Harnessing vaccine hope in a pandemic – in conversation with Sir Jon Symonds, Chairman of GlaxoSmithKline

Q. Why is a vaccine so essential to tackling COVID-19?

A. The human immune system has developed over millions of years and is incredibly sophisticated at identifying and fighting off foreign bodies. If there wasn't a vaccine, we would eventually adapt, but many hundreds of thousands of people would die before the immune system overcame the threat.

A vaccine accelerates that natural process by putting the pathogen in your body at safe quantities in order to stimulate a response without an extreme reaction. By doing so, it saves millions of lives.

Q. How have we been able to achieve a vaccine so quickly?

A. The process shows what the world can do when it genuinely unites to solve a problem. It normally takes eight years to produce a vaccine, but the industry collaboration, between companies of all sizes and with academia, is unprecedented.

The second thing we've seen is collaboration between the industry, governments and regulators. Financial and regulatory are two of the big risks associated with long-term vaccine development. Government funding took the financial risk off the table, and closer partnership with regulators made the standards of approval clear. The third and probably the most important thing is that the new sciences have really delivered. The pathogen was sequenced literally within days of being identified and from that sequencing and all the data that came with it, scientists were able to identify this spike protein, enabling a really specific definition of what the protein the virus really attached to. And then you got the mNRA technology, and the analytics that went with it. So those three things coming together have enabled this unique response.

Q. Obviously when something is developed so quickly, there are popular concerns about the safety. What does the testing process entail, and is it ongoing?

A. Typically this is a sequential process, so you do your testing either in silico or in animals, and then you move to the three human phases. This time, a lot of those processes have been undertaken in parallel, which has seen the same things being done but considerably faster, crucially with no shortcuts.

Going into large scale trials means that you would already be pretty confident that it's safe. So, whilst you'd still be surveying safety, the important question now is does it work? And this is why we've been hearing the efficacy statistics because simply if it wasn't safe, it wouldn't have reached this stage.

Later stages of testing are to try to establish how effective it is and in which patient populations is it safe. Obviously, you don't normally expect to get 90 per cent responses – these are extraordinary, which would tend to suggest that it's effective across all groups. But what you're really looking for is optimal usage, taking into account data such as age, ethnicity, gender, other pre-existing medical conditions, and so on across the patient population.

Q. We've heard about 95 per cent efficacy and 70 per cent efficacy. What are the other factors that matter when thinking about the 'best' vaccine?

A. There is a trade-off between ease of distribution and access and efficacy. The Pfizer vaccine is 94.5 per cent effective, but needs to be stored at minus 80 degrees, so distribution is complex. The AstraZeneca is 70 per cent effective but like a flu vaccine, it can be distributed through a refrigerated process which is significantly easier. The vaccine that GSK's developing, is expected to be like a flu vaccine where the distribution systems already exist. And 70 per cent, which is probably better than the annual flu vaccine, is still pretty good. Of course, what we don't yet know is which vaccine produces the strongest antibody response and how durable those antibodies are. That work to understand the durability of immunity will continue and those patients currently in clinical trials will continue to be monitored to find out how the antibodies react.

Q. Has enough been done to ensure the vaccine reaches people in the emerging economies?

A. Being able to think beyond self and consider the wider good is a huge test for humanity. One aspect of that is our commitment to rebuilding global health institutions. Facing their first big health shock, those institutions haven't operated as effectively as they should have and rebuilding those and committing to global health needs to be driven because the world believes that everybody has the same right to human health whether or not you've got money in your pocket.

At GSK, every time we've negotiated a contract for a vaccine, we have always made an appropriate amount of our production available to developing countries through mechanisms like COVAX, and I think the same is true for other manufacturers.

Q. When and how do you envisage a vaccine being rolled out?

A. Estimates are that a large part of the UK or US population will have been vaccinated by Q2 2021, and that certainly by the middle of 2021, we should be very well through this. Obviously, the more choice of vaccine, the better because that means that there will be more production readily available.

When it comes to how it is rolled out, choices will have to be made because there simply won't be 100 million doses available on day one. I think the first sets of choices are probably quite easy, so care homes, care workers, the NHS. The other question is whether you go through the age cohorts or prioritise people who interact most in the community, like teachers. There's no right answer to that and it requires a structured process of thinking 'how do I eliminate the maximum amount of societal risk at each step?'.

Q. What do you anticipate uptake of a vaccine will be?

A. When you're really faced with the question 'will I protect my family by having a vaccine?', it's quite hard to not do that in the face of the overwhelming evidence. It's certainly our responsibility as an industry to continuously prove that vaccines are safe, but people ultimately have to make their own judgment. I'm definitely not in the camp of mandated vaccination, but I think when people are confronted with their own health and that of their families, they take rational decisions.

Q. Will a vaccine mean a return to normal life and, if so, when will that happen?

A. If you use a vaccine to protect those at high risk – such as the elderly and vulnerable, and those most socially active, or that interact most with the public, like frontline hospital staff and so on – then the more parts of that population you protect, the freer the rest of society becomes, particularly for the young, who are at relatively low risk anyway.

So, even if everybody's not been vaccinated, I think, as you start getting into Q2 next year, you could see an acceleration of a return to normal – particularly if we ensure the vaccination process goes hand in hand with continuous testing to reduce the amount of circulating virus in the community. We're also likely to know more about the antibody response and the risk of those people who have had it getting it again. Those three factors could really accelerate the return of normality.

However, as the health risk from the virus gets under greater control, the economic damage will become the greater risk and we will also then have to deal with this enormous backlog of routine medical care, the mental health issues that have built up over time, the dreadful impact that this has had on young people. We'll realise that we've solved one problem and yet we've now created other problems that we've got to deal with. At the moment though, the focus is on the vaccine and the hope that brings.

Q. Thinking of the processes to develop the vaccine, what potential does that have for the future?

A. I think the whole pharmaceutical industry and therapy element will be different. We are unlikely to go back to vaccines that take eight years to produce, for example. The application of these new scientific techniques, and the collaboration between governments and regulators in interpreting this will lead to important discussions about the role and use of vaccines in eliminating disease and how that's a far better investment than preventing symptoms.

A lot of the techniques will also help in other therapeutic areas, for example in developing more targeted cancer treatments with fewer side effects. This could be a step change for the industry.