New vaccines should help India fill gaps in vaccination campaign

Even as India emerges from a brutal second wave of Covid-19, public health experts are already preparing for a third wave they anticipate will be in store by the end of this year. In the intervening months, the Union government and State governments across India have a critical window in which to vaccinate as much of the population as possible.

Given that only 4% of the population has received a full vaccination regimen thus far, political leaders and health bodies will have to use all the tools at their disposal to meet the fixed objective of fully vaccinating 95 crore people by the end of this year. To reach that ambitious goal, health experts warn Indian officials cannot continue to “put all their eggs in one basket” by relying too heavily on a single vaccine or a single supplier, a strategy whose dangers have been made clear by the production issuesat the Serum Institute of India (SII)since the start of this year.

Instead, the shortfalls from the SII, and their impact on both India’s vaccination campaign and the global COVAX vaccination pipeline, has made diversifying vaccine supplies beyond Covishield (India’s local version of the jab developed by Oxford University and AstraZeneca) a matter of urgency to achieve the objective of 216 crore vaccine doses produced “in India and for Indians” between August and December.

Covaxin,Covovax, and Moderna add to India’s arsenal

To address that need, the Modi government, the SII, and both Indian and foreign pharmaceutical companies are quickly adding a new slate of vaccines alongside Covishield.Those include the indigenous Covaxin vaccine, developed by Bharat Biotech, and Biological E, which is currently in Phase III trials.

According to the latest numbers from the government’s CoWin platform, India has already administered over 4 crore doses of Covaxin, with the National Institutes of Health (NIH) in the United States giving the “made in India” Covid vaccine an additional boost with its new findings that Covaxin is effective against both the Alpha and Delta variants of the coronavirus. While Indiais still trying to convince the European Union to recognise Covaxin and Covishield as valid vaccines for travel, Covaxincould soon be approved by the World Health Organisation (WHO) for emergency use.

The growing list of vaccines also includes the US-made Moderna, an mRNA vaccine which uses the same technology as the more-famous Pfizer/BioNTech jab and which has just been approved for import and distribution in India. While Indian officials are still in discussions with Pfizer for its mRNA vaccine and with Johnson & Johnson for its single-shot alternative, Moderna will be the second imported vaccine – alongside the Russian Sputnik V – administered in India. Another American vaccine, Novavax, is also expected to be cleared for use within the next few months, and will be produced locallyat the SII under the name Covavax.

While Moderna and Pfizer’s mRNA vaccines have demonstrated some of the highest rates of efficacy against Covid-19 of all vaccines available thus far, their stringent refrigeration and storage requirements make them unfit for use across much of India. Compared to Covishield, which can be kept at temperatures of 2-8°C, Moderna needs storage temperatures of -20°C – an impossibility for most communities across India, and especially those with limited access to electricity.

Akston offers a refrigeration-free vaccine

In order to reach the isolated or impoverished segments of the population most at risk from Covid-19, India will need to augment this list of existing and forthcoming vaccines with alternatives that are better designed for use in places where “cold chains” cannot be maintained on account of unreliable transportation, electricity, or storage networks.

One such vaccine is the AKS-452 jab developed by US-based Akston Biosciences, which is currently undergoing Phase I/II trials in the Netherlands. Unlike all of the Covid-19 vaccines currently on the national market, AKS-452 does not require refrigeration at all, and can instead be kept shelf-stable for four months at temperatures of up to 25°C. Even in warmer climates, the vaccine retains its efficacy for a full month at temperatures of up to 37°C.

Since Akston does not use the virus itself to produce the vaccine, instead directing the immune system to focus on repelling the receptor binding domain (RBD) of the coronavirus’ now-infamous spike protein, the vaccine is designed to be effective against different variants while also remaining straightforward to produce. According to the drugmaker, a single production line could turn out over 100 crore doses of the AKS-452 vaccine per year.

Thanks to its viability without refrigeration, Akston’s AKS-452 vaccine is representative of a “second generation” of Covid-19 vaccines that are a better fit for the parts of the world – including many parts of India – that have been left out of the global inoculation effort thus far. Other companies, such as Germany’s CureVac, are also working on second-generation vaccines that can be distributed without cold storage, while firms such as Altimmune are working on vaccines that don’t require a needle at all.

Covavax will be the first of this second generation of vaccines to be used in India, but given the sheer number of jabs needed to inoculate the whole of the country, it will almost certainly not be the last.