Being one step ahead…

Developing an intranasal vaccine against COVID-19

The availability of a safe and efficacious vaccine against COVID-19 is urgently needed to reduce the social and economic impact. Therefore, in a short period of time, Utrecht University, Wageningen Bioveterinary Research and the Institute for Translational Vaccinology (Intravacc) joined forces to develop an intranasal vaccine against COVID-19 to prevent further spread, ICU admissions and mortality. The vaccine will consist of a Newcastle disease virus (NDV) vector that expresses the immunogenic spike (S) protein of SARS-CoV-2, which is an important target for neutralising antibodies. The project “development of an intranasal vaccine against COVID-19” received PPP Allowance from Health~Holland, following the COVID-19 call that was launched at the end of March.

What are the advantages of an intranasal vaccine compared to other methods of vaccination?

‘By means of intranasal vaccination, we induce local antibodies, IgAs, that are produced in the nose and lungs. COVID-19 is a respiratory disease, and with this approach, the virus immediately encounters the immune system when it enters the body. Other vaccination methods often use antibodies found in the blood, IgGs. With intranasal vaccination, we hope to prevent the virus from entering the blood circulation, by being one step ahead’, explains Peter Soema, Programme Manager at Intravacc. Ben Peeters, Molecular Biologist at Wageningen Bioveterinary Research, adds: ‘Furthermore, we use a respiratory virus as a vector against COVID-19. By using a replication competent respiratory virus such as NDV, the local immune system can be stimulated even more.’ Soema: ‘There are also some socioeconomic benefits. No trained nursing staff are required to administer an intranasal vaccination. This will speed up the vaccination process. Secondly, a needle-free approach does not produce hazardous waste that can cause infections and injuries, especially in third world countries. Third, vaccination will be painless, as no injection is required. We hope that this contributes to a high vaccination coverage.’

What are the next steps when you finish this project?

‘During this project, the efficacy and safety of the vaccine will be tested in a preclinical animal model. As soon as the vaccine has proven to be preclinically efficient, we want to perform clinical studies in humans for further vaccine development and optimisation. In parallel, a scalable vaccine production process will be developed ready for GMP production. To further accelerate the process, we will generate a roadmap to see which aspects of the research on vaccine development can be done in parallel to the preclinical studies,’ says Peeters. Soema: ‘The Intravacc viral vaccine manufacturing process is based on a cGMP class Vero cell line. This platform is used for routine large-scale commercial human vaccine production by customers around the world. We hope to make use of these existing facilities to produce the vaccine on a large scale as soon as possible.’

When do you think the vaccine becomes available?

Soema laughs: ‘That is the billion-dollar question. About a year after finalising this project, we aim to be in Phase 1 of the clinical studies. It can take several years to bring the vaccine from clinical studies to the market. However, we will try to accelerate every aspect of the process.’ Peeters adds: ‘Besides, the authorities have set up a lot of initiatives to accelerate the regulatory processes. When the world is under pressure, things become more fluid.’

Who will be vaccinated against COVID-19 when the vaccine becomes available?

Peeters: ‘Initially, a vaccine will not be available for everyone. It is up to politicians to decide but it is fair to assume that the elderly and people with underlying diseases will be eligible first, as well as personnel in the health and care sectors.’ Soema continues: ‘When the vaccine becomes available and affordable, I would advise allowing everyone to be vaccinated. That will prevent outbreak sources of COVID-19.’

Three tips from Ben Peeters and Peter Soema for setting up a public-private partnership

Make sure you have partners in your consortium who complement each other and do not include more partners than necessary. This focus provides speed and strength to the project. Ensure a good division of tasks within the consortium, so that everyone knows what they are responsible for. Include not just scientists, but also people who understand the regulatory and financial aspects so that everyone can contribute their strength.

Shedding a light on…

The shadow side of mental health problems among healthcare workers

It is an underexposed theme in today’s society: mental health problems among healthcare workers. However, interestingly enough, research has shown that healthcare workers are at a considerable risk of getting a post-traumatic stress disorder (PTSD) at some point in their lives. Although PTSD is often associated with veterans, hospital doctors have a higher prevalence of PTSD (15%) compared to defence personnel (4-9%) and even police officers (7%). Amidst the hectic COVID-19 crisis, we are likely headed to a peak in mental health problems. ‘There should be more publicity for PTSD among healthcare workers. The phenomenon is there, but few people talk or write about it’, says Marieke Soeter, research scientist from TNO.

Marieke Soeter is an expert in neuroscience and clinical psychology, and she dedicates a fair amount of research into the treatment of psychotrauma in high-risk professions. Soeter also works for the research & design project: “a new treatment for traumatised healthcare workers”. She executes this research in a consortium of TNO, Kindt Clinics and SENSIKS. The project received PPP Allowance from Health~Holland, following the COVID-19 call, that was launched at the end of March.

The potential of the treatment

‘You can never prevent trauma, you experience it, and it is part of the job in high-risk professions’, states Soeter. Since we cannot prevent PTSD, we are looking for a cure. Therefore, the consortium is testing a new treatment for traumatised healthcare workers. Soeter explains that this is a promising treatment that comes with many benefits. Contrary to existing anti-anxiety therapies that (a) have limited long-term efficacy and (b) are rather time-consuming and demanding – i.e. repeated reliving of traumatic memories – the current treatment may yield long-term cure from PTSD within a single treatment-session.

Economic and societal opportunities

What are then the economic opportunities if this treatment proves to be effective? ‘If this new treatment proves to be effective, you can treat people in the very short term and accelerate their return to work. Thus, the treatment is much cheaper, because it is only one session and that also reduces the incapacity for work costs’, says Soeter. ‘On the societal side, we hope to improve the quality of life for the people who get traumatised’. The step to long-term treatment is often greater than if you can do a single session. Therefore, the new treatment will be easier to access than long-term therapy.

Breaking the silence

Another hurdle that needs to be taken is that we need to break the silence on mental health problems among healthcare workers. They don’t openly talk about the subject, and it has always received little exposure in the media. However, Soeter does notice a slight, but gradual change here. ‘Since the COVID-19 crisis, the media have been writing more and more about the events at the intensive care departments and the consequences for the hospital doctors. I have never seen this happening before’. So, in the end, something positive could come out of the COVID-19 crisis, as mental health problems among healthcare workers are now receiving increased attention in the media. ‘That attention must be held and continued. And it is a great start that the subject is genuinely receiving more attention’. Finally, we need more research on the issue. ‘Because too little research is being done now and I believe the issue will be accepted more when scientific research is done’, concludes Soeter.