How St George’s is accelerating the development of Covid-19 vaccines in the UK

Published: 27 November 2020

Since the start of the coronavirus pandemic, it’s been clear that one of the main routes out of lockdown restrictions and a return to normality is through developing vaccines that can prevent the disease. Here at St George’s, our researchers have been involved in running four major trials for three different Covid-19 vaccines in the UK.

Leading on the management of these trials is the Director of the Vaccine Institute at the University, Professor Paul Heath. We caught up with him to find out more about the latest vaccine news and how these vaccinations will eventually be rolled out.

St George’s is running multiple Covid-19 vaccine trials

Trials at the Vaccine Institute are managed in collaboration with the Clinical Research Facility at St George’s Hospital. Up until the announcement of the Janssen vaccine trial in the UK earlier this month, the Institute was acting as a site for all the vaccine trials taking place in the country. These include the phase I, II and III trials of the Oxford vaccine, the phase I trial of the Imperial vaccine and the phase III trial of the Novavax vaccine, which is being led by Professor Heath in the UK.

The Novavax trial has just completed its 15,000-participant recruitment making it the largest phase III double-blind, placebo-controlled vaccine trial ever to be conducted in the UK.

So far, the team at the University has vaccinated more than 1,100 participants, who will now be followed up to see if they develop any Covid-19 symptoms. “This is key,” says Professor Heath “As this will determine the efficacy of the vaccines and whether they are preventing people from developing the infection.”

With all trials now fully recruited, the focus will be on completing the schedules of vaccines for participants (all trials require 2 doses), as well as coordinating these follow up appointments. The team is also now considering running future COVID-19 vaccine trials, especially those that focus on certain groups, such as vaccines for children, adolescents and pregnant women. Professor Heath also predicts that there may be more trials once vaccinations are licensed for use, for example, of combinations of different COVID-19 vaccines.

“When you have two vaccines that are licensed, you can run trials that start with giving participants one vaccine, and then a second dose with a different vaccine,” he says. “This is called heterologous prime boosting and will allow the team to understand whether giving a different second vaccine is more effective than providing a booster with the original vaccine.”  

The recent news about the success of three different vaccines is exciting

The last three weeks have seen exciting declarations from two of the leading vaccine candidates from the USA, one from Pfizer and the other from Moderna, and one from the UK and Brazil with the Oxford University / Astra Zeneca vaccine. The Pfizer and Moderna vaccines claim to have greater than 90% efficacy for preventing Covid-19 and the Oxford vaccine around 70%, with 90% in one sub-group.

“This is really great news,” says Professor Heath.

“The interim analyses show high efficacy with no major safety concerns. Up until three weeks ago we actually had no idea if any of these vaccines would work!. This bodes well for all the other COVID vaccines that are still in development.”

The Pfizer and Moderna vaccines are both RNA vaccines, which are made differently to the Oxford and Novavax vaccines, which use a viral vector and protein / adjuvant combination, respectively. This is the first RNA vaccine technology to have been tested in this way and shown to be effective, and is promising for the Imperial vaccine, which is also based on RNA.

All of these vaccines have one thing in common, they are based on targeting the spike protein of the Covid-19 virus – a protein on the outside of the virus that helps it attach to and infect human cells. Each of the vaccines is teaching the body to develop antibodies that bind to the spike protein on the virus, enabling it to be destroyed by the immune system. With the recent successes, Professor Heath says this method of targeting is “the right thing to do” and that it is now “reasonable to expect all of the vaccines will prove effective.”

However, Professor Heath also notes that we should still remain cautiously optimistic about the new data from these trials as they haven’t yet been peer reviewed. “We all want to see definitive data published in a peer reviewed journal,” he says. “These estimates are unlikely to change much when we get to final results, but they don’t give us very much information about important things like the proportion of severe cases or participant characteristics.”

At this point, more information is required and will be necessary before final approval by regulatory authorities.

Vaccine rollout in the UK is on the way

The way vaccines are usually licensed takes years of data and approvals before they are distributed widely as part of a vaccination programme. But, with a global pandemic, researchers and approval committees have managed to accelerate the pace of development beyond anything seen before.

“All of the vaccine companies will now be applying for authorisation from the US Food & Drug Administration, the European Medicines Agency and the Medicines and Healthcare products Regulatory Agency” says Professor Heath.

“Normally, to apply for licensure, vaccines need to complete their full trials, but this early approval may allow vaccines to be given earlier than waiting for the full package of approval.”

Once the vaccines have been approved for early distribution guidance from the Joint Committee on Vaccination and Immunisation will indicate who should be vaccinated first, starting with the most vulnerable or high risk populations and moving through towards low risk groups when more vaccines become available.

“The idea will be to provide direct protection for those at highest risk of disease and death from Covid-19,” says Professor Heath.

“It’s trying to protect the most vulnerable first, and then healthcare workers shortly thereafter, who are more likely to be exposed to the virus and be a source of the disease.”

Although difficult to put a timeline on when distribution will begin, Professor Heath is hopeful that the Novavax trial being run out of St George’s will be able to present their data in the first few months of 2021.

With the UK Government having already purchased 45 million doses of the Pfizer and Moderna vaccines, and 160 million doses of the Oxford and Novavax vaccines, the hopes are that these developments will help protect the nation and beyond sooner rather than later.

Covid-19 vaccine trials at St George’s are now fully recruited and not currently looking for further volunteers. It is possible to register interest in further Covid-19 vaccine trials on the NHS website.

The Covid-19 vaccine trials extend a portfolio of research at St George’s to tackle the coronavirus pandemic. The University has launched a Coronavirus Action Fund to raise money for vital research into the pandemic and is actively seeking support for a broad research programme involving all parts of the University.