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Coronavirus vaccine Q&A with Professor Keith Neal

 

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As we begin to see Coronavirus vaccination programmes roll out both here in the UK and across the world we thought it was well worth catching up with one of the University's leading experts, Professor Keith Neal. Keith has been one of our leading commentators throughout the pandemic, with has 30 years' experience controlling infectious diseases, such as SARS, MERS, swine flu and Ebola in the UK public health system. He also has 25 years of experience in the research of the epidemiology of infectious diseases at the University of Nottingham.

Keith on...how a vaccine tackles a virus

"If you take insects or those animals without backbones they mount the same sort of response to any infection, which is a non-specific attack with inflammatory cells and proteins which help kill germs and other bacteria. Once you get to fish and other animals higher up the evolutionary ladder, they have an immune system, which is able to remember what its seen before and mount a faster, more directed response against infections. This is why humans never caught measles twice (in the days before vaccinations). Once you've seen it your immune system is ready for it the second time round. What a vaccine does is essentially gives you the equivalent of a natural infection in advance so when you're exposed to a pathogen your immune system has already got the right tools to deal with it."

Keith on...the decision (in the UK) to prioritise first doses for many over two doses for few

"To be perfectly blunt I think a lot of people have been trying to play politics with the vaccine rollout. For example, if you have 2,000 doses of a vaccine and you give it to 1,000 people twice it would probably protect around 900 people. If we give 2,000 doses to 2,000 people you would probably protect 1,400 people.

"If the vaccine also affects transmission (and we don't know if it does or not yet), but by stopping people getting badly ill it should help reduce transmission even if it doesn't block it, then that difference between 900 and 1,400 will be amplified for each chain of infection broken."

Keith on...why the UK has vaccinated more of the population than other European countries

"The reason the Oxford and Moderna vaccines were so fast out of the blocks was that both had already developed similar products. Oxford in particular already has SARS and MERS vaccines, which are in essence versions of a Coronavirus. A lot of this work goes back to the Ebola outbreak in West Africa in 2014.

"Bill Gates was correct in stating that we needed to start building vaccine production factories at the start of the pandemic - this is one of reasons the UK is doing so well in comparison to our neighbours. AstraZeneca started making the Oxford vaccine before they even knew it was viable. The EU for comparison still hasn't licenced the Oxford vaccine despite ourselves and the USA doing so. This is also the one with more product than any other in the world.

"Various countries in Europe are now trying to sue Pfizer because the company hasn't delivered as much vaccine as promised because they've had to rejig production. Several countries in the EU bought equal quantities of the French and German vaccines even though the French product is nowhere near production, whereas in Britain we've concentrated on securing the first one over the finishing line."

Keith on...what virus mutations mean for vaccines

"If I get vaccinated I won't just make one class of antibody, I will make lots of different antibodies. Each white cell makes its own, so there are thousands of white cells sitting there ready to make antibodies. If they come along to meet another Coronavirus which is partially the same as what the vaccine was and, let's say, 500 of my cells have met it before but the other 500 aren't good matches, the 500 that match best have a propensity to divide more than those which don't. This means you get a better quality of antibody with repeat infection. So even if the current vaccine doesn't stop the whole infection it's very likely it will stop people getting sufficiently ill to end up in healthcare.

"On a cost basis producing an altered vaccine will be an irrelevance. According to Pfizer we can create a new virus vaccine in six weeks. There will be problems with this currently because the vaccine is licenced as it is. If we change it will we have to do more trials? With the flu vaccine, the vaccine itself isn't licenced but the production process is. If you had to do a two-year trial on the flu vaccine each year it would be out of date by the time it was licenced. So we may need to change the licencing arrangement for Coronavirus to bring it in line with the flu vaccine."

Keith on...what life might look like in 12 months' time

"In 12 months’ time, we will need a vaccine policy but Coronavirus will be largely beaten. It will be in good retreat by this summer, threatening a reoccurrence by October/November, which gives us time to put implications in. I certainly hope this is the case as there are certain parts of the economy which will not survive for much longer. Most importantly it does mean we're going to have to take personal responsibility for our protection to a certain degree."

Professor Neal is Professor emeritus of epidemiology of infectious diseases

Posted on Thursday 28th January 2021

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