The UK government aims to secure stocks of not one vaccine or even two but up to 12 that are being developed around the world, hedging its bets to ensure it has something that works as early as possible to try to end the health, social and economic havoc being wreaked by Covid-19. As Oxford University published early results of its trials, showing its vaccine is safe and provokes a good immune response, Kate Bingham, the chair of the government’s vaccines taskforce, said the strategy was to have an entire portfolio rather than one star player. On Monday the government announced it was investing in BioNTech/Pfizer’s vaccine and a second being developed by Valneva, a French company that has a manufacturing site in Scotland. That is a total of 90m doses – almost as many as the 100m secured from Oxford. “The strategy has been very clear,” Bingham said. “We have no template to show us how to make a vaccine against coronavirus because it has never been done.” So the intention is to “explore the landscape” and select a few out of each of the four “buckets”, as she described them – the different modalities or technologies being used around the world in vaccine development. “There are the two hairy, scary, sexy ones which are the most advanced,” she said. Those are the vaccines such as Oxford’s delivered by an inactivated adenovirus like the common cold, and the mRNA vaccines that employ a genetic code rather than parts of the virus, being developed by BioNTech, Imperial and Moderna. “An mRNA vaccine has never been approved by any regulator ever,” Bingham said. Johnson & Johnson has had regulatory approval for an Ebola vaccine that uses an adenovirus vector approach, but only in the last couple of weeks. “Those are the most advanced clinically, but about which we know least. Then you’ve got the rather boring, much more established vaccine formats, which we know much more about but they are further behind in clinical development. The one company we announced, Valneva, with the Scottish manufacturing site, which grows up live Covid virus and then inactivates it – that is a very proven form of vaccination. “Polio, the new flu vaccines – basically you just take whole virus and then inactivate. They are good at eliciting an immune response because you get the full virus, as it were.” The “other boring approach which is well-understood”, she said, was the use of an adjuvant – a protein to boost the immune system – which was what the big pharmaceutical companies GSK and Sanofi were doing, for example. Bingham said vaccines based on those latter two technologies would not get approval before the middle of next year. “But they are better understood and more proven and, as formats, more likely to work – but slower. So what we’ve done is pick what we think are the best in class of the different vaccine types and secure rights to those.” The people most at risk of dying from Covid-19 are older people, those with underlying health problems and ethnic minorities. A vaccine for older people could prevent 90% of deaths. But there have already been many questions as to whether the vaccines in development will work well for them. In flu it is possible to get efficacy of only 50%, which nonetheless is very worthwhile. Bingham said the adjuvant vaccines held most promise for older people who have weakened immune systems. They provoke the immune system into a better response, she said. She cited GSK’s Shingrix vaccine against shingles: “They showed over 90% responses in the elderly. That’s why I say it’s more likely to work in those patient cohorts. It doesn’t mean they can get a vaccine for Covid, but it’s some evidence the adjuvant may work in this format and the whole inactivated virus also uses an adjuvant. “So both those two are the ones that – if I had to bookend high risk to low risk – those would be the lower risk and more likely to work in the elderly cohort than these new ones. These new ones may well work – we just don’t have the data.”
Bingham said nobody wanted to wait until the middle of next year for a vaccine. The strategy had been to build a broad portfolio “and to recognise that we will lose money by doing that”. She added: “If we’re in the fortunate position that they all work, we will be the vaccine supplier to the world, but the likelihood is most of these will fail. We would kick ourselves if we only had supported the more traditional approaches if the new approaches do work.” She said there had to be commercial companies involved. “The reality is, if you are actually trying to develop a vaccine that can be deployed internationally, you really do need a big pharmaceutical company at your side. A little company is not going to do that well.” The UK is not alone in bidding to secure a supply of vaccine. The US has attracted particular criticism for its America-first policy and the multibillion-dollar deals it is willing to sign with vaccine companies. Bingham said the UK is a supporter of Covax, the World Health Organization and Gates Foundation bid to raise money from donor countries to fund essential supplies of a vaccine for low-income countries that stand little chance of obtaining anything by themselves. What is certain is that when there is the evidence everyone is waiting for that any of the vaccines work, there will be an undignified scramble to buy.