Guidance: How to report accurately on COVID-19 vaccines

(See below for Hindi, Bahasa Indonesia, Bangla, Vietnamese and Thai translation)

Scientists around the world are racing to find a vaccine for the new coronavirus that at the time of writing (9th May, 2020) has killed more than a quarter of a million people globally and the number keeps growing. The creation of a safe, effective and affordable vaccine is seen as a key – if not the only – step in ending the pandemic.

The debate surrounding the COVID-19 vaccine is also a key source of rumours on social media in the region. Posts range from concerns about the potential availability of a vaccine for poorer nations to conspiracy theories and worst-case scenarios of what might happen if a vaccine is not produced fast enough.

As with many elements of this crisis, it is important to fully understand the issue so that you can translate it to a format your audience can understand. With so much scientific uncertainty,  this indeed poses challenges to journalists on reporting things fairly, accurately, and comprehensively.

Are we close to a COVID-19 vaccine?

Traditional vaccine development is a long and complicated process. Only about 6% of vaccine candidates are eventually approved for public use, and the process takes 10.7 years, on average. But these are not normal times. Because of the seriousness of the COVID-19 pandemic, vaccine regulators might fast-track the approval of potential vaccines candidates.

However, researchers point out that any COVID-19 vaccine could take: 

It is important to remember that once a vaccine is created, tested, and approved. It can still take a significant amount of time to create large enough quantities of the vaccine, determine who gets the vaccine first (which countries or which particularly vulnerable groups within those countries). Appropriate time will also be needed to test vaccines to see if they are effective for young and old people (vaccines are often less effective on older people), how serious the side effects are, and how they might react in people with preexisting conditions.

Then there is the supply chain to consider: how will you actually get this product to the people? Depending on how the vaccine is administered, this could involve complicated logistical decisions involving refrigeration, access to other medical supplies such as syringes, and enough medical professionals to actually administer the vaccine.

The genetic sequence of SARS-CoV-2, the coronavirus that causes COVID-19, was published on 10 January 2020. Genetic sequencing was a critical first step in science, needed for the development of a vaccine. It helps identify the chemical building blocks of a virus and unlocks its genetic code to enable researchers to understand its origins and unique characteristics.

Once the genetic code of the virus was known, this triggered a global rush from research laboratories around the world to use the code to develop a vaccine against the disease. At an unprecedented 63 days later, the first COVID-19 vaccine candidate was ready for human clinical testing to begin on 16 March 2020 in the US.  A vaccine candidate is first identified through preclinical evaluations like determining its dosage and how it is to be administered, whether by mouth, as an injection, or into the nose, for example.

A vaccine candidate must show that it is able to prevent disease.  And it should have minimal side effects or long-term consequences. However long-term health implications are difficult to determine when you are rushing to get a vaccine to market. We may not know the potential long term health impact of any vaccine for many years.

How many vaccines are at the stage of human testing?

As of 11 May 2020 there are eight vaccine candidates undergoing human testing in clinics in China, the United States, Britain, and Germany and at least 94 others in various stages of development.

Scientists at the University of Oxford are promising a “super-fast” vaccine against the novel coronavirus and say it will be available by September 2020. The university’s researchers have started the first human trial in Europe of a coronavirus vaccine. More than 800 people have been recruited for the study.

On 24 April 2020, at a virtual event organized by The World Health Organization, heads of state and global health leaders made an unprecedented commitment to work together to accelerate the development and production of new vaccines, tests, and treatments for COVID-19 and assure equitable access worldwide. However, a notable absence was US President Donald Trump.

See here for more tips on how to responsibly report on clinical trials.

How is a vaccine developed?

How vaccines work is fairly simple. When the immune system is exposed to a disease — a pathogen — it creates antibodies to fight the infection. Vaccines expose your immune system to a small amount of this pathogen in an effort to create antibodies, or build a resistance against it.  You can think of it as learning how to lift weights. You wouldn’t start with lifting 100kgs! But if you start with smaller weights, you could progressively build up to that weight. A vaccine is, in its essence, ‘training’ your body to fight a particular disease.

After getting vaccinated, you develop immunity to that disease, without having to get the disease first.

There are 4 conventional types of vaccines:

  1. Inactivated vaccines contain particles (usually viruses). These have been grown in laboratories. They have been “killed” [1] using formaldehyde or by other means. This destroys the pathogen’s ability to replicate or reproduce, but keeps it “intact” so that the immune system can still recognize it and can develop antibodies to fight against the virus.
  2. Attenuated vaccines contain live viruses that have been weakened. Scientists are able to modify a virus to a point where it is unable to replicate or make a copy of itself to reproduce. This modified virus can then safely be used in a vaccine: the modification means it cannot cause disease, but it keeps enough of its footprint to be recognized by the human immune system. A vaccine produced from a live, attenuated virus typically produces better protection than vaccines using an  inactivated vaccine.
  3. Toxoid vaccines are made from a toxin (poison) that has been made harmless but produces an immune response in the human body. One example is tetanus: its symptoms are not caused by the bacterium, but by a neurotoxin it produces. Immunizations for this type of pathogen can be made by inactivating the toxin that causes disease symptoms. As with organisms or viruses used in killed or inactivated vaccines, this can be done using a chemical such as formalin, or by using heat or other methods.
  4. Subunit, recombinant, polysaccharide, and conjugate vaccines use specific pieces of the pathogen, like its protein, sugar, or capsid (a casing around the virus or bacteria). Because these vaccines use only specific pieces of the pathogen, they give a very strong immune response that’s targeted to key parts of the virus or bacteria. They can also be used on almost everyone who needs them, including people with weakened immune systems and long-term health problems. One limitation of these vaccines is that you may need booster shots to get ongoing protection against diseases. These vaccines are used to protect against Hib (Haemophilus influenzae type b) disease, Hepatitis B, HPV (Human papillomavirus), whooping cough, pneumococcal disease, meningococcal disease and shingles.

[1] Inactivated is generally used rather than “killed” to refer to viral vaccines of this type, as viruses are generally not considered to be alive.

Phases of vaccine trials

Trials in humans follow four steps:

  • Phase I – testing for safety and for the immune response it evokes.
  • Phase II – testing at a small scale for efficacy against artificial infection, and checking for side effects.
  • Phase III – testing at a larger scale to evaluate efficacy. If results are promising, the vaccine has to be licensed and moved into use.
  • Phase IV – is a final safety step to check for any adverse events (or negative effects) and to evaluate for how long the vaccine will be effective (some vaccines require booster shots, for example).

Why is the vaccine for COVID-19 different?

There is a new approach being used to find a vaccine for COVID-19 that is unlike the four conventional methods mentioned above. Researchers are looking at mRNA vaccine technology which was only developed a few years ago by scientists studying cancer. Ribonucleic acid (RNA) vaccines are faster to produce than standard vaccines, cheaper, and some argue they may be safer.

RNA vaccines work by introducing an mRNA sequence which is basically a set of ‘instructions’ inside the body. The vaccine instructs cells to create the antigen, which in turn gets the immune system to create antibodies. Immunity then follows, just like with a conventional vaccine, and the body is ready to recognize and fight off the real attacker.

The virus that causes COVID-19 contains a spikey protein. You might have seen images of this spikey looking ball in the news. These spikes are important because they enable the virus to break through a human cell membrane, invade it, and then replicate. When a COVID-19 mRNA vaccine is injected into the body, the muscle cells are tricked into producing copies of the spike protein which the immune system detects as a threat. Like a normal vaccine, this trains the body’s immune system to defend against the virus by being able to recognise the spike protein if it encounters it again.

But are still a lot of unknowns about mRNA vaccines

Because mRNA vaccines are only now beginning to be tested in humans, there are a lot of unknowns which can only be answered through human trials.

Using a new vaccine which has been developed without human testing, that has received very little assessment of its safety, poses potential serious risks. It’s also possible that an untested vaccine could even accelerate or enhance the effects of the virus instead of blocking them.

Some experimental vaccine designs, using technology similar to mRNA have been researched to fight two other coronaviruses – the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). In these trials, the vaccine made disease symptoms worse in laboratory animals. So there is a lot of caution  and concern around the use of this technology to find out whether it could also make symptoms worse in humans.

The rapid approval process by vaccine regulators to introduce mRNA vaccine candidates into human trials could also pose ethical questions related to consent, privacy and the protection of vulnerable people in the testing, especially where payments from big pharmaceutical companies may be involved. This could undermine public trust in clinical research.

Scientists will need to weigh up the demand for this new vaccine to be developed quickly with the serious ethical and safety concerns.

The COVID-19 vaccine and mutation

We have seen an increase in rumours that the SARS’CoV-2 virus has mutated into a more dangerous, or aggressive strain. The World Health Organization says that there is no credible evidence of this.

These rumours may be driven by preliminary research out of India which suggests the coronavirus has developed a mutation so severe that it could hinder some of the existing vaccine work. However, this study has not been peer-reviewed. As with other COVID-19 studies, this research will need to be reviewed and confirmed as valid by other scientists.

Antibodies, which the body produces in response to a vaccine or an infection, work by binding to specific spots on a virus called antigens. If a mutation changes  the shape of an antigen, it can make a vaccine less effective against the virus.

Nonetheless, viruses do commonly mutate. Influenza, for example, regularly mutates and that is why the flu vaccine is regularly updated to try and match the virus. Mutations can also cause more dangerous versions of a disease as we have  seen in HIV, hepatitis C, and measles.

In a worst-case scenario where the SARS-CoV-2 virus ends up mutating as often as the flu, researchers might have to be ready to issue new vaccines on a regular basis to keep up with the genetic changes.

How can the media report on vaccines?

  • Explain clearly what is known and what is still unknown about vaccines. Don’t be tempted to draw conclusions of your own for a more catchy headline.
  • Don’t base your reporting on press statements from vaccine developers. Ask to read the full research, consult with impartial experts not involved in the study.
  • Keep up to date with the latest information. Trials are moving at an unprecedented rate – check the progress of the vaccine clinical trials at this database developed by the US National Library of Medicine.
  • Explain the vaccine production process and give real-world examples that your audience can relate to. For example, the flu vaccine or other common vaccines in your context.
  • Ensure your stories research and respond to the questions and concerns your audience has on this issue.  Develop and support channels that allow them to easily ask more questions! This should be an ongoing cycle of listening, responding and listening again.
  • Explain that strong health systems, adequate testing capacity, and an effective, universally available vaccine will be key to protecting societies from COVID-19. In the interest of public-service journalism, journalists must pressure health authorities to ensure that conditions for global, equitable, and affordable access to COVID-19 vaccines be built into any vaccine-development program from the start.
  • Advocate for poorer countries to be included in immunizations. There are already signs of “vaccine nationalism” where powerful countries like the United States and Britain are providing support to big pharma companies and research institutions in exchange for preferential treatment to their own citizens. This will leave out in the cold people in low-income countries.
  • Showcase and humanize the work of virologists, epidemiologists, vaccine makers, geneticists, and other researchers. Science and medical innovation, especially in vaccine development, thrive and progress when researchers exchange and share knowledge openly, enabling them to build upon one another’s successes and failures in real time.
  • Tell the participants’ story, if possible. Good Participatory Practice in clinical trials include the protection of the privacy of trial participants, so unless you know of an individual who specifically wants to publicly talk about their experiences, it may be difficult to arrange stories about participants’ experiences. However, great human stories can often be found by talking to participants in past trials. A common motivator for people volunteering in trials is that they would like to help fellow humans and help to advance science. 

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