 This disease is having massive impact, but particularly impacting the poor in a disproportionate way. And the reason we're concerned with that is because we are about trying to get people out of poverty. And as I said at the outset, the main way we can try to get over this is if we were able to come up with treatment or vaccines. And that's one of the reasons why we, our colleagues Dieter and Vish, have volunteered to tell us about what's happening in that space. Much appreciated. Vish, are you there? Hi, Jimmy. Yes, I am. Thank you. Thank you. Thanks. Okay. Well, hi. Good morning everybody in Nairobi and the rest of Wilry, wherever you are. So, but Jimmy and Dieter have given a very good introduction into the necessity of having treatments of one way or another for controlling this disease. And so I'm just going to give you a little bit of snippets of information. Essentially, good news and not so good news in terms of where we are with respect to development of vaccines. So the first good news is that there are many different vaccines that are under development for COVID-19. At the last count, there were more than 100 different initiatives. Clearly, there is a mad scramble both within the academic sector, but also within the large private private sector companies, the big pharmaceutical companies, and also a number of smaller biotech companies that have technologies that they have developed for developing vaccines. So if you think about what is the job of a vaccine? So the job of a vaccine is really to stimulate your body to be able to raise an immune response. And this could be either antibodies as Dieter was eluding to. But there is a second set of immune responses which are generated as well, which are dependent on cells. And these are called T cells. So the job of a vaccine really is to generate these responses artificially in you before you actually get infected. So that your body then can recognize the infection or the virus once it gets into you and hopefully neutralize it so that either you're immune to the disease or you at least suffer very much less consequences of the disease. You don't have severe disease. So there are a number of different ways that the science community can go around developing vaccines and in the middle here I have a little cartoon showing you the structure of the SARS-CoV-2 virus. Now, fortunately, it's not a very complex virus. It consists of just five different proteins, the particle this is. And the genetic material instead of being DNA, which you're probably more used to is actually RNA. So, because we've had coronaviruses with us for a long time, quite a lot of work has been done on different types of coronaviruses before. So the science community actually knows how to go about developing a vaccine, at least getting it to proof of principle quite quickly. And in the boxes that I have listed as one to seven are different types of approaches that different groups are taking around the world. So number one is by and large the simplest way forward. So what you do is you grow the virus, you purify it, and then you inactivate it so that it's no longer infectious. But that's the material that you use in the vaccine that's injected into people. And there's a company in China called Sinovac, which has just published on some preliminary information that they have from preclinical trials, which look really good. The second box over there is instead of using inactivated virus, what you do now is you isolate the virus, but you attenuate it. So you make changes to it so that it remains infectious, it induces the immune response, but it doesn't cause disease. I'm not aware at the moment, at least of many companies that are going down this road, but there are certainly academic labs that are looking at how to develop this based on the previous work that's being done with SARS virus, for example. Number three that then looks at using synthetic molecules that are derived from the virus. So this is peptides which are made chemically, but which correspond to components of the virus, which you then immunize with to get an immune response. Number four is rather than using a small portion of the protein, you now use the whole protein, which are called recombinant subunits. And here, most people are concentrating on what's called the spike protein. I'm sure you've heard about the spike protein if you've listened to any of the news that's been going on for the last several weeks. And these on the virus particle, those little things that look like golf tees, which Jimmy was very familiar with, is what people are basically immunizing with. Now the thing is that this particular molecule has to have a particular structure. It's a very fussy molecule. And so you need to have it made in the structure that's kind of shown in that box in number four, containing these three little globules at the top with that cylinder at the bottom. And so structural protein chemists have basically identified how to make this and how to reproduce this. And a lot of people are taking this approach. One particular lab that we're familiar with is the Institute for protein design, which is at the University of Washington. And they're using this particular structure and putting it onto nanoparticles, which are now being prepared to go into clinical trials. Number five is instead of using proteins, you can actually use genetic material. So you can use DNA. So you can use the DNA and inject DNA into a patient into a human. And if you remember your molecular biology courses, DNA is converted into RNA and then RNA is converted into protein. So in this way, the protein is actually made in the cell after the vaccine has been administered. And the other way is rather than immunizing with DNA is you skip the DNA section and you put in mRNA itself, which then gets converted into protein. Now in block number six, instead of using DNA on its own in a naked format, you actually put it into an attenuated bacterial species, which you then immunize with the bacteria and then present the vaccine that way. Or in number seven, you put the gene into different types of attenuated viruses and immunize that way with viruses. So one of the things to keep in mind is that human vaccine development work and livestock vaccine development research is very similar. The concepts are very much similar. The methodologies are similar. And as I'm sure you're aware, we have a very active vaccine group with the military base, particularly on the Nairobi campus. And so one of the things that we are actively exploring methodologies within our program is that shown in number one in number two in number four and number seven. We've dabbled in the past with methods of number three and number six. We've done the DNA work in number five and the mRNA approach is something that's new. It's come about in the last five to 10 years. And this is something that we are thinking about using in our program, but we haven't. So there are lots of parallels that go around here. And as a result of this, we actually have a lot of contact with the with various groups who are developing COVID vaccines themselves. So for example, in number seven, you may have heard the name Sarah Gilbert from the General Institute mentioned. The UK government has just given Oxford University a huge amount of money to start working with this and this is using an ad no viral vector vaccine. And for those of you who may remember, we had a postdoc from their group who was working at Hillary using absolutely the same technology. But in exploring the development of a vaccine for Rift Valley fever virus. And then in number four, we have a very active program with the Institute for protein design there as well. So we keep a close look on what is happening in this field and where it's going on as well. So the bottom line here is that there is a race to develop a vaccine exactly for the reasons that both Jimmy and Dieter have alluded to. Not only would a vaccine save lives, it would actually remove the restriction that we're all currently under the social distancing. And more importantly, the economic lockdown that's going on. And the consequences of this, not just currently on the on the global economy, but also for the sustainable development goals is enormous. So this is the good news. So if I could have the next slide. The not so good news is that a typical vaccine takes about 15 to 20 years to develop. And the reason is that this is a very costly affair. It's about costs about 200 to $500 million to develop a vaccine. And not many experimental vaccines actually become commercial products because they fail along various pathways in the development of a vaccine. And just below that I've outlined a little diagram there, which shows you how this process is developed. So you start off with preclinical trials and preclinical trials are carried out in animal models, basically to assess the safety and suitability of your experimental vaccine for use in humans. At the moment, this is being done in mice, you eventually get on to using non human primates in terms of the COVID vaccines that are being developed. If you get through that, then you get into phase one clinical trials and all face all clinical trials are in humans. Now this can take anything from 10 to 20 years if you're lucky. And phase one is essentially testing for safety. So it's a small number of people that take part in this trial. The next phase which is phase two is much larger. Tens of hundreds of people are involved. And here what you're looking for is when you immunize these people with the experimental vaccine, do they make the right type of response that you want? Do they make those antibodies? Do they make those T cells, et cetera. If you get through that, you get into phase three. And you're now talking about tens of thousands of people. And here what you're looking for is whether the vaccine actually protects against the disease. Now above that you can see that there is a manufacturing process that's involved. Initially that starts off with a small scale. You have to have very high grade clinical material that you use. That then goes into manufacturing scale up smaller scales, maybe say hundreds of thousands of doses and then large scale manufacturing, which is millions of doses. And then if you're successful you get into licensing so that you submit a dossier to a licensing authority that can take as long as two years. So typically vaccine development is very much a linear process because of the cost of everything. It's a very linear process and you don't move from one to the next. Lots of stop go decisions, lots of experimental vaccines fail, less than say 10% actually goes through it. So the good news, which is in the next slide, is that the scientific community and the regulatory committee have developed a compressed pathway for COVID-19 vaccines. Obviously we need a vaccine now. But even under the best case scenario, a COVID vaccine will take about 18 months to be able to be available in large scale. And what you see they've done here is that they've overlapped the previous linear processes now so that you have things that are carrying out in parallel. But this becomes an extremely expensive affair. The other thing is that there is an emergency licensing that will be given. So this is not a normal licensing protocol or procedure. And the reason that we can do all of this is because over the last 10 years and in particular because of the Ebola outbreak as well as the last SARS outbreak. And because we now know how vaccines work, we have a generally good idea about safety efficacy and things like that, that all of this can be compressed. So the next slide, which is the other good news is that as I'm sure you're aware earlier this week, there was a call by the EU that was asking for money. And various countries got together and pledged a total of about 6.5 billion euros. And below that you can see that more than half of that is going to be spent for development of vaccines. Now unfortunately three very important countries were not present at that, but we won't talk about that anymore. And you can see that there's some money that's going for treatments and then some more for development of diagnostic tests. So in the last slide, basically I think we can remain optimistic. I think scientifically we know how to make vaccines. But keep in mind that vaccines are still difficult to make. Okay, I hope I've conveyed that message to you adequately. There are still a lot of unknowns. We don't know whether we will need more than one immunization. We don't know how long that immunity would last. We don't know whether it'll be 100% efficacious or whether what we're going to do is to go for what Jimmy was referring to earlier as herd immunity. So we have a lot of unknowns that are here, but I think the really good thing that's happening is that the global community has mobilized, having realized the impact that this is having. But the one sobering thought that we do have to keep in mind here is that unfortunately low to middle income countries don't have the capacity for research or development or manufacturing in the vaccine space. And so a lot of questions that are being asked at the moment is even if vaccines were available, where would they be used? Who would get them? When would they get them? And all sorts of issues like this. So in thinking about this, it's extremely important for all of us to be able to say that we really need to have these types of research activities ongoing and the investments that are required for this. So that low to middle income countries are not left out of these types of developments that take place. Okay, so I'm going to stop there Jimmy and hopefully that's given you all a flavor of where we are with vaccines and obviously if there are any breakthroughs, we will basically come back and let you know about them. So thank you for your attention. Thank you, Vish. Thank you from your lovely, what looks like your lovely penthouse windows and so on. It looks like a really nice place to be locked down. Vish, we don't have an upper means of opening up for questions generally but let me ask you to based on previous example. When we had swine flu, you remember, I don't remember 2010, was it? The rate it to produce that vaccine required some sort of process that used eggs. Is it likely that this process is going to use and that took about a year to produce that vaccine. So that was a rate limiting step that it took so long to grow up the vaccine. The second rate limiting step was that you have to put this in vials and you have to then go to existing pharma companies to do that. And their capability to do that was also a rate limiting steps. Could you comment on those two aspects with respect to this 18 months? This is 18 months to call that into consideration. The fact that packaging alone might take a long time. Exactly. So there are two issues, right? The first one that you're referring to is creating the vaccine doses in large enough numbers that are needed. A number of particularly the flu viruses are actually made by injection in eggs, but that now is also moved over to a tissue culture system. The eggs, I mean the seasonal flu vaccines for example that are given to humans, a lot of those are still made from eggs. And quite honestly, eggs are the most efficient way of amplifying these viruses because if you think about eggs, they're little sterile incubators of their own. But actually getting clean eggs is a big issue. There's a huge industry just revolving around production of pathogen free eggs for making these vaccines. But the methodologies that we're talking about here for the COVID system, for example, are using recombinant methodologies. So for example, the DNA recombinant protein approaches, all of these are made from systems that are scalable. But the biggest issue in all of this is the small scale production is usually much, much easier than the large scale manufacturing. And that's the most expensive part because this becomes a biological engineering feat. It's got nothing to do with the science behind the vaccine. And really the vaccine world spends most of its time trying to develop that type of technology and that's why manufacturing is absolutely so expensive. The bottling part of it is the second component because that has to be done under sterile conditions as yet. I don't think the bottling part of it is as big an issue as the production of the antigen itself. So those are very good questions to me and I think that that's something that will rate limit the availability of the COVID vaccine once it becomes available. And of course, the last part, the place you closed about the equity issue, I remember that the swine flu vaccine was produced expecting a second wave of the flu. And of course, the developed countries bought up all the vaccine and there wasn't any available for the developing ones at the time. So I hope that equity issue is also being considered. How would the developing world get some of this as well? Absolutely. So I mean people like the Gates Foundation, DFID, USAID are very aware of this inequity and there's a lot of thinking that's going into that. Also in terms of thinking of parachuting, manufacturing capacity into low to middle income countries. But these are, this is kind of band-aid things at the moment. There has to be a much more systematic long-term view taken towards this because what you've said this in the past and what we all know, once we're over COVID-19, we have to gear up for the next one that's going to come and it's inevitable there will be something else. Vish, thank you very much, much, much, much appreciated. Thank you. And I hope you're getting a round of applause from the various living rooms or penthouses or wherever our colleagues are. Thanks to you. Thanks everybody. Bye.