Vaccines: a double dose with Professor Brian Cox | The Royal Society

well good evening everybody and welcome to this evening's event which we've called vaccines a double dose it's part of the ongoing series here at the royal society uh analyzing and looking at the scientific landscape around the kobit 19 pandemic back in january in our first discussion we looked at the early stages of the vaccine rollout and tonight we thought we'd take a current view so reflecting on the vaccine rollout but also on taking more global view of the vaccine roll out and look at how the vaccines are being delivered across the world now i'm professor brian cox i'm the royal society professor for public engagement in science and one of my jobs this evening is to put your questions to our panel um so you can submit your questions by going to slido.com so on your web browser type slido.com and then type in the code v605 so that's v605 you can also follow the slider link in the video description and you can also vote up questions and that i found very useful in previous events so i get a sense of what questions you really want me to put to the panel so you can ask them and also vote up questions that you think are interesting and you'd like to be asked we also have closed captioning this evening you'll see a link at the bottom of the video bar that you can click for closed captions and you can also tweet of course we have a hashtag covered science if you'd like to do that so without further ado let me ask the panel to introduce themselves thank you very much brian my name is salim karim i'm the director of caprisa the center for the aids program of research in south africa and i'm the professor of global health at columbia university hi and um i'm katrina lithgow i'm a research fellow at the university of oxford um and i work on the evolution of viruses so um previously hiv and hepatitis c and now on sarsko v2 which is the virus that causes covid19 good evening i'm chris whittie i'm the chief medical officer for england and she's santa advised with the plant of health and by background i'm an infectious disease epidemiologist and clinician hello my name is wendy barclay i'm a professor of virology at imperial college london and i've always been interested in respiratory viruses that cause pandemics mainly influenza until now but now sarsko v2 thank you all now to get started um also you can ask questions of slido but we also have a couple of polls that i'll introduce throughout the evening and also a word cloud which we found really very useful actually in the previous discussion on long code because it gives a sense of how you're feeling about particular issues and i can also put that to the panel and just to try it out the first one if you go to slido is um we're asking you to say in one word how you are feeling about the kobit 19 vaccination program in your country so um i think that would be particularly interesting to get a sense of how you think the vaccination program is going so just one word and i'll refer to that in a moment as the word cloud builds up so that's on slido um but i thought i'd begin by getting an overview from each member of the panel of the the vaccine rollout and how that program is going and i thought i'd start with selling and ask um specifically that question so what does the landscape of vaccines look like right now when you think about vaccines we normally think about years and years that it takes to make one uh i myself have been involved in hiv vaccine development for 30 years so it was very pleasing to see how quickly we were able to make a vaccine against covert 19. and if we look at the current landscape there are now well over 200 candidates and exactly 124 are now in clinical studies from ranging from phase one study all the way to phase three we have eight approved vaccines that are for widespread use we have six others that are of limited and limited approval but overall part of the reason why vaccines have become so quickly available is the newer technologies particularly mrna and live viral vector vaccines and among the four different kinds of vaccines those are the two kinds of vaccines that have been at the front end and have been now most widely distributed about 1 billion doses of vaccines have been so far administered across the world thank you very much thanks sam that's quite surprising actually 124 currently in clinical trials that's because especially with mainly here in the uk unless it's to wendy we've we've heard of probably two or three of those so wendy can you set the scene now describe the situation here in the uk yeah so i mean here in the uk we've only so far immunized people with two types of vaccine or two brands if you like one mrna the fisa vaccine and then the adenovirus vector vaccine from the oxford astrazeneca combination um but there are others in motion if you like there are other opportunities coming and for example inactivated virus vaccines and other other versions of both mrna type of vaccine and vector vaccines can become available as we move forwards but actually most people who've who've had a vaccine today in the uk would have received the oxford astrazeneca one because we've used by far more doses of that in uk than pfizer um and you know we're very lucky to have had such early access to those two vaccines and uh chris what are the main issues around vaccines now i thought it's internationally used to look at the word clouds because people don't i think the the sense of this is mainly uk audience perhaps is that really there isn't an issue in most people's minds i mean the big words are relieved confident hopeful proud positive optimistic uh fantastic so people clearly think there aren't really any issues but are there issues in the uk around the vaccination roll out so then indeed perhaps in context across the world well i think the thing um that i'll just maybe focus on is is how you actually deploy vaccines um because sediment when you've already talked about the different types of vaccines and um different diseases you actually do this in different ways so uh with um covid because it is a disease which in the uk context has so heavily dominated in terms of really severe disease and mortality uh older people so 86 of people who died were over 70 aged over 70 or those who immediately cared for them we've done a vaccination program that has started strictly on an age basis apart from those of some very specific uh pre-existing health conditions and gone down the ages but the people at the top end of the age are the people who are the most likely to die from covid or the people who are most likely to end up in intensive care or at a slightly younger age in hospital in those maybe people in their 50s or early 60s but a lot of the transmission of this disease happens with people who are younger than that so that our current vaccine program is very successful at reducing the chances that in the long run people go into hospital and die what it won't have the same effect on yet it will do as we go down further down the ages is as big an imp impact on transmissions a lot of the transmission is from people in their uh late uh late childhood adolescents and uh in particular young adults people in their 20s and 30s and that's in complete contrast to some other diseases for example measles where you really need to get the the vaccines into the youngest people because a lot of the damage is done in the youngest people uh the final thing is just to acknowledge that um some of the severe symptoms for example the group of things that are currently called long covered can occur to younger people and that's one of the reasons it is essential that they also are vaccinated so they're both contributing to the transmission in the whole community but there's also risk of them getting severe illness uh even if uh in terms of long-term illness uh even if they don't actually uh have a very high chance of dying now this will be slightly different in different countries and the final point i'd make on this uh is that it is really important that we see this as a global problem not just as a uk problem uh although obviously uh with the moment we're just concentrating on the uk situation that the vaccine escapes with vaccine variants is another issue but i think you're coming on to that later on brian yeah and so just to i suppose summarize what you've said i suppose a tendency to look at the deaths which are extremely low in the uk and think well the the problem is on the way to being sold i suppose what you're saying is that that does not reflect the overall immunity in the whole population because we've got severe problems potentially with younger people who wouldn't appear in those statistics necessarily exactly and if we would suddenly let go of all the current uh cautiously being removed um social distancing things we've got the rates would go up very rapidly actually if we did it immediately because there's still a lot of people who are susceptible and who could transmit and there's plenty of virus around for them uh to get infected so we should see this as we're in a you know currently heading in the right direction uh but there's quite a way still to go even in the uk which is a long way ahead in its vaccination sadly many other countries are a lot further behind at this point in time um katrina um what are the the unknowns here and chris has touched on a few of them perhaps but what in this context of the global vaccine program what are the what are the unknowns yeah very much what chris kind of said before but to me the key unknowns to what extent vaccination really will reduce transmission because that really affects our predictions um in the future for future waves and whether for example that immunity and protection might wane through time for example and then it's about how the virus might evolve um to escape those vaccines and there's um lots of different ways that we can imagine the virus escaping escaping the vaccines it could um it will enable people enable the virus to infect people who have already been vaccinated but it's to what extent are those people going to be infected if they've been vaccinated if there's an escape variant will um disease be as severe you know are we worried so much if um people get infected but disease isn't so uh severe and then to what extent if you are vaccinated and you get infected by one of these new variants you know will you go on to transmit that to other people and so these are really key unknowns um which really affect how we will see the virus kind of progressing in the future so thank you you mentioned new variants now so they're very closely connected with the with the the the progress of the pandemic around the world and and so in this sort of section i'd like to speak about the global vaccination program perhaps i i could speak to or ask selling initially um how we should and how we are approaching the global vaccination program and um related to that why is that important so when we look at the global situation the first vaccine was delivered somewhere around the second week of december since then we have vaccinated with about a billion doses i think the big concern and the thing that most concerns me is that off the billion doses that we've delivered that seven countries account for about three quarters in terms of salim has mentioned it there i i suppose the the main contrast between approaches in the world is is one of numbers there is science said maybe seven countries that have been extremely successful and the rest catching up but are there any differences in approach across the world other than pure availability of vaccines yes so there are several well there are several differences and a few which are actually important although i completely concur and i'm sure everyone actually concurs with selim's point about you know this is something which we need to see as a global problem and where we should be aiming for global coverage uh some uh kind of the way in which different countries have tended to prioritize citizens has varied depending on what they were primarily aiming to achieve some countries have for example prioritized uh vaccinating those who are providing uh social social services i mean that in broader sense police uh teachers doctors and others uh some have uh tried to look at how could we actually interrupt transmission but i i think that the point uh that uh katarina made earlier on that we don't really know the impact on transmission i think is something we just need to bear in mind it certainly reduces it but but how much i think is uh still uh slightly unclear um so there have been quite a number of different approaches different countries have tended to use different vaccines and there is one vaccine the uh currently in in in operation the jansen or johnson johnson vaccine which you only need to give one dose rather than two doses and the final difference is that for those who need to give two doses different countries have taken different approaches on how long to delay so the manufacturers all suggested quite short periods 21 days for example the uk's view because we were very because we were shorter vaccines every country short of vaccines was we were going to delay second doses because we thought the maximum public health impact would come by delaying them by which we chose uh 12 weeks and that was primarily to mean that we could double the number of people in the first period that we could actually vaccinate so we could increase coverage uh there are some theoretical reasons for thinking that a longer delay may lead to a better immune response actually but but the main reason was in fact just to increase the number of people who got the initial protection which is the majority protection different countries have taken a slightly different approach to that although interestingly on the whole countries are now moving to to increase the delay between doses rather than to decrease it that's the direction of travel now yeah i noticed the us and specifically have taken that you know haven't they i think i read and several several european countries are now starting to consider this katrina i i know your expertise in part is in the modeling of the epidemiological modelling and spread of the virus so we've touched on the idea it's a clear message actually haven't touched on it that you have to deal with this pandemic globally and could you comment on if we don't if we tried to take this view that we will be a very single country focused view what would the consequences be as far as we can tell given what we know in the modeling yeah i mean so the consequences for the uk really come in terms of um the variants that would be coming into the uk from from from travelers for whatever reason people are traveling and and and the variance in the virus that comes in will be kind of a reflection of what's circulating in the countries that people are coming from so of course if um if there's a lot of um virus circulating if we're seeing heaven forbid yet more you know um variants that we need to uh really worry about then then then they'll constantly be coming at our shores and and and the like and the and the kind of the greater that flow into our shores the la the bigger the probability that one one of one of those um infections coming in can kind of seed a big outbreak um so it's really um you know uh you know i think all on the on the panel here we'd really like to see you know equitable access to vaccines but at the same time you can think of it you know from quite um you know a personal kind of selfish point of view as well that by protecting the world we're also protecting ourselves i think it's fair i saw um i think someone produced a graphic of the spread the the spread over time of the of the epidemic the pandemic through europe and it looked to me like almost like a forest fire that you see that it emerges in one area initially with modernistically wasn't it i suppose in spain and then it just inexorably spreads um no matter what you do i mean is that really the the message that you really do have to stamp it out pretty much uniformly across the world otherwise you won't contain it i i yeah i mean i think i think kobe's um with us to stay but the more that we can yeah keep it down the fewer sparks if you like to keep your analogy from that fire and then they're the few the fewer than that those fewer kind of um sparks we need to try and chase down and you know and kind of eliminate and perhaps i can also add that you know the other reason to keep the amount of virus down is because the more virus there is in the world in total the more evolutionary space as we say the virus can explore so the more chance of a mutation or a combination of mutations being created if you like as the virus makes its errors and and searches out that space that can escape a vaccine so it's it's really about numbers game as well it's not just about keeping it out of one place it's about the total amount of virus that's replicating across the globe with and keeping that under control i think that's a good introduction actually the next section which i think mutations is that i'm looking at the questions is one of the things that people are particularly concerned about so we'll get to that in a moment i should just say we've got our first live poll up which is interesting in the context of global vaccination program we'd like you to answer the questions multiple choice poll but it's who should be responsible um is individual governments the world health organization the pharmaceutical pharmaceutical companies g7 nations or something else or all of the above so i think it'd be particularly interesting if you just give your opinion on who should be responsible for coordinating a global vaccination program and and with that well actually so so it says all of the above seems to be oh the world health organization seems to be the the two that are in there at the moment on the poll um maybe i mean it maybe it's a question just generally to the panel before we get onto mutations on that poll who who is responsible is is someone specifically responsible is the framework in place at the moment um would anybody like to take that question perhaps i'll just make a quick comment i think that in addition to what we've heard very eloquently outlined by katrina and wendy i think there's a moral and an ethical imperative that you know if we have in one country young low-risk individuals being vaccinated while in most of africa the highest risk healthcare workers have not been vaccinated that's an unconscionable situation it's unacceptable and it should be unacceptable to the world but that's the reality that's just exactly what is happening and now we're going to be seeing in the us they are decreasing the age of vaccination down to 12. while in most of the rest of the world we haven't even received doses for healthcare workers i think that that's also part and parcel of the challenge and it to me it points to uh the real challenge of the way in which vaccines are currently being distributed which is allowing market forces to play the game if you've got money you buy you get if you don't have money sorry go to the back of the queue now the world health organization did try to address this by joining up with sepi and gabi and creating an organization called kovacs and the basic idea of kovacs was to buy in bulk and then to distribute on an equitable basis and when you think about at its most fundamental it's a it's a pretty good concept for equitable distribution the challenge comes about that there are many countries that just can't afford vaccines and so that's so donations have to be made in order to least receive that but the biggest problem was that countries who with more financial clout jumped the queue they're willing to pay higher prices they negotiated with companies and so kovacs went to the back of the queue so kovacs is distributing vaccines after most of the other countries have received it because they were rich so i think market forces have shown that they are flawed so we need some kind of centralized approach and to me the world health organization has the moral standing and the responsibility for global health and so well placed to take this on and they need to create an organization like covax but with more clout and more ability to buy vaccines and distribute them faster so thank you so the in in terms of um we've heard the arguments for indeed for the fact that you we need to vaccinate across the world it's the only way really to get this pandemic under control i i thought i'd move on to mutations that one of the most popular question at the moment that's been asked is that related to that are there any variants already in the uk that vaccines don't protect against perhaps i could start with chris on then uh i'll have i'll have a first go but this is very much an area where wendy in particular i think could add a huge amount um i i mean the short answer is that we're not we're still at the early stages of understanding how the different vaccines interact with the different variants so that we don't have absolute certainty on this um the b117 variant which is the one that was first described in the uk often described as a uk variant we are confident that the vaccines that at least are currently available in the uk work against that for practical purposes in terms of the other uh variants that have come from other uh countries uh in terms of their first description to be clear this isn't necessarily where they arose and i'm going to refer to them by their uh than the country they rose in simply because that's what most people understand um the uh the one where the uh evidence would be strongest that there is some degree of vaccine escape uh is the variant that was first described in south africa uh and um that seems that doesn't seem with most of the vaccines available to lead to a complete failure of the vaccine so we think it probably provides some level of protection against severe disease and from against mortality but it does probably reduce the effects of the vaccine in milder disease and transmission of disease that would be i think where we would currently take situated and then there are a number of other variants which are somewhere in the middle including one that arose in brazil circle p2 variant and then there's several variants being described in india recently which we don't yet fully know although i think they probably also fit in the middle so i don't think there's any variant which at this point we think the vacuum won't work at all but there's a sliding scale from situations where the vaccines work as well essentially as they do against the wild type the original one that was first described coming out of china then into europe uh all the way through to the one which at this point looks the most concerning for the escape which is the south african bones we have in relatively small numbers here obviously uh saleem has a much more experience of this in south africa there's a lot uh in southern africa indeed there's a lot in various other countries in the world but wendy might want to comment on this uh she this is really something she's very expert on um well thanks chris for saying that um i think i totally agree with your summary uh what for a vaccine to predict protect against transmission is a tall order um and so that's the bit that you lose first as as the sort of match between the circulating or the new variant virus and the vaccine strain moves apart it'll be transmission that drops off first and then it'll be symptomatic disease and then finally you know hospitalization so the good news is the very straightforward answer to the question is no there are no variants in the uk at the moment against which we think the vaccine won't work to protect people against severe disease hospitalization and death because um you know the distance between all of the variants and the virus we started with is not that great as of yet i think what's in the back of all of our minds is that this is an rna virus and that there is evidence coming out from people frantically studying some of the other seasonal coronaviruses that we know have circulated amongst humans for a long time that that probably these viruses do drift in the same way that we know classic influenza virus drifts and so over time over years it may well be that this virus can accumulate more and more mutations that change more and more um parts of its surface so at the moment because we all make what's called a polyclonal response one change here and there on the virus means that we've still got antibodies that see the other parts of the virus that haven't yet changed but when you get to a point where the virus has changed in in several different places you you will begin to erode away that polyclonal response that we've made so i think it's something we have to be very aware of and we can see variants emerging with different degrees of distance from the first virus that came out but so far nothing that completely throws off the vaccines and the other thing i'd just like to say is these vaccines are incredible as saleem started out they are really really great vaccines that particularly i think the mrna vaccines make huge amounts of antibody and that gives you a lot of breathing space if you like because it's not like the vaccines only just work they work pretty well and so even if you get a little bit of a mismatch you've still got a little bit of space there where the vaccine will have may induced enough antibody to still protect at least against symptomatic illness yeah i wouldn't say as katrina because i know that before kobe do your expertise influenza and um so how does this compare in terms of you know the influenza strategy everyone will be familiar in the uk at least with the fact that you have the flu jabs and the we make a decision at the start of the year on what flu jab will manufacture and so on um how will this ultimately compare and then maybe a deeper question is what do we know about the comparison between the viruses mutation rates and so on how similar and different is covered to influenza in this respect yeah so it i mean so on our side is that um uh saskop2 does it it has a low mutation rate so it evolves slower than um a lot of other rna viruses and but it's i think it's really interesting that um analogy you make with influenza because influenza we see kind of evolution we call it like drift and shift so you know um from year to year we see these kind of small changes and then you'll suddenly see a big change and that's what causes a flu pandemic and so it's um it's interesting to think about um sars cop2 in that way because all of these variants of concern that we have in the uk they've they've been actually a large number of mutations which really kind of threw every everybody off at the beginning was really unexpected um and they're probably a raise in a single individual and then and then that sparked uh you know a new chain of transmission so we could potentially think of that as kind of like a shift you know a big change but then we we're going to get all the kind of these little changes like a mutation here and mutation there which is like to be a lot more gradual and so i think it's i mean it it's a virus which is in a completely new host um so it's i it's really anyone's bet as to kind of what direction that will go in the future and there's a question that's perhaps related it was something that wendy said actually um about you know the mrna vaccines in particular you felt it had this quite stunning effect quite there's a big a lot of people are interested in the question about the differences between the in the uk anyway the pfizer and modern vaccines and astrazeneca the the um does it would anyone like to comment on that what we know about the the relative effectiveness of these vaccines and also perhaps relating to what wendy said the potential for a mutation to evade the vaccine in some sense is the one that we think is more likely to be evaded or would anybody like to maybe that's too speculative but the initial question about the effectiveness what do we know in the data about the effectiveness well i'll have a first go with this because um there's the trial data but trial data is always a bit difficult to compare because uh people do trials in slightly different ways and then there's the real-life data that we've seen in terms of effectiveness in different groups in the uk and we have our most state the most data in the uk on people people who've had a single dose of either the az adeno uh virus vectored uh um vaccine or the pfizer one and um for the our own variant the b117 variant uh the um which is now dominant in very large parts of the world uh unfortunately um the uh although um there is some difference about 21 days my view is that by the time you get out to about 35 days with a single dose the difference between them is really very small these are highly effective uh vaccines um we have good data from around the world that shows that a second dose of pfizer substantially increases even further the protection that pfizer produces we're beginning to get those the the data on that from the az vaccine is a bit less it's a bit earlier because we deployed pfizer earlier uh for practical reasons um but i think you know the key thing to say is that both of these um vaccines and i would extend the same to moderna which we're starting to use in the uk look to be highly effective against the uh the the main principle variant that's circulating in the uk and also relative to other other drugs and other vaccines very safe vaccines these are the risk benefit in terms of being protected uh to having side effects with both of these vaccine types uh is very favorable for the great majority of people and actually you mentioned maybe sally i could ask you because i think chris mentioned you obviously have a great experience in southern africa for example so what is the situation there with the the different vaccine technologies available and how effective they are against the dominant variants in southern africa yeah sure right so you know mutants are mutant uh mutations in viruses uh pretty much standard for all viruses and most of the mutations we don't really care about because they're very minor and they don't really make any changes but south africa got a wake-up call in december when we discovered a new variant we call it the 501y v2 or the b1351 just a bunch of numbers but basically a a virus with three mutations occurring in the key part of the virus that attaches to the human cell and there were four things we were concerned about when we first described these values the first was is it more transmissible and we now have pretty good evidence that it is it's about 50 percent more transmissible and similarly to the similar sort of increased transmission transmissibility as what has been described for the b117 therein from the uk and it's probably true also for the p1 variant in brazil and also probably i mean evidence is too early yet in india to make any definitive comment but it looks also that it's more transmissible indeed it needs to be more transmissible to dominate the way a virus evolves is to be better adapted and to be able to spread faster the second issue is is it more severe that's what we were really concerned about it turns out that in south africa the evidence we have now is that it's not more severe but we did see more deaths and those deaths accumulated in our peak so at peak the hospitals were full they were too busy and so the quality of care was impacted and so we saw increased deaths but the virus itself is not causing more severe disease per se the third is does it evade natural immunity and here we have pretty good evidence because this trial was done where individuals with past infection and individuals without past infection we looked at the new infection incidence rate and the answer to that is yes the variant b13 351 or 501y b2 escapes partially past immunity so if you've been infected with a virus before you are not fully protected this time about half the individuals who were exposed who had past infection did get infected again so we were seeing three infections occurring and then our biggest concern is do these variants escape vaccine immunity and there we have some pretty good evidence from four vaccines so if we look at for example the astrazeneca vaccine that was found to be 70 percent effective in the uk was only a 10 percent effective against the 501y v2 but that was a study that focused on mild disease we don't have clinical evidence on severe disease if we look at the vaccine called novobax that was 89 protective in the uk but only 49 protective in south africa on the other hand the johnson and johnson vaccine showed pretty similar levels of quite consistent levels of protection at around 62 to 66 percent in the us in brazil against the p2 variant and in south africa against the 501 yv2 so it shows similar levels of efficacy across these variants and if we take pfizer because the fisa vaccine trials were also done in south africa the first time has been shown to be around 91 to 95 percent effective depending on when you look at the data in south africa it remains 100 percent effective but it's a small component of the study that we've had no infections no clinical infections or sub or asymptomatic infections and those vaccine vaccinated with the fisa vaccine despite 501 yv2 infections in the control group so these vaccines show some differences in the ability to neutralize this particular virus and that's one of our big concerns about these variants because it's a it's a harbinger of things to come are we going to see next another variant that is more effective in escaping vaccine immunity and i think that's our big concern right now i think most of us would sort of want to believe and think based on indirect evidence think that pretty much all the vaccines are very good against severe disease now we don't have you know strong data on all of the different vaccines but it seems that that's the case but the next stage is going to be can we really prevent infection to actually prevent viral transmission and so asymptomatic disease and mild disease is going to be important for us to be able to control with vaccines down the line and so we're going to see our vaccine needs change right now vaccine needs and let's prevent deaths let's prevent severe disease and down the line it's going to be let's try and control this virus and so it's going to be quite important what role variants will play in this there's actually there's actually a question there that came up which related to what sally had said there maybe someone would like to take it which is whether there's any given that um there is a variation in the effectiveness it seems in the data against particular variants for each vaccine whether there's any plan to mix the doses so to give people an azad and a pfizer or a modena or whatever it is is there any reason to believe that that would be useful and is when he plans to do so so there's so much i have a first go that i mean i think so in the uk at least we are doing trials where we do exactly this where we mix different vaccines and see whether the immune responses are better worse or the same and also if there are side effects that you weren't expecting from them and that's also important obviously um from first principles so from other vaccines mixing vaccines is often quite a good idea but we didn't have data on this so the reason at the moment if you've had an az first osu to nasa's secondary so you get and they said pfizer first get it first a second it's those are the combinations for which we actually have scientific data as we get more information we'll have greater flexibility and it may well be that actually by mixing doses you actually have a wider level of protection and then in the long run what we all i think anticipate is we'll end up with what's called polyvalent vaccines vaccines that actually cover several different types of covid and hopefully they will actually protect against quite a wide range to go back to saleems and wendy's earlier points and indeed katarina's points not only protecting against severe disease but preventing against symptomatic disease and uh transmission uh potential so the the aim in the long run i think will be to have a much wider range of mixing different vaccines and the same vaccine with several different types within it yeah i just wanted to before i get to the next poll i just wanted to ask a question because i know before we came on air katrina was uh speaking with personal experience of these questions never could ask it to you which is that why do some people experience worse symptoms after the az as a zed chad specifically in question but we could broaden that to any job than others and then it it seems that if people have been unwell with kobe 19 they get a worse reaction to the jab afterwards so what do we know about that situation whether you've had the disease and the reactions to the jabs katrina that was yeah well so i was the one who's talking from personal experience that um you know i i'm self-diagnosed had cobia back in march and then when i when i was lucky enough to have the um astrazeneca vaccine um a couple of months ago i i really um you know it it laid me flat for a day really and so so uh yeah so i was reiterating that question to what extent um what what is the effect of kind of um prior infection and that and and that was my question to wendy really my my answer to that question is that um there's quite good evidence now that people who've had a covered and recovered and have already sort of seen those immunogens once make a very very robust response when they get their first dose of vaccine because the way you know these vaccines work or the way your immune system works is that you get primed and then you get boosted and the priming is sort of setting the scene and telling your immune system what to do and then when you see the same antigen again you make a big response and we see that a lot actually in healthcare workers who've been part of a lot of the studies that have gone on looking at the immune responses the vaccines have rolled out and we do know you know sadly that in the first wave of the covet pandemic a lot of health care workers did acquire coveted infection and and so they had an immune response to their own infection and then when we've subsequently uh immunized them uh with the vaccines they get a very robust um response in comparison to their colleagues who didn't get infected previously and got their first dose of vaccine and made a good response but but not as good as the others um i mean my answer to why you know you sometimes feel quite poorly um is that the immune system is very energy rich and hungry and and it takes a lot of work to make an immune response and also the way it's working is that there are lots of chemicals cytokines and chemokines which are part of our immune system which make it work properly and it's it's those same chemicals that make you feel like you've got slight aches and and tiredness and and uh sometimes even a fever but usually that's a sign that your immune system is responding very robustly to the vaccine that you've been given so i don't think it's surprising that that you experienced those those sort of symptoms if you like from the first dose and i normally tell people to take heart from that because it means the vaccine was working and you were making a very robust response so i think we'll go to the next poll which is um a question to everybody which is how do you think we can ensure a fair and equal access to the vaccines i suppose it is in a sense yeah and you can enter one word so it's gonna be a word cloud so that's quite quite a difficult one actually it's challenging itself how do you think would ensure a fairer national access to vaccines in one word so maybe that's a tricky one but then there we are that's the poll well whilst you're playing that poll in that world word cloud there was a question which a lot of people are interested in um and it's a question from the uk perspective but it's related to the the different variants and the effectiveness of the vaccines and the question was whether we are lulled into a false sense of security and because clearly you know we all you see the pressure it was precious to open the borders people wanted on holiday abroad to europe and beyond and so on so is this situated in the uk because it's at the moment the disease looks to be the low level if you look at the statistics anyway people are feeling confident because they vaccinated is that leading to a false sense of security particularly with reference to international travel who'd like to i didn't address it to anyone specifically i mean i i mean i can i can answer that from um kind of a you know a modeling perspective um and you know at the moment we're you know we have the you know this famous arnold number which is you know currently less than one and well you know it's very low anyway and and and that may as you're saying that makes us feel confident but it doesn't take much for for that number to increase for they are not to increase it doesn't take that much opening up and we saw that after um the summer holidays and so the que so so it's a really careful balancing act and i'm sure uh chris would agree between opening up but keeping that r value down and so you're balancing that with the um with the amount of people who are vaccinated and then you have to think about new variants and if those new variants are more transmissible then that pushes the arnold number up which then means you need to vaccinate more people or um keep other restrictions in place so um it it can feel like we're in we're in a very happy place and and in the uk at the moment fortunately we are in a very good place but it's you know i think history has told us that it doesn't take much um to reach that tipping point and for for infections to start to grow very quickly chris would you like to comment on yeah and i think well i mean the first thing is uh i think that people in the uk and this is true in multiple other countries but the uk is where i know uh best have been really quite remarkable how patient they've been and how pragmatic they've been about this and if you look at the polling data the great majority of people have actually called it absolutely right they've said how long it's going to go on for they've actually judged that remarkably accurately uh they've all accepted that you need to do a lot less meet fewer people and that's still the case today the reason rates are low is a combination of people meeting fewer people and not taking risks and the vaccines but it's that combination in one alone either one alone wouldn't have got us to the place uh the fortunate place that we are at the moment so i think we just got to take it steadily the whole point about the vaccines is they take more and more of the heavy lifting and hopefully we can little by little reduce all these until we get to the point where we're living a life that's basically back to normality as it was before the pandemic but people are being sensible living steady that's the path we're trying to take and i think that i think most people accept that's the appropriate way to do it steadily lays things uh at the rate you can do it in terms of people going overseas there are two separate sets of risks and i think they they are they are much more dif ones more difficult to calculate than the other the first is if a country's got a very very high rate and another country's got a very low rate then there is a significant risk of importation in either direction and the uk has at some points been a net importer of vaccine of varys and at some point a net exporter of virus depending on where we were relative to other uh countries the much more difficult one is the one we were talking about in the earlier section which is the risk of importing a variant which is either more transmissible than our own one or which can escape vaccines so could cause significant problems in the long run and the trouble here is that these are low probability high impact events and they're much more difficult to model and to predict on scientific basis than are ones where you can say how big an impact will this have because they've another country's got a slightly higher rate of of transmission of b117 which is the one we currently have so that's what makes the international issues uh really so much more difficult and i think a third thing of course is people often travel through more than one country and that makes all these issues around travel uh really quite difficult for policymakers in every country this is not a uk problem particularly this is a global problem yeah um just some comments on the word cloud if you're not um looking at it it's it's yes there was interesting actually so how can we show up here and you can access it share collaboration wh who again so so a quite um yeah a clear message um i think the message earlier particularly from all the panelists that this is a global problem seems to be shared by our audience at least and required global response and the the last i'll just say the last um poll which you can begin to look at actually i'll just wait for a minute i'll just let me ask another question before i go to the last poll and so we have a um this is an interesting question we dealt with it before actually but a lot of people are interested in it which is maybe i ask them wendy initially and how might developments related to kobe vaccines change their ability to tackle other infectious diseases so will these technologies have an impact further afield yeah a great question and i really hope so because i think what this past year has shown us if anything is is that the vaccines work and that we can produce them pretty well and that modern technology has some great routes uh to produce vaccines and again thinking of experience with influenza um where we sort of race against time every year to try to best guess which strain of flu is going to cause most of the illness in the winter and the vaccine manufacturing process takes the six months and you have to try and pick a strain in february that you're going to put into people's arms in october actually with some of these modern technologies you can probably respond much more rapidly and also much more accurately because you don't need to grow virus up in eggs or other ways that can affect the efficacy of the vaccine so i'm really hopeful that um not only for for rapid responses to future newly emerged viruses but also for the kinds of vaccines that we deliver routinely year on year some of these new technologies can really begin to push the boundaries and improve our vaccines uh saline the question that a lot of people are interested in is you touched on it actually but at what point do we make a decision in a country like the uk or the us to um to prioritize and other countries given what we've said about the the importance necessity of doing that rather than chasing diminishing returns in a particular country let's say the uk so there's no uh simple way of solving this because it's as much a political issue as it is a scientific one in that you know i can't see any politicians saying oh you know we've got several million unvaccinated people in our country but we're going to send the vaccines elsewhere that's going to be quite a difficult thing to do but it is you know that's that's just part of people wanting to protect themselves but there's also part of the challenge is the kind of donald trump-like view you know me first and i don't care about anybody else and you know we we've seen a bit of both of these play themselves out in the vaccine world um i think for me the highest priority should be to try and get the world the two groups in the world vaccinated as a matter of priority before we do anything else and the first are healthcare workers because they have the front lines they have such high rates and they are the ones who are most needed when we get into a surge and they're the first ones that get infected and have to go home just when we need them all in the hospital so vaccinating healthcare workers is a very high return rate and then the second is the elderly it can take you know above 60 or whatever cut off you like but those two groups i mean co-mobilities and so on play a role but those two groups really every country should be you know i would have imagined that by the time we reach you know two billion doses that every country would have vaccinated at least those two groups because after that the returns become much much less so and when you start getting down to 30 year olds and 20 year olds you know the return is much much less and so i think once countries have vaccinated the elderly and the healthcare workers some countries essential workers are also counted as important in like school teachers and so on but once those groups have been vaccinated then i think thoughts should be given about you know donating a certain proportion of vaccines or assisting kovacs and getting vaccines to distribute to the poorer countries that i think would be a fair equitable thing whether it's actually practical and politically feasible for politicians to actually do that in a country it's a different matter yeah and indeed the the let me just direct to the closing poll we've got about five minutes to go which is um on a scale of one to five uh one's the lowest fives the highest and how worried are you about the different variants of the virus and the possible third or future waves within your country um and so if you'd like to vote on that um so so yeah well so people are worried about that um related to that actually the question here about the awesome booster program i know this is quite useful uk specific but i suppose it will apply to all countries and the question is will that program which we hear about be tailored specifically to the new variants and if so uh how how what's the response time it's a you know we're presumably or clearly tested the new variants all the time is there a cut off we have to make a decision like the influenza vaccines but what how what we're going to deploy in the autumn booster program um maybe uh i suppose this question to chris really which uk focused initially but anybody who'd like to chip in please do well from a uk perspective i think that there are um there are broadly uh two reasons for wanting to do potentially a booster program but probably for a selected group of the population um in the autumn one of which is we we expect that and we see some evidence that uh particularly older people or people with some in reasons their immune system is damaged whether by drugs or by other diseases will lose their immunity faster than some other groups and they at the same time are the most vulnerable group so there is an argument for just boosting their immunity just in general leaving aside variance uh the second reason uh though is one that uh that wendy in particular but others have made about the fact that these are such uh these that if we can get an enough of a immune response it'll overwhelm a variant even if it's not terribly well designed so your two choices are to go for an older vaccine we know is on the shelf really boosts up the the the the antibody system and therefore will help protect rather indirectly from the variant or a newly designed new variant vaccine in reality i think the chances of having a newly designed new variant vaccine that is effective against the principal variants in particular the one that that was first described in south africa but before christmas are fairly small now obviously we all doing everything we can to speed those processes up but i think realistically uh that is the case and therefore it's likely that it'll be trying to use essentially a rising tide uh raising all boats uh approach uh with some of the old some of the older technologies may not be the vaccines we're currently using actually but some of the older technologies but um in due course i expect that we will be using variant vaccines around the world and they may be ones that we actually tailor to particular geographical areas that is a possible a possible way that we're going to see things in the long run thanks so much we're just about out of time but i do want to just run over a little bit by concluding the discussion there's a final question i'd like to ask so if you could be brief but to everybody on the panel maybe start with wendy and moving on the panel and the final question is what does the future of the pandemic look like in your view and the the sub some text to that is will will the vaccines be the end of kobe 19 so in my view we will not eradicate this virus it is so far spread around the world um and the vaccines do not necessarily completely prevent transmission so i think we will live with the derivatives of south kobe 2 for a very long time and as i mentioned previously there are four seasonal coronaviruses which probably jumped across from an animal source and caused a pandemic in humanity's past which we live with already and this will become a fifth um i am hopeful that we will learn to manage it um and that as time goes by and people have seen it before in early life perhaps they will not get as sick as when this virus first exploded into the human population so i think the long-term future is good but there's a lot to do in the medium term katrina yeah i think just uh re reiterating what um wendy said i mean we've we've only ever eradicated two viruses um from the planet um through vaccination that's smallpox and rinderpest and i i i just can't see us um being able to do that with um covid but as as wendy said i think um we should be very optimistic about um our abilities to cope with it uh chris i think what this is demonstrated is the extraordinary power of science to tackle infectious diseases and we've tackled this epidemic pandemic so far with vaccination and some old drugs new drugs will come along we haven't talked about that but hiv which in which saline for example has so much experience drugs is really the backbone of this we will get them we will get new vaccines but and in the long term i do expect that this will become uh as wendy says a much milder chronic disease overall probably with seasonal peaks and from time to time there'll be enough of an antigenic shift that actually we have another problem to which we have to respond in due course and it'll probably come at the same time as flu and various other infections of that type but in the medium term uh i have to say the outlook still looks pretty bleak around the world and i would really reiterate i think all of us would what selena said until we've got a situation where we've induced immunity and those who are most vulnerable everywhere in the world we're going to continue to continue to see really significant morbidity and mortality from this virus so i think whilst if i take a five-year view the combination of time and science is uh is on our side but he's not going to go away completely agree with the other other speakers on this in the short term i think we do need we do need to look to the next 18 months and say we've really got to make a global effort on this and just to clarify something you said there about the the return of quite significant peaks at some point in the future is that in the sense of the the peaks of influenza pandemics it's no uh you're not saying that we're going to have the uh disaster again yeah one of the slight problems i have is that every time i do any parallel with flu people say that i'm saying it's like flu it's not like flu this is a virus it's very different from flu but there are some there are certain things that are probably similar and one of which is you get good years and bad years if you think about flu in the uk and this is without a major antigenic shift you know we have on average we will have about seven to nine thousand people a year die in a pretty typical bad year maybe 20 000 25 000 people doing die if we have a pandemic with a bad flu it could be a lot more than that and in 2009 we had a pandemic with a much milder flu in fact it was relatively small numbers so it's very variable over time and i you know covered for the reasons uh that katarina and wendy were talking about earlier probably won't be quite behaved quite like flu does but i do expect there to be variability year on year and within year within between seasons that's the expectation with respiratory viruses and i i i think that's likely to be the final sort of end point for for this none of us know that's a that's a sort of educated guess based on other other infectious diseases but i think that's the most likely at this point in time and and stalin the the initial question just to remind you is that what does the future look like for this pandemic i'll make three points i think the first i'd like to concur what both wendy and chris said you know this virus is not going anywhere we're not going to be able to eradicate for many of the reasons they mentioned but also because it infects animals both domestic and wild animals so it will keep jumping across the species so i think that we're going to have to learn to live with this virus in the long term second is that i think there's a reasonable likelihood that we will see the creation of new variants and i think vaccination is going to put immune pressure on the virus to escape and in those who are immunosuppressed who've been vaccinated who've generated these antibodies we may see founder variants that have more capability to escape vaccine immunity and our ability to make new versions of the vaccine as moderna has done and just reported their results on their new version of their vaccine based on the b1351 that as soon as we make those and give them out they probably going to be outdated because there's a new variant in circulation so we're going to see those kinds of challenges and the way to deal with that is for us to remember we have a full prevention toolbox not just vaccines we've got to find a way to use that the combination of prevention some restrictions not ones that impact our economy too much but some personal behavioral changes together with vaccines i think in combination we have a pretty good chance of getting you know to a situation where we can do most things quite normally and then the third point i want to make is that like chris and katrina i'm pretty optimistic that we will see the generation of new technologies i've been involved in hiv research now for over 35 years and i saw from a situation that was dire where people were dying and i mean my wards were full of patience just and nothing i could do for them to a situation where anti-retroviral treatment changed the game completely and now we've never had a vaccine against hiv and prospects of a vaccine looks a little you know distant but we've been able to reduce transmission we've been able to reduce new infections we've reduced deaths so we can impact and i think we're likely to see new scientific innovations an impact in the longer term so i think those three points i think is what i see as the three key issues going forward well thank you and thank you to everybody for listening and watching i'm sorry we've overrun for that it's interesting i hope you agree um so that is the end of tonight's discussion i should say that we're going to carry on this series throughout june because um i know that people have been particularly interested in these questions and others so if you follow the royal society on the volcanic website youtube channel and so on you'll see when we have the next uh scheduled discussion but for now it just leaves me to say thank you everybody for listening thank you to the panel and good night night

Channel: The Royal Society

Views: 63,088

Keywords: royal society, science, scientists, scientific policy, scientific research, science uk, science research, international, international science, science education, science policy

Id: Ev9LMceUPZc

Length: 66min 0sec (3960 seconds)

Published: Thu May 06 2021