INFOGRAPHIC INFOGRAPHIC

THE RACE TO STOP COVID-19

Vaccine development
There are five main approaches being taken to develop a vaccine against SARS-CoV-2, with several biotechnology companies,
academic organisations and pharmaceutical companies employing different technologies in the race to bring their vaccine candidate
to clinical trials. The World Health Organization (WHO) hopes that a vaccine will be available by October 2021.

As a new strain of coronavirus threatens public health systems across Different live replicating
or non-replicating virus CELL NUCLEUS
Viral vector transcribes
the globe, researchers are racing to develop a vaccine. engineered to carry gene the engineered gene
in the c ytoplasm or
enters thenucleus for
DAWN CONNELLY & JULIA ROBINSON transcription  DNA is
transcribed
into mRNA
SARS-CoV-2 
surface protein gene
Plasmid enters
VIRAL VECTOR VACCINE nucleus o f the
In context Symptoms and transmission host cell
Compared with some outbreaks of novel respiratory disease, the death A plasmid is synthesised
• weakness
1
rate for coronavirus disease 2019 (COVID-19) is currently low. This could Common symptoms*: fever (98.6%); that encodes the HOST CELL
genes for the
reduce further as the global outbreak progresses and milder cases (69.6%); cough (59.4%); SARS-CoV-2
are detected. Pandemic (H1N1) 2009 influenza was estimated to infect muscle pains (34.8%); surface protein
1.6 billion people, with a death rate of 1 in80,000
5,000 (0.02%); seasonal flu has RNA can self-amplify
difficulties breathing (31.2%); inside the cell in some RNA
a similar death rate, but infects up to 4 billion people each flu season.
2002: SARS* 2012: MERS**
70,000
Ongoing: COVID-19
Size of
infected
Less common symptoms*: •
diarrhoea (10.1%); nausea Cases in andCasesvomiting (10.1%);
in Total Total
vaccine systems mRNA is
translated
to produce
population mainland (6.5%);
other recovered deaths SARS-CoV-2  SARS-CoV-2
Death rate: 9.6% Death rate: 34.4% Death rate: 4.1% dizziness (9.4%); headaches China locations surface protein gene surface protein
Virus
60,000 stomach pain (2.2%); replicates
COVID-19:
•
Incubation period: 0–14 days; DNA VACCINE inside cell

•
190,000+
Global cases

50,000 Severity: data from 44,000 cases of COVID-19

SARS:
8,096 in China suggest that 80.9% of cases are mild, 2 Replicated
40,000 MERS:
13.8% are severe and 4.7% are critical. Severe Messenger RNA virus buds on
2,494 cell surface
(mRNA) encoding and induces
cases are more prevalent in older people and SARS-CoV-2 surface
The virus induces a strong
30,000
*Severe acute respiratory syndrome ** Middle East respiratory syndrome those with an existing long-term condition, such protein gene immune
an immune response response
as cardiovascular disease, diabetes, directly, as well
Case fatality rates for COVID-19 20,000 respiratory disease or hypertension; as entering cells

•
RNA VACCINE and replicating
By age: Transmission: person-to-person
SARS-CoV-2 surface
15% 10,000 spread between close contacts (up to 1. Viral vector vaccine: SARS-CoV-2 

•
protein synthesised
% of cases who die

virus is weakened
12% 1.8 metres) through respiratory droplets;  rganisations working on vaccine:
O 3 or a recoded and combined with
9%
6%
0
•
Diagnosis: COVID-19 is suspected
20 Jan 23 Jan 26 Jan 29 Jan 1 Feb 4 Feb 7 Feb 10 Feb 13 Feb 16 Feb 19 Feb 22 Feb 25 Feb 28 Feb 1 Mar
based on clinical symptoms. Cases are
Johnson & Johnson; Geovax Labs
and BravoVax; University of Oxford
version of
the virus is
synthesised
adjuvant to enhance
immune response
Outbreak timeline (2020)* SARS-CoV-2
3% only confirmed when there is a positive and Advent Srl; Tonix Pharmaceuticals LIVE-ATTENUATED surface
0% laboratory test; and Southern Research; Altimmune; VACCINE protein
•
0–9 10–19 20–29 30–39 40–49 50–59 60–69 70–79 >80 Overall released
Age range (years) Treatment: treatment of COVID-19 is Greffex; Vaxart; CanSino Biologics;
By comorbid condition: symptomatic, such as providing oxygen. Zydus Cadila; Institute Pasteur 4
By gender:
Males
Medicines specifically licensed for COVID-19 are
not currently available, but clinical trials of several
• Estimated date of first human trials:

June 2020 4. Live-attenuated vaccine:
PROTEIN-BASED
VACCINE

10.5%
Cardio-
7.3%
Diabetes
6.3%
Chronic
6.0% 5.6%
Hypertension Cancer
0.9%
None
2.8%
Females
antiviral drugs are being conducted in China.
2. DNA vaccine:
• OCodagenix
rganisations working on vaccine:
with Serum Institute of India
5
IMMUNE RESPONSE
1.7% • OInovio • EBystimated
*Percentages are taken from a case series of 138 consecutive hospitalised patients
vascular respiratory in China. Antibodies produced
disease disease rganisations working on vaccine: date of first human trials: in response to
Pharmaceuticals with Beijing August 2020 SARS-CoV-2
120,000 surface protein
Advaccine Biotechnology; Applied DNA
Global takeover 30 January 2020: Sciences, Takis Biotech and Evvivax; 5. Protein-based vaccine:
• ONovavax;
110,000
The WHO declares Cases in Cases in Total Total
31 December 2019: The first mainland other recovered deaths Zydus Cadila rganisations working on vaccine:
•
the COVID-19 China locations
cases of pneumonia with unknown 100,000
outbreak a public Estimated date of first human trials:
 Clover Biopharmaceuticals with
cause in Wuhan, China, are
Number of COVID-19 cases

reported to the World Health

health emergency April 2020 GSK; Baylor College of Medicine, University Immune response:
• Iresponse
90,000
of international 16 March 2020:
Organization (WHO) concern 26 February 2020: For the first Total number of
of Texas Medical Branch, New York Blood t is not known how strong the immune
80,000 31 January time, the number of new cases cases and deaths 3. RNA vaccine: Center and Fundan University, China; University needs to be to protect
7 January 2020: The Chinese
authorities identify the novel 70,000 24 January
2020: The
2020: The
first UK cases
reported in China is overtaken
by the number of new cases
in other locations
overtakes those
• OCureVac;
rganisations working on vaccine:
Moderna and US National
of Saskatchewan, Canada; University of
Queensland, Australia, GSK and Dynavax;
against SARS-CoV-2; therefore,
some of the vaccines being developed
coronavirus and temporarily are confirmed reported in the rest of the world in China
name it ‘2019-nCoV’, which 60,000 first case Institute of Allergy and Infectious Diseases; Vaxart; Generex; ExpreS2ion; Vaxil Bio; Sanofi may not work.
is later changed to severe
acute respiratory syndrome 50,000
of person-
to-person 2 February 2020:
The first COVID-19
17 February
2020: China 11 March
Stermirna Therapeutics, Tongji University
and Chinese Center for Disease Control
Pasteur; iBio/CC-Pharming: Generex and
EpiVax; Walter Reed Army Institute of Research
• Before candidates reach clinical
trials, investigators must also ensure
coronavirus 2 (SARS-CoV-2) transmission
40,000 of COVID-19 death outside of records a 28 February 2020: and Prevention; Imperial College London; and United States Army Medical Research they induce protective immunity, not
outside of China is reported spike in cases 2020: The The WHO
10 January 2020: The Chinese in the Philippines after a broader WHO raises the characterises
Arcturus and Duke-NUS Medical School, Institute of Infectious Diseases; EpiVax and immunopathology, as was seen in early
Center for Disease Control and 30,000 China is
definition of global risk level the outbreak Singapore; BioNTech and Pfizer University of Georgia attempts to develop a SARS-CoV
• •
Prevention makes the genome reported
in Vietnam COVID-19 to ‘very high’ as a pandemic Date of first human trials:
 Estimated date of first human trials:
 vaccine after it emerged in 2002.
of SARS-CoV-2 available 20,000
diagnosis is March 2020 By June 2020
introduced
10,000
11 January 2020: The first
SOURCES: China CDC Weekly 2020;2(8):113-122; Department of Health and Social Care; JAMA 2020, doi: 10.1001/jama.2020.1585; JAMA 2020, doi: 10.1001/jama.2020.2648; John Hopkins Center for Systems Science and Engineering; Lancet 2012;12(9):687–695;
COVID-19 death is reported 0 World Health Organization
in China 24 Jan 29 Jan 3 Feb 8 Feb 13 Feb 18 Feb 23 Feb 28 Feb 4 Mar 9 Mar 14 Mar 18 Mar EDITORIAL ADVISERS: Sarah Gilbert, professor of vaccinology, Jenner Institute, University of Oxford; Paul Kellam, professor of virus genomics, Faculty of Medicine, Imperial College London
ILLUSTRATION: Alisdair Macdonald
Outbreak timeline
Outbreak timeline(2020)
(2020)* All data correct as of 19 March 2020

168    THE PHARMACEUTICAL JOURNAL  VOL 304  NO 7935  MARCH 2020 MARCH 2020  NO 7935  VOL 304  THE PHARMACEUTICAL JOURNAL    169