Could Indonesia come up with a vaccine?

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Taruna Ikrar Pharmacologist, Professor and Member of the American College of Clinical Pharmacology, United States

IO – The Coronavirus (COVID-19) has officially been categorized as a global pandemic, having infected millions of the world’s population, with mortality rates of hundreds of thousands of patients. This outbreak not only poses a serious threat to world health, but exacerbates ongoing global trends: economic recession, social and political issues. 

COVID-19 is contagious because it has four properties that show very reactive virulence, namely: 1. T ransmitted from person to person (human to human), 2. Transmitted even when a patient shows no symptoms (asymptomatic), 3. T ransmitted trans-species (Human-Animal-Human), 4. The entry point of transmission is not only aerial, via breath (not only respiratory) but also with the ability to infect mucosal tissue, such as the mucous membranes or mucous in the eye, also the digestive tract, and of course through the respiratory tract, as the main route of transmission of this disease. 

T h e h i g h d e a t h r a t e o f COVID-19 sufferers, based on a scientific report in the New England Journal of Medicine (NEJM 2020) is characterized by three important elements: 1]. Respiratory failure (Acute Respiratory Distress Syndrome) caused by the accumulation of mucus in the lungs, especially in the alveoli. 2] a blockage in the arteries which eventually dilates or causes aneurysms due to atherosclerosis, with potential internal bleeding, 3]. Blood clots (thrombosis), which can be very dangerous, as it can impede and lead to the failure of various organs (multiorgan failure). All three of the above result in a high mortality rate for COVID-19 patients. 

Starting in June 2020, several countries have eased their severe regional quarantine protocol. In a term popularized by World Health Organization (WHO) it is to be known as New Normal Life (NNL), in the sense that people in some regions seeing a decline in the number of cases can ease the movement of people outside the home, while still strictly following health protocol: people would still be required to keep their distance (social distancing), wear masks when leaving the house, avoid crowds and still maintain a high level of bodily hygiene (frequent hand-washing). However, looking at epidemiological data, it is quite clear that COVID-19 will continue to be around us as a threat to world health. 

The urgent need for a COVID-19 vaccine 

Based on the nature of the virus that causes COVID-19, if not handled properly, there will be a serious impact, with an explosion of COVID-19 cases in the future. Therefore, the urgency of finding a COVID-19 vaccine. Moreover, the genetic sequence of SARS-CoV-2 that causes COVID-19 has been defined and stimulates major global pharmaceutical companies to develop vaccines against the condition. The scale of the humanitarian and economic impact of the extraordinary COVID-19 pandemic has prompted the evaluation of the latest generation of vaccine technology, through a new paradigm to accelerate development, promptly bringing to a clinical trial stage new candidates for the COVID-19 vaccine in humans. 

Discovery of a vaccine and search strategies demand global collaboration in prevention and treatment efforts. The basis for this development includes a vaccine development program reported to and coordinated with WHO. Based on WHO reports thus far 115 COVID-19 vaccine candidates have been highlighted. Of these, 78 were confirmed to be in preclinical/clinical testing, while 37 were not confirmed. Of the 78 active projects confirmed, 73 are currently in an exploration or preclinical stage. The remainder are included in clinical trials, namely: mRNA-1273 from Moderna, Ad5- nCoV from CanSino Biologicals, INO-4800 from Inovio, LV-SMENP-DC and aAPC specific pathogens from Shenzhen Geno-Immune Medical Institute. Likewise, several other vaccine candidates will be testing in humans (clinical trials) in 2020. 

The diversity of technology platforms in developing and manufacturing COVID-19 vaccines derives from scientific research into nucleic acid technology (DNA and RNA), particle or peptide technology from viruses, recombinant protein technology, or attenuated viral plasmids. New types of platforms have been found, based on DNA or mRNA, allowing greater flexibility in terms of antigen manipulation and velocity potential. For example, the pharmaceutical company Moderna began clinical testing of an mRNA-1273-based vaccine only 2 months after the identification of the COVID-19 RNA virus sequence. This vaccine, based on a virus vector, offers high levels of protein expression, long-term stability, and triggers a strong immune response. 

Of the confirmed active vaccine candidates, there are 56 (72%) being developed by private/industrial developers, with the remaining 22 (28%) projects are led by academics, the public sector, and other non-profit organizations. In addition to multinational pharmaceutical giants (such as Janssen, Sanofi, Pfizer, and GlaxoSmithKline), many major developers are small and/or inexperienced laboratories are intent on developing vaccines on a large scale. 

It is thus important to ensure coordination in the development and manufacture of vaccines, and the capability of supply and capacity to meet demand. Most COVID-19 vaccine development is taking place in the United States, 36 (46%) compared to 14 (18%) in China, 14 (18%) in Asia (excluding China) and Australia, with 14 (18%) in Europe. 

Indonesia’s “Bio-Farma” opportunities 

There are indications that certain vaccines can be made available in the ongoing pandemic by the end of this year, considering how COVID-19 has become a pandemic with a high level of transmission and fatalities. 

The discovery of an effective vaccine is certainly a must for avoiding an explosion of new cases or suppressing a second peak of COVID-19. In the United States, seven vaccine candidates have been clinically tested on patients and compared with controls. Several have even entered phase 2/3 clinical trials. This will add to our optimism that we can confront and overcome the COVID-19 pandemic. 

By looking at global conditions and the national interests of Indonesia in the search for and discovery of a COVID-19 vaccine, there is also an opportunity for our country, and especially PT Bio-Farma, a company that is more than one hundred years old, a legacy of the Dutch colonial era that is still active until the present. This company has even grown and developed rapidly because it has human capital and technological advantages in vaccine and serum production. For over 5 years, PT Bio-Farma has been assigned by WHO as a supplier of global vaccine needs. The Company has been able to supply more than 18 countries, with around 60-70% of its revenue deriving from exports. 

This company, with its long experience, can likely become an advanced biotechnology firm, as its vaccine manufacturing technology has been thoroughly developed. If given the opportunity to build collaboration with various global companies, PT Bio-Farma will become a leading global company making Indonesia proud. It has on its staff internationally qualified experts with the readiness to build strategic cooperation with world-class companies, especially in technology transfer for the manufacture of medications such as cancer, malaria, meningitis, influenza and other vaccines. 

The COVID-19 pandemic as a world threat infecting millions of the world’s population must be countered by vaccines. This is therefore a golden opportunity for Bio-Farma to participate in a strategic effort in the race to find a COVID-19 vaccine, either alone or in collaboration with global pharmaceutical companies. Either of these strategies will benefit Bio-Farma and Indonesia in two ways, namely: Indonesia will have actively shown its prowess in defeating COVID-19 globally, and if a vaccine is found it would generate hundreds of trillions of Rupiah for the benefit of the national economy. 

Hopefully, the struggle of pharmaceutical companies and scientists can be successful in the not too distant future, to overcome the ongoing COVID-19 pandemic.