Coronavirus: lessons learned to date Contents

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7Vaccines

343.The most successful component of the United Kingdom’s response to the covid-19 pandemic has been the development and deployment of vaccines.499 Globally, it is one of the most stunning scientific achievements in history to have gone from having no protection against a devastating global virus, to deploying a range of effective vaccines in less than a year. In England alone it is estimated that more than 112,000 lives have already been saved by this extraordinary success, with tens of millions of infections being prevented.500 It is an element for which the label world-leading can accurately be applied to the UK response. The UK experience in vaccines is replete with lessons that can be learned which can help us, and other nations, build on this success, and do even better in the future. Our experience in this field also provides valuable insights which can be applied to other areas of public policy and administration in the UK.

344.It is worth noting the outcomes of the UK vaccination programme—although, obviously, the results continue to be added to. By 1 September 2021, over 48 million people in the UK had received at least one dose of a vaccine representing 88% of the adult population.501 Further, by mid-September 2021 the UK had impressively recruited over 500,000 volunteers to join the coronavirus vaccine volunteers registry—we are grateful to these individuals for the critical role they are performing in vaccine development.502 In addition the UK has donated already 9 million doses of vaccines to countries in the developing world,503 and our research support for what has become known as the Oxford-AstraZeneca vaccine resulted by late July 2021 in over one billion doses of the vaccine having been released worldwide.504 More than anything else—non-pharmaceutical interventions, treatments, or test and tracing—vaccines have saved us from an ongoing catastrophe.

345.The UK vaccination project consists of several important, but distinct, elements. Part of its overall success was the effective performance of each element. But part, too, was the effective interplay between different elements—such as between procurement and regulatory approvals—that is all the more remarkable because of the independence of many of the bodies concerned. In this respect, it has been a success of a systems approach rather than centralised command and control. In this Chapter we consider a number of the principal elements of the UK vaccine project, including:

• the process of discovery of candidate vaccines;
• the procurement of vaccines;
• the licensing and approvals processes;
• the manufacture of vaccines to the UK population; and
• the supply of vaccines to the rest of the world.

Discovering a covid-19 vaccine

346.The foundations of the UK being not only a procurer of vaccines but a significant developer of vaccines against covid-19 rely on the strength of our science base, and in particular the life sciences.505 It is important to remember that several UK research institutions were immediately engaged in seeking to discover—at unprecedented speed—a vaccine effective against covid-19 from January 2020 when the virus had first been sequenced. The capability of each—including the Jenner Institute at the University of Oxford, and the Faculty of Medicine at Imperial College, London—has been built up over many years, and, in the case of the Jenner Institute, had been prominent in the search for vaccines to be deployed in previous pandemics, including against MERS.506 It is clear that funding for such internationally excellent research institutions is an investment that pays off in multiple ways—advancing knowledge, training scientists to become world-class—that are not immediate.

347.The UK Vaccine Network was set up in 2016 in the wake of the Ebola epidemic in West Africa.507 The Network, chaired by Professor Chris Whitty, Chief Medical Officer for England, is focused on supporting the Government to identify and shortlist investment opportunities that will combat infectious diseases with epidemic potential. The Network brings together industry, academia and relevant funding bodies. It has four working groups that: identify and prioritise human and zoonotic diseases; understand how a vaccine will impact on an epidemic disease outbreak; produce a process map for vaccine deployment, from discovery to deployment; and look at the manufacture of vaccines.508 As mentioned earlier in this Chapter, the Oxford/AstraZeneca vaccine was based on the same technology developed by a previous project funded by the Government in 2016 to find a vaccine for MERS. That research was funded through the UK Vaccine Network.509

348.It also shows the value of funding different institutions and programmes. Vaccine discovery is an uncertain process510 and it was not knowable at the outset that the Oxford research team would achieve the breakthrough they did, while the Imperial programme has experienced setbacks on the way. During the early months of the pandemic it was not known—or even knowable—that a vaccine would ever be discovered against covid-19. Nevertheless, the Government acted with commendable agility in directing additional funds—at risk—to fund the research avenues that had been embarked on. The Science and Technology Committee, in private, strongly advocated for this investment during the early days of the pandemic, in recognition of how critical a vaccine was given that deaths would continue at unacceptably high levels until a vaccine was discovered. It is also notable that a vaccine was developed within a year of the pandemic, despite, according to Dominic Cummings, the “conventional wisdom […] that we were not going to be able to have any vaccines in 2020.”511

349.The then Secretary of State for Health and Social Care also said that vaccine development would receive the full support of the state:

I first started the push for a vaccine in January. In fact, I had a meeting on 25 January pushing for a vaccine in which I was told that it would take a long time, that it would take normally years and typically, if we accelerated everything and if everything went right, it would take a year to 18 months. I said, “I want one within a year and we will throw the full resources of the state at making that happen”.512

On 28 July 2020, the Government said that it had “fully funded the Oxford clinical trials, to the cost of £20 million” and that it had provided Imperial College London with £22.5 million to allow their vaccine to enter human trials.513

The procurement of vaccines

350.One of the soundest judgements of the entire pandemic was that, notwithstanding the public funding directed to UK institutions engaged in the discovery of vaccines—we should at an early stage procure for the nation supplies from a wide range of different candidate vaccines being developed in other countries.514

351.The Vaccine Taskforce was established in April 2020. The Life Sciences-focussed venture capitalist Kate Bingham was appointed to lead it in May 2020.515 The Taskforce was a team drawn of Life Sciences industry professionals, civil servants and scientists, and was based outside the Department of Health and Social Care physically and in reporting terms. The team was based in the Department for Business, Energy and Industrial Strategy and Kate Bingham reported directly to the Prime Minister. In his oral evidence to us, Dominic Cummings said that the Vaccine Taskforce was an initiative of Sir Patrick Vallance, the Government Chief Scientific Adviser (who had been appointed to his position following a successful tenure in the Life Sciences industry). Mr Cummings said that Sir Patrick texted him on or around 24 March seeking his support in pitching the proposition to the Prime Minister that the team should be established outside the Department of Health and Social Care.516 Mr Cummings said that Sir Patrick, along with the then Cabinet Secretary, Sir Mark Sedwill, and himself put to the Prime Minister that it was “inconceivable we can leave it in DH (the Department of Health and Social Care)” based on concerns over the performance of the Department on procurement during February and March, which had led Dominic Cummings to describe the Department of Health and Social Care as a “smoking ruin”.517

352.The Vaccine Taskforce was asked to deliver three objectives:

(1)to secure access to promising vaccines for the UK population;

(2)to make provision for international distribution of vaccines; and

(3)to support the industrial strategy by establishing a long-term vaccine strategy plan to prepare the UK for future pandemics.518

353.The model of the Vaccine Taskforce built on collaborative arrangements, outside the usual Whitehall organisation, that had been established in the Office for Life Sciences in 2009 and developed further by the Life Sciences Industrial Strategy in 2017.519

354.It is clear that the bespoke structure of the Vaccine Taskforce together with Kate Bingham’s direct approach to leadership, including building a high performing team around her, were of great importance.520 It is also very clear that much of the success of the UK vaccine project was attributable to the Vaccine Taskforce, and in particular its bespoke role within the official system—a diverse group of people, led by an independent, industry-experienced individual, and sitting outside the Whitehall hierarchy.521

355.However, Dominic Cummings expressed to us concern that what made the Vaccine Taskforce distinctive and effective was being eroded and that since Kate Bingham’s departure:

the normal entropy process of Whitehall has got its fingers on the thinking and the operations around this. There hasn’t been the kind of very aggressive approach that some inside government want about thinking through the danger of variants and how to make sure that the vaccine taskforce is ahead of the game.522

356.Crucial too were strategic judgements, and one of the most important was to procure firm orders with a range of potential vaccine suppliers long before they had been established as clinically safe and effective.523 Dominic Cummings said: “Patrick Vallance and his team were saying that the actual expected return on this was so high that even if it does turn out to be wasted billions, it is still a good gamble in the end.”524

357.Vaccines and therapeutics go through three phases of trials before being approved by a regulator. Phase one begins in a small group of people to check safety; phase two has more participants and seeks to establish the immune response; and phase three assesses the degree of effectiveness and establishes side effects.525 By November 2020, before most vaccines had reported their phase three trial results, the Vaccine Taskforce (VTF) had negotiated and signed agreements for:

• 100 million doses of Oxford/AstraZeneca;
• 60 million doses of Valneva;
• 40 million doses of Pfizer/BioNTech;
• 60 million doses of Novavax;
• 7 million doses of Moderna;
• 60 million doses of Sanofi/GSK; and
• 30 million doses of Janssen.526

There have been additional agreements for the UK since November 2020, including 95 million more doses of the Pfizer vaccine;527 50 million doses from CureVac;528 an additional 40 million doses of the Valneva vaccine;529 and 10 million more doses of the Moderna vaccine.530

358.In October 2020, Kate Bingham, the then chair of the VTF, wrote that the Taskforce sought agreements which represented a range of different vaccine technologies to ensure that if one type of vaccine failed, the UK still had access to others.531 This approach built in a high degree of resilience to the UK’s access to vaccines. We also heard that the VTF benefitted from there being clear responsibility and accountability as the team had very clear leadership.532

359.Other aspects of the procurement were to prove critical, including the insistence that orders placed would be fulfilled before other countries who might subsequently place orders.533 Nonetheless, the agreement that the Vaccine Taskforce struck with AstraZeneca in May 2020 envisaged that 30 million doses would be supplied by September 2020, whereas in fact Kate Bingham told us In November 2020 that the UK would probably get “up to about 4 million doses at the end of the year”.534 Kate Bingham explained why the September 2020 deadline had not been met:

Those 30 million doses assumed a linear yield on scale-up. When you manufacture these vaccines, you start at test tube level, scale up sequentially and ultimately get to the 1,000 or 2,000-litre scale. The projections, made in good faith at the time, to get to 30 million doses in September assumed that absolutely everything would work and that there would be no hiccups at all in going from microlitre scales to 1,000 or 2,000-litre scales.

It has not gone linearly, and that is not through lack of care and attention, availability of equipment or anything like that. It is just that it normally takes a very long time. The answer is no, but it is now at the 1,000-litre scale, and that is working.535

Sir Tom Keith-Roach, President of AstraZeneca UK, told the Science and Technology Committee in January 2021 that manufacturing drug substance was a “complex biological process” that took 50 to 60 days and could not be sped up.536

Manufacturing vaccines

360.Another notable feature of the innovative approach which the Vaccine Taskforce took was to contract at risk with vaccine suppliers for supplies to be manufactured before regulatory approval had been given. Dominic Cummings told the Committees that the ability to run in parallel research, regulatory and manufacturing processes, and to finance them, was an opportunity that arose because the UK was outside the EU procurement system, recalling advice that:

The EU plan looks like the classic EU Brussels thing. It will be completely bogged down in bureaucracy. They will not be able to take the right financing decisions. They will not do this parallelisms approach of building everything and subsidising everything as you go along.537

361.Despite issues in scaling up, the UK was able to adapt. In order to speed up the timeline of the covid-19 vaccine, some pharmaceutical companies were producing the vaccine substance ‘at-risk’ before regulatory approval had been granted. Then chair of the Vaccine Taskforce, Kate Bingham, told us:

To ensure that the vaccines are ready as soon as they are approved, we are manufacturing now. We have vaccines already in place, so that as soon as we have approval from the MHRA we will be able to start to deploy them, or hand them to [the Department of] Health to deploy.538

Starting manufacturing early, as described above by Kate Bingham, meant that issues in scaling up were realised and resolved before regulatory approval and the roll-out.

362.The Government and its predecessors also took steps to accelerate the building of vaccine manufacturing capacity in the UK. The 2017 Life Sciences Industrial Strategy had identified the need to reverse the relative underinvestment in vaccines manufacturing capability by the UK—both relative to the UK’s strengths in discovery and the science around new vaccines, and compared with the resilience against the sudden demands of future pandemics.539 The Industrial Strategy proposed and established a national Vaccines Manufacturing Innovation Centre (VMIC) to address this gap.540 While the need to develop vaccine manufacturing capacity had been envisaged in the Industrial Strategy, the covid pandemic and the vaccine requirement came before the VMIC was scheduled to open in 2022. In May 2020 the Government announced £93 million of additional investment to accelerate by a year the completion of the VMIC, followed by a further £47.6m in March 2021.541 As a result, the Centre would be able to produce up to 70 million vaccine doses within a six-month response time.

363.The Government has made further commitments to vaccine manufacturing including in July 2020 to acquire a facility in Braintree for use by the Cell and Gene Therapy Catapult Manufacturing Innovation Centre, due to come on stream in December 2021, and investment with vaccine manufacturer Valneva to update and expand its facility in Livingston, Scotland.542 The UK’s order for vaccines from Valneva has been cancelled.543 As such, it is not clear what the implications are for the facility in Livingston.544

Trials and regulatory approval

364.Another feature of the agile and innovative approach taken in the vaccine programme was that of the approvals processes—in terms of the clinical trials of candidate vaccines, the order of prioritisation for vaccination and the approved dosage intervals.

365.Confidence in the safety and efficacy of new vaccines is of fundamental importance and this confidence is substantially based on the regulatory standards that govern their development and deployment. The expertise, rigour and independence of the UK regulators—principally the Medicines and Healthcare Products Regulatory Authority (MHRA), the Joint Committee on Vaccination and Immunisation (JCVI) and the Commission on Human Medicines—is foundational to that.

366.Prior to the UK’s departure from the European Union, the European Medicines Agency (EMA) would have had a decisive influence on the regulatory process in the UK and as we referred to in paragraph 360, some evidence to our inquiry drew attention to the greater ability to act in an innovative way that came from being outside the EMA’s writ.

367.On 2 December 2020, the MHRA approved the Pfizer/BioNTech vaccine for use in the UK—the first regulator in the world to do so.545 On 8 December 2020, the first person in the UK, outside of a clinical trial, was vaccinated. Pfizer announced the conclusion of its phase 3 trial only on 18 November.546 Dr June Raine, Chief Executive of the MHRA, explained how the MHRA was able to approve the first vaccine so quickly:

We adopted a novel, or innovative, regulatory process known as a rolling review. Normally, all the data on a vaccine’s safety, quality and effectiveness, and all required documentation, must be submitted together to start an evaluation to approve a medicine or a vaccine. In the case of a rolling review—in this case—we reviewed data in packages or tranches as soon as they became available from the ongoing studies, on a staggered basis. By reviewing data as soon as it became available, we could reach an opinion sooner on whether the medicine or the vaccine could be approved.547

While other regulators, namely the European Medicines Agency and the US Food and Drug Administration, were also carrying out rolling reviews of data, Dr Raine put the MHRA’s swiftness down to “the flexibility and agility of the clinicians and scientists at the MHRA”.548 The Oxford/AstraZeneca vaccine was approved in the UK shortly after the Pfizer vaccine on 30 December 2020 with the first person in the UK receiving the vaccine on 4 January.549 The Moderna vaccine was approved in the UK on 31 March 2021,550 and the Janssen vaccine was approved on 28 May 2021.551

Prioritisation

368.On 2 December 2020, following the approval of the Pfizer/BioNTech vaccine, the JCVI updated its prioritisation advice. It was largely based on age bands, but also included frontline health and social care workers, clinically extremely vulnerable individuals and those with more serious underlying health conditions. The Government accepted the JCVI’s advice and followed it. Professor Anthony Harnden, deputy Chair of the JCVI, told the Science and Technology Committee in February 2021 that:

One of the key reasons that the programme has been so successful is that it has been simple, it has been deliverable, it has been rolled out very quickly, and people understand it. If you start picking out certain groups, it will make it more complicated, and the risk of doing that is slowing the programme down. If you slow the programme down, it may be that some people will be exposed to virus and actually suffer harm who would not have otherwise.552

369.During December 2020, as the most vulnerable in society began to get vaccinated, vaccine supply remained constrained. Further, case numbers, hospitalisations and deaths were reaching a peak in England. Considering these two issues, the JCVI advised:

delivery of the first dose to as many eligible individuals as possible should be initially prioritised over delivery of a second vaccine dose. This should maximise the short-term impact of the programme. The second dose of the Pfizer-BioNTech vaccine may be given between 3 to 12 weeks following the first dose. The second dose of the AstraZeneca vaccine may be given between 4 to 12 weeks following the first dose.553

In practice, second doses would be delayed to enable more people to have a first dose. The JCVI cited data indicating high efficacy from the first dose of both Pfizer/BioNTech and Oxford/AstraZeneca vaccines.554 The advice was backed by the four Chief Medical Officers of the UK.555 At the time, the JCVI was criticised by some for its decision to recommend a change in the schedule of doses.556 We note that in subsequent studies conducted by Public Health England, there has not been a decrease in efficacy of the vaccines following the extended interval.557 The JCVI has subsequently changed this advice in response to the new Delta variant. On 14 May 2021, the JCVI advised the Government to bring forward second doses from 12 weeks to 8 weeks to ensure the fullest protection.558 At each stage, the UK’s regulators have shown themselves to be willing to be innovative in setting the rules that must be met with a constant eye to the emerging evidence and optimal public health outcomes.

370.The decision, taken in late December 2020, to indicate a longer interval dose between vaccines was a decisive and courageous one. It was met with criticism by some scientific experts, and occasioned some public opposition among those who had been given their first does and for whom attaining full protection was put back by up to eight weeks. But it was a decision that significantly enhanced the pace of protection for the UK population and, it was established, boosted the efficacy of the vaccine, with AstraZeneca describing an “eight to 12-week interval” between doses as the “sweet spot”.559

Distribution of vaccines

371.From the authorisation by the MHRA of the first covid-19 vaccine on 2 December, the first UK patient outside a clinical trial was vaccinated on 8 December. Less than 8 weeks after the first vaccine was administered in the UK, on 3 February over 10 million people had received their first dose. This included 9 in 10 of those aged 75 and over in England and represented a significant proportion of the top four at-risk groups, who accounted for 88% of covid deaths, having their first vaccination.560

372.The distribution of vaccines was the mirror image of the test and trace operation. It sprang into large scale operation explosively and impressively, rather than slowly and inadequately; it made extensive use of existing NHS resources—hospitals, GPs and pharmacists—it welcomed third party assistance—such as the countless volunteer groups across the country—rather than having the approach of repelling local assistance that test and trace initially favoured.561

373.It is fair to acknowledge that the Government and the NHS had more time to prepare for an effective distribution for the vaccines than was the case with the test and trace regime, given that vaccine approval came ten months into the pandemic. However, one of our concerns about the test and trace operation was its failure to plan for foreseeable future needs even after the initial demand.562

374.The NHS already had substantial experience in rolling out vaccines as it does every year for the annual flu vaccine.563 According to the National Audit Office (NAO), NHS England and Improvement developed three delivery models by December 2020 to help deploy covid-19 vaccines:

• Fixed location mass vaccination sites;
• Rolling vaccination sites; and
• Mobile mass vaccination sites.

By 23 December 2020, the then Secretary of State announced that vaccines were being delivered from 500 sites across the UK. He also announced that vaccinations had begun in care homes.564 As of 26 July 2021, there were nearly 3,600 vaccination sites in England.565 These sites are made up of hospital hubs, GP led services, pharmacies and vaccination centres in the community. According to NHS England, 99% of the population live within 10 miles of a vaccine service.566

375.The then Secretary of State told the Health and Social Care Committee in January 2021 that Primary Care Networks were a key part of the success of the vaccination programme, whilst maintaining the activity of GPs:

One of the reasons we are doing it through groups of GP practices, through the primary care networks, is that most GP practices are contributing to, but not having to take full responsibility for, a Covid vaccination centre. Essentially, groups of GP practices are coming together, with each lending a number of people to create the Covid vaccination team. That allows us to keep many GP services running as normal, but obviously that has to focus on the most important healthcare needs.567

376.On 6 January 2021, the Prime Minister announced a target of offering a vaccine to everyone in the JCVI top four priority groups by 15 February.568 The top four priority groups included an estimated 14.6 million people.569 The Government subsequently announced that it had reached its target, and set a new target of offering everyone in the top nine priority groups the vaccine by May 2021, and all adults by September 2021.570

377.The Government published its vaccines delivery plan on 11 January 2021.571 The plan covered: supply; prioritisation; places; people; and tracking progress. The plan said that an 80,000 strong vaccination workforce had been trained and would be deployed across the country. This included current and returning NHS staff, St John Ambulance personnel and volunteers. The Government also consulted and made changes to regulations to enable more people to administer the covid-19 and flu vaccines. The Government amended the Human Medicines Regulations 2012 (SI 2012, No. 1916) such that healthcare professionals who did not normally vaccinate patients could now do so. This included: paramedics; physiotherapists; student doctors and nurses; and doctors and nurses working outside the NHS.572

378.The roll-out of the vaccine in England and the rest of the UK has been one of the fastest in the world. The NHS had a relatively long lead-in time to prepare for the deployment of vaccines. By September 2020, a new Deployment Programme Board was set up to assure delivery and provide cross-Government oversight. It was also jointly chaired by the senior responsible officer in NHS England and Improvement and the deployment lead within the Department for Business, Energy and Industrial Strategy.573 The NHS also benefitted from having access to large amounts of data through the population’s GP and other NHS records. Using that data to establish different priority cohorts, contact patients and follow up with them has enabled a high take-up rate. The then Secretary of State for Health and Social Care also told us that there was a split between the national and local approach:

On the vaccine roll-out we have local and national data integration. We have the local systems going and finding people who are hard to reach. We have the national system for the big numbers, for the people who are enthusiastic and willing to drive and queue up.574

379.The vaccine rollout was not plain sailing. Notwithstanding the efforts of the Vaccine Taskforce, supply problems from manufacturers meant that there were periods during which vaccines were in short supply.575 Yet the Government and the NHS succeeded in maintaining public confidence in the leadership and operation of the vaccination programme, partly through a transparent communications programme.

Global distribution of vaccines

380.Covid is a global pandemic and its infectiousness does not recognise national borders. Witnesses have consistently pointed out to our Committees that, as with the initial virus itself, border restrictions could at best delay and not prevent the incursion of new variants into the United Kingdom—as the experience of Australia and New Zealand has shown.576 That means that there is a national interest, as well as our moral obligation, to act globally to ensure that vaccination is made available as quickly as possible to all countries in the world. The United Kingdom has long been a leader in providing and coordinating medical assistance, especially to those countries in the world that lack our wealth and scientific and medical assets.

381.During the pandemic, the UK has continued to play a prominent global role in this respect. COVAX is coordinated by the WHO, Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations. The Gavi COVAX Advanced Market Agreement aims to ensure that 92 middle and lower income countries that cannot fully afford to pay for covid-19 vaccines receive access to vaccines.577 The UK has pledged $735 million, making it the third largest contributor behind the United States and Germany, as of June 2021.578 Ahead of the G7 summit in June 2021, the Government pledged to donate 100 million surplus coronavirus vaccine doses to the world within the next year.579 The G7 also pledged 870 million vaccine doses to the world, half of which would be delivered by the end of 2021.580

382.It is notable that the Oxford/Astra Zeneca vaccine, developed with the support of UK Government funding, accounts for almost a third of all the vaccine doses ordered globally.581 It is being distributed in 178 countries, significantly more than the next most available vaccine Pfizer which is available in 106 countries,582 and accounts for more than 90% of the vaccines being distributed by Covax.583

How could things be done better?

383.For all of the success of the UK’s vaccine project there are lessons that can be learned already which have the potential to improve not only our capacity to respond to new pandemics such as covid-19, but with applications more widely for public policy.

384.One such area is in the time taken to progress from identification of the virus to the widespread deployment of a vaccine. Outstanding as it is to have accomplished this in less than a year, it may be that in the future this could be conducted in much shorter time still. Following the identification of the genome of covid-19 on 11 January 2020, what was to become the Moderna vaccine was designed within days.584

385.Dominic Cummings suggested to the Committees that—in the face of a future pandemic of the most consequences for health—we should be prepared to accelerate the clinical trials by authorising human challenge studies in which healthy individual volunteers are willingly injected with the virus and a proportion of them with its prospective vaccine. Mr Cummings said:

The companies doing the mRNA vaccines basically created the vaccine itself in literally hours in January […] if we had done that [human challenge trials] we could definitely have got vaccines into people’s arms by December.585

386.There are a number of other aspects that could be improved to speed up the availability of a vaccine. Professor Andrew Pollard, Director of the Oxford Vaccine Group, told the Science and Technology Committee in June 2021 about some of these areas for improvement:

If we look at the pinch points for speed that are perhaps within control, one of them is the speed of manufacturing for the trial. I do not mean for the roll-out. We had very limited capacity for manufacturing at the beginning of last year to start making vaccines for trials. That was the first component. That is changing already. There is investment in the new vaccine innovation centre in Oxfordshire. There will also be new opportunities with other manufacturing organisations to speed up that process.

The other is the scale of the trials. If you can launch larger-scale trials in more countries more quickly, you have a greater chance of catching a wave of disease in the pandemic, which gives you the cases earlier to get an answer quicker. Those two things would definitely make a difference. […]

Investment over the years ahead in understanding more about other viruses and other potential pandemic threats so that we are prepared as we were with coronaviruses to go so quickly is perhaps the most important thing that we need to do in preparedness.586

Trials of treatments

387.One of the strongest, and most easily overlooked, components of the UK’s response to covid-19 has been in its forward position in trialling treatments against the disease. The RECOVERY Trial had, by mid-August 2021, recruited just over 42,000 volunteers worldwide to mount randomised trials of covid-19 treatments.587 Professor Peter Horby told our inquiry, “It is probably true to say that the UK has, of any country, been the most successful in running clinical trials for the treatment of Covid-19[…] we are, by far, the biggest trial in the world.”588 As a result of these mass-participation randomised clinical trials, treatments like dexamethasone were found to make a major contribution to reducing the severity and duration of covid-19 among patients receiving respiratory support. Professor Chris Whitty, Chief Medical officer for England, for example, told the Science and Technology Committee in November 2020, that “On dexamethasone, the UK can feel proud that this is something we did for the whole world very fast. That will reduce mortality”.589 Establishing the effectiveness of dexamethasone was a vital contribution to the worldwide battle against covid-19 and is estimated to have saved over a million lives globally.590

388.Also, importantly, these trials were able to establish the ineffectiveness of some mooted treatments for covid-19 such as hydrochloroquine. As the then Secretary of State told us:

On hydrochloroquine you might remember […]—that some quite influential figures decided early that it was obviously right and declared victory on it, but when the recovery trial saw it through to the end, when you had a clinically validated and statistically accurate answer, it found no benefit of hydroxychloroquine. You have to follow the science on it. This is one of the areas where Britain absolutely nailed it.591

Conclusions and recommendations

Conclusions

389.The Government presciently identified that a vaccine would be the long-term route out of the pandemic and supported the research and development of a number of covid-19 vaccines, including the successful Oxford/AstraZeneca vaccine. A significant part of the success of the Oxford/AstraZeneca vaccine was due to the Government’s early investment in research and development. Investment and support through existing channels and forums such as the UK Vaccine Network have clearly paid off and illustrate the importance of looking ahead for future challenges.

390.The UK vaccination programme—from discovery of potential vaccines against covid-19 to the vaccination of nearly 80% of the adult population by 1 September 2021—has been one of the most successful and effective initiatives in the history of UK science and public administration. Millions of lives will ultimately be saved as a result of the global vaccine effort, in which the UK has played a leading part. In the UK alone, the successful deployment of effective vaccines has allowed, as at September 2021, a resumption of much of normal life, with incalculable benefits to people’s lives, livelihoods and to society.

391.The strength of the UK’s scientific base—that is to say, the institutions, people, and previous experience on which the discoveries made depended—was foundational to the success of the programme. The Government responded, from the outset, decisively and with alacrity to the need for additional funding to advance projects with a potential to develop new vaccines.

392.The UK regulatory authorities—principally the MHRA and the JCVI—approached their crucial remit with authority and creativity. Allowing the results of clinical trials to be submitted on a rolling basis made the UK the first Western country in the world to approve a vaccine. The bold decision to extend the interval between doses allowed more people to be vaccinated more quickly and so protected the population.

393.The establishment—following the suggestion of Sir Patrick Vallance—of the Vaccine Taskforce outside the Department of Health and Social Care, and comprising a portfolio of experienced individuals from industry, healthcare, science and Government was a masterstroke. The bold, authoritative leadership of Kate Bingham was of crucial importance. The Vaccine Taskforce carried forward the model established in the Life Sciences Industrial Strategy. That strategy also highlighted and acted upon the relative lack of UK vaccine manufacturing capacity. The Government was right to act to accelerate the delivery of institutions like the Vaccines Manufacturing Innovation Centre proposed in the Industrial Strategy, and to have invested further in manufacturing capacity.

394.The decision to procure, at risk, and long in advance of regulatory approval, a broad portfolio of supplies of potential vaccines was bold and prescient, as was the commitment to order vaccines in quantities in excess of what was needed.

395.The successful roll-out of vaccines to the whole of the UK population reflected a collaborative approach between many different groups, national and local, embracing GPs and the NHS locally, pharmacies and community volunteers, as well as the Armed Forces.

396.The success of the vaccine programme has redeemed many of the persistent failings of other parts of the national response such as the test and trace system, so that the outcome is far better than would have been the case without this success.

Recommendations and lessons to be learned

397.It is essential that support for, and investment in, the UK science base is protected and enhanced. This should include delivering the Government commitment from Budget 2020 and the 2021 R&D roadmap to invest £22 billion per year in R&D by 2024/25. Science has saved the world from the even greater catastrophe of covid-19 without the defence of vaccines. The experience should alert us to the risk of unforeseen threats against which a world-class and experienced scientific capability is the best investment.

398.A strategic approach should be taken to manufacturing vaccines. The Life Sciences Industrial Strategy identified vaccine manufacturing as an area in which the UK could and should be stronger and set out deliberately to act on this by creating the Vaccine Manufacturing Innovation Centre. Looking forward and comparing future opportunities and threats against current capability and acting to resolve them is a responsible approach.

399.The Vaccine Taskforce model of forming flexible teams outside of the usual Whitehall administration, but working with it, and comprising people with outside expertise working within it, is a successful one. It should be considered for delivering other Government priorities. However, it is concerning to hear that the Vaccine Taskforce model is being eroded by incorporation into “the normal entropy process of Whitehall”, and this erosion should be arrested. The procurement model deployed by the Vaccine Taskforce of making decisions at risk, outside conventional procurement procedures, proved highly effective. Lessons from this success should be applied to other areas of Government procurement.

400.The UK’s regulatory system responded with rigour but flexibility. It could be that the approvals process and the conduct of clinical trials could have proceeded even more quickly, for example by making use of human challenge trials. This may not be appropriate in anything but the most exceptional circumstances—i.e. a deadly pandemic—but an assessment of this should be made now before such an occasion might arise.

401.The use of the Armed Forces—as well as civilian volunteer groups—proved effective in advancing the vaccine roll-out quickly and reliably. Protocols should be established to allow the Armed Forces quickly and at scale to participate, and the NHS should consider ways in which it can be more accommodating of volunteer support in normal times building on the experience and enthusiasm demonstrated during the pandemic.