This topic was presented in our online class presentation by Dr. Tayyaba Noor (Postgraduate Resident, Pakistan Institute Of Medical Sciences, Islamabad).

A Brief Introduction about COVID-19 Timeline and Vaccines:

• December 31, 2019:
  • China alerts WHO to several unknown cases of pneumonia in WUHAN, the disease goes on to be named COVID-19.
• January 11, 2020:
  • China reported its first known death from COVID.
• March 11, 2020:
  • WHO declares COVID 19 as a pandemic, with 118,319 cases globally
• April 2nd, 2020:
  • Over 1 million COVID-19 cases have been confirmed globally.

In Pakistan:

• Feb 26th, 2020:
  • The first case of COVID 19 identified in Karachi
• Mar 18th, 2020:
  • The first COVID death was reported in Pakistan.
• Jun 7th, 2020:
  • COVID-19 cases reach up to 100,000.

How do COVID-19 Vaccines work?

COVID-19 vaccines help our bodies develop immunity against the disease. The body is left with a reservoir of "memory" T-lymphocytes and B-lymphocytes that will keep in mind how to fight that virus in the future with all types of vaccines, however various vaccines function differently to offer protection.

After immunization, the body normally produces T- and B-lymphocytes over the course of a few weeks. Because the vaccine does not have enough time to offer protection, it is conceivable for a person to contract the virus that causes COVID-19 just before or just after vaccination and subsequently become ill.

Following vaccination, the process of developing immunity may occasionally result in symptoms like fever. These signs of immunity-building in the body are normal symptoms.

The Different Types of COVID 19 Vaccines:

Currently, there are three main types of COVID-19 vaccines that are or soon will be undergoing large-scale (Phase 3) clinical trials.

1. mRNA vaccines:
   • These vaccines contain mRNA sequences to make a harmless protein that is unique to the virus. Our cells duplicate the protein, then they obliterate the genetic material from the vaccine. T-lymphocytes and B-lymphocytes remember how to fight the virus that causes COVID-19 if we are infected in the future.
2. Protein subunit vaccines:
   • These vaccines include harmless pieces (proteins) of the virus instead of the entire germ. Once vaccinated, the immune system recognizes those proteins and begins making T-lymphocytes and antibodies. Memory cells will be able to identify and combat any viruses that may attack us in the future.
3. Vector vaccines:
   • These vaccinations have genetic material from the virus that causes COVID-19 put into a weaker, living virus that is different from the virus that causes COVID-19 (this is called a viral vector). The immunological reaction is the same as what was previously described once the viral vector is within our cells.

COVID 19 Vaccines - Types, Dose, Efficacy, Cost, and Side effects:

BioNTech andPfizer BNT162B2:

The Pfizer-BioNTech COVID-19 vaccine was sent to the FDA for possible Emergency Use Authorization (EUA) in November 2020 and authorized in Dec.

It is a lipid nanoparticle-encapsulated mRNA vaccine that codes for the spike protein of the virus. It demonstrated 95% effectiveness in Phase III trials. The Pfizer-BioNTech vaccine needs to be stored in specialist freezers at a temperature of roughly -94 degrees Fahrenheit.

Side effects of BNT162b2 (BioNTechand Pfizer):

• Local and systemic side effects can occur.
• Side effects are dose-dependent and relatively common after the second dose
• Fever may occur in 16%
• Moderate to severe fatigue has been reported in 38%.
• Headache has been reported in 28%
• Chills occur in 18%
• Rates of side effects among older participants were slightly lower.
• Anaphylactoid reactions were noted in some patients.

Type, Dose, Price, Efficacy:

• Type: mRNA
• Doses: 2 doses administered intramuscularly 21 Days Apart (0.3ml each)
• Price: $19.50 per dose
• Efficacy: About 95%
• Variants: Lab data suggest “quite effective” against the UK variant and the South African and Latin American variants.

Moderna MRNA 1273 Vaccine:

On November 16, Moderna issued a preliminary data readout of its COVID-19 vaccine, suggesting an efficacy rate of 94.5%. The FDA authorized it on December 19 for EUA. It is an mRNA vaccination, just like the Pfizer-BioNTech shot.

The Moderna vaccine, in contrast, is stable for up to 30 days at 36 to 46 degrees F, or the temperature of a typical home or medical refrigerator, and can be kept for up to six months at -4 degrees F.

Side effects of Moderna Vaccine:

The most common side effects are:

• In the arm where you got the shot:
  • Pain
  • Swelling
  • Redness
• Throughout the rest of your body:
  • Chills
  • Tiredness
  • Headache, nausea, vomiting
  • Myalgias, arthralgias

Type, Dose, Price, Efficacy:

• Type: mRNA
• Doses: 2 doses, 28 Days Apart (0.5 ml each)
• EUA Date: December 18, 2020
• Price: $25-$37 per dose
• Efficacy: About 94.1%
• Variants: According to laboratory results, the UK variation, as well as the South African and Latin American variants, are "very effective."

Oxford, AstraZeneca, Serum Institute of India CHADOX1 NCOV-19/AZD1222 Vaccine:

An interim review of the COVID-19 vaccine, AZD1222, by AstraZeneca and the University of Oxford yielded high-level findings on November 23. The analysis, which was based on trials conducted in the UK and Brazil, showed up to 90% efficacy. People who received the immunization experienced no hospitalizations or severe cases of COVID-19.

Approved for use by DRAP in Pakistan.

Side effects of the vaccine:

• fatigue, headache, and fever - 8% in earlier phases.
• In the phase III trial, 2 cases of transverse myelitis. One was thought to be possibly related to vaccination. The other was thought to be possibly related to a previously unrecognized multiple sclerosis.

Type, Dose, Efficacy, Cost:

• Type: Adenovirus-based
• Doses: 2, 28 Days Apart
• EUA Date: Authorized in UK, Argentina, India, and Mexico on January 12, 2021
• Price: $25-$37 per dose
• Efficacy: Currently, total effectiveness is around 70%
• Variants: According to at least one study, it appears to be effective against the UK and Brazilian versions but has no effect on the South African variant.

Novavax NVX-COV2373 Vaccine:

On January 28, 2021, Novavax stated that its Phase III study in the UK for its COVID-19 vaccine, NVX-CoV2373, met the primary endpoint with a vaccination efficacy of 89.3 percent. The vaccine is a full-length spike, protein-containing protein-based COVID-19 vaccine candidate.

Side effects:

• 6% experienced systemic effects (mainly fatigue, headache, myalgias, and/or malaise) following the second dose.

Types, Cost, Efficacy:

• Type: Protein-based vaccine
• Doses: 2, 21 days apart
• Likely EUA Date: Possibly in March or February 2021 in the UK; possibly later in the U.S.
• Price in the US: $16
• Effectiveness: 89.3 %. Effective against UK and South African variants

Sinopharm BBIBP-CORV Vaccine:

An inactivated vaccine based on a SARS-CoV-2 isolate from a patient in China.

Side effects:

• Local Side effects: Swelling, itching, erythema, and flushing
• Systemic Side effects: Headache, fever, chills, flu, fatigue, nausea, diarrhea,  body aches, and cough.

Types, Dose, Efficacy, Cost:

• Type: Inactivated Vaccine (Aluminum hydroxide adjuvant)
• Dose: IM, 2 doses 28 days apart.
• Efficacy: 79% (86% IN UAE)
• Storage: 2 - 8 C
• Licensed in UAE based on interim data from a phase III efficacy data from the trial in that country. Approved in China, Bahrain, Egypt, and Jordan.

Currently Being given in Pakistan to health care workers in the initial phase.

Jansen AD26.COV2.S COVID Vaccine:

Johnson & Johnson announced on November 15 that it initiated a second global Phase III trial of its Janssen COVID -19 vaccine. Whereas all of the other three vaccine candidates require two doses about 28 days apart, the J&J vaccine only requires a single dose.

Interim results from its Phase I/IIa trial demonstrated a single dose of the vaccine-induced a robust immune response and was generally well-tolerated. The ENSEMBLE 2 study evaluated a two-dose regimen as well.

The Phase III ENSEMBLE trial demonstrated the single-shot vaccine is 66% effective overall in preventing moderate-to-severe COVID-19, 28 days after vaccination. However, it demonstrated 100% efficacy ad prevented severe disease after day 49.

Type, Dose, efficacy, Cost:

• Type: Adenovirus-based
• Doses: 1 and 2 dose schemes are being tested
• Likely EUA Date: Possibly March or April 2021
• Price: $10 per dose
• Efficacy: Unknown yet
• Variants: There is evidence the vaccination is effective against the variants, though less so against the South African and Latin American strains, based on clinical investigations conducted in Africa, the UK, and Latin America.

Gamaleya Institute, Russia SPUTNIK V Covid Vaccine:

Around November 11, Russia’s National Research Center for Epidemiology and Microbiology, which Russia authorized for use in August—ahead of even beginning a Phase III trial—claimed to have an efficacy rate of 92% after the second dose.

It was based on a first interim analysis 21 days after the first injection during the ongoing Phase III study. On November 24, the organization claimed 95% efficacy based on new preliminary data. A shot of the vaccine, according to the organization, will only cost $10, or around half as much as the Pfizer vaccine.

In addition to Russia at this moment, it may also be available in India, Korea, Brazil, China, and Hungary. Phase III findings showing a 91.6 percent efficacy against the original strain of the virus were published in The Lancet on February 2, 2021. Pakistan's DRAP has approved the vaccination.

Type, Dose, Efficacy, Cost:

• Type: Adenovirus-based
• Doses: 2
• Probably EUA Date: Inapplicable in the United States
• Cost: $10 for each dose
• Effectiveness: 91.4%
• Variants Unknown. Before the appearance of significant mutations, the majority of clinical trial data was collected in Russia.

CanSino Biologics AD5-BASED COVID-19 Vaccine:

The Chinese military helped to co-develop the CanSino Biologics vaccine. It has a 65.7% success rate in preventing symptomatic instances. Based on a multi-country analysis that Pakistan's health advisor initially published on February 8, 2021. The 30,000 patients in the Phase III trial showed 90.98% efficacy in averting serious illness.

With a contract for 20 million shots, PAKISTAN is conducting one of the largest trials. Additionally, it is collaborating with the WHO to get the COVAX programme approved for the vaccine.

Type, Dose, Cost, Efficacy:

• Type: Viral vector, loading an antigen from the SARS-CoV-2 virus onto an adenovirus.
• Doses: 1
• Cost: Unknown
• Probably EUA Date: Inapplicable in the United States
• Effectiveness: 90.98% effective in preventing severe disease; 65.7% effective in preventing symptomatic cases.

Sinovac, China CORONAVAC Vaccine:

In late-stage clinical trials conducted in Brazil, Sinovac Biotech, a Chinese company, announced that its COVID-19 vaccine had a 50.38 percent efficacy. Clinical research conducted by the company shows markedly different efficacy rates.

Turkey reported an efficacy rate of 91.25 percent, whereas a local trial in Indonesia revealed an efficacy rate of 65 percent. Another experiment in Brazil revealed last week that it was 100% effective against severe and moderate infections while only 78 percent effective against mild infections.

Type, Dose, Cost, Efficacy:

• Type: Inactivated SARS-CoV-2 virus
• Doses: 2
• Likely EUA Date: Not practical in the U.S.
• Price: $60 per dose in China
• Efficacy: 50.38% to 91.25%, depending on the clinical trial
• Variants: Unknown, although Brazilian research showed a 50.4% success rate in preventing symptomatic infections.

RBD DIMER, ANHUI ZHIFEI & CAS,CHINA ZF2001 Vaccine:

In early and midstage studies, a coronavirus vaccine candidate created by the Chinese Academy of Sciences (CAS) was proven to be safe and to stimulate immunological responses.

An innocuous fragment of the SARS-CoV-2 virus is used in ZF2001, a protein subunit vaccine, rather than the whole germ. Many nations, including Pakistan, Malaysia, and Uzbekistan, are conducting phase 3 trials.

Type, Dose, efficacy:

• Type: protein subunit
• Doses: 3 doses, one month apart.
• Efficacy: not yet established.

COVID 19 Vaccination in Pakistan:

Pakistan has so far approved three vaccines for EUA:

• Sinopharm
• Astrazeneca by Oxford
• Sputnik by Russia

While two candidate Vaccines are conducting phase 3 clinical trials:

• CanSino ( NIH, UHS, AKUH, SIH)
• RBD Dimer (UHS, AKUH) Both by China

The first covid vaccine shipment containing half a million SINOPHARM vaccines has arrived in Pakistan, further, we have also secured 17 million indicative doses of the ASTRAZENECA vaccine, out of which 35-40 percent or 6 to 6.8 million doses will be available within the first quarter of the current year.

A ray of hope but we still have a long way to go

Don't Forget!

Wash Hands

Use Face Masks

Keep Distance