VACCINES VERSUS COVID-19 VACCINES: MANEUVER TIMELINE OF DEVELOPMENT AND TRIAL DESIGNS
Development of vaccines and COVID-19 vaccines
Abstract
Recent pandemic of coronavirus disease 2019 (COVID-19) has made a serious threat to public health and became a global burden with millions of people at risk of death. At that time, there were no approved antiviral drugs and vaccines for COVID-19, but few drugs are repurposed with limited benefit. In less than a year, several COVID-19 vaccines have already been approved and hundreds of vaccines are undergoing clinical evaluation. This review focuses on need for vaccines, benefits of vaccination, the World Health Organization initiated new global strategy ‘the Immunization Agenda 2030’ (IA2030), stages and timeline of development, and clinical evaluation of traditional vaccines. We have summarized comparison of clinical evaluation between traditional vaccines and conventional drugs in the pre-pandemic era. The review briefly discusses the prioritized approaches, accelerated timeline of clinical evaluation, and seamless and immunobridging clinical trial designs of COVID-19 vaccines in the pandemic period. We have thoroughly searched recent literature and data on this topic and made a summary of current advances, regulatory amendments, and future perspectives of development and approval of vaccines.
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References
2. van Seventer JM, Hochberg NS. Principles of infectious diseases: transmission, diagnosis, prevention, and control. International Encyclopedia of Public Health. 2017:22–39.
3. Nandi A, Shet A. Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Hum Vaccin Immunother. 2020;16(8):1900-1904.
4. Carter A, Msemburi W, Sim SY, Gaythorpe KAM, Lindstrand A, Hutubessy RCW. Modeling the impact of vaccination for the immunization agenda 2030: deaths averted due to vaccination against 14 pathogens in 194 countries from 2021-2030. (Accessed on 12 May, 2023). Available: http://dx.doi.org/10.2139/ssrn.3830781
5. History of vaccine. Vaccine development, testing, and regulation. (Accessed on 2 May, 2023). Available: https://historyofvaccines.org/vaccines-101/how-are-vaccines-made/vaccine-development-testing-and-regulation
6. Mathieu E, Ritchie H, Rodés-Guirao L, Appel C, Giattino C, Hasell J, et al. (2020). "Coronavirus Pandemic (COVID-19)". Published online at OurWorldInData.org. (Accessed on 2 May, 2023). Available: https://ourworldindata.org/coronavirus
7. Singh K, Mehta S. The clinical development process for a novel preventive vaccine: An overview. J Postgrad Med. 2016 Jan-Mar;62(1):4-11.
8. Covid-19 vaccine: First person receives Pfizer jab in UK. (Accessed on 20 May, 2023). Available: https://www.bbc.com/news/uk-55227325
9. Puthumana J, Egilman AC, Zhang AD, Schwartz JL, Ross JS. Speed, evidence, and safety characteristics of vaccine approvals by the US food and drug administration. JAMA Intern Med. 2021;181(4):559-560.
10. de la Torre BG, Albericio F. The pharmaceutical industry in 2021. An analysis of FDA drug approvals from the perspective of molecules. Molecules. 2022;27(3):1075.
11. Ozawa S, Clark S, Portnoy A, Grewal S, Stack ML, Sinha A, et al. Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001-2020. Bull World Health Organ. 2017;95(9):629-638.
12. Toor J, Echeverria-Londono S, Li X, Abbas K, Carter ED, Clapham HE, et al. Lives saved with vaccination for 10 pathogens across 112 countries in a pre-COVID-19 world. Elife. 2021;10:e67635.
13. Li X, Mukandavire C, Cucunubá ZM, Echeverria Londono S, Abbas K, Clapham HE, et al. Vaccine impact modelling consortium. estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study. Lancet. 2021;397(10272):398-408.
14. Marijam A, Schuerman L, Izurieta P, Pereira P, Van Oorschot D, Mehta S, et al. Estimated public health impact of human rotavirus vaccine (HRV) and pneumococcal polysaccharide protein D-conjugate vaccine (PHiD-CV) on child morbidity and mortality in GAVI-supported countries. Hum Vaccin Immunother. 2022;18(7):2135916.
15. Watson OJ, Barnsley G, Toor J, Hogan AB, Winskill P, Ghani AC. Global impact of the first year of COVID-19 vaccination: a mathematical modelling study. Lancet Infect Dis. 2022;22(9):1293-1302.
16. 10 facts on immunization. (Accessed on 14 May, 2023). Available: https://www.who.int/mongolia/health-topics/vaccines/10-facts-on-immunization
17. Desai AN, Majumder MS. What is herd immunity? JAMA. 2020;324(20):2113.
18. Micoli F, Bagnoli F, Rappuoli R, Serruto D. The role of vaccines in combating antimicrobial resistance. Nat Rev Microbiol. 2021;19(5):287-302.
19. Harputluoglu M, Carr BI. Hepatitis B Before and after hepatocellular carcinoma. J Gastrointest Cancer. 2021;52(4):1206-1210.
20. Immunization Agenda 2030: A global strategy to leave no one behind. (PDF file Accessed on 22 May, 2023). Available: https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/ia2030
21. Huang J, Cheung CKM, Keung VMW, Lo ASC, Chan SC, Pang WS, et al. Factors associated with vaccination uptake among young children: A follow-up study of 1799 toddlers. Vaccines (Basel). 2023;11(3):535.
22. Rodrigues CMC, Plotkin SA. Impact of vaccines; health, economic and social perspectives. Front Microbiol. 2020;11:1526.
23. Global Vaccine Action Plan. (Accessed on 20 May, 2023). Available: https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/global-vaccine-action-plan
24. Explaining the Immunization Agenda 2030. (Accessed 23 May, 2023). Available: https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/ia2030/explaining-the-immunization-agenda-2030
25. Williamson ED, Westlake GE. Vaccines for emerging pathogens: prospects for licensure. Clin Exp Immunol. 2019;198(2):170-183.
26. Zhang X, Sharma PK, Peter Goedegebuure S, Gillanders WE. Personalized cancer vaccines: Targeting the cancer mutanome. Vaccine. 2017;35(7):1094-1100.
27. Zhang AD, Puthumana J, Downing NS, Shah ND, Krumholz HM, Ross JS. Assessment of clinical trials supporting US Food and Drug Administration approval of novel therapeutic agents, 1995-2017. JAMA Netw Open. 2020;3(4):e203284.
28. Gaddam S, Padi SSV. Gepants, calcitonin gene-related peptide antagonists, for abortive treatment of migraine: Current status. Int J Basic Clin Pharmacol. 2021; 10(9), 1156–1162.
29. Pasupulati H, Avadhanula V, Mamilla A, Bamini M, Padi SSV. Antibiotic prescribing practices in primary care settings using 2019 WHO AWaRe framework. J Pharm Res Int. 2021;33(37A):58-66.
30. Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753-2786.
31. Jordan VC. The 4Ps of Breast Cancer Chemoprevention: Putting proven principles into practice. Cancer Prev Res (Phila). 2017;10(4):219-222.
32. Egilman A, Wallach JD, Puthumana J, Zhang AD, Schwartz JL, Ross JS. Characteristics of preapproval and postapproval studies of vaccines granted accelerated approval by the US Food and Drug Administration. J Gen Intern Med. 2021;36(10):3281-3284.
33. D'Amico C, Fontana F, Cheng R, Santos HA. Development of vaccine formulations: past, present, and future. Drug Deliv Transl Res. 2021;11(2):353-372.
34. Han S. Clinical vaccine development. Clin Exp Vaccine Res. 2015 Jan;4(1):46-53.
35. Kashte S, Gulbake A, El-Amin Iii SF, Gupta A. COVID-19 vaccines: rapid development, implications, challenges and future prospects. Hum Cell. 2021;34(3):711-733.
36. Kalinke U, Barouch DH, Rizzi R, Lagkadinou E, Türeci Ö, Pather S, Neels P. Clinical development and approval of COVID-19 vaccines. Expert Rev Vaccines. 2022;21(5):609-619.
37. Kesselheim AS, Darrow JJ, Kulldorff M, Brown BL, Mitra-Majumdar M, Lee CC, et al. An overview of vaccine development, approval, and regulation, with implications for COVID-19. Health Aff (Millwood). 2021;40(1):25-32.
38. Development and licensure of vaccines to prevent COVID-19. Guidance for industry. JUNE 2020. (Accessed on 18 May, 2023). Available: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/development-and-licensure-vaccines-prevent-covid-19
39. Considerations for the Assessment of COVID-19 Vaccines for Listing by WHO. (Accessed on 28 May, 2023) Available: https://www.who.int/publications/m/item/considerations-for-the-assessment-of-covid-19-vaccines-for-listing-by-who
40. Fast-forward: Will the speed of COVID-19 vaccine development reset industry norms? (Accessed on 19 may, 2023). Available: https://www.mckinsey.com/industries/life-sciences/our-insights/fast-forward-will-the-speed-of-covid-19-vaccine-development-reset-industry-norms#/
41. Li M, Wang H, Tian L, Pang Z, Yang Q, Huang T, et al. COVID-19 vaccine development: milestones, lessons and prospects. Signal Transduct Target Ther. 2022;7(1):146.
42. GAO. Operation Warp Speed: Accelerated COVID-19 vaccine development status and efforts to address manufacturing challenges. (Accessed on 16 May, 2023). Available: https://www.gao.gov/products/gao-21-319
43. COVID-19 vaccine. (Accessed on 12 May, 2023). Available: https://en.wikipedia.org/wiki/COVID-19_vaccine
44. Notice regarding Guidance for approval Covid-19 vaccine in India for restricted use in emergency situation which are already approved for restricted use by US FDA EMA, UK MHRA, PMDA Japan or which are listed in WHO Emergency use listing. (Accessed on 22 May, 2023). Available: https://cdsco.gov.in/opencms/export/sites/CDSCO_WEB/Pdf-documents/notice15april21.pdf
45. Emergency use authorization for vaccines explained. (Accessed on 22 May, 2023). Available: https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained
46. Cavaleri M, Enzmann H, Straus S, Cooke E. The European Medicines Agency's EU conditional marketing authorisations for COVID-19 vaccines. Lancet. 2021;397(10272):355-357.
47. WHO issues its first emergency use validation for a COVID-19 vaccine and emphasizes need for equitable global access. (Accessed on 23 May, 2023). Available: https://www.who.int/news/item/31-12-2020-who-issues-its-first-emergency-use-validation-for-a-covid-19-vaccine-and-emphasizes-need-for-equitable-global-access
48. COVID-19 Vaccines with WHO Emergency Use Listing. (Accessed on 22 May, 2023). Available: https://extranet.who.int/pqweb/vaccines/vaccinescovid-19-vaccine-eul-issued
49. Liu M, Li Q, Lin J, Lin Y, Hoffman E. Innovative trial designs and analyses for vaccine clinical development. Contemp Clin Trials. 2021;100:106225.
50. Jiang Z, Wang X, Xia J. Considerations on the clinical development of COVID-19 vaccine from trial design perspectives. Hum Vaccin Immunother. 2021;17(3):656-660.
51. Su SC, Li X, Zhao Y, Chan IS. Population-enrichment adaptive design strategy for an event-driven vaccine efficacy trial. Stat. Biosci. 2018;10(2):357–370.
52. Adaptive design clinical trials for drugs and biologics guidance for industry. December 2019. (Download accessed on 19 May, 2023). Available: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/adaptive-design-clinical-trials-drugs-and-biologics-guidance-industry
53. Mössler C, Groiss F, Wolzt M, Wolschek M, Seipelt J, Muster T. Phase I/II trial of a replication-deficient trivalent influenza virus vaccine lacking NS1. Vaccine. 2013;31:6194–6200.
54. Park YC, Ouh YT, Sung MH, Park HG, Kim TJ, Cho CH, et al. A phase 1/2a, dose-escalation, safety and preliminary efficacy study of oral therapeutic vaccine in subjects with cervical intraepithelial neoplasia 3. J Gynecol Oncol. 2019;30(6):e88.
55. Groome MJ, Fairlie L, Morrison J, Fix A, Koen A, Masenya M, et al. Safety and immunogenicity of a parenteral trivalent P2-VP8 subunit rotavirus vaccine: a multisite, randomised, double-blind, placebo-controlled trial. Lancet Infect Dis. 2020;20(7):851-863.
56. Walsh EE, Falsey AR, Scott DA, Gurtman A, Zareba AM, Jansen KU, et al. A randomized phase 1/2 study of a respiratory syncytial virus prefusion F vaccine. J Infect Dis. 2022;225(8):1357-1366.
57. Datoo MS, Natama HM, Somé A, Bellamy D, Traoré O, Rouamba T, et al. Efficacy and immunogenicity of R21/Matrix-M vaccine against clinical malaria after 2 years' follow-up in children in Burkina Faso: a phase 1/2b randomised controlled trial. Lancet Infect Dis. 2022;22(12):1728-1736.
58. Goepfert PA, Fu B, Chabanon AL, Bonaparte MI, Davis MG, Essink BJ, et al. Safety and immunogenicity of SARS-CoV-2 recombinant protein vaccine formulations in healthy adults: interim results of a randomised, placebo-controlled, phase 1-2, dose-ranging study. Lancet Infect Dis. 2021;21(9):1257-1270.
59. Richmond P, Hatchuel L, Dong M, Ma B, Hu B, Smolenov I, et al. Safety and immunogenicity of S-Trimer (SCB-2019), a protein subunit vaccine candidate for COVID-19 in healthy adults: a phase 1, randomised, double-blind, placebo-controlled trial. Lancet. 2021;397(10275):682-694.
60. Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. Lancet. 2021;396(10267):1979-1993.
61. Kremsner PG, Ahuad Guerrero RA, Arana-Arri E, Aroca Martinez GJ, Bonten M, Chandler R, et al. Efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate in ten countries in Europe and Latin America (HERALD): a randomised, observer-blinded, placebo-controlled, phase 2b/3 trial. Lancet Infect Dis. 2022;22(3):329-340.
62. Chen YH, Gesser R, Luxembourg A. A seamless phase IIB/III adaptive outcome trial: design rationale and implementation challenges. Clin Trials. 2015;12:84–90.
63. A Study to Evaluate the Safety and Efficacy of mRNA-1345 Vaccine Targeting Respiratory Syncytial Virus (RSV) in Adults ≥60 Years of Age. (Accessed on 18 May, 2023). Available: https://clinicaltrials.gov/ct2/show/NCT05127434
64. Sadoff J, Gray G, Vandebosch A, Cárdenas V, Shukarev G, Grinsztejn B, et al. Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19. N Engl J Med. 2021;384(23):2187-2201.
65. Hardt K, Vandebosch A, Sadoff J, Le Gars M, Truyers C, Lowson D, et al. Efficacy, safety, and immunogenicity of a booster regimen of Ad26.COV2.S vaccine against COVID-19 (ENSEMBLE2): results of a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Infect Dis. 2022;22(12):1703-1715.
66. Frater J, Ewer KJ, Ogbe A, Pace M, Adele S, Adland E, et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in HIV infection: a single-arm substudy of a phase 2/3 clinical trial. Lancet HIV. 2021;8(8):e474-e485.
67. Dean NE, Gsell PS, Brookmeyer R, De Gruttola V, Donnelly CA, Halloran ME, et al. Design of vaccine efficacy trials during public health emergencies. Sci Transl Med. 2019;11(499):eaat0360.
68. Licensure and emergency use authorization of vaccines to prevent COVID-19 for use in pediatric populations. Food and Drug Administration. Published June 10, 2021. (Accessed on May 19, 2023). Available: https://www.fda.gov/media/149935/download.
69. Guideline on clinical evaluation of vaccines. Committee for Medicinal Products for Human Use (CHMP). EMEA/CHMP/VWP/164653/05 Rev. 1. Published 16 January 2023. (Accessed on May 19, 2023). Available: https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-clinical-evaluation-vaccines-revision-1_en.pdf
70. Design of vaccine efficacy trials to be used during public health emergencies – points of considerations and key principles. (Accessed on 17 May, 2023). Available: https://www.who.int/docs/default-source/blue-print/working-group-for-vaccine-evaluation-(4th-consultation)/ap1-guidelines-online-consultation.pdf
71. Feng S, Phillips DJ, White T, Sayal H, Aley PK, Bibi S, et al. Correlates of protection against symptomatic and asymptomatic SARS-CoV-2 infection. Nat Med. 2021;27(11):2032-2040.
72. Gilbert PB, Montefiori DC, McDermott AB, Fong Y, Benkeser D, Deng W, et al. Immune correlates analysis of the mRNA-1273 COVID-19 vaccine efficacy clinical trial. Science. 2022;375(6576):43-50.

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