Did you ever wonder how Covid-19 vaccines were developed so quickly? Usually it takes five or ten years to develop and approve a new vaccine, but in 2020 several vaccines were ready in less than a year. This speed led to suspicions about quality and safety being compromised.
For an explanation, turn to the new book Vaxxers by Sarah Gilbert and Catherine Green. They are key members of the team at Oxford University that developed the AstraZeneca vaccine. Vaxxers is an engaging first-hand account that contains many insights.
Gilbert and Green had been working on vaccine development for a great many years. They and their collaborators sought ways to prevent diseases such as Ebola, malaria and MERS. One of their accomplishments was development of a vaccine platform, a cell structure that could be used to enable new vaccines to be created very quickly.
People sometimes say, “Why wasn’t anyone preparing for a new pandemic?” Gilbert and Green say, with some exasperation, that is exactly what they were doing. The trouble was that they found it exceedingly difficult to obtain funds to make better preparations.
Nonetheless, when Covid arrived on the scene, they were far better prepared than they might have been. The initial challenge was to recognise that the first reports of a new infectious disease in Wuhan, China, represented an urgent priority. Gilbert and Green had other projects under way, and a variety of personal and professional commitments. They started monitoring the reports of the new disease. It took some time before they decided to act. When they did, progress was rapid. As soon as they obtained the genetic structure of the new coronavirus, later named SARS-CoV-2, they used their platform to create a vaccine.
“This meant that before we even knew the pathogen’s genome, we knew the design for our vaccine — the gene coding for the SARS-CoV-2 spike protein, plugged into ChAdOx1 — and once we did receive the genome, we were able to design the exact DNA sequence we needed within forty-eight hours. Less than four months after that we had the first doses made, quality-assured, and ready to use in clinical trials.” (pp. 153–154)
They make it sound easy!
As it became clear that the new disease, called Covid-19, would require full attention, they gradually mothballed their other projects and put their full energy on developing and testing a vaccine for Covid. Having a small quantity of a vaccine was just the beginning.
A personal story
Each of the chapters of Vaxxed is told either by Gilbert or Green, giving a personal perspective labelled as Sarah or Cath. The result is in part a sort of scientific autobiography. They each tell of their personal lives, their families and difficulties, their eating habits and especially their anxieties about producing the vaccine.
They put themselves under immense pressure to do everything required to make a high-quality vaccine in record time, knowing that every day shaved from the usual development schedule could make the difference to people’s lives and also knowing that mistakes could make the whole process come unstuck. At crucial stages, such as purifying the vaccine and unblinding trial results, they were confident due to having been through the same stages with previous vaccines, but they were also on tenterhooks because so much hinged on the outcome.
Scientists spend much of their time in labs and with their colleagues, and non-scientists can have a hard time appreciating what goes on. In Vaxxed, we are offered an inside look into everyday science, though in this case undertaken at high intensity and with high stakes. Gilbert and Green show they are humans just like the rest of us, with cares, hopes, distractions and lives outside of science, and with great experience and dedication in their research roles.
It is amazing that such a story has been told so soon after the events, indeed told at all. Scientists working for governments or pharmaceutical companies would have a hard time gaining approval to write such a revealing memoir. For scientists used to writing technical papers for journals in their fields, adopting a style aimed at a general audience is no mean feat. That Vaxxed is so readable may be attributed in part to excellent editorial support. At the bottom of the title page, in small print under Gilbert and Green’s names, is “Written with Deborah Crewe.”
The Oxford lab was set up to develop vaccines, not for mass production. At a crucial time, the pharmaceutical company AstraZeneca was brought on board to collaborate with the Oxford scientists and produce the vaccine in commercial quantities. Rather than using laborious lab methods to produce dozens of doses, AZ could scale up production to millions or even billions of doses.
Unlike other companies producing Covid vaccines, AZ made the magnanimous decision to provide its vaccine at cost, namely with no profit, for the duration of the pandemic, and indefinitely for low and middle-income countries. It is far cheaper than the Pfizer or Moderna vaccines.
Few scientists have a high media profile, nor do many seek media attention. University administrators now encourage scientists to showcase their research, providing support from professional units that help write media releases. Gilbert and Green had been working for many years with this sort of limited interaction with journalists. Vaccines for diseases in foreign countries are seldom newsworthy. With the pandemic, suddenly there was intense interest in vaccine development for a disease affecting people in their daily lives.
Gilbert and Green tell about their steep learning curve doing media interviews, for example learning that an off-the-cuff comment, taken out of context, could become a misleading headline. They were pleased that so much coverage was supportive but then upset when a routine occurrence — pausing the trial while an adverse event was investigated — was misinterpreted and blown out of proportion. Before long, they referred all enquiries to the university’s media unit, as it was impossible to handle all requests and to do so would have meant slowing their work on the vaccine.
Gilbert and Green sometimes had to push back against media intrusions, especially when film crews in the lab caused work to be compromised. On the other hand, they appreciated the opportunity, provided by the media, to publicise the vaccine and, more generally, to enable them to get out messages they thought were important.
Lab life under a media microscope
Quite separately from its contribution to understanding vaccine development, Vaxxers is a valuable contribution to writing by scientists about their own work. The classic book in this genre is James Watson’s book The Double Helix, his account of unravelling the structure of DNA, an account criticised for male chauvinism, in particular downgrading the role of Rosalind Franklin. Vaxxers, in contrast, is written by two women scientists who explicitly deny being pathbreakers or heroes. They repeatedly acknowledge the others in their team and explain how their work on the vaccine built on years of prior work and experience. They worked extraordinarily hard not so they would be recognised as elite scientists but because they wanted to do what they could to save lives.
“Before 2020, no one had ever developed a vaccine in a year. But that was not because it could not be done. It was because it had never been tried. We were able to go faster in 2020 not because we cut any corners or took risks with our product. We still did every single thing that needed to be done to develop a vaccine safely. We did not miss out any steps. Nor was any individual task — filling a vial, vaccinating a volunteer, analysing a graph — done with less than the usual care and attention. We went faster because we had to this time — the world needed the vaccine as soon as possible and, as we know from seeing the daily death rates, every day counts.” (pp. 160–161)
Vaxxers is also different from most books in the first-person scientist memoir genre in consciously being an intervention into the debates surrounding the research. Gilbert and Green are acutely aware of concerns about the safety of Covid vaccines developed at such great speed and want to explain how they were able to move so quickly without compromising quality or safety. In this they have undoubtedly succeeded. What they cannot do, of course, is to provide the same sort of reassurance about other Covid vaccines. We can read Vaxxers but no equivalent story written by government or pharmaceutical company insiders is ever likely to be published.
While Vaxxers addresses some of the concerns about Covid vaccines, it cannot deal with all of them. The full story of the health effects of the vaccine remains to be told, as does the comparison between risks from vaccines and Covid itself, for different demographics. Nor is the story over, because new variants of Covid continue to appear, meaning that new versions of vaccines may be developed.
The only time Gilbert and Green’s treatment loses authenticity is when they write about vaccine hesitancy, about which they rely more on others’ treatments than their own research and experience. For example, Gilbert writes, “I don’t understand anti-vaxxers” (p. 192). This is understandable given that she’s not a social scientist who has spent years interviewing parents and trying to learn about vaccine hesitancy.
Regarding blood clots from the vaccine, Gilbert makes a comparison with the risk of blood clots from having Covid or from taking the contraceptive pill. This is reasonable on the surface, but Gilbert is not an expert on the science and politics of risk assessment, about which there is a vast body of research addressing complexities and value judgements.
Supporters of vaccines can learn from Vaxxers about how the substance injected into their arms was developed. Critics of vaccines can learn this too. All their criticisms will not be answered, but at least they can be better informed.
Gilbert and Green worked exceedingly hard and long for many months, and desperately needed a break. They write about what they will do after Covid priorities recede. It’s good they decided to take the time to write Vaxxers.
Disclosure: I had the AstraZeneca vaccine — hence my special interest in Vaxxers — and had no side effects.
Comments from Robyn Gardner
Your review of Gilbert and Green’s work seems very balanced to me. My only reservation concerns the rush to autobiographical disclosure by scientists, which seems so common now in all fields, in government, media and the military. The speed of publication indicates that at some point it becomes part of the potential framework of research or design in any career-sensitive lab. The ‘confession’ is a kind of promotional agency, akin in some ways to pharmaceuticals’ harnessing of patient groups/parents/human interest stories for their own profits. The result is an erosion of the integrity we may imagine of/in science, pre-empting and incorporating the earlier systems of external critique and history of science.
It seems to me that popularizing and personalizing of research via the highly marketable and more inclusive representation of women is as risky in its way as the effacing of women earlier was, which was, let’s face it, probably no different or inexorable as the effacing of many, many men – there being more men, in earlier periods, so that women may actually have had more ease of access, if only by dint of a family connection or their exception.
We still await some highly nuanced outside assessments of this cultural history and the very problematic politics of vaccine production, something akin to David Oshinsky’s Polio: An American Story which examines the wider cultural context of a pandemic. Oshinsky’s book addresses the ‘boosters’ and marketeers of that first wave of public image harnessing as well as the personal volatile histories of Salk and Sabin. Furthermore, it addresses the upscaling of vaccine production by the moves from research and laboratory science to outsourced not-for-profit production (by the same agencies as for-profit ones or harnessed with them) through the process of ‘gifting’ to middle tier as well as third world countries. Then there’s the old story of poorer places being used for testing in an era when you can’t as easily inject into the bodies of the disabled or the ‘isolated’ cultures of poor countries – unless you redefine them loudly and publicly as ‘most vulnerable’ and needing to be ‘included’.
We rapidly approach the place in which we are all included – so where precisely is the control group, of the unvaccinated? And what, historically, does this serve to cover over, if we’ve all been injected with so many and variable (including simian viral) and DNA active or lipid adjuvant substances, and what levels of biosecurity can possibly pertain given the places and speed of outsourcing in manufacture?
I think of the silencing, and self-silencing, of any possible response, and of the wholesale ‘turn away’ from the polio vaccine origin-of-AIDS thesis by even those scientists who found it highly plausible, and on the part of those who could have been and should have been most active in inquiry.
My concern about AstraZeneca is not the reporting of side effects in the short term, but the widely mediated hijacking of this possibility by labs and agencies and ghost-written preprints focussing on the ‘rare’ clotting events of the disease itself. The possibility of long term and highly likely slower vascular changes, not reversible, but activated – a ‘forever’ event – in vaccinated subjects will tend to get deluged and overwritten, buried, by the usual facile response of Covid causing the same or greater risk. So it goes. I guess this is science and business as usual, and the post-war scepticism about biological research, and rise of ethics, is now in reversal. We are all in thrall again to something called ‘the science’ – which is seen as pure again, and all inclusive, whilst any postgraduate qualification in the human sciences, which might include historical awareness and critical thinking, if not always clear, will cost a leg and an arm.