Inside Singapore’s hunt for a Covid-19 vaccine

By Yun Xuan Poon

Interview with Professor Paul Tambyah, Clinical Lead for the NUS Yong Loo Lin School of Medicine’s Infectious Diseases Translational Research Programme, Singapore.

In a world thrown into disarray by deadly microbes, vaccines offer a glimmer of hope for reclaiming a greater portion of normalcy.

Singapore has submitted three Covid-19 vaccines for approval around the world, according to The Straits Times. The island-state is geographically positioned at the crossroads of international trade in Southeast Asia, making it highly vulnerable to the spread of infectious diseases, says Professor Paul Tambyah, Clinical Lead for the NUS Yong Loo Lin School of Medicine’s Infectious Diseases Translational Research Programme.

Tambyah was the former Head of the National Infectious Disease Research Coordinating Office at Singapore’s National Centre for Infectious Diseases, and recent president-elect of the International Society of Infectious Diseases. He takes us into Singapore’s vaccine labs to share progress.

Singapore’s role in the global vaccine hunt

Singapore has a “huge role” to play in the global hunt for a vaccine, Tambyah says. Its strong regulatory environment, overseen by health regulatory agency Health Sciences Authority (HSA), is helpful for assessing new vaccines. “Regional countries use Singapore’s HSA as a benchmark for vaccine and pharmaceutical regulation for good reasons,” he notes.

For instance, HSA’s approach was used as “a textbook of cautious innovation” when regulating France-based pharmaceutical company Sanofi’s dengue vaccine. HSA requires pharmaceutical companies in Singapore to clearly raise the potential risks of using medical drugs, such as vaccines, and suggest how to properly manage them, according to the Singapore Medical Journal.

How close is Singapore to developing a Covid-19 vaccine of its own? It will take a while still, but there are promising signs. Singapore is trialing some “innovative approaches which have the potential to be game changers in the vaccine space”, says Tambyah, who oversees NUS’s vaccine development projects.

Typical vaccines use dead or weakened viruses to build up the body’s immunity against the full-fledged disease. Some teams are testing out vaccines based on virus-like particles and mRNA, he shares.

mRNA is the body’s trusty postman - it delivers genetic information for cells to convert to useful proteins. mRNA vaccines teach our cells to make proteins that would trigger an immune response, according to the US Centers for Disease Control and Prevention. One mRNA-based vaccine, co-developed by Singapore scientists and an American biopharmaceutical firm, could be ready by the first quarter of 2021, reported CNBC.

Pharmaceutical firm Moderna is seeking HSA permission to use its mRNA-based vaccines in Singapore, and the first batch could arrive as early as this month, The Straits Times wrote. Most mRNA vaccines need to be stored at much colder temperatures, which could make transporting it difficult. But Moderna’s is formulated to survive at regular freezer temperatures, according to NPR.

Teams within NUS are trialing other types of approaches too, including mobilising the immune system against a range of viruses and using different proteins to fight emerging infections, Tambyah shares.

Challenges in coordinating vaccine research

But finding the resources for vaccine research is not that easy, as public health and clinical needs continue to vie for doctors’ time. “It is hard to write a grant or a research paper after coming off a ward round with twenty patients or a lengthy discussion on how to safely continue emergency surgical operations,” says Tambyah.

The manpower crunch makes operating labs difficult too. More advanced labs like the BSL-3 labs have strict safety protocols and need enough manpower to run safely. But that is “always a challenge, all the more so during a pandemic”, he notes.

BSL-3 are the only labs allowed to work on dangerous pathogens, including the virus that causes Covid-19. “Without these labs, it is not possible to do in depth research into those germs,” Tambyah explains.

Globally, Tambyah sees the politicisation of science and research as a mounting threat to infectious diseases research. “Perhaps there is a real need for scientists to form some kind of independent global body that can provide data for transnational organisations such as the World Health Organisation without being constrained by the national issues that United Nations agencies face,” he says.

Lessons over the years

Covid-19 has brought important learnings for both hospitals and nations. “Before SARS, there were much fewer visitor restrictions in Singapore public hospitals but now these are tightly controlled. Many similar changes will occur post-Covid,” Tambyah notes. Hospitals, especially in high and middle income countries, will likely increase the resources available for infection control and isolation facilities, he adds.

Societies have learned how to do lockdowns, but authorities should be careful about enforcing blanket bans in the future. “Hopefully the actual impact of these restrictions will be scientifically and objectively assessed so they do not become a knee jerk reaction with the next emerging infectious disease,” he cautions.

The world has learned from the many public health crises it experienced as well. Tambyah notes some of the collective lessons from managing infectious disease outbreaks over the years.

For instance, the World Health Organisation (WHO) set up the Pandemic Influenza Severity Assessment guidelines after the H1N1 pandemic. “There was some concern that severity was not taken into account when declaring the pandemic in May 2009,” he notes. “Following SARS, the WHO has also hesitated to suggest travel restrictions although in practice, global travel has ground to a halt,” he adds.

Covid-19 has proven itself to be a persistent and difficult foe. Scientists around the world are up in arms to take it down, and Singapore is eager to contribute its resources to the global fight.