Vaxxers review: an up-close and personal insight into the making of the AstraZeneca vaccine
Conventionally, history is best recorded at a distance. Perspective is important. Vaxxers, The Inside Story of the Oxford AstraZeneca Vaccine and the Race Against the Virus, is close-up, personal and immediate. It is reportage from the Covid front of the highest order and an essential tool for future scholars with the leisure to take a longer view.
The authors are Professor Sarah Gilbert and Dr Catherine Green. Professor Gilbert is a Professor of Vaccinology at the Jenner Institute within the University of Oxford. Dr Green is an Associate Professor in Chromosome Dynamics at the Wellcome Centre for Human Genetics and Head of Oxford University’s Clinical Biomanufacturing Facility.
As I stripped the Amazon ripcord from Vaxxers, the first question that popped into my mind was, how on earth – in the warp speed race to structure a vaccine, put it through clinical trials, find a commercial partner to manufacture to scale and roll out global distribution – did this academic duo find time to write a book?
Well, they have written a book… sort of. Much has been made of the book having been “ghostwritten”. Emphatically, it was not. It is, instead, a true and acknowledged collaboration. Lurking on the frontispiece, in the smallest font size, are the unassuming words; “Written with Deborah Crewe”. Huge significance. For Crewe is not your average literary hack, transforming celebrity stream of consciousness into understandable prose.
Before embarking on the literary phase of her career, Crewe spent seventeen years advising Cabinet ministers on policy at the Cabinet Office, the Home Office and the Ministry of Justice. She studied international relations at Harvard and has an MBA from the London Business School.
Her modus operandi is on her website: “Whoever I am working for, the principles are the same. I am perceptive, efficient and discreet. I work hard to find my client’s voice and tell their story in a clear and compelling way. I stay alive to how emotional the experience of writing one’s life story can be, but try to make it an enjoyable and fulfilling experience.”
The chapters of Vaxxers are “voiced” by either Gilbert or Green as the narrative swings across their professional responsibilities. Crewe worked with comprehensive records and diaries kept by the authors during the year-long chase for a vaccine. She has obviously conducted many conversations with her authors, not least to weave personal information about the impact of work on family life through the tale. This is hard science with human interest. The approach makes the book compelling.
The result of this successful collaboration is not only a “must-read” for anyone remotely interested in the most important epidemiological event to occur in current lifetimes but a foundation stone upon which to build the structure needed to meet the challenges of Disease Y, likely just around the corner. Covid-19 (Disease X) may be partly confined in its vaccine box. The authors point out that there need to be better structures in place to meet its inevitable successor head-on.
That is not to imply the trio are doomsters. The opposite. They are optimists, with much to be optimistic about. At times the reader is almost casually reminded how far we have travelled in a few short years. Page 264: Gilbert; “so, we had to work out the new gene sequences to drop into the adenovirus vector – a relatively easy and quick part of the job.”
Easy-peasy? Twenty years ago, that statement was science fiction. Now sequencing genomes is falling off a bike territory. A strength of the book is the passion of the authors’ argument that we are now poised to capitalise globally on that progress. Warning! Only if we choose. Educating the public to demand sensible policies from their elected governments is an essential, preliminary step.
The story is told in thirteen chapters, starting with the making of the vaccine and ending with “Disease Y: Next Time”. The narrative of Vaxxers flows naturally. Designing the vaccine, securing funding, manufacturing in small batches, scaling up, securing a commercial partner, AstraZeneca, the tensions of clinical trials, getting the story into the public domain and the final victory of licencing. Road bumps appear but are overcome.
Along the way, controversies that swirled around the vaccine and its effectiveness are calmly addressed. The motivation is to fill in gaps in people’s knowledge and counteract internet weirdos of the “Chinese bots in your bloodstream” persuasion. Gilbert acknowledges as early as page three: “I knew that we, the Vaxxers, needed to come out of our labs and explain ourselves”.
There was an early claim the vaccine would be unsuitable for Muslims, because of dietary restrictions; a completely unfounded story in a German newspaper saying the vaccine would not be licenced in the EU because it was ineffective in the elderly – before clinical trials in an older cohort of patients had even taken place; the misinformation over the administration of half doses. As well as building a vaccine in record time, Gilbert and Green had to be firefighters prepared to defend it.
There is a determined attempt to counter hokum about vaccine discovery. The authors are self-deprecatingly insistent that delivering a vaccine to meet a novel viral challenge is more about painstaking construction than chancing upon a “Eureka” moment. On page 66, Green comes up with an analogy this inexpert reviewer found helpful.
Precis: Making a vaccine for a novel virus such as Covid-19 is like a baker providing a personalised cake for a special occasion. Every new virus is a special occasion. The generic delivery mechanism is the cake – of which the prudent baker has a “here’s one I prepared earlier” stock. The “Happy Birthday Joe” message iced on top is the only novel bit to be added. To a spiky Covid, it reads “Here I come” and latches onto the spikes. Green points out that a vaccine party is a pandemic. She and Gilbert just bring the cakes out of the cupboard, then add the carefully crafted icing.
Organisations that lurk under the public radar are revealed. I was unaware that the UK government had funded an organisation called VaxHub in 2015 – cash coming from the controversial Foreign Aid budget – to develop vaccines against minority diseases, like Ebola, causing havoc in the underprivileged world.
Gilbert secured her kick start funding from VaxHub. On page 126, there is a useful outline of the potentially enlarged mandate of the Vaccines Manufacturing and Innovation Centre, set up to enhance the UK’s national vaccine response capability. It was reassuring to discover that in the heat of lockdown flip flop battle attention was being devoted to the less glamorous task of building future infrastructure.
Amidst the ground-breaking science, the authors encounter the unfamiliar experience of the responsibility of public accountability. On page 92, Gilbert recounts her trepidation at giving evidence to the Science and Technology Select Committee at Westminster. (She wrongly describes it as a government committee, an important error I would have expected the Whitehall savvy Crewe to pick up on. I wonder if any other references to organisations I know less of might be similarly askew? Caveat reader.)
The impact on the personal lives of both authors colours the chapters in an unselfconscious way. Neither seeks pity, or even approbation, for working all the hours God sends. For Gilbert and Green, that goes with the territory. It is a reminder for the reader that we expect much from our professionals, especially when they unexpectedly find the limelight shining on them. There are times when media attention risked getting in the way of progress. They do not see themselves as heroes.
A much-appreciated visit from the Duke of Cambridge does stop work but has wider PR benefits. The incessant intrusiveness of the media is less helpful. Green bravely admits – “When I was a kid, I dreamed of being famous: that I would be on TV and my photo would be in the Daily Mail” (blimey, that’s a low threshold). “So, I decided to become a scientist. Said nobody, ever.” People are saying it now. Both Gilbert and Green have risen to their media challenges.
The search for a vaccine to counter Covid-19 is never depicted in the lurid terms of a race between teams sporting national flags. That said, there are some subtle swipes at the incoherence of the Trump administration’s policy. Let me put it this way. Neither Vaxxers author were ever convinced that toilet fluid would beat them to the Covid vaccine finishing tape. They are polite – but dismissive – of fantasy prophylactics.
Out of the wrapper, I viewed this book as a suspect. How on earth could engaged commanders on the Covid battlefield produce any meaningful literary contribution so quickly? The answer is they harnessed the same skills to authorship they had mastered in conquering Covid. They sought the ideal collaborator in Deborah Crewe and delivered. Teamwork.
Vaxxers is an honest book. It abhors triumphalism. It narrates the past and looks to the future. It is accessible and absorbing. The authors reveal themselves as skilled, committed, refreshingly normal. Yes, under stress, but without a hint of self-pity. Probably great people to know.
And long after our quadrennial obsession with kicking an inflated 4,800 cc polyurethane sphere around a wet field has deflated, the enduring impact of Vaxxers’ contribution on future health policy will be felt. Must be on Sajid Javid, our freshman Health Secretary’s holiday reading list. It should be on yours, too.