The WHO also reported that 2.8 million vaccines were lost in five countries due to cold chain failures, and less than 10% of countries met WHO recommendations for effective vaccine management practices. While some lyophilized vaccines are available that may be stored at room temperature, such solutions are difficult to produce and present challenges for the healthcare professionals who must reconstitute them on site90.
A highly suitable nanotechnology platform is derived from plant viruses and bacteriophages that evolved as stable nanocontainers protecting their genome cargo under various environmental conditions. Cowpea mosaic virus, for example, is stable at temperatures above 60°C in buffered solution for at least one hour and pH values from 3.5–9.0 indefinitely at room temperature91. Furthermore, plant virus nanoparticles are stable under gastrointestinal conditions92 and orally bioavailable93, therefore opening the door for global distribution and oral vaccination. Vaccines could be produced in edible leaf tissue to enable vaccination of the human population but also livestock, since SARS-CoV-2 is a zoonotic virus that can infect humans and animals. This would be a step forward to meet the goals of the One Health Initiative to unite human and veterinary medicine, which will likely be important to prevent future outbreaks.
Effective vaccination campaigns also require access to health care professionals (HCP), which is challenging in resource-poor or densely populated developing countries under normal circumstances but presents a greater challenge during a global pandemic where the health care system is already strained or breaking. Recently, modern alternatives to such distribution and access challenges have come to light, such as single-dose slow-release implants, film-based vaccines94, and microneedle-based patches that could reduce reliance on the cold chain and ensure vaccination even in situations where qualified HCP are rare or in high demand. Microneedle-based patches could even be self-administered, which would dramatically hasten roll-out and dissemination of such vaccines as well as reduce the burden on the healthcare system. Such modern vaccine delivery devices can be made by solution methods or fabricated via traditional polymer melt-processing (for example, injection moulding). The advantage of melt-processed devices lies in their potential for rapid manufacturing at large scale and their long-term stability independent of the cold chain95,96,97,98. The potential to break the cold chain and ease the burden on the medical system by offering a safe and effective self-administered prophylactic vaccine has been capitalized on by a number of companies such as Veleritas Inc., Zosano, Corium International and Debiotech, and has led to the filing of over 10,000 patents worldwide99
Moreover, several platform technologies described herein may serve as plug-and-play technologies that can be tailored to seasonal or new strains of coronaviruses. Indeed, COVID-19 harbours the potential to become a seasonal disease; underscoring the need for continued investment in coronavirus vaccines. SARS and MERS vaccine candidates did not make it to market due to lack of financial incentive given the low infection numbers, and because the risk of a global pandemic from a newly emerged virus were largely ignored. Yet, because there is some conservation between the coronaviruses, continued research and product development is critical to tackle any new version of coronavirus that emerges in the future.
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