Oxford Covid jab prepares for the final act: saving the rest of the world | Vaccines and immunization
EExactly two years ago, Professor Sir Andrew Pollard began to panic. “We had only just realized the reality of Covid-19 and the fact that we would need vaccines for our very survival,” the director of the Oxford Vaccine Group told the Guardian last week. He teamed up with a colleague, Professor Dame Sarah Gilbert, and together they launched one of the greatest medical missions in modern history. Their seemingly impossible task – to design, develop and deliver a vaccine from scratch to slow the progress of a deadly pandemic – was completed in less than 12 months, to the relief of millions.
Today, however, the landscape of coronaviruses – and the status of their bite, ChAdOx1 nCoV-19 – is very different. In the UK, half the population has received their vaccine, restrictions have ended and, as cases and hospitalizations rise in the UK, a dramatic increase in deaths is not expected. The jab has saved an estimated more than a million lives, but its reputation has been tainted by a toxic mix of misinformation, miscommunication and incidents. Two years after Pollard, Gilbert and their teams started making the miracle jab now known as Vaxzevria or Covishield, it was sidelined in the UK and Europe, and snubbed in the US.
Instead, ChAdOx1 nCoV-19 is preparing for what will likely be its last act: saving the rest of the world. About 2.6 billion doses have been distributed in 183 countries, but 3 billion people have yet to receive a first dose of the Covid vaccine. The highly contagious Omicron variant is waning in the west, but new cases are soaring in less vaccinated areas. Globally, daily cases remain high, averaging around 1.8 million, or three times the 600,000 a day in December. Cases are rising in the Middle East, Asia and Latin America, and the low cost and ease with which the Oxford/AstraZeneca vaccine could be deployed in these regions, as well as in “the most inaccessible parts of the world”, meant that the vaccine could still play a crucial role in helping end the pandemic, Pollard said.
“Protecting people elsewhere is also important for our own defence,” he added. The current vaccine deficit could open the door to a deadly new variant, which is why he believes the Oxford/AstraZeneca jab’s ultimate legacy will be to build a ‘global wall of immunity’ in 2022 – saving more lives in low- and middle-income countries. parts of the world, but also reducing the risk of new variants coming to the UK and elsewhere.
While Pollard takes ‘huge satisfaction’ from a ‘team of boffins’ developing a vaccine that has been so widely used, he admitted the past two years have not been easy, adding: ‘Misinformation has undermined the confidence in the vaccine.” Particularly damaging, he said, was a story from Germany in January 2021 falsely claiming that the jab was only 8% effective in older people. Looking back at the behavior of the politicians who pushed the “absurd” claims, Pollard was scathing. “President Macron amplified the story globally by claiming the vaccine was ‘virtually ineffective,'” he said. “It’s hard to understand why he would make such a comment in the midst of the Alpha wave with thousands dying across the continent, but the damage was done.”
Hours later, the European Medicines Agency approved its use for all ages, but many countries still chose not to use the vaccine for their elderly. “The rhetoric undermined confidence in the vaccine, undoubtedly costing lives,” Pollard said. Delayed deliveries and lower efficiency rates than mRNA jabs didn’t help the Oxford/AstraZeneca cause either.
But other scientists take a different view of the jab’s bumpy ride – suggesting those involved in its development are also to blame. The lack of older people in his trials compared to mRNA studies, for example, was a “big deal”, Professor Paul Hunter, from the University of East Anglia, told the Guardian. “Since those age groups were always going to be the number one priority, not including them was a mistake.” Dr Julian Tang, a clinical virologist at the University of Leicester who previously worked on respiratory virus outbreaks in Hong Kong and Singapore, also criticizes Oxford/AstraZeneca’s “overly complex” early trials. Reflecting on them this week, what still strikes him now is their “uneven make-up” with “no old people to start, and few BAME participants”.
Hunter and Tang also raise the dosing debacle. A gaffe meant that some doses given to the volunteers were only halfway. The initial half dose received by around 3,000 UK patients was found to be far more effective than the full dose which up to 20,000 Brazilians received. The effectiveness rate in Britain was 90%, compared to 62% in Brazil. The overall rate of 70% caused enormous confusion, especially when compared to the much clearer results of the trials from Pfizer and Moderna.
The final straw for some came in March 2021. A link between the jab and rare blood clots has emerged, which is part of why the UK is now favoring other jabs as boosters. In December, Menelas Pangalos, executive vice president of research and development at AstraZeneca, said the company hoped to change its recipe to avoid the problem. However, the Guardian has learned that the company has since dropped the idea – as it has still not identified the cause. “That being so, we are not currently looking to modify the vaccine,” a spokesperson confirmed this week.
Two years after the sting began, Pascal Soriot, AstraZeneca’s chief executive, insists he has no regrets. “It’s really hard to regret anything when you’ve delivered 2.6 billion doses of vaccine, saved 1 million lives around the world, and allowed the economies of many countries to restart,” he said. “A lot of people are focusing on some of the challenges that we’ve faced in some parts of the world, but I would like to remind everyone that the United States and Europe represent about 10% of the world’s population.”
Indeed, an analysis of data for the Guardian by Airfinity, the health analytics firm, reveals that despite the jab’s trials and tribulations, it is already reaching every corner of the globe. Of the 2.6 billion doses delivered, 166 million went to Brazil, 84 million to Mexico, 60 million to Vietnam, 54 million to the Philippines, 19 million to Nigeria and 16 million to Iran, for example. Even Germany and France, once sources of sloppy reporting and misrepresentation about the vaccine, quietly agreed to doses of 31 million and 10 million respectively, the analysis reveals.
Despite the early “excessive hype”, Tang says there remains an “effective” and “useful” vaccine that can still play a big role. “The AZ vaccine is cheap, easy to store, and its overall efficacy is still generally sufficient to be deployed in many countries to provide protection against severe Covid-19.” Designed to be sold on a not-for-profit basis – for around £3 a dose, a fifth of the price of Pfizer’s jab – it has recently started to turn a modest profit. The rivals have won tens of billions of dollars, but Pollard calls AstraZeneca “morally brave” for ignoring “the perverse business incentive in a pandemic to sell to the rich first”. A spokesperson said low-income countries will continue to receive the vaccine on a not-for-profit basis.
AstraZeneca is under contract to deliver an additional 1.4 billion doses worldwide this year, according to a second analysis of Airfinity data for the Guardian. “We estimate these [orders] will be fulfilled by the fall,” said Matt Linley, chief analytics officer of Airfinity. Some of AstraZeneca’s 25 facilities in 15 countries will cut production after that, he expects. “However, we don’t expect demand for the AstraZeneca jab to end completely,” Linley added. “There will remain a need, albeit at a much lower level, especially in hard-to-reach parts of the world.”