Oxford’s Sir John Bell: ‘We’re not going to beat the second wave’
At lunchtime on Tuesday, Sir John Bell received a call telling him that the groundbreaking Oxford coronavirus vaccine trial would, regretfully, be paused. Hours later, news of an urgent investigation into an “unexplained illness” in one of the trial volunteers began spreading across the world. It was, as White House adviser Anthony Fauci described it, “unfortunate”.
If the Medicines and Healthcare Products Regulatory Agency had come back and said it was all over, “then it would all be over”, says Sir John, the Government’s leading life sciences adviser. “That’s just the way the game works.”
But, this weekend, that wasn’t what happened. Instead, now the trial is back on. Following an assessment, the MHRA said it was safe to continue with work.
The 68-year-old Canadian, who sits on the UK’s vaccine taskforce, hadn’t been anxious.
“When I got the call from Andrew Pollard [who leads the project], I told him look, fine, this stuff happens in clinical trials all the time. People who don’t do clinical trials see it and think, this is a disaster. But, when you’ve got so many people in the study, it’s really not very surprising to be honest.”
Sir John has more experience in this area than most. As one of the world’s top immunologists and Oxford University’s regius professor of medicine, he knows how these things can go.
The majority of vaccines take around eight years to develop. “And we’ve been at this for just eight months.”
These is much to be optimistic about with Oxford’s vaccine candidate. Early indications have been good. Recently, the vaccine progressed to Phase 3 testing, which meant it was able to be trialled on large numbers of patients across different geographies.
By last week, around 30,000 people in the UK, the US, Brazil and South Africa had taken part.
With the trial now continuing, a vaccine could be ready by the end of the year.
“We’re not going to beat the second wave now,” says Sir John, whose work in Oxford helped secure the vaccine manufacturing tie-up with pharma giant AstraZeneca.
Last week, Matt Hancock told LBC that AstraZeneca had already started to produce doses of the vaccine. “We’ve got 30 million doses already contracted for with AstraZeneca,” Mr Hancock had said.
Sir John says, even with this, “we’re probably right at the front end of the second wave now, but a vaccine might arrive towards the end of the second wave".
"We’re probably about three to four months ahead of anybody else with a practical vaccine”.
Elsewhere in the world, trials are progressing at speed. China has a number of vaccine candidates which are at the Phase 3 stage, and last month it emerged that scientists in the country had been secretly testing vaccines on key workers.
Russia, meanwhile, said it had approved the world’s first coronavirus vaccine last month, with Vladimir Putin saying it had “passed all the needed checks”.
Last week, a study in the Lancet suggested that the Russian one produced two forms of immune response against the virus.
Yet Sir John is sceptical over the safety of these projects: “Just a personal piece of advice, I wouldn’t have the Russian vaccine.
“Those countries have their own drug regulation regimes; they should do what they want to do, but it’s just not a good way to evaluate the efficacy or safety. We have rules, and the people who oversee those rules are independent of political influence. We do that for a reason.”
Progressing a vaccine through the required steps in the UK will take more time than rushing it out – but there is much to be gained.
Come late 2020, a vaccine could prove a key tool in the UK’s battle against the virus, taking the edge off Covid-19. Boris Johnson has claimed that a vaccine is the “only feasible long-term solution” to the pandemic.
But, Sir John cautions, it will not be a silver bullet. “For people with ageing immune systems, it may be quite difficult to get the same response as you’d get with a 35-year-old.”
What’s more, rolling out a vaccine across the entire world at speed is not feasible. “There’s going to be lots of this virus around for a long time, probably forever. It’ll likely mutate,” Sir John says.
While this may be true, a vaccine to Covid-19 will certainly “help us”, Sir John says. And, until that point, measures to curb the spread of the virus will have to continue.
Among these are social distancing. As of Monday, more restrictions will be brought in across England to curb the spread of the virus, including limiting the number of people that can meet to six. Sir John himself says, with the rising numbers of Covid-19 cases, he will be reining in how much he is travelling for work.
Yet, reducing contact isn’t the only tool the Government already has in its arsenal. Testing is also an important part of curbing the spread of Covid-19, allowing people to identify when they have the virus and then tracing their contacts. Up until now, this has required people to either visit drive-in sites or have tests delivered.
However, over the past few weeks, there have been huge shortages. The pinch point is not the sites themselves, but the processing capacity.
“They’re maxed out,” says Sir John, who is also in charge of evaluating and validating tests for mass testing in the UK. “We just don’t have any capacity there.”
While these more accurate tests will continue to play a role, the Government has now started looking at another option. The Prime Minister last week unveiled plans for mass coronavirus testing, which would allow people to conduct at-home pregnancy-style tests to discover whether they were infectious on a daily basis.
The project, Johnson said, was termed “Operation Moonshot”. “Did they call it moonshot?” Sir John laughs. “I told them not to do that. I mean, you’re kind of setting yourself up.” But, he shrugs, “I guess it’s out there now then”.
Currently, he says, scientists are trying to scale up what is called a “lateral flow test” so millions are available each day.
These 15-minute tests would detect infectivity rather than diagnose Covid in all its forms, and so would have to have much less sensitivity.
Within a few weeks, Sir John says they will likely have more idea over how much of the virus the test will need to detect to pick up infectious people. “Say you end up with a sensitivity of 70pc or 80pc, the people who you wouldn’t pick up are the people with very little virus in their nose and mouth.”
“I’m not going to say we’ve got one for sure, but we’re pretty close and over the next few weeks, we’ll have a pretty good idea of where we are.”
Then, everything will rest on getting the tests manufactured at scale. The focus, he says, has turned very much to these tests over those that detect antibodies, which were once branded a “game-changer”.
Those have now been put “on the back-burner”. “We still don’t really know what antibodies do to protect you,” Sir John says.
Lateral flow tests, on the other hand, could allow for people to start doing things such as returning to cinemas, travelling by aeroplane again and attending football matches.
“It would definitely put us in a good holding pattern until we do get a vaccine,” Sir John says.
Right now, he may have his hands full with a plethora of Covid-19 projects, and says he’s “probably seen more data from more tests than anyone on the planet”.
Yet, as the Government’s “life sciences champion”, this is not the only thing Sir John has his eye on. He is also working towards a broader goal: bolstering the UK’s burgeoning industry. Further cash for life sciences projects in the upcoming spending review is one way this could be achieved. Another potential boon could be changes to state aid rules.
“European state aid rules are completely hopeless,” Sir John says. “We’ve been tied to this really clunky system, so separating ourselves from that will frankly allow us a lot more flexibility as we become an independent economic power. There’d be a lot you could do in the life sciences domain.”
This, however, is further down the line. More immediately, Sir John’s focus is on the pandemic. The next few weeks could be pivotal in the UK’s battle against Covid-19.
His priority now is “chipping away at things that could make the disease more manageable”. “We just need to keep our heads down on it.”
