Preparing for the "Next Generation" of COVID-19 Vaccines

For most people, the concept of "technological progress" is unlikely to need much explanation. "It’s obvious," someone might say. "It’s simply the replacement of one technology by another, better one."

A little reflection yields endless examples. The cell phones of the 1980s, for instance, were cumbersome and heavy. They couldn’t do a fraction of what modern smartphones can do. Texts saved years ago on floppy disks would be inaccessible even if the disks were unearthed. The same would be true of movies recorded on VHS tapes. We now have new and better technologies.

But how does this replacement happen? Who actually decided that one technique for recording film or music, or for communicating, or photographing, was better than another? So far—at least as the above examples are concerned—a plausible answer might be, "It wasn’t a person—it was the market."

Manufacturers, in this explanation, saw the way the wind was blowing and innovated accordingly. Or they didn’t and vanished together with their outdated products. And if a market is large enough, it may fragment. For example, there’s space for some automobile manufacturers focusing on enhancing safety in their new models, others on improving performance, reducing running costs, lessening environmental impact, etc. Sometimes niche markets emerge—creating space, for example, for retro designs or technologies.

These examples have one characteristic in common: They are all consumer products. But not all interactions between manufacturers and potential customers play out in the market. A company looking to develop a more advanced missile system, for instance, or a nuclear power plant, will engage in protracted and highly technical discussions with major clients. Functions and design options will be discussed, choices made. And there are yet other sectors, including sophisticated medical equipment, which fall in between. Sometimes, of course, developments in a particular sector become the subject of political, and potentially rancorous, debate.

The crucial point is that, despite appearances, there’s nothing inevitable about the specific examples of technological progress we come across, whether as consumers, as citizens, or as patients. Innovation is based on assessments of what we—consumers, citizens, or patients—will take if offered, or of what the state, or a profession, considers would be to its or our advantage.

Vaccine Innovation

Vaccines can be thought of as public health technologies. If we do that, we can ask, "How does this apply?" and "Who’s making those assessments?"

With COVID-19 vaccines, we’re in a novel situation—and not only because of the speed with which the first vaccines were developed. Equally unparalleled is the variety of COVID-19 vaccines which have since appeared. More than thirty different vaccines are licensed and in use somewhere, with a hundred others making their way through the pipeline. They are based on three quite distinct approaches.

In the U.S. and many other countries, the majority of people have been vaccinated with one or other of these, some with three doses. Where available, the vaccines have greatly reduced the probability of severe illness and death, though the duration of protection is unclear and reports of (rare) vaccine-related side-effects must be taken seriously.

But what next? Is endless "boosting" with more of the same vaccine the right way forward? Perhaps we need new vaccines, adjusted to changes in the world and in the virus. If so, how should the new vaccines be an improvement on the ones available now? The novelty of the current situation means vaccination history offers few clear pointers.

"Next-Generation" COVID-19 Vaccines

A few scientists are thinking about a vaccine that would protect against all mutations of the SARS-CoV-2 virus or even all coronaviruses. But it’s not yet clear how to do this. It’s something for the longer term. Other projects are more advanced.

In the past few weeks, I have read that Moderna is working on a combined Covid-19 plus flu booster, whilst Pfizer/BioNTech are testing a vaccine specifically tailored to protect against the omicron variant. Some researchers believe that future vaccines should work differently. Instead of stimulating the production of antibodies, they should aim at priming our bodies’ T-cells to find and destroy infected cells.

A group of World Health Organization advisers argues that COVID-19 vaccines that have a high impact on the prevention of infection and transmission, in addition to the prevention of severe disease and death, are needed and should be developed. For others, the priority is a cheap and easily made vaccine. Corbevax, developed by scientists at Texas Children’s Hospital and Baylor College of Medicine, using well-established patent-free technology, might be just that. Phase III clinical trials have been completed and an Indian biotech company, Biological E, has already started large-scale production.

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Adding further variety, there is evidence that existing live vaccines, especially the tuberculosis vaccine BCG, might provide some protection against respiratory infections (including COVID-19). In use for nearly a century, BCG is patent-free and costs almost nothing. An international trial looking at its effect on COVID-19 related illness is getting underway.

There’s even more. Sixty years ago, aware that fear of needles might deter some people, Albert Sabin put his polio vaccine on sugar cubes. Today, some scientists are exploring ways of getting COVID-19 vaccines into people’s bodies without using needles. No doubt there’s also research addressing the causes of worrying side-effects and how these could be reduced or eliminated. Of course, no one can say if or when any of these initiatives will bear fruit.

Scope for Debate?

In some communities, fear of confrontation has discouraged people from talking about vaccination. Positions have become so polarized, so entrenched, that public debate has become almost impossible.

Perhaps thinking of vaccines as technologies, in the way I’ve outlined here, indicates a way of reopening the social conversation. What if we agree that technological progress is the result of choices made? What if we look not sideways, at those with whom we disagree, but forward, focusing on "next-generation" COVID-19 vaccines? It's hard to be sure, but the potential benefits of engaging the community in debating, and in prioritizing, alternative vaccine futures, just might be very large indeed.