The Oxford-AstraZeneca Vaccine

I read this book on the Oxford-AstraZeneca vaccine by two scientists involved in it. The book talks of the technical, political and practical aspects. Everything about America’s behavior through all matters infuriated the authors, and since the anti-vaccine US folks are called anti-vaxxers, so this book’s title is Vaxxers!

 

The World was Prepared (Somewhat): The authors point out that the Ebola scare of 2014 showed how unprepared the world was for a disease that spread and killed quickly. Fortunately, Ebola didn’t spread beyond a few African countries, but it set off alarm bells on the need to have mechanisms and processes ready for whichever Disease X did go global. While by no means perfect, some baby steps had been taken by the WHO and many countries. For example, platform technologies were recommended – make as many steps in the process common, regardless of the final vaccine. This would also for each new disease/vaccine to require only a few tweaks to the constituent ingredients, avoiding the need to set up the entire process (manufacturing, storage, distribution) from scratch. University research teams were told to have contacts with pharma companies – that way, when the day came, connections would already exist. Some risks were to be taken, but those were operational/money risks, not clinical risks e.g. vaccine research teams would jump to Step 2 without waiting for the results of Step 1 knowing that if Step 1 results were bad, all that effort and money would go down the drain. All this explains how so many different vaccines could come up in such short time for COVID-19. Success was by no means guaranteed – something easily forgotten in the oh-so-many-vaccines that succeeded (American, British, Russian, Indian and Chinese) e.g. one Australian vaccine fell through for the most unfortunate of reasons – it triggered false positives in HIV tests!

“Vaccine development was transformed from a funding Cinderella into royalty.”

 

Perfection was not the Goal: To the Oxford team, while efficacy (prevention of disease by the vaccine) was important, other factors mattered too. Such as how much of it can be produced; how easily it can be delivered; and even if vaccinated folks got the disease, at least they should get milder forms of the disease. The Oxford team tested not just in Britain, but also in Brazil and South Africa – they didn’t want allegations that it was only tested with one ethnic group; it had to be a globally acceptable vaccine. AstraZeneca immediately realized the usefulness of the fact that the Oxford vaccine could be stored at fridge temperatures – this, they knew, meant it could be used in most countries. Even though the typical Western mindset is to keep it as low temperature as practical. They also knew that manufacturing at the Serum Institute would ensure the huge quantities would be possible, and it would also keep the price low.

 

Nationalistic Tendencies: The EU attitude was schizophrenic: The (British) vaccine is terrible, but we don’t want Britain to get all of it. Make up your minds, idiots – if it’s useless, why do you care if the British take all of it?! Trump first denied there was a problem at all; then wanted the vaccine ready before Election Day. His pressure on the dates added to the feeling in America that any vaccine that came through was risky, and pushed through for political reasons. The American agency, FDA, insisted trials had to be re-done in the US because hey, the British regulatory system wasn’t good enough. The authors fume about this and contrast it with how quickly China and India approved the British vaccine.

 

Mistrust Factor: Lies, fake news and fear mongering on social media could and did whip up mistrust. As the authors wryly said, it was the moment they realized:

“Science doesn’t exist in a vacuum.”

The West, in particular, has had many instances in the past where minority groups (usu. blacks) were used as test subjects without consent or proper knowledge. Such groups don’t exactly trust authority announcements.

 

It Took so Long: The Oxford team had a vaccine ready in January, 2020 itself (yes, that is 2 months before the WHO declared a pandemic)! Why then did it take almost a year for the vaccine to be launched. Because clinical trials, even the accelerated ones, take time. (They have 3 phases). Plus, you have to wait and watch during trials – sometimes, the side-effects take time to show up. Plus, there is so much paperwork needed for a regulatory submission. And it is often different for different countries. And there is so much of that paperwork (500,000 pages) that agencies take time to go over it.

 

Variants: Since most vaccines used the aforementioned platform technologies, new variants were easy to handle. Just change the gene sequence fed as the ingredient to the manufacturing process and you are all set. This is not something new – e.g. take the flu vaccine in the West: every year, the virus mutates and yet the vaccines are made ready and prove effective quickly. How? They follow the same technique that the COVID-19 vaccines use to handle variants. Yes, in theory, the virus could mutate so much that the manufacturing process cannot work anymore – but in practice, a virus that changed that much would be a totally new virus for all practical purposes anyway.

 

All of which is why the authors, being from a research university, end with:

“We can cross Disease X off our list and move on to Disease Y.”