Vaccinating the world out of a pandemic is a prodigious and unparalleled feat made possible by a small number of vaccinologists including Oxford-based Professor Adrian Hill.
For his key role in the design and delivery of the Oxford / AstraZeneca vaccine, the director of the Jenner Institute at Oxford University, which designs and develops vaccines for infectious diseases like HIV, malaria and TB, will receive an honorary knighthood from Queen Elizabeth.
"It's the icing on the cake after a very busy year," he says, while acknowledging the efforts of the whole Oxford-based team, including Irish professor Teresa Lambe and many other scientists who worked tirelessly to create a vaccine against Covid-19.
“Up until now, the largest number of doses of any vaccine produced in one year has been around 400 million doses – for a flu vaccine. This year, globally, we’re aiming to produce five billion doses and two to three billion should be of the vaccine made in Oxford. We’re trying to do something unprecedented here.
“The plan is to get vaccine-induced herd immunity. If you’re in an upper to middle income economy, it will be more achievable, but the world’s poor have to be protected too. The numbers of doses required is enormous, so the task is complex and expensive. That is why we insisted on a low price for the AstraZeneca vaccine.”
In Africa, for example, vaccine distribution is slow, with some countries like Chad vaccinating fewer than 1 per cent of its population thus far.
Prof Hill, who is originally from Ranelagh, attended Belvedere College in Dublin before studying medicine at Trinity College. In 1978, he transferred to Magdalen College, Oxford for a year and has been in Oxford ever since.
After finishing his medical degree, Hill travelled to the small island group of Vanuatu in the South Pacific to complete his PhD in molecular medicine, focusing on the genetics of Pacific islanders, namely the distribution and molecular basis of thalassaemia (an inherited blood disorder that causes your body to have less haemoglobin than normal).
A research stint in Micronesia, another archipelago in Oceania, followed.
"I did a lot of travelling during the 1980s. While spending time in Zimbabwe with my uncle, who was a priest there, I became interested in malaria and other tropical diseases. I was also struck by the knowledge the local doctors had in gunshot wounds from the recent civil war."
He joined the Weatherall Institute of Molecular Medicine as a Wellcome senior fellow in 1988 and began work on immunogenetics in west Africa, which led to his focus on malaria vaccine development.
Since 1997, his team has developed numerous candidate vaccines for malaria, particularly some which produce cellular T-cell immunity. They have conducted more than 70 trials for malaria vaccines in Europe (in Oxford, London and Dublin) and Africa.
In response to the need for research spaces for trials, he founded the Jenner Institute, also at Oxford University, in 2005.
“We wanted to create a space where lots of key early stage trials can take place. We work on the design of new vaccines, then preclinical studies, leading to phase one and two clinical trials. These data are essential before any vaccine company would want to license a vaccine, develop it further and subsequently bring to market.
“We have our own pilot manufacturing plant capable of producing a batch of up to 1,000 doses.”
Prof Hill says finding funding for the likes of malaria is difficult, as “those who need it most, can’t afford it”. But, despite the difficulties in developing a vaccine for parasitic diseases, the Jenner Institute’s malaria vaccine candidate earlier this year achieved 77 per cent efficacy in early stage trials, making it the first malaria vaccine to meet the WHO’s target of 75 per cent.
In 2014, Hill’s team led the first clinical trials of an Ebola vaccine in west Africa, using a chimpanzee adenovirus vector to generate an immune response, a vaccine technology he has pioneered since 2006.
But his most high profile success has been his work on the Oxford / AstraZeneca Covid-19 vaccine, which was backed by the UK government.
“The chimpanzee adenovirus vaccine for the coronavirus was created in the Jenner Institute within six weeks and clinical trials started in April 2020 with over 60,000 people enrolled in trials in five continents by the end of the year,” he says.
Oxford's vice-chancellor, Irishwoman Louise Richardson – the university's first female head since 1230 – said the vaccine would be a non-profit public health tool. Prof Hill was involved in finding the industrial partners.
"We partnered with AstraZeneca, the Serum Institute of India and many other manufacturers to create a vaccine that costs about $3, so that low income countries can afford to buy large quantities of it."
Modern air travel, despite its benefits, certainly helped spread the virus quickly
At what point did he and other researchers know that the world was heading towards a pandemic?
“When we found that people could be asymptomatic but still pass on the virus, so in January last year. Modern air travel, despite its benefits, certainly helped spread the virus quickly.”
Prof Hill says the level of safety surveillance being conducted on those who are vaccinated is unprecedented in scale.
“Vaccine safety research, particularly modern health surveillance involving data record linkage, can rapidly review potential side effects in millions of vaccinated people. This is how the very rare vaccine-linked clotting issue was first picked up. It could never have been identified so quickly after previous vaccines were first distributed.
"Interestingly, recent vaccine surveillance suggests this rare side effect is even less common in India, South America and in African countries."
Despite the global repercussions of Covid-19, Hill says things could be a lot worse. “We were ‘lucky’ with Covid-19 because the proportion of those infected who die is low – under 1 per cent. With Ebola, the death rate is between 40 and 60 per cent.”
He warns that this will not be the world's last pandemic, especially as climate change is forcing animals from their natural habitats. "This is why we need to build and invest in more manufacturing facilities with specialist staff to manufacture vaccines at a large scale, for when the next bad one comes along. We need to have those huge plants across the world, not just in Asia.
“When you think of military or nuclear defence investments over the past twenty years, compared to investment in pandemic preparation, it’s merely a drop in the ocean. These vaccine manufacturing plants could be used for different products at other times, but we need them.
“Adequate pandemic preparedness will cost billions but the economic cost of Covid-19 has been in trillions,” Prof Hill says. “ Scientists warned the world of a pandemic, but it fell on mostly deaf ears despite the fact that, in just 20 years, we’ve had the original Sars virus outbreak in 2002, bird flu and then swine flu, Zika, Chikungunya, Mers, Ebola and now a really big one, Covid-19.”
We will always have outbreaks. The real challenge is to be able to respond more quickly so that a local outbreak does not become a pandemic
After 43 years at Oxford, Prof Hill is firmly rooted at one of the world’s leading universities. In the coming years, the Jenner Institute will streamline outbreak pathogen research, and find a more rapid way of developing newer vaccine approaches, like intranasal vaccines.
Oxford is also founding a new institute, The Pandemic Sciences Institute, which will include a number of core technologies and collaborate with global research centres to ensure the world is better equipped to counter future pandemics.
“We will always have outbreaks. The real challenge is to be able to respond more quickly so that a local outbreak does not become a pandemic.”
After a hugely successful 18 months in terms of vaccine development, Prof Hill hopes that, through his work, he can help inspire future generations study sciences and even become vaccinologists. “Once you get into scientific research you are hooked. It is fascinating, but also really useful,” he says.
