lessons from the past highlight the importance of a strong partnership between health leaders and the local community, bearing in mind cultural appropriateness and humility; the engagement of multidisciplinary stakeholders; and the importance of foresight in preparing public health infrastructure for the arrival of a COVID-19 vaccine.

Keywords: COVID-19; Philippines; Vaccination; public health; vaccine adherence.

• COVID-19 / prevention & control*
• COVID-19 Vaccines*
• Immunization Programs*
• Philippines / epidemiology
• Vaccination*
• COVID-19 Vaccines

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Persuasive Essay Guide

Persuasive Essay About Covid19

How to Write a Persuasive Essay About Covid19 | Examples & Tips

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Are you looking to write a persuasive essay about the Covid-19 pandemic?

Writing a compelling and informative essay about this global crisis can be challenging. It requires researching the latest information, understanding the facts, and presenting your argument persuasively.

But don’t worry! with some guidance from experts, you’ll be able to write an effective and persuasive essay about Covid-19.

In this blog post, we’ll outline the basics of writing a persuasive essay . We’ll provide clear examples, helpful tips, and essential information for crafting your own persuasive piece on Covid-19.

Read on to get started on your essay.

• 1. Steps to Write a Persuasive Essay About Covid-19
• 2. Examples of Persuasive Essay About Covid19
• 3. Examples of Persuasive Essay About Covid-19 Vaccine
• 4. Examples of Persuasive Essay About Covid-19 Integration
• 5. Examples of Argumentative Essay About Covid 19
• 6. Examples of Persuasive Speeches About Covid-19
• 7. Tips to Write a Persuasive Essay About Covid-19
• 8. Common Topics for a Persuasive Essay on COVID-19 

Steps to Write a Persuasive Essay About Covid-19

Here are the steps to help you write a persuasive essay on this topic, along with an example essay:

Step 1: Choose a Specific Thesis Statement

Your thesis statement should clearly state your position on a specific aspect of COVID-19. It should be debatable and clear. For example:

Step 2: Research and Gather Information

Collect reliable and up-to-date information from reputable sources to support your thesis statement. This may include statistics, expert opinions, and scientific studies. For instance:

• COVID-19 vaccination effectiveness data
• Information on vaccine mandates in different countries
• Expert statements from health organizations like the WHO or CDC

Step 3: Outline Your Essay

Create a clear and organized outline to structure your essay. A persuasive essay typically follows this structure:

• Introduction
• Background Information
• Body Paragraphs (with supporting evidence)
• Counterarguments (addressing opposing views)

Step 4: Write the Introduction

In the introduction, grab your reader's attention and present your thesis statement. For example:

Step 5: Provide Background Information

Offer context and background information to help your readers understand the issue better. For instance:

Step 6: Develop Body Paragraphs

Each body paragraph should present a single point or piece of evidence that supports your thesis statement. Use clear topic sentences, evidence, and analysis. Here's an example:

Step 7: Address Counterarguments

Acknowledge opposing viewpoints and refute them with strong counterarguments. This demonstrates that you've considered different perspectives. For example:

Step 8: Write the Conclusion

Summarize your main points and restate your thesis statement in the conclusion. End with a strong call to action or thought-provoking statement. For instance:

Step 9: Revise and Proofread

Edit your essay for clarity, coherence, grammar, and spelling errors. Ensure that your argument flows logically.

Step 10: Cite Your Sources

Include proper citations and a bibliography page to give credit to your sources.

Remember to adjust your approach and arguments based on your target audience and the specific angle you want to take in your persuasive essay about COVID-19.

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Examples of Persuasive Essay About Covid19

When writing a persuasive essay about the Covid-19 pandemic, it’s important to consider how you want to present your argument. To help you get started, here are some example essays for you to read:

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

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Examples of Persuasive Essay About Covid-19 Vaccine

Covid19 vaccines are one of the ways to prevent the spread of Covid-19, but they have been a source of controversy. Different sides argue about the benefits or dangers of the new vaccines. Whatever your point of view is, writing a persuasive essay about it is a good way of organizing your thoughts and persuading others.

A persuasive essay about the Covid-19 vaccine could consider the benefits of getting vaccinated as well as the potential side effects.

Below are some examples of persuasive essays on getting vaccinated for Covid-19.

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

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Examples of Persuasive Essay About Covid-19 Integration

Covid19 has drastically changed the way people interact in schools, markets, and workplaces. In short, it has affected all aspects of life. However, people have started to learn to live with Covid19.

Writing a persuasive essay about it shouldn't be stressful. Read the sample essay below to get idea for your own essay about Covid19 integration.

Persuasive Essay About Working From Home During Covid19

Searching for the topic of Online Education? Our persuasive essay about online education is a must-read.

Examples of Argumentative Essay About Covid 19

Covid-19 has been an ever-evolving issue, with new developments and discoveries being made on a daily basis.

Writing an argumentative essay about such an issue is both interesting and challenging. It allows you to evaluate different aspects of the pandemic, as well as consider potential solutions.

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

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Examples of Persuasive Speeches About Covid-19

Do you need to prepare a speech about Covid19 and need examples? We have them for you!

Persuasive speeches about Covid-19 can provide the audience with valuable insights on how to best handle the pandemic. They can be used to advocate for specific changes in policies or simply raise awareness about the virus.

Check out some examples of persuasive speeches on Covid-19:

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

You can also read persuasive essay examples on other topics to master your persuasive techniques!

Tips to Write a Persuasive Essay About Covid-19

Writing a persuasive essay about COVID-19 requires a thoughtful approach to present your arguments effectively. 

Here are some tips to help you craft a compelling persuasive essay on this topic:

Choose a Specific Angle

Start by narrowing down your focus. COVID-19 is a broad topic, so selecting a specific aspect or issue related to it will make your essay more persuasive and manageable. For example, you could focus on vaccination, public health measures, the economic impact, or misinformation.

Provide Credible Sources 

Support your arguments with credible sources such as scientific studies, government reports, and reputable news outlets. Reliable sources enhance the credibility of your essay.

Use Persuasive Language

Employ persuasive techniques, such as ethos (establishing credibility), pathos (appealing to emotions), and logos (using logic and evidence). Use vivid examples and anecdotes to make your points relatable.

Organize Your Essay

Structure your essay involves creating a persuasive essay outline and establishing a logical flow from one point to the next. Each paragraph should focus on a single point, and transitions between paragraphs should be smooth and logical.

Emphasize Benefits

Highlight the benefits of your proposed actions or viewpoints. Explain how your suggestions can improve public health, safety, or well-being. Make it clear why your audience should support your position.

Use Visuals -H3

Incorporate graphs, charts, and statistics when applicable. Visual aids can reinforce your arguments and make complex data more accessible to your readers.

Call to Action

End your essay with a strong call to action. Encourage your readers to take a specific step or consider your viewpoint. Make it clear what you want them to do or think after reading your essay.

Revise and Edit

Proofread your essay for grammar, spelling, and clarity. Make sure your arguments are well-structured and that your writing flows smoothly.

Seek Feedback 

Have someone else read your essay to get feedback. They may offer valuable insights and help you identify areas where your persuasive techniques can be improved.

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Common Topics for a Persuasive Essay on COVID-19 

Here are some persuasive essay topics on COVID-19:

• The Importance of Vaccination Mandates for COVID-19 Control
• Balancing Public Health and Personal Freedom During a Pandemic
• The Economic Impact of Lockdowns vs. Public Health Benefits
• The Role of Misinformation in Fueling Vaccine Hesitancy
• Remote Learning vs. In-Person Education: What's Best for Students?
• The Ethics of Vaccine Distribution: Prioritizing Vulnerable Populations
• The Mental Health Crisis Amidst the COVID-19 Pandemic
• The Long-Term Effects of COVID-19 on Healthcare Systems
• Global Cooperation vs. Vaccine Nationalism in Fighting the Pandemic
• The Future of Telemedicine: Expanding Healthcare Access Post-COVID-19

In search of more inspiring topics for your next persuasive essay? Our persuasive essay topics blog has plenty of ideas!

To sum it up,

You have read good sample essays and got some helpful tips. You now have the tools you needed to write a persuasive essay about Covid-19. So don't let the doubts stop you, start writing!

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Frequently Asked Questions

Are there any ethical considerations when writing a persuasive essay about covid-19.

Yes, there are ethical considerations when writing a persuasive essay about COVID-19. It's essential to ensure the information is accurate, not contribute to misinformation, and be sensitive to the pandemic's impact on individuals and communities. Additionally, respecting diverse viewpoints and emphasizing public health benefits can promote ethical communication.

What impact does COVID-19 have on society?

The impact of COVID-19 on society is far-reaching. It has led to job and economic losses, an increase in stress and mental health disorders, and changes in education systems. It has also had a negative effect on social interactions, as people have been asked to limit their contact with others.

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Philippines welcomes the arrival of covid-19 vaccines via covax facility, joint press release by doh, unicef, who, gavi, cepi.

04 March 2021, Manila - Today, more than 480,000 doses of AstraZeneca vaccines arrived in the Philippines from the COVAX Facility, the international partnership established to ensure equitable distribution of COVID-19 vaccines around the world. The Philippines is among the first countries in Southeast Asia to receive vaccines from the COVAX Facility. COVAX is co-led by Gavi, the Vaccine Alliance, the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI), working in partnership with UNICEF as well as the World Bank, civil society organisations, manufacturers, and others.

"The long days and nights of waiting are finally over. These vaccines will be of great help to our valiant healthcare workers who have been at the forefront of the battle against the COVID-19 pandemic. With every dose that we will administer, we are inching towards a safer recovery from this pandemic. So, let us put our trust in science, in vaccines. Together, we will rise as a nation and heal as one,” says Department of Health Secretary Francisco T. Duque III.

Officials from the Philippines’ Inter-Agency Task Force on the Management of Emerging Infectious Diseases (IATF), Department of Health (DOH), World Health Organization (WHO) and UNICEF Philippines received the vaccine doses at the Ninoy Aquino International Airport. The Philippine Government will lead the rollout of the COVID-19 vaccination campaign.

The COVAX Facility leads an unprecedented effort to provide at least 2 billion doses of COVID-19 vaccines by the end of 2021 to low- and middle-income countries. For several months, COVAX partners have been supporting governments and partners in readiness efforts, in preparation for this moment. This includes assisting with the development of national vaccination plans, support for cold chain infrastructure, as well as stockpiling of half a billion syringes and safety boxes for their disposal, masks, gloves and other equipment to ensure that there is enough equipment for healt h workers to start vaccinating priority groups as soon as possible.

The WHO launched the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to accelerate development, production, and equitable access to COVID-19 diagnostics, therapeutics, and vaccines. COVAX is the vaccines pillar of the ACT Accelerator and is led jointly by Gavi, WHO, the CEPI, and UNICEF, which is leading vaccine procurement and delivery operations. WHO is tasked with ensuring fair allocation and prioritization of countries eligible to receive vaccines from the COVAX Facility.

“WHO joins partners and the people of the Philippines in welcoming the arrival of COVID-19 vaccines through the COVAX Facility. These vaccines coming through COVAX will help protect up to 20% of the population in the country during this year, including healthcare workers, other frontline workers and the elderly – groups who are most at risk. The COVID-19 vaccines are proven to protect people from severe disease and death. Used together with public health measures currently in place – wearing masks, physical distancing, avoiding large groups, and washing hands frequently – will help mitigate the effects of the pandemic by reducing deaths and severe disease. We all welcome the addition of vaccines to the available tools in the country which, when used to scale, will contribute to gradual return of day-to-day activities and economic revival in the country. The delivery of COVID-19 vaccines in the Philippines is a powerful step in that direction,” said Dr. Rabindra Abeyasinghe, WHO Representative to the Philippines.

UNICEF is leading the procurement and delivery of COVID-19 vaccines through COVAX facility to countries - the biggest, most sophisticated ground operation in the history of immunization. In the Philippines, apart from supporting COVID-19 vaccine introduction and roll out, UNICEF continues to support the immunization programmes of the government through planning, cold chain and vaccine management, technical know-how and training. Building on over 70 years of experience in providing simple, effective and accurate information to build public knowledge, awareness and confidence in vaccines, UNICEF is working with partners to ensure that local communities are engaged in the overall vaccination process.

“Vaccines are safe and effective. The COVID-19 pandemic has become a child rights crisis which we need to end as fast as possible. The longer the pandemic goes on, the more intense the impact on people, especially on children’s health, rights to education, nutrition, protection and mental health. COVID-19 vaccination should be part of a larger strategy to strengthen health systems for children and families in the Philippines for the long-term,” says UNICEF Philippines Representative Oyunsaikhan Dendevnorov.

The COVAX Facility aims to procure 2 billion doses by the end of 2021. The vaccines are intended to protect frontline health care and social workers, as well as high risk and vulnerable people. COVAX was set up to address concerns around fairness and making vaccines available to all. To control and end the global pandemic, vaccines must be available to all. ###

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About covax facility.

COVAX is co-led by CEPI, Gavi and WHO – working in partnership with UNICEF as key implementation partner, developed and developing country vaccine manufacturers, the World Bank, and others. It is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income countries.

CEPI is leading on the COVAX vaccine research and development portfolio , and investing in R&D across a variety of promising candidates, with the goal to support development of three safe and effective vaccines which can be made available to countries participating in the COVAX Facility. As part of this work, CEPI has secured first right of refusal to potentially over one billion doses for the COVAX Facility to a number of candidates, and made strategic investments in vaccine manufacturing, which includes reserving capacity to manufacture doses of COVAX vaccines at a network of facilities, and securing glass vials to hold 2 billion doses of vaccine.

Gavi is leading on procurement and delivery for COVAX, coordinating the design and implementation of the COVAX Facility and the COVAX AMC and working with Alliance partners UNICEF and WHO, along with governments, to ensure country readiness and delivery. The COVAX Facility is the global pooled procurement mechanism for COVID-19 vaccines through which COVAX will ensure fair and equitable access to vaccines for all 190 participating economies, using an allocation framework formulated by WHO. The COVAX Facility will do this by pooling buying power from participating economies and providing volume guarantees across a range of promising vaccine candidates. The Gavi COVAX AMC is the financing mechanism that will support the participation of 92 low- and middle-income countries in the Facility, enabling access to donor-funded doses of safe and effective vaccines. UNICEF and the Pan-American Health Organization (PAHO) will be acting as procurement coordinators for the COVAX Facility, helping deliver vaccines to all participants.

WHO has multiple roles within the COVAX: among other things it supports countries as they prepare to receive and administer vaccines and does so in partnership with UNICEF. It provides normative guidance on vaccine policy, regulation, safety, R&D, allocation, and country readiness and delivery. Its Strategic Advisory Group of Experts (SAGE) on Immunization develops evidence-based immunization policy recommendations. Its Emergency Use Listing (EUL)/prequalification programmes ensure harmonized review and authorization across member states. It provides global coordination and member state support on vaccine safety monitoring. It developed the target product profiles for COVID-19 vaccines and provides R&D technical coordination. Along with COVAX partners, it is developing a no-fault compensation scheme for indemnification and liability issues. COVAX is part of the Act accelerator which WHO launched with partners in 2020.

UNICEF is leveraging its experience as the largest single vaccine buyer in the world and working with manufacturers and partners on the procurement of COVID-19 vaccine doses, as well as freight, logistics and storage. UNICEF already procures more than 2 billion doses of vaccines annually for routine immunization and outbreak response on behalf of nearly 100 countries. In collaboration with the PAHO Revolving Fund, UNICEF is leading efforts to procure and supply doses of COVID-19 vaccines for COVAX. In addition, UNICEF and WHO are working with governments around the clock to ensure that countries are ready to receive the vaccines, with appropriate cold chain equipment in place and health workers trained to dispense them. UNICEF is also playing a lead role in efforts to foster trust in vaccines, delivering vaccine confidence communications and tracking and addressing misinformation around the world.

About UNICEF

UNICEF promotes the rights and wellbeing of every child, in everything we do. Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.

For more information about UNICEF and its work for children in the Philippines, visit www.unicef.ph .

Follow UNICEF Philippines on Facebook ,  Twitter and Instagram .

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COVID vaccine hesitancy: spell out the personal rather than collective benefits to persuade people — new research

Professor of Clinical Psychology, University of Oxford

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Daniel Freeman receives funding from the National Institute for Health Research and the Medical Research Council. The current research was funded by the NIHR Oxford Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC.

University of Oxford provides funding as a member of The Conversation UK.

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Approximately 10% of UK adults say they will never get vaccinated against COVID-19 or will avoid doing so for as long as possible. Scientists call this group the “vaccine hesitant”, though hesitancy may not seem the right term to describe views often held with clear conviction. People who are vaccine hesitant have often thought long and hard about whether to take a COVID-19 vaccine.

How can such views be shifted? Ideally, one would sit down with people, listen and discuss. In reality, public health campaigners have only mass messaging at their disposal: information disseminated through billboards, TV slots and social media. These are crude tools for tackling sometimes deeply ingrained personal beliefs. What messages delivered through them might really make a difference?

Over the past year, the Oxford Coronavirus Explanations, Attitudes and Narratives Surveys (OCEANS) team has tried to answer this question. We’ve worked to form a psychological explanation for vaccine hesitancy by canvassing the views of people for, against and undecided about vaccines.

We’ve found that hesitancy emerges from a nexus of beliefs , the most important being scepticism about the collective benefits of vaccination. The hesitant don’t accept that taking a vaccine means we’re all better off. They also tend to believe that COVID-19 isn’t a big danger to their health. And they worry that vaccines may be ineffective or downright harmful. The rapid development of COVID-19 vaccines reinforces these concerns.

Behind these specific ideas often lies mistrust. People who are hesitant tend to be suspicious of authority . But while it’s wise to make judgements based on evidence rather than blithely accepting what we’re told, in many cases we’ve found that the vaccine hesitant are susceptible to misinformation.

Fuelling this may be a sense of marginalisation. Vaccine-hesitant people are a little more likely to believe that they’re of lower social status . Feeling that society doesn’t care about them, they are unwilling to trust what they’re told by politicians and scientists.

Getting personal

Equipped with these insights, we decided to see whether we could craft messages that might shift negative attitudes. If people don’t appreciate the collective benefits of vaccination, let’s persuasively set out the case. Let’s explain that vaccines make it less likely we’ll pass on the virus, helping to protect others, particularly those especially vulnerable to the virus. And let’s make it clear that by reducing the risk of getting severely ill, we can help the country bounce back as quickly as possible. That should help shift attitudes, right?

To find out, in early February we surveyed nearly 19,000 UK adults, carefully selected to be representative for age, gender, ethnicity, income and region. Participants were then randomly asked to read one of ten texts about COVID-19 vaccines.

Some texts focused the collective benefits of vaccination, some on the personal benefits, some on safety and some a combination of messages. One text contained only basic information about the vaccine and didn’t provide any detail on benefits, and was used as a control. After reading their allocated text, participants completed a questionnaire on their willingness to be vaccinated for COVID-19.

The results were surprising. Previous surveys had suggested beliefs about the collective benefits of vaccination were pivotal to driving uptake. The extent to which people bought into this narrative seemed to determine their willingness to take a vaccine.

But the text that was most likely to change the minds of the vaccine hesitant (when compared to the control) emphasised not the collective but the personal benefits of vaccination. It pointed out that you can’t be sure that you won’t get seriously ill or struggle with long-term COVID-related problems, and that vaccination will minimise your chances of falling ill.

Months of media coverage in the UK has instead focused on collective responsibility – that we owe it to our fellow citizens to get vaccinated. But for the sceptical 10%, this hasn’t cut through, which is perhaps to be expected. If you think vaccines are unsafe, then you’ll be worried about what getting the jab will do to you. Your decision making then becomes dominated by personal risk.

The best way to counter these concerns, therefore, is to highlight the opposite: personal benefits – and our new research suggests this could well work. It’s also probable that for a group that’s more likely to feel socially excluded, messages that focus on the personal rather than collective ramifications of COVID-19 will be more compelling.

What about the view that the vaccines have been developed too quickly? It’s an understandable fear: these vaccines have been produced with unparalleled speed . In response to this, one text in our study explained that the speed of development reflects the exceptional commitment, investment and cooperation of scientists, governments, public health organisations and pharmaceutical companies – as well as of the tens of thousands of members of the public who volunteered to test the vaccines.

This text noted too that side-effects that affect a significant proportion of people don’t suddenly appear months and years after vaccination. Because of the way vaccines work – quickly training the body’s immune system to fight off a virus – any issues arise within a month and usually much sooner. Happily, this information did seem to reassure people and helped reduce hesitancy.

COVID-19 is unlikely to disappear in the foreseeable future, which means vaccination messaging will remain of critical importance. When it comes to persuading the vaccine hesitant, our research shows that we need to listen, understand concerns and address them seriously. No message will be truly effective if the messenger has not earned trust, nor if it doesn’t account for the desires and worries of those receiving it.

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• v.10(6); Nov-Dec 2020

COVID-19 Vaccines: A Race Against Time in the Middle of Death and Devastation!

Mohammad s. khuroo.

∗ Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India

‡ Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Srinagar, J&K(UT), India

Mohammad Khuroo

§ Indian School Al-Ghubrah, Muscat, Oman

Mehnaaz S. Khuroo

‖ Pathology, Government Medical College, Srinagar, Kashmir, J&K (UT), 190010, India

Ahmad A. Sofi

¶ Burn Hall School, Srinagar, J&K (UT), 190010, India

Naira S. Khuroo

† Gastroenterology and Liver Transplantation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

# Medical Imaging & Radiology, KFSH&RC, Riyadh, Saudi Arabia

∗∗ Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Sector 1, SK Colony, Qamarwari, Srinagar, Kashmir, J&K (UT), 190010, India

The coronavirus disease 2019 (COVID-19) has turned into a global human tragedy and economic devastation. Governments have implemented lockdown measures, blocked international travel, and enforced other public containment measures to mitigate the virus morbidity and mortality. As of today, no drug has the power to fight the infection and bring normalcy to the utter chaos. This leaves us with only one choice namely an effective and safe vaccine that shall be manufactured as soon as possible and available to all countries and populations affected by the pandemic at an affordable price. There has been an unprecedented fast track path taken in Research & Development by the World community for developing an effective and safe vaccine. Platform technology has been exploited to develop candidate vaccines in a matter of days to weeks, and as of now, 108 such vaccines are available. Six of these vaccines have entered clinical trials. As clinical trials are “rate-limiting” and “time-consuming”, many innovative methods are in practice for a fast track. These include parallel phase I-II trials and obtaining efficacy data from phase IIb trials. Human “challenge experiments” to confirm efficacy in humans is under serious consideration. The availability of the COVID-19 vaccine has become a race against time in the middle of death and devastation. There is an atmosphere of tremendous hype around the COVID-19 vaccine, and developers are using every moment to make claims, which remain unverified. However, concerns are raised about a rush to deploy a COVID-19 vaccine. Applying “Quick fix” and “short cuts” can lead to errors with disastrous consequences.

The coronavirus infection which originated from Wuhan, China, in December 2019, has turned into a global catastrophe. 1 The virus has been designated as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and the disease caused by the agent as coronavirus disease 2019 (COVID-19). 2 World Health Organization (WHO) pronounced the disease as a pandemic on March 11, 2020. 3 As of May 4th , 2020, the infection has spread to 212 countries and territories around the World and 2 international conveyances, with over 3.5 million cases and around 250000 deaths. 4 The disease on average affects over 33,000 individuals with over 1300 deaths daily. The world community has responded to the challenge of death and devastation with resilience and determination. 5 Governments have implemented lockdown measures, blocked international travel, and enforced other public containment measures to mitigate the virus morbidity and mortality. 6 , 7 , 8 There has been a major understanding of the disease as well as the pathogen, and these data have been generated and widely publicized in a matter of days and weeks rather than years and decades, an unprecedented occurrence in the history of medicine. 9 , 10 , 11 , 12

Coronavirus family

SARS-CoV-2 belongs to a family of zoonotic viruses known as Coronavirus , genus Betacoronavirus and is closely related to 2 other viruses namely Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). 13 All 3 are bat viruses and cross over to cause human infection through an intermediate host (civets for SARS-CoV, camels for MERS-CoV, and possibly pangolins for SARS-CoV-2). 14 , 15 , 16 , 17 , 18 Coronaviruses are enveloped viruses, around 125 nm in diameter, with a positive-sense single-stranded RNA genome of around 30 kb and a nucleocapsid of helical symmetry. This is wrapped in an icosahedral protein shell. The surface has multiple club-shaped spikes, which creates the appearance of solar corona on electron micrsocopy (EM). The viral envelope consists of a lipid bilayer, in which the membrane (M), envelope (E), and spike (S) structural proteins are anchored. All the coronaviruses use angiotensin-converting enzyme 2 receptors as a cellular entry receptor; however, the propensity of SARS-CoV-2 to attach to these receptors is much higher, giving it high infectivity. 13

Need for coronavirus vaccine

There has been an intensive search for an effective drug against the virus or the resultant disease and has not led to any breakthrough agents. Few drugs namely hydroxychloroquine and remdesivir have been advocated as desperate measures to fight COVID-19 based on a few preliminary, contradictory, and inconclusive studies. 19 , 20 , 21 , 22 , 23 What we need is a drug that is at least 95% effective to stop the pandemic. These and other drugs may save lives but are nowhere near that power to bring normalcy in the utter chaos caused by the pandemic. 24 This leaves us with only one choice namely an effective and safe vaccine that shall be manufactured as soon as possible and available to all countries and populations affected by the pandemic at an affordable price. 25 , 26 A vaccine has the power to generate herd immunity in the communities, which will reduce the incidence of disease, block transmission, and reduce the social and economic burden of the disease. Very high immunization coverage can effectively fight the pandemic, prevent secondary waves of infection, and control the seasonal endemic infection outbursts. Eventually, the disease can be eradicated as has happened in many other diseases that have had even with higher potential than COVID-19 to cause pandemics namely smallpox, poliomyelitis, etc. 27 , 28

Vaccine immunology

Adaptive immune response.

A vaccine is medical preparations ranging from intact organisms (attenuated live or inactivated) to genetically engineered parts of the organisms (antigenic) that induce both arms of the adaptive immune system and stimulate a sufficient number of memory T cells and B lymphocytes. 29 Vaccines should contain antigens necessary to mount the specific response without causing disease. Once challenged with the pathogen, memory cells yield effector T cells and antibody-producing B cells and fight the infection. The antibodies have to be the neutralizing type which binds to the virus and block infection. 30 The virus coated with neutralizing antibodies either cannot interact with the receptor or may be unable to uncoat of the genome. Most currently licensed vaccines induce neutralizing antibody responses capable of mediating long-term protection against lytic viruses such as influenza and smallpox. 31 The T cell–based responses that recognize and kill infected cells do also fight the infection. 32 Following antigen processing in dendritic cells, the small peptides are displayed at the cell surface at the groove of major histocompatibility complex ( MHC ) class I and class II molecules. Cytotoxic T cells (CD8+) recognize MHC class I-peptide complexes and differentiate into cytotoxic effector cells capable of killing infected cells or pathogens. Helper T cells (CD4+) recognize MHC class II-peptide complexes and differentiate in effector cells that produce preferentially T helper 1 cells (Th1) or T helper cells 2 (Th2) cytokines ( Figure 1 ). Th1 support CD8+ T cell differentiation, which is in contrast inhibited by Th2-like cytokines. Vaccines against chronic pathogens namely Mycobacterium tuberculosis , malaria, HCV, HIV, etc. more often require cell-mediated immune responses to control the infection. 33

Schematic drawing of 8 platform strategies used for the development of COVID-19 vaccines, and the pathway each one follows to induce T cell and B cell immune response. The strategies include live-attenuated vaccine ( LA) , inactivated vaccine ( IA ), DNA vaccine ( DNA ), RNA vaccine ( RNA ), viral vector replicating vaccine ( VVR ), viral vector nonreplicating ( VVNR ), virus-like particles ( VLP ), and subunit vaccine ( Subunit ). CV, coronavirus; APC, antigen processing cell.

Vaccine-Preventable Diseases

The success of a vaccine against a pathogen is a complex issue and depends on the biology of the virus and the type of immune response elicited by the body against the organism. While vaccines have been successful against several pathogens including 14 major infectious diseases, 27 , 28 not all infectious diseases are vaccine-preventable. 34 , 35 The development of vaccines against HIV and HCV has proved challenging. These viruses have an extreme genetic heterogeneity including the hypervariable regions (target for neutralizing antibodies), and the mutation contributes to immune escape. 36 The mutations lead to a mixture of genomes in the patient over time and from patient to patient. Also, antibodies mounted against such viral infections are predominantly nonneutralizing. Neutralizing antibodies are often either absent or weak to fight the pathogen or neutralize only a narrow range of circulating viral strains and only appear in a subgroup of patients who either recover or are “elite controller”. 37 Another aspect to be considered is whether the virus can be grown in cell culture and transmitted to small animals for experimentation. Since HCV has been discovered by molecular cloning in 1989, its propagation in cell culture has been difficult, which hampers the ability of investigators to experiment with various antigenic components of the virus. 38

COVID-19 Vaccine Immunology

To develop a safe and effective vaccine against COVID-19, we need to consider several things about the SARS-CoV-2 and the immune response against the natural infection and the vaccine.

Does SARS-CoV-2 mutate, how fast and will mutations cause a phenomenon of immune escape as is seen in HIV and HCV. 34 , 35 SARS-CoV-2 has shown mutations as is true to every RNA virus. However, the mutations are slow and mild, and mutants show nearly similar sequences as in the parent strain. Dorp et al. 39 studied genomic diversity of SARS-CoV-2 and recorded 198 filtered recurrent mutations; however, most of the mutations were either neutral or even deleterious and of no clinical significance in vaccine immunity. Ahmad et al. 40 found no mutations in 120 available SARS-CoV-2 sequences and identified a set of B cell and T cell epitopes derived from the spike (S) and nucleoprotein (N) proteins that map identically to SARS-CoV-2 proteins. These findings provide a screened set of epitopes that can help guide experimental efforts toward the development of vaccines against SARS-CoV-2.

COVID-19 Immune Response

What type of immune response occurs in natural COVID-19 and after vaccination and are antibodies neutralizing in nature? SARS-CoV-2 infection evokes a robust adaptive immune response of both T cell and B cell type arms. 41 , 42 Furthermore, both IgM and IgG antibodies appear around the 10th day of infection, and most patients seroconvert within 3 weeks. The antibodies are raised against internal nucleoprotein (N) and spike protein (S) of the virion and have neutralizing activity. 43 Now that several candidate vaccines are in the clinical trial, investigators shall study the strength and nature of immune response against the vaccine antigen (mostly spike protein).

COVID-19 Re-infections

Are people who recover from COVID-19 infection protected from a second or a third infection? Should re-infections occur, it would imply that immune response against SARS-CoV-2 is not protective, making possibilities of a successful vaccine difficult. There were scary reports from South Korea about patients thought to have recovered from COVID-19 had tested positive again. 44 An intense debate started about re-activation or re-infections of the virus. Soon these reports were put to rest, and the positive sample were found to be residual dead fragments of the virus, not the virus, which had re-activated or re-infected. 45 After these reports, 2 groups of investigators have shown that SARS-CoV-2 antibodies are protective. Bao et al. showed that 2 monkeys who recovered from SARS-CoV-2 infection were protected from re-infection on the challenge during convalescence. 46 Gao et al. administered candidate vaccine PiCoVacc Sinovac Biotech to mice, rats, and nonhuman primates. The antibodies raised against the vaccine in animals showed neutralizing ability against SARS-CoV-2 strains. Three immunizations of 2 doses (3 μg or 6 μg per dose) gave partial or complete protection in macaques against SARS-CoV-2. 47 These data are exciting and if reproducible in humans confirm that vaccines against COVID-19 shall be protective.

Duration of Immunity

For the COVID-19 vaccination program to succeed, the antibody response mounted against the virus/vaccine must be long-lasting. As of today, it is not possible to address this question as the virus has been in the community only for the last few months. However, we can take leads from data generated about the duration of immunity against 2 other coronaviruses namely SARS-CoV and MERS-CoV. 14 , 17 Both these viruses, which are closely related to SARS-CoV-2, induce a robust T cell and B cell immune response which is long-lasting. Many candidate vaccines against both these viruses had gone through successful clinical trials and are safe and immunogenic. 48

Antibody-Dependent Enhancement

The greatest fear among vaccine developers is to create a vaccine that does not protect from infection but causes disease exacerbation, increased morbidity, and mortality. 48 , 49 , 50 , 51 Some vaccines can mount antibody-dependent enhancement (ADE), which negates the basic purpose of vaccination. 52 This response is mediated by the type of nonneutralizing antibodies mounted against infection or vaccination. The immune response to such vaccines is subverted, leading to exacerbated illness. This could be because of Fc receptor- or complement bearing cells-mediated mechanisms. The Fc-region of the antibody binds to FCγR on the immune cells, which subverts the immune response by reducing T H 1 cytokines (interleukin 2 (IL-2), tumour necrosis factor alpha (TNF-a), and interferon gamma (IFN-g)) and skews T H 2 cytokines (interleukin 10 (IL-10), interleukin 6 (IL-6), prostaglandin E2 (PGE-2), and interferon alpha (INF-a)) and inhibits signal transducer and activator of transcription protein pathway leading to increased viral replication ( Figure 2 ). ADE is of clinical significance in several viral infections including influenza, RSV, SARS-CoV, MERS-CoV, Dengue virus, Zika virus, and West Nile virus. Considering ADE is a major impediment to vaccine development, efforts to identify highly selected epitopes have been done to avoid the production of antibodies responsible for disease enhancement.

Schematic drawing depicting FCγ receptor (FCγR)–mediated antibody-mediated enhancement. This response is mediated by the type of nonneutralizing antibodies mounted against infection or vaccination. The immune response to such vaccines is subverted, leading to exacerbated illness. The Fc-region of the antibody binds to FCγR on the immune cells, which subverts the immune response by reducing T H 1 cytokines (IL-2, TNF-a, and IFN-γ) and skews T H 2 cytokines (IL-10, IL-6, PGE-2, and INF-ά) and inhibits STAT pathway leading to increased viral replication. STAT-A, signal transducer and activator of transcription protein-A; IRF, interferon regulatory factor, INOS, inducible nitric oxide synthase.

ADE has been reported in animals during vaccination trials with SARS-CoV and MERS-CoV. 14 , 17 , 35 Vaccine candidates against coronaviruses based on full-length spike protein induce nonneutralizing antibodies, lack of protection of animals against a viral challenge, and severe disease enhancement presenting as enhanced hepatitis, increased morbidity, and stronger inflammatory response. 17 As of today, there are no reports of ADE with the use of COVID-19 candidate vaccines in nonhuman primates and humans. 51 However, it is an early period in the development of these vaccines, and as the matter is of major importance in the success of such a vaccine, we need to be vigilant. ADE following COVID-19 vaccination if reported can be prevented by shielding nonneutralizing epitopes of S protein by glycosylation or selecting critical neutralizing epitopes of the S antigen to elicit a more robust protective immunity.

Developing a COVID-19 vaccine

Stages of vaccine development.

Every new vaccine follows a stringent protocol in Research and Development (R&D) which has to be meticulously followed and completed before it is licensed to be marketed ( Figure 3 ). Regulatory authorities namely WHO, U.S. Food and Drug Administration, the European Medicines Agency, and national authorities of many countries have issued guidelines relevant to the clinical evaluation of vaccines. 53 , 54 , 55 The guidelines for vaccine development are more stringent than those meant for drug development. The reason for this is obvious, and the vaccines are for global use, have enormous potential for production and marketing, and are given to healthy populations including children, elderly, and pregnant mothers. The vaccine development follows a unique stepwise pattern and is broadly divided into Exploratory, Preclinical, Clinical, and Postmarketing stages. The clinical stage is divided into 3 phases, namely phases I, II, and III. There are 2 regulatory permissions needed namely “Clinical Trial Authorization” before the clinical stage to allow “First-in-human” testing and “Biologic License Application/Approval” for the marketing of the vaccine after successful clinical trials ( Table 1 ).

Schematic drawing showing steps in vaccine development. The vaccine development follows a unique stepwise pattern and is broadly divided into Exploratory, Preclinical, Clinical, and Postmarketing stages. The clinical stage is divided into 3 phases, namely phases I, II, and III. There are 2 regulatory permissions needed namely “Clinical Trial Authorization” before the clinical stage to allow “First-in-human” testing and marketing of the vaccine after successful clinical trials.

The Vaccine Development Stages and the Process.

This figure includes vaccines that are abandoned during the development process.

A Race Against Time

Given the above several facts about vaccine development are glaring. Vaccine development from the exploratory stage to marketing is a lengthy process and generally takes between 5 and 10 years. For the COVID-19 vaccine, this period is being substantially compressed by the use of modern platform technology to develop the candidate vaccine (preclinical stage) and fast authorization by regulatory agencies for clinical trials. It took Moderna Inc. (American biotechnology company based in Cambridge, Massachusetts) only 42 days from sequence analysis of the virus to create a new generation vaccine (mRNA-1273) at the Company's cGMP facility. This would have normally taken more than 2 years period without platform technology to develop such a vaccine. However, clinical trials that follow a unique protocol are “rate-limiting” and “time-consuming”. Here also, to respond to the pandemic, the investigators are exploring innovative methods of data collection. Many developers are running clinical trials in parallel (phase I-II) to shorten the time for approval. Some have started collecting data on efficacy from phase II itself (IIb). There is an intense debate on whether challenge studies are ethical in COVID-19, assessing the risk to a healthy volunteer. 56 If allowed and done, efficacy data on the COVID-19 vaccine shall be available in a matter of weeks rather than years. However, it will be dangerous to grant authorization without proof that the COVID-19 vaccine is immunogenic, effective, and safe.

Success Rate

The second item which needs consideration is the success rate of vaccine development from clinical trial authorization to License. Typically, this rate was <10% during the period 2000-2010. A 2016 study showed that around 20% of vaccine clinical trials make up from phase I to license. 57 Of the 37 vaccines developed for the Ebola virus, only one was licensed based on efficacy and safety in the phase II trial. In the COVID-19 vaccine landscape, investigators have introduced a few new generation vaccines based on nucleic acid technology. Such vaccine technology is not in clinical practice against any infectious disease, and experts believe the success rate of such a vaccine to get licensed is not more than 5%. 58 , 59

It has also to be considered that vaccine development is a high cost and high-risk involvement. 59 Apart from competition between other major vaccine manufacturers, the cost of developing a single new vaccine against an infectious disease exceeds US $1 billion. The figure includes vaccines that are abandoned during the development process. Here, given impending human catastrophe and global devastation, several Governmental and nongovernmental agencies have supported institutions with sufficient funds. The Coalition for Epidemic Preparedness Innovations (CEPI) is a foundation that takes donations from public, private, philanthropic, and civil society organizations to finance independent research projects to develop vaccines against emerging infectious diseases. In March 2020, CEPI announced the US $ 2 billion to accelerate the development of the COVID-19 vaccine. 60 Similarly, the US Government has agreed to pay $ 483 million to Moderna Inc. to develop the COVID-19 vaccine. 61 The Canadian Government has initiated a CA $ 1.3 billion innovation fund for vaccine research and development through 2022. 62

Platform Technology—A Gamechanger

The technology behind the development of vaccines in R&D has seen a transformation in the recent past. Over the year's candidate vaccines were made through traditional methods of biotechnology. Because of this making of a prototype vaccine took between 2 and 5 years and was limited to a few types of vaccines. It needed the availability of cutting-edge research facilities to work with the infectious agent and was possible only in few laboratories over the globe. 58 , 59 Recently, platform technology has been employed in developing candidate vaccines. 63 , 64 Platform technology offers several advantages in the development of vaccines which include automation, speed, ability to develop several prototype vaccines from the single system, cost-effectiveness, and developing among other complex mRNA vaccines with ease. It is believed that the mRNA-based vaccine developed by platform technology appears particularly promising in terms of ease of manufacture, adaptability to various targets, and biological delivery. 65 As candidate vaccines can be developed in a matter of days rather than years, the platform technology has been termed as a single game-changer in the fight against epidemics or pandemics caused by new agents. 66 , 67 , 68

COVID-19 Vaccine Platform Technologies

Researches are trialing several designs to develop candidate vaccines against COVID-19. Overall, 8 types of designs, under 4 broad groups have been tried to develop candidate COVID-19 vaccines ( Table 2 ). Each vaccine design has a subtle structure, advantages, and disadvantages in immunogenicity, safety, ease of use, and effectiveness ( Figure 1 ). 29 , 69 , 70

Various Types of VVaccines Categorized by the Antigen Used in the Preparation.

ADE, antibody-dependent enhancement.

Live-attenuated vaccine is developed by the process in which the live virus is passed through animal or human cells until genome mutates and is unable to cause disease. The weekend virus replicates like a natural infection and causes strong T cell and B cell immune response, which is long-lasting. Such vaccines are good to attain herd immunity in the population and block transmission of disease. However, there is a small chance of reversion of mutation to virulence and the occurrence of disease. Besides, such vaccines need a cold chain for distribution to the community. Examples of such vaccines are BCG, smallpox, MMR (Measles, Mumps, & Rubella), Rotavirus, Poliomyelitis (OPV), etc. Inactivated vaccines are treated with formaldehyde or heat, and as the virus is killed, such vaccines are safe and cannot cause disease. However, such vaccines do not replicate, cause a suboptimum immune response, and need repeated dosing and adjuvants to enhance immunity. ADE has been reported in such vaccines, and to avoid this, we need to maintain the structure of epitopes on the surface antigen during inactivation. Examples of such vaccines include poliomyelitis (IPV), HAV, rabies, etc.

Nucleic acid vaccines are the new generation vaccines, made available by modern technology. A DNA vaccine is made by inserting DNA encoding the antigen from the pathogen into plasmid DNA. RNA vaccines employ lipid-coated mRNA of the SARS-CoV-2 which expresses Spike protein. The expressed proteins are presented BY MHC class I to CD+ 8 T cells and inducing a strong T cell response. These vaccines are safe, easy to manufacture by the platform technology, and maybe gamechanger in the future of vaccines. As of today, there are no nucleic acid vaccines in clinical practice.

Recombinant vector virus vaccines are producing through recombinant DNA technology. This involves inserting the DNA, encoding an antigen from the pathogen into bacteria or virus vectors, expressing the antigen in these cells, and then purifying it from them. 67 During vaccination, the vector replicates, and along with it, the encoded DNA is expressed and processed, giving robust T cell and B cell immune response. Vectors may be bacteria such as E. coli or viruses such as Adenovirus or poxvirus. Classical examples of vector vaccines are HBV, HPV, Whooping cough, Hib, and Meningococcus.

Subunit vaccines composed of purified antigen peptides of viruses like Spike protein of SARS-CoV-2 and are safe to use. Such an antigen is directly presented to MCH class II and often does not generate a robust cytotoxic T cell response (MHC class I dependent). Thus, such vaccines need repeated dosing and adjuvants to enhance immunity. Virus-like particles are made from empty virus particles without genetic material. Such vaccines are safe and immunogenic, however, are difficult to manufacture.

COVID-19 Vaccines Landscape

There has been unprecedented fast track path taken in R&D by the World community for developing candidate COVID-19 vaccines. As of 5 May 2020, the global COVID-19 vaccine R&D includes 108 candidate vaccines. 71 The platform for 108 candidate vaccines are diverse and include live-attenuated vaccine (n = 3), inactivated vaccine (n = 7), DNA vaccine (n = 10), RNA vaccine (n = 16), replicating viral vector vaccine (n = 12), nonreplicating viral vector vaccine (n = 15), protein subunit vaccine (n = 36), virus-like particles (n = 6), and unknown (n = 3). These platforms have been used in the past in 45 instances against a variety of infectious pathogens ( Table 2 ).

COVID-19 Candidate Vaccines

Till now, several candidate vaccines have completed the exploratory and preclinical stage, obtained Clinical Trial Authorization, and initiated recruitment of volunteers for clinical trials. 72 Of these, 6 candidate vaccines stand at the forefront of clinical trials ( Table 3 ).

The Candidate COVID-19 Vaccines in Clinical Evaluation.

Ad5-nCoV from CanSino Biologicals Inc. is a recombinant vaccine using Adenovirus-vector. CanSino has an adenovirus-vector vaccine for Ebola (Ad5-EBOV) that is in phase II trials. Phase I trial has been completed on 108 volunteers; however, results have not been disclosed as of today. At present phase II trials are underway, and CanSino plans to enroll 500 volunteers to evaluate vaccine safety and immunogenicity. 73 , 74

mRNA-1273 from Moderna is a lipid encapsulated mRNA vaccine and is undergoing safety and immune response phase I trial in Seattle. The company has filed for an IND to go for parallel phase II trials. 61 , 75

PiCoVacc from Sinovac Biotech is an inactivated virus vaccine and is undergoing parallel phase I-II trials planned on 144 volunteers. Sinovac has partnered with US-based Dynavax. The vaccine produced neutralizing antibodies in mice, rats, and rhesus monkey which are protective in challenge experiments. 47 , 76

ChAdOx1 from the University of Oxford is an adenovirus vector-based vaccine and plans to run parallel phase I-II trials on 510 volunteers for safety and efficacy. The Oxford group has experience with candidate vaccine for MERS-CoV (ChAdOx-MERS) and has undergone a successful phase I trial for safety. The group is pushing ahead with an aggressive clinical plan and is talking of an emergency-use vaccine ready in September 2020. 77 , 78 , 79

BNT162 (a1, b1, b2, c2) from BioNTech is another lipid nanoparticle mRNA vaccine and has received clearance from regulatory authority form Germany to the start of phase I-II trials on 196 volunteers. The trial is dose escalation design (1–100 mcg) using 4 vaccine subtypes (a1, b1, b2, and c2). The developers have claimed to have an emergency-use vaccine by September 2020. 80

INO-4800 from Inovio is a DNA plasmid vaccine. The company has experience with such platforms with candidate vaccines for MERS and SARS. The vaccine needs a delivery system through electroporation, which shall add to the cost of the vaccine. Phase I trial using 2 doses spaced 4 weeks apart has been completed, and results shall be available in June 2020. Inovio is planning to start phase II-III trials soon. 81

Numerous developers at present in the preclinical stage of vaccine development have indicated to procure “Clinical Trial Authorization” by the regulatory agencies and initiate “First-in-human vaccine” testing.

COVID-19 vaccine in the middle of a pandemic

A race against time in the middle of death and devastation.

COVID-19 vaccine development has thrown major challenges in vaccine R&D. 82 The world is facing a major health catastrophe and economic devastation, and one of the definitive solutions is to have an effective and safe vaccine in the shortest possible time. The global vaccine R&D efforts have been unprecedented in history. The virus causing COVID-19 has been sequenced in a few weeks. Ordinarily, it has taken from 5 to 10 years to clone, and sequence a virus from the time the disease is discovered. There has been a tremendous race against time to develop candidate vaccine in a matter of few weeks, and as of now, 10 candidate vaccines have entered phase I-II clinical trials. It has taken us from 5 to 10 years in the history of vaccine development against other infectious agents to reach a stage as we are now with the COVID-19 vaccine. However, clinical trials as are undergoing now will be the greatest limiting factor, as these need time to acquire human data. Normally phase I, II, and III trials to be done on humans are completed between 2 and 5 years and sometimes more. This is necessary for qualifying a vaccine to be safe, immunogenic, and efficacious. As of today, candidate vaccines are undergoing phase I or parallel I-II studies and shall take several months for acquiring these data to start phase III trials. Phase III trial once initiated can take as long as 2 years. To compress the period, vaccine developers are involved in adopting parallel and adaptive development phases (I-II) to acquire safety and immunogenicity data as soon as possible to initiate phase III trials. By any imagination, these data shall not be available by early 2021 for any vaccine for regulatory authorities to allow vaccine marketing. COVID-19 vaccines could be available for human use earlier if innovative methods of clinical trials and regulatory processes are employed. One such is the use of “Challenge studies” to testify vaccine efficacy. 56 Here, following proof of safety and immunogenicity in phase I-II trials, controlled “challenge studies” which can be completed in a matter of weeks are done to confirm vaccine efficacy. Challenge studies have been done in the past in other infectious diseases namely influenza, typhoid fever, cholera, and malaria. Whether “challenge studies” are ethical in COVID-19, considering the risk to the volunteer is a matter of debate before the vaccine developers. 83 Also, regularity authorities can use innovative procedures to allow guarded emergency use of a vaccine. This would need careful consideration of interventional animal safety data and data of safety, immunogenicity, and efficacy acquired from phase I-II trials. With all this, vaccine developers have to be ready to scale manufacturing capacity to massive demands once the product is allowed for marketing. 25

No “Quick Fix” and “Short Cuts” Please

However, concerns are raised about a rush to deploy a COVID-19 vaccine. Applying “quick fix” and “short cuts” can lead to errors with disastrous consequences. 84 What regulators have to worry about is the atmosphere of hype about the COVID-19 vaccine? Public claims about breakthrough research based on poorly conducted studies or data collected through fraud is a real possibility. All data which form the basis of any findings need to be scrutinized and should be confirmed by other investigators. Relaxion on regulatory principles based on political pressure and goodwill needs to be resisted, and one needs to protect the interests of volunteers who are a part of such experiments. 85 Finally, vaccine development is a risky process, and one critical issue in the COVID-19 vaccine would be the occurrence of ADE which may be disastrous for those receiving the vaccine. 49 , 50 Regulators have to take all precautions to discourage candidate vaccines which may show such a phenomenon.

Contributions

All authors have contributed to this manuscript equally, and the final draft has been read and accepted by all authors.

Human and animal experiments

No human or animal experiments were done for the study.

Financial support

The work was financially supported by Dr. Khuroo's Medical Trust, a nonprofit organization that supports academic activities and helps poor and needy for treatment.

CRediT authorship contribution statement

Mohammad S. Khuroo: Coceptualization, Methodology, Writing - review & editing. Mohammad Khuroo: Software, Resources, Formal analysis, Data curation. Mehnaaz S. Khuroo: Writing - original draft. Ahmad A. Sofi: Software, Resources, Formal analysis, Data curation. Naira S. Khuroo: Supervision, Writing - review & editing.

Conflicts of interest

The authors have none to declare.

Lessons learned: What makes vaccine messages persuasive

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Vaccine hesitancy threatened public health’s response to the COVID-19 pandemic. Scientists at the University of Maryland recently reviewed 47 randomized controlled trials to determine how COVID-19 communications persuaded—or failed to persuade—people to take the vaccine. ( Health Communication , 2023  DOI: 10.1080/10410236.2023.2218145 ).

What they learned:  Simply communicating about the vaccine’s safety or efficacy persuaded people to get vaccinated. Urging people to follow the lead of others, by highlighting how many millions were already vaccinated or even trying to induce embarrassment, was also persuasive.

Why it matters:  Understanding which message strategies are likely to be persuasive is crucial.

➡️ Idea worth stealing:  The authors found that a message’s source didn’t significantly influence its persuasiveness. But messages were more persuasive when source and receivers shared an identity, such as political affiliation.

What to watch:  How other formats, such as interactive chatbots and videos, might influence persuasiveness. And whether message tailoring could persuade specific population subgroups.

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