Coronavirus: the global race for a vaccine | FT Interview
Jeremy Farrar, the director of the Wellcome Trust, speaks to the FT's Vanessa Kortekaas about the global race to develop a Covid-19 vaccine, how to prevent 'vaccine nationalism' and the lessons learned so far from the coronavirus pandemic
Produced by Vanessa Kortekaas. Edited by Petros Gioumpasis. Filmed by Rod Fitzgerald. Still images by Getty and Reuters
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It's widely accepted that a vaccine is the only way to end the Covid-19 pandemic. And there are various estimates of the number of vaccine projects currently under way. The London School of Hygiene and Tropical Medicine has put this figure at 183, and other estimates put that at over 200. Of all the vaccine projects that are currently in development, can you give a sense of how many of these have actually gone to human trial and you think are viable? What are the chances of success?
Yeah, it's really important that there are a lot of vaccine candidates in play. Whether there's 183 or over 200, it's a big number. And that's a very good thing because we don't know which of them is going to work. We don't have any other vaccine for a human virus like this coronavirus. We don't have vaccines for Sars 1 as or Mers or indeed yet Sars 2. So it is important that there's a diverse portfolio to take forward.
Of those 200 I would guess at the moment there are about 20 lead candidates. Of those 20 lead candidates I'm aware of probably about 10 that are in human trials already - phase 1, phase 2 trials around the world, from China to Europe to the US and elsewhere.
Chances of success. It's a hugely important question. And it, of course, depends what you mean by success. But I think if you said each individual one at the moment maybe has a 10 per cent to 15 per cent chance of success, maybe 20 per cent with the more advanced ones, that's a reasonable estimate.
Even with the number of vaccine projects in development, is it the case that most of the money that governments are investing are actually just going to a handful of these because they want to back a winner and ensure that their own population has access to a vaccine first?
Yeah. Globally, there's investment in all of these 200, whether from national governments, from the ACT accelerator, which has just got started in the last month or so, or indeed from Cepi and other agencies. And it is absolutely crucial there's a broad portfolio because we don't yet know which vaccine is going to work.
Yes, the lead candidates have had more funding. But that's a good thing because it allows them to progress at speed. And speed is very important here. But what is important is that we don't just back one vaccine or two vaccines because they may fail. What is important is that as a world we back a whole portfolio of these vaccines, including disruptive ways of making vaccines - RNA or DNA technology or other technologies which we haven't used before in vaccine developments.
The danger will be that countries back one or two with all of their resources, and those one or two don't work. And then those countries that do that will be left without access to, hopefully, a potential future vaccine.
And what about the production and distribution challenges? So once we hopefully actually get a vaccine. I mean, you have pharmaceutical companies now warning about shortages of glass vials. Can you give a sense of what our production and distribution capability for a vaccine is now compared to what it will need to be to do something that's never been done, to vaccinate the entire global population?
Over time we will need to vaccinate very large percent... parts of the population of the world's 7bn people. But to begin with we would have to target those at highest risk. Healthcare workers, the elderly, people from other backgrounds who have suffered disproportionately in this infection.
You're absolutely right, though. Having a vaccine is not enough. Having a vaccine that can be offered to 1,000 people is not enough. If we're going to really have the exit strategy through vaccines to this pandemic, we're going to have to be able to vaccinate very large numbers of people around the world. And that means doing the science. It means doing the research and development.
But critically, in parallel, rather than in sequence, it means making sure we can turn that vaccine into the billions of doses that we need to provide for the world. And that means thinking about things in a very different way than traditional development. It means thinking in parallel, not in sequence. It means thinking now, if I had 200m doses of a vaccine could I put it into a vial? Have I got enough syringes? Do I have a cold chain that could deliver this all over the world?
And instead of doing that one after another we're having to do that at risk, at scale, and as a global manufacturing base in ways that, frankly, we've never had to do before. And that is the thinking. It's the thinking behind what Cepi is doing, what Gavi is doing, what the WHO is leading, and what individual countries are all contributing to.
And in terms of that equitable access to any vaccine, I mean, can you talk a little bit about the issue of vaccine nationalism? Is an internal agreement the only way to ensure equitable access to any vaccine? And to those priority groups that you mentioned - health workers, for example - even in the poorest countries, to ensure that they have access to it. How realistic do you think that is?
It's got to be realistic. I mean, it may sound idealism and it may sound naive, but effectively that's what we have to do. And there are two reasons for doing it. One, because it's the right thing to do. Healthcare workers have suffered disproportionately through this, as indeed have the elderly, as indeed in many countries in Europe and North America have people from BAME backgrounds have suffered more than others. And we have to focus our vaccine strategies on those at highest risk.
Vaccine nationalism. In other words, I'll make a vaccine for my country or my region, and I'll deal with my country first, and I'll leave the rest of the world for later. That is not enlightened self-interest. Not only is it the wrong ethical or moral thing to do, it's also not sensible. It's not smart science.
The best way of addressing this pandemic is to see it as a global issue. It is not an issue for America or Britain or China or South Africa. It's an issue for all of us. And until we deal with this as a global issue we're not any of us are going to be safe. So we have to make the case that just looking after yourselves and leaving the rest of the world for later isn't going to be on the solvers to get out of this pandemic.
Well, and on that point, as you say, this is a global issue. And global leadership arguably has been something that's been lacking, at least from among political leaders in this crisis. What is your response to how the US has handled this pandemic? And if China and the US, if powerful countries like China and the US aren't engaging or working constructively on the global stage together within this response, how damaging is that for efforts to not only find a treatment and vaccines, but also to ensure equitable access to those?
At a scientific level, I mean, we have many partnerships and collaborations with scientists both in the United States and in China. And those are continuing. I appreciate the tensions that there are politically and the rhetoric that is there politically. But at a scientific level, whether it be in academics in China, academics in the United States, or in industry in either country, I have to say that we are very much engaged with both of those.
And that's how we have to go forward. I'm afraid on this one the rhetoric from the politics is not something that I can get into. It's not something I can influence. What I can influence, and colleagues in Cepi, Gavi, WHO, and elsewhere, the European Union, et cetera, what we can influence is the partnerships at the scientific and the research and development and the manufacturing levels to make sure that we have vaccines available independent of your ability to pay and independent of which country you are in.
Yes, I would love countries to come together to address a global crisis and come together in political partnership as well. And I hope out of this we have a new dawn which people will appreciate that whether it's pandemics like Covid, or indeed it's climate change or drug resistance or the issues of mental health that we all struggle with, that this will demonstrate to the world there is no future in narrow nationalism. There is no future in a polarised world.
These are challenges which will face us all. And unless we work out ways to work together - yes, scientifically, but also as societies and politically - we won't be able to address them. Because nationalism is not the future and is not the answer to those great challenges.
So at a scientific level actually we're making great progress. We talk to American scientists, Chinese scientists, not every day but almost every week. And we're finding great traction there and huge support from both of them in order to move forward.
And let's talk about the funding behind all of this. I mean, you supported initial calls for an $8bn response fund to respond to this crisis which was met. Can you give a sense of where that money has been spent so far and how much more will be required?
Yeah. That was the initial request. And as you rightly say, and I pay tribute here to the European Commission and to other governments that have played a critical role in bringing that together from the G20 to many countries around the world that have contributed.
Yes, we were successful in raising that initial sum, in fact, a little bit past that. And that has allowed the work to go on since that pledging conference on the 4th of May. So the science, the research and development, the progress that's been made in health sciences and therapeutics. We mustn't forget the therapeutics angle either. That progress is continuing, and indeed there is tremendous progress both on vaccines, therapeutics, and diagnostics, and in support for health systems.
But that was only ever a starting point. If you take that a new drug or a new vaccine... let's say it costs you a billion dollars to get to the first starting point of having a vaccine. And we need more than one vaccine, and we need therapeutics, and we need support diagnostics. And critically, we need to support the public health response, protection of healthcare workers, personal protective equipment, and the rest of it. We're going to need significantly more than that.
What we're working with, with WHO, with Gavi, with Cepi, with the Therapeutics Accelerator, the Gates Foundation, Wellcome, many governments around the world, is to work out, now having had that initial injection to allow that first work to get started, what more is now going to be needed in order to enhance public health support around the world, to enhance the critical work of WHO and Gavi and other Cepis and others? What's really going to be needed to solve this crisis?
They sound like eye-watering amounts of money. $8bn seemed a lot of money when we called for it in February. The new request will inevitably be bigger than that because the challenges are now greater. But if you look at what the world is losing as a global economy it is hundreds of billions of dollars a week.
And the longer this goes on the longer that that is going to make middle income, high income, low income countries suffer. And the impact on the younger generations, on employment, on societies in general is going to be profound and long lasting. The quicker we come out of this through therapeutics, vaccines, diagnostics, and enhanced public health, the better the world economy will be.
So whatever we spend at the moment will come to be seen in history as a tiny fragment of what the world has lost through its economy.
And I just want to turn to the UK for a minute. You're obviously a member of their Scientific Advisory Group, Sage, which is informing the government in its decisions. And you've spoken about the need for transparency before in that decision-making. Do you think that the UK government is being transparent enough with the public around its decisions?
And specifically on testing, given that the lockdown has already begun to ease do you think the UK's testing capabilities - not just in terms of numbers, but in the turnaround times for results and the groups that are being targeted for tests - does that capability match the risks associated with the easing of the lockdown?
It's a great question. I would pay absolute tribute here to the role of Patrick Vallance as the chair of Sage. He has pushed to the Sage minutes becoming available publicly. And I think that's the first time that's ever happened during the crisis, as opposed to some later date. And I think all of the papers and the contributions of people - more than 250 people that contribute to SAGE. The fact that those minutes are now available, I think, is a key step.
I do think we could go further. I think there could be more questions and answers about how certain scientific advice was gained. As you know, and I've said this publicly, I think the lockdown measures were eased a little bit too early. I would have rather they were lifted about now actually, rather than three or so weeks ago.
Because now, three weeks on from when the starting of the lockdowns was initiated, the numbers in the UK have come down. They were 10,000 new infections a day just a few weeks ago. That is down now to about 3,000 new infections a day, and it's continuing to come down.
When the numbers come down, as they have done in much of continental Europe, then your ability to deal with local epidemics, to deal with little outbreaks that happen, as are happening now in meat packing factories and in other areas around the UK, your ability to deal with those is much better.
I would have liked the test, trace, and isolate system that Baroness Harding has put in place to have been more mature and more developed and able to respond to the new infections that were coming. That is almost in place now and fully functional. I would like to see it a little bit more functional.
Because the fastest way out of this pandemic for the UK is to drive down the numbers where you can deal with them with your public health response, have a really robust test, trace, and isolate system which is both nationally run, but also locally responsive, and have the ability to care for people in care homes, in hare-to-reach communities, homeless shelters, factories, and indeed in the NHS. And that's what we need to have in place as we lift the restrictions.
The worst thing that could happen is we went too quickly with that, and we have to reimpose the restrictions. That would be very damaging to trust. It would be very different damaging to the economy, and would set us backwards if we had to reimpose restrictions. That's what we need to avoid.
And we need to use this time of June, July, and August to step back and think really carefully, how can we make sure we're in the best position possible with test, trace, isolate, clinical care, caring of care homes, vulnerable populations, for the inevitable coming of the autumn and winter when we will see the normal respiratory infections and maybe a second wave or rebound of the current?
That's what we need to use this three months for is really stepping back, learning lessons, and thinking what do we need to have in place for the autumn.
And I want to go back to the big picture now. I mean, it's at about the six month mark since the outbreak started. And we've had some progress, as you say on, treatments. And it sounds like a second wave is inevitable. Is the autumn the time then where we'll have that answer to the immunity question, whether people who have previously been infected have the antibodies and can't get infected again?
It is. The autumn is the crucial time in the northern hemisphere. But just to put the pandemic into perspective still, Europe is in a position now where the first wave is coming off its peak and the numbers are dropping, including here in the UK. But globally, the numbers are accelerating. This pandemic is only just starting.
If I could just give you a figure for that, it took two and a half months for the world to have its first 100,000 cases. Every day at the moment, there are 200,000 cases being reported globally. This pandemic globally is accelerating, getting worse, and going into new jurisdictions that previously had not suffered from it.
So this pandemic is very, very far from over. And given that we believe only about 6 per cent or 7 per cent of the populations in Europe are protected, we believe, from having antibodies, it means that 90 per cent plus others remain susceptible to a potential second wave.
So whether a second wave comes or not is at least in part dependent on the decisions we make today, the preparations we make, and whether we can avoid it coming back in future. But we should assume it's coming back to make sure we use this three-month window of relative peace and quietness in Europe to make sure we're absolutely better prepared than we were going into February or March of this year.
What would you say has been the most important lesson for the scientific community since the outbreak started?
Most important lessons from the scientific community. I think the importance of collaborations are absolutely critical. The importance of learning from experiences in China, from experiences in Singapore, experiences in Korea, and making sure you don't just learn from those but you then implement those learnings.
The fact that we're dealing with a brand new human infection which we've never seen before. Is there immunity? Does the virus change? What sort of clinical syndrome does it cause? How can we best manage patients? And how can we develop treatments?
The coming of showing that dexamethasone, through the recovery trial, has reduced mortality in those people ventilated by 30 per cent or so, that's a remarkable finding that science had no idea about even three months ago. The fact that chloroquine does not work in treatment is an absolutely critical finding.
And the development of vaccines at an unprecedented pace. We will have vaccines that are being tested in 2020, less than a year after a new infection emerged. That is a remarkable thing to say. We must make sure that those vaccines are both safe before we give them to hundreds of millions of people around the world and also that they are effective. We need to know they are safe as well as effective.
And we must not just think of putting all our money into vaccines because we may not have a vaccine. I sincerely hope we will, and I'm optimistic we will, but we also have to develop the health systems, the public health. We have to push forward with the development of therapeutics and drugs that can prevent and treat this infection, and we have to roll out better diagnostics so that we can understand where this infection is spreading.
But if we do all of those things, and we commit the resources that are really needed, and we work as a globe rather than as a single nation state, then we will make progress. And I would be absolutely optimistic that we can come out of this Covid pandemic at some point in the future. And then we must develop the sort of world and put in place the collaborations at a global level that are going to be needed if we're going to address emerging infections, climate change, drug resistance, or the other great global challenges of the 21st century.
And I'd like to end just by asking you about that final point, that risk of failure. Even with all the efforts going into looking for a vaccine to trying to develop one across the world, how big is the risk that those efforts will fail and the virus is something that humanity just has to live with? I mean, is there a plan B?
There is a plan B. And we will have to live with it. I mean, physical distancing, which has been very effective in reducing transmission, but you cannot keep it going forever. You cannot keep schools closed. The inequality that closing schools brings, the lack of educational opportunities for young people is profound. The impact on the economy - the shielding of elderly populations therefore not able to see their loved ones - is something that the world cannot keep going with in long.
Lockdowns do not change the fundamentals of the biology of this virus. They don't change transmission. They do not change our ability to come out of the Covid. They buy us time but they don't change the fundamentals.
The only way out of the pandemic and changing the fundamentals is to have diagnostics, stronger public health, treatments that can prevent and save lives, and a vaccine. And we need all of those. We shouldn't be betting on one of them. We need all of them. And if you ask me, will we succeed in any of those? The answer is an unequivocal yes. But I don't know which one of them will have the biggest impact, and that's why we have to invest in all of them at scale, at risk, and as a world rather than as individual nation states.
Jeremy Farrar, thank you very much.