Which COVID-19 vaccines are lined up for roll-out on the NHS?

As GPs and their teams prepare for delivering a COVID-19 vaccination programme that could start as early as December, GPonline looks at the vaccines that might be used in the coming months.

(Photo: CMB/Getty Images)
(Photo: CMB/Getty Images)

This article was last updated on 30 November to reflect an increase in the number of Moderna vaccines the UK government has on order.

The first half of November saw promising developments in COVID-19 vaccines. The Pfizer/BioNtech was  shown to be 95% effective at preventing illness in its phase 3 trials and US biotech company Moderna produced early phase 3 results showing its vaccine was 94.5% effective in preventing COVID-19.

Meanwhile, this week the Oxford/AstraZeneca vaccine published data showing it is up to 90% effective.

Portfolio of vaccines

There are over 100 COVID-19 vaccines in development around the world. Since early in the pandemic, the UK government has been working to secure early access to a range of vaccines should they prove successful. The government now has deals in place for a total of 357m vaccine doses across seven different vaccines.

Experts have said that countries will likely need a portfolio of vaccines to tackle the coronavirus pandemic because some may prove to be more effective in particular groups, such as older people.

So, which vaccines has the government placed orders for and which are likely to be rolled out in the NHS first?

Pfizer/BioNTech

  • Doses secured by UK government: 40m
  • Type of vaccine: mRNA vaccine
  • Stage of development: Phase 3 clinical trials
  • Doses required: Two doses, three weeks apart

Following publication of its phase 3 trial data Pfizer and BioNTech said they planned to submit the vaccine for emergency use authorisation by the US Food and Drug Administration (FDA) and other authorities around the world.

At a Downing Street press briefing on 20 November, health secretary Matt Hancock confirmed that the UK's Medicine and Healthcare products Regulatory Agency (MHRA) had received the required data from the companies to assess the vaccine for approval and that he hoped it would be available for use in December. The UK is expecting to take delivery of 10m doses of the vaccine before the end of the year.

It seems likely that this will be one of the first vaccines available on the NHS, but it will not be without its challenges. The Pfizer/BioNTech vaccine needs to be kept at a temperature of -70 degrees Celsius and it cannot be removed from that temperature more than four times. When the vaccine is moved into a fridge with a temperature between 2 and 8 degrees Celsius it has an effective life of up to five days.

This will make distribution, storage and administration a logistical challenge. LMCs have reported that the vaccine will need to be diluted by practices delivering it to patients.

Both the Pfizer/BioNTech and Moderna vaccines use mRNA (messenger RNA) technology, which uses a pathogen's genetic code to create an mRNA sequence that tells cells in a vaccinated person to produce antigens, generating an immune response.

If the Pfizer and Moderna vaccines are approved these will be the first mRNA vaccines ever licensed. The companies involved say that this technology has allowed them to develop their vaccines more rapidly than if they used a traditional approach.

AstraZeneca/Oxford University

  • Doses secured by UK government: 100m
  • Type of vaccine: Adenoviral vector vaccine
  • Stage of development: Phase 3 clinical trials
  • Doses required: Two doses

The UK's vaccine taskforce chair Kate Bingham told the House of Commons science and technology committee in November that the government was expecting to take delivery of 4m doses of the AstraZeneca/Oxford University COVID-19 vaccine before the end of the year.

Phase 3 trial data showed the vaccine to be 70.4% effective across two dosing regimens. However, higher efficacy of 90% was found in a regimen which used a half first dose and a standard second dose. In those that received two full doses the vaccine was shown to be 62% effective.

The researchers said that the interim phase 3 results backed up previously reported phase 2 data, which have shown strong antibody and T cell immune responses in all age groups, including older adults. No safety concerns relating to the vaccine have been reported throughout the trials.

THe MHRA is currently assessing the vaccine for approval.

The government has invested heavily in the Oxford vaccine with an order for 100m doses and the UK will be the first country to get access to the vaccine if it is approved. It is highly likely that this will be among the early vaccines used in the UK's COVID-19 vaccination programme. The government has said that, as part of its deal, AstraZeneca will also be making the vaccine available to developing countries at the 'lowest possible price'.

ChAdOx1, as the vaccine is known, is a chimpanzee adenovirus vaccine vector that contains the genetic sequence of the surface spike protein from the SARS-CoV-2 virus.

Moderna

  • Doses secured by UK government: 7m
  • Type of vaccine: mRNA vaccine
  • Stage of development: Phase 3 clinical trials
  • Doses required: Two doses, 28 days apart

Following publication of its interm phase 3 trial results, the government secured an initial 5m doses of the Moderna vaccine although it is unlikely to be available in the UK before spring 2021. It later increased this by a further 2m. Moderna has said that it intends to apply for emergency authorisation for the vaccine from the FDA in the 'coming weeks'.

Like the Pfizer/BioNTech vaccine this is an mRNA vaccine, but it has some advantages. It can be stored at normal freezer temperatures of -20 degrees Celsius for six months and in vaccine fridges for up to 30 days. Once the vaccine is removed from the fridge it can also be kept at room temperature for up to 12 hours.

This will make distrbution and the practicalities of administering this mRNA vaccine much more straightforward than the Pfizer/BioNtech jab. Moderna has also said that dilution will not be required prior to vaccination.

Novovax

  • Doses secured by UK government: 60m
  • Type of vaccine: Protein adjuvant vaccine
  • Stage of development: Phase 3 clinical trials
  • Doses required: Two doses, three weeks apart

US company Novovax is currently undertaking phase 3 trials of its vaccine in the UK, which is expected to be available by mid-2021. As part its deal with the government some of the vaccines will be manufactured in the UK.

The vaccine is made using Novovax's 'recombinant protein nanoparticle technology'. It is engineered from the genetic sequence of SARS-CoV-2 and generates an antigen derived from the coronavirus spike. The company has said it can be handled in unfrozen liquid form that can be stored at 2 to 8 degrees Celsius.

Janssen

  • Doses secured by UK government: 30m
  • Type of vaccine: Adenoviral vector vaccine
  • Stage of development: Phase 3 clinical trials
  • Doses required: One or two dose (eight weeks apart), depending on results of trials

Jansen's vaccine was in the news recently because it began its phase 3 clinical trial of a two-dose regimen of the vaccine, which includes UK volunteers. A phase 3 trial of a one-dose regimen began in several countries in September. The two trials will run in parrallel.

The government has said it expects this vaccine to be available by mid-2021 if it is approved.

The vaccine is based on technology the company used to develop its Ebola vaccine, which was approved by the European Commission in July 2020 and has been used in the Democratic Republic of the Congo and Rwanda. It uses an adenovirus as a vector of an antigen’s genetic code.

The vaccine can be stored for two years at -20 degrees Celsius and at least three months at 2-8 degrees Celsius.

GSK/Sanofi

  • Doses secured by UK government: 60m
  • Type of vaccine: Protein adjuvant vaccine
  • Stage of development: Phase 1/2 clinical trials
  • Doses required: One or two dose, depending on results of trials

Sanofi and GSK started their phase 1/2 clinical trials in September and hope to move into a phase 3 trial before the end of the year. The companies say they expect to seek regulatory approval in the first half of next year.

The vaccine is based on the DNA technology used to produce Sanofi's flu vaccine. Trial participants are receiving either one or two doses or a placebo vaccine, so as yet it is unclear if the vaccine will have a one or two-dose regimen.

Sanofi and GSK say they will be able to produce 1bn doses of the vaccine in 2021 if it proves successful. Sanofi is also developing another COVID-19 vaccine, based on mRNA technology, in partnership with biotech company Translate Bio and GSK also has further vaccines in development with other partners.

Valneva

  • Doses secured by UK government: 60m
  • Type of vaccine: Inactivated whole virus vaccine
  • Stage of development: Pre-clinical trials
  • Doses required: Two doses

Valneva's vaccine is expected to enter clinical trials by the end of the year, with a view to being approved in the second half of 2021. The company is using a traditional approach to its vaccine development and developing an inactivated whole virus vaccine.

It is expected to be a two-dose vaccine and will be able to be stored in the same way as conventional vaccines.

Along with its order for 60m doses of the vaccine, the UK government is also contributing to UK clinical study costs and investing in expanding Valneva's factory in West Lothian in Scotland, wih a view to creating jobs alongside boosting vaccine production. Valneva says it is aiming to be able to deliver 200m doses of the vaccine a year.

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