Application of Traditional Vaccine Development Strategies to SARS-CoV-2

Over the past 150 years, vaccines have revolutionized the relationship between people and disease. During the COVID-19 pandemic, technologies such as mRNA vaccines have received significant attention due to their novelty and successes. However, more traditional vaccine development platforms have also been applied against SARS-CoV-2, yielding important tools in the worldwide fight against the virus. A variety of approaches have been used to develop COVID-19 vaccines that are now authorized for use in countries around the world. In this review, we highlight strategies that focus on the viral capsid outwards, rather than on the nucleic acids inside. Such approaches broadly fall into two categories: whole-virus vaccines and subunit vaccines. Whole-virus vaccine approaches use the virus itself, either in an inactivated or attenuated state. Subunit vaccines isolate an immunogenic component of the virus using various strategies that is then introduced through vaccination. We highlight specific vaccine candidates that utilize these approaches in different ways. In a companion manuscript, we review the more recent and novel development of nucleic-acid based vaccine technologies. We further consider the role that these COVID-19 vaccine development programs have played in providing immunity to people around the world. Well-established vaccine technologies have proved especially important because of the significant role they have played in COVID-19 vaccine access at the global scale. Vaccine development programs that use established platforms have been undertaken in a much wider range of countries than those using nucleic-acid-based technologies, which have been led by wealthy Western countries. Therefore, these vaccine platforms, while less cutting-edge on the biotechnology side, have proven to be extremely important to the management of SARS-CoV-2.