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

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

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BRIAN COX: Well good evening everybody and welcome to this evening's event Vaccines: A Double Dose part of a series. Back in in our first discussion weigh looked a the early stages of the vaccine rollout and tonight we thought we would take a current view reflecting on the vaccine rollouts but also take a more global view of the vaccine rollouts and look at how the vaccines have been throughout the world. I am professor Bray an Cox pip and 1 of my jobs this evening is to put your questions to the panel. You can go to slido. com on your web browser and type in the code #V605.

You can also follow the Slido link in the video description. You also can vote up questions. That I found useful in previous events so I get a sense of the questions you want me too put to the panel and also questions you think are regular and want to be asked. We also have Closed Captioning. There is a link at the bottom of the video bar. And we have a hashtag #CovidScience . pgh without further ado

let me ask the panelists to introduce themselves. SALIM ABDOOL KARIM: Thank you very much, Brian. My name is Salim Abdool Karim I am the Director of Centre for the AIDS Programme of Research in South Africa and I am the professor of global health at Columbia University. KATRINA LYTHGOE: Hi, I am Katrina Lythgoe a research fellow oh at the university of Oxford, working on the evolution of viruses, previously HIV and Hepatitis C and now on to SARS COV- 2 the virus that causes COVID-19 .

CHRIS WHITTY: Good evening I am . CHRIS WHITTY: The Chief Medical Officer for England and the UK government's Chief Medical Adviser. By backend I am an infectious disease epidemiologist and physician . WENDY BARCLAY: Hello, my name is. CHRIS WHITTY: I am is.

WENDY BARCLAY: I am a Action Medical Research Chair of Virology, Imperial College of London and I have been interests in respiratory virus that cause pandemics mainly influenza until now, but now SARS COV 2. BRIAN COX: Thank you. You can ask questions in Slido but also I will introduce polls. Also a word cloud which we found useful in the previous discussion on COVID. It gives a sense of how you are you feeling about particular issues . Just to try it out, you get Slido , we are asking you to say in one word how you are feeling about the COVID-19 vaccination programme in your country. So I think this will that will be particularly interesting to get a sense of how you think the vaccination programme is going. Just one word and I will refer to ha in a moment as the word cloud builds up. That is on Slido.

I thought I would get an overview from each panel member about the vaccine rollout and how the programme is going. I thought I would start with Salim and ask that question : So what coos the landscape of vaccines look like right now? SALIM ABDOOL KARIM: When you think about vaccines, you normally think about years and years that it takes to make one. I myself have been involved in HIV vaccine development for 30 years so it is very close E.

pleasing to see how quickly we were able to make a vaccine against COVID-19. And if we look at the current landscape they are now well over 200 candidates and exactly 124 are now in clinical studies from Phase I all the way to Phase III studies , we have 8 approved vaccines for widespread use, six others that have 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 that have been at the front-end and have been now most widely distributed . About 1 billion doses of vaccines have been so farad mored across the world. Thank you, Brian. BRIAN COX: Thanks. That is quite surprising actually 124 in clinical trials, especially mainly in the UK, this is to Wendy, we have heard probably two or three of those. So, Wendy, can you set the scene or describe the situation here in the UK. WENDY BARCLAY: Yes.

Here in the UK we have only so far immunised people with 2 types or brands of vaccine. 1 mRNA the Pfizer and the add know virus vaccine from AstraZeneca combination but there are others in motion , if you like, other opportunities coming and for example in activated virus vaccines and other versions of both mRNA type of vaccine and vector vaccines can become available as we move forward. But actually most people who have had a vaccine today in the UK would have received the AstraZeneca one because we received far more dose of that in the UK than Pfizer and we are very lucky to have such early access to those two vaccines. BRIAN COX: And then , Chris, what are the main issues around vaccines now? In the word cloud, people don't -- I think . . .

the sense of it is mainly UK perhaps there isn't an issue in most people's minds. The big words are relieved, confident, hopeful, proud, optimistic. Fantastic. So, people clearly think there aren't issues.

But: Are there issues in the UK around the vaccine nation rollouts and the world? CHRIS WHITTY: The thing I will focus on is how you deploy vaccines because Salim and Wendy talked about the types of vaccines. And different diseases you do this in different ways. So, with COVID because it is a disease in which the UK context has so heavily dominated in terms of really severe disease and mortality , older people, so 86% of people who died were over aged over 70 or those who immediately cared for them. We have done a vaccination programme strictly on an age basis and specific conditions. The people at certain ages end up you dying or in intensive care or hospitalized.

Slightly younger, people in their 50s or 60s. Transmission of the disease happens with people younger hand that. Our to current vaccine programme ray Dawess the cases that people go into the hospital and die. What it won't have the same effect on yet. Will do as we go further down the ages, impact on transmission.

Because a lot of the transmission is from people in their late childhood, adolescence and in particular young adults, people in their 20s and 30s. That is in complete contrast other diseases such as measles where you need get the vaccines into young people where with a lot of the damage is done in the youngest people. The final thing is to acknowledge that some of the severe symptoms, for example, the group of things lung COVID can occur to young people and that is a reason they also vaccination Nate the. transition to the well community. There is also risk of them getting severe illness even in terms of long-term illness even if they don't have a very high chance dying. Now this will be slightly different in

different countries. The final point I'd make on this is that it is really important that we see this as a global problem not just as a UK problem although obviously at the moment we are just concentrating on the UK situation. The vaccine escapes with vaccine variants is another issue but I think you are you coming on to that later on, Brian. BRIAN COX: Yes, just to summarise what you said I suppose the tendency to look at the deaths which are extremely low in the UK and think, well, the problem is on the way to being solved, I suppose what you are saying is that that does not reflect the overall immunity in the overall population because we have severe problems potentially with younger people that would not appear in those statistics necessarily. CHRIS WHITTY: Exactly.

If we let go of the current cautiously being removed social distancing things we have got, the rates have gone up rapidly. Because a lot people are susceptible and can submit and there is plenty of virus around for them to get infected . We can see this as we are currently heading in the right direction but you still a long way to go even in the UK, a long way in the vaccination nations sadly a lot of countries are behind at this point in time. BRIAN COX: Cat reason what are the unmoans? Chris touched on a few of these. In the current global vaccine programme what are the unknowns? KATRINA LYTHGOE: Very much what Chris said before the key unnouns to what extent vaccination will reduce transmission because that affect s our predictions in the future for future waves and whether for example that immunity and protection might wane through time and about how the virus mighty solve to escape those vaccines. There are lots of different ways we can image the virus escaping the vaccines.

It could -- it will enable the virus to infect people who've already been vaccinated but you to what extent are they going to be infected if they have been vaccinated. If there is an escape variant will with disease be severe. Are we worried so much if people get infected but disease isn't so severe and: To what extent if you are vaccinated and get infected by one of these new variantses will you go on to transmit that to other people. These are key unnouns that really I expect how we see the virus kind of progressing in the future . pgh. BRIAN COX: Thank you. You mention ed the variants.

S closely connected with the pandemic around the world. In this connection, I'd like to speak about the global vaccination programme. Perhaps to Salim initially: How we should and how we are approaching the global vaccination programme; and related to that: Why is that important? SALIM ABDOOL KARIM: When we look at the global situation, the first vaccine was delivered somewhere around the second week of December. Since then we have vaccined vaccines yachted about a billion doses.

And doesn't address the fundamental issue: This is a pandemic and needs to be dealt with as a global problem. BRIAN COX: And, Chris, Salim has mentioned it, I I suppose. The main contrast between approaches in the world is one of numbers. 7 countries have been extremely successful and the others are catching up. Are there differences in approach other than pure availability of vaccines? CHRIS WHITTY: Yes.

There are several differences and a few which are actually important or they are like completely concurred with and I am sure everyone concurs that this is something we fade to see as a global problem and we should be going to global coverage. The way in which different countries tended to prioritize citizens has varied depending on what they primarily want to a I chief . Some countries are vaccinating those in social services, in the broadest sense, doctors, police, nurses, others . How do we interrupt transmission arors. The point that Katrina made we don't know the impact on transmission is certainly something to bear in mind; however it reduces it but how much is unclear. There have been different approaches. Different countries use different vaccines and there is one vaccine currently in operation, the Janssen or Johnson & Johnson, only 1 dose not 2.

Finally, the 2-dose vaccines, different countries take different approaches on how long to delay. So the manufacturers all suggested quite short periods, 21 days for example. The UK's saw because we were short of vaccines -- every country is -- were we were going to delay second Decembers because weigh thought the maximum you social health impact delaying them by -- we chose 12 weeks -- and that was primarily meaning that we could double the number of people in the first period. Increase coverage.

There was thinking that longer delay might lead to a better immune response. The main reason was to increase the number of people who got the beginning protection . The majority protection.

Different countries are taking different approaches, although countries are increasing rather than delay. BRIAN COX: I notice the US has taken that view. CHRIS WHITTY: And several European countries are starting to consider it. BRIAN COX: Katrina I know your work is modeling the virus.

So we touched on the -- clear message , tallly: We have to deal with this pandemic globally. Can you comment on if we don't; if we he try to take this view that we will be a very single-country focussed view: What would the cans consequences be as far as we can tell in the modeling? KATRINA LYTHGOE: The consequences for the UK really come in Terrence of variants will be coming into the UK from travellers, reasons people are travelling and the variance in the virus coming in will be a reflection of what countries people are coming from. So, of course, if there is a lot of virus circulating; if we are seeing that heaven for bid yet more variants , that we need to to worry about, those constantly will be coming at our shores; and the like -- kind of the greater that flow into our shores, the bigger the probability that one of those infection coming in can kind of SIDA big outbreak. So it's really, really, you know, I think all on the panel here would really like to see equitable access to vaccines.

At the same time we can think of it from a kind of personal selfish point of view as well: Protecting the world, we are protecting ourselves. BRIAN COX: I think someone produced a graphic of the spread over time of the pandemic through Europe and it looked to me almost like a forest fire; you see it emerges in one area, initially Northern Italy, then Spain and inexorably spreads. No matter what you do. I mean, is that really the Metsage: That you really have to stamp it out across the world otherwise you won't contain it? KATRINA LYTHGOE: Yeah. I think COVID is with us to stay but the more we can keep it down, the fewer sparks, if you like, to keep your analogy from that fire, then the fewer kind of sparks, we need to try and chase down and kind of eliminate.

WENDY BARCLAY: Perhaps I catch also add the other reason to keep the virus down : The more virus in the world in total the more evolutionary space as we say, the virus can explore ; so a chance mutation or combination of maw stations being created if you like as the virus searches out that space, can escape a vaccine. So it's really about a mums game as well. It's not just about keeping it out to of one place but the total amount of virus replicating across the globe, keeping that under control. BRIAN COX: That is a good segue for for the next section. People have questions things they are concerned about. We

have our first live poll up. Interesting in the condition text of global vaccination programme we want you to answer the multiple choice poll questions: Who should be responsible, governments , World Health Organizations, . . . if if you would give your opinion in that poll who. For who should be responsible for coordinating a global vaccination programme. With that, we will he actually . All of the above and the World Health Organization are the two on the poll. Maybe some questions generally to the panel before we exeat to mutations on that poll: Who is specifically responsible? The track.

take that question? SALIM ABDOOL KARIM: A quick comment. In addition to what we heard he will equantly outlined mainly by Katrina and Wendy there is a moral and an ethical imperative : That if we have in one country young, low-risk individuals vaccine vaccinated, while in Africa, the highest risk healthcare workers have not been vaccines mated that is uncon shunnable and unacceptable and should be unacceptable to the world but that is a reality. That is exactly what is happening. Now we will be seeing in the US they are decreasing the age of vaccination down to 12 while in most of the rest of the world world we haven't even received doses for healthcare workers.

I think that is part and parcel of the challenge . pgh to me, it points to the real challenge of the way in which vaccines are currently being distributed, which is allowing market forces to play the game. If you 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 SEFI and G A GI (phonetic) and forming COVAX, the idea was to buy in bulk and distribute on an he can wit withable basis. When you think about at its most fundamental it is a pretty good concept for equitable distribution. The challenge comes about that there are many countries that just can afford vaccines. So that's -- so to, donations have to be made.

The biggest problem was that countries with more financial clout jumped the queue. They are willing to pay higher prices, they negotiated with companies; so COVAX when to the back of the queue. So COVAX is distributing vaccines after most of the countries that received it. I think market forces have shown that they are flawed . So we need some kind of centralized approach. To meetings the World Health Organization has the moral standing and the responsibility for global health. (Pause) . BRIAN COX: Are there any variants in the UK that vaccines don't protect against? Props I can start with Chris on that? CHRIS WHITTY: I will have a first go but this is an area where I think Wendy could add a huge amount.

The short answer is we are still in the early stages of understanding how the different vaccines interact with the different variants so we don't have absolute serenity on this B 117 variant, first described in the UK, often described as the UK variant we are confident the vaccines least currently available in the UK work against that for practical purposes. In terms of the other variants that have come from other countries in terms of their first description to be clear this isn't necessarily where they arose I am going to refer to them by the country they arose because that is simplest to understand. The 1 where the evidence would be strongest there is some degree of vaccine escape was the variant first described in South Africa and that seems -- that doesn't seem with most of the vaccines available to lead he a complete he failure of the vaccine. So, we think it probably provides some level of protection against their disease and against mortality but it does probably reduce the effect of the vaccine in milder disease and transmission of disease. That would be where we currently situate it .

pgh then there are a number of other variants which are somewhere in the middle , including one that arose in Brazil , a variant and several variants have been described in India recently which we don't know, although they fit in the middle . There is no variant that we think the vaccine won't work at all. But there is a side sliding scale. As the original first described. Coming out of chin that China then to Europe.

All the way through, looks most concerning, the said South Africa variant. Salim obviously has much more experience with this in South Africa. There is a lot in South Africa and in various other countries in the world. But Wendy might want to comment on this. This is an area she is very expert on.

WENDY BARCLAY: Well, thanks, Chris for saying that. I think I totally agree with your summary. For a vaccine to protect against transmission is a tall order.

And so that's the bit that you lose first. As the sort of match between the circulating or the new variant virus and the vaccine strain moves apart, it will be transmission that crops off first then it will be symptomatic disease; then finally hospitalization. So the good news is the very straightforward answer to the question is: No. There are moo variants in the UK at the moment against which we think the vaccine won't work to protect people against disease, hospitalization and death. 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 our minds is this is an RNA virus end there is evidence coming from people frantically studying from the season al viruses that circulated among humans sometime: Probably these vairses do drift in the same way we know classic influenza virus drifts.

So, over time, over years it may well be this virus can accumulate more and more mutations that change more and more parts of its surface. Because we will make a poly clone al response, one change here and there on the virus means we still have ukes antibodies that see the other parts of the virus that has not changed. But when you get to the point where the vairs has changed in different place , you will begin to erode away that poly clonal response that we have made. I think it's something that 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 would like say: These vaccines are incredible as Salim Sartreed out, they are really, really great vaccination, particularly I think the mRNA vaccines make huge.

Huge amounts of antibody and that gives you a lot of breathing space you'd like. It's not only that the vaccine ises just work; they work pretty well. So even if you get a bit of a mismatch you still have enough space where it will produce enough antibody to protect against symptomatic illness. BRIAN COX: Katrina, before COVID your expertise was influenza: So, how does this compare in terms of the influenza strategy.

In the UK we are familiar with you have the flu jabs and make a decision at the start of the year. Hu does this compare and what do we know about the comparison of the viruses mutations similar to influenza in itsy effect? KATRINA LYTHGOE: On our side is SARS COV 2 evolves slower than a lot of other RNA viruses but I think it's really interesting that analogy you make with influenza . Because influenza we see kind of the evolution called drift and shift. From year to year we see kind of small changes then suddenly see a big change and that causes a flu pandemic.

It's interesting to think of SARS COV 2 in the same way. All of the concerns we have in the UK, they have matched a large number of mutations which kind of really threw everybody off at the beginning, it was really unexpected . And probably arose in a single individual ; and then that sparked a new chain transmission. So we can potentially think of that as kind of like a shift.

You know, a big change. But then we are going to get all of these kind of -- these little changes; a mutation here, a mutation there. Which is likely to be A lot more gradual.

I think -- it's a virus that is in a completely new host to. So it's really anyone's bet as what direction that will go in the future . BRIAN COX: Hm. There is a question actually related. It is something that Wendy said, tallly, about, you know , the mRNA vaccines in particular felt is quite an event. A lot of people are interested in the question about the differences between the -- in the UK Pfizer modern a and AstraZeneca. Would anyone like to comment on that, what we know about the relative effect I haveness of these vaccines and also perhaps related to to what Wendy said potential of a mutation to evade the vaccine in a sense, the one is that more likely we think to be a danger? Is that too speculative? The initial questions.

What do we know to date about effectiveness. CHRIS WHITTY: I will have a first go at this. There is the trial data, always a bit difficult to compare because people do trials in different ways; then there is the real real life data with different effectiveness in different groups in the UK and we have the most data in the UK people with a single dose of the add know virus. COVID vaccine.

Or the Pfizer one. And our own variant, B1 17 which is now dominant in large parts of the world unfortunately, although there is some to difference about 21 days , my view is by the time you get to 35 days with a single dose the difference between them is fairly small. These are highly effective vaccines.

We have good dearn the world that shows a second dose of Pfizer substantially in creases even further the protection that Pfizer produces. We are beginning to get the data on that from the vaccine is a bit earlier. Because we he deployed Pfizer earlier for practical reasons but I think you know the key thing to say is that both of these vaccines and I would extend the same to modern a which we are starting to use in the UK look to be highly effective against the main, principal variant circulating in the UK and also relative to other drugs and vaccines, very safe vaccines. The risk benefit in terms of being protected to having side ee Februaries with both these vaccine types is very favorable to the great majority of people. BRIAN COX: Actually, maybe Salim can answer this: You obviously have a great experience in southern Africa, for example. So what is the examples of different vaccines and how effective they are against the different variants.

are -- mutants . . . mutations and viruses are pretty much standard for all viruses and most of the mutations we don't really care about because they are very main or and don't really make any changes. But South Africa got a wakeup call you in December when we discovered a new variant we call it 501 ** a bunch of numbers with basically a virus with three mutations occurring . The key part of the virus that attaches to the human cell. And there were 4 things we were concerned about when we first described this virus. The first was is it more transmissable and we now you have pretty good evidence that it is.

It is about 50% more transmissable and some of it leads to -- some of sort of increased trans missbility what has been described for the B1 17 variant for the UK and also for the P 1 variant in Brazil and probably -- I mean the evidence is too early yet in India to make any comment but also looks like it is more transmissable and it needs to be, in order to dominate. The way a virus evolves is to be better adapted and be able to spread faster. The issue: Is it more severe. That is what we really were concerned about and it your Honor s out that in South Africa the evidence that we have now is that it is 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 sort of quality of care was impacted . So we saw increased deaths but the virus itself is not causing more severe disease per se. The third is: Does it evade naturalism immunity. Here, we have pretty good evidence because as the trial was done with 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, B 351 or 50 to 1 Y V # (phonetic) escaped partially past immunity. So, if you have been infected with the virus before, you are not fully protected this time. About

half the individuals who were exposed who had past infection did get infected again. We were seeing repeg ifs occurring. Then our biggest concern is do these variants escape vaccine immunity. And there we have some pretty good evidence from 4 you vaccines. So if we look at for example the AstraZeneca vaccine that was found to be 70% ee he effective in the UK, was only 10% effect I have against the 501V2. That focussed on mild disease. We do not have clinical evidence on severe disease.

If we look at Nova Vax that was 89 protective in UK but only 40% in South Africa . pgh on the other hand the Johnson & Johnson vaccine showed pretty similar levels, quite consistent levels of protection , around 62 to 66%. In the US, in Brazil, against the P2 variant and South Africa 501 YV 2. Different levels of efficacy across these variants. Because the Pfizer trials were son in South Africa, the trial has shown 91 to 95% effective depending on when you look at the data, in South Africa it remains 1 100% effective . But it is a small percent of the study we have had no infection s, no clinical infections or asymptomatic infections in those vaccined with the Pfizer vaccine despite infections in the control group.

So, these vaccines show some differences in the ability to utilize this particular virus and that is one of our big concerns about these variants because it is a harbinger of things to come. Are we going to see next another variant that is more effective in escaping vaccine immunity? I think that's our big concern. I think right now most of us would want to believe and think, based on innovative evidence, think that pretty much all of the vaccines are very good against severe disease. Now we don't have strong data on all of the vaccines but it seems that's the case . pgh but the next stage is going to be can we really prevent infection, prevent viral transmission.

Asymptomatic disease and mild disease is going to be important . pgh. For us to be able to control with vaccines down the line. So, we are going to see is our vaccine need s change. Right now vaccine needs let's prevent deaths, severe disease. Down the line it will be let's try and control this virus . So it's going to be quite important what role variants will play in this. BRIAN COX: There is actually a question that came up related to what Salim said . Maybe Salim should take it: Given that there is a variation in the effects, in the data , against particular variants.

Is there any plan to mix the dosing, to give A- z, Pfizer ? Is there any reason do that and any plan to do that. CHRIS WHITTY: I will have a first G in the UK we are doing trials where we mix different vaccines and see if the responses are better, worse, the same and also if there are side effects you weren't expecting from them. That is also important. From first principles, mixing vaccines is it. Quite a good idea. We didn't have data. If you had an A Z first and second and Pfizer first -- as we get more information we will have greater flexiblable.

It may be by mixing Decembers you have a wider level of protection . In the long-run what we all I think anticipate we will end up with Poly valent vaccines, that cover different types of COVID and effective against a wide range to go over Salim, Wendy and Katrina 's points: Protecting against symptomatic disease and transmission potential . The aim in the long-run will with be to have a wider range of mixing different vaccines and the same vaccine with different type s . pgh. BRIAN COX: I am going to the next poll.

I want to ask the question. Before we came on air, Katrina was talking of experience with the questions: Why would somebody experience worse symptoms with the A z more broadly then with others. As people are unwell with COVID-19 they get a worse reaction to the jabs.

What do we know about that situation: If you have had the disease and the reactions to the jabs? Katrina? KATRINA LYTHGOE: I was the one talking from personal experience. Self-diagnosed I had COVID back in March and when I was lucky enough to have the AstraZeneca vaccine a couple of months ago, I really -- you know, it laid me flat for a day, really. And so reiterating that question: To what extent, what is the effect of kind of prior infection. And that was my question to Wendy, really. WENDY BARCLAY: My answer to that question he is that there is quite good evidence now that people who had COVID and recovered and already sort of have seen those Im Immunoges once make a robust response in response to the vaccine. The way your immune system works: You get prammed and then boosted.

The priming is setting the scene, telling your immune system what do. When you see the same antigen again you make a big immune response. In healthcare workers that have been part of the study Is looking at the immune responses of vaccines rolled out. Sadly in the first wave of the pandemic a lot of healthcare workers did acquire the COVID infection and had an immune response to their own infection and when we subsequently immunized them with the vaccines they get a very robust response in comparison to their colleagues who didn't get infected previously and got their first dose made a good response but not as good as the others.

My answer to why you sometimes feel quite poorly is that the immune energy is very energy -rich and hungry; and it takes a lot of work to make an immune response. Also the way it's working there are a lot of Cytokines that work, making ugh. You feel like you are tired, have aches and have a fever sometimes. That is a sign usually that your immune system is responding robustly to the vaccine that you have been given.

So I don't think it is surprising that you had the symptoms from that dose. I tell people to take heart to that that means that the vaccine was working and immune system is giving a robust response. BRIAN COX: Next question: How do you hi we can ensure equitable access to the vaccines. It will be a word cloud. Challenging in itself. How do you think we can ensure fair and equal access to vaccination, in one word. I guess that tricky. While you are filling that poll in, that word cloud there was a question a lot of people are ready in from the UK but it is related to the different variants and the effects of the vaccines.

The question was whether we are lulled into a false sense of security. Because clearly, you know, we all -- you see the pressure on to borders, people want to holiday abroad and so on. So, is there pressure on the UK, because the disease lacks to be low level people are feeling confident because they have been vaccinated.

Is that leading to a false sense ever security specifically with respect to international travel . Who'd like to -- I didn't address it to anyone specifically. KATRINA LYTHGOE: I can answer that from kind of a molding perspective molding perspective. Modeling perspective. ** **. It's currently less than 1, very lot. and as you say, that makes

us feel confident. But it doesn't take much for that number to increase . It doesn't take that much opening up . pgh and we saw that after the summer holidays. So it's a really careful balancing act and I am sure Chris would agree between opening up but keeping the value down. So you are balancing that with the amount of people who are vaccinated. Then you have to think about new variants and if they are more transmissable, then that push es the number up; which means you need to vaccinate more people or keep other restrictions in place.

So it can feel like we are in a very happy case and in the UK fortunately at the moment we are in a very good place. But I think history has told us that it doesn't take much to reach that tip ping point for infections to start to grow very quickly. BRIAN COX: Chris would you like to comment on that? CHRIS WHITTY: Well the first thing I think people in the UK this is true you in multiple other countries but the UK I know best: Have been quite remarkable how patient and pragmatic they have been about this . If you look at the polling data, the great majority of people called it absolutely right. They said how long it's going on for. Judged that remarkably accurately. They all accepted that you need to do a lot Test ** to people.

That is still the case today. The reason the rates are low is people meeting fewer people, not taking riskses and taking vaccines. Both. Either would not get us to the place wire at the moment. The point is the vaccines take more and more of the heavy lifting and hopefully little by little we can reduce all of these so we are living a life back to normality as it was before the pandemic. But people are living sensibly, living steady. That is the part we are trying to take and people would accept that is the way to do it. Steadily, the rate

to do it. Going overseas there are 2 separate risks one more difficult to calculate than the other. First if a country has a high and another country low rate there is a significant risk of importation in either direction. UK has been the importer of the vaccine -- the virus -- and at some point an exporter of the virus, depending on where we were relative to other countries. The much more difficult one is the one we were talking about in the early earlier section, the risk of I am parting a variant either more transmissable or can escape vaccines, so cause significant challenges in the long run. These are low probability high impact events more difficult to model and predict on scientific bases than the ones how will this -- because another country has a slightly higher rate of transmission of B1 17 the 1 we currently have. That makes the international

issues more dif bullet. A third thing is people often travel through more than one country and that makes all of the issues around travel quite difficult for policymakers in every country. This is not a UK problem particularly; this is a global problem.

BRIAN COX: I have comments in the world cloud looking at it. Interesting, actually, collaboration. WHO . . . quite a clear message. I think the message earlier from old pandemics, global problems seem to be shared **. I will say the last poll which you can begin to look at -- let me ask another question before I go to the last poll.

So, we have an interesting question we dealt with before. A lot of people are interested in it. Maybe I will ask Wendy initially. How might developments related to COVID vaccine affect our to ability to tackle other infectious diseases will these technologies have impacts for other fields? WENDY BARCLAY: A great question. I really hope so. What this past year shows if anything that vaccines work and we can produce them pretty well and that modern technology has some great roots to produce you vaccines. And again, thinking of experience with influenza, where we sort of race against time every year to try to best guess which strain of flu is going to cause most of illness in the winter and the vaccine manufacturing takes 6 months and you have to pick a strain February that you will put into people's arms October. Actually with the modern technology toes you probably can respond much more rapidly and also much more rapidly because you don't need to grow virus eggs or other ways that affect the efficacy of the vaccine . So I am really hopeful that not only for rapid responses to future newly emerged viruses but also for the kinds of vaccines that weigh deliver routinely year on year some of these new technologieses can improve the boundaries and our production of vaccines.

BRIAN COX: Salim, people are interested in -- you touched on: At what point do weigh make a decision in the UK or US to prioritize other countries, given what we have said is about the important mess ty of doing that rather than chasing diminishing returns in a particular country like, say, the UK? SALIM ABDOOL KARIM: So, there is no 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 politician saying oh we have several million unvaccinated people in our country but are going to send the vaccine elsewhere. That will be a difficult thing to do. But that is part of people wanting to protect themselves . But also also -- part of the challenge is the kind of Donald Trump like view: Me firns I don't care about anybody else.

We have seen a bit of both of these play themselves out in the vaccine world . pgh I think for me the highest priority should be to try and get the two groups in the world vaccinated as a matter of priority before we do anything elimination. The first are healthcare workers because they are the front lane, have such high rates and are most needed when we get into a surge. They are the 1s that get infected and all have to go home when we need them in the hospital.

Vaccinating healthcarew errs is a very high return rate. Second is elderly. Take 60 or whatever cutoff you like.

Those 2 groups -- co-morbidity and all . . . but those two groups every country should be -- I imagine by the time we reach 2 billion doses that every country would have vaccinated those two groups after that the returns become much, much less. When you get down to 30 and 20 year old, the return is much, much less. And so, I think once countries have vaccinated the elderly and the healthcare workers, some country 's essential workers are counted as important, school teacher and are so on, but once those groups have been vaccinated then I think thoughts should be given about dough mating a certain portion of vaccines or assisting COVAX and assisting distributing vaccines to other countries. I

think it is pair. Whether practical and politically feasible for politicians to do that in various countries is a different matter. BRIAN COX: Indeed. Let me go to the closing poll -- we have 5 minutes to go. On a scale of 1 to 5, 1 the lowest , 5 highest, how worried are you the virus variants and the possible third or future waves within your country. Related to that, the question here about the awesome boost to the programme -- UK specifically but I suppose it will apply to all countries, will that programme that we hear about be tailored specifically to the new vans and variants; and, if so, what's the response time. You know, we are presumably testing new variants all the time.

Is will a cutoff we need to make a decision like with influenza vaccines but what we are going to deploy in the booster programme. I suppose this questions clear. Chris you can take it initially but anybody jump in. CHRIS WHITTY: From the UK perspective there are 2 reasons wanting to do abuser programme probably for a select group.

One of which is that we expect that and see evidence that particularly older people or people with some reasons their immune system is damaged whether by drugs or other diseases will lose their immunity faster than other groups and at the same time are the most vulnerable group. There is an argument for boosting their immunity in general , leaving aside variants. The second reason is that Wendy in particular but others have made: The fact that if we can get enough of an immune response it will overwhelm a variant even if it is not terribly well designed. 2 choice are go within with an older vaccine weigh know is on the shelf , really boost the antibody system and protect indirectly from the new variant or a newly designed variant vaccine. The chances of having a newly designed new variant vaccine effective against the principal variants, in particular the first described in South Africa, before Christmas, are fairly small.

Obviously we are all doing best we can to speed those up. I think realistically it is the case and therefore it is likely trying to use a rising tide raising all boats approach . Some of the older technologies using them but in due course I expect we will use variant vaccines around the world and they may be we tailor to geographic areas. That is a possible way we are going to see things in the longer run. BRIAN COX: Thanks. We are just about over time. I want to run over time a bit by asking this question.

it can be brief to everybody on the panel. Maybe Wendy: What does the future pandemic look like in your view and the subtext: Will the vaccines be the end of COVID-19 ? WENDY BARCLAY: So in my view we will not err add indicate this viers. E. virus. It is so far spread around the world and the vaccines do not necessarily stop transmission. We will live with the drive riffs of SARS COV 2.

And there are 4 season al Coronavirus that jumped from animal and in humanity 's past and we live with already. This is the fifth. I am hopeful we will learn to manage it. As time goes buy and people see in early life they will not get us sick as when the virus first exploded into the human population.

The long-term future is good but there is a lot to do in the medium term. BRIAN COX: Katrina. KATRINA LYTHGOE: Reiterating what Wendy said. We only err add indicated 2 viruses from the planet through vaccination that is smallpox and Riddipest (phonetic) I don't see us being able do that with COVID but as Wendy said, I think we should be very optimistic about our abilities to cope with it. BRIAN COX: Chris? CHRIS WHITTY: I think this demonstrated the extraordinary power of science to tackle infectious diseases and we have tackled this epidemic pandemic so far with vaccination and old drugs new drugs will come along weigh haven't talked about. HIV has so much

experience. Drugs is really the backbone of this. We will get new vaccines but -- and in the long-term I do expect this will become as Wendy says a much milder chronic disease overall probably with seasonal beats and with an antigenic shift so we will have another problem to which we will he have to respond in due course and probably will come at the same time as flu and other infections of that type. But in the medium term I have to say the outlook looks pretty bleak around the world. I would reiterate I think all of us would what Salim said: Until we have a situation where we he induced immunity with those most vulnerable in the world we will continue to see morbidity and mortality from this vairs. While I take a 5-year view, the swings combination of time and science is on our side but not going away. I completely agree with the other speakers on this.

In the short-term I think we need to look to the next 18 months and say we really have to make a global effort on it this. BRIAN COX: To clarify something you said about the return, the peaks at some point in the future: Is that in the sense, peaks of influenza pandemic? You are not saying that we are going to have the -- CHRIS WHITTY: Every time dash and would. BRIAN COX: -- disaster again.

CHRIS WHITTY: 1 of the problems I have when I do a parallel with flu people think I am saying it is like flu. It is very different from flu. There are certain things that are probably similar and one is you get good and bad years. Thinking of flu in the UK, this is not a major antigenic shift. On average 7-to 9,000 people dying. Bad year, 20-25,000 people dead.

Pandemic with a bad flu, a lot more than that. 20 to 09 weigh had people with a multi flu. It was ** numbers. Sit variable over time.

COVID for the reasons that Katrina and Wendy were talking about earlier, won't bee have quite like flu but I expect year on year variability and within yearn with the change of seasons. I think that will be the likely end point for this: None of us know. That is a sort of educated guess based on other infectious disease but that I think is most likely at this point in time. BRIAN COX: Salim to remind you the original to question. What does the future look like for this pandemic.

SALIM ABDOOL KARIM: Three points. First I would like to concur with what both Wendy and Chris said: This virus is not going anywhere . We are not going to err add indicate for many of the reasons they mentioned but also it infects everyone , both domestic and wild animals so it will keep jumping across the species. I think we are going to have to learn to live with the virus in the long-term . Second I think there is 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, vaccinated generate antibodies we may see vans.

Variants that have more capability to escape vaccine immunity; and our ability to make new versions of the vaccine as mod iron a has done modern a did , reported new results on their vaccine based on the BS 51. As soon as we make those, give them out they will probably be out dated because there is a new variant in circulation. So we will see these kind of challenges. The way for us to deal with is to say we have a full prevention toolbox. Not just vaccines. We have got to find a way to use the combination of preventions. Some restrictions.

Not ones that impact our economy too much but some personal behavioural changes together with vaccines. I think in combination we have a pretty good chance of getting to a situation where we can do most things quite normally. Then the third point I want to make is that, like Chris and Katrina, I am pretty optimistic that we will see the generation of new technologies . I have been involved in HIV research now over 35 years and I saw prom a situation that was dire where people were dying. I mean my wards were full of patients. I had nothing I could do for them, to a situation where antiviral treatment changed it completely.

Now -- we never had a vaccine against HIV and prospect s of a vaccine looks distant; but we have been able to reduce transmission, able to reduce infections, deaths. I think we are likely to see new scientific innovations make 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. BRIAN COX: Thank you and thank you to everybody for listening and watching. Sorry we overrun. But it's interesting. I hope you agree. So that is the end of tonight's discussion. I should say we are going carry on this series throughout June.

I think people have been particularly interested in these questions and others. If you following The Royal Society website you will see when we have the next discussion. But for now it leads me too say thank you everybody for listening thank you to the panel and good night.

2021-05-11 08:20

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