Coronavirus (COVID-19): search for vaccines and treatments

As of early August 2020, the world is close to reaching 20 million cases of the coronavirus disease (COVID-19). The number of new cases and deaths is declining in some regions, but it is mounting in others. As countries slowly lift strict isolation measures, innovative biotech firms and established pharma brands are continuing to support the research, production, and distribution of investigational treatments and candidate vaccines.

Vaccine as a true game-changer

Finding a safe and effective vaccine is a public health priority. As the infection spreads and cases increase, pharmaceutical and biotech manufacturers are trying to develop vaccines and antivirals, arranging clinical trials to test drugs that could potentially prevent or treat the disease. To be the first company producing a vaccine against the new disease is a matter of prestige and even more of potentially high profits. Not only the established big pharma companies, but also small innovative biotech firms are racing to create a vaccine against the new coronavirus. Several such companies have already increased their market capitalization as a result of being involved in research on SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2 - the virus that causes the COVID-19 disease).

Moderna and other frontrunners

One of the most discussed vaccines in development is named mRNA-1273, which has been developed by biotech company Moderna in partnership with the National Institute of Allergy and Infectious Diseases (NIAID). Considering how slow drug development can take, the new vaccine was ready in record time, far quicker than drugs manufactured during previous pandemics. It has been made possible by significant scientific advances in recent years, but also by Chinese scientists, who promptly shared the genetic sequence of SARS-CoV-2. Understanding the sequence allows research groups to study how the virus invades human cells and makes people sick.

The mRNA-1273 vaccine has shown promise in animal models, and healthy adult volunteers in Seattle were the first humans to receive a dose of the vaccine in the United States. The urgent situation means that regulators have started to grant emergency approval for the testing of some vaccines and treatments. After Moderna, CanSino Biologics from China was the second company which started running clinical tests in healthy volunteers. As of today, several other companies started running clinical trials, while many more are preparing them. In general, three types of vaccines are in trial: vector-based vaccines, gene-based vaccines, and inactived vaccines.

Chinese efforts to get the first vaccine are also among the most promising. CanSino Biologics is the first company to publish its full phase I clinical trial results in a peer-reviewed paper and is now in clinical phase II with 500 adult volunteers. In the meantime, Moderna has still to provide the complete data on phase I in a peer-reviewed journal, but phase II is also already running. On the other hand, a team at the Oxford University (now partnered by AstraZeneca) – probably the most prominent candidate – received a certain setback: while vaccinated monkeys became protected from the disease, they were still infectious and could spread the virus. All three projects - at Moderna, CanSino, and Oxford - are already being prepared for clinical phase III where tens of thousands of participants will be involved in the trials.

The 'old school' way

In the shadows of these vaccine projects, which are all using the latest – but sometimes still unproven – technologies, is Chinese Sinovac’s vaccine based on an inactivated pathogen. This is the most traditional ‘old-fashioned’ way of producing a vaccine and has been used for decades, for example to fight influenza and polio. First clinical phase I/II results showed a high efficiency against the novel coronavirus (SARS-CoV 2) and therefore Sinovac might soon rush to phase III, too.

What about COVID-19 treatments?

Besides finding a vaccine to prevent the COVID-19 disease, the focus is on finding drugs to treat already infected persons. The drug that has gained the most attention for fighting SARS-CoV-2 is remdesivir, which was originally developed by American biotech firm Gilead Sciences for use against Ebola. The University of Nebraska Medical Center was among the first to begin testing remdesivir to evaluate its safety and efficacy in COVID-19 patients. The first volunteer for a trial was an American who was repatriated after being quarantined on the Diamond Princess cruise ship. As of mid-April, results of a study with 125 COVID-19 patients in Chicago were leaked, highlighting the promise of remdesivir: almost all of the patients with severe symptoms (113) were able to leave the hospital within a week. However, a study from China comparing 158 patients with remdesivir and 79 with a placebo showed no significant improvement for COVID-19 patients. In another switch of events, the NIAID published results from another study which were said to prove that remdesivir led to a quickened hospital discharge among COVID-19 patients. Following that, the FDA approved an EUA for remdesivir, as of May 1st, although it looks like the drug is effective only in a certain group of not too severely ill COVID-19 patients.

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