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It's not like giving your name and your position.

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My name? Name's Andrew Pollard. I'm the director of the Oxford Vaccine Group and I'm a paediatrician here in Oxford.

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Thanks very much. So that's what can you just tell me a little bit about yourself without giving me your entire life

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history from how you first decided medicine was going to be a career to how you got to where you are now?

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Well, I decided to to do medicine.

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Yes. So I guess I decided that I would go into medicine only when I was already had started my A-levels.

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And when I looked at the admission criteria, I discovered that you needed to have a physics A-level equivalent of a GCSE in order to do that.

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So I then had to a great rush at the age of 17 to do an extra physics exam whilst studying

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with my uncles and then applied to various medical schools and set off to do medicine.

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But what was it that made you decide that medicine is going to be it? I think I always entertained the possibility and I don't know what it was.

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The sudden it suddenly clicked as a 17 year old, but maybe I could do it.

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I think before that I thought I just wouldn't have been up to it, but that perhaps it was actually the teachers giving me the encouragement.

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You didn't have medics in the family. My parents are both dentists, but I didn't have a particular connection.

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20 minutes. And so how did you get from doing a medical degree to where you are now?

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Well, when I finished my medical degree, I mean, I enjoyed everything in medicine, so I didn't really know which area I wanted to specialise in.

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So where did you study? So I studied at St Bartholomew's Hospital Medical School in London, and I so I did a job in A&E after I qualified.

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And of course you see the whole spectrum of medicine there.

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And I had always been quite interested in paediatrics and this was partly why did I need to

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see whether I because in medical school you don't do a huge block of studying children.

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And I thought there was a lot to offer and I really enjoyed communicating with children and their parents.

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And so I then started training in paediatrics. And over the years I guess the large proportion of what you see in paediatrics are infectious diseases.

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And that's I think the greatest number of people who come through the front door, snotty children.

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And during the course of that early training, I was always doing some research,

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interested in academic development and decided I wanted to do a PhD and looked at possibilities of doing

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PhD in the tropics and discussed with the head of the Medical Research Council unit in the Gambia.

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And we decided that I would go to the Gambia and and do my PhD there as a junior doctor,

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but the funding fell through and so I ended up going to St Mary's and studying meningitis for my PhD.

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That's in London. In London. And at that experience was just completely eye opening in terms both of the medicine,

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because I was moonlighting as an intensive care doctor and children's intensive care dealing with these desperately sick children.

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And during the very large increase in meningococcal disease, one form of meningitis during the 1990s, why was there a big increase when it goes?

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It always goes in cycles. There's this particular disease and we were in an upsurge of a new strain, I guess in today's parlance,

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a new variant emerging in in fact initially in the UK, but across the whole world, which caused a large increase in disease.

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So over the the few years I was there at St Mary's, maybe saw 400 children in intensive care with this dreadful condition.

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And my Ph.D. was studying the immunity to to this bacterium.

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And the obvious step from there is into vaccines. And so I decided after I got my Ph.D. to finish my training in infectious diseases in Canada.

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And so I spent two years in Vancouver and was offered a post to come back to Oxford after when I was in in Canada and decided that I

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really wanted to continue this theme of studying immunity to infectious diseases and realised that the best tool to do that was vaccines.

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Because you can study children's immune systems by vaccinating them and seeing how they respond.

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And so 20 years ago I came to Oxford and started work on here at the Office of Vaccine

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Group on trying to get a better understanding of immunity and very quickly realised

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that you can actually save lots of lives by booking all vaccine development in

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parallel with studying the immune response and the science behind how vaccines work.

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So in terms of your own particular contribution in this field,

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would it be true to say that you've been looking at the immune response and trialling vaccines in designing vaccines as somebody else's job?

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Is that right to have you know,

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I'm a bit of a not very good at anything but does everything and so we some what what might I do in my team is that we both design vaccines.

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We try to understand which bits of bacteria or viruses are needed to make immune responses and test those out in the lab.

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And then some of those vaccines we've taken into the clinic, we have phase one studies of vaccines for meningitis.

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Currently, we work on a vaccine for plague. The that the biggest pandemic ever affected humans that we know of.

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I mean, the 1300s where half of the population of Europe was wiped out.

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The black death, the black that. So we have a number of those.

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But but also because vaccine development normally takes a long period of time,

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we have studies with other collaborators where we look at vaccines they've developed and evaluate them, help move them along more quickly.

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And a particular area of interest for me has also been to look at the the vaccination program we already have and try to

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understand whether it is optimal and to to do studies to see whether we can tweak it to improve immunity in children,

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to make sure it persists better.

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And so I think the contributions really from my team over the last 20 years, some of it's new vaccine development, some is evaluation of vaccines.

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It helps get them licensed. And another part is understanding the population immunity so that we can treat vaccine,

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tweak vaccine programs so that huge populations, particularly children, can be better protected.

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So a lot of your work, apart from looking at the UK vaccine programme, you've done quite a lot of work in in tropical in developing countries.

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Why? Why is that important?

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Well, the biggest burden of infectious diseases in terms of both mortality and the severe disease is actually seen in low income settings.

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And so in some ways, in a high income setting like ours,

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we've dealt with most of the diseases that cause the infectious diseases that cause severe problems in children,

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not all of them, but but a large proportion. And in low income settings.

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There are lots of diseases that we don't have here at all that need addressing. But in addition to those diseases that that we don't have here,

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even the diseases we do have here are at a much greater burden and children are under-vaccinated.

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So focusing a lot of our work in those settings has a much bigger impact on those populations than it would do here.

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So these are things like measles and meningococcal meningitis.

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So the leading cause of death in childhood is pneumonia.

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So a large programme, for example, in Nepal has been on pneumonia.

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But my biggest program in terms of studies over the last decade was actually on typhoid.

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And we came into that because working on pneumonia in Nepal,

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I discovered that the bacterium that causes typhoid was the commonest cause of bloodstream infections in children.

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And astonishingly, when we looked at children who came to the hospital and the paediatricians there thought that these were probably viral infections,

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and we took blood samples. They had these bacteria growing in their blood.

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And that's the reason why they were on. Well, fortunately, they they were all treated with antibiotics,

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but it was a realisation that there's this disease which is causing a huge burden affecting children's health and their education in that setting.

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And so when I made those observations in the early 2000, one of the thought was, well, we actually know how to make vaccines for typhoid.

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What's holding it up? And we started working with an Indian vaccine company to try and support that

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programme and to convince people that actually that could be a huge impact.

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And what we did here in Oxford was that we vaccinated volunteers who were from a wide range of backgrounds,

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but people particularly from science backgrounds, and then deliberately infected them with typhoid.

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So we got to drink these bacteria as would happen if you went travelling and you got typhoid as a traveller.

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And they what we found was that the vaccine was highly effective in preventing typhoid and that then led to the World

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Health Organisation making global recommendations for the use of the vaccine and the Global Alliance for Vaccine,

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releasing money so that countries could apply for funds to implement programmes there.

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For us in our research, the next question really was for typhoid is how do you implement a typhoid vaccine now that we know that they work?

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And so we did two things. The first, we went to countries in Africa and in Asia and set up a surveillance program to document the

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burden so that we can help countries understand just what could be prevented if you had a vaccine.

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And that was really hard work. We had 100,000 people in each of three countries, so 300,000 people in total.

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And we just followed them to see if they'd develop typhoid, what the risk factors were and found this enormous burden of disease.

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And with those sites now set up and we understood the epidemiology of typhoid we're funding.

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From the Bill and Linda Gates Foundation. We went into those populations and vaccinated 100,000 children.

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And that allowed us to show the massive impact there is of a vaccine program.

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And now today, programs are rolling out in multiple countries that the most impressive so far this year was Pakistan,

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that in February vaccinated a million children per day for typhoid in the middle of a pandemic of COVID.

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My goodness, that is impressive.

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So by the time COVID came along, you had enormous amount of experience in running vaccine trials on a global, global scale.

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So just thinking back to the very beginning of the pandemic,

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what when did you first become aware that something pretty bad was in the offing and that you might get involved?

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Well, in January, I mean, we knew that there was this virus in and we had in China.

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Did you hear about that just in internal just from the media?

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I think probably from the media. I mean, it was on never with BBC stories as early as the 11th of January that I remember very, very distinctly.

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In fact, the on the 14th of January, the first case outside of China was documented.

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The headline on the 11th of January was New Virus in China, but it doesn't spread between humans.

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So, I mean, I think we were aware of it.

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I didn't I'm not much less interested in viruses because I always consider them not terribly important in the world.

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Bacteria is so much more interesting. They've got much bigger genomes and so there's much more to them.

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And they're tougher than viruses. But.

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So I think during January, I don't think anyone was very aware of just what's a risk to the world this was going to be.

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Not least because knowing that it was a coronavirus,

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there have been two previous coronavirus outbreaks over the last 20 years which didn't turn into a pandemic.

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And fortunately, my colleagues here in Oxford were already thinking about, well, if there was an outbreak in China, maybe we could help them.

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And so it started as an academic interest project, putting together the vaccine in February,

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obviously things became very obvious that there was there was going to be a major problem.

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And so as it became very clear that this was a pandemic, the various vaccine teams in Oxford got together to discuss how we could help.

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And I think it's important to understand that usually in universities you work on your research programme,

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another people might have other research programmes in the same area, and you might work together on some programmes,

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but to do to respond in a pandemic you have to do something unusual,

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which is bring all of the teams together that would normally work in their own silos to develop their products or to do their own research.

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Have to find a different way of working where everyone says, Actually, this is not about me, this is about a much bigger effort.

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And so what we did in structuring that was put people in charge at different bits of the operation.

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And so my colleague Sara Gilbert was was on the design side.

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And to get the manufacturing started optimising manufacturing was Sandy Douglas and test lab was about initial

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design but then took over coordinating the laboratory infrastructure and I took over the clinical trials.

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And the great thing was that I then had access to multiple teams across Oxford who do clinical trials of vaccines,

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but they had all reported to me that some live for Test lam in the laboratory.

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She took my laboratory staff and they reported to her that capacity and capability that there is in the system here meant that we can

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really stand up something which has competed with Big Pharma in being able to develop a vaccine and get it licensed in less than a year.

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And how easy is up to do, as you say? I mean, were people out of their comfort zones or did everybody just not do it?

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And I think the definitely the starting point of how do you work together and who's my boss was it had some teething troubles,

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but I think it was very rapidly apparent as time went on that the virus that

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arrived in the UK and the urgency of focus really brought everyone together in,

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I think in a very strong team to do that.

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Now there's clearly lots of different ways of thinking and discussions that you have to have as you build a team to work on it.

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But because people were working as a single unit rather than split by departments or research groups, it really did mean that we could,

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I think, bring the necessary focus and that that got beyond any of the sort of the personal interests that you normally have in an academic.

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You make it cool, you get your paper published.

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This was much more about can we make a vaccine that can contribute to saving the world in the pandemic?

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And I think we did that know that was you pre-empt the question I was going to ask that that's that's great and.

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I think just I think it would be helpful at this stage just to talk me through the clinical trials.

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How did you start? How did the scale of your ambition grow?

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As as time went on and they put further questions to you as we go.

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Well, I mean, it all, of course, starts before the trial.

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The first thing that was was happening was getting the the initial designed vaccine through the the early

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stage processes that allows it then to go into a manufacturing facility that makes things for humans.

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I should say that I've already interviewed Kathe Green. Okay. And I'm hoping to interview Sarah.

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Yes. Put me off for the time being, but I'm working. So you don't need to tell me all the things they did because you get that from them.

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But there's an important bit of context, though, that was lost. That work of getting into the manufacturing facility was happening.

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Yeah, the that gave us the sort of timelines of what we needed in order to get everything stood up to the trials.

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Yeah. And so we had to work very closely together to understand that.

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And there's the, once the manufacturing has started, as long as nothing goes wrong,

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you have a fairly clear idea of when things should actually be in a vial.

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And then when the released testing, which is the quality testing of the product, can be completed.

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So the, you know, the date on which the first dose can be given and we had a few weeks of uncertainty when that exactly would be.

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And there are also animal studies going on in the US which were interestingly

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the regulators didn't require to have those data in order to start the trial.

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But internally, in discussion with the university,

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we'd agreed that we would wait for those data before actually giving the first dose on your vaccine,

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on our vaccine,

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so that there are lots of the vaccine made in the US because there's some very good collaborators who had the best animal models already set up.

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And of course early in the pandemic, lots of people were setting up the other models to allow you to do the studies.

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But you we were fortunate to have a partner who had it already worked with coronaviruses and was ready to go and got this set up very quickly.

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And so as the the readouts came from the animal studies and then the final release testing arrived, which was the 22nd of April,

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we were then able to have worked out roughly what that date was so that on the 23rd of April we were able to start the trials.

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But by that time you would have had to recruit the people. So.

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So the way that we did that was having knowing the timescales, we could go to the Ethics Committee and to the MHRA,

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the UK regulator, and to get all of the protocols and our plans approved.

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And of course the UK regulator doesn't usually approve a trial until they've got that release test and the quality.

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And so we negotiated with them. I know very flexible about this.

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They would approve everything apart from the final signature which came on the 22nd of April.

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But we had that preliminary approval many weeks before that,

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and the MHRA did their approval for the trial in one week, and suddenly they were normally after you.

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Once you submit the documents, you should get a result in about 30 days,

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assuming they accept everything from this questions and it takes longer than that with the Ethics Committee, they were able,

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from the date of submission of our protocols and information for the trial participants,

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they gave approval four days later and nobody got any corners cut with any of these processes.

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They just they didn't have administrative time lines to say, well, we'll review to the next committee in three months time.

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They just said, we'll set up a committee to meet as soon as you submit.

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And that's exactly what they did. So I think both of those organisations met in March.

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We actually had the provisional approvals to start the study so.

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So that meant that by the end of March, beginning of April, we could start advertising and we were completely inundated.

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We opened a website and I don't know what it was, 10,000 people responded within a matter of hours wanting to take part.

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And so we knew that we would be able to get the trials moving.

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And it just they needed the capacity in the in the team here in the office to to do some initial screening of people and start booking appointments.

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And do you think people volunteered out of altruism or because they thought they would it's that best chance of getting protected against the virus.

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When I think if you can think back to that time and although I have no experience of lockdown, apart from the fact when you come to work,

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there's no one on the street, most people were locked down at home, desperately wanting to make some contribution and to help end it all.

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And most of the people I've spoken to that at that moment, they were saying we just felt we needed to do something.

191
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The scientist felt, I can't go to work and do my science, but I could contribute in some way to the science that's required.

192
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And it was it was, I think, quite emotional in a way that people were so desperate to make some contribution.

193
00:21:31,040 --> 00:21:39,120
And the altruism question is an interesting one, because I, I suspect that it largely was about we've got to help the world to improve.

194
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Self-interest, I think, is may may have driven some people, but when they come through the door and we say to them,

195
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we don't know if this vaccine is safe, we don't know if it'll work.

196
00:21:51,330 --> 00:21:58,530
Can you take part in the trial? I think altruism goes out of the door that this sorry, the self-interest goes out of the door.

197
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At that point, people really are there because they've decided that they can make a contribution.

198
00:22:03,460 --> 00:22:09,060
Many of them turn around and leave at that. I mean, usually we screen people out on the phone in that moment.

199
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But of course, some people when you go through things like detail, you tell them how many blood tests they're going to have.

200
00:22:14,820 --> 00:22:18,660
That's just too scary for them and they don't want to take it. So that was the next thing I was going to ask.

201
00:22:18,660 --> 00:22:20,670
Well, what did they have to commit themselves to?

202
00:22:21,300 --> 00:22:29,640
So the people who took part in the studies really committed to to be with us for at least one year and

203
00:22:29,640 --> 00:22:35,790
to have multiple blood samples taken over the course of that time to monitor their immune response.

204
00:22:36,270 --> 00:22:44,159
Those who were in the initial trials had a much more intense sampling because that's required to demonstrate the safety of the product,

205
00:22:44,160 --> 00:22:49,620
and the regulators needed to have as much information as possible in order to do that.

206
00:22:50,640 --> 00:22:56,550
And for people who took part in the later phase trials, they had much less intense involvement.

207
00:22:58,360 --> 00:23:01,890
Yeah. So it's it's a big burden certainly initially for people.

208
00:23:02,110 --> 00:23:06,000
What's the difference to you what you're looking for in the phase one trials and then in the next?

209
00:23:06,360 --> 00:23:10,800
Well, the Phase one trial is trying to essentially evaluate safety.

210
00:23:11,280 --> 00:23:19,710
And so we we're measuring how people feel or any symptoms, any adverse events they sort they suffer from.

211
00:23:20,490 --> 00:23:28,800
But we also take blood tests to see if the blood flow is altered in any way by being vaccinated.

212
00:23:29,040 --> 00:23:38,730
Does it affect their kidneys or their liver or, you know, does it have any effect on their their ability to fight infections and so on?

213
00:23:39,030 --> 00:23:46,319
So all of us documented we also measure their immune response to the vaccine in the later phase trials.

214
00:23:46,320 --> 00:23:50,430
We did measure immune response to the vaccine, but we don't do all of the other detailed blood work.

215
00:23:51,480 --> 00:23:57,540
But the main point of those is to find out, does the vaccine work? And so half the group get the new COVID vaccine.

216
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The other half gets a controlled vaccine, which doesn't protect.

217
00:24:01,020 --> 00:24:06,870
And we wait to see who gets COVID and hopefully those who've been vaccinated with the new vaccine and are protected.

218
00:24:06,870 --> 00:24:13,049
And indeed, that's what we saw. But of course, at the time that was happening, we were we were all in lockdown.

219
00:24:13,050 --> 00:24:21,600
So the virus was that the circulation of the virus was being prevented as far as possible by the non pharmaceutical interventions.

220
00:24:21,840 --> 00:24:25,320
Did that make it more difficult for you to conduct a trial?

221
00:24:25,380 --> 00:24:32,520
Well, one of the one of the aspects of the trials that that was for us was critical was our ability to adapt to the circumstances.

222
00:24:33,000 --> 00:24:35,579
And so when we set out with the Phase one trial,

223
00:24:35,580 --> 00:24:41,370
I was talking to the well-known modellers who were predicting what was going to happen in the pandemic.

224
00:24:41,940 --> 00:24:51,810
And in March the predictions were terrifying, and we thought that with a single dose of the vaccine, we could have an impact.

225
00:24:52,260 --> 00:25:00,450
And they felt with the numbers of cases coming through by then, but by late March, April would be enough that we'd actually get the answer.

226
00:25:00,810 --> 00:25:06,180
Within the phase one trial of whether the vaccine worked and because of this sort

227
00:25:06,180 --> 00:25:11,580
of terrible scenario of maybe 300 or 500,000 deaths very rapidly in the UK,

228
00:25:12,660 --> 00:25:19,110
we felt that a single dose was the only option because two doses would take too long to actually save people's lives.

229
00:25:19,620 --> 00:25:29,729
And so the initial plan was a single dose vaccine. What then happened with lockdown was that the cases evaporated and there were two results for that.

230
00:25:29,730 --> 00:25:35,400
One was that realising that the non-pharmaceutical interventions would work better than anyone had predicted.

231
00:25:35,910 --> 00:25:39,120
So to maximise immune responses, we'd go to two doses.

232
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And the second thing was that in order to increase the chance of being able to capture infections and be able to get a result,

233
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we needed much larger studies because of the non-pharmaceutical interventions and I remember thinking,

234
00:25:57,960 --> 00:26:00,450
I have no idea what's going to happen with the next wave.

235
00:26:00,750 --> 00:26:07,080
Will it appear in Sheffield and not in Oxford, and would it only appear in some other country and not here?

236
00:26:07,380 --> 00:26:12,480
Will we have to wait six months? We can't afford to wait. We need to find a way of answering that.

237
00:26:12,480 --> 00:26:14,840
So we immediately may fact to.

238
00:26:14,900 --> 00:26:22,910
I did this a couple of days after the first dose went and realised that we were going to need to expand for the later phase trials.

239
00:26:23,330 --> 00:26:32,150
Contacted colleagues all over the UK and asked them if they would take part in a much bigger phase three trial.

240
00:26:32,620 --> 00:26:38,960
And every single person said yes. And they started working on setting up their their trial site to be able to do that.

241
00:26:39,500 --> 00:26:43,370
Three weeks later, we started the trials with them.

242
00:26:43,400 --> 00:26:49,270
So they did their own recruitment, did they. So so we had a centralised database.

243
00:26:49,280 --> 00:26:52,669
Yes, but they used it, it was locally so they had I mean,

244
00:26:52,670 --> 00:26:59,630
the ethics means that the data about the personalised data needs to stay with the local trial sites so it all runs through those sites.

245
00:27:00,930 --> 00:27:04,820
So that was just a few days after the first dose had gone and we already knew we had to do that.

246
00:27:05,390 --> 00:27:09,940
And over that week, I then contacted colleagues in Latin America,

247
00:27:10,160 --> 00:27:15,379
in Africa and in Asia with the same message that know we need to collaborate is we

248
00:27:15,380 --> 00:27:20,480
need much larger scale studies in order to move on to the next the next stage,

249
00:27:20,690 --> 00:27:22,890
because we don't know where the virus is going to appear next.

250
00:27:23,450 --> 00:27:30,500
And we then set up trial sites seven in South Africa and six in Brazil, as well as the 19 in the UK.

251
00:27:31,010 --> 00:27:32,719
And we started work on Asian sites.

252
00:27:32,720 --> 00:27:41,090
But in the end with the Partnership AstraZeneca, they contracted with service use of India, who then ran the Asian trials.

253
00:27:41,510 --> 00:27:48,440
So at portfolio studies was UK, Brazil and South Africa a major challenge at that point,

254
00:27:48,680 --> 00:27:53,809
having decided that's where we needed to go to get the scale needed to get the answer quickly,

255
00:27:53,810 --> 00:27:57,620
but also to meet the next wave of the virus that was was funding.

256
00:27:58,100 --> 00:28:00,470
And so the government had funded the UK trials,

257
00:28:00,740 --> 00:28:06,080
but it was difficult at that moment to persuade anyone that they should fund a trial in Brazil or South Africa.

258
00:28:06,090 --> 00:28:08,899
I said, Well, why? Why would we do that? We don't need that.

259
00:28:08,900 --> 00:28:15,170
And I don't think we managed to make the argument that you need big, big studies and we should they should follow all of them.

260
00:28:15,740 --> 00:28:25,480
And so in the end, the Bill Melinda Gates Foundation funded South Africa and the Lemon Foundation, a charity funded the trial in Brazil.

261
00:28:25,790 --> 00:28:32,810
And so we then were able to coordinate those three trials, unfortunately run separately because of that and those different arrangements,

262
00:28:33,410 --> 00:28:39,770
which made it much more complicated to then bring the data together for our regulatory submissions later on.

263
00:28:40,580 --> 00:28:45,200
But I think we still managed that without too much difficulty, but much harder than it should have been.

264
00:28:46,860 --> 00:28:53,380
Good. So, yes, you mentioned the AstraZeneca coming.

265
00:28:53,620 --> 00:29:01,989
Was that something that you were personally involved in at all? So there were some initial discussions with several companies because it's absolutely

266
00:29:01,990 --> 00:29:07,420
clear that whereas we know how to do vaccine design and development and clinical trials,

267
00:29:07,840 --> 00:29:14,070
the things that we don't do is regulatory submissions and global manufacturing and distribution.

268
00:29:14,080 --> 00:29:21,100
That's not what universities do. So we knew we needed a farmer partner and there was discussions with a number of these.

269
00:29:21,310 --> 00:29:28,209
AstraZeneca in some ways was more unlikely because they although they did have a flu vaccine business, it wasn't the major part of what they do.

270
00:29:28,210 --> 00:29:32,110
They're a big oncology pharmaceutical company, particularly.

271
00:29:32,920 --> 00:29:37,480
And but they were, I think, very keen to get involved.

272
00:29:37,540 --> 00:29:43,780
They also share the same vision of a not for profit development that the university had.

273
00:29:44,260 --> 00:29:53,080
And so those those initial discussions, I think, showed that there was a joint thought process about how they should move forwards.

274
00:29:53,530 --> 00:29:58,359
And then Central University that dealt with the negotiations over that and very much led

275
00:29:58,360 --> 00:30:02,590
by senior figures in the medical sciences division and the Vice Chancellor herself.

276
00:30:05,450 --> 00:30:12,870
And I'm. Yeah. You talked about MHRA and there was also the vaccine taskforce.

277
00:30:12,870 --> 00:30:19,440
So all these national bodies, one of which you actually chair the Joint Committee on Vaccination Immunisation and.

278
00:30:21,060 --> 00:30:28,800
Tell me about how you managed that role, but at the same time as running a mexican truck.

279
00:30:28,890 --> 00:30:36,390
Yeah. So there's this several components to your question as they make sure they're the regulator, they're independent.

280
00:30:36,600 --> 00:30:38,370
They're tough with us, as they should be.

281
00:30:39,060 --> 00:30:46,770
But they were one of the most flexible regulators in the world in immediately getting this rolling review idea,

282
00:30:46,770 --> 00:30:53,339
both for the trials and then later for regulatory submissions, which shortens the timescale of the review processes.

283
00:30:53,340 --> 00:30:54,600
And I think to move swiftly,

284
00:30:55,170 --> 00:31:03,420
they also were prepared to be very engaged to give advice during the trials in a much more open way than the normally happens,

285
00:31:04,470 --> 00:31:08,400
obviously vigorously defending their independence from us,

286
00:31:09,090 --> 00:31:15,870
but allowing me to share data with them to help advise on the next stages of the trial so they can make rapid decisions as they went along.

287
00:31:17,070 --> 00:31:26,760
The vaccine taskforce, which was chaired by now Dame Kate Bingham, were absolutely critical both in working out where to put the government's money,

288
00:31:27,210 --> 00:31:31,770
but but then also making the decisions about spending and moving things quickly forward.

289
00:31:31,770 --> 00:31:37,110
And I think Kate has done the most astonishing job in doing that.

290
00:31:37,110 --> 00:31:43,559
And I had regular meetings with her on usually on Sunday mornings to talk about the latest crisis or or

291
00:31:43,560 --> 00:31:51,090
to share the latest results that she could use to inform government about how things were going and.

292
00:31:52,950 --> 00:31:58,230
As far as GBI is concerned. I have charged GBI for many years now.

293
00:31:58,740 --> 00:32:06,030
And very early on in the pandemic, we agreed with the Department of Health that I should recuse myself from chairing

294
00:32:06,030 --> 00:32:09,840
the Komen committee because of my involvement in the vaccine development.

295
00:32:10,440 --> 00:32:16,020
And so one of the other members, Wayne Limb, has been chairing the COVID 19 committee.

296
00:32:16,350 --> 00:32:21,960
And I haven't taken any part in it. I haven't attended any of the meetings or been involved in any decisions there,

297
00:32:22,620 --> 00:32:27,600
which in some ways for me has been frustrating because I'm so interested in what's going on.

298
00:32:28,380 --> 00:32:36,120
But I've not taken part. But the main GBI meetings for all of the vaccines I continue to chair and those have continued.

299
00:32:36,120 --> 00:32:40,669
But it's a slow pace during the pandemic, as has been so hard for the rest of the committee.

300
00:32:40,670 --> 00:32:43,950
You've been meeting every week on the other on the other diseases.

301
00:32:43,950 --> 00:32:48,139
So it's not unlike Georgia is not a regulated is it an advisory body?

302
00:32:48,140 --> 00:32:55,950
Is that so? So GBI is a is a an independent scientific advisory body of the Department of Health.

303
00:32:57,330 --> 00:33:06,959
And what we we do is we advise ministers on on vaccine policy for the U.K. So we don't we don't approve vaccines.

304
00:33:06,960 --> 00:33:14,970
That's up to the MHRA, but we look at how they might be used optimally for the UK population and in the absence of a pandemic,

305
00:33:15,810 --> 00:33:21,840
very much also whether it's cost effective for the NHS using Treasury rules to help make that determination.

306
00:33:22,950 --> 00:33:28,980
So they would have been involved in decisions like how long the interval between vaccines should be.

307
00:33:29,130 --> 00:33:35,760
Yeah, so? So jcvi decide on who should be vaccinated first.

308
00:33:35,760 --> 00:33:39,540
And they quite rightly went for older adults and people with health conditions

309
00:33:39,540 --> 00:33:44,669
first and then will decide on when pregnant should roll out in children and so on.

310
00:33:44,670 --> 00:33:51,899
Yes. So all of those decisions are made by JCI and we jumped ahead a bit because we're talking about rollout now.

311
00:33:51,900 --> 00:34:01,080
But what what were some of the moments that stand out in your mind from during the period when the trials were going on?

312
00:34:01,560 --> 00:34:09,090
And. Well, probably the first jab was the first dose being given was was a major day.

313
00:34:09,720 --> 00:34:15,280
And of course, the media ruled here. And it was it was a very busy day.

314
00:34:15,280 --> 00:34:23,820
You got lots of filming of what was happening, talking to various media on camera and on a radio.

315
00:34:25,340 --> 00:34:33,860
But I had a sense on that day that this is a huge palaver for what is the very beginning of the most enormous journey that we that we've set out on.

316
00:34:34,610 --> 00:34:42,379
And but I didn't expect just three days later to be facing fake news.

317
00:34:42,380 --> 00:34:46,430
The first Trump volunteer had died, which, of course, she hadn't.

318
00:34:47,510 --> 00:34:55,070
And I got the got the information when I was out for a run early on the Sunday morning.

319
00:34:55,790 --> 00:34:59,480
And as the person responsible for all the participants in the trial,

320
00:34:59,660 --> 00:35:04,250
my thought was obviously for this individual and how she must be feeling her family,

321
00:35:04,250 --> 00:35:07,950
who some of whom wouldn't even know whether it was true, her colleagues at work.

322
00:35:08,510 --> 00:35:11,550
But then, of course, the impact it has on the other people in the trial.

323
00:35:11,570 --> 00:35:16,070
And of course, competence in vaccines in general. And so there's two things I did.

324
00:35:16,100 --> 00:35:21,170
One was talk to the university comms department to make sure that we got information out quickly.

325
00:35:23,300 --> 00:35:27,660
And then also, I talked directly to the BBC and said, no,

326
00:35:27,710 --> 00:35:33,250
you just met this this lady a couple of days ago and I need some help because this

327
00:35:33,290 --> 00:35:37,820
the implications of not dealing with this quickly are just awful for the world.

328
00:35:38,480 --> 00:35:42,200
And they immediately contacted the participant.

329
00:35:42,590 --> 00:35:49,520
They tweeted an interview of her. He went on the BBC news website and it was immediately all around the world that it was fake news.

330
00:35:49,940 --> 00:35:58,820
And I think that was, for me, the first moment where I realised that we were not in the place that we normally are with vaccine development,

331
00:35:59,720 --> 00:36:05,320
because every time we looked out the window from then on, the whole world was watching.

332
00:36:07,000 --> 00:36:12,970
And that's very different. I mean, I you know, I have to confess, I didn't know about your typhoid study, which is clearly had enormous global impact.

333
00:36:13,120 --> 00:36:16,750
Well, the typhoid study has been in the news. You obviously don't read the news. Certainly.

334
00:36:17,410 --> 00:36:27,100
I mean, that kind of. No, but it but interestingly, it's had more media attention than almost any other of the programs that run.

335
00:36:27,100 --> 00:36:33,280
But on vaccines, it's had huge media attention. But because the Chinese studies that we were doing went to infecting people was big news.

336
00:36:33,850 --> 00:36:40,300
And the the the work that we did in Nepal showed the vaccine was reported all over the world.

337
00:36:40,600 --> 00:36:47,079
But it but it doesn't chime with the public because it has for most of us, typhoid is a traveller's problem.

338
00:36:47,080 --> 00:36:54,310
You go to the travel for they can get your vaccine. Um, but here we're dealing with COVID, which matters for all of us.

339
00:36:54,730 --> 00:36:58,570
And I think in, in some ways it makes me feel a bit frustrated.

340
00:36:58,570 --> 00:37:05,590
The impact of vaccines are having every day in the world is greater than COVID vaccines, and yet we don't celebrate them at all.

341
00:37:07,740 --> 00:37:12,650
Maybe that will change. Maybe. At the moment.

342
00:37:13,590 --> 00:37:19,170
Yes. So we've been talking about that with other events during the trial that really stand out in your mind?

343
00:37:19,230 --> 00:37:27,270
Yes. I mean, I think during the trials, the other big events that were very difficult to handle were around safety.

344
00:37:27,930 --> 00:37:35,159
And what what happened there was that the right way of managing safety in trials is

345
00:37:35,160 --> 00:37:41,220
that you have a system where whenever there is an event which you can't explain,

346
00:37:42,250 --> 00:37:50,370
that if it's serious and you think it might be related to the vaccines, you can't disprove that.

347
00:37:51,180 --> 00:37:56,190
You then have to go through quite a process of deciding whether it's safe to

348
00:37:56,190 --> 00:37:59,340
give further doses whilst you're trying to work out whether this is a problem.

349
00:38:00,000 --> 00:38:10,380
And so on two occasions during the trials, I took the decision to stop the trial in order to have independent review of an event which had happened.

350
00:38:10,920 --> 00:38:17,999
And that's done by our Data Safety Monitoring Committee, who are independent, the Americans mostly.

351
00:38:18,000 --> 00:38:26,100
But there's also representation from Latin America and Africa and the UK and the MHRA.

352
00:38:26,340 --> 00:38:32,670
And in fact we also had an independent neurologist who was also reviewed information.

353
00:38:32,970 --> 00:38:43,710
So there's a very well set up review process that gives me the confidence that it's all been looked at by people who are not vested in the trial,

354
00:38:44,340 --> 00:38:50,910
and that allows me to then restart. And so we went through that process on two occasions in the clinical trials,

355
00:38:51,630 --> 00:38:58,080
and on the second occasion it was someone who developed a neurological condition called transverse myelitis,

356
00:38:59,010 --> 00:39:04,560
which I think the view is that it's not associated with the vaccine,

357
00:39:05,460 --> 00:39:12,960
that even if it had been with a single case when it was looked at at that time, there's no way that you could have told whether it was or not.

358
00:39:13,920 --> 00:39:18,719
But as it turns out, those cases are not the size of the vaccine. You know, that there's 2 billion doses been given.

359
00:39:18,720 --> 00:39:25,440
We know it isn't. But at the time, we I couldn't say for certain that this wasn't a very unusual, rare side effect.

360
00:39:25,440 --> 00:39:32,790
So it needed independent review as to the processes were followed as they are in every clinical trial I've ever been involved with.

361
00:39:33,390 --> 00:39:40,200
But the media side immediately got hold of this trial, stopped a serious neurological event caused by the vaccine,

362
00:39:40,710 --> 00:39:47,610
and the difficulty of managing that because, you know, again, it's having this global impact on confidence.

363
00:39:48,090 --> 00:39:53,520
But the message should have been this is normal safety processes.

364
00:39:53,670 --> 00:39:58,950
Isn't it wonderful that the trials are running in that way to very carefully evaluate each case?

365
00:40:00,300 --> 00:40:06,690
And what was surprising to me now in retrospect, and I know this happens with other developers, zero media noise about any of them,

366
00:40:07,050 --> 00:40:15,120
but I just can't understand why we got so much attention damaging to the vaccine because of these events happening.

367
00:40:15,330 --> 00:40:19,409
And I think probably it was because we were so far ahead of everyone and there

368
00:40:19,410 --> 00:40:23,160
was nothing else to talk about it apart from what was happening in our trials.

369
00:40:24,660 --> 00:40:32,760
But in a way, to me, it just shows good trial governance and it haunts many people who suffered through

370
00:40:32,760 --> 00:40:37,320
the the and the difficulties of that and the huge media attention it generated.

371
00:40:37,860 --> 00:40:47,790
And so then but eventually your positive result emerged, although in a slightly nuanced way, it wasn't just one number.

372
00:40:48,660 --> 00:40:54,870
Well, it's interesting that you say that, because for all of the vaccines that have been out, there isn't just one number.

373
00:40:55,050 --> 00:40:59,880
And I think one of the maximum was something like seven or 11 with one of one of the vaccines.

374
00:41:00,390 --> 00:41:03,990
But again, we had three numbers and I'd explain why.

375
00:41:03,990 --> 00:41:08,700
But but that generated an enormous amount of media attention as it being a problem.

376
00:41:09,750 --> 00:41:12,900
From from our perspective, we didn't want to hide anything.

377
00:41:13,110 --> 00:41:17,850
Absolutely. We wanted to put the information out publicly that was there.

378
00:41:18,060 --> 00:41:21,570
We discussed that with a data safety monitoring board.

379
00:41:22,260 --> 00:41:25,310
And it was the right thing to do to to.

380
00:41:25,800 --> 00:41:36,660
And, of course, it's important to understand that what happens is that you do this initial analysis focusing on the high level numbers and those,

381
00:41:36,840 --> 00:41:41,790
and that that was on a Saturday, which would have been the 21st of November.

382
00:41:42,670 --> 00:41:45,840
And those I didn't know the results.

383
00:41:46,680 --> 00:41:54,149
They don't put together by an independent statistician who then goes through them with the Data Safety Monitoring Board.

384
00:41:54,150 --> 00:42:01,410
So this is all online. I was sitting here in my office at the computer when I was then invited into that meeting.

385
00:42:02,100 --> 00:42:06,270
You know, I felt like I was in the headmaster's office, about to hear the results.

386
00:42:06,280 --> 00:42:12,990
I had no idea what it would show. And I think that this was in the evening, I know, 630 or something in the evening.

387
00:42:13,470 --> 00:42:18,000
And they they then went through the results are some of the results of the first time.

388
00:42:18,000 --> 00:42:22,080
I was the only person who saw those apart from the statistician,

389
00:42:22,740 --> 00:42:27,930
and there was no discussion with the Data Safety Committee that they had ended the call.

390
00:42:28,350 --> 00:42:33,030
And then I had the results the next step. And I phoned Sara Gilbert and told her the results.

391
00:42:33,930 --> 00:42:40,170
And then we had to start a process of sending all of the data to AstraZeneca so it could be verified during day,

392
00:42:40,710 --> 00:42:47,160
and then we could work through Sunday to establish how we would then start sharing that publicly,

393
00:42:47,160 --> 00:42:53,940
because for them, those the markets meant that when they had new data, they had to go to the markets.

394
00:42:54,270 --> 00:42:59,639
So we just had this these high level three numbers that we had not had time to dig

395
00:42:59,640 --> 00:43:03,360
into the data and fully understand why they were like they were and what they meant.

396
00:43:04,470 --> 00:43:11,280
But to show just one of them would have been it would have been a commercially the right thing to do

397
00:43:11,460 --> 00:43:16,440
before an integrity point of view was it would not have been right because we knew we had three numbers,

398
00:43:17,520 --> 00:43:23,480
but in fact were quite good. They're they're all good. They're good. And so the next day we took it.

399
00:43:23,490 --> 00:43:27,120
We should make this clear. The number we're talking about is the percent effectiveness.

400
00:43:27,120 --> 00:43:29,400
Yeah, it's the efficacy of the vaccine.

401
00:43:30,590 --> 00:43:37,580
And in fact, it's more than three numbers because it was 100% protective against severe disease and hospitalisation.

402
00:43:38,550 --> 00:43:43,500
And then we had within the study two different dose intervals.

403
00:43:43,500 --> 00:43:52,140
We had the shorter interval, which had a lower efficacy, the longer dose until and it gave an overall number of around 70% efficacy.

404
00:43:52,870 --> 00:43:58,079
One of the things that's also very difficult to to for people to understand is

405
00:43:58,080 --> 00:44:03,270
that the efficacy as you measure it very much depends on what you call a case.

406
00:44:03,900 --> 00:44:09,900
And in our trials, we were looking largely at very mild disease because we were hoping people every week.

407
00:44:10,410 --> 00:44:13,590
And so we had a lot of cases that were extremely mild.

408
00:44:14,250 --> 00:44:22,560
And so as we now know, the efficacy of vaccines against mild disease or asymptomatic infection is much lower than it is against severe disease.

409
00:44:22,860 --> 00:44:29,730
So if you put your study in a way that you're measuring much more severe disease, you'll have a higher number than if you look at milder disease.

410
00:44:30,900 --> 00:44:38,970
So the comparisons made with the other vaccines that we that people were understanding that in the absence of head to head study, you can't say that.

411
00:44:40,350 --> 00:44:46,080
And then the fact that we couldn't fully explain why we had three numbers made it look like it was messy.

412
00:44:46,350 --> 00:44:54,890
But actually it wasn't. It was the study. And it was just just presenting things as they on the Monday morning.

413
00:44:55,140 --> 00:44:58,560
You know, I then had to do lots of interviews by the evening.

414
00:44:58,860 --> 00:45:01,830
I was in Downing Street announcing the results with the Prime Minister.

415
00:45:02,250 --> 00:45:08,430
And so that whirlwind of the huge amount of work to get the data ready to go to the statisticians the week before.

416
00:45:08,910 --> 00:45:14,570
And I remember standing there at the podium in in Downing Street and thinking, I have no idea what I've just said.

417
00:45:14,580 --> 00:45:18,720
I'm so tired. I'm exhausted. It was the most.

418
00:45:20,010 --> 00:45:29,140
I mean, I remember every moment of it, but I just at that time, I was just in some ways, it was a blur.

419
00:45:29,160 --> 00:45:37,889
It was just a blur. And how did you feel emotionally? I mean, did you did you feel triumphant or was it to with all this other stuff,

420
00:45:37,890 --> 00:45:41,790
making it difficult for you to feel a sense of, yes, we've put this off?

421
00:45:42,920 --> 00:45:49,560
I think there wasn't really much time for reflection because there was so much to do from the moment of getting the results.

422
00:45:50,970 --> 00:45:55,650
There was thinking about Sarah, we need to get the data, upload it to AstraZeneca tomorrow.

423
00:45:55,650 --> 00:46:00,780
We've got to start meeting with them with their statisticians and all the relevant parties

424
00:46:00,780 --> 00:46:04,830
meet with government to show them the results so that they're not blindsided the next day.

425
00:46:05,520 --> 00:46:11,640
It really wasn't time for a triumphant moment or a deflated moment or whatever.

426
00:46:12,540 --> 00:46:18,660
And of course, the we were very aware that having some uncertainty be what the three numbers meant.

427
00:46:20,100 --> 00:46:26,430
It looked like it was probably the dose interval, but we couldn't we hadn't had time to dig into the data to answer that.

428
00:46:26,920 --> 00:46:33,860
And so we weren't in a position initially to say categorically, and that made us look like we didn't know what we were doing.

429
00:46:33,870 --> 00:46:36,910
But of course, that really wasn't the case. And.

430
00:46:38,260 --> 00:46:44,890
So, yes, I think there was a lot of time spent thinking about how best to manage all of these uncertainties.

431
00:46:45,430 --> 00:46:53,680
And I don't know whether we got it right, but somehow, certainly from a UK perspective, there's been huge confidence in the vaccine.

432
00:46:54,160 --> 00:47:00,610
And today when you know, when I look at the UK data, tens of thousands of lives have already been saved here already in November.

433
00:47:01,510 --> 00:47:05,440
We're into the millions globally of lives saved, which is just astonishing.

434
00:47:06,670 --> 00:47:12,420
We're in December now, actually. It's just an.

435
00:47:17,650 --> 00:47:23,470
Yeah. So were you involved at all in the discussions about the rollout or was that the people's responsibility?

436
00:47:24,260 --> 00:47:27,640
Um, so the yes and no.

437
00:47:27,650 --> 00:47:34,330
I mean, the rollout really was something that the Department of Health and the NHS were putting together.

438
00:47:34,730 --> 00:47:40,180
I did have some interactions with with scientists in government over this period,

439
00:47:40,180 --> 00:47:45,250
but the details of how the rollout was going to work was really not in our hands.

440
00:47:45,460 --> 00:47:54,190
I mean, the fact that we had a vaccine which could be used for average temperatures meant that it was much easier to roll it out,

441
00:47:54,370 --> 00:48:02,070
particularly at that time, because the RNA vaccines didn't have the the data to show how they could be more widely distributed.

442
00:48:02,080 --> 00:48:05,080
So that was really hubs that were dealing with those vaccines.

443
00:48:05,920 --> 00:48:12,729
So there was some of those discussions, but really the details of the rollout was the NHS doing that and looking at it globally.

444
00:48:12,730 --> 00:48:19,210
I mean, one of the things that I think people have been very proud of is that the university

445
00:48:19,870 --> 00:48:25,780
agreement with AstraZeneca was that it should be provided on a not for profit,

446
00:48:26,020 --> 00:48:30,490
not for profit basis to the two lower middle income countries.

447
00:48:30,790 --> 00:48:36,729
Was that something you had any part in? So we had discussions about that.

448
00:48:36,730 --> 00:48:45,340
And, you know, our views were sort of on that. And I think, yeah, I mean, all of the academics felt that was the right direction to go in.

449
00:48:45,920 --> 00:48:50,170
You know, the vice chancellor was very strident on it about not profiteering in a pandemic.

450
00:48:50,680 --> 00:48:54,129
And so I think it was it was the academic view.

451
00:48:54,130 --> 00:48:55,450
It was the university's view.

452
00:48:56,590 --> 00:49:03,790
And as I say, whenever there was discussion about it, but I don't think there was there needed to be much discussion, as everyone just agreed.

453
00:49:04,990 --> 00:49:10,900
And so what proportion of the vaccines that have gone to the developing world?

454
00:49:11,380 --> 00:49:18,730
Is it possible to say what proportion have been yesterday? Well, through COVAX, it's I believe today it's around 40%.

455
00:49:18,730 --> 00:49:23,680
But but a bit critically, the vaccines that save lives are the ones that got out early.

456
00:49:24,340 --> 00:49:31,690
And although supply was low for most of the first six months of this year,

457
00:49:31,690 --> 00:49:38,380
over 90% of the doses were from from our programme because the other developers were focusing on high income markets.

458
00:49:38,890 --> 00:49:47,920
And so I think it really this whole idea of not for profit means there's no commercial driver to to sell to, to a high income country.

459
00:49:48,250 --> 00:49:54,460
The driver is to distribute the doses and to do the right thing, not to do things for commercial benefit.

460
00:49:54,790 --> 00:49:58,209
And that to me was it was 24th of February.

461
00:49:58,210 --> 00:50:05,200
The first dose went through COVAX. That was an incredibly exciting moment to see those planes landing in Africa.

462
00:50:05,590 --> 00:50:13,540
So COVAX is so COVAX is a is a facility which has the funding to to purchase vaccines from the

463
00:50:13,540 --> 00:50:19,360
developers and then connections into governments globally to to distribute them when they're ordered.

464
00:50:19,530 --> 00:50:22,870
And who supports that? That's a collaboration.

465
00:50:22,870 --> 00:50:29,860
Presumably it's governments who put money into that to to international governments to fund it.

466
00:50:30,430 --> 00:50:37,990
And there's international organisations like GAVI, A.J., who and UNICEF, who are involved in all of those processes.

467
00:50:38,440 --> 00:50:43,210
But of course, there's already a vaccine distribution system globally, normally anyway for vaccines.

468
00:50:43,570 --> 00:50:51,430
And so it's tapped into the partners who work on both the the driving new vaccines into the into developing countries,

469
00:50:51,430 --> 00:50:55,210
as well as the routine vaccines we all enjoy.

470
00:50:55,440 --> 00:50:58,630
Mm hmm. And you talked a little bit about.

471
00:51:01,210 --> 00:51:08,340
Oh, yes. The question I had, which I haven't seen, he answered in a straightforward way in the sort of general scheme of things.

472
00:51:08,350 --> 00:51:14,710
Is it an expensive vaccine? I know how you put prices on these things is a bit of a mystery to most people.

473
00:51:14,950 --> 00:51:19,360
But well, because it's not for profit, I it's around about $3 a dose.

474
00:51:19,990 --> 00:51:22,410
I mean, that's that's not an expensive vaccine.

475
00:51:23,130 --> 00:51:34,330
And if you it depends where you look at the perspective from, you know, some vaccines cost hundreds of dollars and to to buy in high income markets.

476
00:51:35,740 --> 00:51:42,950
But usually for low income countries, there are systems in place to have a low price for that.

477
00:51:43,120 --> 00:51:47,290
It doesn't need to be kept in a -80 degree fridge. Help to keep the price then.

478
00:51:47,740 --> 00:51:51,280
Well, that isn't included in that price of the vaccine.

479
00:51:52,540 --> 00:52:03,360
I mean, a big part of the the price of vaccines is, is the delivery, which is both the the storage facilities and they have the staff injected.

480
00:52:04,050 --> 00:52:10,570
And but but the the not for profit relates to the costs of actually binding the materials and manufacturing it.

481
00:52:16,640 --> 00:52:26,270
So. So you told me that it was it wasn't exactly a new experience for you to have to deal with the media, but the level of it was much higher.

482
00:52:26,660 --> 00:52:32,690
Yeah, I do. I mean, I've I've done some media since since the mid-nineties,

483
00:52:32,690 --> 00:52:39,650
and I felt like my first televised interview was with Fergus Walsh from the BBC in about 1996 or seven,

484
00:52:40,400 --> 00:52:49,400
which a very odd experience because I was doing my Ph.D., I came into some Mary's hospital where the lab was I was working in,

485
00:52:50,060 --> 00:52:55,820
and the CEO of the hospital grabbed me and said, Could you do a press conference?

486
00:52:56,350 --> 00:52:57,050
What was on?

487
00:52:57,620 --> 00:53:04,579
And they my supervisor had been up all night working on the intensive care unit and had gone home and he was supposed to do a press conference.

488
00:53:04,580 --> 00:53:08,420
So they gave me the press release, which was about the genetics of meningitis.

489
00:53:08,900 --> 00:53:10,610
And of course it was in my department.

490
00:53:10,610 --> 00:53:16,819
So I knew roughly about I read the press release and then I went and did a press conference based on the press release,

491
00:53:16,820 --> 00:53:23,390
and it was about 20 minutes of journalists napping and asking questions.

492
00:53:23,720 --> 00:53:29,510
And then the last person to ask question was Fergus Walsh. And I answered his his question succinctly.

493
00:53:29,930 --> 00:53:35,930
The first one, I was just thinking succinctly, and that was the one that was broadcast across all of the news outlets that evening.

494
00:53:36,350 --> 00:53:40,459
And so I've been interviewed by him a number of times now, over over many years.

495
00:53:40,460 --> 00:53:41,810
But that was the first experience.

496
00:53:42,590 --> 00:53:48,710
So I'd say, well, you perhaps were displaced by the massive media scrutiny as some of your colleagues might have been.

497
00:53:51,050 --> 00:53:51,890
No, I mean,

498
00:53:51,890 --> 00:54:06,920
I've been surprised and sometimes shocked by the journalists and but also found many who genuinely do want to report the stories truthfully.

499
00:54:08,420 --> 00:54:14,240
So, yes, I know a lot more about the game that that playing than I did before.

500
00:54:14,780 --> 00:54:18,440
But I think you're right to say that it wasn't I wasn't totally fazed.

501
00:54:19,190 --> 00:54:27,260
But I'm also somewhat wary about the intentions of some journalists, particularly some of the experiences in the U.S.

502
00:54:27,380 --> 00:54:31,610
Yeah. Yeah. And then, of course, social media is another thing altogether, isn't it?

503
00:54:32,900 --> 00:54:38,479
Yes. I mean, social media is complex because a lot of social media is really an echo chamber.

504
00:54:38,480 --> 00:54:44,120
So if you've got a view about something, it's very easy to find that lots of other people agree with it.

505
00:54:44,840 --> 00:54:51,379
And the I mean, certainly social media for me has had some downsides because I get targeted

506
00:54:51,380 --> 00:54:55,310
by anti-vaccine people and I have some pretty horrible things said about me.

507
00:54:55,730 --> 00:55:01,370
I also get lots of emails from people accusing me of genocide and appalling things like that.

508
00:55:02,720 --> 00:55:10,220
But I think the most sinister bit from the social media side has been some evidence that we're aware of,

509
00:55:10,220 --> 00:55:16,070
of state actors trying to deliberately amplify negative messages about our vaccine and of course,

510
00:55:16,070 --> 00:55:20,990
other vaccines as well, which, of course, there's nothing we can do about it.

511
00:55:20,990 --> 00:55:31,280
And as a group of academics, but it is all part of the additional burden that there is on us to communicate, to tell how serious the problem is.

512
00:55:31,280 --> 00:55:34,940
Vaccine, misinformation, I think, is a terribly serious problem.

513
00:55:35,120 --> 00:55:40,770
And it's the misinformation that is through this.

514
00:55:41,300 --> 00:55:46,370
The more widely used social media platforms is clearly very problematic but should be regulated.

515
00:55:46,940 --> 00:55:53,440
The misinformation from websites in other countries that that no one can control, there's nothing you can do about.

516
00:55:53,450 --> 00:56:01,190
So the fake news about the person dying, that's a well known fake news website, but no one in the UK has any reach into that to, to stop it.

517
00:56:02,120 --> 00:56:13,960
And the clearly the, the state actors, this is, is a sort of political issue which is again not for us to,

518
00:56:14,300 --> 00:56:18,970
to deal with, but misinformation is a major, major problem.

519
00:56:18,980 --> 00:56:22,670
And it gets amplified by, by social media.

520
00:56:22,670 --> 00:56:34,130
One of the other problems that I've seen is communities who have their own interactions but may not interact much with the mainstream media.

521
00:56:34,610 --> 00:56:46,040
And so I had dealings with a community who work in the hospital, and one of their members said to me, you know, you involved in the vaccine?

522
00:56:46,040 --> 00:56:47,839
And I was talking to them about it.

523
00:56:47,840 --> 00:56:58,520
And he had a list of multiple concerns that he had and it was his community and were communicating with each other using WhatsApp groups and so on,

524
00:56:58,760 --> 00:57:04,910
and discussing the fact that vaccines were dangerous and they might affect their fertility and so on.

525
00:57:05,450 --> 00:57:16,130
And there was no reference that he could get to the to the safe information about it as we talk through all of those issues earlier this year.

526
00:57:16,800 --> 00:57:21,360
And there's sort of a couple of weeks later and he said, yes, 15 of us got vaccinated after I spoke to you.

527
00:57:21,780 --> 00:57:25,919
And it just made me think that the problem is we can't reach into many of the communities.

528
00:57:25,920 --> 00:57:30,660
We need to we need to get better at doing that because know that that's 15 people.

529
00:57:30,670 --> 00:57:39,480
But there will be tens of thousands just in our country and who who are in those communities that they don't have access to the credible information.

530
00:57:40,140 --> 00:57:44,260
So I'm hoping to interview some of the other people around Oxford who specifically look at this area.

531
00:57:44,310 --> 00:57:50,030
So, yeah, the it's very interesting to hear that you've at least managed to have a positive impact on.

532
00:57:50,400 --> 00:57:53,850
Well, I hope I've had some personal effects business. You can never be sure.

533
00:57:54,300 --> 00:58:01,740
Yeah. I think one of the other things you've actually written about that in a sense the opinion articles rather than interviews is vaccine equity.

534
00:58:01,740 --> 00:58:08,010
In terms of this question, do we go for boosters in this country or should we be getting doses overseas?

535
00:58:10,050 --> 00:58:18,690
I mean, do you think your relatively high level of experience with the need to make you more confident that making those statements?

536
00:58:20,820 --> 00:58:25,500
I felt I feel sort of a duty to to say these things,

537
00:58:25,500 --> 00:58:34,590
particularly in the face of a of a system which is not really geared up to be thinking outwardly and maybe we've got worse.

538
00:58:34,590 --> 00:58:43,290
And it's in the UK and it's absolutely clear when you look at the number of doses being produced in the first half of this year,

539
00:58:43,920 --> 00:58:48,240
that there were enough doses to prevent almost all of the deaths in the world that have happened since.

540
00:58:49,020 --> 00:58:56,759
And that is if we had focussed on older adults and people with health conditions everywhere as we did in the UK,

541
00:58:56,760 --> 00:59:00,780
if we, if we could have done that first, most of the deaths would have been prevented.

542
00:59:01,530 --> 00:59:07,439
The problem for domestic politicians is the most of the deaths because there would still have

543
00:59:07,440 --> 00:59:12,600
been deaths in young people and those who weren't in those initial programmes in the UK.

544
00:59:13,230 --> 00:59:18,750
And for our elected politicians we expect them to protect us.

545
00:59:19,140 --> 00:59:22,320
And so there is this dilemma between what's right to do.

546
00:59:22,350 --> 00:59:27,780
From a global equity point of view and the drive of domestic politicians.

547
00:59:28,290 --> 00:59:37,480
And I think the problem is that until domestic politicians feel confident that that the things are okay for them,

548
00:59:37,750 --> 00:59:45,690
that they've done all that they could have done, it's very difficult for them to take those global decisions to protect the rest of the world.

549
00:59:46,650 --> 00:59:56,310
And I do think the news I was speaking just over a week after the new Micron variant was named,

550
00:59:56,820 --> 01:00:00,240
do you think is going to make things worse because of the scale of the booster programme?

551
01:00:01,770 --> 01:00:02,540
Yes and no.

552
01:00:02,550 --> 01:00:12,660
I mean, I think that there's no doubt that boosters are going to be scaled up everywhere that can afford them and that will reduce the global supply.

553
01:00:12,930 --> 01:00:21,570
However, we are at a moment where there is quite a lot of global supply and doses that could be widely distributed.

554
01:00:21,840 --> 01:00:25,200
So I think it's an uncertain moment in time.

555
01:00:26,190 --> 01:00:35,070
The the lifting of the blockade in India of distributing vaccines from India, which has the biggest centres for producing, including our vaccine,

556
01:00:36,210 --> 01:00:44,010
really means that there is a moment where if countries have the capacity to receive and distribute the doses,

557
01:00:44,010 --> 01:00:52,020
that things could change very rapidly over the next few months. But the only way that can happen is if the systems now start working for distribution.

558
01:00:52,920 --> 01:00:59,520
But as far as boosters are concerned, they are a risk, but they're not as much of a risk as they were a few months ago,

559
01:00:59,670 --> 01:01:11,600
simply because there's a lot more supply in the world that might. But they say the devil's in the detail of what happens next.

560
01:01:11,630 --> 01:01:19,970
Yes. Yes. Which we don't know. Yes. Well, yes. You know, now we are in another very uncertain and sad moment,

561
01:01:20,930 --> 01:01:26,460
uncertain about how countries will react, but not so uncertain about what we're seeing happening.

562
01:01:26,530 --> 01:01:34,130
I mean, as you would still expect with all the remains to be proven, but you still expect the vaccine to prevent severe disease caused by it.

563
01:01:34,760 --> 01:01:38,840
And probably from the data we're seeing in South Africa, it will spread readily.

564
01:01:40,930 --> 01:01:49,659
But of course the centre of the population is a bit different from ours. They've had almost no vaccination and waves of following.

565
01:01:49,660 --> 01:01:56,140
We've had of beta that delta. We're in a highly vaccinated population that has had alpha and delta.

566
01:01:56,680 --> 01:01:59,860
So how does that play into it? We just don't know.

567
01:02:01,180 --> 01:02:05,080
So the world is conducting a massive experiment all the time. Know.

568
01:02:05,890 --> 01:02:11,800
But. But the knee jerk reactions are likely to be to be small because it probably that is a good idea.

569
01:02:12,670 --> 01:02:16,000
But we have to that's ahead of the evidence to say that that's necessary.

570
01:02:17,700 --> 01:02:22,640
So that the last few questions are more about your personal question.

571
01:02:22,650 --> 01:02:31,620
Is that your personal response to things that went long but that how did the first lockdown impact on what you were able to do?

572
01:02:32,790 --> 01:02:38,760
Did it change the way you work and where, in fact, any of those changes positive after the first lockdown?

573
01:02:39,180 --> 01:02:45,520
And I mean, it didn't really change the the way that you conduct trials and to you know,

574
01:02:45,810 --> 01:02:48,630
now we were all in work everyday doing the same jobs that we always do.

575
01:02:48,660 --> 01:02:55,559
So it's it was a it's a strange thing that people, you know, giving accolades to us for having done something extraordinary.

576
01:02:55,560 --> 01:02:58,710
We've actually done something pretty ordinary at an extraordinary moment.

577
01:02:59,370 --> 01:03:08,220
And so from that perspective, you must have had provision for how you were able to work together and if you were coming into the into the building.

578
01:03:08,700 --> 01:03:12,820
Yes. So so we had to put in place social distancing and so on to trial.

579
01:03:13,030 --> 01:03:18,149
And we didn't have any outbreaks in the team over the last two years. And because of the attention to detail,

580
01:03:18,150 --> 01:03:24,540
I asked one of the team to be responsible for infection control and to make sure we were keeping up with the latest guidance.

581
01:03:24,540 --> 01:03:30,780
We actually had clinical social distancing and mask wearing and protocols before the NHS did.

582
01:03:31,290 --> 01:03:38,310
Were you able to get as much PPE is you needed? So we we had a problem with PPE.

583
01:03:39,360 --> 01:03:46,590
Interestingly, we managed to get a large donation from China very early on, which helped.

584
01:03:47,130 --> 01:03:55,709
But we had we did have some crunch points. And there was one day where Sara Gilbert and I were on a call with Matt Hancock and asked

585
01:03:55,710 --> 01:04:00,480
him if he could provide help us get PPE because we needed to run a clinic that week.

586
01:04:00,960 --> 01:04:07,080
And he picked up the phone to talk to the head of the Trust Hospital here at Oxford.

587
01:04:07,080 --> 01:04:11,940
And we had PPE delivered the next morning from them to support the vaccine effort.

588
01:04:14,870 --> 01:04:18,440
Well, the power.

589
01:04:21,810 --> 01:04:26,730
And to what extent did did I mean, did you ever feel personally threatened by the infection itself?

590
01:04:27,060 --> 01:04:32,120
By the infection? By the infection? I have looked at the data.

591
01:04:32,130 --> 01:04:38,310
I'm fit. I'm just over the age of people worried about being in my mid-fifties.

592
01:04:39,540 --> 01:04:47,400
And so my overall personal risk is relatively low and being being a healthy individual.

593
01:04:48,450 --> 01:04:53,880
So I didn't personally feel very threatened. But I think I was take life as it comes.

594
01:04:53,890 --> 01:04:56,100
So if I got sick, I would have to deal with that.

595
01:04:56,100 --> 01:05:04,440
But, you know, we were all taking great care and precautions to to make sure we were protected from the virus.

596
01:05:04,440 --> 01:05:09,080
But, you know, we just have to deal with whatever it is anybody tries to infect it all.

597
01:05:10,110 --> 01:05:17,790
Well, there are there are people in the team who've been infected, you know, home from their kids or from their families.

598
01:05:17,790 --> 01:05:24,420
So there's lots of people around that I know who have been infected, but we haven't had any of that spread within the team here.

599
01:05:24,540 --> 01:05:34,800
Right. Mm hmm. And yet when I got a question about working out, as you said, you just kept on coming to work as normal, but it doesn't.

600
01:05:35,010 --> 01:05:38,640
You did that. But you also mentioned that you were completely exhausted by the type of results.

601
01:05:38,700 --> 01:05:46,649
Yeah. I mean, I think the thing that's different was I was I've always worked a lot, but it really didn't.

602
01:05:46,650 --> 01:05:50,580
I made it very hard in the evenings to even get away from here, to go home.

603
01:05:51,140 --> 01:05:57,150
And particularly with the international nature of the work.

604
01:05:57,690 --> 01:06:05,880
There's definitely some time zone issues which meant that a lot of the communication was happening in during other hours of the day.

605
01:06:06,960 --> 01:06:08,520
So it was it was much longer hours.

606
01:06:08,520 --> 01:06:17,960
And I think everyone I say that all the senior people in the team worked seven days a week and many of the more junior people as well, um,

607
01:06:18,600 --> 01:06:24,600
over the course of the two years and it that really hasn't stopped today that I was in a meeting

608
01:06:24,600 --> 01:06:28,050
for an hour this morning and I had 100 emails that came in whilst I was in the meeting.

609
01:06:28,530 --> 01:06:34,620
I just, it just shows the amount of activity that still lives and you seem remarkably well on it.

610
01:06:35,620 --> 01:06:40,500
What is there that you're able to do to keep your your general state of wellbeing?

611
01:06:40,920 --> 01:06:48,080
I think I think a lot of it is is where you where you sit mentally and it all it's,

612
01:06:48,090 --> 01:06:55,350
um, I, I think to a large extent most of what I do I'm in control of.

613
01:06:55,800 --> 01:07:03,000
And so I think if you from a resilience point of view where you feel in control, then it's quite easy.

614
01:07:03,000 --> 01:07:10,410
The problem for most of us is when we're not in control. And so I think the stressful points were when external things were happening,

615
01:07:11,400 --> 01:07:17,879
the the unpleasant things being said about the vaccine or about us, I think those things are much more stressful and troubling.

616
01:07:17,880 --> 01:07:19,200
But the things you can control,

617
01:07:19,200 --> 01:07:27,870
which and I tried to run high quality studies and to look after the team and that's I think that's fairly straightforward.

618
01:07:28,140 --> 01:07:34,470
But you mentioned running earlier and I noticed from something I've read that when I was being a mountain climber.

619
01:07:34,620 --> 01:07:38,820
Yes. Well, I mean, I cycle every day to work and I run on the weekend.

620
01:07:38,830 --> 01:07:42,960
So that but that's about the only stuff that I do, I suppose.

621
01:07:43,060 --> 01:07:48,630
I've watched a number of late night Netflix series,

622
01:07:49,350 --> 01:07:57,089
usually between about 11 to midnight to try and get my head out of the the thinking about vaccines to help sleep.

623
01:07:57,090 --> 01:08:00,240
But apart from that, there's not really been space for anything.

624
01:08:00,630 --> 01:08:12,300
And and as far as the team as a whole is concerned, have you felt the need to institute any kind of support provision for the wellbeing of people?

625
01:08:12,780 --> 01:08:22,100
Well, I think there's several aspects that one is trying to make sure we recognise the team and we've had a number of opportunities to do that.

626
01:08:22,110 --> 01:08:26,519
And over the course, particularly of this last year, good communication.

627
01:08:26,520 --> 01:08:34,920
So particularly during the most troubling moments to communicate with the whole team about what's going on and to to thank them and congratulate them.

628
01:08:35,760 --> 01:08:42,180
We've also been able to help here with in my team in the Department of Paediatrics

629
01:08:43,080 --> 01:08:49,649
with rewarding them for the work that they've done and by giving some extra time off,

630
01:08:49,650 --> 01:08:53,040
things like that which to try and to support people, recognise them.

631
01:08:53,520 --> 01:09:01,890
And we've, we've also done the best we could to make sure people get holidays and get breaks that I that's not true for all of us,

632
01:09:02,640 --> 01:09:09,030
but it's been quite an important part of it. Of course the difficulty with that is that for everyone holidays have been very, very difficult.

633
01:09:09,030 --> 01:09:14,459
So it's very hard to give people a proper break. And in the middle of a pandemic, I can't fix that.

634
01:09:14,460 --> 01:09:17,490
But we've sent people away from wherever we could.

635
01:09:18,960 --> 01:09:25,560
And yet in terms of talking rewarding people, you were knighted in the in the Queen's Birthday honours.

636
01:09:25,980 --> 01:09:29,410
Yeah, I was. Was that a surprise or did you know it was coming?

637
01:09:30,150 --> 01:09:39,090
Well, you always know it's coming because they you get a letter from the asking whether you accept it.

638
01:09:39,330 --> 01:09:50,520
And but but in a way, the way that that is written, you don't have absolute certainty until the the the award appears in the London Gazette,

639
01:09:50,910 --> 01:09:56,280
because the letter says, you know, if you accept the nomination, we'll ask the queen if she agrees.

640
01:09:57,090 --> 01:10:01,499
And so until it appears that there's no communication at all about it.

641
01:10:01,500 --> 01:10:06,420
But but I will say I'm delighted, but actually delighted for the team because it really,

642
01:10:06,970 --> 01:10:10,530
you know, I'm just one of the cogs in this enormous operation.

643
01:10:10,890 --> 01:10:14,100
And if you take any of the cooks out of the whole thing falls apart.

644
01:10:14,520 --> 01:10:18,030
And so there are many other people who are just as deserving as me.

645
01:10:18,030 --> 01:10:23,340
But so I sort of see this as something that I receive on behalf of a of a larger group.

646
01:10:24,390 --> 01:10:30,360
Just two more questions. How has this work raised new questions that you're interested in exploring in the future?

647
01:10:31,680 --> 01:10:37,470
Well, I think it raises a lot of questions. And coming back to where we started about understanding the immune response,

648
01:10:37,920 --> 01:10:43,530
there's so much that we've started to scratch the surface of with COVID vaccines,

649
01:10:43,530 --> 01:10:47,610
about dose intervals, about whether high doses or low doses are better.

650
01:10:47,970 --> 01:10:55,110
And the studies now being started, which we're involved in, in different countries, looking at could you boost with much lower doses?

651
01:10:55,650 --> 01:10:58,870
So all of all of these questions need addressing.

652
01:10:58,890 --> 01:11:03,540
To me, it also raises the profile of being better prepared for pandemics.

653
01:11:03,540 --> 01:11:13,230
What what do we need to do? So that when it's a virus that we've never heard of before, that we can react as rapidly as we did with Kobe.

654
01:11:13,560 --> 01:11:17,070
Kobe, it was easy. It's a virus that we knew a lot about.

655
01:11:17,280 --> 01:11:20,580
We knew that you had to use spike protein to make the vaccines.

656
01:11:20,970 --> 01:11:30,960
We knew which platforms were likely to work, like the RNAs and the viral vectors, and we were fortunate that it only had a 1% mortality.

657
01:11:31,380 --> 01:11:36,150
What would we do if it was a virus we'd never heard of before from an animal species?

658
01:11:36,990 --> 01:11:42,690
We didn't know which part of it to make the vaccine from, and it killed 50% of the people it infected.

659
01:11:43,110 --> 01:11:47,429
We need to be much more on the ball for that scenario than we are.

660
01:11:47,430 --> 01:11:51,090
And I think to me, that's a critical part of the next steps.

661
01:11:51,300 --> 01:11:57,900
Mm hmm. So has the experience of COVID changed your attitude to your approach to your work?

662
01:11:57,900 --> 01:12:01,110
And how would you like things to change in the future? You've covered that.

663
01:12:01,770 --> 01:12:06,310
I haven't had any time to reflect on on whether my attitudes have changed at all.

664
01:12:06,330 --> 01:12:11,970
I mean, at the moment, we've just got too much to do in the in the day job to think much about the future.

665
01:12:13,380 --> 01:12:24,270
I think it's I've always known the importance of what we do and seeing the impact, the work, what we have on people's lives and particularly children.

666
01:12:24,270 --> 01:12:34,230
Because that's my main focus as a paediatrician. And every day the work that we've done here is saving lives and even before COVID.

667
01:12:34,650 --> 01:12:38,969
So in many ways, that's, that's what I want us to continue to do, is to have an impact.

668
01:12:38,970 --> 01:12:43,680
And that's the great thing about vaccines. They work. Thank you very much.