A year ago a day, and before the eyes of the whole world, the United Kingdom began its vaccination campaign against Covid-19, slightly ahead of the rest of the planet. Margaret Keenan, 90, will go down in history as the first person in the world to benefit from the messenger RNA vaccine developed by the Pfizer-BioNTech laboratory. An expected moment, so much helplessness dominated until now before the devastating waves of Covid that later turned the United Kingdom into the most heartbroken country in Europe by the disease.
Since December 8, 2020, injections have never stopped throughout the Canal. As of December 5, around 118 million doses had been administered in England, Scotland, Wales and Northern Ireland. With L’Express, Immunology professor at Imperial College London, Danny Altmann, looks at what still seemed like a crazy gamble at the time.
L’Express: How do you see the UK vaccination campaign?
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Here it is often described as a great success! It is true that it first acted quickly and powerfully to stop the wave of contamination by the Alpha variant in the winter of 2020. On the other hand, adherence has been gradually decreasing compared to other European countries: in the second dose, we are only the ninth most advanced country on the continent. In addition, we have been remarkably slow to approve vaccines for adolescents. This means that many of them returned to school at the beginning of the school year without being vaccinated. They played a very important role in the long plateau of contaminations linked to the Delta variant (still ongoing). Second, because we got vaccinated early, we lost immunity before everyone else, and the booster campaign wasn’t launched quickly enough. So my verdict is this: the campaign did quite well, yes, but not brilliantly either.
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Instead, the UK has relied on the adenovirus-based AstraZeneca vaccine rather than mRNA vaccines in the first place. Was this the right choice, after the criticism made of it, especially in Europe?
I was a bit shocked to see this vaccine trivially politicized to the detriment of public health. In the end, in my opinion, AstraZeneca / Oxford has arguably had the biggest global impact on mitigating the pandemic, benefiting more countries and accounting for billions of injected doses. Our lab [au Hammersmith Hospital, sur le campus de l’Imperial College] performed one of the most comprehensive meta-analyzes of all vaccine trials. The advantages and disadvantages are different each time. Vaccines obtain slightly better results in terms of neutralizing antibodies, some for T lymphocytes, others see that their effects last longer, others less … And all this also varies according to the responses to the variants. In truth, any of the 20 vaccines currently on the market could get a country out of the mess Covid has gotten it into. The use of mRNA vaccines for the booster (or third dose) is a more nuanced scientific decision based on concerns about potential resistance related to antiadenoviral antibodies. [propriété des vaccins à adénovirus comme AstraZeneca], although that may not be a problem.
What were your fears before British Covid-19 vaccination started? The country was the first to embark on mass vaccination, with products certified but still unknown to the general public.
My fears were just that we wouldn’t get the vaccines fast enough to prevent an even bigger disaster. As an immunologist and vaccinologist, I was aware of the scope of work done on adenovirus (such as AstraZeneca) and mRNA (Pfizer-BioNTech-Moderna) vaccines over the past ten to fifteen years. So I had high hopes that they would be successful.
What conclusions can be drawn a year later on the evolution of vaccination?
The overwhelming bottom line is that there are now 24 different vaccines in the world (and more than 100 in trials), largely based on highly immunogenic presentations of the Spike protein. Many of them have already been overwhelmingly effective in alleviating the horrors of the pandemic.
On the other hand, and after spending a long time mapping the immunity to SARS-CoV-2 (and its decline), I have been more deeply disturbed by the dangerous misinformation that “natural immunity”, to catch Covid, could in a way of be an alternative strategy to vaccination. We see the cost of this unfortunately, as in the United States, where some anti-mask and anti-vaccine counties have several times the mortality of others. This price to pay is very high.
What do you think are the consequences and lessons to be learned from this campaign in terms of public health?
We need a true pandemic preparedness strategy, including vaccine platforms that are fully ready to go. I deeply hope that the lessons are now being learned. On the other hand, more positive, the new impulse behind vaccines and new technologies will fuel tomorrow the fight against other great killers where progress had slowed down: malaria, HIV or tuberculosis.
What strong image of this vaccination campaign do you take into account?
Having worked in this field all my life, I felt a certain emotion to see hundreds of people in front of the vaccination centers queuing early in the morning to be greeted by volunteer vaccinators, cups of tea and, above all, vaccines with a level. efficiency that none of us had dared to dream of. Of course, there are negative images. SARS-CoV-2 acts like a killer virus that binds to our ACE2 receptors and can kill us unless it has a high level of neutralizing antibodies, induced by vaccination. Unfortunately, I have met many people who are not convinced of this and who claim to have done their own “research” on Facebook or Google. Or others that evoked “alternative facts.”
How do you see next year? Should we now develop new vaccines, even more robust, or go first for a third dose for all? Both maybe?
The global landscape of SARS-CoV-2 viral evolution and host immunity is now diverse and rapidly changing. We are faced with a much more complex disease than the blank sheet we started with in December 2019. People all over the world may not be infected or have been infected in various ways with the Wuhan strain, Alpha, Beta, Gamma, Delta, Omicron, this overlapped by several vaccines, or none at all.
The most important thing now is to work hard for a fair global distribution of vaccines. It is not just altruism. It is the certainty that we will never be free from new epidemics and variants until we have brought everyone to safety. We have seen with Omicron that a variant can cross the globe in a few days. In the short term, the answer is definitely callbacks. In the longer term, it will be necessary to resort to new generation vaccines that will offer more extensive and lasting protection.
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You talk about universal access to vaccines, but will we be able to convince the whole world to get vaccinated?
At first, many of us looked at data from around the world on vaccine reluctance in various countries (especially France) and worried that it would lessen its effects. In fact, most countries have adopted the vaccine much earlier than expected. That is, many returned who doubted the vaccines. The data still fluctuate by country, but in general this reluctance tends to decrease with the increase in cases and deaths.
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