SINGAPORE: Even though community transmission of COVID-19 has been low in recent weeks, Singapore will have to be prepared for a second wave of infection.
The good news is that a vaccine is in development in Singapore. Human clinical trials started last month as volunteers got dosed. But can this race to develop a vaccine be won ahead of the second wave?
According to Ooi Eng Eong, deputy director of the Duke-NUS Medical School's emerging infectious diseases programme, there is a “major advantage” now that the clinical trial has begun.
“If the next wave hits during our phase III trial, then we might be able to get a faster answer as to whether the vaccine works,” he said.
“And the sooner we get it, the sooner we can get the vaccine available to everyone.”
To find out how far along Singapore is with the vaccine — and whether it can mitigate a second wave of COVID-19 — the programme Talking Point gets exclusive access to SingHealth’s Investigational Medicine Unit, where the trials are conducted. (Watch the episode here.)
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‘NOTHING TO BE AFRAID OF’
Having human trials done in Singapore guarantees that the Republic can get its hands on a COVID-19 vaccine once it is ready to be released.
The vaccine being tested here is called Lunar-Cov19 and is jointly developed by Duke-NUS Medical School and United States pharmaceutical company Arcturus Therapeutics. It has already shown promising responses in mice.
Typically, clinical trials of vaccines involve three phases, with only a small number of volunteers in phase I, usually fewer than 100.
In the second phase, the number of volunteers increases to several hundreds, while the final phase usually involves thousands of people to find out the vaccine’s efficacy.
To expedite the development of Lunar-Cov19, the researchers have combined phases I and II.
Around 100 people have received the vaccine candidate. They were selected from the 250-plus people who volunteered, as not just anyone can be a volunteer, noted Lunar-Cov19 trial co-investigator Shirin Kalimuddin.
“It’s the first time (this investigational vaccine) is being given in humans. So we need to make sure that the volunteers are healthy, and whatever medical conditions they have are well controlled,” she said.
“This allows us then to study and better understand the safety of the vaccine.”
The first cohort of volunteers had to pass all the screening tests including electrocardiograms and various blood tests before they could take part in the trial.
One volunteer, who spoke on condition of anonymity, hopes that by joining this clinical research, he can help doctors to understand more about the virus and speed up the process.
On the risks involved in participating in the trial, he felt that “there’s nothing at all to be afraid of”.
“Even if we were to mop the floor at home, there’s a risk. If you were to drive a car, there are risks also,” he said.
WATCH: Will COVID-19 vaccine trials be done before second wave hits Singapore? (4:45)
OBSERVING FOR SIDE EFFECTS
During this phase I of the trial, the researchers must ascertain the highest dose of the vaccine that can be given safely to the volunteers before any side effects become “a bit intolerable”, said Ooi.
“When you increase the dose, then side effects start to become more common. We’re just trying to find that sweet spot, so that we get the best response possible without all the unnecessary side effects,” he said.
The researchers think four doses would be “within that range”, with the aim of administering all four by now.
“Ideally, you’d want to give as much vaccine as you can so that the immune system has a chance of making a good and strong response to protect … against the (virus),” he added.
Ooi’s team is in charge of analysing the results of the current trial, which is expected to last until October. During this time, they will be observing the volunteers for side effects and their immune response.
While there are concerns over the unprecedented pace of vaccine development for COVID-19 — what normally takes 10 to 15 years is being compressed into a very short time frame — he thinks the pandemic can spark a change in that regard.
“Today, we have far better ways of assessing safety in humans than to go through the kind of animal studies that we’ve done in the past,” he said.
Still, he added that there is “no way we can promise” that the vaccine can be made publicly available before a second wave hits Singapore, or can stop the wave before phase III of the trial.
COOLER MONTHS, HIGHER RISK
In Asia, places like Hong Kong, Australia and South Korea are now confronting a second wave of COVID-19 cases.
Jeremy Lim, co-director of global health at the NUS Saw Swee Hock School of Public Health, said Singapore’s second wave is most likely to occur during the northern hemisphere winter months of December, January and February.
The virus can survive longer in colder conditions and is more likely to spread when people spend time indoors. So there is a chance of Singapore’s next wave coming in the form of imported cases from temperate countries.
Lim, who was involved in modelling potential pandemic responses when COVID-19 first hit, warned that imported cases could easily raise the infection numbers even though community cases here are under control now.
“We’re a very porous country, and our economy depends on this porosity, on travellers coming in to do business, to do trade. So, inevitably, we’ll see cases come in,” he said.
The challenge is that COVID-19 is an “exponential disease”, which means “one case becomes two, two becomes four, eight, 16, 32, and before you know it, it’s completely out of control”.
“We just need one case to slip through this very tight net that the Singapore government has wrapped around Singapore, and we’ll (have) the second wave,” he added.
Watch this episode of Talking Point here. New episodes on Channel 5 every Thursday at 9.30pm.