LIVE BLOG: R&D response to COVID-19 pandemic (archived)

A Canadian study exploring cross-cultural differences in knowledge and attitudes towards COVID-19 shows that people in Europe had the least knowledge of COVID-19 and the lowest tendency to care about the coronavirus, while people in the US had the lowest tendency to comply with public health restrictions.

As the pandemic began to unfold, people in the Middle East and Asia were the most aware of COVID-19. People in the Middle East were also the most afraid of the coronavirus.

The study was led by researchers at McGill University who conducted a survey of 1,296 participants in 8 different countries over 5 continents in April 2020. The aim was to measure whether age, gender, education, and occupational status had an impact on knowledge of the coronavirus.

Knowledge of COVID-19 was higher among females overall, particularly in regions like Oceania Africa, the Middle East, Europe, and South Asia. However, in north America, knowledge of COVID-19 was higher among males.

The researchers note the COVID-19 death toll was highest in the US and in Europe compared to other regions and suggest that perhaps with more awareness of COVID-19 in advance, the damage could have been reduced.

Effective pandemic management requires support from the general population to combat the spread of the disease and previous studies of contagious disease outbreaks, like the H1N1 flu, have shown that improved knowledge increases the uptake of preventive measures and influences protective behaviour at the individual and community level.

Despite the severe COVID-19 situation in Europe, researchers found that in April 2020 only 35.5% of people wore a mask. This rate was significantly lower compared to the overall mask wearing rate of 78.1%.

Antibodies in the airways quickly wane after SARS-CoV-2 infection, but vaccination results in a strong increase in antibody levels, especially after two doses, according to a new study from Karolinska Institutet.

The results suggest that having a second dose of vaccine after recovering from COVID-19 may be important for protecting against re-infection and to prevent transmission.

“What makes the study unique is that we have looked at samples from both blood and airways, which has given us new knowledge of the local immune response where the virus infects,” said Anna Smed-Sörensen, research group leader at the Department of Medicine, Solna, Karolinska Institutet. “Since it is more difficult to sample the airways, we know much less about antibody levels there than in the blood.”

The researchers examined how the levels and durability of antibodies to SARS-CoV-2 differed between individuals who had mild to severe COVID-19. 147 patients were recruited in March to May 2020 and monitored for up to eight months after infection. In 20 of the patients, they also studied antibody levels after vaccination and compared the results with a control group that had not previously had COVID-19.

Their results show that individuals who had more severe COVID-19 infections had higher antibody levels upon recovery, compared to individuals with mild disease. The antibodies in the blood remained at measurable levels for at least eight months, while those in the airways were short-lived and disappeared after three months.

“The positive news is that the antibodies quickly returned after vaccination in those who previously had COVID-19, not only in the blood but also in the airways,” said Smed-Sörensen. “We found that the antibody levels in the airways after two doses of vaccine were often even higher than they were during the course of the disease. People who had not had COVID-19 before vaccination had much lower or undetectable levels.”

“Our results demonstrate that to only study blood does not reflect the antibody levels in the respiratory tract, which likely play a major part in neutralising the virus locally,” said Karin Loré, professor in the Department of Medicine. “Completing the vaccination with a second dose may therefore be important for achieving optimal immune responses and reducing the spread of infection between individuals.”

The level of antibodies required for protection against infection remains unknown, as well as whether the rapid drop in antibody levels in the airways allows for re-infection. The researchers will now continue to analyse samples from additional longitudinal time points and examine the inflammatory environment in the respiratory tract during infection, convalescence and after vaccination.

Valneva said it is moving to submit its COVID-19 vaccine for approval by the UK regulator MHRA and to the European Medicines Agency, after reporting positive results in a phase III trial.

The vaccine, VLA 2001, successfully met two primary endpoints, generating higher levels of neutralising antibodies than AstraZeneca’s approved vaccine, against which it was compared, and with more than 95% of participants developing antibodies against the SARS-CoV-2 virus.

In addition, VLA2001 was well tolerated, with fewer side effects reported than with the AstraZeneca vaccine.

The trial was designed to show the immune response generated by VLA2001 is non-inferior to that generated by AstraZeneca’s vaccine; it was not able to assess how effective VLA2001 is in preventing infection. There were cases of infection in participants who received VLA2001, but none required hospital admission.

The occurrence of COVID-19 cases was similar between both vaccines. Valneva said the complete absence of any severe COVID-19 cases suggests that both vaccines can prevent severe COVID-19.

VLA2001 is based on traditional inactivated virus vaccine technology. Thomas Lingelbach, CEO of Valneva, said, “These results confirm the advantages often associated with inactivated whole virus vaccines. We are committed to bringing our differentiated vaccine candidate to licensure as quickly as possible and continue to believe that we will be able to make an important contribution to the global fight against the COVID-19 pandemic.”

The results are “both impressive and extremely encouraging,” said Adam Finn, professor of paediatrics at Bristol University, who was principal investigator for the trial. “This is a much more traditional approach to vaccine manufacture than the vaccines so far deployed in the UK, Europe and north America and these results suggest this vaccine candidate is on track to play an important role in overcoming the pandemic,” Finn said.

The Commission issued a report on the EU digital COVID certificate and its implementation across the EU, showing that the certificate has been a crucial element in Europe's response to the pandemic, with more than 591 million certificates generated.

The EU says it has set a global standard and is currently the only system in operation at international level. At present 43 countries across four continents are plugged into the system, and more will follow over the coming weeks and months.

Twenty member states also use the EU Digital COVID Certificate for domestic purposes, such as for the access to large events and restaurants, cinemas and museums, with an additional national legal basis.

The certificate, which covers COVID-19 vaccination, test and recovery, facilitates safe travel and has been key to support Europe's hard-hit tourism industry, the report says.

Commissioner for Internal Market, Thierry Breton said, “The EU system is adopted by countries around the world, demonstrating how Europe can set global standards through decisive and coordinated action.”

The European Medicines Agency has approved two additional manufacturing sites for the production of Pfizer/BioNTech’s COVID-19 vaccine in Italy.

Following the approval, the two sites will be operational immediately and will produce up to 85 million additional doses to supply the EU in 2021.

At the same time, EMA has approved a ready-to-use formulation of the vaccine, with much easier handling requirements than the original version. The new formulation does not require dilution prior to administration, will be available in a 10-vial pack size containing 60 doses, and can be stored at 2-8°C for up to 10 weeks

The current concentrated formulation requires dilution prior to administration, is available in a 195-vial, 1,170 dose, pack size and can be stored at 2-8°C for one month only.

The improvements will provide better storage, transport and logistic options for vaccine distribution and administration. The new formulation will be available in a phased rollout starting in early 2022.

EMA also announced it has started evaluating an application to extend the use of BioNTech/Pfizer’s COVID-19 vaccine to children aged 5 to 11.

Curevac has withdrawn its COVID-19 vaccine from the approval process at the European Medicines Agency, after ditching it in favour or a second generation product.

The company said recent communication with EMA indicated the earliest approval date was the second quarter of 2022 and by this time, it expects the second generation vaccine programme, being advanced in partnership with GlaxoSmithKline, will have progressed to late stage clinical development.

The decision is also reflects the evolving dynamics of the pandemic response towards a greater need for differentiated vaccines to address the fact that SARS-CoV-2 is becoming endemic. As a result, the existing advanced purchase agreement with the European Commission, which was predicated on employing the first generation vaccine to address the acute pandemic need, will cease.

CureVac is assessing the possibility of leveraging existing commitments for the second generation vaccine.

CureVac and GSK have tightened their collaboration by adding further resources and experts to accelerate development and manufacturing of the broad second generation programme. The companies anticipate entering clinical development in the next months, aiming to achieve regulatory approval for an improved COVID-19 vaccine in 2022.

“We remain committed to making a difference with a safe and efficacious vaccine. This goal has not changed, but the requirements to effectively address the virus and emerging variants have changed,” said Franz-Werner Haas, CEO of CureVac.

EMA said it has been looking at data on the Curevac vaccine since February 2021, as part of a rolling review, whereby the company submits data as they become available in order to speed up the evaluation of an eventual marketing authorisation application.

The agency said it had raised some questions about the vaccine’s quality, impacting the benefit-risk balance of the vaccine, and the fact that results of the main clinical study showed only a modest vaccine efficacy in adults. These issues “still remained to be satisfactorily addressed,” EMA said.

The vaccine was only 47% effective in preventing COVID-19 infections in the 40,000-person phase III study.

A survey of 321 scientists who have spoken to the media about COVID-19, many of whom had also commented on social media about the pandemic, has found that 15% experienced death threats and 22% received threats of physical or sexual violence.

The survey, carried out by the journal Nature, found that more than a quarter of the respondents said they ‘always’ or ‘usually’ received comments from trolls or personal attacks after speaking about COVID-19. More than 40% experienced emotional or psychological distress.

Respondents who reported most frequently being trolled online or receiving personal attacks were also most likely to say that their experiences had greatly affected their willingness to speak to the media in the future. Some anonymous respondents wrote that they were hesitant to speak about some topics because they saw the abuse received by others.

However, scientists generally appreciated their interactions with media despite their other experiences: overall, 85% of researchers rated their experiences with the media during the pandemic as ‘always’ or ‘mostly’ positive; 84% said they were able to get their message out to the public; and 63% said speaking to the media was personally rewarding.

Michael Head, senior research fellow in global health at Southampton University, said, “I myself have received plenty of abuse throughout the pandemic. For those of us who have been pulling apart anti-vaccine misinformation from pre-pandemic times, the presence of these attempts at intimidation is very wearying, but not surprising.

He added, “In my view, the intensity of such harassment has gone up significantly across the pandemic, including becoming more organised and frightening than simply mindless comments on social media.”

The misinformation spread around Europe and North America also has far-reaching consequences in terms of inducing vaccine hesitancy further afield, Head said.

A large scale French study has confirmed the effectiveness of three COVID-19 vaccines, with real world data showing the risk of being admitted to hospital with severe disease was cut by over 90% at 14 days after the second dose.

The research, carried out by the government health data research body Epi-Phare, used information on 22.6 million people aged 50 to 74, and 7.2 million aged over 75.

In each cohort half were vaccinated, with either the Pfizer/BioNTech, Moderna or AstraZeneca vaccines, and half were not.

Among those vaccinated aged 50 to 74 years, just over 53% had received Pfizer vaccine, 7.1% Moderna and 39.2% AstraZeneca. Among those aged 75 years and older, just over 85% had received Pfizer, 8.7% Moderna, and 6.1% AstraZeneca.

Epi-Phare says the results are very consistent, highlighting the significant effectiveness of the three vaccines, with reduction in the risk of hospitalisation from the 14th day after the injection of the second dose greater than 90% in both age groups, for each vaccine. The reduction in the risk of death was also cut by 90%.

The effectiveness of vaccination against severe forms of Covid-19 did not appear to wane over the follow-up period of up to 5 months.

To examine the impact of the Delta variant, the reduction in the risk of hospitalisation for COVID-19 was estimated during the start of circulation of the Delta variant in France, between 20 June and 20 July 2021. Over this period, efficacy was 84% ​​in the cohort aged 75 and over and 92% in the cohort aged 50 to 74. The researchers say that although based on a short period, this provides the first evidence on the effect of the Delta variant on risk reduction.

There will be continued monitoring to measure the evolution of efficacy over a longer period and to better characterise the impact of the Delta variant.

People without immunity against COVID-19 were at considerably lower risk of infection and hospitalisation as the number of family members with immunity from a previous infection or full vaccination increased, according to a nationwide study in Sweden, carried out by researchers at Umeå University.

While there is plenty of evidence to show vaccines strongly reduce the risk of COVID-19, less is known about the influence of vaccination on transmission of the virus in high-risk environments, such as within families.

The researchers found there was a dose-response association between the number of immune individuals in each family and the risk of infection and hospitalisation of non-immune family members in a study involving 1.8 million individuals from more than 800,000 families.

“The results strongly suggest that vaccination is important not only for individual protection, but also for reducing transmission, especially within families, which is a high-risk environment for transmission,” says Peter Nordström, professor of geriatric medicine at Umeå University.

“It seems as if vaccination helps not only to reduce the individual’s risk of becoming infected, but also to reduce transmission, which in turn minimises not only the risk that more people become critically ill, but also that new problematic variants emerge and start to take over,” said Marcel Ballin, co-author of the study. “Consequently, ensuring that many people are vaccinated has implications on a local, national, and global scale.”

A large-scale trial in Sweden succeeded in increasing the vaccination rate by four percentage points with the modest inducement of €20 (200 Swedish kronor). The promised reward helped to raise the already high rate in the trial from 72 percent to 76 percent.

“Our study shows that financial incentives can increase vaccination rates, even in places like many EU countries where they are already high,” said behavioural economist Armando Meier, senior research fellow at the University of Lausanne, Switzerland, who is co-author of the research published in Science.

The study was conducted between May and July 2021 with a representative sample of around 8,300 people between 18 and 49 years old. As soon as a vaccination was approved for their age group, the study participants were asked through an online survey whether or not they intended to get vaccinated.

Participants were then randomly assigned to five different groups. The members of the first group were promised a financial reward if they got vaccinated within 30 days. In three of the other groups, the scientists used other methods to try to increase the vaccination rate, such as sharing information on the safety and effectiveness of COVID-19 vaccines and emphasising that vaccination helps others.

Participants in the fifth group, which served as a control group, were not offered anything.

The researchers checked whether the individuals had actually been vaccinated against COVID-19 in the following 30 days through an anonymous linkage with data from the Swedish health authorities. They found that the prospect of a payment not only increases the declared vaccination intention, but actually leads to higher vaccination uptake.

“We also discovered, somewhat surprisingly, that the vaccination rate rose for everyone, regardless of gender, age and level of education. This indicates that monetary incentives have the potential to increase the rate among people regardless of background. The results also show that the incentives have an effect even in countries with relatively high vaccination levels such as Sweden”, said Erik Wengström, professor of economics at Lund University.

By contrast, other methods with which the researchers attempted to influence the behaviour of the participants were less successful. These included asking participants to name people close to them whom they could protect by getting vaccinated. While these “nudges” increased intentions to vaccinate in the short term, like information and reminders, they ultimately failed to translate into higher vaccination uptake.

Co-author Florian Schneider said, “The results put into perspective the fear that financial rewards are counterproductive and could deter undecided individuals from getting vaccinated, by fuelling suspicion, for instance. On the contrary, even modest monetary incentives can have a positive effect on the vaccination rate.”

The researchers also looked at whether it could it be cost effective for governments to pay people to get vaccinated.

“There is no detailed cost analysis in the study, but it is reasonable to assume that it would be cost-effective for society. The incentives can be considered as a stimulus package, transferring money from the government to people’s pockets, which at the same time would save people’s lives,” said co-author Pol Campos-Mercade.

“Even with low incentives, we can increase the vaccination rate against COVID-19. The result does not necessarily mean that we should pay people; we do not take a stand on whether it is ethically acceptable to pay people to get vaccinated or not. However, as the pandemic continues, incentives should be one of the tools worth considering in the fight to reduce the spread of COVID-19,” said Wengström.