Matthew Snape, your member of Common Room,
it's across College Oxford and associate professor of Paediatrics and Vaccinology at the University of Oxford.
Welcome to some cross coloured shorts. Could you describe your everyday role within the university?
Yes. Well, I'm a first and foremost a paediatrician, I guess.
So I still work as a paediatrician at the Children's Hospital in Oxford in General Paediatrics.
But I've been working for 17 years now at the Oxford Vaccine Group alongside that, where I've been involved,
involved with doing studies of new and existing vaccines, initially, especially focussed on vaccines,
are of benefit to children, but increasingly also working with adult health and obviously with recent developments
with things such as Ebola and Kofod 19 is very relevant across all age groups.
So what I do is help run the clinical trials and clinical research that's happening within the Oxes vaccine group.
I've been involved with VAK developing vaccines against meningitis for children and in
fact the first dose of the men B vaccine that's given routinely to infants now in the UK.
The first dose of that paediatric dose of that vaccine was given here in Oxford at the Oxly Vaccine Group Studies,
and I am act as the principal and chief investigator on those studies.
So help basically run the team that runs. The studies have been working, as I say, for 17 years now with the group.
All of that time with Andy Pollard, who is the director of the Oxford Vaccine Group.
I initially started as a research fellow and then did a postgraduate degree and
then went on to becoming a principal and chief investigator in my own right.
And right now, we're very focussed, of course, on kind of at 19 vaccines and generating as much data on these as quickly as we can.
Koban, 19, changed things for everybody across the four corners of the globe.
How did you do so for you and your work in particular? Well, we had to rethink everything, didn't we, in February and March?
And in particular, I was running a study where we're looking at many vaccines.
So vaccines against meningitis, a particular type of meningitis called Group B Mónika caucus that affects teenagers in particular.
And I was running a study in schools where we had recruited 24000 teenagers across the UK for a study to look to see if the administration
of the many vaccines reduced the carriage of the of harmful bacteria that can cause meningitis in the throat of these teen teenagers.
So we've done all the hard work and created 24000 teenagers and then the schools shut.
And so it was quite devastating, actually. We ended up being able to follow up about half of them.
But really, it was then half of the students were lost to follow up. And so, you know, that's very upsetting.
Many a lot of people did lose a lot of a lot of research activity along those lines.
And obviously, I everyone is taking their own hits in different ways, fortunately, which we should be able to recover.
That can make the most of the data we've collected from that study.
And that's just one example of about six different studies that I had to one down in March.
And instead, we adopted some studies to to look at covered.
So, for example, we're already running a study. We were taking blood tests from children to look at their antibody levels,
their immunity against vaccine induced diseases like a vaccine, protected diseases like diphtheria and meningitis.
And we were able to adapt that to look for antibodies against covered. And that study is ongoing at the moment.
It's called What's the story? Serum Testing of representative youngsters.
And we have recruited now nearly 2000 young people and teenagers for blood tests to help better understand immunity against Kofod,
19 in the paediatric population. So that was one example of how we had to adapt and kind of change our studies, either one down studies or adapt them.
So they became relevant to Kov at 19.
And then, of course, there's the massive covered 19 vaccine studies that have been run from the company, from the Oxy vaccine group, which are Andy.
Paula has led on this. And it's been an amazing success story and a remarkable achievement.
Had I had a little bit to do with that in terms of being able to help with
some of the protocol development at the beginning and then actually recording
some of the videos that were shown to participants and had been seen by far
too many people across the country explaining the study and what it involves.
The Copan 19 vaccine studies have been a huge undertaking for the Oxford Vaccine Group.
Can you describe some of the major challenges that you've had to face? Well, where to begin?
I think and as I say, Andy, Pollards led on these and led a team here that have just been extraordinary challenges, workload to start with.
The team here have just been working day and night for a year now.
And in fact, we're having an imposed one week break where the whole group is not allowed to work for a week so that we get a break.
Other challenges, I think we're adapting to a very rapidly changing situation.
If we think back in February, March, it wasn't even called covered 19, then it was the new Corona virus.
That's how much we knew about it. Things have adapted so quickly. And I think when it comes to the covered vaccine studies, you know,
that is shown that initially it was going to be a one dose study and then it was adapted to be a two dose schedule,
which is now what is licence and is being used in it and is appropriate.
There was an element of trying to work out how to best use these vaccines as we're going along.
I think another very challenging part was.
In these studies, we were actually trying to directly show that the vaccines were protecting against disease.
And so there was an element of trying to work out where was there going to be disease.
And so that's why we say why studies were launched not only in the U.K. and as they were launched, the first wave really came to an end.
So the disease kind of petered out to some extent in a good way, but not so good for the study.
And therefore, new sites were launched in South Africa and then in Brazil and Brazil in particular, that provided a lot of cases,
along with the UK second wave, those companies trying to predict where was the disease going to be and getting them immunised ahead of that.
So if you had the best chance of showing the signal, if the vaccine was preventing disease cases.
So I think there's that scientific challenge of trying to work out how to best
use the vaccines and how to best get a signal that the vaccines were working.
But the logistics challenge was just extraordinary. And of what had to be done so quickly,
including setting up a mobile mobile clinical trials unit in the car park outside the box of vaccine group that was set up in a day or two,
complete with plumbing, fully planned electricity, everything else,
so that we'd have enough capacity to see the number of participants that we needed to.
And as a reminder, we've recruited over 12000 participants to study in the UK alone, let alone running studies in Brazil and South Africa.
And the team have done an extraordinary job from that point of view.
Huge numbers of studies to ask a follow up question, if I may, would have involved existing international collaboration.
So imagine some Brazil and South Africa. I can only imagine that Europe had already known collaborators, people who work with them, trust and so on.
Well, even within the UK, there was a network of 18 clinical trial sites that we ran the studies across in the UK.
And really that was a weekend of ringing around people that we knew, investigators that we knew and it worked with beforehand and seeing if they
want to take part in the study and the media answer was always immediately, yes, really.
Over the course of a week or so, we were able to expand the study from five sites to 18 sites across the country.
And a lot of those had been collaborations that we'd had before. Some of them I'd worked with, for example,
on the teenage meningitis courage study that we were talking about before and other ones with entirely new with South Africa and with Brazil.
There were people that we had not directly worked with before, people that we knew of and colleagues and so on,
especially Andy Pollard and on site here as part of the team, we had a DFL student who is from Brazil and had some connexions there as well.
And so really was building on those because we hadn't directly worked with the team in Brazil beforehand.
This was a new collaboration that was set up again, very quickly.
And again, the enthusiasm from everybody wanting to take part in this study was was really quite something.
And soon as that, you know,
they saw that they had a chance to make a difference with this terrible disease and be part of a really important story about developing this vaccine.
Then there was an announcement of enthusiasm.
And I think that Wendle went for everybody, not just for the sites and the corporations, but everybody, the regulators, the university itself.
Our ability to bring in staff from other research groups who'd had activity wound down and they were all perfectly willing to provide doctors,
nurses, administrators to help us run this study. So we had 200 people working on this study during March and April,
many of whom were on loan, if you like, but everyone was willing to chip in and help out.
Can I ask you if you're a South African story now allows you to think about and work on the new variant of COGAT 19?
Well, that's really important story. So the answer is yes.
Obviously, we'll be able to look at whether the vaccine is effectively preventing disease due to the new South African strain.
And that's really important. The blood samples that we are collecting also the UK and in Brazil,
there is an important element of now being able to use those blood samples to test to
see how well the antibodies induced by the vaccine work against this new variant.
So that work is ongoing as well. So as well as looking directly for effectiveness in South African setting,
and we've got to remember that not all of the strains that circulate in South Africa are the South African variant, but some of them are.
So we will be able to look for direct protection against disease in that context,
but also using the blood samples that have been collected from UK, Brazil,
South Africa and testing them in the lab against the South African strain to
see if the it is able to kill off the virus as well as the existing strain.
Does that mean that haven't done the baseline work at Oxford with all the collaborators
approved that this work on the new strain could in some way be accelerated?
Yeah, without doubt. I mean, we have the blood samples already. The laboratory assays are actually being done,
mostly public health England when it comes to the actual testing of the neutralisation and other collaborators.
So these existing collaborations. Absolutely.
We can then build on to it's the same people, the same expertise that is being called on here to then test against these new variants,
kind of just a variation of what we've already done to some extent. So, you know,
ever I think there is a clear recognition that both the UK variant and the South
have confirmed this is really important to get on and test as quickly as possible. But these things don't happen overnight.
These are especially the asset. It's called a neutralising essay where you're looking to see if the blood from vaccine recipients is able to.
Was a virus. These are these are biological tests. You have to get the virus to grow up.
You have to have enough of the virus and have to be able to show that the virus is stable and reproducible growth.
And then that you're able to detect an effect from the antibodies if it is there.
So this two sides that can't be developed overnight.
Normally, they'll be you know, we'll be talking months or longer and or at least trying to get these done within weeks.
As I understand it. Well, ongoing work. Does the Oxford Vaccine Group have planned for Kofod vaccines?
Yes. I think, you know, it's fantastic that we have some effective vaccines now that are being rolled out in the general population.
And if we thought that we could have been here a year ago, then, you know, we would be.
And we are delighted. It's been an incredible achievement. But it immediately comes up with new questions of you've raised one of them.
What is protection against the new variant? And is this a situation where the vaccine is going to have to be adapted?
We honestly don't know.
And if it does have to be adapted, then of course, that will have to be in new studies to test to see how well the new versions of the vaccines work.
But that is very much an unknown at the moment. We're getting ahead of ourselves there.
Before we get to that point, you have to think about how long does immunity from these vaccines last for?
And so already we're planning that we're doing blood tests after six months and then at 12
months after the vaccines to look to see how long the antibodies are hanging around for.
So that's an important first step to see if there may be any suggestion of waning or not of the antibodies.
And let's hope that this gel, these vaccines do generate a very sustained immunity.
The other areas that we're exploring are going to paediatric population.
And, you know, that's been there right from the start as part of the plans that to take this at the moment,
it's gone down to 18 year olds, but no younger. This is we're talking specifically about the Oxford vaccine.
And so there are plans to be doing a paediatric study over the next few months.
And we're in discussions with him, HRA and other groups about that at the moment, what that would look like.
I think that's important because we know that children and teenagers rarely get sick with this disease or very sick with the disease.
We've seen very few children hospitalised with Cofan 98, which is fantastic.
But we do know they have bearing the brunt of school closures and anything that can be done to
help with this problem of opening up schools and a Kofod 19 environment would be a good thing.
And one part of that solution might be immunising teenagers.
So but first, we need to look to see how well teenagers respond to the vaccine,
how well what the side effect profile and teenagers like is it like is what is in adults, which is what we would expect.
Which case that would be fine.
But we need that information first before obviously we can start thinking about immunising teenagers to open up schools again,
if that would be necessary. The other area that we're looking at is actually thinking about is there any flexibility in the immunisation schedule?
So all these vaccines are a two dose schedule and at the moment they will involve giving the same vaccine for the first and then the second dose.
But there is the potential for some flexibility if you could give four different doses for the first and second dose.
If somebody turns up to for immunisation, but it and they received one vaccine, that actually what is available that day is another vaccine.
Is it okay to mix and match like. And that's a study that will be starting in Oxford and then running through multiple sites across the country.
That'll be coming up for February and March. So that's something else that's coming along.
Now, the Oxford Vaccine Group's been previously involved in rapid vaccine responses to bird flu, swine flu.
How does the present challenge compare to those all as each has been building on the other one?
I think it's fair to say, and it's remarkable how it seems that every five years we have a new challenge to respond to and literally has been,
you know, bird flu is 2005, swine flu, 2009 10 and then Ebola 2014 15.
And now we have Corona virus. Ebola really was one of the biggest challenges we faced up to that time.
We went from first notice that we might be doing a study to rolling out first participant within, I think, two to three months.
And that was with a vaccine that had been developed and already had some information about a known virus,
already had been tested in animals and so on.
So the speed with which this was moved forward while maintaining safety was it was of another degree of difficulty again.
And a lot of these things happen in parallel.
So we started writing the protocols for the human studies and getting the approvals for those ready in place for when the animal data came through.
So they were unable to get going with the human studies as quickly as possible.
So getting that right, I think was a key step and really part of the genius of what Andy's done here.
And people out and the rest of the group has been able to get that set up and then obviously scale it up and to credibly,
quickly went from the first participant, having had any vaccine to a thousand participants having vaccines within a few weeks again.
So the scale of logistics has been beyond anything we've done before,
that order of magnitude and the team have responded to that challenge incredibly well.
How do you see your own research going into the future, whether it's long term or short term or both?
At the moment, it's very much about Kofod and we really haven't think about to what extent do we keep other
aspects of research going because there are other still other vaccines that need to be developed.
I've worked a lot previously on Vaccines Against Fires, but RSV.
Which is the most common cause for children being hospitalised with acute illness in the UK.
And that work was going apace beforehand, a business has now been put on pause.
And so we're all looking forward to when we can actually start to think about things other than over 19 again, maybe next year.
Who knows? So hopefully we have to return to some of those things clearly. I mean, the covered 19 issues is aren't going to go away.
There's always going to be new questions.
What we've been talking about drifted strains, waning immunity, how to best boost participants going at different age groups.
These are all questions that are going to be really important in the coming year.
And and and we don't perhaps even know what the questions are going to be that come up.
There will be unpredictable signals that we'll need to respond to and questions that we need to answer that we're not even aware of.
So I think we're all kind of there's no doubt it's exciting to be involved in such an important story.
It's also somewhat daunting to know that this is going to be a story that is going to run and run for
potential years to come in terms of thinking about how to respond to potentially different strains.
Do we need new vaccines or not, etc., while still maintaining a diverse kind of range of interests as we have in the past?
There are still children, adults becoming sick from other infectious diseases for which we have put into many years of work,
and we want to kind of carry that onwards as well. So a mix of Cauvin 19 and hopefully building on some other things.
I think that's the question. Matthew Sun, thank you so much for your time.
We've had this conversation in early January at the start of lock down three in the UK and the very,
very best wishes for the work that's ahead of you. Thank you very much, Stanley.