What's coming next for COVID-19 vaccines? Here's the latest on 9 leading programs, after Pfizer and Moderna

  • Two coronavirus vaccines are now authorized for emergency use in the US. 
  • Other shots have gained the OK in foreign countries. 
  • The world will need multiple safe and effective vaccines to immunize the world's population against this pandemic.
  • Here's the latest on 11 frontrunners, including Pfizer, Moderna, and AstraZeneca, as well as top Chinese, Canadian, and Russian vaccines.
  • Visit Business Insider's homepage for more stories.

While there are more than 200 coronavirus vaccine candidates in development, only a handful are being rolled out or in the final stages of clinical research.

The first authorized COVID-19 shots, developed by Pfizer and Moderna, started being rolled out in the US in December, marking a new phase in the fight against this pandemic. But there's still a long road ahead, and experts are hoping multiple vaccine programs pull through to have enough doses to eventually protect the world's population.

Here's the latest on the 11 top coronavirus programs, ranging from the first authorized vaccines to a handful of candidates still undergoing human trials. 

 

1. Pfizer and BioNTech's program leads the world

The New York pharmaceutical giant Pfizer and German biotech BioNTech developed the first coronavirus shot to be authorized for emergency use in Western nations. A late-stage clinical trial found the two-dose jab was 95% effective at preventing symptomatic COVID-19.

Dr. Ugur Sahin and Dr. Özlem Türeci, co-founders of BioNTech.Stefan F. So¤mmer via www.imago-images.de/Reuters

Regulators around the world, including in the US, UK, and Canada, have OK'd the vaccine. The first immunizations happened on December 14 in the US.

Pfizer aims to produce 1.3 billion doses in 2021, with supply deals already in place with many countries. Even with a highly effective shot, the research work isn't done. The companies are working on a next-generation version that could be rolled out sometime in 2021. This improved shot would hopefully be stable at warmer temperatures, evading the ultra-cold temperature requirements that limit the current version.

Read more: How the pharma giant Pfizer teamed up with a little-known biotech to develop the first authorized coronavirus vaccine in record time

2. Moderna's vaccine is highly effective and now being rolled out

The Massachusetts biotech upstart Moderna developed a two-dose shot that's 94% effective at preventing symptomatic COVID-19. US regulators OK'd the vaccine for emergency use in December, making it the second authorized shot in the US. 

Moderna's study also showed a profound impact on severe disease, suggesting the shot could be 100% effective at preventing the worst COVID-19 outcomes. 

Moderna plans to produce somewhere between 600 million and 1 billion doses in 2021, the company said on January 4. The US should receive about 100 million doses in the first three months of 2021 and another 100 million doses in the second quarter. That should be enough to vaccinate 100 million Americans.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, prepares to receive Moderna's coronavirus vaccine.Patrick Semansky-Pool/Getty Images

Unlike Pfizer's shot, Moderna's vaccine doesn't need to be kept at extremely cold temperatures. It does need standard refrigeration.

Both vaccines have only been tested as a two-dose regimen, with Moderna's second booster dose coming 28 days after the first injection. While there has been much debate around both vaccines about testing lower doses or delaying the booster shots, US regulators have thrown cold water on those proposals.

Read more: Inside Moderna's historic coronavirus vaccine program that transformed the biotech upstart into a $55 billion drug industry powerhouse

3. AstraZeneca and Oxford's shot faces scrutiny, wins OK in the UK

AstraZeneca is testing a two-dose vaccine developed by University of Oxford scientists. The two organizations are running several phase-three studies, including in the US, the UK, Mexico, Brazil, and South Africa. 

UK regulators authorized the shot on December 30, and India OK'd the shot on January 2.

This program has faced plenty of questions since AstraZeneca and Oxford touted success in November, saying the shot was 70% effective on average.

In particular, they emphasized a certain dosing regimen — a low dose first followed by a high dose — appeared to be more than 90% effective. But that claim faced intense scrutiny, particularly when it became known that the dosing regimen wasn't part of the original research plan. It's not clear if the low-high dose arm was accidental or intentional.

The original dosing plan — which has the most data behind it — was 62% effective at preventing COVID-19. While that may be helpful, it's not as good as shots from Pfizer or Moderna. It raises a thorny question, given that AstraZeneca's shot is easier to produce and being sold for around $3 to $4 per dose. 

The British pharma said it could produce a whopping 3 billion doses in 2021 — more than Pfizer's and Moderna's projections combined. 

More rigorous studies should help clarify how well the shot really works. A US-based study, which was put on hold for more than a month in the fall to investigate a major safety concern, has since resumed and enrolled about 29,000 volunteers as of December 30, and top US officials expect a readout from the study in the coming months, potentially supporting an emergency OK in April.

4. Johnson & Johnson's one-dose shot could get US authorization next month

J&J could provide the world with a one-dose coronavirus vaccine. But unlike Pfizer and Moderna, J&J's program has yet to provide definitive results from a late-stage trial.

That data should come in January, according to the company and top US officials. A massive study is testing both a one- and two-dose vaccine regimen. If positive, J&J could submit for emergency use in the second half of January, setting up a regulatory decision in February.

If successful, J&J would be able to tout the simplest logistics by far: a single dose that can be kept stable at typical refrigerator temperatures for several months. J&J is aiming to manufacture 1 billion doses in 2021.

Read more: The top scientist at the world's biggest healthcare company told us the top challenge facing J&J and rivals racing to develop a coronavirus vaccine

5. Novavax is running several trials of its protein-based shot

The Maryland vaccine developer Novavax started a 30,000-person trial in the US and Mexico in the final days of 2020, testing its protein-based shot as a two-dose regimen. That trial likely will take until spring 2021 at the earliest to provide results.

The company is also running two smaller late-stage studies that could both produce efficacy results in the first three months of 2021. Those are a 15,000-person UK-based trial and a South African study with nearly 5,000 volunteers.

It's unclear how many doses Novavax expects to produce in 2021. But the company has said that by the middle of 2021, it should be able to make shots at a rate of 2 billion doses per year.

Read more: The CEO of a tiny biotech working on a coronavirus vaccine tells us how a $1.6 billion grant from the US government will 'level the playing field' with Big Pharma

A staff member tests samples of a potential COVID-19 vaccine at Sinopharm.Zhang Yuwei/Xinhua via AP6. Sinopharm's vaccine is approved in China

Since the beginning of the outbreak, Chinese scientists have developed a range of vaccine candidates. One of the most advanced is being tested by the state-owned pharmaceutical company Sinopharm. 

In the final days of 2020, China approved Sinopharm's vaccine, saying a late-stage study showed it to be 79% effective at preventing COVID-19. Detailed results aren't available, and United Arab Emirates health officials had previously said Sinopharm's shot was 86% effective, having granted an emergency OK for the vaccine in September.

Even before the official OK, China had already started mass-vaccinating its citizens, aiming to immunize 50 million people by mid-February. 

7. Sinovac is another vaccine frontrunner from China

Another vaccine frontrunner from China has also produced promising, but limited, efficacy results. 

The Beijing-based biotech Sinovac's vaccine was about 91% effective in a late-stage study, Turkish researchers said on December 24. Brazilian health officials had previously said the vaccine was above 50% effective but did not share detailed results at Sinovac's request, Reuters reported.

8. Russia's Sputnik V is said to be highly effective, but scientists haven't yet published the proof

One of the unlikeliest vaccine frontrunners comes from Russia. The Gamaleya National Center of Epidemiology and Microbiology is a Russian-based research institute that developed a two-dose shot. 

Russian officials say late-stage testing has shown the vaccine to be more than 90% effective at preventing COVID-19. Russian scientists have yet to publish those efficacy results in a medical journal. 

Despite some level of skepticism around the program, Belarus and Argentina became the first foreign countries to OK the shot in December. It's also available in Russia.

9. CureVac is developing a vaccine using the same technology as Moderna and Pfizer-BioNTech

CureVac is a German biotech that's developing a messenger RNA-based vaccine, the same technology used by Moderna and BioNTech. 

A late-stage study started in December and will enroll more than 35,000 people in Latin America and Europe. CureVac said it could have results in the first half of 2021. Like other authorized vaccines, CureVac's candidate is a two-dose vaccine. 

The company has no previous experience in mass-manufacturing or selling vaccines, but has built a European manufacturing network it projects can produce up to 300 million doses in 2021 and up to 600 million doses in 2022.

Researchers work at Medicago's greenhouse in Durham, North Carolina.Medicago10. Medicago and GlaxoSmithKline are collaborating on a plant-derived shot

The Canadian pharmaceutical company Medicago started the final stage of clinical trials in November, aiming to see if two doses of its vaccine given with a GlaxoSmithKline adjuvant three weeks apart will be effective. 

The phase-three study will enroll over 30,000 people across the world. Medicago's shot is plant-derived, building off research that turns greenhouses full of a close relative of tobacco into protein-producing minifactories. The company is backed by the tobacco giant Philip Morris.

Read more: The Canadian biotech Medicago is betting it can make a coronavirus vaccine out of plants, and it just started testing it in humans

11. Sanofi and GlaxoSmithKline are vaccine experts, but their coronavirus shot stumbled

Sanofi and GSK's program immediately became a frontrunner when the two vaccine giants decided to team up in the spring to develop a coronavirus vaccine. 

But the pharmaceutical giants have stumbled, saying in December that an early study showed a lack of immune response in elderly volunteers. The duo was already well behind companies like Moderna and Pfizer, and this setback pushed their timeline for a potential launch out to the second half of 2021. 

The pair are working on an improved version and hope to start a mid-stage trial in February.

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