“Countries can still change the course of this pandemic if they detect, test, treat, isolate, trace, and mobilize their people in the response”

- Tedros Adhanom, WHO Director General

THE SCOOP:

Some COVID-19 milestones for India include 6.25 lakh confirmed cases, 2.93% mortality rate and colossal economic losses worth Rs 30.3 lakh crore triggered by a massive unemployment spike of around 23%

Google Trends has earmarked “COVID vaccine” as one of the most searched-for requests over the past 4 months. With this term garnering over 2,50,000 searches, the race for the vaccine is surely heating up…or is it?

Hydroxychloroquine, which is used to treat Malaria, showed initial promise, but the World Health Organization stopped its further trials because it proved to be concretely ineffective in reducing the global mortality rate.

The names Favipiravir, Remdesivir, and Dexamethasone, have been on the tips of everyone’s tongue these days, and whilst these hard-to-pronounce drugs are beneficial to an extent, they are still just prescribed drugs, and the need of the hour is a vaccine, which will help contain the disease.

DIVING DEEP:

To get a better understanding, let us understand how the virus affects the host body. The virus infects healthy cells. It then makes copies of itself and multiplies throughout the body, especially the lung region. This later gets inflamed and affects the breathing due to which the person eventually dies. It also develops Pneumonia, an infection of the tiny air sacs (called alveoli) inside your lungs where your blood exchanges oxygen and carbon dioxide.

The reason why current antidotes are ineffective is that every virus possesses different genes, different sequences, and has a different chemical structure. In this case, SARS-CoV-2 is a positive-sense-single-stranded RNA virus. Early work on some of the vaccine candidates suggested that they may not stop the infection in the upper respiratory tract, and they may not stop an infected person from spreading the virus by coughing or speaking. On the other hand, Antibiotics act on bacteria and not viruses. Therefore, a specific vaccine is required to deal with it.

What do Favipiravir, Remdesivir and Dexamethasone do?

Let us clear the air by stating that these drugs are just Antivirals that minimize the symptoms and shorten the duration of illness but don’t fully cure the disease. Antivirals don’t destroy the microbe (virus) but rather act by inhibiting replication. In this way, they prevent the viral load from increasing to a point where it could cause pathogenesis, allowing the body's innate immune mechanisms to neutralize the virus.

Remdesivir, the first widely used drug, was created and developed by Gilead Sciences in 2009 for hepatitis C. It didn’t work on hepatitis C but later on was repurposed for treating Ebola. It helps to terminate the multiplication of the virus by mimicking as a viral and breaking the strand which minimizes the multiplication and helps in recovery.

Next in line is Favipiravir, which was formulated by Toyama Chemicals (Fujifilm group) to initially treat Influenza in Japan. This drug tries to stop the growth of the virus in the host body by duplicating the viral RNA, but it is recommended to those who are mildly or moderately ill.

The holy trinity is completed by Dexamethasone, which is a generic corticosteroid that is useful to fight any inflammation that develops as the immune system overreacts to fight the infection. It is usually used to treat severe allergies and asthma. It has experimentally been shown to work well in tandem with Remdesivir, as together, they have not only shown rapid recovery but also significantly reduce the mortality rates of the test subjects.

DEVELOPMENTS:

Let’s take a look at the approaches that have been creating waves:

• Pathogen Inactivation
  • What it does: This method follows the traditional route of injecting a patient with weakened virus particles in order to instigate the immune system to produce antibodies to fight the disease.
  • Major Players: Chinese company Sinovac, in collaboration with certain medical research institutes, have successfully isolated the virus strand. Other individual entities include research teams from France and Germany that are focusing on BCG based research
  • Downside: Creating cultures of attenuated viruses on a mass scale for vaccines is both a strenuous as well as time-consuming task

•   Viral Proteins
  • What it does: Genes that code for the notorious Spike Protein in the virus, are spliced into different viruses, which are then nurtured in a controlled environment for large scale production.
  • Major Players: The vaccine division of Sanofi has commercially explored this recombinant DNA approach. Similarly, Novavax has ventured into using nanotechnology to further aid it, while Canadian company Medicago has experimented via botanic means.
  • Downside: Capital and time-intensive factor due to mass growth of such a vaccine

• mRNA Approach
  • What it does: This approach fast tracks the above method by directly injecting the molecular instructions in the person’s body in order to produce the protein inside the body itself.
  • Major Players: This field was trailblazed by Moderna. German company CureVac soon followed, along with the highly publicized venture of BioNTech and Pfizer. Recently Elon Musk announced surprisingly that Tesla will explore RNA micro-factories.
  • Downside: Since it is a comparatively unexploited field, there is the fear of catastrophic failure. Apart from that, there is also concern for unknown side-effects.

• Adenovirus Vaccine
  • What it does: This method genetically engineers Adenoviruses to express the viral Spike Protein which can then be introduced in the body to trigger an immune response.
  • Major Players: Janssen, a subsidiary of conglomerate Johnson & Johnson, has used its AdVac technology while China-based CanSino Biologics with Ad5-nCoV and Oxford University’s Jenner Institute with its ChAdOx1 nCoV-19 have ventured here.
  • Downside: Initial results haven’t been successful. Also, it is tricky to navigate through live viruses with the immunocompromised at risk. 

ANALYSIS:

Coronavirus has resulted in a nationwide lockdown in India as well as several mobility restrictions worldwide. This has impacted the world markets; however, it has created new avenues for the manufacturing of certain equipment including protective masks, sanitizers, and PPE kits. The exponential increase in demand, fueled by mass hysteria, has triggered production of over 4.5 lakh Personal Protective Equipment (PPE) suits daily along with 1.5 billion three-layered masks.

The situation has also led to hoarding and the creation of a shadow economy. Out of the manufacturing capacity of 59.4 million pieces of four-layer masks, 1.9 million is spare capacity. Similarly, the country has 5.05 million surplus capacity of reusable/washable masks. It has a production capacity of 31.2 million pieces of N95 masks, of which 1.05 million is surplus.

The disturbing trend of panic-purchasing was discovered by analyzing the meteoric increase in sanitizer demand. The size of the category touched Rs 43 crore in March from Rs 10 crore a year ago. 152 new manufacturers started making sanitizers in March, commanding 61 percent market and 46 percent value share.

With a daily hike of 15,000- 19,000 cases, India is unable to accommodate the patients due to a shortage of beds. The number of hospital beds in the public sector and the private sector is 19,29,692.  The number of ICU beds in the public sector and private sector are 96,485 and ventilators (public + private) = 48,242. Normal treatment costing Rs 50,000-1 lakh has now surged to Rs 1-2 lakh for Covid-19 treatment (due to an increase in the cost of consumables, patient distancing in hospitals, etc.) and to Rs 6-7 lakh or more where comorbidities are involved or treated in expensive hospitals.

This race has also seen participation from the stock exchange. People are now trying to add pharmaceutical companies and are altering their portfolios accordingly. Many pharmaceutical companies have recorded all-time high and experts are stating that these stocks are the new IT stocks.

The recent developments have led some companies to come out on top with regards to their stock prices, thus mirroring investor perception in their ability to grow. These include:

1. Biocon with their share price hitting a fresh 52-week high of Rs 355.25
2. Abbott India share price has gained a whopping 109% in FY20. Abbott India hit a 52-week high of Rs 18,500
3. Cipla share price also saw a new 52-week high of Rs 692.50
4. AstraZeneca saw a hike after the announcement of the vaccine in-process and saw a 52-week high of Rs 3670.00

Similarly, there have also been companies that have not been able to instill market confidence, and have unfortunately fallen towards the wrong side of the market boom. These include:

1. Sanofi is one of the top washouts as its stock price fell from Rs 8500.00 to Rs 7870.00
2. Glenmark has witnessed a new 52-week high after the announcement of Favipiravir which is Rs 573.05 but that was only for a day and now it is being traded at Rs 450.30
3. Pfizer has seen a downfall since its new 52- week high of Rs 5170.00 in April to Rs 3960.00 in June.

VERDICT

World Health Organization has recorded around 143 efforts currently underway, in what could probably be one of the most important contests in this century. As we inch closer to the finish line, we can only ponder over ‘How long will it take?’, ‘What is most likely to work?’, ‘Do we escalate the risk of trials to overtake competition?’ Either way, it is going to be a photo finish, and we are all strapped in for the same.

NOTES:

1. Statistics used have been sourced from the government/company websites.
2. Literary inputs given by Ritik Mehta.