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Monday, July 5, 2021

Zydus Cadila nears world-first human plasmid DNA vaccine approval

 Zydus Cadila has filed for emergency use approval (EUA) in India of its plasmid DNA-based vaccine for COVID-19, which if given a green light could become the first shot of its type to be cleared for widespread use in humans. 

Leaving aside the possible technological milestone, the ZyCOV-D vaccine has a few characteristics that could stand in the way of its rollout, including a need for three doses, whereas all India’s current vaccines only need two.

The 28,000-patient trial conducted in support of the EUA fling also showed a top-line protective efficacy of 66.6%, which is above the World Health Organization threshold for an effective vaccine but lower than the already-approved shots.

ZyCOV-D has one big factor in its favour however, as its clinical trial included a large proportion of patients infected with the delta variant of SARS-CoV-2 raising concern around the world.

So far, India has approved four vaccines, including the AstraZeneca/Oxford University jab (sold there as Covishield and made by the Serum Institute of India (SII), which accounts for almost nine in 10 administered shots to date.

The others are the Covaxin from India’s Bharat Biotech, Russia’s Sputnik V, and Moderna’s mRNA vaccine, with at least three more in the pre-approval stage including Pfizer/BioNTech.

In a statement, Zydus Cadila said it hopes to produce upwards of 100 million doses of ZyCOV-D a year, with 10 million expected to be available within the next few weeks, which could help the Indian government meet its targeting of vaccinating all adults by December.

Coronavirus infections in India have dropped from the devastating highs of April and May, with hundreds of thousands of cases per day that pushed its health services to breaking point, but are still running at upwards of 40,000 per day.

“As the first-ever plasmid DNA vaccine for human use, ZyCoV-D has proven its safety and efficacy profile in our fight against COVID-19,” said the company’s managing director Dr Sharvil Patel.

One advantage for the latecomer vaccine could be data from its clinical trial showing activity in 12- to 18-year-olds, according to analyst Prashant Khadayate at GlobalData, who said it is the first shot to have data in this age group.

“It will focus on this patient pool as the third wave is said to affect children below 18 years,” said Khadayate. “Moreover, the vaccine is administered through a needle-free injection system, which may further increase the acceptance of this vaccine in this age group,” he added.

The vaccine has also shown good stability at temperatures of 25 degrees Centigrade for at least three months, which could be a big help in delivering vaccinations to India’s vast rural communities.

Zydus Cadila also says that the plasmid DNA technology can be quickly modified to generate new vaccine constructs against emerging variants of SARS-CoV-2.

https://pharmaphorum.com/news/zydus-cadila-nears-world-first-human-plasmid-dna-vaccine-approval/

Ramsay Health Care Increases Final Offer for Spire Healthcare

 Ramsay Health Care Ltd. said Monday that it has made an increased all-cash final offer for U.K. rival Spire Healthcare Group PLC, valuing the business at an enterprise value of around 2.11 billion pounds ($2.92 billion).

The Australian hospital operator said that under the terms of the final offer, Spire shareholders will receive 250 pence a share in cash, a premium of 30% to the closing price of 193 pence a share on the latest practicable date.

The final price is an increase from the 240-pence offer previously made to Spire on May 26, which Spire management unanimously recommended its shareholders accept. Spire said separately on Monday that the increase follows extensive engagement with its shareholders.

Ramsay Chief Executive Craig McNally said the offer provides Spire shareholders an ability to realize a premium on their investments at attractive values, without further risk.

The acquisition will be funded by existing debt facilities and Ramsay has already secured undertakings to vote in favor of the scheme from shareholdings representing about 30.4% of Spire's issued share capital.

Spire said that it unanimously recommends shareholders vote in favor of the increased final offer at the court meeting and general meeting, set for next Monday.

https://www.marketscreener.com/quote/stock/RAMSAY-HEALTH-CARE-LIMITE-6492228/news/Ramsay-Health-Care-Makes-Increased-Final-Offer-for-Spire-Healthcare-35791742/

S. Korea in Talks With MRNA Vaccine Makers to Make up to 1 Billion Doses

 South Korea is in talks with mRNA vaccine makers including Pfizer and Moderna to produce COVID-19 shots in the country and is ready to offer the capacity to make up to 1 billion doses immediately, a senior government official said.

The plan, if agreed, would help ease tight global supply of COVID-19 vaccines, particularly in Asia which lags North America and Europe in vaccine rollouts, and put South Korea a step closer to its ambition to become a major vaccine manufacturing centre.

South Korea already has deals to locally produce three coronavirus vaccines developed by AstraZeneca/Oxford University, Novavax, and Russia. It also has a vaccine bottling and packaging deal with Moderna.

"We've been holding frequent talks with big pharmaceutical companies to produce mRNA vaccines," Lee Kang-ho, director general for the global vaccine hub committee under South Korea's health ministry, told Reuters in an interview.

"There are only a few mRNA vaccine developers - Pfizer, Moderna, CureVac and BioNTech. Thus there's a limit to how much they can produce to meet global demand... South Korea is keen to help by offering its facilities and skilled human resources," Lee said.

It's not immediately clear how advanced these talks are and whether and when a deal will be agreed.

BioNTech declined to comment, Moderna and CureVac did not reply to Reuters' requests for comments.

A Pfizer spokesperson said the company is making efforts to enhance its COVID-19 vaccine supply chain but added "we do not have anything specific to announce at this time."

Lee declined to name local vaccine makers which have the capacity to produce mRNA vaccines immediately, but a government source said they include Hanmi Pharmaceuticals Co Ltd and Quratis Co Ltd.

Hanmi confirmed that it has a big capacity reserved for Sanofi's diabetes drug and it can be used for COVID-19 vaccine production as the Sanofi project has stalled.

"We happen to have this facility available right now because our clinical trial (with Sanofi) was discontinued in the middle of last year," Kim Soo-jin, senior vice president of Hanmi, told Reuters.

"It’s very timely that we have a fully ready, GMP, state-of-the-art facility available," she said, referring to good manufacturing practice.

Quratis, which makes a tuberculosis vaccine, said its new factory built last year can now be used for mRNA vaccine production.

Shares in Hanmi erased early losses and rose nearly 7% on Monday after the Reuters report, and its top shareholder Hanmi Science jumped 10.3%.

COLLABORATION WITH WHO

South Korea has stepped up its effort to produce more vaccines since U.S. President Joe Biden in May agreed with South Korean President Moon Jae-in on a comprehensive partnership on COVID-19 vaccines.

Lee said his team is having frequent video conference calls with the vaccine makers and the World Health Organization (WHO).

WHO spokesman Tarik Jasarevic told Reuters the organisation is "talking with South Korea and other countries," but did not elaborate.

The WHO said last month it will set up a hub in South Africa to manufacture mRNA vaccines within 9-12 months that will give companies from poor and middle-income countries the know-how and licenses to produce COVID-19 vaccines.

Lee said mRNA vaccine makers may be reluctant to share their technology, but they can take advantage of South Korea's raw material suppliers to address a global shortage of such ingredients as lipids, nucleotides and capping reagents.

"They're capable of manufacturing and developing such raw materials to help vaccine makers... and the South Korean government is committed to provide all necessary support including financial and administrative aid."

Lee said the country also has a capacity for at least another 500 million doses of fill-and-finish vaccines apart from the deal Moderna announced with Samsung BioLogics in May.

South Korea has deals to buy 106 million doses of mRNA vaccines from Pfizer and Moderna to cover full vaccination of its population of 52 million this year. The government said last week it would purchase more mRNA shots to use them as a booster shot next year.

Leaked Memo Raises Thai Concern About Sinovac Vaccine's Efficacy

 A leaked health ministry document has prompted calls in Thailand for medical staff inoculated against COVID-19 to be given a booster of an mRNA vaccine, after it included a comment that such a move could dent public confidence in Sinovac Biotech's vaccine.

The internal memo, which included various opinions, was reported by local media and shared widely on social media. It was confirmed by Thai Health Minister Anutin Charnvirakul as being authentic.

It included a comment from an unnamed official who recommended authorities do not give a booster shot of Pfizer-BioNTech's vaccine to frontline health workers, because such a move would be "admitting that the Sinovac vaccine is not effective".

Thailand has administered Sinovac's inactivated virus vaccine to most health workers and its real-world study showed two doses were 95% effective in reducing mortality and severe symptoms. The study showed it was 71% to 91% effective in stopping infection with the Alpha variant.

The comment in the leaked document prompted calls from prominent Thai health experts, including a top medical council official, to give health workers a Pfizer-BioNTech booster shot.

The hashtag "Give Pfizer to medical personnel" was trending on Thai Twitter with more than 624,000 tweets on Monday.

Senior health official Opas Karnkawinpong told reporters the document was not real, however, contradicting health minister Anutin.

Anutin said the comment on the booster shot was "just an opinion" and there was an expert panel to set vaccine policy.

He said two doses of Sinovac's vaccine were effective and "deliver results beyond the standard".

Thai experts have urged the government to use various types of coronavirus vaccine to better protect the population.

It is relying mainly on AstraZeneca's locally manufactured viral vector vaccine, while authorities say Moderna's mRNA vaccine will also be available.

Thailand has procured 20 million doses of the Pfizer-BioNTech vaccine for future delivery and will this month receive 1.5 million doses donated by the United States.

World Health Organization experts found the Sinovac vaccine was efficacious in preventing COVID-19 in adults under 60, but some quality data on the risk of serious adverse effects was lacking.

https://www.usnews.com/news/world/articles/2021-07-05/leaked-memo-raises-thai-concern-about-sinovac-vaccines-efficacy

Sunday, July 4, 2021

Combined Metabolic Activators Accelerates Recovery in Mild-to-Moderate COVID-19

 Ozlem AltayMuhammad ArifXiangyu LiHong YangMehtap AydınGizem AlkurtWoonghee KimDogukan AkyolCheng ZhangGizem Dinler-DoganayHasan TurkezSaeed Shoaie

DOI:  

https://doi.org/10.1002/advs.202101222

PDF: https://onlinelibrary.wiley.com/doi/epdf/10.1002/advs.202101222

Abstract

COVID-19 is associated with mitochondrial dysfunction and metabolic abnormalities, including the deficiencies in nicotinamide adenine dinucleotide (NAD+) and glutathione metabolism. Here it is investigated if administration of a mixture of combined metabolic activators (CMAs) consisting of glutathione and NAD+ precursors can restore metabolic function and thus aid the recovery of COVID-19 patients. CMAs include l-serine, N-acetyl-l-cysteine, nicotinamide riboside, and l-carnitine tartrate, salt form of l-carnitine. Placebo-controlled, open-label phase 2 study and double-blinded phase 3 clinical trials are conducted to investigate the time of symptom-free recovery on ambulatory patients using CMAs. The results of both studies show that the time to complete recovery is significantly shorter in the CMA group (6.6 vs 9.3 d) in phase 2 and (5.7 vs 9.2 d) in phase 3 trials compared to placebo group. A comprehensive analysis of the plasma metabolome and proteome reveals major metabolic changes. Plasma levels of proteins and metabolites associated with inflammation and antioxidant metabolism are significantly improved in patients treated with CMAs as compared to placebo. The results show that treating patients infected with COVID-19 with CMAs lead to a more rapid symptom-free recovery, suggesting a role for such a therapeutic regime in the treatment of infections leading to respiratory problems.

https://onlinelibrary.wiley.com/doi/10.1002/advs.202101222

Delayed 2nd dose, 3rd doses of Oxford-AstraZeneca vaccine lead to heightened immune response

 Research on the ChAdOx1 nCoV-19, also known as the Oxford-AstraZeneca vaccine, indicates that a long interval between first and second doses does not compromise the immune response after a late second dose.

Additionally, a third dose of the vaccine continues to boost antibodies against SARS-CoV-2. The results were released in a preprint today.

COVID-19 vaccine supply shortages are causing concerns in some countries about compromised immunity as the interval between first and second dose extends due to limited vaccine availability. When examining the effects of a delay of up to 45 weeks between first and second doses in study participants, results demonstrated that antibody levels were increased after a delayed second dose. Additionally, a longer delay between first and second doses may be beneficial, resulting in an increased antibody titre and enhanced immune response after the second dose.

Professor Sir Andrew Pollard, Professor of Paediatric Infection and Immunity and Lead Investigator of the Oxford University trial of the vaccine, says, ‘This should come as reassuring news to countries with lower supplies of the vaccine, who may be concerned about delays in providing second doses to their populations. There is an excellent response to a second dose, even after a 10 month delay from the first.’

Conversely, some countries are considering administering a third ‘booster’ dose in the future. Studying the impact of a third vaccine dose, the researchers found that antibody titres increased significantly with a third dose. T-cell response and the immune response against variants were also boosted.

‘It is not known if booster jabs will be needed due to waning immunity or to augment immunity against variants of concern,’ says Associate Professor Teresa Lambe OBE, lead senior author for these studies. ‘Here we show that a third dose of ChAdOx1 nCoV-19 is well tolerated and significantly boosts the antibody response. This is very encouraging news, if we find that a third dose is needed.’

Side effects of the vaccine itself were also found to be well-tolerated, with lower incidents of side effects after second and third doses than after first doses.

Further research is required to follow up with study participants who received third doses beyond the period that was part of the initial study.

https://www.research.ox.ac.uk/article/2021-06-28-delayed-second-dose-and-third-doses-of-the-oxford-astrazeneca-vaccine-lead-to-heightened-immune-response

Scientists quit journal board, protesting ‘grossly irresponsible’ study claiming COVID-19 vaccines kill

 Several reputed virologists and vaccinologists have resigned as editors of the journal Vaccines to protest its 24 June publication of a peer-reviewed article that misuses data to conclude that “for three deaths prevented by [COVID-19] vaccination, we have to accept two inflicted by vaccination.”

Since Friday, at least six scientists have resigned positions as associate or section editors with Vaccines, including Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, and Katie Ewer, an immunologist at the Jenner Institute at the University of Oxford who was on the team that developed the Oxford-AstraZeneca COVID-19 vaccine. Their resignations were first reported by Retraction Watch.

“The data has been misused because it makes the (incorrect) assumption that all deaths occurring post vaccination are caused by vaccination,” Ewer wrote in an email. “[And] it is now being used by anti-vaxxers and COVID-19-deniers as evidence that COVID-19 vaccines are not safe. [This] is grossly irresponsible, particularly for a journal specialising in vaccines.”

The paper is a case of “garbage in, garbage out,” says Helen Petousis-Harris, a vaccinologist who directs the Vaccine Datalink and Research Group at the University of Auckland and who also resigned as a Vaccines editor after reading the paper. Diane Harper, an epidemiologist at the University of Michigan, Ann Arbor, who was founding editor-in-chief of Vaccines, also resigned, as did Paul Licciardi, an immunologist at Murdoch Children’s Research Institute in Parkville, Australia, and Andrew Pekosz, a respiratory virologist at the Johns Hopkins University Bloomberg School of Public Health.

The resignations began Friday, the day after the paper was published. By early Monday, Fanny Fang, the journal’s managing editor, wrote to the editorial board members that Vaccines—a reputable open-access journal launched in 2013 by Basel, Switzerland–based publisher MDPI—had opened an investigation into the paper. “We are treating this case with the utmost seriousness and are committed to swiftly correcting the scientific record,” she wrote.

Later on Monday, Vaccines’s editors published an Expression of Concern about the paper. “The major concern is the misrepresentation of the COVID-19 vaccination efforts and misrepresentation of the data,” they wrote. (On 2 July, the journal officially retracted the paper.)

The paper has drawn nearly 350,000 readers as of 1 July and has been tweeted by antivaccination activists with hundreds of thousands of followers.

None of the paper’s authors is trained in vaccinology, virology, or epidemiology. They are: Harald Walach, a clinical psychologist and science historian by training who describes himself as a health researcher at Poznan University of Medical Sciences in Poland; Rainer Klement, a physicist who studies ketogenic diets in cancer treatment at the Leopoldina Hospital in Schweinfurt, Germany; and Wouter Aukema, an independent data scientist in Hoenderloo, Netherlands.

The three peer reviewers on the paper, two of them anonymous, did not offer any substantial criticism of the authors’ methodology in these brief reviews. One of them, Anne Ulrich, a chemist who directs the Institute of Biological Interfaces and is chair of biochemistry at the Karlsruhe Institute of Technology in Germany, wrote that the authors’ analysis “is performed responsibly … and without methodological flaws … and the results were interpreted with the necessary caveats.”

Ulrich reiterated that view in a 1 July email to ScienceInsider: “The analysis by Walach et al. was done in my opinion responsibly and without flaws,” she wrote.

One of the anonymous reviewers wrote that the manuscript “is very important and should be published urgently,” offering almost no other comment.

Vaccines did not respond to a list of questions, including how the peer reviewers were chosen.

Petousis-Harris says: “It’s very evident from their reviews that they don’t have any topic expertise. The authors don’t either. It’s a bit remiss when you don’t bring any of a large body [of expert vaccine safety scientists] into your study and manuscript review.”

To draw their conclusions, the paper’s authors computed COVID-19 deaths prevented by vaccines by using data from a study of 1.2 million Israelis, half of whom received the Pfizer-BioNTech vaccine and half of whom did not. They estimated that 16,000 people needed to be vaccinated to prevent one COVID-19 death—a measure that is problematic, critics say, because as a vaccine succeeds, the number of people that must be vaccinated to prevent a death grows ever-larger.

To compute deaths “caused” by vaccine side effects, they used EU data on the number of vaccine doses delivered in the Netherlands and data from that country’s national database for adverse drug reaction reporting, which was more voluminous than registry data from other EU countries.

The Netherlands Pharmacovigilance Center, called Lareb, is similar to the United States’s VAERS reporting system, in which anyone can file a report of an adverse event that occurs after vaccination; the existence of a report in the database does not prove a vaccine caused an adverse event or death. Such databases are not used to systematically assess vaccine risks, but to search for early signals of rare but real vaccine side effects, such as the clotting disorder associated with some COVID-19 vaccines, that can then be followed up with systematic study.

The website of the Dutch registry clearly notes its reports do not imply causality. But the authors reported that, using it, they found “16 serious side effects per 100,000 vaccinations and the number of fatal side effects is at 4.11/100,000 vaccinations. For three deaths prevented by vaccination we have to accept two inflicted by vaccination.”

On 25 June, the day after the paper’s publication, Lareb’s head of science and research, Eugène van Puijenbroek, sent an email to Vaccines’s editors, criticizing the paper and requesting a correction or retraction.

A reported event that occurred after vaccination is … not necessarily being caused by the vaccination, although our data was presented as being causally related by the authors,” van Puijenbroek wrote. “Suggesting all reports with a fatal outcome to be causally related is far from truth.”

He also took the authors to task for stating in the paper that “the Dutch [registry] data, especially the fatal cases, were certified by medical specialists.”

“This point is simply incorrect,” van Puijenbroek wrote. “The authors seem to refer to [Lareb’s] policy plan. However, in this plan (in Dutch), it is nowhere mentioned that the reports are ‘certified’ by medical specialists.”

In an email to ScienceInsider, van Puijenbroek also worried that the paper will erode public willingness to report to the Dutch registry. “[People who report adverse events to us] have to be sure that the data they are contributing will be used in a correct and scientific sound way. Articles like this undermine this confidence.”

Walach, the first author, says he stands by the paper. He adds that the clinical trials of the vaccines that are now authorized for emergency use, which involved tens of thousands of people, “were not big enough or long enough to really see whatever safety concerns you will have.”

Aukema adds that he’s pleased about the controversy, because it means “the [COVID-19 vaccine safety] topic is getting a lot of attention. I’m happy about that.”

The three authors submitted a rebuttal to Vaccines’s expression of concern on 29 June. In it, they write that they interpreted Lareb’s public statements “to mean that those reports that are obviously without any foundation are taken out such that the final data-base is at least reliable to some degree.”

The authors also insist that they did not imply that the side effects reported in the Dutch registry were necessarily caused by COVID-19 vaccines. “Currently we only have association, we agree, and we never said anything else.”

Petousis-Harris says she has been pleased with what she sees as a speedy and serious response from the leadership at Vaccines, and that her resignation may not be permanent.

“It has been a good, solid, respectable journal. And if [the paper] is going to be retracted … then I would still be happy to part of the team.”

*Update, 2 July, 12:10 p.m.: This article has been updated to note Vaccines retracted the paper.

https://www.sciencemag.org/news/2021/07/scientists-quit-journal-board-protesting-grossly-irresponsible-study-claiming-covid-19