The next generation of coronavirus vaccines won't come as quickly
A barrage of cash from Operation Warp Speed has got a number of biotech companies competing for a coronavirus vaccine, but the incentives to keep working on new competitors won't be nearly as strong.
Why It Matters: This initial cash flow worked - it delivered several highly effective vaccines in record time. In other disease areas, second and third generation vaccines usually become the dominant products. And the first COVID-19 vaccines don't necessarily fit the whole world.
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The big picture: Pfizer and Moderna's mRNA vaccines are extremely effective. In the US and other affluent countries, the cold storage and multiple dose requirements are easy to manage.
"The incentive to develop a vaccine to replace such a vaccine is not overwhelming," said NIAID Director Anthony Fauci.
The American government doesn't have much reason to invest billions of dollars more in subsequent research, and the vaccine market is heavily dependent on governments and non-governmental organizations.
Yes, but: Each of the vaccines that exist has some characteristics that make them an imperfect candidate for use in lower-income countries, and it is ultimately in the self-interest of rich countries to vaccinate as much of the world as possible.
Pfizer and Moderna are both two shots and require very cold storage. AstraZeneca is two shots and has been plagued by bad headlines and safety concerns from European regulators. Johnson & Johnson is a shot, but it also takes some reputational damage due to extremely rare side effects.
The intrigue: Mainly because most of the remaining demand is in poorer countries, the traditional market incentives for developing a cheaper competing product do not really apply here.
"Trying to develop a different vaccine at a lower price is probably not a good incentive," said Craig Garthwaite, a professor at Northwestern University.
"We now have standards of performance ... for efficacy, safety, cost, ease of use, the speed of developing a new generation of variant coverage and manufacturing scalability," said Krishna Udayakumar, founding director of Duke Global Health Innovation Center. "New vaccines likely need to be better in one or more of these areas to be sustainable in the longer term."
What We're Watching: The vaccine pipeline is not completely dry - Novavax will likely seek approval soon, others are still under development
"Access to capital may become more difficult in the future. However, there appear to be several vaccine candidates that are still receiving significant research and development support," said Udayakumar. These include vaccines that use different platforms and some that could be given orally.
The existing vaccine manufacturers will continue to work on their products: Pfizer is investigating whether the vaccine can be stored at warmer temperatures in order to make it more accessible worldwide.
"I think you will see strong interest from low and middle income countries in access to mRNA vaccines, and I think you will see companies invest a lot of research into eliminating the vaccines cold chain requirements that they have," said Fauci.
Bottom line: "You will always have individual investigators working on new platform technologies," said Fauci. "They're not done at the Operations Warp-Speed level. They're done by individual fellows who develop a concept."
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American immunologist and director of the US National Institute of Allergy and Infectious Diseases
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