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Possible vaccines/treatment(s) for Coronavirus

On flu and SARS-CoV-2 combinations, with a view to offering them as a yearly booster...

Moderna's combination vaccine, mRNA-1073, encodes for both the SARS-CoV-2 spike protein and the influenza hemagglutinin (HA) glycoproteins. They hope to carry out a study in the next 6-12 months.
Meanwhile, Novavax has started a phase 1/2 study of their combined NVX-CoV2373 protein subunit vaccine, targeting SARS-CoV-2, and quadrivalent recombinant hemagglutinin protein nanoparticle influenza vaccine.
 
Later this month BioNTech will publish results of BNT162b2 trials in 5-11 year olds and seek approval for such use from multiple regulators. They are in the process of bottling a lower-dose pediatric version. Regulatory approval for younger children will be sought later this year.
 
From France/Argentina (Sorbonne/Cordoba) a thermostable (at room temperature) oral eVLP (enveloped virus-like particle) vaccine, expressing SARS-CoV-2 spike and membrane proteins, which appears to induce high levels of mucosal IgA and IgG in hamster and mice models, particularly when used as a booster following an initial intramuscular prime dose.
IgA titres after (left) intramuscular eVLP vaccination and (right) oral eVLP vaccination for various vaccine formulations. IgA titre after oral booster vaccination following intramuscular prime for various vaccine formulations.
DOI: 10.1101/2021.09.09.459634.
 
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Later this month BioNTech will publish results of BNT162b2 trials in 5-11 year olds and seek approval for such use from multiple regulators. They are in the process of bottling a lower-dose pediatric version. Regulatory approval for younger children will be sought later this year.
Apparently FDA approval for this could be granted before the end of October.
 
UK government terminates vaccine supply agreement with Valneva for VLA2001 claiming breach of obligations under said agreement. Valneva continuing with production and trials. Further phase 3 study results expected next month and the company still intends to seek regulatory approval from the MHRA later this year.
 
I havent read any speculation about what exactly the breach was, or whether there were alternative motivations at work that made the UK reach for the get-out clause. Any ideas?
 
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I haent read any speculation about what exactly the breach was, or whether there were alternative motivations at work that made the UK reach for the get-out clause. Any ideas?
Perhaps they've realised that an incompetent intern contaminated the entire production run earlier this year?
058cae1f-7d0a-4291-8fdf-99f5833c50ef_w1600_r1.5045135406218655_fpx55.8_fpy50.jpg
 
I havent read any speculation about what exactly the breach was, or whether there were alternative motivations at work that made the UK reach for the get-out clause. Any ideas?

Javid just said "...it was clear to us that the vaccine in question that the company was developing would not get approval by the MHRA here in the UK."

 
I havent read any speculation about what exactly the breach was, or whether there were alternative motivations at work that made the UK reach for the get-out clause. Any ideas?

I smell a stitch up if they are saying mhra wouldn’t approve, as I’d be surprised if the mhra would tell them that before trial results are released.
 
I smell a stitch up if they are saying mhra wouldn’t approve, as I’d be surprised if the mhra would tell them that before trial results are released.

If there was a large, specific and undeniable fly in the ointment then I suppose I could well believe informal discussions about the inevitable implications may have been discussed. But I wouldnt like to bet either way without knowing the key detail in full.
 
I smell a stitch up if they are saying mhra wouldn’t approve, as I’d be surprised if the mhra would tell them that before trial results are released.
Might have access to as yet unpublished data from COV-Boost maybe, but not the Valneva clinical trial study?


(AF the PI there (VLA), as well as sitting on the JCVI).

FT claims sources suggest COV-Boost indicates it performed 'less well' than other vaccines, but no clarification beyond that.
The UK has terminated a €1.4bn agreement with French biotech Valneva for the supply of at least 100m doses of a Covid-19 vaccine, saying the group was in breach of its obligations under the deal.
Manufacture of the vaccine, which is in late-stage trials and still awaiting regulatory approval, was planned to take place in Scotland and deliveries were set to start next year.
The disclosure of the termination by Valneva sent shares in the Paris-listed company down by 42 per cent on Monday. The group added that it “strenuously” denied breaching its obligations, but declined to comment further.
The vaccine performed less well than rivals in a recent UK trial, named Cov-Boost, that explored the effectiveness of various potential booster jabs, according to people familiar with the results, which are yet to be published. Valneva did not respond to a request for comment.
Competition for vaccines has proved politically explosive, with the EU this month settling an acrimonious dispute with AstraZeneca over delayed supplies. The French government came under fire last year when the UK first struck a supply deal with Valneva.
Downing Street said on Monday that the dispute with Valneva was an “ongoing commercial issue”.
The government had announced in August last year that it was investing a multimillion-pound sum in Valneva’s manufacturing plant in Livingston, Scotland, supporting 100 skilled jobs. At the time, Kwasi Kwarteng, the business secretary, hailed the plant as a potential “vaccine production powerhouse”.
The termination comes as the UK prepares to become the first big country to administer mix and match” coronavirus vaccines for its booster programme.
Results of Valneva’s late-stage trials are expected in the fourth quarter, with UK approval possible before the end of the year, the company said.
Given the timeline, it is unlikely the shot would have played an immediate role in the booster campaign in which patients will be given a third shot that is different from the two they received earlier in the vaccination drive.
“The MHRA (regulator) has not approved the vaccine,” Downing Street said. “It does not form any part of our vaccine rollout in autumn and winter.”
Humza Yousaf, the SNP health secretary for Scotland, told the BBC that the cancellation of the contract was a “blow for the facility in Livingston”.
“We are very keen and will be reaching out to the company to try to get security and secure a future for that facility in Livingston,” he said.
Headquartered outside the French city of Nantes, Valneva is not a newcomer to vaccines. Its jabs for cholera and Japanese encephalitis have received approval from regulators either in the US or EU, and it has several others under development.
The company had warned in April that exporting vaccines between the EU and the UK could be a “substantial risk” to its operations. Although the vaccine was due to be manufactured in Scotland, the company said it would be put into vials and packaged in the EU.
Its vaccine candidate uses a whole inactivated virus to elicit an immune response against coronavirus, a technique that can prolong the manufacturing process but provides greater coverage against all variants. Most other shots are designed to target the spike protein of the virus.
Addressing the termination, Valneva said it had worked “tirelessly, and to its best efforts” on its collaboration with the UK, adding that it would “increase its efforts with other potential customers to ensure that its inactivated vaccine can be used in the fight against the pandemic”.
In late August, a French official said the country still planned to use Valneva’s vaccine as part of its autumn booster campaign, if the company secured European regulatory approval.
It is unclear if those plans have since changed, and France has let the company negotiate its potential contract with the EU instead of directly with France.
“We are one of the countries who have signalled interest in the Valneva vaccine, but we are prioritising a collective approach,” said a French government spokesman on Monday.
Frédérique Vidal, France’s minister in charge of higher education, research and innovation, declined to comment on the UK’s decision.
“Discussions are still under way with the European Union,” she told TV station BFM Business. “This case shows the challenges in biotech where when you try to do innovation you cannot succeed every time.”
Link.
 
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One of the September SAGE documents released is a Public Health England analysis of the duration of protection that vaccines seem to be offering so far.


Figure 1 shows VE against symptomatic disease for all ages. Follow-up data for Alpha is limited as Alpha circulation had stopped by the time the later follow-up periods were reached. VE against Delta is generally lower with the AstraZeneca vaccine than the Pfizer vaccine, but with both vaccines, waning of VE against symptomatic disease is seen from around 10 weeks, reaching just over 50% with AstraZeneca and just over 70% with Pfizer by 20+ weeks. With the Moderna vaccine, data is not yet available beyond 10 weeks.

VE against hospitalisation for the AstraZeneca and Pfizer vaccines for all ages is shown in Figure 2. Waning against hospitalisation appears to be much more limited, in particular with the Pfizer vaccine where VE of around 95% continues to be seen beyond 20 weeks after vaccination. With the AstraZeneca vaccine, there appears to be some waning to just under 80% VE against hospitalisation from 20+ weeks.

VE against death for all ages is shown in Figure 3. Similar to hospitalisation, there appears to only be limited waning of VE against death, though for AstraZeneca, follow-up data beyond 20 weeks is underpowered.

Stratifying by age group gives similar results to the overall analysis, though there is some suggestion of greater waning with AstraZeneca in the oldest age groups from 20+ weeks, however confidence intervals are wide (Figure 4). Further stratifying the 40-64 years age group according to whether they are in a risk group indicates that the waning seen with AstraZeneca is restricted to those in clinical risk groups (Figure 5). In those aged over 65 years, the broader clinical risk group variable is not available, however, Figure 6 shows the stratification according to whether they are in the narrower clinically extremely vulnerable group. Waning appears to be greater with both AstraZeneca and Pfizer among those in the clinically extremely vulnerable group, though data beyond 20 weeks is limited.
 
More vaccination data from Israel* which might provide some insight into the pandemic endgame (warning: controlled for age, gender and timing of infection, but other biases almost certainly still persist).

Any infection plus original vax combination appears to be as effective as a recent third dose booster (and durable too; can't comment on third dose booster in this respect yet).
Relative risk for COVID-19 infection (versus 2x dose vaccination) among persons 60+ (Jul 11-Aug 17), Israel.

Note that vaccination then infection appears to not be quite as effective as infection then vaccination (as Crotty speculated), and particularly so for 6-12 months previous (though not a reason to risk getting infected than vaccinated, of course).

The implication of this data is that some degree of natural immunity will inevitably play a role in reaching a steady state herd immunity situation. That is, a number of 'breakthrough' cases in a highly vaccinated population, gradually reducing in number as the years pass. Because we can't keep boosting every couple of months to keep most of the population up at that >10x less risk level.

* original summary of analysis here.
 
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Another gem from Crotty. Here a comprehensive longitudinal study of low dose mRNA-1273 (25 μg ie one-quarter of the standard dose) recipients from early dosing trials last year. (Note that BNT162b2 standard dosing is 30 μg).

T cell, binding and neutralising antibody responses to the 25-μg Moderna mRNA-1273 vaccine (two doses, standard interval) were examined over 7 months post-immunisation, across multiple age groups (35 participants, ages 18-70+, 20 male, predominately white), to assess whether pre-existing cross-reactive T cell memory impacts vaccine-generated immunity.

They found strong T cell memory ( CD4, CD8, TFH and cytokine) at 6 months after the second dose that looks like it will endure for several years.
(A) Longitudinal spike-specific CD4+ T cells in mRNA-1273 vaccinee. (B) Comparison of spike-specific CD4+ T cell frequencies between vaccinees (red) and COVID-19 convalescent donors (yellow). Comparison of spike-specific CD8+ T cell frequencies between vaccinees (red) and COVID-19 convalescent donors (yellow).
This low (quarter) dose regimen produced immunoresponses similar to full (100 μg) dosing, with comparable CD8 populations and only a two-fold reduction in CD4 and antibodies, at least equalling natural immunity alone (previous research has highlighted vaccine induced immunity as being more durable than natural immunity alone). Whilst a small reduction in antibodies was observed, CD4 and CD8 T cell memory in the older cohorts (56+) were comparable to younger (18-55) cohorts at the same time points. Pre-existing cross-reactive memory T cells were found to enhance spike-specific CD4+ T cell, TFH, and antibody responses after a single dose. Cross-reactive memory TFH cells may both accelerate B cell priming and antibody responses to a new antigen, and also increase robustness of long-term humoral immunity.

This work highlights the possibility of deploying dose sparing and lower reactogenic regimens which are both effective and durable.
DOI: 10.1126/science.abj9853.
 
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And here we see some vaccine issues combine with longstanding complaints that the medical establishment doesnt take all issues involving womens health seriously enough. Or at the very least I'd say that was part of the backdrop for stories like this, although the following article doesnt explicitly say so.

 
From PH Scotland, a matched case-control study investigating whether vaccine efficacy against severe COVID-19 has decreased since delta/B.1.617.2 became the predominant variant, and how efficacy wanes with time since second dose (the study analysis covers cases from the period 1 December 2020 to 19 August 2021).

The efficacy of two vaccine doses against severe COVID-19 in the most recent time windows was found to be around 92% and did not differ between AZD1222 and mRNA (BNT162b2/mRNA-1273) products. Efficacy against the broader category of hospitalised or fatal COVID-19 remains slightly lower for the AZD1222 vaccine than for mRNA vaccines (88% versus 91%).

Efficacy against COVID-19 declined rapidly in the first two months since second dose (any vaccine type) but more slowly thereafter. For hospitalised or fatal COVID-19 the model best supported by the data was one in which efficacy was the sum of a rapidly waning effect with half-life of 17 (95%CI:9-39) days and a time-invariant efficacy of 83%.

These results suggest that the rapid early waning of efficacy against hospitalised COVID-19 after the second dose tapers off within a few months. This weakens the rationale for policies based on delivering booster doses to the entire population, rather than to vulnerable individuals for focused protection.
Best-fitting models of waning to zero efficacy and waning to constant efficacy for the narrow outcome of severe COVID-19 and the broader outcome of hospitalised or fatal COVID-19.
DOI: 10.1101/2021.09.12.21263448.
 
Phase 2/3 trial of two-dose regimen of 10µg BNT162b2 administered 21 days apart in (around 4,500) 5-11 year olds finds it to be well-tolerated and safe, with strong immunogenic responses comparable to 16-25 year olds given the standard 30µg dose regimen (used as the control for this study).


Results of trials in under-5s, dosing at 3µg, are expected later this year.
 
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From the CDC, a case-control analysis (3,689 US adults aged 18+ years) of vaccine effectiveness of the three vaccines approved there.
These real-world data suggest that the 2-dose Moderna and Pfizer-BioNTech mRNA vaccine regimens provide more protection than does the 1-dose Janssen viral vector vaccine regimen. Although the Janssen vaccine had lower observed VE, 1 dose of Janssen vaccine still reduced risk for COVID-19–associated hospitalization by 71%.

VE against COVID-19 hospitalization was slightly lower for the 2-dose Pfizer-BioNTech vaccine than the Moderna vaccine, with this difference driven by a decline in VE after 120 days for the Pfizer-BioNTech but not the Moderna vaccine. The Moderna vaccine also produced higher postvaccination anti-RBD antibody levels than did the Pfizer-BioNTech vaccine. Differences in VE between the Moderna and Pfizer-BioNTech vaccine might be due to higher mRNA content in the Moderna vaccine, differences in timing between doses (3 weeks for Pfizer-BioNTech versus 4 weeks for Moderna), or possible differences between groups that received each vaccine that were not accounted for in the analysis.
Serum anti–receptor binding domain and anti-spike immunoglobulin G levels 2-6 weeks after full vaccination among healthy adult volunteers, April-June 2021

DOI: 10.15585/mmwr.mm7038e1.

Meanwhile, separately, J&J have stated that their vaccine is more effective in a two-dose regimen.
Additional data show a booster increases protection 94% protection [against symptomatic (moderate to severe/critical) COVID-19] in the U.S. with booster given at two months, four-fold increase in antibodies when given at two months, 12-fold increase in antibodies when booster given at six months.
 
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Beginning phase 1 trials in Manchester, the (Gritstone) self-amplifying mRNA second generation SARS-CoV-2 vaccine, GRT-R910 (codes for spike protein and highly conserved non-spike proteins to increase breadth of immune response). Here investigating utility as a booster to AZD1222 to improve resilience to new VOCs in the elderly, looking at dosing, reactogenicity and immunogenicity.
 
Initial results from a phase 1/2 dosing trial in Thailand of the low-cost, inactivated SARS-CoV-2 vaccine NDV-HXP-S (ButanVac, UTex Austin). Promising reactogenic and immunogenic results from this study see the programme move forward with the 3µg adjuvanted (CpG1018) dosing to advanced phase 2 trials.
Distribution and GMC of anti-S IgG (BAU/mL) in placebo, vaccine groups and HCS controls (A), distribution and GMC of NT50 by PNA (IU/mL) in placebo, vaccine groups, and HCS controls (B). Percentage of subjects with ≥4-10-fold increase in anti-S IgG (C), and percentage of subjects with ≥4-10-fold increase in NT50 by PNA (D).
DOI: 10.1101/2021.09.17.21263758.
 
On extending the dosing interval, here from Quebec, a study investigating immunoresponses in short (standard 3-4 week) and long (16 week) dosing of naive and previously infected vaccinees with BNT162b2.

Previously reported "super" hybrid immunity was observed for single-dose convalescents (blue) as was the minimal subsequent response to a long interval second dose (black) - similar to that in the standard double-dosing regimen.

For the previously uninfected, a 16 week dosing interval (between first and second dose; red) resulted in antibody (perhaps significantly IgA to both RBD and spike overall) immunoresponse nearing that afforded by hybrid immunity and typically far in excess of that of previously infected persons vaccinated with the standard dosing interval (green).

Notably, looking at neutralisation of a wide range of variants, long interval dosing of the previously infected resulted in breadth of immunity comparable to that of hybrid immunity in (any dose) convalescent vaccinees.
16weekdosing.png
This study might suggest that it could be worth investigating an even longer dosing interval for convalescents (cf proposed third-dose booster intervals), strongly points to extended intervals enriching affinity maturation and hints at it improving class switching recombination. Conclusions are not inconsistent with earlier commentary and speculations of Crotty (LJII).
DOI: 10.1101/2021.09.17.21263532.
 
Results from the phase 2/3 trial of Clover Biopharmaceuticals' CpG1018/Alum adjuvanted protein vaccine, SCB-2019.

100% [95%CI:42.7-100] efficacy against severe COVID-19, 100% [95%CI:25.3-100] against hospitalisation and 83.7% (95%CI:55.9-95.4] efficacy against moderate-to-severe COVID-19 caused by any variant, with 78.7% [95%CI:57.3-90.4] efficacy against COVID-19 of any severity caused by delta/B.1.617.2.

It was well tolerated with a favourable safety profile. The company planes to seek regulatory approval in China and the EU and emergency use listing with the WHO (for COVAX) both in the final quarter of this year.
 
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