When it comes to managing Covid-19, few countries have a spotless record. This includes the UK, where early mixed messages from Prime Minister Boris Johnson, too-soon reopenings later on and some potentially risky vaccine strategies marred the response. I have been critical, for instance, of Britain’s decision to extend the dosing interval of the Pfizer Inc.-BioNTech SE vaccine without any data to back it. But despite the UK’s stumbles, there is still much to admire in its strategies for tackling Covid and it’s worth pointing them out.
However vilified Britain’s National Health Service is at times by its citizens, the centralized health-care system — combined with the UK's capabilities in genomic sequencing and well-run vaccine task force — has enabled the country to make significant contributions to the understanding of Covid-19. Even the vaccine decision I have questioned may pay off. Here’s a short list of successes:
Vaccine leader: The UK was the first to approve a vaccine — the Pfizer-BioNTech shot. Its drug regulator received a lot of flak for its rapid approval, though not from me. In hindsight, this was a great move and allowed the country to rapidly deploy the vaccine, putting it at the forefront of inoculation efforts after only Israel. This speedy deployment was made possible in part by a radical vaccination schedule that didn’t fit with the design of the Pfizer-BioNTech trial: The UK’s Joint Committee on Vaccination and Immunization is recommending a 12-week gap between the first and second dose, though the phase III trial used a three-week interval. While I still believe this to be a risky decision — especially in terms of the potential for lower efficacy in the elderly — it may be worth it if there is a reduction in Covid-19 infection rates in the weeks ahead among the vaccinated. It could even set an example for other countries.
Gene genie: The UK is far and away the leader on the genomics front, and its massive efforts toward fully sequencing the virus has allowed scientists to track how it is evolving. This is how researchers found the variant B.1.1.7 and its later evolutions. The UK is responsible for fully half of all genomic sequences of the Sars-Cov-2 virus loaded into the database of the GISAID Initiative, a global effort for sharing and tracking information on viruses such as those that cause Covid-19 and influenza. The feat was made possible by the efforts of the COVID-19 Genomics Consortium (COG-UK), funded by the UK government. By contrast, the US has contributed only about 1% of the sequences in the GISAID database. This matters because countries that are not sequencing the virus in a systematic and comprehensive way can’t track its evolution, making it harder to manage. They are essentially flying blind in a thunderstorm.
Recovery trial: The UK’s Recovery trial of hospitalized patients — with 37,000 enrolled at 178 centers around Britain — aims to test in a large setting how well drugs with some evidence of effect in either treating Covid-19 disease or reducing death are working. This is the trial that told us the generic steroid dexamethasone is a useful therapy and that convalescent plasma doesn’t work in hospitalized patients if used too late. One of its most valuable contributions was its finding that hydroxychloroquine was ineffective at treating Covid-19, which led the US Food and Drug Administration to revoke its emergency use authorization. The Recovery trial is a modular design allowing the addition of drugs to be tested as the trial progresses. And because it is financed by the UK government, it has no commercial aim, allowing it to test generic drugs that large pharma companies probably wouldn’t, given the lack of profitability. Recent treatment additions to the Recovery trial are Eli Lilly & Co.’s baricitinib and generic colchicine to assess their potential after smaller trials showed some benefit.
More vaccine trials: After already tweaking vaccine protocols, the UK is going one step further with an interesting experiment that, if successful, will lend further support to its prior dosage decision and allow for a more flexible inoculation regime. In what it calls a “world-first Covid-19 alternating dose vaccine study” — supported by a grant from the government — the UK is testing two things: mixing different types of vaccines and testing two different dosing intervals. While the main aim is to look at safety, the trial will also provide data on antibody responses. This in turn will help tease out if a dose of Pfizer-BioNTech’s vaccine is better when followed by the AstraZeneca-Oxford shot, or another Pfizer-BioNTech jab, or vice versa. It’s also comparing four-week dosing intervals to 12-week gaps. While the data, expected this summer, will not tell us about efficacy, it will tell us which regime induces the best immune response. By then we should also know what immunological reaction to the vaccine correlates best with efficacy. With that knowledge and this data, vaccinations can become more flexible, or, possibly, even better. The study will also help figure out whether a person who had one type of vaccine in 2021, can be boosted with a vaccine that targets a variant using another technology. Basically, it will be a gold mine of information.
All in all, the UK should be celebrated as a pioneer in the fight against the pandemic, not just for its contribution on the vaccine front, but also in utilizing its relatively unique health-care system to answer questions about drug treatments for the disease. Through its efforts we have learned more about the therapies that do and don’t work, the emergence of new virus variants and a potential vaccination strategy that may help many countries exit the pandemic faster.
Bloomberg
