Sharvil Patel Managing Director, Cadila Healthcare Talks About Approaches To Treating Covid – Preventives To Therapeutics
Although I am a vaccine manufacturer and developer, vaccines alone will not be the answer for us to get out of the pandemic. We will need vaccines and other solutions, including therapeutics and faster diagnostics or better diagnostics. The virus is mutating very fast. One hopeful answer to this would be that with multiple mutations, hopefully, over some time, the virus will become less immunogenic and less harmful and then become the regular kind of flu virus in the future. We hope that as the mutation continues, the virus will lose its virality and become less neurological.
There is a lot of movement on vaccines – 44 are under development. We have all types of vaccines – the traditional inactivated vaccines like the Bharat Vitech, live vaccines like Serum, J and J and Sputnik. We have also seen protein sub-unit vaccines that will come up very soon and virus-like particle vaccines that will come very soon. Today, there are two platforms in the new generation of recombinant vaccines: the RNA (Pfizer and the Moderna) and then the DNA platforms, which Zydus and a few other companies are researching. These are the future vaccines that will help in overall immunisation.
Our vaccine, which we have under development, is under the approval stage with the regulators. So, very early on, last year, the genesis for us and why we are different from many of us is that our platform is something where we have entirely developed ourselves. We have not relied on partnerships or licensing technologies. We are developing it on our own, and hopefully, when we get the approval, this will be the first DNA platform that gets fully approved for vaccination for any of the viruses.
We selected the platform based on these principles: safety which is paramount when you talk about large immunisation. We believe that this is potentially an annual vaccination like the flu vaccine. We strongly believe that Covid vaccines will potentially become a part of the yearly global vaccination programme. Multiple dosing will become critical; people are talking about taking booster doses. So, how frequently can you give a particular type of vaccine is going to be very critical. The third crucial part is the cost and supply chain, the cold storage required when you carry vaccination in different countries; our platform enables us to be stable at 25 degrees for at least 4-5 months for a considerable amount of time. If it freezes by mistake, you can still use it; if it is left outside for four days, you can still use it.
So, the platform offers versatility that reduces wastage. Those were some of the reasons we selected this platform. The final challenge was that DNA vaccines need to be delivered intradermally. It means that generally, there is a lot of vaccine hesitancy in children and adults regarding needles and injections. So, one of the beauties of this vaccine is that you cannot give it intramuscularly; you give it intradermally. So, not an injection but just a high-pressure jet that makes a pump in the upper skin of your dermis, and you deliver 100 microlitres of dose. So, it is pain-free almost. It is even less painful than the small prick you take for testing blood sugar. So, it is a non-evasive, needle-free application that will have a good acceptance among people who are hesitant about needles. And because most recombinant vaccines are devoid of any vector-based immunity, which is when you use other immunogenic agents or when you use things related to adjuvants which create its own reaction. So, when you hear of certain vaccines’ side effects, they may not be related to the vaccine but can be connected to the adjuvants and vectors. So, I think this is devoid of many of these things. Thus, this will be a very stable platform for multiple dosing and ease of administration and safety when it comes to a vaccine.
While we are very good at access and affordability, we need to pivot more on the discovery side because we won’t find answers in the West every time. We already know that it is difficult to source some of the vaccines from India. So, we need to be self-reliant not only in vaccines but other medications too. We need to do our own discovery and innovation to answer diseases that are more frequent and critical for countries like ours and for some of the nations near us.
Could it help to develop the vaccine if you knew how the coronavirus was generated?
I don’t know if it was lab-engineered or came out naturally, but it would not help develop the vaccine. Maybe there will be some answers to that, but I don’t have any. Second, I don’t think the Chinese have a better vaccine. In my view, they have better tracking and tracing. When I spoke to one of the Chinese officials sometime back, they said that when Beijing saw an outbreak, they would cordon off the whole area and test three crore people in four days. So, that tracking and tracing that they were able to do has helped them limit it. If you look at the Sinovac vaccine, they are talking of efficacy of 50 per cent. So, I don’t think they are preventing the disease from getting there. It seems that they have a far better tracing protocol in place, which they can afford to do. That is the answer for them.
Why do we need a booster dose for Covid every year? There are other diseases like smallpox and polio for which we take a dose only when we are children?
In terms of a booster, three reasons it is necessary: 1) In people infected with Covid or who are vaccinated, anti-bodies are seen waning after six months. So if you look at neutralising anti-bodies, they are also coming down, which is one part of what is happening. 2) The virus is mutating and escaping the current form of vaccines. So, in future, maybe you need a vaccine or a cocktail of vaccines for the dominant strain. Coronavirus is not like smallpox and viral vaccines, which also had a 50 per cent efficacy when first developed. I think the virus is moving towards a direction where you may not get 90 per cent immunity to it, and that is why we believe that maybe some vaccination will be required to minimise the severity of infection.
I was reading that the vaccine for children is at quite an advanced stage; when is it coming to the market?
We have finished the studies for our vaccines; safety is complete, the thousand-children research has been submitted. So we are hopeful that the regulator will approve it in August. We believe that whatever dialogues we had with the government, they would like to prioritise children because currently, no vaccines are approved for children. So in terms of vaccines, this could be the first to be used for children.
Do you think schools should start or wait?
I would love to send children back to school, but I don’t think it is the correct answer because they will bring it back, and we have joint families; it will be high risk. I know children don’t get to seem the best of it, but I don’t think it is right to start school unless we can vaccinate them. Especially in countries like ours where the school sizes are enormous, it is not practical.
Is it only Covid-19 that is causing side effects or also the medicines and treatment of Covid-19?
Both. Anyone who has suffered from Covid has seen the prescription running into pages; that is a challenge. Secondly, people have decided to take the medicines as preventive measures and sometimes, using high doses has created side effects. We started getting a lot of complications for liver damage in young adults and children. We found out that they never had Covid, but because they had so many alternative options, just as preventive, there has been overuse or wrong usage. That is a big concern.
If, hypothetically, everyone in the world takes the vaccine, is it the end of covid?
I don’t think Covid would be gone if everybody is vaccinated because the virus is mutating and escaping the current vaccines. You can protect yourself from the severity of the infection. There is no answer, but the cases will come down, and deaths will come down.
I read that someone was developing a nasal spray to get rid of Covid.
Two types of products are being developed: Bharat Vaccine, doing a vaccine development with nasal delivery as a platform, and then some other companies used nitrous oxide, which they believe can eliminate Covid in the nasal passage. Too early to say that it is working, but these are two companies.
What do you think of mixing vaccines? Are you doing something for long-term Covid wellness through Zydus Wellness?
About mixing vaccines: the European Union has cleared that if you have taken 1st dose, and they stopped the 2nd dose, they are switching all of them to Pfizer, and they have data to show that switching between the two is okay. Beyond that, there is not a lot of data available. Is it a good idea to mix vaccines? Theoretically, yes, because then you have a more comprehensive range of anti-bodies, but if it has a long-term complication, there are no answers as of today. I think it also depends on the type of platform, mRNA or DNA platforms don’t have immunogenic materials. So, they are innate in how they work, and it is easier maybe to switch there, perhaps not the vice versa way. Doctors are the right people to decide on that.
On the wellness side, we have not done anything big, apart from vitamins and sanitisers. We are doing a nasal product, a mouth spray to kill 99% of Covid virus, to reduce risk. We are also working on a nasal product which we will hopefully launch soon. We are currently launching it on doctor forums so that it is more credible.
Has Covid taken over most of your research, or is there a balance?
No, we have not reduced our research on other things.
Is Ivermectin useful? And, do DNA vaccines have any long-term damage that could take place?
I don’t think there is enough data to show that Ivermectin works. It is used a lot in other treatments, so I believe it is safe; I don’t know if it is effective in Covid. But it is safe. There is a lot of myth in terms of DNA as since 1995, WHO has approved for a protocol of DNA vaccine when we have Ebola outbreak as it is the easiest platform. So, there is at least evidence for DNA-based vaccines, and there have been trials on tens and thousands of patients. So, from our point of view, it is a safe platform.
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