Kate Bingham on the secret to UK’s vaccine success

In a candid interview with La Repubblica’s Antonello Guerrera and Die Welt’s Stefanie Bolzen, Kate Bingham, former Chair of the UK government’s Vaccine Taskforce, talked about the differences between the UK and EU strategies, the claims the AstraZeneca jab doesn’t work well in the elderly, and the future of coronavirus inoculation. You can read the full interview here.

First on the agenda was the success of the UK’s vaccine strategy, which has already seen more than 12 million people receive their first dose of a Covid-19 jab.

“The instruction I was given by the Prime Minister was to save lives as soon as possible, so we had a very clear goal. We had a very clear focus on being quick and securing the most promising vaccines for the UK as soon as possible.”

“So the first thing we did was basically to narrow down the landscape to those [vaccines] that could enter the clinic in 2020. So that was our first cut off, because if they couldn’t get into the clinic in 2020, that means they were going to be probably next generation vaccines – and too late for the immediate pandemic.

“Therefore, we focused, first of all, on what could get into clinics first and then we looked at the data. Now, of course, all the different companies have different types of data. None of the models were comparable and that reduced the list probably to 20. Then we probably did really deep diligence on a dozen, maybe something like that. And then we had to make decisions. [The team’s judgment was based] not only on what the immunogenicity and safety data were like, but just as importantly, what was the ability to supply like.”

According to Bingham, the key to the UK’s vaccine success story was flexibility:

“Being quick and nimble was definitely important. The fact that I’ve been in the industry for 30 years and the team that I work with have been in the industry at least as long, if not longer, meant that we had connections very broadly across the industry. So that meant I could just pick up the phone and speak directly to a company. With one company we had our first meeting on a Thursday and we had a follow up meeting on Saturday, and would agree the rough outline of a deal the following week.”

“So we had to make ourselves good customers to make people want to supply to the UK because there was going to be a limited amount of vaccine initially. Our goal was to do whatever we could do to encourage the companies to talk to us. That meant we had a sort of “UK offer”, as it were, which is if the company needed support in the scale of the manufacturing and fill finish and if we could offer that, we offered it and if the company needed us to help with running the clinical trials, we did that, too.”

Bingham also said that the UK’s focus on speed rather than cost-effectiveness was what set it apart from the EU. “The UK had a very strategic approach, which was to secure vaccines quickly. And the European approach seems to be more of a typical procurement approach, which was more about making sure you got the best value for money for your vaccines. It wasn’t related to Brexit and is not related to people being better or more experienced.”

That said, Bingham said she was not given a blank cheque by the government for the project. “We had to prepare a business case to secure an overall framework budget from which we would then make recommendations,” she said. “As it turned out, we paid a little bit more than £10 a dose [on average across all vaccines] and it’s about the same as the US paid. So it wasn’t as if we threw money at it.”

Bingham was also asked about France and Germany criticising the Oxford-AstraZeneca vaccine because they believe it is not very effective for the over 65s:

“The fact is in the Oxford study the way the trial was designed is that they recruited the older adults later on in the study, after it was proven safe in younger adults. Approximately 10,000 people were recruited initially. And then the last 2,000 or 3,000 were older adults that were recruited later. Because they were recruited later, there was less time for infection to occur and also older adults – and I am sure it’s true in Europe as well as in the UK – are being cautious. So their infection rate, relative to younger people, was lower. So it takes longer to get to an answer on efficacy.

“But what we’ve seen is good immune responses in healthy older adults, in the Phase 2 paper, and that was published in “The Lancet”. The MHRA then reviewed further data on the immune response to the Phase 3 trial, which I have not seen. So it is fair to say that there is limited information available on the efficacy in elderly patients.

“But there is nothing to suggest lack of protection or lack of safety. What the Swiss and French regulators are saying is we want more data – completely fair. We all want more data.”

Bingham addressed the options for the future of vaccines, explaining that we don’t currently know how long immune protection will last. She said it was probably reasonable to start with the assumption that we would need to do a boost within a year and then take a year after that to see how frequently it would need to be administered: “It may be five years, it may be one year. I don’t know the frequency. We just need to see the data to see what that’s going to be”.

She said that the process needed to get to a point where flu and coronavirus jabs could be administered simultaneously, but that ideally, science would move away from needles. “If you can induce an immune response by putting a patch on, or use a spray or a tablet, that would be much, much easier, because the cost in the UK of the vaccines is doubled when you add the cost of deployment as well. That’s a very substantial cost,” she said.

Bingham was also asked about the recent accusations of cronyism against her, as well as the Whitehall source quoted in the Guardian, who said she was “used to doing things quickly and without bureaucratic bullshit”.

“I wouldn’t believe everything you read in The Guardian. There’s very little that they’ve written that is correct. In terms of bureaucracy: I think our government did a beautiful job because I reported it to the Prime Minister and we created a process and team just like a venture capital investment for the approval of vaccines. I don’t touch any money of course; I make no spending decisions nor am I involved in any operational contracts, etc.”

Asked whether a global effort on vaccines was still possible despite the recent EU-UK “vaccine war”, she said:

“I absolutely think it is a global effort to resolve pandemics now and in the future. It’s only because we had a really good, competent, generous community of people that we’ve made as much progress as we have. That’s going to continue irrespective of political rhetoric. The scientists talk to each other irrespective of borders. The clinicians talk to each other irrespective of borders. Venture capitalists do. Politics is separate. But what actually goes on is co-operative”.