Vaxxers by Sarah Gilbert and Catherine Green; Until Proven Safe by Geoff Manaugh and Nicola Twilley – reviews
On the first day of Wimbledon, Dame Sarah Gilbert, professor of vaccinology at Oxford’s Jenner Institute, was treated to a standing ovation from grateful spectators on a packed Centre Court. Together with her Oxford colleague Catherine Green, Gilbert had delivered the AstraZeneca vaccine against Covid-19 in record time, and tennis fans, enjoying a rare maskless day out in SW19, were keen to show their appreciation. But as Gilbert and Green point out in their new book, Vaxxers, not everyone shares the Centre Court crowd’s enthusiasm for vaccines, and as long as the coronavirus continues to mutate and conspiracy theories propagate on social media, their job is not over.
It is remarkable that Gilbert, a 59-year-old mother of triplets, and Green, a specialist in vaccine manufacture, found time to write this book, given the considerable technical and logistical hurdles involved in developing a new vaccine from scratch in little under a year. The previous “lab-to-jab” record holder was the mumps vaccine, developed in four years in the 1960s. But because of the difficulty of raising funds for vaccine research and the various regulatory hurdles, it takes 10 years for most new vaccines to be licensed, and even then, a hurried press release or an errant remark by a politician can quickly undo your hard work.
Gilbert and Green, rightly, have no time for anti-vaxxers. There is no more cost-effective way of improving the length and quality of someone’s life than a vaccine against a nasty disease, they point out. Vaccine hesitancy, however, is a different matter, and it reflects their care and concern that they devote large passages in their book to demystifying their research and putting the risks of vaccination in context. Indeed, Vaxxers can be read as much as a manifesto for the importance of good science communication and an antidote to anti-vax conspiracy theories as a biomedical thriller.
In alternating chapters, told from either “Sarah’s” or “Cath’s” point of view, Gilbert and Green are at pains to point out that they are not “big pharma” but two ordinary people who managed to pull off an extraordinary feat while dealing with the everyday stresses that come with being full-time mums and breadwinners in a notoriously insecure and poorly paid field.
For every vaccine that makes it to licensure, there are many that never get beyond proof of concept, let alone to the clinical trial stage. Research groups, like the one Gilbert heads at the Jenner, are like small businesses or charities, with scientists lurching from one project to another on insecure, short-term contracts. Indeed, it is impossible to read Vaxxers without coming away with a newfound respect for Gilbert and Green’s ability to juggle multiple tasks while sounding coherent in front of the TV cameras after another sleepless night wondering where the funding for the next stage of their research will come from. And that’s before you get to the UK’s controversial decision (subsequently vindicated) to extend the interval between the first and second jabs to 12 weeks, or the unfavourable comparisons in the US biotech press between AstraZeneca’s efficacy results and those of the Pfizer and Moderna vaccines.
Gilbert is understandably sore about the barbs directed against her and her team. “There were days when we seemed to be battling against our employer, or the media, or a swarm of wasps, as well as the virus,” she writes. But she never loses sight of the goal of delivering a safe and effective vaccine against Covid.
When, on 11 January 2020, the Chinese published the genetic sequence of the coronavirus and Gilbert began designing a vaccine to target the spike protein using a “plug-and-play” technology employing a modified chimp adenovirus, the benchmark for success was anything in excess of 50% efficacy. Yet for all the questions about the optimal dosing regimen (the trials produced the unexpected result that a half dose followed by a full dose generates more antibodies than two full doses), AstraZeneca was able to demonstrate 70% efficacy in trials and 94% effectiveness in the real world – better than Pfizer.
Having previously designed vaccines against influenza, Ebola and Mers using the same vaccine platform technology, Gilbert and Green never had any doubt that they would succeed. Their only regret is that due to a lack of funding for a putative “Disease X” in the run-up to the pandemic they weren’t able to move even faster. In a charming passage aimed at Bake Off fans, Green describes how making a vaccine against a new disease is a little bit like waiting for a bespoke order for a birthday cake. Since the delivery system is the same, you can expedite the process by preparing the dough and baking the cake beforehand. Then, once you know whose birthday it is, you simply apply the icing with the message, ie the spike protein.
The good news is that as the coronavirus continues to mutate, this puts the Jenner Institute and AstraZeneca in a strong position to update their recipe against new variants. The problem is that despite delivering millions of doses on a not-for-profit basis around the world, there are still many countries that have yet to benefit from this bounty or where immunisation rates remain worryingly low.
For instance, as British tennis fans were enjoying their strawberries and Pimm’s in the sun, in Sydney and Brisbane, Australians were enduring another round of stay-at-home orders in a bid to keep the Delta variant at bay. It was a sobering reminder of the way Covid has divided our world (in Australia only 7% of the population has been immunised against Covid versus 60% in the UK), and how, in the absence of vaccines, the only solution is to employ quarantines.
As the academics Geoff Manaugh and Nicola Twilley point out in their brainy but accessible book on the history and future of quarantine, the first quarantine dates to 1377, when Dubrovnik banned travellers from plague-infested areas entering the city. Derived from the Italian word quarantena, meaning 40 days, quarantines are a tried-and-tested means of delaying the arrival of a potentially fatal pathogen. In theory, quarantine works by separating people suspected of sickness from those known to be well. But making this seemingly simple distinction opens worlds of philosophical uncertainty, ethical risk and – as we have seen in India and elsewhere – the abuse of political power.
Though it is usually viewed negatively, quarantine can also be a powerful generator of creativity and connection, the more so in the era of Zoom, and should be considered “part of our collective immune system”. Yet when it became clear that border closures and quarantines were the only way of buying time until vaccines came on stream, few experts, and few politicians (in the west at least), seemed to have grasped their utility.
Manaugh and Twilley suggest this failure was due as much to a lack of imagination as the inability to take note of the many historical examples of the successful application and embrace of quarantines. The result was that rather than employing technology and design solutions to make quarantines more palatable to the populations of advanced democracies in the 21st century, most experts assumed they would be unworkable.
In retrospect, this was a mistake. It would also be a mistake in the future, not least because, as Gilbert and Green make clear, Covid-19 is not the last pandemic the world is likely to face and, even with better funding, vaccines will always be playing catch-up with a virus.
• Vaxxers: The Inside Story of the Oxford AstraZeneca Vaccine and the Race Against the Virus by Sarah Gilbert and Catherine Green is published by Hodder and Stoughton (£20). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
• Until Proven Safe: The History and Future of Quarantine by Geoff Manaugh and Nicola Twilley is published by Pan Macmillan (£25). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
