Top Covid scientist issues warning over pandemic vaccine access

Yoghurts, planes and penalty shootouts were among the colourful analogies Professor Sir Jonathan Van-Tam used to explain the latest Covid developments as England’s deputy chief medical officer. JVT (as he was affectionately known) became popular for his straight-talking manner and off-the-cuff analogies at televised Downing Street briefings. Once scientists had won the metaphorical football match, relegating Covid from a global title-contender to a lower league, Sir Jonathan stepped down from his role in March 2022. He is semi-retired at 62 but still spends a significant amount of time pondering our pandemic future.

A recent report from the Tony Blair Institute for Global Change (TBI) warned that the UK was dangerously exposed to growing biological threats, including bioterrorism and climate-driven diseases. The authors argued that the geopolitical conditions which allowed for rapid access to Covid vaccines may not hold in the next crisis. And they called for vaccine manufacturing to be treated as critical infrastructure and a core pillar of the nation’s defences. Sir Jonathan, who was quoted in the report, agrees.

“I’m not saying they should be level pegging,” he adds. “But I’m saying that they should be framed in the same way that we would frame energy security, food security and defence security. Vaccines are a health security matter and they deserve their place at the table.”

The TBI report put the cumulative probability of another pandemic in the next 25 years at between 47% and 57%, based on an annual risk of around 2.5-3.3%. A flu pandemic is the most likely scenario, but another bat-borne virus or unknown Disease X are also possible causes.

When contemplating the prospect of another global outbreak, many of us fall into the trap of the Gambler’s Fallacy. We just had one, surely another cannot be around the corner? Pandemic fatigue also plays a role — people exhausted by the emotional toll of recent years are more likely to minimise future threats.

But, as seasoned gamblers know, every roll of the dice is an independent event. Sir Jonathan says: “I’ve been told by people that this is a once in a lifetime thing and I’ve said: ‘Absolutely not’.

“I’ve had two pandemics in my professional lifetime, 2009 [swine flu] and 2020. I teach young scientists and doctors there will be at least two, probably more in their working lifespan.”

So are we better prepared for the next one? The Moderna Innovation and Technology Centre in Harwell, Oxfordshire, became fully operational last year and is the UK’s first onshore facility for manufacturing messenger RNA vaccines — the same type as the Moderna Covid jab given to millions of Britons. It could produce up to 250 million vaccine doses a year.

But the Vaccine Manufacturing and Innovation Centre — envisioned as the UK’s permanent, state-backed fortress against biological threats — was sold by the government to a private pharmaceutical company in 2022.

And the government has come under fire for recent funding cuts to global health initiatives including the Pandemic Fund, which supports infectious disease prevention and response efforts in low and middle-income countries, and the Global Polio Eradication Initiative.

Sir Jonathan says: “If the same kind of pandemic occurred, we’ll be much more confident about messenger RNA technology and we would have it onshored. So that bit’s better. But there are also plenty of other bits that are worse and the public is in a different place compared to 2020. I think it’s impossible to say that we are in a better place.”

Messenger RNA technology is sometimes described as a “plug-and-play” platform. Once you know a virus’s genetic sequence, you can quickly create a vaccine.

But it is not a universal silver bullet and future threats may be more suited to other types such as viral vectors, protein subunits, virus-like particles or technologies yet to be developed.

Meanwhile, many jabs used in the UK are made overseas. Even if a vaccine is bottled in the UK, the process usually involves ingredients or components crossing borders.

“Some of the vaccines we use are made heavily in Europe. Some are made in North America,” Sir Jonathan says. “These places are not invulnerable to difficulties in the movement of goods, or costs, tariffs.”

The TBI report recommended “a hybrid approach: marshalling existing domestic capabilities into a coherent sovereign manufacturing core; building allied surge capacity through international partnerships; and targeting investment to remove critical bottlenecks across the vaccine pipeline”.

It added that such capacity — plus regulatory readiness and skilled workforces — cannot be built in a crisis, so “the premium for preparedness must be paid in advance”.

Asked for a suitable metaphor, Sir Jonathan says it is like building a strong football squad. He explains: “The longer the season runs, the more you appreciate the depth of your squad, because you start to pick up injuries, people aren’t available, and things happen that you couldn’t have predicted.”

Clubs that do well are often those that have the most resilience, he adds. “They’ve got a nice big squad covering every position. That’s how I see the different types of vaccine manufacturer, different modalities of vaccine type. We’ve got great cover if we want something really agile — messenger RNA, if it works. But we can’t be absolutely sure. That’s like saying we’ve got a great central defender. Are you going to put the central defender up front, if something changes?”

It is a difficult argument to make in pandemic peacetime, Sir Jonathan knows. He says: “In terms of political terms of office and political lifespans, it doesn’t fit very well. There’s always an immediate, pressing problem to spend money on, and the ones that might happen in the future feel a bit like they’re on the never-never. It’s a can that’s too easily kicked down the road.”

The estimated cost of the UK government’s Covid measures was over £300 billion. The TBI report argued that vaccine access can also determine how quickly a country reopens its economy, protects its healthcare system and preserves social stability.

Sir Peter Horby, director of Oxford University’s Pandemic Sciences Institute, led the clinical trial that discovered the world’s first treatment proven to slash risk of Covid death. He told the Express last year that although lockdowns played a vital role in slowing the virus’s spread, he had “significant doubts that you could ever do that again, not in my lifetime, because of the memories of the people who were very adversely affected and the scepticism that’s been present in various forums”.

Sir Jonathan agrees that the public may not support such sweeping measures again. He adds: “When it was discovered that at No.10 Downing Street there had been parties, when other people were asked to stay away from their loved ones and make sacrifices about visiting their elderly loved ones in nursing homes, that left a very bitter taste in the mouths of many. And so I think it would change public sentiment.”

Now self-employed, Sir Jonathan consults for a range of companies including pharmaceutical firms. He adds: “I take more time off and have whole days off to browse through vinyl record shops and so forth, which is super fun.” Despite giving up his position as a top defender on the national team, his message to the government is clear: if the UK wants to avoid being caught off guard, it needs to start building a stronger vaccine squad today.

A government spokesperson said: “Pandemic preparedness remains a top priority for this government, and research and innovation play a vital role in protecting the public from future health threats.

“Our recently published Pandemic Preparedness Strategy, supported by around £1 billion of investment in health protection, sets out ambitious plans to strengthen the UK’s ability to develop, test and deploy vaccines, diagnostics and treatments at speed in response to emerging threats. This will help ensure the UK remains at the forefront of scientific innovation and is better prepared for future pandemics.”