A federal advisory committee Tuesday will vote on whether regulators should authorize a COVID-19 vaccine made by Novavax, an early beneficiary of the government’s Operation Warp Speed program.
The experts to the Food and Drug Administration will base their recommendation on the company’s clinical trial data, which is strong. But before the agency could authorize the shots, the FDA would also need to sign off on Novavax’s manufacturing process, which has stumbled repeatedly over the course of two years.
If the FDA authorizes the Novavax two-dose vaccine, it would become the fourth shot to win clearance for adults in the United States. But even if the company does get the green light, it is unclear when or how widely the vaccine might be available. Shots from Pfizer, Moderna and Johnson & Johnson have been authorized for well over a year, and the country is not short of doses. And in a number of countries where Novavax has already earned authorization, uptake has been low.
The federal government is coordinating with Novavax to receive “a limited quantity of vaccine” if it is authorized and recommended in the United States, Jorge Silva, a spokesperson for the Department of Health and Human Services, said in an email. “We remain committed to ensuring that any American who wants a vaccine can get one, including those that prefer a non-mRNA option.” (Pfizer and Moderna’s shots are made with mRNA.)
The Novavax vaccine contains nanoparticles made up of proteins from the surface of the coronavirus, a fundamentally different design than the three authorized shots.
Frequently Asked Questions
A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.
There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.
Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.
In clinical trials, the Novavax vaccine was found to have an efficacy of 90.4% at preventing mild, moderate or severe infection with older variants of the virus. None of the volunteers who got the vaccine experienced moderate or severe infection, translating to an efficacy of 100%.
The trial took place before the rise of the delta and omicron variants, which have evaded some of the immunity from other vaccines.
In briefing documents released Friday, FDA scientists identified six cases of myocarditis and pericarditis, forms of heart inflammation, in about 40,000 trial volunteers.
“These events raise the concern for a causal association with this vaccine,” the FDA documents stated.
“We believe there is insufficient evidence to establish a causal relationship,” Novavax said in a statement. “We will continue to monitor all adverse events, including myocarditis and pericarditis.”
Moderna and Pfizer did not find any cases of myocarditis or pericarditis in their initial clinical trials. But after authorization, once the vaccines were given to millions of people, they were both found to create a small extra risk of myocarditis in boys and young men.
The Novavax vaccine has been authorized in dozens of countries, including India, South Africa and Britain, and has also received clearance from the European Union and World Health Organization.
But the vaccine is falling far short of initial hopes, both in terms of the number of vaccines distributed around the world and the number of people who are receiving them. In February 2021, Novavax pledged 1.1 billion doses to COVAX, the U.N. program supplying shots to developing countries. But because of the delays, COVAX has not yet ordered any doses from Novavax.
Demand for the vaccine also appears to be tepid in other countries. Novavax has shipped 42 million doses through the first quarter of this year to 41 countries. In its briefing documents, the FDA said Australia, Canada, the European Union, New Zealand and South Korea provide data on how many people have actually received the vaccine. The grand total in these countries came to fewer than 750,000 doses.
When contacted for comment, Novavax did not provide a total number of doses administered worldwide in other countries, such as India.
As part of its initial support for Novavax’s research, the United States agreed to buy 110 million doses of the vaccine if it won authorization. But two years later, with the country already flush with effective mRNA vaccines, the government has little need for more.
Novavax had planned for factories around the world to manufacture its vaccine, but the company had trouble scaling up production and was slow to demonstrate that its process met FDA standards. The Serum Institute of India, the world’s largest vaccine producer, is now manufacturing Novavax’s vaccine and would be the supplier of any doses sold in the United States.
The FDA said in its briefing documents that testing and submission of manufacturing data on the vaccine “were still in process” at the time of its review.
Novavax CEO Stanley Erck said the company was in discussions with the government about how many doses it will supply.
“I anticipate that there will be several million doses coming into the U.S. within weeks of the EUA,” he said, referring to an emergency use authorization.
This article originally appeared in The New York Times.By Carl Zimmer and Rebecca Robbins