Abu-Zidan, Fikri M

Sheek-Hussein, Mohamud

Bioline International

Invited Editorial.  COVID-19 Vaccine: Hope and reality   Mohamud Sheek-Hussein1, Fikri M Abu-Zidan 21. Institute of  Public Health, College of  Medicine and Health Sciences, UAE University, Al-Ain, United     Arab Emirates. 2. Department of  Surgery, College of  Medicine and Health Sciences, UAE University, Al-Ain, United Arab     Emirates.Emails and other details:Mohamud Sheek-Hussein: msheekhussein@uaeu.ac.ae,   https://orcid.org/0000-0003-4925-2447Fikri M. Abu-Zidan: fabuzidan@uaeu.ac.ae, https://orcid.org/0000-0003-0143-8568DOI: https://dx.doi.org/10.4314/ahs.v20i4.3Cite as: Sheek-Hussein M, Abu-Zidan FM. Invited Editorial.  COVID-19 Vaccine: Hope and reality. Afri Health Sci. 2020;20(4):1507-9. https://dx.doi.org/10.4314/ahs.v20i4.3 Corresponding author:Fikri M Abu-Zidan, Department of  Surgery, College of  Medicine and Health Sciences,UAE University, Al-Ain, United Arab EmiratesE-mail: fabuzidan@uaeu.ac.aeIntroductionThe novel COVID-19 pandemic started at the Chinese province of  Hubei in December 2019 after which the WHO declared it to be a public global health emergen-cy.1  The COVID-19 virus has a zoonotic source with similarities to other highly infectious zoonotic corona-viruses. COVID-19 infection is highly contagious and continues to spread in both developed and developing countries.2 It has caused more than fifty million in-fected cases and more than one million two hundred fifty thousand deaths worldwide.3 Recently, the World Health Organization (WHO) and United Nations Chil-dren’s Fund (UNICEF) reported an alarming decline in childhood immunization around the world because of  the disruption caused by the COVID-19 pandemic.4 Immunization significantly reduced disability and death related to vaccine-preventable diseases worldwide.5   De-livering essential immunization is important to protect the health, well-being, and economy of  a community. Until now, COVID-19 disease does not have effective antiviral drugs nor a fully licensed approved vaccine. Implementing public health measures that aim to pre-vent the transmission of  COVID-19 such as wearing a facemask, social distancing and frequent hand washing are a real challenge.3 COVID-19 severity is increased in those having comorbidities and those having strong immunological reactions. While it is important to study treatment options for COVID-19 disease, an effec-tive vaccine against COVID-19 is more rewarding be-cause it will stop its spread. There is an urgent need for safe, effective, and long-standing high immunogenicity COVID-19 vaccines. Lessons from historyDevelopment of  a vaccine has always been difficult. It requires extensive experimental and clinical testing before being approved by the regulatory bodies. This may take years before approval.5, 6 During this long pe-riod, it will be difficult for public health measures alone to eliminate the virus. Just to highlight this point, in 1796 Edward Jenner inoculated a 13 year-old-boy with vaccinia virus (cowpox) and demonstrated immunity to smallpox. In 1798, the first smallpox vaccine was developed. Systematic mass immunization resulted in global eradication of  smallpox only in 1979.7, 8 There have been several attempts to develop vaccines against recent emerging viral infections such as the Zika virus, Ebola, SARS and MERS-CoV. These attempts were dis-appointing. Difficulties encountered were the rapid ge-netic mutation of  the pathogens and finding an appro-priate animal model for testing. Similarly, the immune mechanisms against the three most devastating global diseases, malaria, tuberculosis and HIV are still poorly understood.9 We have also to stress that the develop-ment of  a weak immunogenic vaccine could worsen the COVID-19 pandemic if  authorities wrongly assume it causes a substantial reduction in risk.10  © 2020  Sheek-Hussein M et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of  the Creative commons Attribution License (https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.   African Health SciencesAfrican Health Sciences, Vol 20 Issue 4, December, 2020 1507One globe one health approachThe “one globe one health approach” is essential for the global fight against the COVID-19 pandemic. The scientific community and progress in finding a vac-cine is affected by using COVID-19 as a political tool between different parties. This delays the world from reaching its similar global target.  We must appreciate that mass global immunization is the only way to ad-dress the COVID-19 pandemic. Participation in COV-ID-19 immunization trials will be essential to reduce the impact of  COVID-19 disease. The magnitude of  participation will depend on the community attitude to-wards vaccination. Accordingly, vaccine hesitancy in a community must be defined. There is high acceptance for a COVID-19 vaccine in the USA11, 12, EU13, 14 and China15 but this has to be defined in other countries. The cost of  giving the immunization in poor countries is a real concern because immunization should be given globally to quickly eliminate the disease and to reduce the chance of  genetic mutations. Changing our strategyIt is a real challenge to develop vaccines against “com-plex” infections such COVID-19. Although the vac-cine development seems difficult, the reward is huge. This requires innovative thinking. Our knowledge of  biotechnology, immunology, genetics and virology is expanding. Furthermore, advancements in molecular engineering and platform technology which were ap-plied in the vaccine development for tuberculosis, Zika, HIV, and Ebola will be tremendously useful in the de-velopment of  a COVID19 vaccine.16 A successful vac-cine should cause a proper humoral reaction usually through the organization of  proteins from microbes. Therefore, designing effective vaccines requires a shift in our strategy by finding a vaccine that can produce a quick immune response. Vaccination response can be measured by antibody titers.  Majority of  those who are vaccinated may produce high titers of  antibodies. Nevertheless, some may produce no or low levels of  protective antibodies (Non or low responders) because of  genetic predisposition, immunosuppression, or oth-er disorders. Furthermore, the human body will retain its own memory on how to fight that diseases in the future. Nevertheless, after a while, immunity might de-cline. Therefore, booster doses may be needed to raise immunity to optimal levels. The way forwardWe think that getting a COVID-19 vaccine, although it has multiple challenges, is feasible but may take time if  it is going to be safe and effective. Currently, there are 45 candidate vaccines in clinical evaluation, and ten more in phases II and III clinical trials.17 Which of  these rapid developed vaccines will be effective against COVID 19 is still unknown? Developing a vaccine needs proper understanding of  the immune response against the COVID-19 virus.18 We have to acknowledge that this knowledge is still limited.  An effective vaccine would generate a safe reaction producing antibodies to COVID-19 antigens.19 Antibody induced protection may be different from the normal defence against vi-ruses because of  the resistant naturef  COVID-19. An-tibodies solely directed towards the SARS-CoV spike (S) protein have been able to counteract the virus and halt infection.20 Studies in progress try to define wheth-er the S protein or its receptor-binding domain (RBD) have comparable value as immunization targets.21 Finally, we should be optimistic. The prospect of  effec-tive vaccine may be on the horizon. An ongoing clinical trial gave very promising results. Interim analysis of  a study on a new vaccine which is given in two doses, showed that it was more than 90% effective at prevent-ing COVID-19 infection. The vaccine which is a virus messenger RNA enters the human cells and stimulates the production of  the coronavirus spike proteins which are the target for the human immune system. Whether this vaccine will give long term immunity or whether it can be used in different patient populations is still unknown.22 References1. World Health Organization. Novel Coronavi-rus (2019-nCoV) SITUATION REPORT, 21 JAN-UARY 2020 Available at https://www.who.int/docs/default-source/coronaviruse/situation-re-ports/20200121-sitrep-1-2019-ncov.pdf;   (Accessed 10th  November 10 , 2020)2. Khan G, Sheek-Hussein M, Al Suwaidi AR, Idris K, Abu-Zidan FM. Novel coronavirus pandemic: A global health threat. Turk J Emerg Med. 2020;20:55-62.3. European Centre for Disease Prevention and Con-trol. COVID-19 situation update worldwide, as of  12 November 2020 Available at https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases  (Ac-cessed 12th November 2020).4. World Health Organization. WHO and UNICEF warn of  a decline in vaccinations during COVID-19. Available on  https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vacci-nations-during-covid-19 ; ( Accessed 10th  November 10 ,2020)5. Andre FE, Booy R, Bock HL, Clemens J, Datta SK, African Health Sciences, Vol 20 Issue 4, December, 20201508John TJ, Lee BW, Lolekha S, Peltola H, Ruff  TA, San-tosham M, Schmitt HJ. Vaccination greatly reduces dis-ease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86:140-6.6. Hajj Hussein I, Chams N, Chams S, et al. Vaccines Through Centuries: Major Cornerstones of  Global Health. Front Public Health. 2015;3:269.7. Riedel S. Edward Jenner and the history of  smallpox and vaccination. Proc (Bayl Univ Med Cent). 2005;18:21-25.8. World Health Organization. No Smallpox, 26 Oc-tober 1977 to 26 October 1979, Weekly Epidemiological Record: 1979, 54, 329-335.9. Boraschi D, Abebe Alemayehu M, Aseffa A, Chiodi F, Chisi J, Del Prete G et al. Immunity against HIV/AIDS, malaria, and tuberculosis during co-infections with neglected infectious diseases: recommendations for the European Union research priorities. PLoS Negl Trop Dis. 2008;2:e255.10. Krause PR, Fleming TR, Ellenberg SS, Henao-Re-strepo AM; WHO Ad Hoc Clinical Trial Expert Group. Maintaining confidentiality of  emerging results in COVID-19 vaccine trials is essential. Lancet. 2020 Oct 27:S0140-6736(20)32259-5.11. Reiter PL, Pennell ML, Katz ML. Acceptability of  a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine. 2020;38:6500-650712. Malik AA, McFadden SM, Elharake J, Omer SB. Determinants of  COVID-19 vaccine acceptance in the US. E Clinical Medicine. 2020;26:100495.13. Fadda M, Albanese E, Suggs LS. When a COV-ID-19 vaccine is ready, will we all be ready for it? Int J Public Health. 2020;65:711-712.14. Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nev-ers E, Gagneux-Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vac-cine. 2020;38:7002-7006.15. Sun S, Lin D, Operario D. Interest in COVID-19 vaccine trials participation among young adults in China: Willingness, reasons for hesitancy, and de-mographic and psychosocial determinants. medRx-iv [Preprint]. 2020 Jul 14:2020.07.13.20152678. doi: 10.1101/2020.07.13.20152678.16. Florindo HF, Kleiner R, Vaskovich-Koubi D, Acúr-cio RC, Carreira B, Yeini E, Tiram G, Liubomirski Y, Satchi-Fainaro R. Immune-mediated approaches againstCOVID-19. Nat Nanotechnol. 2020;15:630-645.17. World Health Organization. Draft landscape of  COVID-19 candidate vaccines. Available at https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines (Accessed November 10 ,2020)18. Oyston P, Robinson K. The current challenges for vaccine development. J Med Microbiol. 2012;61:889-894.19. Funk CD, Laferrière C, Ardakani A. A Snapshot of  the Global Race for Vaccines Targeting SARS-CoV-2 and the COVID-19 Pandemic. Front Pharmacol. 2020;11:937.20.  Jeyanathan M, Afkhami S, Smaill F, Miller MS, Lichty BD, Xing Z. Immunological considerations for COVID-19 vaccine strategies. Nat Rev Immunol. 2020;20:615-632.21. Hotez PJ, Corry DB, Bottazzi ME. COVID-19 vac-cine design: the Janus face of  immune enhancement. Nat Rev Immunol. 2020;20:347-348.22. Galaway E. What Pfizer’s landmark COVID vaccine results mean for the pandemic. Nature, 9th November 2020. https://www.nature.com/articles/d41586-020-03166-8 (Accessed on 11th November 2020). African Health Sciences, Vol 20 Issue 4, December, 2020 1509

Invited Editorial. COVID-19 Vaccine: Hope and reality

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