Name: Chary Johanne G. Meneses Submitted to: Helen C.

Ramos
Course: MS Biology Education

The SARS-CoV-2 Virus and COVID-19 Vaccines

Severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 is the virus

that causes COVID-19. COVID-19 is not the first severe respiratory disease
outbreak caused by the coronavirus (Li et al, 2020). Within two decades, there have
emerged three highly pathogenic and deadly human coronaviruses, namely SARS-
CoV, MERS-CoV and SARS-CoV-2 (Li et al, 2020; Zhu et al, 2020). SARS-CoV
first emerged in Foshan, China in November 2002, and was subsequently transported
to Hong Kong in February 2003, from where it spread globally (Zhu et al, 2020). On
April 2012, MERS-CoV first occurred in Jordan and has been causing persistent
endemics in countries within and sporadically spreading to countries outside the
Middle East regions (Zhu et al, 2020). SARS-CoV-2 first occurred in Wuhan, China
in December 2019 and has then rapidly spread to all over China and the world.

Human coronaviruses, namely SARS-CoV, MERS-CoV and SARS-CoV-2, is

a positive-stranded RNA virus belonging to the Coronaviridae family, genus
Betacoronavirus (WHO, 2021). The 3’ terminal region which is one-third of the
genome, is responsible for encoding structural proteins, namely spike protein,
envelope protein, membrane protein, and nucleocapsid protein, are critical for viral
life cycle (Zhou et al, 2020). The 5’ terminal region which is two-thirds, is the non-
structural protein coding region, comprising significant genes, which are essential
for viral replication (Zhou et al, 2020). The spike protein, S protein, or glycosylated
protein binds with the cell membrane and is considered to be the prime antibody
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targets as they are accessible and have an essential role in allowing the virus to attach
to and infect host cells (Li et al, 2020).

SARS-CoV-2 gets into the cell through recognition by the spike protein
present on the surface of the virus envelope of the angiotensin converting enzyme 2
(ACE2) receptors (Li et al, 2020; Romano et al, 2020). This recognition or binding
represents the initial step for virus entry into cells. After attachment, the human
transmembrane protease serine 2 (TMPRSS2) cleaves and activates the spike protein
in an event that allows SARS-CoV-2 to enter the cells by endocytosis or direct fusion
of the viral envelope with the host membrane (Romano et al, 2020). Once inside the
cell, the infecting RNA acts as a messenger RNA, which is then translated by host
ribosomes to produce the viral replicative enzymes, which generate new RNA
genomes and the mRNAs for the synthesis of the components necessary to assemble
the new viral particles (Romano et al, 2020). The SARS-CoV-2 uses the same cell
entry receptor, which is angiotensin converting enzyme 2, same as SARS-CoV
(Zhou et al, 2020).

How COVID-19 Spread

Coronavirus is spread through droplets and virus particles released into the air
when an infected person breathes, talks, laughs, sings, coughs or sneezes (Sauer,
2021). It is also possible for someone without symptoms to spread the virus
(Kandola, 2020). Symptoms show up in people within two to 14 days of exposure to
the virus (CDC, 2021). A person infected with the coronavirus is contagious to
others for up to two days before symptoms appear, and they remain contagious to
others for 10 to 20 days, depending upon their immune system and the severity of
their illness (Sauer, 2021). The outcome of SARS-CoV-2 infection in individuals is

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heterogeneous and dependent on multiple variables, including age, sex, ethnicity,
and comorbidities (Hodgson et al, 2021).

In humans, the angiotensin converting enzyme 2 (ACE2) receptor is expressed

in almost all tissues, whilst being abundant in lungs and in the nasal and oral mucosa.
It is widely expressed on the epithelial cells of the trachea, bronchi, bronchial serous
glands, and alveoli, as well as alveolar monocytes and macrophages. Females have
fewer angiotensin converting enzyme 2 receptors on the lung surface than males,
and this makes them less susceptible (Rotonda, 2021). The ACE2 receptor is also
highly expressed on the luminal surface of intestinal epithelial cells, which may
explain some initial disease manifestations, such as vomiting and diarrhea. The
ACE2 receptor is also distributed in organs, such as the heart, kidney, endothelium,
and retina, could explain the multi-organ dysfunction observed in patients (Rotonda,
2021).

Variants
Variants of viruses occur when there is a change or mutation to the virus’s
genes (Bollinger & Ray, 2021). Bollinger & Ray (2021) added that it is the nature of
RNA viruses such as the coronavirus to evolve and change gradually. A mutation can
help the virus spread or sicken, many don’t have any effect at all, and some forms of
the virus emerge and then disappear (Joseph, 2020). Occasionally, a mutation will
give the virus a better chance of surviving and reproducing itself and will result in a
new population known as a new lineage (Cleveland, 2021). Some changes of the
virus may affect its properties, such as how easily it spreads, the associated disease
severity, or the performance of vaccines, therapeutic medicines, diagnostic tools, or
other public health and social measures (WHO, 2021).

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 RNA viruses mutate faster than DNA viruses because the polymerases of most
RNA viruses lack 3’ exonuclease proofreading activity and hence are more error-
prone than those of DNA viruses (Sanjuan & Domingo, 2016). The exception to this
rule is provided by coronaviruses, a family of positive-strand RNA viruses encoding
a complex RNA-dependent RNA polymerase that has a 3’ exonuclease domain
(Haas, 2021). Haas (2021) added that coronaviruses have a slightly lower mutation
rate than many other RNA viruses because they can do some light genetic
proofreading. Each time a new copy is made, there’s a chance that an error, or
mutation, will occur. According to Weisblum’s et al (2020) research, the SARS-CoV-
2 can mutate its spike proteins to evade antibodies.

According to the Centers for Disease and Control Prevention (2021), the
Alpha (B.1.1.7), Beta (B.1.351, B.1.351.2, B.1.351.3), Delta (B.1.617.2, AY.1, AY.2,
AY.3), and Gamma (P.1, P.1.1, P.1.2) variants are classified as variants of concern.
The World Health Organization (2021) has assigned labels for key variants of SARS-
CoV-2, using letters of the Greek alphabet. Since scientific names can be difficult to
recall, this system makes things easier to understand and helps prevent misreporting.
It also can help eliminate stigmatizing and discriminatory labels that people often
use when they refer to variants by their places of origin. The Variant of Concern
indicates highest threat perception among other coronavirus variants along with
possibly increased transmissibility, infectivity, or resistance to vaccines (WHO,
2021)

The Alpha variant is first detected in United Kingdom in September 2020.

According to Centers for Disease and Control Prevention (2021), the alpha variant
has a mutation in the receptor binding domain of the spike protein at position 501,
where the amino acid asparagine (N) has been replaced with tyrosine (Y). The
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shorthand for this mutation is N501Y. In Galloway’s et al (2021) research, the
variant has 13 other B.1.1.7 lineage-defining mutations, including a deletion at
positions 69 and 70 and is hypothesized to increase transmissibility. Symptoms of
the Alpha variant are largely the same as those previously linked with covid-19, such
as persistent cough and fever (LePage & McNamara, 2021). However, fewer people
reported symptoms of anosmia, a loss or change in sense of taste or smell (LePage
& McNamara, 2021).

The Beta variant is first detected in South Africa on May 2020. This variant
has multiple mutations in the spike protein, including K417N, E484K, N501Y
(CDC, 2021). In K417N mutation, the amino acid lysine (K) is replaced with
asparagine (N). In E484K mutation, glutamic acid (E) is replaced with lysine (K).
The E484K and K417N receptor binding domain mutations and mutations in the N-
terminal domain have been associated with neutralizing antibody escape (CDC,
2021). The E484K mutation could help the virus dodge a person's immune system
and may affect how well vaccines work (Roberts, 2021). As with the SARS-COV-2,
the risk is still highest for elderly people and those with significant underlying health
conditions (Roberts, 2021).

The Delta variant is first detected in India in October 2020. According to Liu
et al (2021) research, the Delta SARS-CoV-2 has efficiently outcompeted the Alpha
variant in human lung epithelial cells and primary human airway tissues. Also, Zhao
et al (2021), has estimated that the Delta variant is about twice as transmissible as
the virus from the initial outbreak. P681R spike mutation is responsible for increased
infectivity of the delta variant by increasing the dissociation of the spike S1 and S2
subunits at the furin cleavage site (Liu et al, 2021; Zhao et al, 2021). Zhao et al
(2021) concluded in their research that its infection has a shorter incubation period
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with a viral load of >1,000 times greater than that by earlier variants, but it remains
uncertain whether or not it can cause more severe disease (Zhao et al.). Liu et al
(2021) suggested in their study that spike mutations that potentially affect furin
cleavage efficiency must be closely monitored for future variant surveillance

The Gamma variant is first detected in Brazil in November 2020. According

to the International Journal of Infectious Diseases (2021), Gamma variant has 21
lineage-defining mutations, including 10 in the spike protein, three of them in the
receptor binding domain K417T, E484K and N501Y. These three mutations
combined have been shown to increase the receptor binding affinity. There is so far
no strong evidence for an enhanced lethality due to Gamma variant, but more studies
are required to verify this (Global Virus Network, 2021). The study was conducted
among nearly 70,000 health care workers in Manaus, which was the epicenter for
the emergence of the P.1 variant was shown to be 50% effective in preventing illness
14 days after administration of the first dose in its two-dose schedule (Global Virus
Network, 2021).

COVID-19 Vaccine
The COVID-19 outbreak, that started in Wuhan, China, in December of 2019
spread rapidly around the world, and the WHO has declared it as a pandemic on
March 11, 2020. Because no reliable COVID-19 treatment has yet been established,
vaccination has become the focus of public attention. Vaccination against COVID-
19 is largely believed to be the only effective method to end the current pandemic.
Because COVID vaccines have only been developed in the past months, it’s too early
to know the duration of protection of COVID-19 vaccines (WHO, 2021). But
according to the data, it suggests that most people who recover from COVID-19

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develop an immune response that provides at least some period of protection against
reinfection (WHO, 2021).

On the study of Hodgson et al (2021), regarding the efficacy of COVID-19

vaccine and a review of the challenges assessing the clinical efficacy of vaccines,
they stated that, “The goal of vaccine development is to gain direct evidence of
vaccine efficacy in protecting humans against SARS-CoV-2 infection and COVID-
19 so that manufacture of efficacious vaccines can be selectively upscaled.” A
candidate vaccine against SARS-CoV-2 might act against infection, disease, or
transmission, and a vaccine capable of reducing any of these elements could
contribute to disease control (Hodgson et al, 2021). The beneficial effects of such a
vaccine on a population can be observed only if the vaccine is efficacious in older
adults, that is approximately >60 years old and widespread distribution of the
vaccine exists, including to people who are most susceptible to COVID-19 (Hodgson
et al, 2021). A high coverage among these groups who are at high risk of severe
COVID-19 would have the greatest effect against disease endpoints.

Scientists around the world are developing many potential vaccines for
COVID-19. All COVID-19 vaccines approved by WHO for emergency use listing
have been through randomized clinical trials to test their quality, safety, and efficacy.
To be approved, vaccines are required to have a high efficacy rate of 50% or above
(WHO, 2021). After approval, they continue to be monitored for ongoing safety and
effectiveness. Vaccine efficacy is a measure of how much the vaccine lowered the
risk of getting sick in a controlled clinical trial, while vaccine effectiveness refers to
how the vaccine performs in the wider populations (WHO, 2021).

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 There are many types of COVID-19 vaccine. These are messenger RNA based
vaccines, viral vectored vaccines, inactivated vaccines, and protein-based vaccines.
Messenger RNA based vaccines are Pfizer-BioNTech and Moderna, it works by
directly delivering the genetic information to the cell for expressing the spike protein
into the body and the expressed viral protein will induce immune responses (GVN,
2021). Viral vectored vaccines are AstraZeneca, and Johnson & Johnson, it works
by delivering and expressing the spike protein using other viruses (GVN, 2021).
Inactivated vaccines are Sinopharm, and Sinovac, are the classic vaccine approach,
because it uses a killed virus particles containing the spike protein but also all other
viral proteins (GVN, 2021). A protein-based vaccines is Novavax, which use
harmless fragments of proteins or protein shells that mimic the COVID-19 virus to
safely generate an immune response (WHO, 2021).

Pfizer
The Pfizer vaccine has been developed by an American corporation called
Pfizer in New York and BioNTech, a German biotechnology company based in
Mainz, Germany (Walsh, 2021). The Pfizer-BioNTech COVID-19 Vaccine will now
be marketed as Comirnaty. On December 11, 2020, the US FDA authorized the
emergency use of the Pfizer-BioNTech COVID-19 Vaccine to prevent COVID-19 in
individuals 16 of years and older. It was on August 23, 2021, that it was approved
by the FDA as the first COVID-19 vaccine. The vaccine continues to be available
under emergency use authorization, including for individuals 12 through 15 years of
age and for the administration of a third dose in certain immunocompromised
individuals. Its mode of action according to the Pfizer-BioNTech Fact Sheets (2021),
is the nucleoside-modified mRNA in Comirnaty is formulated in lipid particles,
which enable delivery of the mRNA into host cells to allow expression of the SARS-
CoV-2 S antigen. It uses an mRNA to provide a blueprint for the cells to build body’s
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defense against the virus and this allows the body to generate an antibody response,
and to retain the information in memory immune cells, with the goal of attacking the
virus if the vaccinated individual is exposed.

The vaccine is given as an injection into the muscle in a series of 2 doses given
3 weeks apart, and a third dose is given in certain immunocompromised individuals.
A single dose of Comirnaty contains 30 ug mRNA in a volume of 0.3 mL, and it
does not contain preservative. In an analysis presented by the Pfizer-BioNTech Fact
Sheets (2021) to support its use in individuals 16 years of age older, there are 36,523
participants in the ongoing randomized, blinded, placebo-controlled international
study, the majority of whom are U.S. participants, who completed the 2-dose
vaccination regimen and did not have evidence of SARS-CoV-2 infection through 7
days after the second dose. Among these participants, 18,198 received the vaccine
and 18,325 received saline placebo. The vaccine was reported to be 95 % effective
in preventing COVID-19 disease among these clinical trial participants. Data is not
yet available to inform about the duration of protection that the vaccine will provide.

A study conducted between July 27, 2020, and November 14, 2020 by Polack
et al (2020) measures the safety and efficacy of Pfizer vaccine on a total of 43,548
participants who underwent randomization in preventing Covid-19 in persons 16
years of age or older. The participants who underwent randomization are from
United States, Argentina, Brazil, South Africa, Germany, and Turkey. The safety
profile of Pfizer vaccine was characterized by short-term, mild-to-moderate pain at
the injection site, fatigue, and headache. They concluded that the two-dose regimen
of Pfizer vaccine, given 21 days apart offered a 95% protection against Covid-19 in
persons 16 years of age or older (Polack et al, 2020).

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Moderna
The Moderna COVID-19 vaccine or mRNA-1273 is sold under the brand
name Spikevax. The vaccine is developed by the Moderna is a US pharmaceutical
and biotechnology company in Cambridge, Massachusetts. The mRNA-
1273 vaccine is like Pfizer vaccine, an mRNA vaccine that sends the body’s cells
instructions for making a spike protein that will train the immune system to
recognize it. The immune system will then attack the spike protein the next time it
sees one. The vaccine is given as an injection into the muscle in a series of 2 doses,
.5ml each given 28 days apart. The Moderna vaccine has an efficacy of
approximately 94.1 % in protecting against COVID-19, starting 14 days after the
first dose (WHO, 2021). According to the World Health Organization (2021), the
new variants of SARS-CoV-2, including the Alpha and the Beta, do not alter its
effectiveness.

A phase 3 randomized, placebo-controlled trial was conducted by Baden et al

(2021) at 99 centers across the United States between July 27 and October 23, 2020.
The 30,420 participants are 18 years of age or older with no known history of SARS-
CoV-2 infection, were randomly assigned in a 1:1 ratio to receive either vaccine or
placebo. They concluded that the mRNA-1273 vaccine showed 94.1% efficacy at
preventing Covid-19 illness, including severe disease (Baden et al, 2021).

A placebo-controlled trial was conducted by Ali et al (2021) at 26 sites in the

United States between December 9, 2020, and February 28, 2021. The 3732
participants are 12 to 17 years of age and are randomly assigned in a 2:1 ratio to
receive two injections administered 28 days apart of either mRNA-1273 or placebo.
In the mRNA-1273 group, systemic adverse reactions were reported in 68.5% of the
participants after the first injection and in 86.1% after the second injection. The
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most common systemic reactions were fatigue, headache, myalgia, and chills.
Headache was reported in 44.6% of the participants in the mRNA-1273 group after
the first injection and in 70.2% after the second injection, as compared with 38.5%
and 30.2%, respectively, in the placebo group. Fatigue was reported in 47.9% of the
participants in the mRNA-1273 group after the first injection and in 67.8% after the
second injection, as compared with 36.6% and 28.9%, respectively, in the placebo
group. After the second injection, among the mRNA-1273 recipients, fever occurred
in 46 of 2477 participants. They concluded that mRNA-1273 vaccine had an
acceptable safety profile in adolescents as there are no serious adverse events were
noted.

AstraZeneca
The ChAdOx1-S or AZD1222 or Oxford–AstraZeneca COVID-19 vaccine is
developed by Oxford University and AstraZeneca Pharmaceuticals. It was on 28
January 2021 that the FDA authorized its emergency use to prevent COVID-19 in
individuals 16 of years and older. The vaccine is composed of a single recombinant,
replication-deficient chimpanzee adenovirus vector encoding the S glycoprotein of
SARS- CoV-2 (FDA, 2021). Following administration, the S glycoprotein of SARS-
CoV-2 is expressed locally stimulating neutralizing antibody and cellular immune
responses. The recommended dosage is two doses given intramuscularly at .5 ml
each with an interval of 8 to 12 weeks. According to the World Health Organization
(2021), the AstraZeneca vaccine against COVID-19 has an efficacy of 63.09%
against symptomatic SARS-CoV-2 infection. Longer dose intervals within the 8 to
12 weeks range are associated with greater vaccine efficacy (WHO, 2021)

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 A study conducted by Bernal et al. (2021), compared the effectiveness of
Pfizer vaccine and AstraZeneca vaccine against the Delta variant and the Alpha
variant against symptomatic sequenced cases of COVID-19 in England. They found
that a 2 dose of Pfizer vaccine effectiveness is 93.4% with Alpha and 87.9% with
Delta (Bernal et al, 2021). With AstraZeneca vaccine 2 dose effectiveness is 66.1%
with Alpha and 59.8% with Delta (Bernal et al, 2021). They concluded that
sequenced cases detected after 1 or 2 doses of vaccination had a higher odd of
infection with Delta compared to unvaccinated cases (Bernal et al, 2021).

In an analysis of over 130 SARS-CoV-2 infected healthcare workers across

three centers in India during a period of mixed lineage circulation, they observed the
reduced AstraZeneca vaccine efficacy against the delta variant (Mlcochova et al,
2021).

Johnson & Johnson

The Janssen COVID-19 vaccine or Ad26.COV2.S or Johnson & Johnson
COVID-19 vaccine was developed by the Janssen Pharmaceutical Companies of
Johnson & Johnson in Leiden, Netherlands. It is a single-dose COVID-19 vaccine.
According to the company, the vaccine contains recombinant, replication-
incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein, citric
acid monohydrate, trisodium citrate dihydrate, ethanol, 2-hydroxypropyl-β-
cyclodextrin (HBCD), polysorbate-80, and sodium chloride. After it enters, the
human cells then express the SARS-CoV-2 spike antigen without virus propagation
on the cell’s surface. The displayed S antigen triggers an immune response that will
help prepare the body to respond to future exposure to SARS-CoV-2. According to
WHO (2021), 28 days after inoculation of the Janssen vaccine was found to have an
efficacy of 85.4% against severe disease and 93.1 % against hospitalization. WHO
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(2021) added that a single dose was found in clinical trials to have an efficacy of
66.9% against symptomatic moderate and severe SARS-CoV-2 infection.

In an international, randomized, double-blind, placebo-controlled, phase 3

trial, by Sadoff et al (2021), they evaluate the safety and efficacy of Janssen vaccine.
They randomly assigned 44,325 participants aged 18 years up to 60 years of age
from Argentina, Brazil, Chile, Colombia, Mexico, Peru, South Africa, and United
States in a 1:1 ratio to receive a single dose of Janssen vaccine or placebo. In the
vaccine group, injection-site pain was the most common local reaction 48.6%; the
most common systemic reactions were headache in 38.9%, fatigue in 38.2%,
myalgia in 33.2%, and nausea in 14.2%. Efficacy against moderate to severe–critical
Covid-19 was 67% against disease with onset at least 14 days after administration
and 66% against disease with onset 28 days after administration. Efficacy against
severe–critical Covid-19 is 77% against disease with onset at least 14 days after
administration and 85% against disease with onset at least 28 days after
administration. They concluded that a single dose of Janssen vaccine gives a
protection against symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection
and was effective against severe–critical disease, including hospitalization and
death.

A phase 2a–b trial in South Africa, was conducted by Shinde et al (2021).

They randomly assigned 4387 participants between the ages of 18 years and up to
64 years in a 1:1 ratio to receive doses of either the NVX-CoV2373 vaccine or
placebo. Vaccine efficacy among participants was 60.1%. Post hoc vaccine efficacy
against Beta variant was 51.0%.

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Sinovac
The private Chinese company Sinovac developed a coronavirus vaccine called
CoronaVac (Corum and Zimmer, 2021). It is a vaccine made from Coronaviruses.
To create CoronaVac, the Sinovac researchers started by obtaining samples of the
coronavirus from patients in China, Britain, Italy, Spain and Switzerland (Corum
and Zimmer, 2021). One sample from China eventually served as the basis for the
vaccine. According to the BBC News (2021), the CoronaVac works by using killed
viral particles to expose the body's immune system to the virus without risking a
serious disease response. This means part of the coronavirus' genetic code is injected
into the body, triggering the body to begin making viral proteins, but not the whole
virus, which is enough to train the immune system to attack. The Sinovac-CoronaVac
vaccine is given as an injection into the muscle in a series of 2 doses, given 2–4
weeks between the first and second dose.

According to the World Health Organization (2021), a phase 3 trial in Brazil

showed that two doses, administered at an interval of 14 days, had an efficacy of
51% against symptomatic SARS-CoV-2 infection, 100% against severe COVID-19,
and 100% against hospitalization starting 14 days after receiving the second dose. In
an observational study, the estimated effectiveness of Sinovac-CoronaVac in health
workers in Manaus, Brazil, where Gamma variant accounted for 75% of SARS-CoV-
2 samples was 49.6% against symptomatic infection (WHO, 2021).

A study was conducted from February 2 through May 1, 2021, in Chile that
measures the effectiveness of SARS-CoV-2 Vaccine and the cohort included
approximately 10 million persons (Jara et al 2021). Among persons who were fully
immunized, the adjusted vaccine effectiveness was 65.9% for the prevention of
Covid-19 and 87.5% for the prevention of hospitalization, 90.3% for the prevention
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of ICU admission, and 86.3% for the prevention of Covid-19–related death (Jara,
2021).

Clinical research by Ranzani et al (2021), conducted in January to 29 April

2021, estimate the effectiveness of the CoronaVac or Sinovac vaccine, against
symptomatic covid-19 in the elderly population of São Paulo state, Brazil during
widespread circulation of the gamma variant. The participants are 43,774 adults aged
greater than 70 years and Sinovac vaccine is given in a two-dose regimen. The results
shows that the vaccine effectiveness against symptomatic covid-19 was observed to
decline with increasing age. The Sinovac vaccine is 59.0% effective among those
aged 70-74 years, 56.2% among those aged 75-79 years, and 32.7% among those
aged greater than 80 years (Ranzani et al, 2021). They concluded that Sinovac was
associated with a reduction in symptomatic covid-19, hospital admissions, and
deaths in adults aged greater than 70 years in a setting with extensive transmission
of the gamma variant (Ranzani et al, 2021).

Novavax
The Novavax COVID-19 vaccine is codenamed NVX-CoV2373. The
Novavax Incorporated is an American vaccine development company headquartered
in Maryland, US, with an additional site in Uppsala, Sweden (Whitehead, 2021).
The vaccine is manufactured at Fujifilm Diosynth Biotechnologies in Stockton-on-
Tees in northeast England (Whitehead, 2021). The NVX-CoV2373 COVID-19
vaccine contains a full-length, prefusion spike protein made using recombinant
nanoparticle technology and a proprietary saponin-based Matrix-M™ adjuvant
(WHO, 2021). The purified protein is encoded by the genetic sequence of the SARS-
CoV-2 spike protein and is produced in insect cells (WHO, 2021). The saponin-based
Matrix-M adjuvant stimulate the entry of antigen-presenting cells into the injection
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site and enhancing antigen presentation in local lymph nodes, boosting immune
response, and helping an immunized person make antibodies against the virus
(Carlson and Lutmer, 2021).

According to the World Health Organization (2021), the NVX-CoV2373

vaccine was 90% effective at preventing symptomatic COVID-19 disease in its
Phase III efficacy trial involving more than 15,000 volunteers in the U.K., where the
Alpha variant has become predominant.

According to the phase 2 trial by Shinde et al (2021) in South Africa, they

randomly assigned participants with ages of 18 and up to 84years old to receive two
doses of either the NVX-CoV2373 vaccine or placebo. Of 6324 participants who
underwent screening, 4387 received at least one injection of vaccine or placebo. The
vaccine efficacy among participants was 60.1%. The post hoc vaccine efficacy
against Beta variant was 51.0%.

According to the phase 3, randomized, observer-blinded, placebo-controlled

trial by Heath et al (2021) that is conducted at 33 sites in the United Kingdom, a total
of 15,187 participants underwent randomization between the ages of 18 and 84
years. A post hoc analysis showed an efficacy of 86.3% against the alpha variant and
96.4% against non-alpha variants. They concluded that a two-dose regimen of the
NVX-CoV2373 vaccine administered to the participants gives an 89.7% protection
against SARS-CoV-2 infection and showed high efficacy against the Alpha variant.

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 References

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Adolescents.” New England of Journal of Medicine. 11 Aug 2021. 12 Sep
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Baden, Lindsey et al. “Efficacy and Safety of the mRNA-1273 SARS-CoV-2

Vaccine.” New England of Journal of Medicine. 4 Feb 2021. 12 Sep 2021
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variant.” Biorxiv. 24 May 2021. 7 Sep 2021
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