The Science and Technology Committee and Health and Social Care Committees held their third public evidence session as part of their Coronavirus: lessons learnt inquiry.
This session focused on treatments that can be used for COVID-19, including repurposed therapeutics. There was also a focus on the development of vaccines for COVID-19 and the UK’s preparations for the roll-out of a future vaccine.
Witnesses
Panel one (at 9.30am)
Professor Peter Horby, Professor of Emerging Infectious Diseases and Global Health, University of Oxford
Panel two (at approx. 10.15am)
Professor Andrew Pollard, Trial Chief Investigator, University of Oxford; and
Professor Robin Shattock, Chair in Mucosal Infection and Immunity, Imperial College London
Panel three (at approx. 11.00am)
Professor Wei Shen Lim, Chair, COVID-19 Panel, Joint Committee on Vaccination and Immunisation; and
Kate Bingham, Chair, UK Vaccine Taskforce
The Science and Technology Committee and Health and Social Care Committee’s joint inquiry into Coronavirus: lessons learnt was launched on Thursday 8th October. Evidence sessions will be chaired alternately by Committee Chairs Greg Clark for Science and Technology and Jeremy Hunt for Health and Social Care.
Transcript of full session can be found here:
https://committees.parliament.uk/oralevidence/1136/default/
Dean Russell: I have a few practical questions to both of the witnesses. I will go through them all together, if that is okay. First of all I am interested to know whether the vaccine is planned to work on people who have already had Covid. A large number of the population will have had Covid during the past eight or nine months. Will it be used for them?
Professor Shattock: The first question related to whether the vaccines would be used for those who have already had Covid-19. The answer is that yes, there is evidence that they would boost, potentially, those who may have a variety of levels of immune response to Covid-19. That is already incorporated in our current trials, and I suspect in the Oxford trials as well. The question about transmission versus infection is one that we will not know until we get the data.
Professor Pollard: The first question was about people who had previously had Covid, those who are positive already at the baseline. One of the requirements for regulators around the world is that that group of people is included in the clinical trials. The reason for that is when we get to the point of roll-out, we know that there will be some people in the population who do not know that they have had the disease and so we need to know, first of all, whether or not they need a boost, and whether there are any safety concerns for people who have been previously infected getting the vaccines. So in our trials, we have included zero-positive people, people who have previously had infection. We will be able to answer that question.
Dean Russell: The second question relates to previous questions around the order of rollout. It also relates to a comment that has been made around what the vaccines will actually do. Could they prevent transmission and so on? Do you see there being a chance that there will be multiple vaccines, with one perhaps reducing transmission and another preventing somebody from getting the symptoms? Do you see a position where we might get to a point where we have an annual vaccine or do you see it as a one-off?
Professor Shattock: The question about transmission versus infection is really one that we will not know until we get the data. Do I think there may be a requirement...
Dean Russell: Sorry, on that point do you see a point where, if one vaccine could work for transmission, and a different trial, perhaps from another country, works on another level, could you ever see a case where there were two vaccines that people would have to take?
Professor Shattock: It is more likely that we will see different waves of introduction of vaccines. It is unlikely that a vaccine that blocks transmission will not also prevent severe disease but it's certainly possible that the first vaccines may reach the bar of preventing severe disease but may not necessarily block transmission. Those may be introduced first, because they will be first past the post, but, as we see later vaccines that may be more potent, they may be replaced. It is quite likely that we will have a number of vaccines introduced. They will need to be monitored carefully because we will not know how long they will provide immunity for so we certainly need a strategy for re-boosting, most likely the re-boosting of vulnerable populations where immunity may potentially wane faster. Those considerations need to be taken into account. The approach that we are developing is particularly suitable for re-boosting campaigns because you get no immunity against the vaccine itself, which is something that occurs with some of the viral vectors delivered to vaccines.
Professor Pollard: The second question was whether we will have different types of vaccines that do different things. First of all, we do not have the data so I don’t know that yet. That is something we will have to find out in time. Secondly, when you look at the different trials that are going on around the world, I am not sure that all of them will actually address the question you are asking. We may have quite good clarity about whether the vaccine prevents symptomatic disease, because that is the primary end point, the primary analysis, that is undertaken in all the trial.
But the transmission question is much harder to get to. One way you could do it is by looking at the households of people who are vaccinated to see if fewer people in the household get the disease. The other would be to look at individuals to see whether they get infected when they have been vaccinated, even if they have no symptoms. That is what we are doing in our trials in the UK. There has been a pretty amazing effort with the Government and the NHS. We are taking swabs from 10,000 people in the trials every week during the course of follow-up, to find out whether people have asymptomatic infection. If those who are vaccinated do not get asymptomatic infection, it makes it very likely that the vaccine could be transmission blocking. That is something we will know in time, but it is going to take a while to begin to resolve. One word of caution is that I am not sure that we will have the transmission question from all the trials that are going on around the world.
You also asked whether we need annual vaccines. Of course, we do not know the answer. The main reason you would need an annual vaccine is that the immunity you get from the first two doses does not last and you become susceptible to reinfection. That is possible. The only situation we have to fall back on is the coronaviruses that all of us normally get as children. This is a family of viruses that are very common. We all get those viruses as children. Unfortunately, we do not get perfect immunity when we get those infections as children. Through our adult life, every few years we will get a cold caused by coronavirus. We do not get severely ill with it. We get a mild infection. That tells you something about immunity from natural infection over time not being complete. It does not give you complete protection. We do not know whether vaccines are going to be like that or whether they will give complete protection that lasts for years. The only way we will know the answer to that is actually by some time passing. The first vaccines are only six months in, so we cannot tell whether we will still be protected a year from now. We do not even know yet whether the vaccines are protective yet in the first six months.
The other reason why we might need annual vaccination is that it is like influenza, where the virus changes each year. Perhaps if you have lots of people vaccinated, the virus will have to mutate in order to survive, so the vaccine is no longer able to protect against it. That is what influenza does to some extent. That would be another reason why we might need a revised vaccine in future years. At the moment, we do not know the answer to that question either. So far, we have not seen changes in the virus that seem likely to have that impact, but there are a lot of immune people in populations at the moment to drive the virus to do that.
Dean Russell: I am also very keen to understand the trials. One of the big issues that has been reported is the impact on the BAME community. How is that going in terms of trials? Does it have more or less of an impact? How is that working?
Professor Shattock: You asked about BAME effects. We are certainly looking at that in our trials. We would still like to encourage more people from those groups to come forward for clinical testing because it is an important consideration, but so far we have not seen any evidence of either increased side-effects or less potent immune responses in those groups.
Professor Pollard: You asked about the BAME population included in the trials that we are undertaking here in the UK. That will be part of the analysis that we do later on. One of the really important strategies in our vaccine development programme was to ensure that we were inclusive of the UK population and that there was generalisability around the world. Our trials are set up such that we have 10,000 people vaccinated in Latin America and 2,000 in Africa, and, through our partnerships, we have people being vaccinated in Asia as well. We have a large database of information that is being gathered from different ethnic and geographic settings around the world, as well as trying to address those issues here and in the UK.
Dean Russell: Finally, I have a very practical question. Am I correct in assuming that any vaccine that comes out will be an injection, or will it be delivered through a different approach from the work that has been done so far?
Professor Pollard: Lastly, you asked whether it was all injection. The answer is that almost all of the vaccines being developed are looking only at injections. It is possible that there could be some vaccines later on which use a different route of immunisation, like the nasal flu vaccine that is used at the moment. But none of those are at an advanced stage of development so we cannot answer as to whether that is possible, certainly not in the near future.
Dean Russell: My questions were also about roll-out, but I have one big question connected to that, on which, hopefully, you can help. I have heard conversations recently to do with concerns about taking the vaccine. I do not mean extremes of anti-vaxxers—obviously a very dangerous movement—but where the general public have said, “This has gone through very quickly. I’ve got to inject something into myself that we’re unsure of.” Could you give me reassurance on two parts? The first is whether it will be safe and, the second is whether at this point there have been discussions about a sophisticated and strong communications strategy to reassure the public that, should they be able to take a vaccine, it will be okay for them.
Kate Bingham: Great questions. Will it be safe? Andy talked a little bit about that earlier. The safety testing and safety standards that are being imposed in these vaccine trials are no different from any new therapy or vaccines that are being developed. There has been no diminution of standards, no shortcuts or anything. Are we using the gold-plated world class safety monitoring? Yes, we are.
We also benefit in the UK because everybody has an NHS number, so we can actually do real time pharmacovigilance, which is how people who have received the vaccine are performing so we can monitor the long-term safety of the studies. As an aside, I have joined a vaccine study so if I thought there were concerns about safety, I would not have done so. I have done so and can be quite clear that in the treatment I have been getting, care with safety is absolutely paramount. That is your first question.
On the second question about comms, there are two aspects. From the vaccine taskforce perspective, our broad strategy for public education just to tell people about how the vaccines work, what progress we have made and what strategies we are using to tackle some of the issues, because our goal is to establish the UK as a global leader in vaccine R&D and to encourage international communication. Ultimately, this will be a great industry for the UK economy. In our strategy to communicate and collaborate, I have talked to all sorts of groups, whether women’s groups, civil society groups, like Global Justice Now, industry, clinical and manufacturing groups, as well as international groups like the World Bank and Gates. I have given more than 100 interviews and have written in Nature and The Lancet. We now have nine podcasts on Spotify and Amazon where we specifically tackle some of the specific issues about safety. How do we get different communities into clinical trials? How are we manufacturing it? What is the role that the UK is playing in the international community? There is narrow communications activity from the vaccine taskforce, but the broader vaccine communications will be led by the Department of Health as part of its broader vaccination and deployment campaigns and communications. That will address vaccine hesitance because a lot of vaccine hesitance is not to dismiss people’s concerns. They are right to be concerned and it is a complicated and fast-moving field, and we need to address the concerns and allow people to have conversations with their doctors, civic leaders or whoever is trusted to give them advice and the discussions that would be helpful. We need to be open to it.
Dean Russell: I have a couple of related questions. First, I am pretty confident that I asked a question a few months ago in one of our Health and Social Care Select Committee sittings where we heard about tests of a combined vaccine with flu. I heard a comment earlier that seemed to indicate that that is not the case. I would be keen to know whether there is any movement on a combined vaccine. Secondly, related to that, how have the tests been done with regard to people who are taking other types of drugs? We do not all live in a Covid-only world. People take lots of other things so I am keen to get reassurance on that. Very finally, you mentioned tracking symptoms once the vaccine is out there. I am conscious that the NHS track and trace app has performed very well, and I believe, had the fastest download of any app ever on the App Store. Have there been any discussions on using an app to enable people who have had a vaccine to track their side-effects, if there are any, or their symptoms immediately after they take it? I know that with the flu vaccine many people report not feeling too great for a few days after having it.
Kate Bingham: There are a lot of questions. There are small arms of clinical studies are being done on co-administering with flu, but the bulk of the main phase 3 studies is currently not being done with the flu. The initial label is not expected to allow for co-administration with flu, albeit that it is under investigation now. Ultimately, from a vaccine taskforce perspective, I would like to see a single shot, ideally a pill or something that does not involve a needle, which could combine a flu and Covid antigen and then stimulates immunity twice. At the moment, the initial label the regulators are likely to give will not allow for co-administration with flu. By this time next year, I am sure that the answer will be that it will be, but not yet. On co-administration with other drugs, yes, because the point of the trials is to include a diverse group of people in clinical trials, so that we can be sure the vaccines can work in all people who are most vulnerable. We have pushed very hard to enrich for black, Asian and minority ethnic communities in our vaccine trials because they are at specific risk from Covid infection. We are also enriching for the elderly and people with underlying serious diseases. All of those, especially the people with underlying serious diseases, will be taking medicines. We want to be sure that the vaccines are safe in those groups and that they are effective. That is in hand. We need to wait for the data to see whether or not the vaccines actually work, but that is being investigated. Tracking is an issue for the Department of Health. The MHRA is an agency within the Department of Health, and how it uses the different tools is up to it. I do not know whether or not track and trace feeds into electronic medical records, but ultimately that is what we want. We need to be able to get to a position, using the latest AI tools, where we can identify how vaccines are performing in the wild, as we call it, to be sure they are doing what we expect them to do and that they are safe.
