September 28, 2020 BARRON’S 21
patient’s immune response to the
protein in the vaccine.] Among smaller
vaccine developers that we’re most
confident about, Novavax [NVAX] is
in the lead. Sanofi [SNY] and
GlaxoSmithKline [GSK] are behind
them, but catching up quickly. They
have taken a similar approach, using
Glaxo’s adjuvant and Sanofi’s antigen [a
substance that causes the immune
system to produce antibodies against
it]. I have confidence in both the safety
and efficacy of those products. They’re
probably not going to be available until
the first part of next year.
The viral-vector vaccine programs
[using a weakened virus to transport
pieces of a pathogen into the body to
stimulate an immune response] are
limited by the immunogenicity of the
vector [its ability to provoke a
response]. The messenger RNA
programs [which instruct the body’s
cells to make proteins] seem pretty
reactogenic [side effect–inducing]; 80%
of people getting them get high fevers. I
am somewhat concerned about their
safety and tolerability in large
populations.
Moderna [MRNA] is the most
prominent mRNA company, and
probably the most controversial.
BioNTech [BNTX], CureVac , and
Arcturus Therapeutics Holdings
“Sometime in the next 18 months, a
combination of technology, capital,
expertise, and brilliant people is going to
win the battle.” Geoffrey Porges
treating Covid.
Edward Yoon: While we don’t know
which companies will be the winners
in therapeutics and vaccines, it might
pay to invest in contract manufacturers
who will supply the products. I’m
talking about companies that make
vials and syringes and tests to measure
SvO2 [mixed venous oxygen
saturation] in Covid patients, and
antibodies at scale. It is boring stuff,
but these are the picks and shovels of
the industry. While vaccine manufac-
turers might not make a profit on their
products, companies in the supply
chain could make a bit of money.
For example?
Yoon: I’m referring to companies like
Becton Dickinson [BDX], Danaher
[DHR], and West Pharmaceutical
Services [WST]. On the SvO2 side,
Masimo [MASI] and Medtronic ’s
[MDT] Nellcor unit have a global
duopoly. If testing goes on for a while,
companies such as Hologic [HOLX],
Danaher, and Quidel [QDEL] could
benefit.
Casdin: These are high-margin
businesses with incredibly sticky
products. While there can be volatility
in any given drug program, these
companies have tremendous demand
and are able to diversify across a broad
client base.
Let’s get a quick read: When will we
have a viable Covid vaccine?
Porges: What is “viable”? There will
be EUA [emergency use authorization]
approval of one or more vaccines by the
end of the year, and it will probably be
met with a resounding yawn, other
than by some high-risk people with
pre-existing conditions or occupational
exposure. I’d be surprised if there were
more than a couple of million doses
administered under those
circumstances. The medical
professionals I talk to are profoundly
skeptical about the basis for EUA
approval. If you map out the timeline
for a more general recommendation, or
what I would consider adequate safety
characterization, that doesn’t happen
until the second quarter of next year.
Then there’s the Food and Drug
Administration review, and the ACIP
[Advisory Committee on Immunization
Practices, a committee of the U.S.
Centers for Disease Control and
Prevention] review and recommen-
dations. ACIP’s review will probably
will be even more important than the
FDA’s. Most of us will probably
contemplate getting a vaccine with a
reasonable degree of efficacy that has
been determined safe in the second half
of next year.
Celniker: From a science perspective, I
agree. A lot of these vaccines are
composites. They aren’t a single agent
in a vial, but a mixture of adjuvants
and antigens to which you’re trying to
induce a response. As a result, you
can’t extrapolate the safety profile of
one vaccine to others. Each will have to
go through its own hurdles to
determine safety and efficacy. Then,
what is the value of these vaccines if
the durability of the response isn’t
there? Durability won’t be known for
another year. People have gotten used
to the flu vaccine, which provides
protection for a year. If a Covid vaccine
doesn’t provide durability of at least a
year, there could be a lot of resistance
to getting it.
Yoon: It is unclear how durability will
be defined, too. Will it be defined by the
presence of antibodies, or T-cells? The
science isn’t yet fully understood. I
don’t disagree with Geoff’s timeline,
either, but people have to consider how
high the risk is in their community and
environment. A frontline worker might
want to get a vaccine that could reduce
the severity of the infection. If there is a
big second wave in your community,
you will probably be more willing to
get vaccinated than if the prevalence is
low. We are going to get a ton of vaccine
data in the next eight to 10 weeks,
which will tell us a lot about how
effective the vaccines under
development are. We might have a
different answer 10 weeks from now.
Casdin: The public sees a vaccine as
the gating factor for people to get back
to a normal course of life, but for me,
ease and access to testing and having
data around who is and isn’t infected
seems the best opportunity to return to
normalcy. We are about 35% of the way
to where we need to be when it comes
to testing. If we can get to 75%, even in
the absence of a vaccine, the economy
can get back to some sort of normalcy.
Which vaccine developers are most
likely to produce a successful
product?
Porges: When you talk to vaccine
experts, nearly 100% say they have the
most confidence in traditional adjuvant
protein subunit vaccines, because we
know that technology works. [An
adjuvant is a substance that boosts the
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