Rooting for the home team: British journalist weighs in on U.K. vs. U.S. vaccine response

In the international race for Covid-19 vaccinations, the U.K. was first to a key milestone. It was the first country to authorize a fully tested Covid-19 vaccine, the one from the partnership of Pfizer and BioNTech. And the country has also embraced a strategy of spacing out vaccine doses to begin immunizing as many people as quickly as possible.

The U.K. has now given 34% of its population at least one dose, and about 2% have been fully vaccinated, according to Bloomberg’s vaccine tracker. The U.S. has given 18% of its population at least one shot, and less than 10% are fully vaccinated.

To discuss who does it better, STAT spoke with Natasha Loder, health policy editor of The Economist and host of The Economist’s new podcast, The Jab.

This conversation has been lightly edited and condensed for clarity.

So there have been very different approaches to the AstraZeneca vaccine in the U.K. versus the U.S. In the U.K., it’s a source of national pride and already is being administered widely. Here in the U.S., we’re waiting on data from a Phase 3 trial run. Despite a promising start, the vaccine program, which is partnered with the U.K.’s Oxford University, has been one misstep after another, almost all self-inflicted.

I would say, look, there’s no question the data has been messier than everyone would have liked. And certainly there was some confusion in the initial press conference that made it harder to report. And I remember after the first press conference, I was being asked a lot of questions. You know — is it 60%, is it 70%, is it 90% efficacy? And I stuck with 70% at the time for the simple reason that I didn’t know whether this sort of special half-dose group had been predefined.

I know it’s a bit of a nerdy sort of discussion to have, but that was very much the conversation I was having with my editorial colleagues. And unless somebody can tell me that this is a group that they set up initially, I just have to report 70%. And so that caused a lot of confusion and the confusion just went on. I always had quite a lot of confidence that it would get sorted out, confidence that I think was not shared by everyone.

I remember there was a piece in Wired almost maybe a day or so afterwards, which was very skeptical about the AstraZeneca data. Again, a lot of people just wanted to give it a good kicking for various reasons. And I’ve always felt the need to just be a little bit more careful. It was clear to me then that we would need people to be confident en masse on this vaccine. And so even though there were some problems with the data, if they could get ironed out, it seemed that it would probably not matter in the longer term.

So last month you tweeted, “I am ridiculously pleased that Oxford has done a big [stick out your tongue emoji] to all the vaccine doomsayers.” So I wonder, do you feel like you were rooting more for the home-grown U.K. vaccine than any others?

I’m going to get on my high horse again. I’ve been rooting for this vaccine from day one because there was a commitment to creating a great vaccine at huge volumes, about 3 1/2 billion doses around the world, at low cost. And if you look back at our history with outbreak medicine, whether it’s HIV anti-retrovirals or H1N1 vaccines — the lesson we had from those incidences was that rich countries get medicines and poor ones don’t. And you look at what we’ve done this time around, almost at the same time simultaneously in rich countries and poor, we have launched this medicine. That’s a historic first. Yes, it’s a British vaccine, and I have some pride in that. As an Anglo-Swedish company, it’s an international global pharmaceutical company. I’m sure you guys think that Pfizer is an American company. Well, guess what? It’s only American because you wouldn’t let it go to Ireland. So, you know, it’s like, I’m pleased. I’m proud that we supported that vaccine from an early stage and I’m proud that it’s getting delivered around the world today.

How do people in the U.K. view the U.S. approach to vaccines and our vaccination strategy?

I think there is an acceptance that different countries go different routes. I know that many Americans kind of look down their noses at the way we’ve done things. And I wouldn’t say that the same is true in reverse. I do think that you could have done more to expand the distance between the first dose and the second dose. I think that, yes, we took a calculated risk on extending the dosing. And I know that the purists will say, well, you didn’t have the data. Well, maybe, maybe not. We do know generally for vaccines that a longer dosing schedule is generally better. Now, that’s not a lot to go on. But I think, you know, we’re in a pandemic and British people are quite pragmatic. And also we have a much stronger sense of our society and societal needs in Britain than perhaps in America, where you’re very much more individualistic and it’s like, “I’m getting my vaccine and I’m getting my second dose because that seems to be what’s best.” You know, when we have the debate in Britain, I would put it to people like this, I would say, “OK, you’ve got two doses of vaccine. Which of your two parents are you going to give it to or are you going to give them one dose each?”

Maybe we can all agree that the United States and the U.K. are doing better than Europe.

Yes, we can. I think the U.S., in terms of procurement, you’ve done brilliantly. I think your distribution saddens me. And I think that’s a consequence of your health system. I mean, the fact that, you know, 65-year-olds are having to sort of go to an event website to try and get a vaccine dose like they’re trying to get Barbra Streisand concert tickets — it’s kind of shocking to me. And we have a list of every single 80-year-old in the country with their comorbidities. And they get a text message from the doctor, come in for your vaccine. They’re not having to try and compete online for lifesaving medicines. So I think while your science and technology has been brilliant, it’s the distribution has really kind of revealed some of the sort of underlying fault lines in your system. And that’s not to say that Britain is perfect. There’s lots of things that we did absolutely terribly wrong from the science to test and trace and things like that.

So the government here has also been using the Defense Production Act to prioritize vaccine manufacturing. But has this been having an impact internationally?

Yes. So I’ve just spent the last couple of days in a Chatham House meeting with vaccine suppliers, vaccine supply chain people, governments, and the like. And there is a growing sense of disquiet at how the Defense Production Act is having an impact on the movement of key critical items. And, just to sort of explain, vaccine supply chains are global. Although the U.S. has tried to be quite independent when it comes to all that sort of doodads that you need, actually things come from everywhere, from Europe, whether it’s tubings, sterilization equipment, and things like that.

And the Defense Production Act is definitely causing delays to everything from raw materials to keep its equipment. And so we could get into a situation where there’s sort of tit for tat. Export controls, and that actually could essentially kind of gum up the whole vaccine production. Except for MRSA, all the other vaccines are made using the same equipment that you used to make monoclonal antibodies. And so if we don’t sort this out, this is clearly going to have an impact on the production of other drugs — lifesaving drugs, monoclonal antibodies. How can it not, you know, about anything can go in a bio bag. And so if you’re trying to get up from 3.5 million doses of vaccine or whatever it is we produce annually to, you know, 14 billion. That’s a big deal.

On your podcast this week, you have an interview with the organizer of the world’s first challenge trial for a Covid-19 vaccine. The idea being volunteers are exposed directly to the virus. These were advocated as a way to speed up vaccine development. But now we have multiple vaccines that are already authorized around the world. What’s the point of this now?

It’s a great question. What is the point of this? I would love to read their application to the ethics review board. I’d love to have been a fly on the wall when they had the discussion. Clearly, they’ve convinced someone that the benefits are worthwhile. I think we can all see that there’s a risk that even if you take young, healthy people, there’s the risk of long Covid as the risk of complications. We don’t really understand this disease. We do human challenge trials with diseases that we understand much better and that we have therapies for.

I would say that Britain has had a lot more experience doing human challenge trials over the years than many other countries and probably we’re a bit less squeamish about them. I’m not sure why that is. Maybe it goes back to the fact that we do have much more of a sort of sense of community and society when it comes to health care. I don’t know. I have a hunch.

As a potential participant, why would you want to enroll in a trial like that?

Here’s what you might get out of it, if they come away knowing what the correlates of protection are. And then you can then apply that information so that basically you never need to do a Phase 3 trial again for a Covid vaccine, then that is actually kind of quite useful. And remember that most vaccines that we do approve just generally are done on correlates of protection these days because they’re kind of revisions. And we don’t want rerun the Phase 3 trials. So you could argue it from that point of view.