Sir Andrew Pollard feels at home in the mountains. The escapes into nature had helped the 57-year-old director of the Oxford Vaccine Group survive long days in the lab during the pandemic. It was this lab that created the Oxford-AstraZeneca vaccine, which saved around 63 lakh lives.
A professor of paediatric infection and immunity at the University of Oxford, Pollard is currently working on a vaccine to prevent paratyphoid, an infection that is common among children in India. Excerpts from an interview:
Q The development of the Covid vaccine was a landmark. Are you happy with the way things have turned out?
A The work that we did in Oxford, with AstraZeneca and with the Serum Institute of India, has been a huge success. An analysis by Airfinity (health data analytics group) suggests that of the 19 million (1.9 crore) lives saved [by vaccination], the vaccine that saved most lives was the Oxford-Serum Institute one―around 6.3 million (63 lakh) lives. That is because of the distribution of that vaccine, particularly targeting older adults with health conditions. Equitable distribution of the vaccine helped save many lives.
Q Do Covid-19 vaccines work for immunocompromised people like transplant recipients? Are monoclonal antibodies a potential vaccine substitute for them?
A For many of the immunocompromised people, vaccines are still the most effective way of protecting them from the pandemic. But there is a group of severely immunocompromised individuals whose immune systems are unable to respond to a vaccine. Monoclonal antibody therapy may be right for those individuals. But we need to have monoclonals that work against the variant that is circulating.
Q The immune-evasive sub-variants like XBB and XBB.1 are a concern in India.
A In highly vaccinated populations, and countries where there have been multiple waves of infections, we see a high level of immunity. The variants are not likely to lead to the pandemic disease again. They will cause more minor infections.
That said, the elderly and those with health conditions should be wary. The variants could put them in hospitals with the virus as a co-factor in the admission. Just like influenza, Covid-19 can cause infections every year in future. It may put pressure on our health systems.
Q What are some of the lessons hospitals should learn from the pandemic? In India, we faced a medical oxygen crisis that led to many preventable deaths.
A Health systems that are running at 100 per cent occupancy do not have the spare capacity to cope with seasonal viruses, whether it is influenza or Covid-19, and are definitely not prepared for a pandemic.
One of the difficulties that planners of health systems face is that the number of cases with different waves of Covid-19 and the severity of the infection are going to be variable. So it is difficult to predict what capacity is needed.
Q In developing countries like India, hospital-acquired infections are a major concern. What should hospitals do to prevent such infections?
A All hospitals have some infection control policies. However, with respiratory viruses, it is extremely difficult to prevent transmission in a hospital setting. Doctors and nurses need close contact with patients in order to care for them.
Hand-washing and minimising contact could reduce the odds of infection to a great extent. Face masks are also recommended to prevent respiratory infections. But even after the pandemic, we are still unsure about the extent to which the staff or patients wearing masks helps ward off infections.
Q Is there a rise in respiratory infections this year? Apparently, people are on a revenge travel mode.
A This year in the UK we have seen an earlier than usual rise in influenza, which is similar to what we saw in the southern hemisphere, in Australia, during their winter. Interestingly, another respiratory virus that is a big problem with children and babies is RSV (respiratory syncytial virus). We had a very long and unusual season with RSV in spring and summer.
Q Flu season is around the corner. How worried should we be?
A The flu season particularly affects the very young, the elderly and those with health conditions. Influenza is not usually a severe problem for children, which is very fortunate. We do know that children can be an important vehicle for transmission of influenza. Some countries have programmes for vaccinating children. In UK, we use the nasal spray vaccine from two years of age. In the US, the flu vaccine programme starts at six months of age and both injectable vaccines and nasal spray vaccines are used. Vaccinating children helps reduce transmission among the rest of the population.
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Q How does living in a highly sanitised environment impact immunity?
A We see better immune responses to many vaccines among children in low-income countries than in more sanitised high-income countries. But for other vaccines, such as the anti-diarrhoea rotavirus vaccine, protection is higher in high-income settings. We do not know for sure whether it is because of the sanitised environment they live in. There is likely to be some environmental differences. Genetic factors also play a key role in immunity.
Q When dealing with future infections, how can we make better use of technology?
A While dealing with future infections, the first critical part of technology is the early warning systems. Surveillance is crucial in controlling infections, especially in a big country like India. Technology helps a lot in getting the genetic code of a new virus identified quickly, which is used to make vaccines. It is worth remembering that in the pandemic of Covid-19, Chinese scientists circulated the genetic code of the new virus in January 2020. Before we even realised it was a pandemic, people were making vaccines.
But we are still a long way behind where we could be, particularly with having electronic records properly linked.
Q Tell us about the new projects you are working on.
A In Oxford, we have a wide range of projects targeting diseases that could cause havoc in future. One of our investigators, Prof Teresa Lambe, is working on an Ebola vaccine, hoping to tackle the current outbreak in Uganda.
One of the vaccines I am working on with colleagues in India is a paratyphoid vaccine. Paratyphoid is a disease very close to typhoid. It causes a lot of infections in India. Our study could help protect children across India.
We have many different projects and many different vaccines in development. I work with 150 research staff, and we spend a lot of time working to make sure we have enough funding to invest in the next generation of vaccines.