Transcript: Episode 16
When will we have a vaccine?
vaccine, people, ucl, side effects, population, vaccination, pandemic, engineer, produced, magic wand, risk, require, benefit, expecting, engage, clinical trials, safety, developing, antibodies
Sudaxshina Murdan, Eli Keshavarz-Moore, Sarah Edwards, Vivienne Parry
Vivienne Parry 00:05
Hello and welcome to Coronavirus the whole story, the award winning podcast by and for the UCL community. I'm Vivienne Parry. I'm a writer broadcaster UCL alumna and the ones happily been charged with bringing you the latest news and insights on Coronavirus through interviews with UCL treasure trove of researchers and staff. Today we're returning to a topic from a few months ago, one which now has an even bigger spotlight on it. vaccines. Some of you might remember Episode Seven, how close are we to finding a cure, which was a special episode we made for the challenge festival? If not, you can catch up on our website. In this episode, I'm going to find out what progress has been made in the development of a vaccine and have a look at some of the challenges that there might be in rolling it out. I'm joined remotely Of course, by three key researchers bringing their expertise of biochemical Engineering by ethics and pharmaceutics to the critical question of vaccines. My first guest is Professor Eli Moore from the Department of Biochemical Engineering. Eli is a principal researcher at Vax Hub, an ESRC funded research hub focused on the manufacturing and supply of essential vaccines, and part of the team developing a COVID-19 vaccine. We are joined by bioethicist Professor Sarah Edwards from the Department of Science and Technology studies. Sarah studies population health and during lockdown has been investigating preparedness for COVID-19 using knowledge gained in previous pandemics. And last but not least, Dr. Sudax Murdan, a reader in pharmaceutics in the UCL School of Pharmacy see that her research focuses on the delivery of vaccines, for instance, comparing injections to other forms of drug delivery, as well as pharmacy education and the reception of vaccines. Let me start this off with Eli to kick us off. Could you give us some update on where we are now with the COVID-19 vaccine. What stage are we in now? And how close are we to having a vaccine?
Eli Keshavarz-Moore 02:10
This is interesting because globally apart from what is happening within the UK there are overall 20 vaccines which are in clinical trials worldwide. And this is part of over 100 I think about hundred to 100 and 150 candidates which have been actually looked into. Now the one that obviously is very much in the news is the one that are co the CO director of the Vax hub. Sara Gilbert has been working on where she has shown the most promise in terms of timing simply because there were a bit ahead of the game. They started by having the base this was needed in order to develop the the Seems simply because they had already had a vaccine developed against MERS which is the Middle East and Respiratory Syndrome and using that as a as a backbone effectively built on it, they have managed to be working towards actually getting healthy volunteers. And um, she said that you see he was across hospital has been very effective in actually helping with providing the volunteers to test these and it shows that in fact, it does provide in invoke immunity both in terms of antibody and T cell generation in the healthy volunteers. And of course, the next phase is now taking place of phase two is to ensure that a larger population are looked at and this is going to be given to people where the actual days days Hi, admin toss these, that disease being in the in the public because obviously you have to actually demonstrate that the vaccine is working. And these are taking place in South America and United States as well as South Africa, I believe, and this is ongoing.
Vivienne Parry 04:18
And the reason it's taking place in those countries is because we contrarily we haven't actually got enough
Eli Keshavarz-Moore 04:26
infection here. Indeed, indeed, yes. And and in terms of what UCL is doing to help is that the actual manufacturing part, there's one part obviously is the the frantic creation of the sort of vector which is going to be used as a as a form for providing the vaccine but another part of it is effectively manufacturing this, and the manufacturing is quite a complex process. And there are bottlenecks that currently are being resolved our Vax hub at UCLA So helping the Oxford group to overcome using engineering techniques that we have developed at UCL to the company's bottlenecks, so that there's a platform available, which would make it suitable for scale up, which is going to be taking place. As you know, it has been taken over by large pharmaceuticals to make, I think around 2 billion doses. He says we can never say something works until it works. But the signs are very, very promising. And I really have high hopes for that.
Vivienne Parry 05:34
Yeah, we should say that sort of, just to make everybody aware that 90% of vaccines actually fail. So it's, it's, it's, I'm so glad that you're very hopeful, but we'll come back to the timing of when we all get it, but I just want to get a su dx because you are also developing a vaccine in your group, but with a different sort of administration. Tell us about your one.
Sudaxshina Murdan 05:59
Yes. My research, actually we track we're in UCL, we are putting together a proposal and we help the government funds it. One of the routes is parental by injection and a second route is by sublingual. So we would put the vaccine, meaning bit beneath your tongue under the tongue. Yes. And there are many advantages of that. So one advantage is the efficacy when we get vaccines under the tongue, we expecting to get immune responses antibodies in the mouth and in the nose. And it might possibly also be in the eye to fluids. And the good thing about that would be we would get antibodies where the virus enters the body. So the antibodies would prevent would bind to the virus and prevent the virus from entering the body. So can
Vivienne Parry 06:48
you see that can you use that for all that method of administration for all the different kinds of vaccines that are being developed at the moment or is there any side Have them.
Sudaxshina Murdan 07:02
I? Well, we have not everything has not been tested by that route, but many have been tested. So for example, proteins in Act would be possible inactivated virus. For example, flu is now given by the nasal route. So I'm assuming for the sublingual route, it might also work as a nose and under the tongue, they are quite close and they are the immune system is related. So I'm expecting that quite a few of the different vaccines being tested. Could be test could be administered under the tongue. Yes.
Vivienne Parry 07:38
So Ellie, of course, developing a vaccine is one thing, getting it out the door of the factory is another thing altogether. And just so people know we've got a basket of vaccines, if you like in development, that not all the same time some of our no vaccine summit. In a vaccine summer, a weakened backseat, summer live strains, all different sorts. So, and they all have slightly different manufacturing. And of course you don't know which one is going to win the race until very late in the day. What kind of problems does that present for an engineer like you?
Eli Keshavarz-Moore 08:23
Let's let's pray for for for an engineer is a challenge most welcome because that keeps us occupied and give us a job to do. So, from an engineer's perspective, this is a very nice challenge because you're looking at different platforms. But having said that, I think it's a healthy thing. One of the things that you mentioned, which I maybe I should sort of question a bit is the question of which one is going to win the race. And at the end of the day, I think that it is important to have all these varieties to be looked into And whilst one may be ahead of others, there are going to be other possibilities as well. For there are there are other vaccines on the market, nothing to do with procreate, that are produced with different types of platforms possibly for different types of, you know, diseases. And it's good to have that variety and have people actually produce them in different ways, because they might be nice to actually have more than just one source of vaccine produced by one single platform. So I welcome that as an engineer and I think that there are enough people with enough sort of ability to be able to effectively optimise those platforms and use them to actually get to the to the to the point of exit where we're going to have vaccine Of course, one of the things that everybody is concerned about at the end of the day is affordability, efficacy, efficacy and affordability. I I take it that Oh, they're all going to be safe. Possibly regulatory, you know, hurdles. But when it comes to the efficacy, clearly if something is more efficacious, it's a win to the heart of everyone. And if it's more affordable, clearly, all the health organisations, we've got to pay for it, the government will have to pay for it, they would probably prefer it. But we are not at that point, everybody is trying to do their best to come up with whatever they can because there is no solution yet. So that's why I think that it's important to have this sort of multifaceted effort, in other words,
Vivienne Parry 10:31
so they're very multifaceted effort. But actually, the final bit of the puzzle was called the film finish. Just give us a hint of the kind of problems that we're facing there.
Eli Keshavarz-Moore 10:45
Well, I mean, one of the things that you were discussing what the what the supply, first of all, there's enough capacity for film finish, because it's not just the manufacturing part. That's why a lot of these manufacturing companies are on in negotiations, we'll have signed deals with the Finland Finnish ancillary companies to be able to push the material which is produced through quickly. Also there they're in whether there's going to be enough supply of the material for the fulfilling finish, where you know that sometimes you have things that we require an event to be added, is there going to be access to enough occupant by all the companies who are actually working on on these vaccines? Is there going to be capacity? Or is there going to be competition for a film finished provider or not? So whether we need to actually extend that part of the whole supply chain and also I think earlier on before the conversation started, the issue was the supply chain is something that should not be overlooked, because it's not just the actual molecule is not just about the manufacturing is how to get the product to the market, but at the same time, how to make sure that is enough. supply of the initial materials to make all of those stages possible.
Vivienne Parry 12:06
So all the world is depending on engineers, not just a vaccine developers. So that's let me come back to you because let's talk a bit about safety because we're doing these vaccines at extraordinary speed. And indeed in the US, it's called the warp speed protectiveness beads but of the name and people are concerned that safety corners are being cut, because this is so urgent. What are your thoughts on that?
Sudaxshina Murdan 12:39
So the FDA and HRA ama the regulatory bodies, it's their responsibility before they lie before it can be licenced safety is paramount. Safety will be the number one concern before licencing so I would have even though it speed it up numbers of people and adverse effects found it will be judged safety will be judged. So I wouldn't worry, because it's one of the main criteria before the vaccine comes on the market.
Vivienne Parry 13:14
And that segues perfectly to our bioethicists. Sarah, what are the ethical considerations when creating a vaccine in a public health? emergency?
Sarah Edwards 13:24
Yes, well, vaccine development can be very challenging, you know, at the best of times, but certainly in a public health emergency. All the moral aspects of such a process are clearly accentuated. And that's as a general point, but it also may, indeed raise peculiar questions relating specifically to the urgency of trying to get a new vaccine, you know, under development and licence for for widespread use. I mean, certainly the usual precautionary approach. That regulators take to licencing new medicines generally and vaccinations are part of that process, or based on clear clinical evidence of clinical trials, which seek to evaluate the risks and expected benefits in largely controlled conditions based on the consent of participants, before the evidence is appraised and judged to be sufficient to produce a sort of a rollout and programme and to allow more people from the population to gain access to it and indeed to embark on the induced herd immunity which vaccination programme is designed to fulfil.
Vivienne Parry 14:46
Nobody would ever say that vaccines are completely without harm, because they do cause harm, although in very rare instances, and it's a risk benefit that we will have to consider. But one of the issues when we're doing these things at breakneck speed is that you don't see the very rare side effects until a very large number possibly millions of people have had their vaccines. I'm thinking particularly of during the last flu pandemic, there was a vaccine called Pandemrix, which caused narcolepsy in a few children, I mean, millions and millions, it was a very, very rare side effect. But that kind of thing is going to come up. How do we deal with that and maintain public confidence at the same time?
Sarah Edwards 15:43
So one of the substantive issues that scientists and regulators alike are grappling with at the moment is indeed how we promote the clinical trials that are needed to understand in a scientifically robust way. whether a particular vaccine can cause particular outcomes that are desirable, and indeed prevent the adverse effects that you're raising, at the same time as generating the real world data from large unit populations from which we might be able to tell how the vaccine would be implemented, and how we might be able to support the more rare side effects that would be required during the sort of longer term surveillance that would be required, no matter when the vaccine is licenced, for wider use.
Vivienne Parry 16:35
Is there anything about the current pandemic that's changed the way we consider vaccine development in a pandemic from an ethical point of view?
Sarah Edwards 16:43
And yes, yes, I think there are off the top of my head, I mean in in two main ways, one is quite what the limits are to having a compressed process of development. So we we heard One vaccine in the States, getting what we would usually regard as a very important necessary step to ensure safety. And that is preclinical animal studies. They will run in parallel with the first human trials which were designed to to test safety and what doses might be tolerated by biological system. That's only one, though example. In the whole raft of clinical trials that we're seeing, I think you were quoted 20 clinical trials with about 100 candidates. So this compression of the process certainly isn't being universally applied. And in some cases, it's quite the reverse that the regulations being imposed to require greater evidence of safety are being tightened rather than relaxed.
Vivienne Parry 17:57
And indeed some of these vaccines that are being tried at the moment RNA vaccines? They are new vaccines. I mean, then that, you know, they're first in class. They're not vaccines that we've had much experience of in the past.
Sarah Edwards 18:11
Yes, yes. And we've had to learn salutary lessons from testing first in class compounds in humans, and perhaps mistakenly relying on evidence from non human primates, and assuming that they would act as a good human model of the disease. So whichever way you look at it, we're going to have to be careful and take as as sensible as steps as we can to mitigate that risk, as well as monitoring very carefully the effects that those vaccines are having, you know, on the human body
Vivienne Parry 18:46
and how has the anti vaxxer movement and these extraordinary conspiracy theories I'm I spoke to someone the other day, who said that they thought that they were being injected with they would be injected with something Which would be picked up by 5g and it will have sort of Bill Gates in it. And somehow he was it was world dominance. It was just so outlandish but it, but these conspiracy theories just breed on the internet. And they produced an extraordinary and really alarming amount of vaccine denial.
Sarah Edwards 19:20
Yes, I think we have to be a little bit careful here. I mean, there are some theories which are clearly, you know, outlandish and denial of true facts has to be countered in various ways. Some of the social media platforms are trying to filter out some of the more extreme anti Vax views. That said, there are less outlandish rumours which do also build up on social media. And sometimes they can illustrate one of two things. They can illustrate a concern For even a glimmer of truth,
Vivienne Parry 20:03
indeed, we should never forget that.
Sarah Edwards 20:05
Yes. And that's where community engagement is, is really so very, very important. I don't think the old days of developing a new drug and then assuming we'll be able to implement it on a unsuspecting population, all right for this pandemic, if ever they were, but certainly, I think whatever, whatever the rumours, if you like, which seems to be quite a pejorative way of describing it, take us we should be engaging with that where we can, and certainly where there's a glimmer of truth. And in some cases, for example, we are hearing that there are very local protests against the vaccine trials in South Africa. Now we can quite understand why there may be suspicion about vaccines. trials, particularly in South Africa, we've got in living memory, some historic cases, that would have been better handled in other ways and perhaps vaccines that ended up being trialled on the population that could have been stopped much earlier, leading to wasted resources to name but a few sort of difficulties.
Vivienne Parry 21:24
Sudan because I know that you've been working on some community engagement.
Sudaxshina Murdan 21:29
Yes. So what we did is me and my friend from Public Health England, and second year pharmacy student, we trained 60 pharmacy undergraduates to become vaccination champions. So this is this happened this month. We did a survey students were invited to participate by Eventbrite. They had to fill in a pre workshop questionnaire about their beliefs in vaccination. And then we had to ask Training online. And after that, they filled in a questionnaire about whether their attitudes and beliefs have changed. And then they have to conduct an action and action. And 60 students conducted a variety of actions like talking to a friend who was hesitant, even talking to a friend who put something on their website on their Facebook, who said, Oh, I don't, who said to their followers, I don't think we should take the vaccine. I just don't feel we should. So she challenged a person and hesitant person. And other students have created posters or they've talked to their family and a lot of family members are hesitant. So this is what I was saying about community engagement. Students, we train them and then they can engage with their own communities and their families, their friends. And in this way, we can we can increase the provox output as well. So I think we need to do much more of this. So on In a way, what we need to do train more undergraduates to do this and even schoolchildren, because they can talk and they can engage social media much more than people of our generation. They don't have the same hesitancy to engage with social media and to engage with their friends. And we need we need to lay the ground really for the vaccines coming. We need to lay the ground for people to accept it when it comes and to challenge misconceptions. But in a way before we can try, we need to educate our trainers. We need to educate our champions so that they can communicate with their family and friends about the misconceptions of vaccine. Thank you.
Vivienne Parry 23:42
You're listening to Coronavirus the whole story a podcast brought to you by UCL Minds. If there's a question about Coronavirus you'd like our researchers to answer, email us at firstname.lastname@example.org or tweet at UCL. We'd also really appreciate it if you could complete our survey which can be found on the UCL Minds website, if you haven't had a chance to yet. So, so far, we've been discussing how to get a vaccine out there safely, assuming that it's going to work. Let me just turn that on its head now and ask what we're risking here. What if it doesn't stop people being infected? In other words, it might stop people dying, but it doesn't stop people being infected. Is that enough? If there are unanticipated side effects, what effect will that have on public confidence? And what level of side effects are acceptable? Ellie, I'm gonna start with you on that. Just briefly.
Eli Keshavarz-Moore 24:44
Well, I think that as we heard public sex isn't standards. In other words, what becomes important is the education of the public. You might think that versus engineers would not be involved with learning anything about ethics, but the ethical issues of, of priming persons to illustrate what an engineer needs to do in order to actually produce their products, because we don't want an engineer to again get engaged to something that he or she would consider unethical. So I think public education, especially at the youngest stage onwards, is is fundamental in being able to actually do this. Whether things work or not, as you heard is something is that math is a risk benefit situation. And as long as all possible solutions and questions have been considered, then hopefully that would give us a positive outcome at the end.
Vivienne Parry 25:49
And indeed, I guess that people see COVID as a really dread disease, particularly older people, and they're very keen to have vaccine. What about you, sir? What are your thoughts on this?
Sarah Edwards 26:05
Yes, well, then certainly being able to reduce the severity of the disease in those who are most vulnerable, if not prevent infection seems to be a very laudable objective, it would mean that the vaccine could be at least as good as a treatment. However, when we're looking at the risks and how those the possible burdens of the vaccine are distributed across the population, in order to achieve anything like a sort of, you know, the, the the herd immunity that that we all sort of hear about and expect is the underlying presumption behind you know, such a result, the young and healthy would be required to undergo an excessive burden for to themselves perhaps a little benefit. So if we're mainly trying to protect those who are older, perhaps With underlying health conditions at the very people who are currently regarded as prognostically vulnerable and should be protected, we don't want them to be protecting them at the expense of the rest of the population.
Vivienne Parry 27:15
And of course, the older people will probably require, certainly require a couple of doses because their immune response to vaccines is less, and then might require more agile vented vaccine. So an Agilent is something that you add to a vaccine to make it have a stronger immune response. So there are all sorts of tricky things to consider here. And I was wondering, Sudan, what you thought about warning people that this is this might well be a very, what's called a reactor genic vaccine. In other words, a vaccine a bit like yellow fever, which is pretty horrible vaccine. It's very protective, but you feel pretty rotten for a day or so after you've been Given it, and there's lots of evidence from the trial so far that this one is going to be similar. How much do you think we ought to warn people about that in advance?
Sudaxshina Murdan 28:09
So this is very interesting. Firstly, I recently had yellow fever vaccine because I was supposed to travel to Kenya, but I didn't because of COVID. Anyway, my I didn't have any reaction. And I was really scared and expecting a reaction, because I'd read up about it. And I knew a lot about it, but I didn't have any reaction. But coming back to your question, warning people is very important, I think, because it also will stop the rumours. People will go into something expecting something and there, then they are less surprised and shocked and upset and think, Oh, you didn't tell me before. So I think warning is good. The other thing I read recently was vaccines. vaccination does have side effects that say even if it's one in a million, but because In a pandemic, we'll be let's say vaccinate the whole of the UK 65 million people, we will end if it's the risk is one in a million, we will have 65 cases of side effects, let's say. And because it will happen in a very short time, there will be a lot of attention on the 65 cases, a lot of public attention and media attention. But all the other 65 million who did not get any side effects or who did not get the disease and the death was low, it will not get attention. So the dialogue has to be about both, we need to have this dialogue about the risk and the benefit. And if we don't, if you don't get the vaccination, what could you what will happen? What are the risks of not getting the vaccine as well as the risk of getting the vaccine?
Vivienne Parry 29:48
So that's a very strong argument, isn't it for really telling people in advance that actually, you know there will be side of very serious side effects for a few people but the benefit It's outweigh the risks.
Sudaxshina Murdan 30:03
Yeah, and most side effects are mild for vaccines, there are more A lot of people have fever or pain at the site of injection or tenderness or, but they're resolved within a day or two. So most vaccine side effects are mild. So this also goes in that conversation that you will expect. If you are expecting some tenderness and is up and you know that it will go away in a day or two, then you are less likely to worry about it when when you get it.
Vivienne Parry 30:34
Sarah, what do you think about wanting people in advance like that?
Sarah Edwards 30:39
Suddenly, we should be as open and transparent about the evidence, as is currently known, while we're trying to prepare the population. I mean, it's worth knowing, you know, how people process information about statistics, and how salient different stories are for people, when they're judging the risks of different interventions, but the need to be able to be open and transparent probably overrides what may be the temptation to manipulate information in order to try and persuade more people to take up the vaccine. We should be working with people's concerns, not simply trying to think that we're somehow educating people who are disbelievers, then there may be very understandable and justifiable reasons why people have concerns. So the more we can engage with those,
Vivienne Parry 31:35
the better so important to recognise, I guess that for some people, being anti vaccine is a belief system, and there's no amount of education is going to persuade them differently. And maybe we need to think about those people in a different way because they're not going to be open to persuasion. I was finished these programmes by trying to get people to accept my magic wand. And so I want to do that to all three of you. And from the perspective of an engineer, a bioethicists and a pharmacologist, if you had your magic wand, what is it that you'd wave your wand for in order to get us a successful vaccine? Let's start with the early.
Eli Keshavarz-Moore 32:30
Magic one. Engineers don't believe in
Vivienne Parry 32:35
engineers are a magic bones in and of themselves.
Eli Keshavarz-Moore 32:43
And I would, what the discussion we had was, in fact, very pertinent. They say this fact that the buy in is important. I had a magic wand, I would want to be able to tell people that know to stress, follow the rules, but at the same time, be open minded about vaccines. And my when I used the term, educating people, it wasn't in the sense of sitting people down and telling them telling people is not the way but engaging them in actually making them understand what what it is that you're trying to say. That's the way to actually persuade people. So my thing would be not just the production of the vaccine, but also people being prepared to accept it.
Vivienne Parry 33:36
How about you, Sarah?
Sarah Edwards 33:38
Yes, well, thinking in terms of utopian ethics is not magic ones. we'd certainly be looking at having fairer, far more participative or indeed democratic procedures for bringing populations, effective populace populations into the discussions about vaccines and indeed Designing the vaccines with those people in mind with their concerns and their values.
Sudaxshina Murdan 34:05
So ducks. Okay, so I'm a pharmacist and my magic wand, I would like the government to fund different routes of giving vaccination not just by injection. So for example, sublingual, that what that I'm trying to do, and by the nose because hopefully by funding different streams, at least a few will get will become successful and get to the market. Some of these will have less side effects. Some of these different routes will be cheaper because you don't need in syringe and needles and maybe they will fit different populations. So my utopian is a several successive vaccines. And then we will have enough for the 7 billion of us and different vaccines which suit different populations, by populations. I mean, older people or younger people, or people who are scared of needles and that sort of thing.
Vivienne Parry 35:00
Well, if I can wave my very own magic wand, what I would say is that we need to recognise that where none of us are safe until all of us are safe that vaccination is a global problem. We need to address it in a global way. And on that note, can I say thank you to all of you? It's been an absolutely fascinating discussion. You've been listening to Coronavirus the whole story This episode was presented by myself Vivian Perry produced by UCL with support from the UCL health of the public and UCL grand challenges and edited by the stupendous carrots Bradley. Our guest today were Professor le kesher As more and Sarah Edwards and Dr. Su DAX Mehrdad. If you'd like to hear more of these podcasts from UCL Minds, subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus. And whilst you're there, why not fill out our survey this podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights and expertise through events, digital content and activities open to everyone. Have to be with you again soon. Bye for now.