The race to vaccinate

Emma Ross

[Pause] Okay, great. Welcome, everyone, and thanks for joining us today, to all the members and friends, friends of Chatham House, where we have been covering the big issues for more than 100 years now. As many of you may know, we’ve passed our centenary. So thanks for joining tonight to help us continue on that tradition.

Tonight, we’re going to be discussing The Race to Vaccinate, the backstory of the race to develop and rollout COVID vaccines in record time, what we’ve learned from the UK experience, that resulted in them bringing the first COVID vaccine to the world, what worked and what didn’t with the strategy, and with the whole new R&D model in the first place, which really emerged from after the Ebola outbreak, and this was really the first test of that thinking, and how did we do with that? We’re going to look at that, and what this all means for the global co-operation around vaccine development and rollout and for future vaccination development and delivery.

Being Chatham House, of course, we are going to delve into the politics, and The Race to Vaccinate, the title in and of itself, can have, you know, a few different meanings, one being the race to get a vaccine out as soon as possible to save people, and the race between all those racing to produce a vaccine, who’s going to win the race. So whichever way you’d like to look at it, both are quite valid.

With us today to discuss this we have, to my left, I’m not very good with left and right, sorry, Melanie Saville, who is the Executive Director of Vaccine Research and Development at CEPI, which is a non-profit partnership that works on developing vaccines and has a mission going forward to produce vaccines in the first 100 days after the identified need. So, we will be talking about prospects for that, whether that’s still looking realistic, or whether we can say 50 days now, maybe.

Kate Bingham DBE

That’s a stretched target, we…

Emma Ross

To her left is Dame Kate Bingham, who’s the Former Chair of the UK Vaccine Taskforce, many of you know. Next to her is Dr Tim Hames, who’s a Writer and Consultant and Senior Adviser, who co-authored a book with Kate on the vaccine, the UK vaccine experience, and over at the end, we have Hugo Gomes da Silva, who’s the Global Medical Head for Vaccines and Infectious Diseases at AstraZeneca.

But just before we start, I just have to go through a bit of housekeeping, and the first one is on when we’re talking about the vaccine, so the first vaccine that came from Oxford, if we could please everyone refrain from mentioning the brand name of the vaccine. Because of regulations, AstraZeneca’s not allowed to use the brand name ‘cause it’s seen as promoting a product in a public forum. So, in a forum like this, let’s just call it “the Oxford vaccine,” so we won’t use the brand name. If you could bear with us on that, that would be great. Also, you are encouraged to tweet, ‘cause this is all open and live cast, the following hashtags, CHEvents and Chatham House, and if you want to ask a question when it comes to questions, if you just raise your hand and identify yourself, I will also go online and take some questions online.

So, I think we’re going to start now, and Melanie, let’s start with your takeaway experiences from this ride that was the first test of CEPI. If you could start by just briefly introducing what CEPI was for and what it’s been like and what we’ve learned.

Melanie Saville MB BS

Certainly, and thank you, Emma, and thank you to Chatham House for this event, and really maybe just to start off with, to say a few words of CEPI and why CEPI was formed, before really going through our experience. So, we were actually set up in 2017, following the Ebola crisis in West Africa, where despite years of research, there was no organisation that was set up to respond to such epidemics or outbreaks, really bringing public and private sector together to accelerate vaccine development.

So, we were already working on vaccine development against priority pathogens and thinking about what we call Disease X. So, you know, we know that there will be emerging epidemics and pandemics, but we don’t know what they are. So, we were working, for example, on developing MERS vaccines, including with University of Oxford, and we were working on rapid response platforms, such as mRNA.

So, when, and I remember it very distinctly, on the first day back at work in 2020, my boss, who many of you will know, Richard Hatchett, just came to my desk first thing in the morning and said, “Melanie, we have a problem.” That day, it was apparent that this virus in China was probably a coronavirus, and so at that point, that very day, we knew we needed to act. This is the third coronavirus outbreak in the 21st century.

So, on the 23rd of January 2020, we had our first three partnership agreements to develop vaccines against COVID-19, really building on the partnerships that we already had working on Disease X and working on things like MERS. And we built what I think is the largest portfolio of vaccines to be developed in the world, 19 vaccines that we supported in the context that we really didn’t know what was going to work. And it was built on the premise of speed of development, so bringing rapid response platforms together, scale of manufacturing, anticipating this is a pandemic, so how many billions of doses do you need to make, and access? So, core to CEPI is equitable access, to make sure that the most vulnerable people, no matter where they are in the world, that they are – have access to vaccines that they need.

It was very quickly identified that there was no end-to-end organisation to really have that equitable access piece in place and so, we were a founder of COVAX, together with WHO, Gavi, and UNICEF, and so far, COVAX has delivered 1.8 billion doses of vaccine and most of those to the low and middle-income countries. We would’ve liked to do better, we know that there are many challenges as to why that was not possible, and I think many of those will be discussed today, but obviously, there were many challenges to get to there. So, through COVAX, through CEPI, we have funded seven vaccines that have got to emergency use and licence and are being used globally. Includes the Oxford vaccine, it includes Moderna, it includes Novavax, and importantly, they’re vaccines, obviously, that also received funds from the UK. Lots of challenges on the way, and…

Emma Ross

Janssen, presumably, as well, J&J?

Melanie Saville MB BS

We actually did not fund Janssen.

Emma Ross

Did you not? Okay.

Melanie Saville MB BS

No, no, but there were many challenges on the way and many bumps in the road, and one of those is relating to manufacturing. So, we saw very early on in 2021 that there was a problem with input suppliers, a problem with manufacturing capacity. And this is actually something we did with Chatham House, is really, we set up a summit to really look at what the problems were and to try and get rid of those bottlenecks, find the suppliers, so that the billions of doses of vaccine could be delivered.

The other challenge that we’re all very aware of is variants. So, just as, you know, 8th of December 2020, you know, we were rolling out vaccines, the emergence of variants started. So, the real question is – so, I think, yeah, in amongst here, we’re saying, you know, the pandemic is behind us. Really, is the pandemic behind us? We really need to think of next generation vaccines and there are some key attributes to really be doing better for COVID-19, broadly protective approaches to vaccines, better durability. Can we even think of transmission-blocking vaccines that would have a higher impact? So, in a way, that’s what CEPI is moving onto. We know there’s vaccines available, they’re being used, but we’re already thinking about how can we make those improvements, or even prepare for the next COVID-19 or COV – next coronavirus pandemic that could happen?

And also through this, it is remarkable the speed, and I think we’re very lucky with a virus that was actually relatively easy to make a vaccine, and the first vaccine was rolled out 326 days after the sequence. What if we could’ve done that in 100 days? At that point, there were only 2.3 million cases, as opposed to 68 million cases. So, that’s our 100-day mission that’s been taken up by the G7, the G20, and by some manufacturers, as well, so we’ve been looking at what are the key elements of innovation to move forward? So, we have been publishing on the 100-day mission in terms of perspectives, take everybody’s innovations together, you can improve, but really, we need a paradigm shift to go into preparedness. I’ll leave it at that.

Emma Ross

Thank you, but before we move onto Kate, I did want to ask just one quick one, and that is in terms of what went really well and what didn’t. If you were doing it again, what’s the one thing, the most important thing, you would do differently?

Melanie Saville MB BS

I think the one thing we’d do differently is have something like COVAX or whatever it needs to be in place right from the beginning.

Kate Bingham DBE

Oh, completely agree.

Melanie Saville MB BS

You know, the R&D, I mean, we’re lucky enough, we’re funded by governments, we’re funded by philanthropic organisations, to react very quickly, but we also need, for that equity, the reaction in terms of advance purchase agreements, and they need to be on par with the countries procuring the vaccines.

Emma Ross

So that’s doable, I mean, there’s a…

Melanie Saville MB BS

Yeah.

Emma Ross

…platform ready…

Melanie Saville MB BS

Yeah.

Emma Ross

…to do that. Doesn’t seem, like…

Melanie Saville MB BS

Yeah.

Emma Ross

…impossible. Okay, thank you. Kate, we’re moving on to you, your insights and takeaways of the UK experience and the race element. We’ve heard the technical race element. Can you explain the race element from your perspective…

Kate Bingham DBE

I mean, the race element…

Emma Ross

…from the UK’s…?

Kate Bingham DBE

…from my perspective is – was incredibly clear. It was not about competing with countries or vaccine companies competing with each other. It was competing against the virus to stop people from dying. So, for me, the, you know, first two things, I think they make good headlines, but that was absolutely not was driving – what was driving us, and the Prime Minister at the time was incredibly clear. He said, “It doesn’t need to be perfect, but it needs to be fast,” and that were – those were the right instructions and those were the same instructions as Warp Speed in the US. So, that emphasis on speed rather than cost, I think, was right.

I mean, the – looking back now, we had a lot of things that did go right. So, the fact that government, both here and in the US, was willing to put cash upfront, what they called “no regrets funding,” before we knew which of any of these vaccines – we didn’t get as many as you. So, we – there were – when I was appointed, May 2020, there were 190 different vaccine candidates, and so we’d put, basically, a massive SWAT team, and we absolutely spoke to CEPI because they knew, you know, a lot about it. And the predecessor of the vaccine taskforce was a group that Richard was very influential on, and so we, basically, went from that 190, down to a long list and then down to the shortlist of the seven, and we did that within a few weeks.

I mean, it – we had to work out which vaccines were most likely to be safe and effective based on whatever data they had from trials in other infectious diseases, or anything else, and then this manufacturing issue. And so, the fact that the government was willing to put money in to run the clinical studies and to start scaling out the manufacturing, was a big deal, and we in the UK had a reasonably vibrant biological manufacturing capability, but super low scale. And so, what we had to do was to beef it up in two levels where you could start giving population quantities.

So, I would say all of that worked pretty well in terms of government taking quick decisions, putting money upfront that it knew that it could lose. And according to the National Audit Office, afterwards, we put up £900 million worth of cash, of their no regrets cash, which could’ve all been lost if those vaccines had failed, which actually, in the grand scheme of the context of the pandemic, is actually not that much. And then the rest of the money that we committed, and I think on my watch was about 3.7 billion, was all linked to the actual successful progress of the vaccine.

So, that was a big game change in terms of how the vaccines were developed. So, there was no change to the safety testing of the vaccine. If anything, it was bigger, it was a bigger scale of safety testing than would be normal. But for those of you who remember these big announcements, as I do, the July 2020 Oxford – that’s correct, Oxford announced their clinical data of their first what I call phase II studies, so basically, the first evidence that their vaccine could trigger an immune response, and what we didn’t know was whether or not that immune response would actually be protective against severe disease, death, infection. We knew it did something, and what was interesting then is at that point of the announcement in July 2020, the Oxford team had already recruited at least, I’m making it up, half the phase III study.

Now that is unprecedented to have invested in those big scale-up, pivotal clinical trials before you even knew whether the vaccine was going to do anything, and that was what was incredibly exciting. And the willingness of the governments, as in the US and the UK, to really put that money in was a big deal, and that, I think, was a massive, massive plus. And the fact that the government – so, again, we didn’t change the way governments work, so we didn’t change the rules, as it were. So, we were third party advisers, we made recommendations to government, the Whitehall Committee, basically, made sure that it was legal, and that’s making it a bit flippant, but it’s making sure what we were recommending was – fitted in with the process of government, and then the Ministers made the spending decision. All we did was compressed it, and when there was a decision, they had to make a decision, they couldn’t go round department by department and defer it, so that we had a single Investment Committee making decisions.

And so the answer is all of this can be done quickly if the government wants to, and that’s why it – where we’ll get onto it, what we need to be doing is to maintain that level of urgency, to think about pandemics over the long-term and not just in the very short-term.

Emma Ross

Yeah, well, thanks for that. What do you think will be the lasting impact of the experience in terms of the way we’re going to do things now? Is there something that will stick around that’s going to be – now be adopted, you hope, or you think is likely?

Kate Bingham DBE

So, there’s what I would like and what will happen.

Emma Ross

Okay, well, let’s hear both, what you would like…

Kate Bingham DBE

What…

Emma Ross

…and what you think’s most likely.

Kate Bingham DBE

So, what we should – what I’d like is we that treat pandemic security like we treat defence. So, we need – if you take it as a direct comparator, we do forward-looking landscaping, we work out who all the bad actors are in the world, who’s doing what, what they might do and to whom, and with what. So, that in terms of looking at new tools and what do military call it, ordinance, but basically, you know, new weapons to try and keep our world safe, we should be doing exactly the same thing. We’re vastly more likely to be getting another pandemic in the world than we are if we just take the UK to get invaded.

Now, of course, there are other reasons to build up defence, but in defence, there are close relationships with industry. There’s deep investment in R&D, too, for surveillance, for new tools and new weapons to work out how to deploy, and the analogies are direct. So, we need to have that global surveillance, we need to be investing in the next – what Melanie’s been talking about, the next generation vaccines. Our vaccine’s been phenomenal to protect against serious diseases and death, but phenomenally bad at protecting against transmission, lasting for a long time, expensive to develop – to deliver. I mean, if you have to have cold chains and -70 degrees, that rules out a large chunk of the world, they can’t get that. And so, we have to get to better vaccines that are more accessible, more durable, and more implementable in, sort of, ropy public health systems.

So, what I would like is to see a Pandemic Adviser, Minister, whatever they are, somebody who actually understands the sector. Just in the same way as we don’t put, you know, Joe Shmo into leading the military and the planning in the UK, we need to have the same thing here. So, with people with backgrounds like Melanie, so people with R&D backgrounds, who understand new technologies, clinical development, regulatory, manufacturing scale-up, and keep those relationships, so that as and when innovators come up with new things, which they do the whole time, all the vaccines, all the early vaccines to get approved all came originally from little companies, and we need to be maintaining those relationships. And we need to do so with a long-term view in mind, not chopping and cutting and running as soon as we decide we’ve got enough vaccine, then we move onto the next…

Emma Ross

Well, that brings me to my question of what do you think is likely?

Kate Bingham DBE

Not that – I’m going to hand that one to Tim.

Emma Ross

A smooth segue.

Kate Bingham DBE

Tim, you are an adviser.

Emma Ross

All those things of what you’d like, what – you know, from your experience of working for it, and maybe Tim can come in with that. I don’t want to, kind of, take you off track with what your opening remarks were going to be, but I think it’s interesting to see…

Kate Bingham DBE

So, on…

Emma Ross

It seems a very clear description of what needs to be done, it sounds very sensible, but from your experience from working in this, what do you think is likely to be taken up on that and heard?

Kate Bingham DBE

I left in December 2020, so that’s two – over two years ago. Nothing what – that I’ve talked about has been put in place.

Emma Ross

And is it reasonable to expect it should have been, or could we still hope? I mean, has it been five minutes and that’s too much to expect…

Kate Bingham DBE

It’s two years.

Emma Ross

…now, or it’s – should’ve been done a long time ago?

Kate Bingham DBE

I think it should have been done a long time ago.

Emma Ross

Okay. Tim, over to you. Tim is the politics guy.

Dr Tim Hames

Yeah, okay.

Emma Ross

So…

Dr Tim Hames

Thank you very much.

Emma Ross

…let’s delve into the politics, our favourite Chatham House angle, here.

Dr Tim Hames

Well, so…

Emma Ross

So what’s your perspective on all of this?

Dr Tim Hames

Our book, “The Long Shot,” and somebody’s obliged to sell it well here, it’s predominantly focused, inevitably, on the story of the Domestic Vaccine Taskforce and how it came to achieve what it did. But inside that tale, which I’m sure you’ll all be queuing up to buy immediately afterwards, are lots of separate references to international elements, be they big or small, and sometimes comical, which actually tell you a lot about mindsets and how international political institutions and Politicians do and don’t work.

So, right early on, Kate is assembling a team at very, very high speed, including a team underneath her, Deputy Clive Dix, who will actually make an assessment of the quality of the vaccines, so will they work, right, and…

Kate Bingham DBE

So, can you…?

Dr Tim Hames

…can you make ‘em? And the initial team bar one slot came together at incredible speed, but the one slot was very complicated to fill, and it turned out the ideal candidate was an Italian national living back in Italy at the time.

Now, there were parts of the British state for which you could have said “We’re going to hire a Martian,” and it would have received a more happy, warm reception, the notion that somebody foreign would have any sort of vantage point into what we’re doing, so that’s very peculiar. Yet, the other hand, and June, early June 2020, President Macron floated the notion, initially privately, of a French-British-German collaborative effort on the vaccines, which actually made quite a lot of sense because all three of those countries had quite a lot of what was needed to move quickly towards a vaccine attempt, but none of ‘em had all of it.

And Kate was, so, perfectly willing to consider it, let’s see how this would work in practice, as long as it wouldn’t impede what she’d already started doing, the VTF. The European Commission could not have been less enthusiastic about the notion of leading member states going off on their own and trying to get there quickly than they were. Indeed, the President of the Commission would say later on…

Kate Bingham DBE

But it was on behalf of everybody.

Dr Tim Hames

But on behalf – exactly, it wasn’t as if we weren’t going to give any to the Swedes, you know. It was a question of how could you move fastest? And indeed, when the EU was criticised about this in early 2021, the President of the Commission said, “Well, huh, you can’t expect an oil tanker to move at the same speed as a speedboat,” to which you ask yourself, “Well, who’d volunteer to go on an oil tanker, then?” What an extraordinary case for the defence of the Commission, basically, hardballing member states into devolving vaccines policy to them.

Personal relations between Kate and the VTF and their equivalents, particularly in the US, at the senior level, were excellent…

Kate Bingham DBE

Fantastic, as they were with Europe.

Dr Tim Hames

…I think, absolutely fantastic, as they were with Europe. There was no nationalism involved in the dialogue between the VTF and BioNTech, which happened to have a German flag on it, or Pfizer, which happened to be US.

Kate Bingham DBE

And just as an interrupt, briefly, if you look at the Chile vaccination programme, I happened to get a call from the Ambassador on the day I was appointed, and he said, you know, “Do you know anything about this?” and I said, “Well, not much, but I can tell you what we plan to do.” And actually, if you look at their vaccination approach, I gave them all the emails of all the people we were working with, and with the exception of Sinovac, ‘cause they couldn’t get vaccines early so they used the Chinese to begin with, their vaccination programme looks identical to ours, because they use the same people that we work with. So, it wasn’t that there was any hostility to any other country.

Dr Tim Hames

Except where the Politicians get involved, and – the Politicians and those who think they’re operating towards their political norms. So, although the relationship with the – with Warp Speed was excellent, Warp Speed itself was, as – you know, as the American elections approached, increasingly politicised as an institution, and that made life a bit more complicated than this.

And finally, a very comical story in the book about how the deal with Pfizer was that Pfizer would submit their last batch of data to the US authorities first, with a few hours delay before they could release it to the UK. By this stage, the number two at Warp Speed was – a General was really, kind of, in charge, and this was a security issue. So, he insisted that the material was divided into three separate, sort of, discs, to be put in three separate lorries, to be really driven by three separate armed convoys from the middle of New York City to Silver Spring, Maryland, with the FDAs. The British said, “Email it,” you know, it’s – so, it’s again the kind of, mostly – and, you know, gave – in June 2020, and Kate was there, it was a virtual thing, big summit around vaccine policy. Lots of noise, lots of political waving, lots of seemingly very impressive pledges in terms of money on the table. How long did it take for that money to come? It certainly wasn’t, sort of, there next Tuesday. And you get this surreal scenario, which, you know, the US administration, basically, decided it hates the World Health Organization, under Donald – under President Trump. It’s incredibly disruptive to the whole effort.

In theory, there should have been no effort, if the Politicians had been left out of it, in synthesising Gavi and CEPI, they did different things. Gavi, historically with a large amount of money from Bill Gates, had been interested in how you distribute vaccines more efficiently, and CEPI was interested in how you…

Kate Bingham DBE

Which ones.

Dr Tim Hames

…R&D vaccines much more efficiently. So, they weren’t rival institutions. Indeed, the – Bill Gates was a significant donor in both of them, and the number of people on this planet whose lives were saved, that Bill Gates appears to be the only billionaire who doesn’t want to spend his money into going into space, really is quite extraordinary. But again, it’s – you know, once the Politicians get involved, it’s – if you’re going to create this thing called COVAX, well, “We’ve got to have one of our people there.” “But they don’t know anything about it.” “No, no, no, we’ve got to have one of our people there, and you can’t have that person there because they’re” this, that or the other. So, really, I mean, it really – we’re echoing very similar themes here.

If we’re going to do better next time, we need to prepare before it happens, rather than afterwards, and we need to have international institutions which have genuine, sort of, almost Central Bank type independence, and at the better end of the spectrum of Central Bank independence, as well, operating on similar sorts of mission statements, sort of – or budgets, lines of authority, and so forth. Otherwise I fear that when the next pandemic come – comes along, and it is a when not an if, when the next come – pandemic comes along, and it might not necessarily be identical in form, or a close cousin to the one we’ve been living through, that actually once again, we’ll think we have preprepared, and discover that not very much is ready on the table.

Emma Ross

Okay, thank you. I do want to ask a follow-up question, but I’m conscious that I’m being a bit overgenerous with time, so I’m going to reserve that and move onto Hugo for your opening remarks from an industry perspective. It might’ve been quite a ride, I would imagine, for this, so could you share with us what your take homes are from that, and then I definitely, before opening up to questions, have a couple of rather sticky follow-up questions that I hope you’ll humour me with. But let’s hold over to you as to your general perspective on this.

Hugo Gomes da Silva

Very good. So, thank you very much for inviting me to be here, it’s such a pleasure to share this forum with this such illustrious panel. Actually, I was – in hindsight when I was invited for coming here today, I was thinking where I was specifically back at the end of 2019, and I was living in the US at the time and I got an invitation to join AstraZeneca, and “We’re starting something on infectious disease and particularly looking at coronavirus.” I’m an ID Doc, and, “Well, this seems interesting,” but, you know, AstraZeneca was – never came to me as the infectious disease company. And that’s something that really struck me, because when I had the opportunity to talk with the senior leaders of the organisation is “What is really your appetite to make a difference? Tell me more about it.”

And I was significantly overwhelmed how AstraZeneca decided to take a step forward on the fight against COVID, not only talking very early on with academia, in this case particularly with Oxford, to try to find a solution, but the other centres of excellence around the globe, namely Vanderbilt, but also tried to think how can we ramp up and create the right infrastructures to – like the partnership we did with CEPI, to really make sure that we can, from early stages, development, manufacture, get the regulatory approval, and make it accessible worldwide? So, we started early discussions with Oxford and I think that we were pretty much aligned where we wanted to go about equitable and broad access around the globe, and so, for that end, we were able, very early on, like Kate said…

Kate Bingham DBE

Before – so, April 2020.

Hugo Gomes da Silva

April 2020, absolutely, very keen on making sure that we were able to generate data, particularly leveraging the existing data, don’t forget then viral vector platforms, they’d been around for over 20 years, and that I think people always tend to forget that this is not something that we generated data that was generated overnight. It’s a lengthy process that enabled us to get us where we were back at the beginning of 2020, and leveraging the existing data, we were able, together with Oxford, generate the phase II data and then, at risk starting phase III without even knowing if phase II would be pretty much eliciting us the ability to do that and ultimately, being able to deliver a vaccine, which has been one of the worldwide most used vaccine around the world.

Emma Ross

Whose name we won’t mention.

Hugo Gomes da Silva

Which name we shall not mention. AstraZeneca Oxford vaccine, let’s call it this way, but…

Kate Bingham DBE

I mean, it’s – just for the – to put the stats out there, the Oxford vaccine saved more lives than any others in 2021. There was more vaccine manufactured by your company.

Emma Ross

The biggest footprint.

Kate Bingham DBE

The biggest footprint and it was the most relevant because it was being sold at non-profit. So, it was actually being sold and given to those people who actually needed it, as opposed to those people who could pay for it, and that is a massive deal.

Hugo Gomes da Silva

It’s a huge endeavour, and I think that’s something that, not us, as all the industry, but also, I think that the collaboration we saw eye-to-eye with Oxford very early on. We were very keen that we had a broad and equitable access around the globe to make sure that – if you think that two thirds of our vaccine was used in low and middle-income countries, and with the partnerships that we had with COVAX, namely, yeah, through SII, I think that that’s something that it’s ground-breaking and transformative in the way it impacts the world. And you’re absolutely right, Kate, and we’re talking about estimated – 2021 estimated six millions lives saved just based on the AstraZeneca Oxford vaccine. So I think…

Kate Bingham DBE

And this is data that comes from Airfinity, so it’s 6.3 million is what they predict on deaths averted by AZ compared with 5.9 for Pfizer.

Hugo Gomes da Silva

Yeah, so it’s – we’re not comparing vaccines, all vaccines are great, and…

Emma Ross

I want to ask you about the non-profit thing. So, when there – and not that there was a market failure in this case, but there was definitely a public interest and equity issue, it’s sometimes challenging to bring industry to the table and get a deal that is good for everyone. This non-profit thing during the pandemic, was that something that had to be squeezed out of you or bullied out of you, or, you know – I’m wondering how you ended up with the deal. In general, was it considered a coup within the industry to get something like this, or was it a real hard sell and you had to be dragged, kicking and reluctantly, “Okay, we’ll do it but here’s what we want”?

Hugo Gomes da Silva

I think, from the early days and the early conversations that we had with Oxford, we were really seeing each other eye-to-eye on that front. I think one of the major drivers that we had as an organisation was really that broad and equitable access. So, the at not for profit during the pandemic was something that, for us, was absolutely critical, absolutely critical equally for Oxford. So, those aligned, the adenoviral platform, a well-established platform, a vaccine that was refrigerated, that enabled to be delivered, particularly in low and middle-income countries, where the cold chain supply is something of a challenge sometimes. I think that all of those really brought together the collaboration between AstraZeneca and Oxford. So, it’s something that we are proud do – saying this, there are some good learnings, I think there – if I would have to – and some of them I’ve already heard them today.

There’s probably three key learnings, I would say. The first one is really around the partnerships, the very early on establishment of partnerships, like the ones we had with CEPI, different governments, with academia, to really establish the ground-breaking, transformative approach in times of pandemic, of desperate need, it’s absolutely critical. If we don’t hold ourselves together, united in this same common goal, it’s going to be impossible to really get the 100 days goal that we just heard Melanie saying. So, that’s one of the key learnings for us, establish those partnerships really early on.

The second one for me that it’s also critical, we also already heard, which is about manufacturing, scale-up, and at risk. We need to make sure that we have the right infrastructures to build the capabilities and the tech transfer to ensure that we have, around the globe, in the appropriate way, the amount of vaccines that can be developed at very early on stages.

And the final one is really around what Kate just said, around the importance of having a certain structure from a regulatory perspective that enable us to generate data, not only to be valuated at just in time, so data that just emerges and almost like – which we saw in most regulators around the world, to – as we get the data, we were submitting the data, whether it’s preclinical, first-in-human, phase I, phase II, pha – so on and so forth, to enable that fast access. So, ultimately, creating a framework that enable us to generate the data quickly, so that regulators, critical regulators, that have such an important voice around the globe, like the MHRA, it’s absolutely of pivotal importance as we move into the next stage of, hopefully, interpandemic. I don’t like to even call it pre-pandemic, I like to call it interpandemic periods, so people understand there’s going to be another pandemic.

Emma Ross

Okay. That’s a great start to the conversation. I’m going to open it up now. Sorry, I took an extra five minutes than I wanted to, but I think we’ve got to a good place now. Please raise your hand and the microphone will come, identify who you are and ask your question. I think over here first and then, over there.

Euan Grant

Yeah, thank you very much, indeed. Euan Grant, I’m a Former Law Enforcement Intelligence Analyst, so I have some experience of the politics behind this and looking much very forward to how – what people have to say about Matt Ridley’s book with his co-author, the Chinese lady. But my question is – thank you, yeah, my question is you referred to second generation vaccines. How far along the line are we with those, and to what extent could these presumably superior vaccines, on various criteria, really nail those of the antivaxxers everywhere who can be persuaded? We know that there are some antivaxxers, nothing will persuade them, so where do we – where are we and what hope for second generations? Thank you.

Emma Ross

Melanie.

Euan Grant

I’m a shareholder in AZ, by the way.

Emma Ross

Lucky you. I think Melanie.

Melanie Saville MB BS

Yes, maybe if I can talk a little bit about that. So, yeah, when we’re looking at next generation vaccines, there – as I say, there are three key elements that I think everyone would agree would be improvements, whether it’s more variant-proof vaccines. So, you know, are we going to be able to avoid this kneejerk reaction that we have to have every time a new variant comes along? First of all, evaluating, you know, are the current vaccines still going to work against this, and what does it mean for vaccination campaigns moving forward?

Durability, again, because what we’re seeing is these vaccines that we have are good vaccines, but we need boosters, frequent boosters. And then the third piece again is the transmission-blocking potential vaccines, and the best way to think about blocking transmission is delivering a vaccine to the mucosa, so, you know, like an anti-nasal vaccine or something like that, which is a different type of vaccine to the ones that you have injected.

So, this is really looking at novel – a lot of novel technology, a lot of effort into the immunogen design, so going beyond that spike, thinking very carefully as to what is the right approach to add breadth to the vaccine. So, most of these candidates that we have looked at – so a lot of people are working at them, we are investing in 14 candidates, NIH is investing in vaccines, as well, for broadly protective approaches, and they’re mainly pre-clinical. But we want to at least get some of those candidates into the first clinical trials this year, to, you know – but we have to recognise it’s not quite the same sense of urgency. We need to spend more time, these are innovative approaches, we have to think of the manufacturing, we have to gather the data, so that they are still quite early, but they could have, potentially, huge advantages compared to the variant-proofing.

Transmission blocking, we know that these vaccines that we have work really well against severe disease, but they don’t prevent disease and they certainly don’t prevent transmission. Again, that is a really high bar for a vaccine to pass, so, again, these are, sort of, early approaches that really need to be evaluated, but again, they could have impact. And it’s beyond the how effective they are, it will impact programmes, you know, how often do you have to have a vaccination programme? So, it’s not just about the R&D, it’s about, eventually, you know, the policies that will be put in place if, and I have to say it is an if at this point in time, those vaccines were to work.

You mentioned antivaxxers and antivaxxers is a very complex issue. A lot of it is around safety of vaccines and perception of safety, and just the importance there to make sure that you are following up safety very carefully and that you are communicating on the safety profile of the vaccines, it’s – is the sort of things that we can do but it is a very complex issue. And I think wherever you are around the world, you have to understand, what is the motivation behind the antivaxxer folks that have the concern relating to vaccines?

Kate Bingham DBE

And I’d make just a couple of very quick points. I think Melanie’s described the R&D, so the improved vaccine characteristics, to deal with transmission and so on, but I think there’s the, sort of, feasibility and affordability. They’re too expensive, they require needles. You want something that, you know, you can receive in the post, you know, and if it’s a spray or something that doesn’t require – again, when the NAO did – audited us and then their deployment in the UK, it was more expensive per dose to give the vaccine than it was to buy the vaccine.

Melanie Saville MB BS

Yeah, thermostability.

Kate Bingham DBE

Yeah.

Melanie Saville MB BS

A classic example…

Kate Bingham DBE

Yeah.

Melanie Saville MB BS

…of something…

Kate Bingham DBE

So…

Melanie Saville MB BS

…to look at. How can we make…

Kate Bingham DBE

…it’s room temperature.

Melanie Saville MB BS

…mRNA vaccines more thermostable for delivery is another key area where we really need to look at R&D and innovation to get those vaccines more deliverable.

Kate Bingham DBE

And cheaper, and my other point on the antivaxxers, and of course, if they’re very extreme, you’re not going to be able to do anything, but I’m afraid to say, people’s understanding of biology is not very good. And so, the number of conversations I’ve had where they’d say, “Well, of course, you know, the mRNA gets into your genes, doesn’t it?” and you say, “No,” and, you know, you can carry on talking past people, but there isn’t really a good understanding.

So, actually, I do think there’s a very strong argument for having what I call old-style vaccines. So, the adeno and the mRNA are, basically, where you’re injecting the genetic material, which gets into the person’s cells and it harnesses the cells’ machinery to then make this protein. Now, the old-style vaccine was you just put the protein or the peptide in directly with a bit of a juicer, with a adjuvant, or you put in an activated whole virus with an adjuvant. Now, those are the old-style vaccines, that’s what Louis Pasteur did, that’s what – go back with the, you know, variolation, that whole idea of you give the immune system a chance to look at it.

My view, and I’m completely not an expert here, is actually to deal with the, sort of, extreme vaccine hesitant, not the, sort of, really extreme vaccine – antivaxxers, but the vaccine hesitant, if you go back and say, “Look, we are now offering you a range of vaccines, you can have the super hi-tech, genetic-based vaccines, or you can have the really low-tech but they’re safe and effective, and they’ve been used for a very long time,” I would’ve thought that does help with vaccine hesitancy. And that’s not, again, a theme that anyone has really picked up on.

Emma Ross

Okay.

Dr Tim Hames

Just on the antivaxxers…

Emma Ross

Briefly, briefly…

Dr Tim Hames

…point, two points.

Emma Ross

…‘cause I’m going to come – then I’ll come and get more than one question in.

Dr Tim Hames

Firstly, I think we should always recall the wise words of Robert Kennedy, who said, “One in five people are against everything all of the time.” Alright, it’s just – but in many ways, the take-up rate, certainly in the UK, amongst the people we most wanted to take it up…

Kate Bingham DBE

[Inaudible – 44:47] was good.

Dr Tim Hames

…the relatively old and the relatively vulnerable, in medical terms, was staggeringly high, given that this was a completely new thing that had been brought out at relatively high speed.

Kate Bingham DBE

But not ethnic minorities.

Dr Tim Hames

Ethnic minorities was a difficult, different barrier, and I think possibly not because of an anti – pure antivaxxer sentiments, so, vaccine hesitancy, yeah.

Emma Ross

Okay and question over here, if it’s – if you – if it hasn’t been answered already.

Sam Martin

It almost exactly has been answered, it was about vaccine hesitancy, but I wanted to ask off the back of that, and particularly this is maybe for Tim and Kate on this, whether you felt that the previous…

Emma Ross

Oh, can you say who you are?

Sam Martin

…UK governments perhaps – sorry.

Emma Ross

Right, can you introduce yourself?

Sam Martin

Oh, Sam Martin, I work at Chatham House here, as well, and I wanted to ask if you thought that previous UK governments perhaps hindered your ability to convey information around the vaccine at a crucial moment. And I know it’s intimated in your book that they’ve, kind of, believed the government perhaps that you were taking too much of the limelight, in a – I believe in an incorrect way, and that it was a moment where you needed to really show the efficacy, the speed, and the reliability of these vaccines, and you were therefore hindered by that. And that might explain, as you pointed out, Kate, that for some minorities, or people even in my age group, I am quite alarmed at the amount of vaccine hesitancy I see in people of my age group.

Kate Bingham DBE

Super speedy response. Our job was not actually to be the government mouthpiece on explaining how vaccines work. That was, as it turned out, seven different conference groups within government. No, our job was, how do you get vaccines to people that are approved and manufactured? And to do that, we needed to get people into clinical trials and so, the communication we wanted to do was to get those vulnerable people, the old, the ethnic minorities, the people with underlying diseases, into clinical trials, ‘cause it would be no good having vaccines that worked beautifully in young, fit people. We had to have those people in trials.

And I’ve worked in this sector for 30 years, and I have never taken part in a clinical trial, and if you think about that and then, you think, well, actually, you want some little old lady who lives outside Bradford to take part in a clinical trial, that requires a lot of information to say why they should be doing it and why it’s safe, and why it’s making a contribution, and what it will ultimately do. So, that is what we were trying to do and that was what was challenging.

Emma Ross

Okay, thank you. I am going to come back to the floor, but first, there are a couple of questions online, just to include people online. I’m going to put two of the questions together, that together add up – they’re on the same thing, but they add up to the most upvoted, and that’s about origins. And one is from Abdulmalik Badamasuiy, “Just wondering if there is a finding or conclusion on the origins of COVID-19, please.” And second is Trisha de Borchgrave, related question, “Does it help to know and have confirmed the origins of any virus, including COVID-19, in order to better contain future pandemics?” Who wants to take on this one? Melanie?

Melanie Saville MB BS

Oh, my goodness. I often think of – you know, you often look at it in the context of Patient Zero, don’t you? And many times, we’ve actually been proven that the Patient Zero was not Patient Zero. So, yeah, where did COVID-19 come from? I don’t think that is definitive in any way whatsoever. Is it helpful? I mean, I think it’s helpful to understand, you know, what was the species, what actually happened in terms of spillover into the human population, in the context of, you know, trying to prevent that happening in the future? Do we really know, will we ever know, where it actually came from? I really don’t know, I would say.

Kate Bingham DBE

A thing that does matter is trying to find that host species, because they originated in bats and I think there’s no – that’s not controversial, they ended up in humans. Could…?

Melanie Saville MB BS

So, yeah…

Kate Bingham DBE

Either it went via a lab…

Melanie Saville MB BS

…found there, yeah.

Kate Bingham DBE

…and there was some sort of genetic manipulation, and it was either deliberately or not deliberately released, or it went via a host animal, and so I think the bit that would be useful, and pangolins is one…

Melanie Saville MB BS

Yeah.

Kate Bingham DBE

…potential, but understanding that would then give us a better ability for, again, ongoing surveillance. So, I think understanding that element is something that we need to continue to do, and with MERS it was camels, and with SARS, SARS-1 was…

Melanie Saville MB BS

Civet.

Kate Bingham DBE

…civet cats.

Melanie Saville MB BS

Civets, yes, it was civets.

Dr Tim Hames

Yeah.

Kate Bingham DBE

Yeah. So, they’re different species, that, basically, the bats infect these different species, and then, from those species, they then jump to humans.

Dr Tim Hames

I’d just say on that I’m concerned about the debate around lab leaks and the rest of it because I think it’s part of a kind of arrogance in which human beings say, “This couldn’t have happened to us without us somehow being involved in it.” You know, it – even though SARS was a near miss, and no-one has suggested that SARS was created in a lab or accidentally leaked from a lab. MERS, a more – not really as big a near miss, but a very high death rate. If you had the misfortune to be a camel herd, next to an infected camel, 23% death rate amongst people who got MERS.

So, it wasn’t as if – and in, you know, other realms of life, there’s avian flu, it’s not as if we haven’t had warning signs that zoonotic transfer is entirely possible, and so, it slightly bothers me that the, kind of, lab thing is almost a sort of, “Ah, yeah, we should take relief here, at least it was manmade.” I mean, come on, which I think is just the wrong approach, and I think we have to start from the attitude that pandemics like this can and will regularly happen, and that mankind’s involvement, insofar as there’s an artificial mankind element, is actually the way that we treat the animal kingdom and our surroundings. In ordinary circumstances, if you’re part of the people, which I am, frankly, who believe the opening theory of bats to pangolin, an intermediate horseshoe bat based in central China should never meet a pangolin based in Malaysia. It’s because the second is trafficked to be somewhere near the first that this could happen.

Emma Ross

Thank you, I’m going to go to the floor, here at the front. If you could introduce yourself and – hang on.

James Anderson

Hi, I’m James Anderson from the IFPMA, the International Pharmaceutical trade association. And so, my question followed on from there, really, which is that one of the things that worked well in COVID is that the – once the virus was identified, it was shared globally, publicly, for all Researchers to use really fast, and yet, we’re worried that some of the proposals under discussion will slow that down, in fact. And so that, of course, sets the day zero of the 100 days, and any delays to making that available to Researchers will push back the delivery of vaccines and treatments in the future.

So, one question is any observations on how we can make sure that that doesn’t happen, but then, a bit more broadly, when you look at the pandemic treaty being – starting to be negotiated in Geneva, and the observations of the political dynamics playing out against some of the more scientific practical dynamics, what – you know, again, with the one question, what would you like to see the treaty really deliver that makes the world better prepared, and what is – what should it – what does it need to avoid? What do we all need to make sure that the treaty doesn’t, you know, make worse than what we’ve had in COVID?

Emma Ross

Can we have somebody nominating themselves, who’s most keen on doing that, so we can get through a few more questions?

Hugo Gomes da Silva

I can start. There’s – when you look at a treaty, I think that it’s absolutely spot on, I think it’s important that we look at all the variables that will enable us to deliver effective vaccines that are safe vaccines, that are easy to administer, that we heard just now, but also that are accessible worldwide. And to that end, I – the first thing that I would like us to really think is how can we particularly, in a interpandemic world, create a resilient and sustainable health system that will enable us to do that? And I think that’s something that we really need to reflect, and this is, once again, bringing back to the discussion of having the different partners around the table, of creating that infrastructure.

If you think in hindsight back to the 2009 pandemic for H1N1, and for many years the Scientists were saying, “Well, it’s going to be a flu virus, it’s going to come from China and it’s going to be highly deadly,” and all of a sudden, lo and behold, when we look at the 2009 H1N1 pandemic, the death rate was not as high as initially anticipated, it was coming from Mexico. So, I think that caused significant question marks around the world and some suspicions, particularly around how good are the Scientists to really predict what’s going to happen, and how can we prevent this? Are, really, the pandemics going to be that severe? So I think that this pandemic, the COVID-19 pandemic, that was one of the critical lessons for me, and for the whole of the world, I think it’s really – we need to create an infrastructure that enable us to be pandemic ready, because the next one is going to hit.

Just pinging back on what Tim just flagged, we are entering more and more in ecosystems that we haven’t been there before. That intervention, that human intervention in those ecosystems, it’s leading us to expose to environments like the one bat cave that it’s supposedly the origin of the virus, that it’s 98% homology to the current – to the SARS-CoV-2 initially wild type, that’s really the reflection that we need to take away as we think about what it should be for the future. There’s going to be more pandemics. We see the time in between coronavirus and other pandemics is narrowing down and down, in between, the interpandemic periods are growing smaller and smaller, so bringing this all together and create this unique resilient and really sustainable force is important.

In AstraZeneca, we have built a new partnership that is now being deployed in 30 countries to really create that policy to prepare the world for the next one that it will come, for sure. When we don’t know, but it will come.

Kate Bingham DBE

Just putting the, sort of, stats around it, I mean, I think these are stats from Richard, 26 viral families that are likely to be pathogenic to humans, we’ve only got vaccines for 15 of them. We just need to divvy the remaining 11 around the world, and say, “Right, let’s come up with a whole bunch of prototype vaccines.” I’m sure other countries have got what we’ve got, which where we scaled that portion down to some of the screening, head-to-head screening of the vaccines against different variants. Oh, I’m sure that’s possible to do that round the world, spread it out, make sure you build up manufacturing capability in low population countries, so it’s not just in India and so, regionally, you’ve got capacity. I don’t think it’s rocket science, but it will require some money and it will require the Politicians to stop making this political and just making this a non-political, you know, global resilience project.

Emma Ross

Resilience is all the rage at the moment, it is quite the buzzword, everything is resilience, supply chain resilience…

Dr Tim Hames

I’ll just offer…

Emma Ross

Yeah.

Dr Tim Hames

…an analogy to this gentleman here. My first career was I was teaching American government, and one of the striking things to me, as somebody into these things, is that the New Deal legislation regulating financial institutions in the US in the 1930s was astonishingly short in the terms of number of pages. What it was, basically, about was creating a very strong agency, awarding it very strong powers and the pre-emptive right to police, not merely the passive right to police, and that worked magnificently for 40/50 years. And then the various, shall we say, political allies of institutions who wanted reform have gradually moved it to a different model, in which the legislation got longer and longer and longer and longer and longer, but the autonomy of the agency got shorter and shorter and shorter and shorter and shorter, and so, its ability to engage in pre-emptive policing got weaker and weaker and weaker. And that’s the model you don’t want in this case. You want the simpler model, that’s a stronger agency, clear set of powers and the ability to be pre-emptive, and not a 45,000-page treaty in which the agency concerned has no idea where its standing is, really.

Emma Ross

Okay, thank you. I’m just going to – oh, we’ve got two and now everyone’s putting their hand up with five minutes to go. So first, this gentleman here, then here, and then we’ll go over to the left. So go ahead, please introduce…

Peter Watkins

So…

Emma Ross

…yourself first.

Peter Watkins

…Peter Watkins, Associate Fellow here with the International Security Programme, and I’d like to continue on this theme of preparedness for next time. Kate Bingham, you made this interesting comparison with the defence, and that’s my own background, so I’d like to follow up on that. I mean, defence budgets are very contested, they’re either too big or too small, so do you have a view as to what would be a reasonable and politically defensible amount of money to spend per annum?

The other point is that defence ministries never spent enough money on consumables, on munitions, basically, because governments don’t like spending money on things that time out, that they, you know, they run out of life and they have to be thrown out. So, how would you address the, sort of, political issues around that, or could we hope for an everlasting vaccine?

Emma Ross

Okay.

Kate Bingham DBE

Well, just to take the point, I mean, you can stockpile and then you just continue to do stability testing to see how long they can continue, and then you get regulatory approval. It doesn’t mean you can do it forever, but actually, you could stockpile and keep it very cold. I mean, stockpiling, I think, is certainly possible.

Melanie Saville MB BS

Stockpiling is possible, and you may – but I think the issue is still you have to recognise you may never use it and…

Kate Bingham DBE

Yeah.

Melanie Saville MB BS

…you will have to throw it away, but that is an insur – exactly, it’s an insurance policy, and that is the way it works.

Kate Bingham DBE

But it may not be the right solution to stockpile ‘cause you don’t know what you’re stockpiling against. What you really need to do is to have the cell lines and the cell banks and the capability to scale up very quickly when you know what it is you need to vaccinate against. So, I can’t give you a number, whatever it is, but it – I mean, if you look at BARDA, and – the US Biological whatever, Agency, for threats, they have – they spend a billion a year just working with industry to come up with new ideas, new products, new technologies, new approaches, that may be used in the future, quite separately from all those – the long-term programmes they’ve got.

So – and if you look at what we’re doing now, I think the government’s been very effective at procuring vaccines that work well against preventing COVID – well, SARS-COVID-2. So, in the actual procurement now, I think we’re doing fine. In the long – in the broad, what we need to be doing next, I don’t even think there is a budget. So, I mean, I think anything would be better than nothing, but I think it needs to be material so that we can be a genuine contributor, and we’ve got the capabilities. That’s what’s so annoying, is, you know, we do have the reporting down, with the manufacturing that we’ve – network we’ve put in place, there’s lots there, just it’s un-co-ordinated.

Emma Ross

Okay, and I want to squeeze in – so I will literally go and quickly squeeze in maybe one more question, maybe two. So, this gentleman here, if you can introduce yourself…

David Salisbury

Yeah, sure.

Emma Ross

…and your question.

David Salisbury

David Salisbury, I’m an Associate Fellow here. Thank you. I think this is for, sort of, Melanie and maybe Hugo, as well, and it’s the 100-day issue. You know, it’s fantastic to have that ambition, but we have to accept that that is not going to give us safety, that’s not going to give us efficacy and most of all, it’s not going to give us capacity to produce. And we talk about things like 100 days and “When will we get the first dose?” but my consideration has always been when do we get the last dose, so that we actually have enough? And I think we should be more obsessed with when do we get the last dose, rather than focusing so much on when do we get the first, because it’s the last that matters.

Emma Ross

That’s a good question.

Melanie Saville MB BS

Yeah, it is a very good question, and, you know, our definition of 100 days is, you know, a vaccine ready for use at scale. the second 100 days is as important as the first 100 days and as you say, having that global capacity to make the vaccines and, you know, really be able to jump when needed. And that really comes back to how do you actually get there, is going to have to do a lot more for endemic diseases, and already vaccine preventable diseases on some of these rapid response platforms to make them sustainable. So, how do we sustain mRNA, as an example, as a platform that can respond in 100 days? You need to have, you know, a Japanese encephalitis, a flu vaccine, or something else on those, to have the capacity ready to divert when you need it.

Safety and efficacy, your other point relating to that, is, for sure, I think there are only certain circumstances when 100 days is appropriate, and that’s based on benefit-risk assessment. You know, a highly lethal, highly transmissible virus, you may look at that slightly – quite differently from something that just, you know, causes a mild respiratory disease, but there’s a lot that can be done from a platform perspective, the safety of the platform, looking at working on virus families and looking at related viruses. We do that in flu, we change the flu every year, and we don’t even have to do a clinical trial. We want to get to that point with virus families, that you can develop these prototypes and it’s a strain change, that would be the ideal situation and that you have the capacity.

Hugo Gomes da Silva

If I could actually just…

Emma Ross

Okay, Hugo, quickly.

Hugo Gomes da Silva

No, very quickly, because I think that the flu model was actually one of the best examples on how we are getting ready for a pandemic, because in fact that – the fact that we have seasonal flu platforms for so many years enabled us to scale-up, because we have the manufacturing in place to really produce flu pandemic, if in case needed, right? And so, I think that, exactly like you said, having the platforms ready, continue to generate data, benefit-risk safety to allow us to make the right decision when the next come.

Kate Bingham DBE

And I might just make one point to the audience. If David Salisbury had been actually in government, the Vaccine Taskforce wouldn’t have existed because they’d have had the capability and the knowledge and all the – everything that was needed to have actually done it themselves. So, actually, there is something about why isn’t there a David Salisbury anymore in government, equivalent? There should be.

Emma Ross

Okay, well, I’m go – it is time, but I’m going to squeeze in one more question as a kicker, ‘cause it can be answered quickly, I believe, and it’s directed directly at Kate, and it’s the most upvoted question. Just to get a – one more question from the online, and Lee Jones, he is asking, “Much of the UK pandemic response was shambolic, vaccine development and rollout were the – was the exception. What would you say were the three key things that explain this?” And I’m sure you’ve been asked this a million times, and thank you for your contribution.

Kate Bingham DBE

Yeah, so, it was reporting to the – having a very clear mandate was important, so that was vaccines for the UK, vaccines for the world and pandemic preparedness. Now, we only really did a good job in one, not really two and three. Reporting to the PM made a big difference, because it just sped everything up, not that he was that involved, but the threat of him being involved was important. Having a ringfenced budget from which decisions from the Ministers could be taken quickly was incredibly important, and quick – taking quick decisions, again, on the government side was highly unusual and incredibly important, and for – on the Vaccine Taskforce side, our ability to recruit the team and who we wanted to work with, who, even if they were foreign nationals from Italy, was incredibly important, and those all things could be done again.

Emma Ross

Okay, great. So, I’m going to – unfortunately, I’ll get in trouble if I go on any longer. There – I’m sorry, there are so many more questions, and apologies to everybody online, I tried to be fair and distribute it and move across the floor and manage online, as well, but I think it’s been really a fruitful discussion. Thank you so much and love to have you back again, and for anybody in the room who didn’t get a chance to ask your question, please do, yeah, collar the speakers on their way out and make sure you get that in. So, thank you very much for joining us, and this is now over.

Kate Bingham DBE

Thank you.