DURHAM, N.C. -- Speculation that a vaccine for COVID-19 might be widely available by the end of this year is overly optimistic, three Duke experts said Wednesday.

While there may be substantial scientific progress by the end of 2020, there will still be significant manufacturing hurdles to clear before a vaccine is available to most people, the experts said during a briefing for media.

Below are excerpts from the briefing:

David Ridley, health economist

Dr. Fauci is quite optimistic. I think optimism is good. I think optimism has a really important role. We need people within these companies being optimistic. If everyone sits back and talks gloom and doom nothings ever going to get done. So I respect that optimism.

But will you and I get vaccinated this year? No way. Its possible a vaccine will be approved this year. But not at scale. We wont have a lot of doses of this.

We might have some people vaccinated this year. But the average person wont be vaccinated this year.

Thomas Denny, chief operating officer, Duke Human Vaccine Institute

If youre going into a tough game, you need a coach thats getting the team revved up. We may have some good science by the end of the year and think we have some leading candidates. But manufacturing them to have it all administered, thats a tall order to be ready by the beginning of 2021.

Ooi Eng Eong, deputy director, Emerging Infectious Diseases Programme, Duke-NUS Medical School in Singapore

Once we get to the efficacy phase and ask the question of whether this vaccine will work to prevent infection, that depends on how common the infection is at that time. If the situation still goes on as it is, we shouldnt have any problem testing efficacy."

But if for whatever reason the prevalence of the disease goes down, it will take us a much longer time to assess efficacy.

Were not going to get rid of the coronavirus in a hurry. Its going to stay with us. Even if we can vaccinate people, protect them from infection the question is how long will immunity last?

If we think about using vaccines in stages, potentially we could get one, possibly at the soonest to me, about this time next year. Anything sooner than that is extremely optimistic. Others have said we could get it by the end of this year. Im an optimistic person, but Im not that optimistic.

David Ridley

Were preparing to manufacture at scale. Fortunately, some of these vaccine makers are already manufacturing now. Sanofi said theyre going to be able to make 100 million doses this year and a billion doses next year. Thats really unprecedented. Usually youd wait to see if your vaccine is having some success. If you think theres a 1-in-8 chance that youre going to get on the market, and youre already spending tens of millions, hundreds of millions of dollars, thats kind of crazy. But thats the crazy world we live in and I salute them for it.

Usually it takes years to manufacture. You want to be sure you got a good vaccine before you begin making it at scale. Typically this is going to take four or five years. Maybe now we can do it in one or two years. Part of this is going to depend on the appetite of these manufacturers to start building something now that they probably will never use.

My guess is this will take longer than people will assume because there will be a little bit of foot-dragging. If you drag your feet a little bit longer and make sure its a good vaccine, that its going to work before you make the huge investments in manufacturing, you can save a lot of money.

Thomas Denny

The duration of immunity post-vaccination is a major scientific issue were trying to understand. Were also trying to understand right now whats the duration of immunity after natural infection. That will help us probably understand how well or how well not vaccines will work for us.

One of the approaches were taking at the vaccine institute, were also exploring the potential development of a pan-coronavirus vaccine.

If we can develop a vaccine that would cover protection to all types of coronaviruses that may be a threat to us we think that would be a big benefit. Thats a longer-term goal for ours. Its 18 months to two years out. I dont think there are many playing in that space currently. Most are looking at the short-term COVID-19 pathogen and trying to get a rapid vaccine developed for that one.

Ridley

Its very common for the second product, a later product to be better than the first. Lipitor was fifth to market for cholesterol drugs and was arguably better than the previous four.

Its reasonable to expect that later entrants will be better. Assuming the virus is still with us and still a threat, Id expect other companies to continue product development.

Ooi Eng Eong

Obviously theres pressure. Theres pressure from the demand from the public for a solution so they can go back to some level of normality in their lives. Theres pressure from colleagues in the hospitals saying we need to deal with this.

Theres also competition from other groups working on vaccines. I think competition is good. It forces us to think harder to come up with better, more innovative ways of doing things. There is pressure but I think at some level of pressure is good to really push the boundaries.

Ridley

We need a lot of materials in this process. Some are very simple. Gowns and masks are pretty simple things. Swabs for diagnostics are pretty simple things. Rubber stoppers, medical glass sound pretty simple. But we really have a high standard for those because anytime we have something coming into contact with the vaccine thats going to go straight into your blood stream, we have a really high standard for sterility.

Sterile water always seems to be in shortage. Water should be easy to make. But it has to be sterile because its going straight into the bloodstream. We cant underestimate the importance of all these products along the line.

We might be a little concerned about hoarding. Theres cost to scaling up PPE. Theres cost to scaling up medical glass and rubber stoppers. Someone might hoard those. One of the vaccine manufacturers, one of the hospitals might try to grab those materials. Theres all sorts of parts in this process and if one of them breaks down, it slows the process of getting the vaccine to people."

Ridley

None of the major vaccine manufacturers will charge ridiculous prices. Theyre in this game to try to do good, to try to impress their employees, to try to impress their shareholders. Theyre not going to do that by charging ridiculous prices.

Ooi Eng Eong

Were testing (our vaccine) as a preventative vaccine. But is an intriguing possibility. Our fight against the virus relies on the body to recognize first of all its infected with the virus. It triggers a series of processes. So it is entirely possibly theoretically that because were using an RNA vaccine, the vaccine will trigger the processes that will allow the (body) to fight an RNA pathogen.

Weve only had this virus for seven months now. Theres a lot we dont know about this virus.

Think about it like a thief breaking into your house. If this person is very skilled at overcoming your alarm, they will be able to break into your house. If you have another system that can activate the alarm while the break-in is in process, you would actually trap the thief. So it is something that is possible.

Denny

Those with underlying medical conditions, and first-line responders. Hospital workers, theyre the highest priority. If we cant keep those folks going, were in trouble.

Faculty participants

Thomas N. DennyThomas Dennyis chief operating officer of the Duke Human Vaccine Institute, a professor of medicine and an affiliate member of the Duke Global Health Institute. His administrative oversight includes a research portfolio of more than $400 million. Denny has served on numerous committees for the NIH over the last two decades.thomas.denny@duke.edu

Ooi Eng EongOoi Eng Eongis a professor of medicine and deputy director of the Emerging Infectious Diseases Programme at Duke-NUS Medical School in Singapore. He also co-directs the Viral Research and Experimental Medicine Centre at the SingHealth Duke-NUS Academic Medical Centre (ViREMiCS), which studies therapies and vaccines against viral infections.engeong.ooi@duke-nus.edu.sg

David RidleyDavid Ridleyis a professor of the practice at Dukes Fuqua School of Business, where he is faculty director of the Health Sector Management program.He was lead author of the paper proposing a review program to encourage development of drugs for neglected diseases that became U.S. law in 2007.david.ridley@duke.edu

---Duke experts on a variety of other topics related the coronavirus pandemic can be found here.

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COVID-19 Vaccine in 2020 Highly Unlikely, Experts Caution - Duke Today