ENTERTAINMENT

Can shark liver, tree bark and piles of sand contribute to the delivery of the Covid vaccine?


Could we really be on the verge of returning to normal life? This certainly points to the recent breakthroughs in coronavirus vaccines.

The US company Moderna announced yesterday that the first results could be 95 percent effective, and the UK had ordered five million doses in a matter of hours.

Last week's announcement revealed that Pfizer has a vaccine that is one of the seven now ordered for the UK that is 90 percent effective.

With the results of an Oxford University study of their vaccine expected in a few days, hopes are high that there is finally a way to beat this virus.

The US company Moderna announced yesterday that initial results show that the results could be 95 percent effective and that the UK had ordered five million doses in a matter of hours

The race is only partially driven. Questions remain. For example, the Pfizer shock is not clear what exactly is meant by being 90 percent effective.

We know the vaccine prevents symptoms from developing, but can they still infect others?

And how effective is it in the elderly – the group will likely be vaccinated first if the push is delivered as early as next month? It is also unknown how long it will protect people.

Professor Robin Shattock, head of the team at Imperial College London, which is also developing a vaccine, told Question Time last Thursday: “We don't know if it (the Pfizer vaccine) will protect us for six months or twelve months. & # 39;

In any case, we will need more than one type of prick because some may work better than others in some age groups – and just because a vaccine hits the market first doesn't mean it's best for everyone.

Many other questions remain open: who should get the push first? And how is it spent?

Last weekend, GPs warned that NHS England's plans to launch the vaccine – with more than 1,000 vaccination centers based largely on larger GPs as of December 1 – "have no realistic expectations".

But even before that there is a practical logistics in the manufacture of the vaccine. Given that the world’s adult population is nearing five billion – and all of them need to be vaccinated – this is a daunting undertaking.

The shocks must be produced at an unprecedented scale and speed, transported to all corners of the world and finally injected arm by arm.

The race is only partially driven. Questions remain. For example, the Pfizer shock is not clear what exactly is meant by being 90 percent effective. We know the vaccine prevents symptoms from developing, but can they still infect others?

The race is only partially driven. Questions remain. For example, the Pfizer shock is not clear what exactly is meant by being 90 percent effective. We know the vaccine prevents symptoms from developing, but can they still infect others?

No wonder Sir John Bell, member of the Government's Scientific Advisory Group on Emergencies (Sage) and Regius Professor of Medicine at Oxford University, told MPs last week that the news about the vaccine means there are 70 With an 80 percent chance that life will be back to normal by Easter, he added, "Provided the government doesn't screw up the vaccine distribution."

From delivering the raw materials for the vaccines, which in some cases also includes ingredients such as an oil found in shark liver, to making the glass vial that holds a dose, everything needs to be carefully planned.

And of course the cost must be taken into account. The Pfizer vaccine is believed to cost around £ 15 per dose, while the vaccine developed by Oxford University costs around £ 2.23 per dose – although both have agreed not to benefit from their bumps.

Here we look at the practical ways to immunize the UK – and the world – against Covid-19. To see how ready we are in each area of ​​this process, we rated them with a traffic light scheme – green means “ready to go”; Amber, "potential hiccups"; and red, "great obstacles to overcome".

Ingredients can be hard to find

There are around 500 components to making a vaccine, from chemicals to devices – and with such high demand, some may be in short supply. For example, there are concerns about the supply of adjuvants – compounds that are added to vaccines to boost the immune response to them and allow lower doses to keep the vaccine going.

One potential puff of Covid manufactured by US company Novavax and ordered by the government for use here involves an adjuvant compound extracted from the bark of Quillaja saponaria, a tree native to South America

One potential puff of Covid manufactured by US company Novavax and ordered by the government for use here involves an adjuvant compound extracted from the bark of Quillaja saponaria, a tree native to South America

One potential puff of Covid manufactured by U.S. company Novavax and ordered by the government for use here involves an adjuvant compound extracted from the bark of Quillaja saponaria, a tree native to South America.

It can speed up and strengthen the immune response. As a natural product, however, the range is limited. The trees are prone to drought and the bark can only be harvested a few months of the year.

Another adjuvant is squalene, an oil found in shark livers that are already used in flu vaccines. Conservation group Shark Allies has warned that the sudden surge in demand could mean an additional half a million sharks are killed each year and threatened populations already at risk.

GlaxoSmithKline, which describes the oil as an "essential part" of its Covid vaccines, says adjuvant use is especially important during a pandemic because "turbo-charging" the immune response can reduce the amount of vaccine needed per person, so that supplies can be reduced can go further.

Research into alternatives, including synthetic versions of squalene, is ongoing, but these won't be ready in time for the current pandemic. RNA vaccines, which involve injecting part of the coronavirus genetic code into the body, produce a strong response without an adjuvant. The Pfizer shock does not contain one.

There are concerns that supplies of materials could be disrupted by the pandemic "if borders are closed or transportation and travel are restricted, staff falls ill, production facilities are sub-par or shut down," said a recently released report by the Royal Society on the manufacture and distribution of a vaccine.

READINESS: AMBER

Do we have glass for the vials?

Vials, the bottles that hold the vaccine before injection, are made of borosilicate glass.

Also known by the brand name Pyrex, it is used to hold vaccines because it is more leach-resistant than regular glass, which means it will not chemically react with the medicine and contaminate it.

In April, however, an analyst at a US bank advisory firm warned of a shortage of sand with the type of "angular" grain used to make borosilicate glass. In the same month Sir John Bell warned: "There are only 200 million vials in the world because they were all sucked up by different people who can expect a vaccine."

Solutions include adding more than one dose to each vial, with five or ten doses of the Oxford and Pfizer vaccines likely to be in one vial. Each dose would be delivered using a different needle to prevent contamination.

Dave Dalton, executive director of the British Glass Manufacturers' Confederation, told Good Health that although the UK is no longer making borosilicate glass, deals have been made to buy enough from overseas to make hundreds of millions of vials for the vaccination program (companies) Laboratory glassware manufacturers make the vials in the UK from larger sections of glass purchased from overseas.

Vials, the bottles that hold the vaccine before injection, are made of borosilicate glass

Vials, the bottles that hold the vaccine before injection, are made of borosilicate glass

"There have been concerns as to whether we will be able to meet the demand, but I think now we are comfortable that we can," he says.

Filling the vials, a process carried out by robotic machines known as filling and finishing, is another potential sticking point in the process as it involves large numbers of doses being dispensed, the Royal Society report warned.

To reduce the risk of delays, the government has reserved a production line at a pharmaceutical factory in Wrexham for 18 months.

Kate Bingham, Chair of the Government-appointed Vaccine Task Force, which aims to drive production of a coronavirus vaccine, announced the deal in August, saying, "The filling out and completion is a critical step in the process of turning the vaccine into a Given form to bring patient.

"The agreement will improve our ability to ensure that from the time a successful vaccine is identified, we will be able to produce the required quantities of vaccine as quickly as possible."

READY: GREEN

Find the right delivery truck

Once in the vials, getting the vaccines to where they're needed requires a large number of trucks and airplanes – the aviation industry trade organization has called it the "Mission of the Century".

The International Air Transport Association (IATA) has calculated that it would take 8,000 jumbo jets to carry enough vaccine to give a single dose to everyone in the world. The precious cargo would also need to be stored safely and, more importantly, refrigerated.

Most vaccines need to be cool to prevent them from breaking down. If they're too warm, any protein can get stuck in them, much like the egg hardens when cooked, making them unusable. Some have whole virus particles as their main component, and viruses contain a large amount of protein.

Other vaccines contain more key proteins than the whole virus, and some contain RNA, an extremely fragile genetic material, in the core. The Pfizer vaccine is based on RNA.

The Oxford vaccine must be stored at 2 ° C to 8 ° C, while Pfizer's vaccine must be stored at -70 ° C. The vaccine developed by Imperial College London (another promising vaccine, but it is in an earlier stage of development), which also contains viral RNA, may need to be kept at -80 ° C.

Toby Peters, professor of cold economics (including drug refrigeration studies) at Birmingham University, warned: "Nowhere in the world is there the logistical capacity to get vaccines at this temperature and volume without massive investment."

Ryan Pulleyn, managing director of Pulleyn, a shipping company that specializes in temperature-controlled transport of pharmaceuticals, adds that medicines are regularly transported across the country between 2 a.m. and 8 a.m.

"But trucks that cool down to -70 ° C are not currently available and would have to be built on a bespoke basis."

The IATA says planes have long been transporting medicines in refrigerated conditions. And instead of adapting aircraft to transport frozen vaccines, manufacturers need to package their products to keep them at the required temperature for the duration of the flight.

Pfizer has developed suitcase-sized vials for use in airplanes and trucks. If these “cool boxes” are packed with dry ice, the vaccine is said to remain frozen for up to ten days, even if the holds of airplanes or trucks are at room temperature.

However, IATA told Good Health that dry ice is classified as a hazardous material – which limits the amount of vaccines that can be carried on airplanes at one time. "The challenge will be the volume of vaccines that will have to be transported," said an aviation industry spokesman. "Some types of refrigerants that are used to keep vaccines cool are classified as dangerous goods."

Imperial College London, meanwhile, has stated that while the first vaccine it made must remain frozen, attempts are being made to make a version that only needs to be refrigerated, followed by a version that is freeze-dried and can therefore be stored at room temperature.

READY: RED

Are there enough factories to do the push?

The government has ordered more than 340 million doses of vaccine from seven manufacturers, including Pfizer. In this context, 15 million influenza vaccinations are given in England every year.

Globally, it takes more than 15 billion doses of Covid vaccine to get the two shots that most companies believe are necessary. This is 15 times the number of shocks of any kind that GSK, the world's largest vaccine manufacturer, performs annually.

So large are the quantities required that production of Covid vaccines, including at Pfizer, began before scientists even knew they would work.

For example, mass production of the jab developed by Oxford University with pharmaceutical company AstraZeneca began in April (final test results are expected before the end of the year).

"Ordinarily, full production wouldn't begin until … you knew the vaccine was working," says Professor Nilay Shah, director of chemical engineering at Imperial College London and author of a Royal Society report on the practicalities of manufacture and use Distribution of a Covid vaccine. "Otherwise, you will be spending a tremendous amount on vaccines when the chances are that you will just have to throw them away."

The various butts are also made in Belgium, Germany, the Netherlands, the USA and India.

Production is limited here because "while other countries were investing in production, the UK government focused its funding on vaccine research," says research scientist and ex-Pfizer managing director Professor Mike Wyllie.

GSK, which has several Covid vaccines in development, has locations in the UK, Europe, Canada and the US. Some vaccines are made in factories that make other puffs, others in plants that make medicines, including cancer therapies, and some in new locations.

However, the lack of capacity has accelerated the construction of new facilities in the UK. That includes the £ 200million vaccine-making innovation center in Oxfordshire, which should produce 70 million doses of coronavirus vaccine within four to six months of opening in the summer of 2021 – enough for one shot for everyone in the UK.

READY: GREEN

How do you give 100 million bumps?

The vaccines are manufactured, packaged and shipped, and have yet to be given to those who need them. According to the Royal Society, this is the “main bottleneck”.

A mass vaccination program is more prone to human error than the manufacturing process, which is largely automated, explains Professor Nilay Shah, director of chemical engineering at Imperial College London and one of the authors of the Royal Society's report.

He says it could take up to a year to vaccinate the UK's 50 million plus adults, even with 500,000 shots a day (the number it would take to give 100 million doses of the vaccine, two per person) .

Professor Shattock said last week that vaccination of "ten million vulnerable people" in the UK would take until April and "provided everyone comes for their first and second vaccinations". (The Pfizer shock must be given as two vaccinations three to four weeks apart.)

Veterinarians, dentists, pharmacists, midwives, physiotherapists, student nurses and doctors, as well as the army, will be drafted to manage the shock according to the plans of the Ministry of Health. To give you an idea of ​​the scale of the challenge, pharmacists in England gave 1.7 million flu shots over the past winter.

There are also concerns about the logistics of storing and administering the Pfizer vaccine, which must be kept at -70 ° C. Health Secretary Matt Hancock has admitted that this is a "colossal challenge". Considerations include not only how to keep the puffs frozen, but also how many need to be thawed before use – defrost too many and they can be wasted.

Last week Sir John Bell told mps that the Pfizer vaccine must be stored in such cold conditions: "The idea that this will be done by local general practitioners sounds a little unlikely to me."

General practitioners' practices were asked to work in groups of six or seven people to create a network of more than 1,000 vaccination centers, says Dr. Richard Vautrey, Chairman of the British Medical Association General Practitioners Committee. They are in a practice or other building such as a gym and vaccinate patients 12 hours a day, seven days a week.

Rather than equipping each GP vaccination center with a dedicated freezer to store the bumps, the vaccine could be regularly supplied with freezers from a smaller number of regional locations. At the GP centers, the puffs can be kept in the refrigerator for up to five days before they are used up.

"We need patients who understand that they should keep their appointments to ensure that we can vaccinate as many people as possible and not waste the vaccine," says Dr. Vautrey.

Space could also be an issue. Professor Martin Marshall, Chairman of the Royal College of General Practitioners, said: “We need to consider the time patients have to wait after vaccination in the event of side effects (such as a sore arm or high temperature). We're told this should be 15 minutes, which takes space, especially given social distancing measures. "

Finally, those giving the vaccine will need syringes and personal protective equipment.

"It is an unprecedented challenge and we need to do the planning now," says Professor Shah.

“The Ministry of Health says they are planning all of this and we can stop worrying. I really hope it does all the thinking. To achieve those 500,000 bumps per day, every single bit of the system has to work. "

READY: RED

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