Patrick Vallance :scientist
Nearly a year after the pandemic started, it was a moment of hope when Margaret Keenan — a 90-year-old grandmother, and resident of Coventry for 60 years — received what she described as an “early birthday present”. She was the first person to receive an approved vaccine against Covid-19 and her name will rightly be recorded in the history books.
This is also a moment to recognise the thousands of scientists and engineers behind the many vaccines that are now emerging, and the many thousands of volunteers who have selflessly taken part in clinical trials. Clinical trials are the way to find out what works and what doesn’t, for both vaccines and therapeutics, and are essential to our response.
Vaccine approvals are a clear watershed moment in the collective fight against Covid-19 and vaccines will ultimately provide a path back to normality. But amid the fanfare, we should remember two important things about this breakthrough.
The first is that, while talk of vaccine supremacy and winning races may make for a good headline, it does not reflect the path that was taken. For scientists and regulators tasked with discovering and approving vaccines, protecting public health and ensuring efficacy, safety and quality were the guiding principles, not simply speed. Moving quickly in science cannot mean cutting corners or compromising on the experiment. In science it is also always the case that truth will out and so it is important to identify it along the way, not after the event.
This virus moved from country to country, with no respect for borders. Similarly, the scientific community is not inhibited by man-made borders. The vaccine effort, like the scientific effort on Covid overall, has been truly international.
In January, when the UK started the hunt for suitable vaccine candidates that could be trialled, tested, and manufactured, it did not go it alone. We knew that we had to play a part in what rapidly became a thriving, international effort. The vaccines task force of scientists and engineers worked across the world to identify potentially promising vaccines.
And this global perspective extends to distribution. It is vaccinations, not vaccines that save lives, and if we can’t offer the jab to people around the world, including those in the poorest and least developed countries, then this pandemic could continue to create problems for years. Viruses are replication machines and this one isn’t going to go away.
Governments recognised this at an early stage, and put their money where their mouths were to prevent vaccines being monopolised by countries with the wealth to take a lion’s share. The UK was a driving force in helping form the international alliance — called Covax — to ensure equitable access to vaccines for poor and middle-income countries, and has pledged to back it with up to £571m.
The coalition has grown and now comprises 180 nations with bold plans to develop and distribute a billion doses of vaccines by the end of 2021. This has to remain a priority. If the first notable part of this breakthrough was its global nature, the second is the technology that made it possible. While we take for granted the countless ways in which technological advances have transformed how we work, shop, learn and travel, a quiet revolution has taken place in biotechnology, including in vaccine technology.
Viruses are packets of genetic material, enclosed in a Trojan horse of a protein that can hijack a body for their own ends. Edward Jenner’s vaccine used a mild virus (cowpox) to stimulate an immune response to a deadly one (smallpox).
Traditional vaccines have used inactivated versions of a virus, and now more commonly, synthetic viral proteins which stimulate the immune system to produce a response that will protect against the real thing. It is a tried and tested method, but it takes time, often years. And many vaccine projects fail. These traditional methods will remain a very important part of our armamentarium.
BioNTech, Pfizer’s German partner, made its breakthrough with a different approach. Its technology uses messenger RNA (mRNA) that contains the genetic sequence of a viral protein. When injected into muscle, the cells in the muscle use their own molecular machinery to make a version of the viral protein. This protein is then recognised as “foreign” by the immune system, which generates an antibody response (and possibly other cellular immune effects).
Why is this so exciting as an approach? It is fast and likely to be applicable to other viruses. Once the genetic sequence of the virus is known, it is possible to make the mRNA within days, and to test many options. It doesn’t mean that there will be a vaccine in days, but there could be a decent starting point very quickly indeed. And now we know that this approach produces a good immune response and disease protection, this looks like a great technology for preparedness for any future viral diseases.
While this initial laboratory phase may get off to a quick start, before any candidate goes from lab to jab it is put through the wringer. It remains a time-consuming process, with every stage designed to sieve out candidates that do not produce the right response or ones that have safety concerns. And then the clinical trials start, designed to test tolerability, examine the immune response, and eventually to understand whether the vaccine reduces disease and has an acceptable safety profile.
We are entering a new phase of the pandemic, one that will be fundamentally different because of the promise that vaccines hold. And while every person vaccinated is a single small step back towards normal life, it is vital that we remain clear-eyed and recognise that we are not out of the woods yet. Vaccines will need to be given to many millions of people to protect the vulnerable from severe disease and, we hope, to reduce the transmission of the virus, but we don’t know this for sure yet. It will take time to find out all we need to know, and it will take time for vaccination to reach the levels at which we can begin to lower our guard.
Let’s celebrate the scientific achievement, let’s rejoice that new vaccine technologies will change the outlook for future infectious diseases, let’s recognise the international nature of collaboration in science and medicine, but let’s not throw away the gains we have made by allowing the virus to spread while we wait for vaccination to take effect. Continuing to follow the rules and avoiding the spread of virus is going to be essential, or this virus will simply bounce back. — The Guardian.
Sir Vallance is the UK government chief scientific adviser