SARAH GILBERT & CATHERINE GREEN (WRITTEN WITH DEBORAH CREWE). LONDON: HODDER & STOUGHTON, 2021. 336 PP (INCLUDING APPENDICES AND INDEX). ISBN 9781529369878 (PAPER). $28.54.
Professor Sarah Gilbert is Professor of Vaccinology at Oxford University. Dr Catherine Green is the head of the Clinical Biomanufacturing Facility (CBF): she does this half-time, and the other half of her time is spent “running a research team at the Wellcome Centre for Human Genetics” (58). Together they designed and made (at the CBF) the starting material, and the clinical-grade vaccine which eventually was released to the world as the Oxford AstraZeneca vaccine. AstraZeneca came on board because a “big pharma” company was required to scale-up the manufacture and release of the vaccine in quantities sufficient to meet the need in this Covid pandemic.
Gilbert and Green also collaborated in writing Vaxxers. It provides the “inside story” of the development of the vaccine. The catalyst for writing the book was an encounter that Green had with a vaccine-hesitant woman on a camping trip with her daughter in Wales. A conversation by “a pizza van on the edge of Snowdonia”, sparked the decision to write the book: “This was the moment I knew that we, the Vaxxers, needed to come out of our labs and explain ourselves” (3). And explain themselves they have: in a very readable, and well-written book, with humour, honesty, humanity and, for a book that is in some ways technical, with clarity and very accessible prose.
They have each written chapters, which alternate between the two of them (though not successively through the book, occasionally one writes a couple of the chapters). In the book, they describe the nature of the AstraZeneca vaccine (and vaccines generally), and the procedures and process by which the vaccine goes from design and manufacture through to the eventually (medically approved) roll-out so that it can be put in the arms of the general populace. Along the way, they also describe some of the set-backs, failures (actual and potential), frustrations and anxieties they faced in the year the vaccine was developed. They also address some of the fears, questions, and concerns that people had, or may have, over the nature and safety of the vaccine: in this they display a pastoral sensitivity, and acknowledge the validity of people wanting reassurance that the vaccine is safe.
The book begins, in chapter two (chapter one, “We Made a Vaccine, relates the end of the process, when the AstraZeneca vaccine was pronounced fit and ready to go) with a discussion of vaccines generally, and an overview of several other recent illnesses for which vaccines were developed: Ebola (West Africa), SARS (China and South-East Asia), and MERS (the Middle East). Interestingly, although SARS and MERS are respiratory illnesses, like Covid-19 (this “novel”–new–coronavirus was first known as SARS-CoV-2), it was a vaccine developed to combat Ebola, that proved to be promising for adaptation to the production of AstraZeneca’s Covid vaccine.
The Ebola vaccine, which never got to final trials (an “inadequate response” that was “a wake-up call and a turning point” in vaccine development, 47), is a replication-deficient recombinant simian adenoviral-vectored vaccine. This means it is delivered into the body by a virus (of the group “that cause colds in humans”), but has a gene removed so that it cannot spread through the body’s cells. The removed gene is replaced (the “recombinant” bit) by one that “instructs the cell to make a particular protein” so that an immune response is triggered against the protein (38–39). In the case of Covid-19 the protein to be protected against is the virus’s “spike protein” (the spiky bits that are shown on all the cartoons of the virus, and that enable the virus bind to onto a cell and enter it). In fact, the vaccine replicates only the spike protein, so that the body’s immune system will recognize the protein when it presents.
The AstraZeneca vaccine was produced remarkably quickly (as were other vaccines, such as Pfizer). Why was that? Firstly, it was because of the decades of preparatory work that has been done. One of the pieces of work had been the development of “platform technologies”, that is, a kind of a template, if you will, that provides a base from which a vaccine can be developed, once a new pathogen (e.g. nasty virus) appears. In fact, the team had been working on the possible appearance of a “Disease X” for some time, they just did not know what form that disease would take, or that “Disease X” would turn out to be a coronavirus.
The platform used for the Covid-19 AstraZeneca vaccine was the same as that used for MERS, a ChAdOx1-vectored vaccine. Once the genetic sequence of the spike protein was known, a DNA-coded gene could be designed to be added to the platform, one that would protect against the actual spike protein on the virus. Vaccines usually take several years to produce. But in this case, several factors sped up the process.
In fact, vaccines need not take a long time to develop, but several aspects generally mean that there is a lot of “waiting time” between stages. To begin with, funding is needed for what is a very expensive process. In this case, the funding came together very quickly. Furthermore, the “classic method” entails going through the steps of production in a sequential fashion, where the next step is not begun until the previous one is completed. Because of the urgency required for a vaccine, alongside the “classic method”, a “rapid method” was developed, which meant that stages were done concurrently (while not sacrificing any of the necessary safeguards and regulatory steps). So, for example, all the human volunteers for the phased trials were found and ready to be vaccinated as soon as the trials on animals had been safely completed. The team also worked “at risk”: not at risk to the safety of the vaccine–every required and necessary step was completed–but it was done “at risk” to time and money (a failure would mean a “waste” of time and a loss of money).
Each chapter is headed up by the time-frame within which the work covered in that chapter was done, along with the numbers of confirmed Covid cases world-wide, and the confirmed deaths. These latter numbers increased exponentially over the year (as we all well know). This meant that there was keen media interest in the progress of the vaccine’s development, and the book details some of the difficulties, along with the misreporting, misunderstanding, and misinformation that resulted.
Finally, this is the story of two committed individuals (who worked long and demanding hours, days, weeks, and months with many other colleagues and collaborators), all the while facing their own personal struggles and challenges: one lived for a while with a medical condition, and had an infestation of wasps in the house; the other experienced a separation from her husband, the sale of her house, and living as a solo-mother. They are honest and open about some of their emotions and experiences. But there is also humour, a zest for life, a humane concern for the welfare of others and a pastoral concern for the vaccine-hesitant: there is not room here to detail the clear explanation of the risks, and benefits–the risk analysis–of the vaccine.
As a postscript: While the book is about the AstraZeneca vaccine, enough is said about vaccines in general, and Pfizer in particular, to reassure the reader that Pfizer is a very effective vaccine, and that, for instance, the fact that it is an mRNA vaccine, does not mean that it can permanently change your DNA: mRNA “never enters the cell’s nucleus which is where your DNA is kept, and the cell breaks it down and gets rid of it once it has been used” (203). Appendix A describes different types of vaccine; Appendix B details the “classic method and the “rapid method” of vaccine development; Appendix C provides information on what is in the Oxford AstraZeneca vaccine.
Derek Tovey is the book review editor for Stimulus. He is double-jabbed with the Pfizer vaccine, but would happy to receive the AstraZeneca vaccine as a booster