The story of the Oxford-AstraZeneca vaccine was a story of British success: it was developed on home soil, and less than a year passed from its inception to the release of the first batch. The manufacturer’s intention was ambitious: to create a vaccine for the whole world. But politics and nationalism intervened.
Almost half of the entire adult population of the United Kingdom has received two doses of AstraZeneca’s COVID vaccine. This may have saved more lives than all the Pfizer and Moderna vaccines combined. However, AstraZeneca vaccines are currently under-utilized by the UK National Health Service, and out of more than 37 million people who received a booster, only 48,000 received AstraZeneca. In addition, this vaccine, which has been used in European Union countries, has not been approved in the United States. Why did it happen this way?
While making a documentary for BBC Two, I spoke to scientists, politicians and commentators about the fate of the Oxford-AstraZeneca vaccine, which government officials described as nothing less than a “British gift to the world”. Sir John Bell, a professor at Oxford University who led the team that took the Oxford vaccine from the lab to the masses, is very critical of those who make decisions in the European Union. “They have so undermined the reputation of this vaccine that it has reverberated around the world,” Sir John said. “The foolish behaviour of scientists and politicians may have cost hundreds of thousands of lives, and there is nothing to be proud of here.”
Professor John Bell: EU politicians have undermined the reputation of AstraZeneca’s vaccine.
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But let’s go back to early 2021. The number of deaths and hospitalizations due to the “alpha” variant of the coronavirus was increasing, and the healthcare system in the United Kingdom was under tremendous pressure. But at the same time, there was hope: highly effective vaccines from Pfizer and AstraZeneca began to arrive in hospitals, approved for use in the UK before anywhere else in the world.
The Oxford-AstraZeneca vaccine was hailed as a national success, reflecting the strength of British science. The government even considered putting the national flag on the vials of the drug. However, scientists at Oxford University felt uncomfortable when the UK’s achievements were highlighted, as they believe the pandemic knows no borders. Scientists saw their task as stopping the spread of the virus worldwide and preventing the emergence of new mutations in countries not protected against the virus.
“There was too much nationalism in all of this,” says Professor Adrian Hill, director of the Jenner Institute at Oxford University, where the vaccine was developed. “And it fueled competition between different types of vaccines and the countries that produced them. And that is the worst thing that can happen when you are trying to control a pandemic and get vaccines to the whole world.”
The approval of the vaccine in the United Kingdom coincided with the country’s formal withdrawal from the European Union. “I don’t think the improvement in our relations with Europe was helped by the fact that this vaccine was promoted as British,” admits Sir John Bell. In Britain, despite the terrible damage caused by Covid, there was an uplifting atmosphere in all the vaccination centers I visited. But in mainland Europe, the mood was grim. “We couldn’t understand how it was possible for us not to have a vaccine when we hear that vaccination is in full swing in the UK,” says Dr. Veronique Thriault-Lenoir of the European Parliament’s Vaccine Contact Group.
By the end of January, the European Union, which had lagged behind the United Kingdom on vaccination, appeared ready to approve AstraZeneca’s vaccine. However, before the European regulators could make a decision, Germany decided that this vaccine should not be administered to people over the age of 65, and French President Macron even called this vaccine “quasi-ineffective for the elderly”. However, within hours of these statements, the European Medicines Agency approved the vaccine for use in adults of all ages. Germany and France took a step back, but the vaccine’s reputation had already been undermined. Some doctors in France were forced to throw away expired vials because no one was coming in for vaccinations. But how could this happen? Everything is very difficult.
When France decided to use AstraZeneca’s vaccine again, Prime Minister Jean Castex was vaccinated live on television to restore the French people’s confidence in the vaccine. AstraZeneca (abbreviated as AZ) was approved for use in the adult population in the United Kingdom and the European Union before solid evidence that it protects against COVID-19 was available. The trials showed that this vaccine protected younger volunteers, but older volunteers were added to the trials later. And the blood tests showed that, as in the younger volunteers, the vaccine induced a very strong immune response against the coronavirus.
It was concluded that the vaccine would protect the elderly as well as the young. This conclusion turned out to be true. In the midst of the pandemic, when vaccines were urgently needed, regulators decided to approve their use for older people in high-risk groups. However, France and Germany again decided to err on the side of caution.
On the same day as the French Prime Minister, Boris Johnson received his first COVID-19 vaccination in London. At the same time, a major scandal erupted over the supply of AZ. The vaccine was produced in both the United Kingdom and the European Union. However, because the UK had agreed to prioritize its supplies over the rest of Europe, the company announced that it would not be able to replenish European stocks from UK factories, while one million doses of the vaccine had already been shipped to the UK from the European plant. In the midst of the crisis, the European Commission even threatened to suspend vaccine exports to the UK if Europe did not receive its “fair share”. The vaccine’s reputation in the eyes of many Europeans was finally ruined by the rare but still observed link to thrombosis that was discovered in March. Germany, France, Ireland, Italy, Austria and Denmark were among the many countries that suspended use of the vaccine.
The risk of thrombosis is extremely low – one in 65,000 – but it is more common in young people. When European regulators announced that the benefits of the vaccine significantly outweighed the existing risks, most countries lifted restrictions but introduced new ones based on age. At the same time, confidence and pride in the vaccine remained high in the UK, even after the decision to restrict its use to people over the age of 40 because of the risk of thrombosis. And yet, the fate of the AZ vaccine was finally sealed when it came time for booster shots. The thrombosis problem and the fact that Pfizer and Moderna’s mRNA vaccines have no age restrictions put an end to the matter. Yes, the vaccine is licensed for use as a booster, but it turned out to be easier to vaccinate most people with Pfizer or Moderna, even though they are much more expensive. Later, there was evidence that better protection could be achieved by using different types of vaccines. Many in Europe considered the AZ vaccine to be unsafe or of poor quality; in Belgium it was even nicknamed the “Aldi vaccine” after the name of a low-cost supermarket chain. However, this vaccine was originally designed to be inexpensive. Its developers wanted to make it available to the entire world at a comparable price. Unlike mRNA vaccines, it could be transported and stored in ordinary refrigerators, greatly facilitating its use in hard-to-reach regions. AZ has agreed to license the global production and distribution of the vaccine at cost – approximately £3 ($4) per dose, which is only one-fifth the cost of Pfizer’s vaccine. The key element of this deal was the Indian company Serum Institute, the world’s largest vaccine manufacturer. The company has agreed to produce more than one billion doses for low- and middle-income countries. However, when the “Delta” variant hit India in the spring of 2021, the country’s authorities banned the export of the vaccine for more than six months, exacerbating the global shortage of this drug.
April 2021. “Vaccines are out of stock,” reads the sign at the entrance to the vaccination center in Mumbai. “When India closed the door, it created a sense that this was the real end, because at that moment all hope was pinned on them,” says Dr. Ayoade Alakija, co-chair of the African Union Vaccine Delivery Alliance. The difference between rich and poor countries was dramatic. In September 2021, when the UK, US, France and other countries began offering booster shots, only one in a hundred people in low-income countries received a double dose. “By the end of the first half of 2021, enough doses had been produced to prevent almost all deaths in the second half of that year, assuming, of course, that those doses were primarily intended for older people, people with health problems, and health care workers around the world,” says Professor Andrew Pollard of the Oxford Vaccine Group. “We made a mistake. But how do we make politicians feel comfortable with the moral imperative that should be there during a pandemic?” Dr. Bruce Aylward of the World Health Organization is highly critical of what he sees as a failed attempt to achieve equitable global distribution of vaccines. “We are giving this virus the opportunity to evolve, to mutate, to spread faster and to become more deadly. We will not be able to control the pandemic until closer to the end of 2022, because that is how long it will take for vaccines to be evenly distributed around the world.”
The UK government, which has invested £88 million (approximately $119 million) in vaccine development, has already provided 30 million doses of the AZ vaccine free of charge as part of its commitment to donate 100 million doses. The first donation was made at the end of July 2021. According to former Health Secretary Matt Hancock, the UK’s main contribution has been to provide scientific infrastructure and other resources for global vaccine production. “What they call giving a man a fishing rod and teaching him to catch fish,” he remarked. “This is much more important in terms of saving human lives than any amount of vaccine we could produce here and then export by airplane.”
Recently, global stockpiles of vaccines have increased significantly, along with the promise of free vaccines. However, millions of these donated doses have only a few weeks left before their expiration date, and not all vaccines can be used in time. There is also the issue of vaccine mistrust, which is a serious problem in many parts of the world. Despite these difficulties, more than 2.5 billion doses of the Oxford-AstraZeneca vaccine have been delivered to 183 countries, two-thirds of which are low- or middle-income. The vaccine will continue to be sold at cost to developing countries, while the company expects to make “modest profits” elsewhere. It is certainly impossible to calculate exactly how many lives this vaccine has saved, but the manufacturer believes it is more than a million. AstraZeneca’s share is more than a quarter of the 10 billion COVID vaccines produced worldwide. This vaccine was developed by a small team of scientists at a British university and is sold at cost. By comparison, 9 individuals have made billion dollar fortunes from other COVID vaccines. Despite the failed PR campaign for AstraZeneca’s vaccine in Europe and the US, the company’s CEO, Pascal Soriot, claims that they will continue to adhere to a non-profit strategy in the future. At the same time, he is very open about the fair distribution of the vaccine and the “coercive methods” used by the rich countries that received it before the poor ones. “You cannot change human nature,” he says. “People take care of themselves and their loved ones first, then their neighbors, and only then the rest of the world. One would hope that there would be no export bans and that vaccines would be freely distributed around the world, but one has to admit that the reality is somewhat different.”