Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that emerged in the human population in Wuhan City, Hubei Province, China in December 2019. As of Jan 2022, there are over 328 million SARS-CoV-2 case worldwide and over 5.54 million deaths as a result of infection with SARS-CoV-2 (COVID-19). According to WHO Situation Report on 17 January 2022, Africa has 7 million confirmed cases with over 160, 804 deaths. The COVID-19 pandemic has caused global suffering, mortality, and severe economic pressures. There is thus a continued urgent global need to develop effective and safe vaccines and drugs to make them available at scale and equitably across all countries including in Africa. Despite the rapid successes in vaccine development and issuance of WHO Emergency Use Listings (EUL), the WHO SAGE Interim Reports and FDA Emergency Use Authorization (EUA) for COVID-19 vaccine evaluations have reported limitations on safety and efficacy data in certain populations including children and adolescents, pregnant women, and immunocompromised individuals such as those with HIV/AIDS who are at higher risk of severe COVID-19 disease. Africa is especially vulnerable in this respect given the high prevalence of HIV/AIDS in countries such as Kenya where the prevalence is over 20% in some places. The risk of recurring new waves of COVID-19 cases caused by Variants of Concern (VOC) exacerbates global public health crisis. A weak immune response to either single or two doses of primary vaccination against SARS-CoV-2 has been observed in immunocompromised population. Emerging data from observational studies consistently show waning immunity to primary vaccination for SARS-CoV-2 mutants, and a decline in vaccine effectiveness against SARS-CoV-2 infection and COVID-19 with time since primary vaccinations. These factors have led to consideration of the potential need for, and optimal timing of, booster doses for vaccinated populations. However, vaccine inequality, lack of availability of the same vaccine product used for primary vaccinations and unpredictable vaccine supply remain a challenge in LMIC. Consideration of heterologous COVID-19 vaccine to allow interchangeability (mix and match) use of vaccine products available in LMIC would therefore allow for programmatic flexibility. Based on a recent systematic review and meta-regression analysis, across the four WHO EUL COVID-19 vaccines with the most data (i.e., BNT162b2, mRNA 1273, Ad26.COV2.S and ChAdOx1-S \[recombinant\] vaccine), vaccine effectiveness against severe COVID-19 decreased by about 8% (95% confidence interval (CI): 4-15%) over a period of 6 months in all age groups. In adults above 50 years, vaccine effectiveness against severe disease decreased by about 10% (95% CI: 6 - 15%) over the same period. Vaccine effectiveness against symptomatic disease decreased by 32% (95% CI: 11 - 69%) for those above 50 years of age. For some inactivated vaccines (CoronaVac and COVID-19 vaccine BIBP), WHO has already issued the recommendation for the administration of an additional dose to those aged 60 years or older as part of the primary series to make initial immunity more robust. The FDA issued a EUA for the Janssen Ad26.COV.S1 COVID-19 vaccine for active immunization to prevent COVID-19 caused by SARS-CoV-2 in individuals 18 years of age and older. In September 2021, both the single dose and 2 dose Janssen COVID-19 vaccine regimens demonstrated high efficacy (79% protection (CI, 77%-80%) for COVID-19-related infections and 81 percent (CI, 79%-84%) for COVID-19-related hospitalizations. vs 94% (CI, 58%-100%) protection against symptomatic COVID-19 in the U.S. respectively. Furthermore, the safety profile of the vaccine remained consistent and generally well-tolerated in the 2 regimens. Finally, when a booster of the Janssen COVID-19 vaccine given 6 months after the single shot, antibody levels increased nine-fold one week after the booster and continued to climb to 12-fold higher four weeks after the booster. On June 14, 2021, Novavax reported the results of its PREVENT-19 pivotal Phase 3 trial of the NVX-CoV2373. The results showed an overall vaccine efficacy of 90.4% (95% CI: 82.9 - 94.6) in the US and Mexico. Sequenced data showed a vaccine efficacy was 93.2% (95% CI: 83.9 - 97.1) against Variants of Concern and Variants of Interest which represented 82% of cases. Studies of NVX-CoV2373 with Matrix-M adjuvant have demonstrated an acceptable safety and reactogenicity profile in adults ≥18 years of age. On December 20, 2021, the WHO issued interim recommendations and authorized under its emergency use listing (EUL) procedure, the NVX-CoV2373 COVID-19 vaccine developed by Novavax and Serum Institute of India. The pivotal phase 3 registration trial of the Moderna mRNA-1273 COVID-19 vaccine was conducted in the United States of America and involved about 30 000 participants aged 18 years or older with no known history of SARS-CoV-2 infection.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
1,919
Janssen Ad26COVS1 is formulated to contain 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, sodium chloride.
Pfizer-BioNTech COVID-19 vaccine, BNT162b2, is an mRNA vaccine encoding a P2 mutant spike protein (PS 2) and formulated as an RNA-lipid nanoparticle of nucleoside-modified mRNA (modRNA). BNT162b2 elicits a blunted innate immune sensor activating capacity and thus augments antigen expression.
Sinopharm's BBIBP-CorV and Sinovac's CoronaVac are inactivated whole-virus COVID-19 vaccines. Both are produced by chemically inactivating (using beta-propiolactone) the whole SARS-CoV-2 virus (strain CN02 or similar) and then adsorbing the inactivated viral particles onto an aluminum hydroxide (alum) adjuvant. This traditional vaccine platform presents the immune system with the entire structural repertoire of the virus including spike, nucleocapsid, and membrane proteins in a non-replicating form, thereby inducing a broad antibody and cellular immune response against multiple viral antigens.
Victoria Biomedical Research Institute
Kisumu, Kenya
Solicited Local Adverse Events
Occurrence of solicited local AEs (pain, redness, swelling)
Time frame: Within 7 days after booster vaccination
Solicited Systemic Adverse Events
Occurrence of solicited systemic AEs (fever, headache, fatigue)
Time frame: Within 7 days after booster vaccination
Incidences of vaccine Related Serious Adverse Events
Incidence of SAEs assessed as related to study vaccination
Time frame: Through study completion
Immunogenicity Objective 1: Neutralizing Antibody Titer
GMT of SARS-CoV-2 neutralizing antibodies measured by pVNA
Time frame: At Day 28 post-booster
Immunogenicity Objective 2:Anti-Spike IgG Titer
GMT of SARS-CoV-2 spike-specific IgG antibodies measured by ELISA
Time frame: At Day 28 post-booster
Immunogenicity Objective 3: Fold Rise in Neutralizing Antibodies
GMFR in neutralizing antibody titers from baseline to Day 28
Time frame: Baseline (Day 0) and Day 28
Immunogenicity Objective 4: Fold Rise in Anti-Spike IgG
GMFR in spike-specific IgG titers from baseline to Day 28
Time frame: Baseline (Day 0) and Day 28
Incidence of Unsolicited Adverse Events
Number and percentage of participants with unsolicited AEs, severity, and relatedness.
Time frame: Through 28 days after booster vaccination.
Incidence of Treatment-Emergent Adverse Events (TEAEs)
Number and percentage of participants with TEAEs, by MedDRA term, severity, and relatedness.
Time frame: From Day 0 (booster) to Day 85.
Incidence of Adverse Events of Special Interest (AESIs)
Number and percentage of participants with AESIs
Time frame: From Booster (Day 0) through study completion, an average of 1 year
Incidence of All Serious Adverse Events (SAEs)
Number and percentage of participants with any SAE.
Time frame: From Day 0 through study completion, an average of 1 year
Heterologous vs. Homologous Boost: Neutralizing Antibody Titer
Geometric Mean Titer (GMT) of serum SARS-CoV-2 neutralizing antibodies, comparing heterologous and homologous boost regimens.
Time frame: At Day 28 post-booster.
Heterologous vs. Homologous Boost: Fold Rise in Neutralizing Antibodies
Geometric Mean Fold Rise (GMFR) in neutralizing antibody titers from baseline (Day 0) to Day 28, comparing heterologous and homologous boost regimens.
Time frame: Baseline (Day 0) and Day 28 post-booster.
Heterologous vs. Homologous Boost: Anti-Spike IgG Titer
Geometric Mean Titer (GMT) of serum SARS-CoV-2 spike-specific IgG antibodies, comparing heterologous and homologous boost regimens.
Time frame: At Day 28 post-booster.
Heterologous vs. Homologous Boost: Fold Rise in Anti-Spike IgG
Geometric Mean Fold Rise (GMFR) in anti-spike IgG antibody titers from baseline (Day 0) to Day 28, comparing heterologous and homologous boost regimens.
Time frame: Baseline (Day 0) and Day 28 post-booster.
Durability: Neutralizing Antibody Titer Over Time
Geometric Mean Titer (GMT) of serum SARS-CoV-2 neutralizing antibodies at each scheduled post-boost study visit.
Time frame: Day 28, Month 6, Month 12
Durability: Fold Rise in Neutralizing Antibodies Over Time
Geometric Mean Fold Rise (GMFR) in neutralizing antibody titers from baseline at each scheduled post-boost study visit.
Time frame: Day 0, Day 28, Month 6, Month 12.
Durability: Anti-Spike IgG Titer Over Time
Geometric Mean Titer (GMT) of serum SARS-CoV-2 spike-specific IgG antibodies at each scheduled post-boost study visit.
Time frame: Day 28, Month 6, Month 12
Durability: Fold Rise in Anti-Spike IgG Over Time
Geometric Mean Fold Rise (GMFR) in anti-spike IgG antibody titers from baseline at each scheduled post-boost study visit.
Time frame: Day 0, Day 28, Month 6, Month 12.
Mucosal Immunity: Secretory IgA (S-IgA) Titer (Day 28)
Geometric Mean Titer (GMT) of mucosal secretory IgA antibodies against SARS-CoV-2 spike protein.
Time frame: At Day 28 post-booster.
Mucosal Immunity: Fold Rise in Secretory IgA (S-IgA)
Geometric Mean Fold Rise (GMFR) in mucosal S-IgA antibody titers from baseline (Day 0) to Day 28.
Time frame: Baseline (Day 0) and Day 28 post-booster.
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