{"id":1716,"date":"2021-05-05T09:15:21","date_gmt":"2021-05-05T09:15:21","guid":{"rendered":"https:\/\/horizon.peachpuff-wolverine-566518.hostingersite.com\/?p=1716"},"modified":"2021-05-05T09:15:21","modified_gmt":"2021-05-05T09:15:21","slug":"five-things-to-know-about-mixing-and-matching-coronavirus-vaccines","status":"publish","type":"post","link":"https:\/\/scienceblog.com\/horizon\/1716\/five-things-to-know-about-mixing-and-matching-coronavirus-vaccines\/","title":{"rendered":"Five things to know about: Mixing and matching coronavirus vaccines"},"content":{"rendered":"
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Amid global vaccine rollouts, with\u00a0nearly\u00a0<\/strong>1.2 billion<\/strong><\/a>\u00a0doses currently administered, some countries have recommended a mixed-dose approach where a first prime shot is followed by a booster of a second type.\u00a0<\/strong><\/p>\n<\/div>\n<\/div>\n<\/div>\n

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The measure has been introduced by\u00a0France<\/a>\u00a0and\u00a0Germany<\/a>\u00a0for people who received a first dose of the AstraZeneca vaccine but are in age groups for which that vaccine is no longer recommended in those countries due to rare instances of\u00a0blood clotting<\/a>\u00a0(although the European Medicines Agency (EMA) says the\u00a0benefits still outweigh the risks<\/a>).<\/p>\n

However, a more widespread policy of mixing different vaccines could also help to ease vaccine supply pressures and may even boost immune response. While the World Health Organisation has said there is currently \u2018no adequate data<\/a>\u2019 on\u00a0interchangeability<\/a>, various trials are now assessing this approach.<\/p>\n

Here are five things to know about mixing coronavirus vaccines.<\/p>\n

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  1. \n

    Mix-and-match is nothing new – it started with HIV research<\/strong><\/h4>\n<\/li>\n<\/ol>\n

    Mixing different vaccine types is known as a heterologous prime-boost vaccination. It started in the 1990s as a strategy tested by HIV researchers, according to Dr Pierre Meulien, executive director of the Innovative Medicines Initiative (IMI), an EU and European pharmaceutical industry partnership. \u2018Scientifically, this is not anything new,\u2019 he said.<\/p>\n

    HIV researchers knew that a classical vaccine would not induce the extremely complex immunological mechanisms needed for potential protection from HIV infection. \u2018People were trying to understand how you could induce both T and B cell immunity,\u2019 said Dr Meulien, referring to the critical cells in the adaptive immune system. \u2018And this was the main driver for that work (mixing vaccines).\u2019<\/p>\n

    HIV was also the driver for scientists to develop new vaccine platforms to deliver their payload. These platforms include DNA, mRNA, and viral vectors such as the adenovirus, the last two both used in approved Covid-19 vaccines. The raft of new platforms created over the last 30 years is what enabled coronavirus vaccines to be developed so quickly, says Dr Fr\u00e9d\u00e9ric Martinon an immunologist at the French National Institute of Health and Medical Research (INSERM).<\/p>\n

    Rodolphe Thi\u00e9baut, a professor of public health at France\u2019s University of Bordeaux, says the idea behind mixing vaccines is that \u2018you are basically presenting the antigen (the recognisable part of the pathogen) to the immune system in a different way\u2019 which helps the immune system get a better overview of the antigen and tailor its response.<\/p>\n

    A prime-boost regimen is the only vaccine to ever show\u00a0efficacy<\/a>\u00a0– although not high enough – against HIV infection. In\u00a02012<\/a>, it was shown to reduce transmission by about 30% in phase 3 human trials. This has led to high expectations around the approach, says Prof. Thi\u00e9baut.<\/p>\n

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    1. \n

      Mixing doses can help avoid immunity against a vaccine\u00a0<\/strong><\/h4>\n<\/li>\n<\/ol>\n

      Because some vaccines are delivered into the body using a modified virus, it is possible for the immune system to attack the vaccine itself. Mixing the platforms for the booster could reduce the risk of developing immunity against a viral vector vaccine.<\/p>\n

      When it comes to Covid-19 vaccines, Russia\u2019s\u00a0Sputnik V<\/a>, Johnson & Johnson, CanSino Biologics and AstraZeneca\u2019s products use a virus, an adenovirus – it usually causes a common cold – modified to express the coronavirus spike protein that the immune system activates against. It is \u2018replication deficient\u2019, so it can\u2019t copy itself in the body once injected and give us a cold, explains Pia Dosenovic, an assistant professor in immunology at Karolinska Institutet in Sweden\u00a0who researches vaccine development through the project\u00a0VIVA<\/a>.<\/p>\n

      But it\u2019s possible for the immune system to develop a response against the adenovirus platform. This is not dangerous, says Prof. Dosenovic, but it could dampen the vaccine\u2019s effect.<\/p>\n

      To get around this possible risk, Prof. Dosenovic says Sputnik V uses a different adenovirus in each shot, and AstraZeneca uses one from chimpanzees that our systems have never encountered.<\/p>\n

      Prof. Dosenovic says getting a third shot – which is possible if vaccines are updated to address variants – with a viral vector vaccine would not be optimal. From this perspective, it makes sense to change platforms to mRNA or one that is protein-based like Novavax.<\/p>\n

      \u2018This is not brand new thinking. We have decades of experience in pre-clinical and clinical (work), especially in HIV, using these approaches.’<\/p>\n

      Dr Pierre Meulien, executive director of the Innovative Medicines Initiative<\/p><\/blockquote>\n

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      1. \n

        Mixing vaccines can elicit a stronger\/longer-lasting response than a single vaccine regimen<\/strong><\/h4>\n<\/li>\n<\/ol>\n

        When it comes to viral vector-based vaccines, a mixed-dose approach may not only stop the immune system from inhibiting a vaccine, but also confer stronger and longer-lasting protection.<\/p>\n

        \u2018If you give a vector, vector, vector, or you give a vector, vector, protein, then I would expect that you get a stronger antibody response (to the encoded antigen) in the second approach,\u2019 said Prof. Dosenovic. \u2018But to know that you would have to do experiments.\u2019<\/p>\n

        Again, this is because we want to train the immune system to attack the virus causing the disease rather than the one delivering the vaccine.\u00a0\u2018<\/em>If you mix different types of vaccine, we can imagine that you will increase the (immune) response against the common antigen which is the antigen of interest and not against the vector itself,\u2019 said Dr Martinon.<\/p>\n

        And there is precedent. The\u00a0Ebola vaccine<\/a>\u00a0developed by Johnson & Johnson is an example of a mixed-dose approach being specifically chosen because the immune response could be long-lasting. The first shot uses the same adenovirus as the AstraZeneca coronavirus vaccine, and the second uses an\u00a0MVA vector<\/a>\u00a0\u2013 a modified version of a poxvirus \u2013 a type that is also\u00a0under investigation<\/a>\u00a0for future Covid-19 vaccines.<\/p>\n

        Prof. Thi\u00e9baut is coordinator of\u00a0EBOVAC2<\/a>, a programme assessing the safety and efficacy of this vaccine. He says they have had a \u2018very good response\u2019 with this strategy and\u00a0predict that the new boost will enable protection to last\u00a0<\/a>longer than it would otherwise. \u2018At least half of the cells that are producing the antibodies will probably stay at least five years,\u2019 he said.<\/p>\n

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        1. \n

          The safety and effect of mixing coronavirus vaccines must be assessed\u00a0<\/strong><\/h4>\n<\/li>\n<\/ol>\n

          While experts don\u2019t consider the approach of mixing vaccines to be dangerous, they say that we don\u2019t have enough data about coronavirus vaccine mixing and that safety should be evaluated as in any new vaccine strategy.<\/p>\n

          In particular, mixing mRNA vaccines with adenovirus-based vaccines and vice versa has not been done before, says Dr Meulien, as the first instance of mRNA vaccine technology being approved for human use was for Covid-19.<\/p>\n

          \u2018I think you really need to start from scratch,\u2019 he said. \u2018You have to do dosing regimens and all the usual things that you do in a precautionary way. You will have to do it with these new things because none of them have been tested together before.\u2019<\/p>\n

          Various trials are underway to test coronavirus vaccine mixing. One anticipated study is that of the Oxford Vaccine Group\u2019s\u00a0Com-Cov<\/a>\u00a0trial –\u00a0launched<\/a>\u00a0after the UK in January approved a mixed-dose approach – to study immune responses and any side effects of combinations of four vaccines:\u00a0AstraZeneca, Pfizer\/BioNTech, Moderna, and Novavax. \u2018What I’m hoping is that we won’t rule out any combinations,\u2019 chief investigator\u00a0Professor Matthew Snape<\/a>\u00a0told the BBC.<\/p>\n

          In terms of the research questions that need to be answered, Dr Meulien said: \u2018I think the types of immune response that are induced, the longevity of response, and then of course, the safety profile would be the three things that I would say would be very important.\u2019<\/p>\n

          Spain is\u00a0planning human trials<\/a>\u00a0of the effects of following one dose of the AstraZeneca vaccine with a dose of the Pfizer\/BioNTech vaccine. Countries that have already taken decisions to mix vaccines are operating by weighing up risks and benefits, according to Dr Meulien.<\/p>\n

          \u2018This is not brand new thinking,\u2019 he said. \u2018We have decades of experience in pre-clinical and clinical (work), especially in HIV, using these approaches. So it\u2019s not as if we\u2019re putting populations at risk doing this.\u2019<\/p>\n

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          1. \n

            Mix-and-match could help us fight variants<\/strong><\/h4>\n<\/li>\n<\/ol>\n

            For Dr Meulien, the main incentive to mix vaccines is to potentially induce a broader immune response. \u2018I mean broaden to cover the variants that are now popping up all over the place,\u2019 he said.<\/p>\n

            But there needs to be a real scientific and regulatory justification to mix, he says.<\/p>\n

            Dr Martinon says vaccines will be improved for different\u00a0variants<\/a>\u00a0such as those that emerged in the UK, Brazil, South Africa, and most recently in India, which is currently facing a surge in cases and a new coronavirus mutation that is potentially making Sars-CoV-2 more contagious and able to\u00a0reinfect<\/a>.<\/p>\n

            The next generation of vaccines will probably be directed against several coronavirus variants, he says, with different vaccines targeting different variants. Mixing these vaccines would give broad collective immunity and make it harder for variants to circulate or for new ones to emerge, according to Dr Martinon.<\/p>\n

            Periodic shots will be required, he says, although how much time between them is unknown, the hope is it will be years.<\/p>\n

            From a public health perspective, Prof. Thi\u00e9baut says mixing vaccines could help overcome this pandemic by speeding up the vaccination rollout. Obtaining good evaluations of vaccine combinations that show what works well is key.<\/p>\n

            \u2018It’s good news in terms of flexibility of every government to be able to use what they can get as soon as possible,\u2019 he said. This flexibility is crucial. \u2018The best way to fight these variants is to vaccinate as quickly as possible the largest part of the population on Earth.\u2019<\/p>\n

            The\u00a0<\/em>VIVA<\/em><\/a>\u00a0project is funded by the EU\u2019s European Research Council and\u00a0<\/em>EBOVAC2<\/em><\/a>\u00a0is funded by the IMI.<\/em><\/p>\n

            Originally published on Horizon Magazine<\/a><\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

            Amid global vaccine rollouts, with\u00a0nearly\u00a01.2 billion\u00a0doses currently administered, some countries have recommended a mixed-dose approach where a first prime shot is followed by a booster of a second type.\u00a0 The measure has been introduced by\u00a0France\u00a0and\u00a0Germany\u00a0for people who received a first dose of the AstraZeneca vaccine but are in age groups for which that vaccine is … Read more<\/a><\/p>\n","protected":false},"author":298,"featured_media":1717,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"generate_page_header":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[12],"tags":[360,405,252],"class_list":["post-1716","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health","tag-covid-19","tag-mrna-vaccines","tag-vaccine"],"yoast_head":"\nFive things to know about: Mixing and matching coronavirus vaccines - Horizon Magazine Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/scienceblog.com\/horizon\/1716\/five-things-to-know-about-mixing-and-matching-coronavirus-vaccines\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Five things to know about: Mixing and matching coronavirus vaccines\" \/>\n<meta property=\"og:description\" content=\"Amid global vaccine rollouts, with\u00a0nearly\u00a01.2 billion\u00a0doses currently administered, some countries have recommended a mixed-dose approach where a first prime shot is followed by a booster of a second type.\u00a0 The measure has been introduced by\u00a0France\u00a0and\u00a0Germany\u00a0for people who received a first dose of the AstraZeneca vaccine but are in age groups for which that vaccine is ... 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