The testing you're getting. So this is I'm talking to John Bell for the second time.
And we're picking up from having got to the point where we had agreement between AstraZeneca and the university and the government.
Yeah. So so I have to go back to go forward because the what became very clear during the month of February as the disease took off in Lombardy,
in Italy, that the that we were likely to have a really bad pandemic.
So this is February 2020. Exactly. That's it. Yeah. And that.
You can. It was interesting because I spent a lot of time looking at the curves and the numbers of cases,
and you can see the curve in Lombardy, which went like that.
And if you just went back about six weeks, we were just here and we were following the curve.
Exactly. So you knew it was going to happen and the the health service hadn't yet sprung into action?
Not that it ever would, I don't think. But anyway, the the health system was largely unprepared for trouble.
And there were a set of things that were of real concern.
One was PPE, where despite the fact, knowing something was coming from early in January, they made no effort to fix the PPE problem.
That was going to be a catastrophic problem which had turned on me and I didn't have anything to do with that.
I stayed completely away from that nonsense. I actually wasn't entirely true.
I did take a big shipment of PPE from. Friends in Hong Kong rang me up and said, We are in trouble.
My life. You want a container for PBS? Yes, please. But that.
That society. That's the second one with ventilators.
And everybody knew you're going to need a lot of ventilators.
And the Italians had started to run out of ventilators, so thinking it's good.
So the government decided to launch a competition for ventilators.
In the hope that they would be able to find a design for a ventilator that would
work and that we could make here because they didn't have enough ventilators, basically.
And I, I was not directly involved in competition, but I was very directly involved in thinking about the ventilator solution.
And indeed, in the middle of March, at the end of March, I called the Chennai Zoo,
who used to be the minister of health in China, who's an old colleague.
And I called him up until we need a ventilator. So he said, no, I will get your ventilators.
And they lined up a big shipment of ventilators from the UK and then I passed that
through to number ten and they actually number ten were on the call with me,
I think. And that and, and meanwhile they were running this competition.
But the competition in the end got to a completion.
But they never they never activated because they turned off.
They had nothing later. So I was in, but there was a very good ventilator done by the engineers here, which I thought was one of the best in play.
And I helped them to get it in the right place. But in the end they never got their ventilators deployed.
But it was another problem. And then the third thing was testing.
And I was involved in a meeting, I guess that second or third week of March with the team from number ten and that small group of people from.
And DHC and because it was pretty clear and the W.H.O. had even said it, if you don't testing, you're done because you don't know who's got it.
At that stage, we didn't know that at least half the people were going to be asymptomatic.
That's a little hamstring. So we didn't know that. But if if it was true and we know from flu that a large number of people are often Asian man.
So if it was like flu, we were going to be in big trouble if we had no testing.
So I was at a meeting where we were trying to work out a testing strategy and we ascertained that the whole of the NHS,
the whole of the NHS were managing about 4000 tests a day.
Actually, I think we did this. Okay. All right. Okay. We've done this. Okay.
That's how we do. We do the Lighthouse Labs. Yes, we do. All right. Okay, so roll that.
That's all good. That's fine. That's okay. Yeah. So then.
Then lots of action stuff done to deal with Pasco.
Ready to go? Pasco then launched off to try and find global manufacturers for the vaccine, which she did unbelievably well,
signed a deal with Serum Institute within about a week of signing the deal with us.
Serum Institute is the big global player in vaccine production, so that was really exciting.
In India. It's in India. Yeah, that's right. And and actually at its peak, Sherman said it was producing 250 million doses a month of our vaccine,
which is, if you think about it, is eyewatering amounts of vaccine.
So so these they really did do what they said they were.
So that was good. And and and of course, I was tracking down they phase two trial, which Andy had done is phase one now moving into phase two.
And of course, during the course of that spring there was quite a lot of disease in the UK.
So we were quite optimistic we were going to get a signal.
We thought there would be a signal by September based on that prevalence of cases, but everybody was pretty wary about that.
It's a it's a pandemic goes away, then you don't get an answer, if ever.
And that's what happened. So you'll remember that for summer, the disease largely went away in the summer.
Yes. And and as a result, they were now in Brazil, where they were having a wave in July, August, September.
But the whole thing was a bit awkward, actually. And and then there were multiple events over that period that were complicated.
They had a lady in the trial who.
Developed transverse myelitis and inflammation. And and Andy quite rightly stopped the trial.
And the MHRA looked at it. Single case transverse myelitis happens in young women.
What to do? The vaccine? Who knows? They thought about it was fine.
She was getting better. But on steroids all time back in action.
So that was all complicated. But the problem with that was that the Americans who hated this vaccine because it wasn't
an American vaccine decided that they would put a full hold on the AstraZeneca trial,
which AstraZeneca had now started and which was going to be one of our key pivotal trials for approval in America.
And the Americans said, no, no, you had a case of transverse myelitis.
You got to stop the trial. And instead of doing what the imagery did, which was, hey, look, you know, let's keep going.
And to be clear, there were no other cases transverse myelitis throughout all the trials.
They paused the AstraZeneca trial for six weeks, which actually is pretty identical, actually, a trial which is in fact is very, very bad behaviour.
And AstraZeneca was then in a series of scraps with the American.
Hierarchy. Operation Warp Speed, which has been set up by Trump to accelerate the development of vaccines,
was accelerating the development of the American vaccines and holding up AstraZeneca at
every turn with a whole load of ridiculous inputs that just didn't make any sense at all.
Run by coming months have Slaoui,
who had run vaccines GSK and I'd often wondered whether he had a grudge about AstraZeneca being in the lead rather than GSK.
Anyway, that's a separate issue.
But the anyway he was that was that was very bad behaviour and and the American press were being pretty negative about it and saying, well it's bad.
And by the way they hated the fact that it was a not for profit. Yes, they really hated it.
And they said, well, you know,
the only successful vaccines are going to be ones where people make a lot of money because the money driving innovation turned out not to be true.
So anyway, so that was so that was pretty bumpy all the way through the summer.
And that. Obviously that caused a lot of.
Questions and challenges, and we had to work quite closely with AstraZeneca to manage all that stuff.
And I was meeting with them weekly with many and Pascal and Andy Pollard and I were on the phone saying, What do we do about this?
What to do about that? And then there was lots of tricky got.
Communications issues, as you might imagine, because everybody want to know about the vaccine,
but they also wanted to know if there were any problems with the vaccine.
So it was it was the usual press melee. And then as we got through the end of the summer or then there was excitement was
growing because we thought we might get a readout of the vaccine fairly soon.
And the way that works is you have a safety monitoring committee that sees the cases as
they come in and they're either in the placebo group or they're in the treated group.
And once you get to a certain number of cases, you can then look to see if it's 5050,
in which case it hasn't worked or whether it's 73, in which case it has worked or whether it's 9010 and all that stuff.
And so we we had expected a result late September, but of course, we didn't know.
And Andy didn't know. Nobody knew.
On our end it was all data was going in and out, but we did know it was going to be slower because of the lack of UK cases.
And then that ground on a bit through the autumn until I guess late October when the news of the Pfizer vaccine,
which was either late October, early November, but it was about that time their result came through because they had had a much bigger trial.
Their trial was 40 or 50,000 people in America where the disease was rife.
So they got lots of cases and they had a great result.
With very high levels of efficacy, 90 some percent efficacy.
And so everybody said, wow, we, you know, there will be a vaccine.
Now, the problem with that vaccine, of course, is it had to be handled at -80 degrees.
You could never get it to the developing world. And they were charging a ton of money for it.
So it kind of didn't meet any of our criteria for what we wanted to achieve, but it was a good vaccine.
And so we knew at that point that things were going to be okay, probably.
And and and I was famously asked by Sarah Montague on the back of that whether I thought things would be okay by the spring.
And I did say that they would be. And this was I think I made a note because you had to comment to the Select Committee on Science and Technology.
This whole epidemic has relied too heavily on assumptions that have turned out not to be true.
My strong advice is to be prepared for the worst. So I think that was the most downbeat I ever heard you be.
And after that, you started being more on the optimistic and chirpy trophy.
That's exactly right. And I and actually what's interesting is I she said by the spring, we're going to be getting back to normal.
And I said I said, yes, yes, yes, we will.
And that got broadcast everywhere, keeping broadcast even to this day.
And it turns out that actually I was probably right and the only thing and because that that corresponds to exactly their on my behalf.
Had we paid attention to the date of the message.
Sorry, I'm just saying that on the graph this is a massive falloff in the number of jobs deaths, I guess.
And so what did I think? And to be clear, I didn't know this when I said that.
But what is now become apparent is that it had this massive impact on the most severe form of the disease,
which is that terrible, inflammatory pneumonia that put lots of old people face down in a hospital on a ventilator.
And that was almost completely eliminated by two doses of any of the three big vaccines.
So so that was marvellous, actually. So I thought, okay, here we go, this is going to be great.
Let's wait and see. Modiano reported about two weeks later, same sort of data and then about two weeks later.
And he called me up in a weekend and said, You better get together because the data is now in.
And I knew if you called me that we had a result because they wouldn't have that.
We wouldn't have had a result. Okay, well, that's fine. So we had a long chat on Sunday night and the data was pretty good,
but not easy to interpret in the sense that there were several groups of patients that were different because of the way the vaccine had been given.
In one group there had been a low dose in a normal dose.
And you know, that sounds about right. Yeah. And annual explained to you what it actually happened.
And you know, the good news is at its best it was 90% and at at at its worst it was 60%.
And that's still a fantastic result, a message that we we we were hoping for 60%, I have to say that's I kept saying if we got 60%, be amazing.
So that was a gap.
And and of course, the other thing, which, of course, emerged as we interrogated the data was the dose interval turned out to be crucially important.
And they the 60% was a four week after dose interval, which is the worst interval you can have.
Six is better, eight is better, ten is better, 12 is better. So as we got better, of course, the the results got better and better.
And I did make the point and I think I made this point on Radio four over that period.
I said, look, first of all, it's not a it's not this is not an Olympic 100 metre race.
We're not competing against anybody. We're just trying to get vaccines out and terrific work for everybody because it's great,
but just go a bit carefully trying to compare this vaccine to that vaccine, because the truth is they were different trials.
They were done in different groups of people. The end points are completely different.
And now that turned out to be a very wise observation because the endpoint had been severe pneumonia leading to death.
We would have been equally good as any of the other vaccines.
If it was a head cold and bit of a cough, they might have been a bit better than we were and so on and so forth.
And I also said, look, you know, we still don't know the rules of the road. So and we also don't know how durable vaccines are going to be.
Said, you know, be careful because they only last three months.
It's not much help to you. And of course, all that's played out.
It turns out that none of the vaccines are very durable and none of the vaccines
stop transmissions and none of the vaccines stop you getting the head cold.
And they're very bad against various forms of the variant of the virus,
but they fix that problem, which is to win, because that's actually what we were trying to do.
The problem of the people, severe illness. That's right. Exactly.
So that I mean, that was hugely exciting. And then, of course, over the course of the next three months,
we started to get lots of real world data in from what was really happening in people who've been vaccinated.
And that data showed that our vaccine was within a couple of percentage points, the same as the RNA vaccines.
And you can do all this stuff. So.
So that was that was a very interesting time.
But, you know, it had its all its challenges. So we you know, the Russians took a run at us.
They said if you had the vaccine, you'd turn into a monkey because it was a challenge vector German virus in the times and all that stuff.
And then and then we had then, of course, Pascal, this massive fight with the Europeans,
which was entirely bad behaviour from the Europeans beginning to end, wasn't Pascal's fault at all.
He'd spoken to me earlier in the autumn and said, Oh, JBS, and now I understand why you guys get Brexit.
I'm trying to negotiate the bloody European complete nightmare because they were trying to procure in a classical European procurement mode.
And he was trying to say, If you want some vaccines, get your name on the bloody list because everybody else wants a vaccine.
And then of course, when it when the vaccine actually then was approved and the Europeans said, well, where's our 200 million doses?
You two were like, can you be tremendous? And you him 40 million doses, whatever the number was,
which incidentally was as a percentage at least as much as they were going to get from Pfizer and more much more than they were going to get from JNJ.
But despite that, I think again, because of the Brexit UK thing,
they could see that the UK was rolling out this massive vaccine programme largely based on our vaccine,
and they were going, Well, hang on then, what about us? And Pascal said, Sorry, you guys.
They signed the agreement in July. You waited forever to sign it, and we're doing it as fast as we can, so you have to stay calm.
So that was ugly. And then there was a lot of bad social media, mostly driven by the Russians again, which talk the vaccine down.
Macron said it couldn't be used in the over 50 fives.
And then it said, well, it can only be used in the older kid, you guys.
And then he said, I'm not having the nature of my word at it. So, I mean, he was a complete idiot.
Angela merkel and the Paul Eric Institute in Germany were also completely helpless because they had decided,
because they had their own German vaccine, that they didn't want any bother about the anniversary.
So they caused a lot of trouble with misinformation, even a statement that the vaccine had an 8% efficacy level.
And I mean, A&E has never been able to work out where that number came from.
Somebody just dreamt it up. I think we can all in despair.
So that that was tough.
But the good news was MHRA responded immediately and got the approval and in the first week of January they started to run the vaccine.
And then, you know, AstraZeneca was great about providing 5 million doses.
We started out with three fab actually Oxford Biomedica, another star performer, best production on the planet.
Well, actually, volume wise, it was Sherman's stupid speed watch.
It was actually Biomedica. So that was great. The only people who couldn't produce the vaccine were the Americans who were trying
to make it and they couldn't make it and they couldn't make the vaccine either,
which is quite interesting. And and then the plant in Belgium which the European plant, they couldn't make it either.
So so all our raw that you got from America was, you know, specious because the truth is they didn't you know,
they didn't know the first thing about CMC and all that stuff. So they were pretty stupid.
But nevertheless the UK program went terrifically well. They rolled it out.
Nadhim Zahawi Star. I knew him from the last government thing.
He's such a good guy and set the programme up, took it out of the NHS, get it as a separate programme, which is the right thing to do.
And off they went. So that now then about mid-March we got a few reports of surgical vein thrombosis,
a form of stroke, but a venous stroke clustered in northern Europe, mostly Norway.
Denmark and Germany.
And at first we thought, okay, because we'd seen a bit here and it was very difficult to know whether it was above background levels.
And we we because the numbers were so small, we get to know.
But when more cases started to be reported, there was a question whether it's an ascertainment bias or whether it was a real problem.
But as the cases started minor, we could think of probably a real problem.
So we're going to just go have a look. Then we had a whole load of people looking at vaccine registries and then adding
up everything that they could find that had happened to people who had a vaccine,
which was a massive overestimate of what was going on.
But fortunately, sensible people looked and it looked like this had just had a prevalence of about one in 100,000,
and it had a mortality of about one in a million,
which in the context of a national vaccine was perfectly acceptable, particularly when you saw the mortality from that anyway.
That that, of course that developed its own momentum, revved up by the press, caused all kinds of trouble,
created huge amounts of vaccine hesitancy in various parts of the world,
which is not very helpful and turned out to be, you know, an impediment for the vaccine.
But they the decision taken by the government, which I think was a good decision,
was to just give the vaccine to people over the age of 40 and avoid it going in to younger people and women in particular,
because, of course, we had RNA vaccines, which didn't have that either. So and that was a good decision.
And both Andy and I agreed that for the vaccine, it was best possible thing,
because what you really want to do is give the vaccine to people are going to die,
not people who are six years old and going to school, who you don't want to spread the vaccine or on site, which is fine.
You want to put RNA vaccines into those guys. Good luck to you, because we want our vaccine to be used to stop people from dying.
So the majority of our vaccine globally has actually gone into the high risk populations, which is quite interesting.
And that means that the tally of lives saved gets better and better, because once, you know,
the Americans are now in their fifth dose, you'll be saving no lives in people who are on their fifth dose of vaccine.
Pfizer will be making lots of money, but there will be no lives saved.
So so that basically is that, you know, that's sort of part of that.
It was part of the philosophy. Yeah, I thought, yeah, well, we're not making any money, so let's forget that.
How do we get it out? And then we started to run into trouble because India decided they had a big problem.
We'd always worried about India because lots of people with comorbidities, diabetes, hypertension, fairly elderly population.
There was some worry about ethnic liability and that's how patients want to take care of people.
That story is not really held up by data. We were worried about it and so the Indian government said, well, you know,
Serum Institute's great but and we know most of that have that vaccine's intended to go
to Africa but we're not going to let it go we're going to give it to everybody in India.
So they embargoed the plant. And then I knew we had a problem because that meant Africa was going to get tougher because you couldn't use
the RNA vaccines in Africa and JNJ was still months behind in terms of we haven't entered COVAX in all this.
So the COVAX with the guys deploying the vaccine. Yes. So, so, so.
And they had relied very heavily on AstraZeneca for all the right reasons.
But, you know, they were stuck as well because they didn't have any vaccine supply from India.
So we shipped them a bit of vaccine back and forth from other places.
But they, you know, on the whole, they didn't have much.
And that was made worse by the fact that the South Africans decided that they didn't like the vaccine either.
And so they shipped back. They had X million doses and they shipped them back to headquarters saying we don't want the vaccine,
which again was a completely stupid decision because they were back to India.
No, they went back to Geneva because that was where Covaxin shut them in.
So and again, that was it was not you know, it's all this was all there was all this stuff going on and so that it caused what's true.
So so that so Africa was basically unvaccinated, so they were completely exposed.
And and in fact, in the end, although they're vaccinating at reasonable rates at the moment, they protected themselves by natural infection,
which caused lots of deaths in South Africa, but not that many deaths in places like Nigeria, which is interesting.
And nobody really understands that. Maybe ascertainment of it, maybe something else.
So all that was going on as well at the same time.
And it was a you know, it was a pretty bumpy journey because we set up a big program in Eswatini.
So as the South African said, we don't want the vaccine. And that's where people said, well, you know, we want the vaccine.
So Annie and I set up a program there to vaccinate the whole population.
And then subsequently we've been working with Zimbabwe, Uganda, Tanzania, Ghana, whole variety of countries.
So the. The vaccine is still being manufactured and still still being distributed.
Yeah, most of it is still being distributed, although there is now a massive surplus of vaccine.
Is it being used in the UK at all? Don't know. The UK stopped when they got to the booster and I don't think it's being used at all in the UK,
which is fine, you know, because remember it's the first two doses that make a difference.
All the rest of this stuff is just. Yes, that's that's what the booster did.
Absolutely nothing. So. So I so I think it's all you know, I'm relaxed, but it's not a big deal.
But we were also then getting Nepal blue, so we had to get them vaccine.
Thailand, fortunately out of sight in Thailand, which I don't set up to manufacture.
So they started going Malaysia blue, Indonesia got into trouble.
And, you know, the AstraZeneca vaccine was used pretty widely in all those places.
So. So it was a pretty it was pretty good run.
And I'm going to have to go. Yeah, sorry. We've got to go because I've got to.
I'm sorry. I've got a lunch. Yeah, yeah. Oh three. Is that all right?
That's fine. That is.