Some statisticians say the case count could be at least 5 to 20 times higher due to inconsistencies and variations in testing and testing protocols in different countries. A paper published by the Imperial College London estimated that the number of people infected by COVID-19 in the UK as of March 30 was between 800,000 to 3.7 million. The official case count then was just 22,141. Even the more conservative actual estimate of 800,000 is 36 times higher than the reported count.
Without a vaccine and an effective treatment, we may never get back to life as it used to be.
With new cases in the US and Europe declining, they are starting to gradually re-open their economies.
Singapore has started to re-open some but limited businesses and social activities ahead of the official "circuit breaker" end date of June 1. There will however not be a sudden relaxation of the lockdown rules on that date - only a very gradual and controlled return to some form of normalcy which the government say will take months.
One of the activities that have not ceased during the lockdown is the search for a vaccine in the city-state which is a leading centre in the region for medical research.
Singapore was involved in the international clinical trial of the Gilead Sciences drug remdesivir which was initially developed to treat Ebola. Around 100 patients in Singapore were enrolled in the US National Institute of Allergy and Infectious Disease (NIAID) led international trial which had about 1,000 patients taking part globally. The trial showed that remdesivir significantly improved recovery prospects of COVID-19 patients.
Singapore biotech firm Tychan in partnership with the Singapore Agency for Science, Technology and Research (A*STAR), is working with Chugai Pharmaceutical of Japan on a monoclonal antibodies drug.
Monoclonal antibodies drugs work by using plasma from blood taken from recovered COVID-19 patients which can bind with the virus protein thereby preventing them from entering a person's cells. It can be used both as a prophylactic and for treatment. Prophylactics are a group of drugs while not a vaccine, can be used by high-risk individuals, like frontline health staff, to prevent that person from contracting the virus.
On the vaccine front, the Singapore Duke-NUS Medical School is working with Arcturus Therapeutics on its mRNA (messenger Ribonucleic Acid) vaccine which has been shown to be highly effective in pre-clinical studies.
RNA vaccines use a relatively new technology that works by introducing an RNA with specific information into the human body that will produce the antigen (a protein from the pathogen) which will then stimulate the immune system to fight the disease.
Another Singaporean biotech firm Esco Aster is developing a chimeric vaccine with US company Vivaldi Biosciences. Chimeric vaccines work by replacing genes from the target pathogen for similar but safe genes from a closely related organism.
The unique feature of the vaccine Esco Aster is working on is that the vaccine is based on a protein backbone which is structured in a way that allows researchers to modify the vaccine within weeks to react to the virus if it mutates. Esco Aster says that once their vaccine passes all necessary trials and approvals, it can scale up production quickly.
However, none of the vaccines being developed in Singapore is expected to win the race to be the first vaccine in the market. Nor does any biotech firm needs to be first to market to be successful. The key would be a combination of how fast a safe and approved vaccine can be developed, the speed at which a facility can be built to mass-produce the vaccine and thereafter in what volume that vaccine can be manufactured and distributed.
India's Pune-based Serum Institute is not only India's largest biotech company but one of the world's largest. It has the capacity to produce 1.5 billion doses of vaccine annually. It is currently working on three projects to produce COVID-19 vaccines - one is with UK's Oxford University, another with US-based biotech Codagenix, and it is also working on its own vaccine. To save time, it is taking the risk of preparing part of its facilities to be ready to produce between 20-40 million doses as soon as in September although one or more of the vaccines being worked on may not succeed in clinical trials or be approved by health authorities.
Usually, a factory is prepared for manufacturing a vaccine only after the vaccine has been approved as the equipment and set-up needed to produce different vaccines can be quite different. This process can take up to 6 months or more.
It is with this "running in parallel" concept in mind that the Bill and Melinda Gates Foundation is funding factories to prepare for 7 different vaccines in the hope that it will save time and lives when a vaccine is ready.
Although an accelerated timeframe for producing the COVID-19 vaccine of between 12 to 18 months is being touted by drug companies and some health officials especially in the US, on average, it takes 4 years to develop a vaccine, even if fast-tracked. The Rotavirus vaccine took 15 years from development to shipping.
A New York Times report in early May says that there are at least 95 vaccine candidates as well as 254 therapies being explored.
A company that has received a fair amount of media attention is US biotech firm Moderna whose early success has led to the US government funding the company to the tune of USD500 million to help develop and test its candidate vaccine.
The other vaccine candidates that have been in the news is the AstraZeneca's collaboration with Oxford University and Chinese government-sponsored effort by Chinese firm CanSino.
That many companies are developing the vaccine simultaneously is a good thing as the success rate of vaccine development is low and that one firm is not likely to be able to meet the demand of the billions of doses of vaccines required to immunise the whole world.
Investors betting on a particular company or companies to vastly improve their bottom-line as a result of developing a successful vaccine should note that the road to a vaccine is not paved in gold. Many of the ongoing research is funded by governments or organisations with the promise that the eventual vaccine will be provided free or at a low cost. Some, for ethical reasons, have decided that what they will sell the vaccine to just to cover their costs, at least in the initial phase of the expected global COVID-19 inoculation drive.