Live Discussion: Avast CEO Ondrej Vlcek and CEPI Head of Programmes and Technology Nick Jackson

Hello, thank you very much for the very kind invitation. I'm excited about this. Thank you.

Sure. So CEPI stands for the Coalition for Epidemic Preparedness and Innovation. So it's really in our DNA to prepare the world for future outbreaks, to have the tools in place to prevent them and help control them. And at the heart of that strategy is vaccination. Vaccination has done more for public health comparable to fresh water and sanitation as a means to help prevent disease. So we were born out of the Ebola outbreak in 2017 where our founders and investors realized we have to be much better prepared. So if you think about it, back in 2017 they were really visionary because they saw Disease X, that unknown threat, as a great challenge to our humanity. And of course they are now vindicated with the outbreak of COVID-19. So again, it's in our DNA to facilitate and fund vaccines to help prevent emerging infectious diseases that we know about and the future threat of diseases as we go forward. Which is why we have nine vaccines in development for COVID-19. And as we get results, we want to move from the development phase to the implementation phase because a vaccine does no good if it sits in the fridge. It has to be used widely and immunize patients and subjects accordingly.

That's right, Andre. We're very fortunate to work with dedicated developers. Our role is very much to act as a catalyst, to be funders, and to facilitate the science and technology. In some cases where our developers may be a university or a small company, we have expertise to help them move forward. So we have selected nine vaccines for COVID-19. We used our internal experts and our external experts to pick the best nine to give us frankly the best shot on goal. And then use our partners all around the world at laboratories, clinical sites, manufacturing facilities, all working around the clock to get everything moving forward. So to be brief, we have dedicated partners. We've got facilities around the world on standby, working very hard and at risk to get things moving forward.

Our annual budget runs in several hundred million dollars. The development of vaccines is not cheap. The reason for that is it requires a lot of capital investment in vaccines, both in the manufacturing, preparing clinical sites, and making investments at risk. So that's why it quickly builds up in terms of cost. And also vaccine expertise is very niche. There are very few people around the world that know how to make vaccines. So these all add to the challenges of how you move forward. And also let me maybe if I can ask you a question: how did you first hear about CEPI?

Yes, well we're very, very grateful for your kind donation, a very substantial one. I'm very pleased to say that your donation has gone directly into vaccine research and development. So you and your organization can be very proud that that funding has gone right to the heart of our effort. So what does that mean specifically? It means the money's gone towards the first preclinical assessment of our vaccines, trying to find out which ones are the best to move forward, and then towards manufacturing these vaccines so that we can then begin to test them in subjects all around the world. So that money has helped facilitate nine vaccines to move forward and therefore get us closer to that goal of two billion doses at the end of 2021, which would be a profound achievement from a public health perspective and frankly a historic delivery of vaccines. So again, I think Avast can be very proud of playing a part in getting these normally quite risky projects moved forward, where if there were not resources, everyone would hesitate and that would lose time.

Yes, well the numbers are remarkable. And when I say them, I sometimes find it hard to believe what I'm saying. There are over 300 vaccines in discovery or development today. This is truly historic. We have 10 of those in late development, which means they're being tested in very large numbers of subjects and they're being manufactured in very large volumes. So those are getting close to the finishing line. In CEPI's portfolio, the nine projects that we've invested in, where you've helped move those forward, we have eight of those in clinical testing, which is fantastic. Now the results that we've seen recently are truly inspiring and give us great hope that we can end this pandemic. We've had three results. All of those results are very positive and very encouraging. They come from Moderna and Pfizer in the United States and from Oxford and AstraZeneca in the UK. So those projects again, an incredible number. From the day the sequence was released, the day the backbone of the virus was released in January, to get to those results today was done in just 300 days. Now normally, I've been working in vaccines for 20 years and you normally count the development in years or even decades. And you can spend your whole life working on vaccines and see very little move forward. So 300 days is a remarkable achievement. And again, the donation from Avast helped that happen because we and others could make investments at risk so that we could move so quickly. And in fact, we helped move in particular the Moderna, AstraZeneca, and Oxford vaccines forward. What we've got to do next, Andre, is look for safety. We've got to continuously look that these vaccines are safe and then move them towards implementation so that they get to all the vulnerable populations around the world, in your country, in all the countries around the world.

I think we can wave the flag that we've got some success. There are still some hurdles ahead. First of all, we need the national authorities around the world to grant licensure. So they need to do their job independently to review the safety, review all the data, and give the necessary license. And then we have to distribute vaccines, and the volume that we need to distribute is quite a task. And that's going to require incredible, almost military precision around the world to make that happen. And then last but not least, Andre, we need people to accept the vaccine. There are groups around the world that sometimes hesitate. So we need communities, we need doctors, we need organizations like yours to help communicate the facts and data so that people have the confidence to stick out their arm and get immunized.

Well, you raise a really pertinent topic. There are vaccines, as you said, like influenza that require updating every single year, and then yellow fever for example which pretty much protects you for your entire life. I'm afraid we don't know yet today how long these vaccines will protect. The available clinical data that's emerging around the world suggests that the vaccine is at least able to maintain an immune response in your body for around 3 to 4 months. And these studies will continue to follow subjects in some cases up to two years so that we can judge how long protection will last. And another very important point for the viewers to understand is that even when a vaccine is licensed, even when it's distributed around the world, you have to keep monitoring its performance. You can't just go home and say the job is done. So surveillance all around the world for many, many years to come will be following these vaccines to see how they work so that we don't see this virus ever come back again. Because if we do see that the vaccine becomes less effective, we may need to give people boosters so that they come back perhaps after two to three years and get a boosting dose. We simply just have to work that out.

Yes, most of the vaccines today look as though they will end up at two doses. So typically day zero and then a month later or six weeks. Now some organizations are being very ambitious and are seeking one dose because in an outbreak situation, of course one dose is far more simple to give. You don't have to remember to come back and get your second dose. And actually that goes to the heart of what CEPI has tried to do in our portfolio: to have as many shots on goal. We're seeking to invest in platforms that may have the opportunity to get down to one dose because that obviously lowers the cost and increases the compliance of immunization. So again, it's a little bit early to know exactly where we'll end up, but there is hope that we can get potentially some one-dose vaccines as we move forward.

Well, there are three main challenges. I think the first is resources and of course capital investment. That's been really difficult. A vaccine, as I said at the beginning, requires many millions of dollars to move forward. So one of the first challenges for us and all around the world in fact was getting the right resources, both financially and in terms of headcount, which again is why your donation has made a very tangible impact. The second is biology. Biology has in many cases some unknowns. Scientifically, we didn't know this virus very well. In some cases, we didn't quite know what to look for scientifically and technically. So there were a lot of challenges for all the scientists and clinicians and experts around the world. And last but not least, at-risk investment. In a normal vaccine development and in many manufacturing processes, you do things sequentially one after the other because that minimizes your business and financial risk. We couldn't do that here. We had to do activities simultaneously and therefore at financial risk. So it was a real challenge for CEPI and our developers to decide on what to do at risk. And again, I can't say more strongly how important it was to have support financially so that we could take financial risks to move quickly. We can't cut corners on safety, but we can cut corners on finance. And again, those contributions that we've received have allowed us to do things at risk and move forward in such an incredibly fast way.

Well, I've never seen such a coming together of resources, finance, manufacturing capability, and workforce activities in my career. And I think history will look back and see how remarkable the effort has been to avert this humanitarian disaster. So from a government perspective, all around the world a remarkable amount of governments have stepped forward to provide funding, to provide access to resources, and also to make sure that the regulations which govern vaccines allow things to move in an expedited way. So there again, I think the history books will tell a remarkable story of collaboration and commitment to have moved this forward. And so many governments have done a remarkable job.

Yes, COVAX is a very exciting collaboration and utterly unique collaboration between CEPI, GAVI which stands for the Global Alliance for Vaccines and Immunization, and the World Health Organization, the WHO. So bringing those three organizations together under one roof with one governance to help us move forward as quickly as possible. So within the COVAX facility, within that collaboration, we've got the research and development of vaccines, we've got the production of vaccines, and we've got the procurement of vaccines. And within those collaborations, that means we've got the knowledge and the means with our developers to move these vaccines through to licensure and then implementation. Because the goal that we've set ourselves is those two billion doses available next year. And in fact, COVAX has now got 187 countries. I'll say that again: 187 countries behind it, which can only be compared to the Paris Climate Agreement in terms of countries coming together. So remarkable achievements for all of those organizations to be able to move forward.

It is hard. I confess it's hard to get my head around it. We're very lucky that we have the infrastructure in place. In any normal year, many companies around the world provide billions of doses of vaccines. Now they do that with enormous resources. So what's different now is that we're doing it in an incredibly short period of time for just one vaccine. So the key to success is going to be preparation, preparation, and preparation. To take the vaccine from the facility in which it's manufactured, let's take for example Belgium where some of the vaccines we've been talking about are being manufactured, they have to go from the facility into trucks, into planes. The temperature has to be maintained. They then go to a depot. Let's say the depot is in Prague. That depot has to maintain the vaccine in vast volumes at the right temperature. And they're called in some cases freezer farms, if you can imagine a warehouse with thousands of freezers packed with thousands and thousands of doses of vaccines. And then they have to individually go to all the different places of immunization around the country. So again, it requires military precision. It requires the government, private companies like FedEx and UPS to get those vaccines to where they need. And we don't have unfortunately room for error because if we want to get those vaccines out quickly, we need that supply chain and that cold chain to allow the vaccines to get to where they need. At the end of this year, we may see some of those vaccines get out, and then through 2021 each month more and more vaccines coming out towards the cumulative number of 2 billion.

Yes, it's a key question. Because we have nine vaccines in our portfolio. Some of them can still fail. Typically there's only a 10% probability of success for a vaccine in a normal business. So our target is to get three to licensure, and those three should then be able to provide those two billion doses. And of course the procurement process is also valuable. And outside of COVAX, we've got many dedicated organizations pursuing their own delivery of vaccines means because of course we need billions and billions to get to every person around the world. And to your point earlier, Andre, if we need two doses, then we need two times the world's population in order to get the vaccines out in a remarkably short period of time.

Yeah, sure. I mean to end this pandemic, we certainly need vaccines, but we need many other tools. We certainly need treatment. We need reliable and cheap diagnostic tests. We need the personal protection that we've all been seeing used both personally and in the clinic. And last but not least, we need education. We need people to understand how they can act as an individual and as part of a community to help end this pandemic. So with that toolbox, we should be able to help end this pandemic. And the therapeutic target, which I know you've kindly donated to as well, they also have incredible numbers that are hard to get your head around. Their goal is to get 245 million doses of treatment in the next 12 months because unfortunately the vaccines will still take a little bit of time to get out there. So treatment is of course a very important way to protect vulnerable populations and vulnerable people that have already been infected.

Well, keep your eyes open for the data. There's certainly more data that needs to come out. We need to see more vaccines get licensed. And we need to see that implementation. We need to see the doses get out. And then last but not least, we need communities to come forward, people to come forward and get vaccinated. So more to follow. And thank you for the great conversation as well. It's been a lot of fun. And thanks again for your donation. Thank you.