We have one of the best TB vaccines in the world: Bharat Bio's Krishna Ella

Saying he is a bit fatigued but ready to focus on his key projects like the tuberculosis (TB) vaccine, KRISHNA ELLA, executive chairman of Bharat Biotech, the makers of Covaxin and the nasal Covid vaccine iNCOVACC, shares his future plans in a conversation with Sohini Das at the biotech company's HQs in Hyderbad. Edited excerpts:
 

What is the next vaccine programme close to your heart after Covaxin?

We are working on the TB vaccine, as the Prime Minister’s view is also to eradicate TB from the country. We have one of the best TB vaccines in the world, and we are working with a Spanish company on this. It has already completed Phase-II studies and has entered Phase-III studies in South Africa.

This is one of the latest-generation TB vaccines. We are now in the technology transfer phase with the Spanish company, and we are trying to partner Indian Council of Medical Research (ICMR) to conduct efficacy trials in India as well.

This is a live-attenuated vaccine. Bacillus Calmette-Guerin (BCG) has done a great job, and people are trying to come up with an upgraded BCG vaccine. But BCG is different from the TB vaccine. We now need a TB vaccine that would stop the transmission of TB. We don’t yet have evidence of transmission, but that is where we need ICMR’s help.

ICMR and the Ministry of Health need to collaborate to come up with a strategy. We don’t want to shortcut science, but we need to speed up our understanding. Experts like Soumya Swaminathan, who is an authority on TB, can lead the programme in mission mode with ICMR and take it forward.

You also have a cholera vaccine ready to roll out. What are the timelines?

The main target countries for the cholera vaccine are African countries. Right now, there is a shortage of cholera vaccines globally. Our vaccine is ready, and we are waiting for licensure.

The eastern parts of India — West Bengal — and then neighbouring countries of Bangladesh and Nepal have incidences of cholera, but we don’t want to admit that there is a cholera problem. We want to say that we are free from cholera, but many people still get diarrhoea and dysentery because of cholera. Our cholera vaccine will be available to both children and adults.

Do you think Covid vaccination will become like an annual flu shot?

The virus is more intelligent than humans; it is changing. One has to keep watch, and since this is a respiratory pathogen, it is more dangerous for the elderly, especially those with comorbidities.

I really don’t want people to be scared of Covid and be commercially exploited due to that fear. But we need to be vigilant. My worry is that if this virus goes to animals and comes back in a different form, that can be scary.

Will it become like a seasonal flu shot? Yes, it may. If the Covid virus remains in global circulation for one or two more years, then I feel it may become like a flu vaccine. We are also working on a combination product. Flu is also going to increase in this country, so both are going to be important.

The Nipah virus keeps coming back. You had a Zika candidate. What is your opinion about developing vaccines for diseases that do not infect a lot of people?

If I were only the chairman of a company, I would not take on such small problems that do not have large volumes.

But as a scientist, I would like to do it because we don’t know when Nipah becomes a big problem; it is already giving sporadic small signals. We are ignoring it now, but it might become big one day. The initiative has to come from the government rather than from companies for small problems like this.

When developing a vaccine, what is more important, safety, or efficacy?

My first priority is always safety when developing a vaccine because we are giving vaccines to healthy people, and you can have the best platform technology in the world, but that doesn’t matter if there are safety concerns.

In contrast, antibiotics are given to infected people, but vaccines are not only given to healthy people, mostly to children.

During the pandemic, everyone was talking about efficacy, and now that the pandemic is over, everyone is talking about safety.

Viruses do cause problems for people, but we don’t expect the vaccine to cause problems. Covaxin is perhaps the safest vaccine in the entire world; it stays in the muscle but does not enter the body. That’s a critical aspect that makes this a safe vaccine.

T-cell response is very important, not immunoglobulin G (IgG). People were testing the IgG response, and now the US is saying that the messenger ribonucleic acid vaccine is not giving a T-cell response but only an IgG response.

Tell us a bit about your days during the pandemic developing Covaxin.

There was a lot of negativity in the countries around India that developed vaccines, a lot of politics, and polarisation. I stopped watching television, ignored all that, and only focused on making the vaccine.

My wife and I would be at the plant until midnight. Some of the health ministry calls would only be around 11 pm or so. We were working almost 24 hours a day then.

When you see the suffering of the people, it’s all worth it. We are working in much better containment facilities than anyone on the road. By the end of it, none of my employees had died of Covid. We have more than 5,000 people directly and indirectly employed with us.