Development of a COVID-19 vaccine
When the new SARS-CoV-2 virus emerged in China at the end of 2019, the BRC Vaccines theme was already working on human coronavirus vaccines and was in a unique position to respond rapidly to the pandemic. The Oxford team – led by Prof Sarah Gilbert, Prof Andrew Pollard, Prof Teresa Lambe, Dr Sandy Douglas and Prof Adrian Hill – identified a vaccine candidate and began testing in human volunteers in April 2020. In December 2020, the vaccine was found to be safe and effective, according to the peer-reviewed findings of the Phase III trial. The efficacy data were based on 11,636 volunteers across the United Kingdom and Brazil who took part in the trial.
In January 2021, the NHS launched a roll-out of the Oxford AstraZeneca vaccine, with patients at Oxford University Hospitals NHS Foundation Trust the very first to get the life-saving jab. The Oxford team has now launched the first study to assess the safety and immune responses in children and young adults of the vaccine.
The University of Oxford is working with the UK-based global biopharmaceutical company AstraZeneca for the development, large-scale manufacture and distribution of the COVID-19 vaccine.
The RECOVERY Trial
The RECOVERY Trial is the world’s biggest clinical trial looking at whether existing therapies can help to treat people hospitalised with COVID-19. The trial was launched as an emergency response to the pandemic, with the first patient enrolled just nine days after the protocol was first drafted and the first result announced after 12 weeks.
The trial has found effective treatments: dexamethasone, a cheap and widely available steroid, which was found to cut the risk of death for COVID-19 patients on ventilators by a third; tocilizumab an anti-inflammatory treatment; and Ronapreve, a monoclocal antibody treatment developed by Regeneron. The discovery that dexamethasone is an effective treatment is estimated to have saved over a million lives worldwide, including 22,000 in the UK.
Since it began, RECOVERY (Randomised Evaluation of COVid-19 thERapY) has recruited more than 45,000 patients across 188 NHS hospitals. The trial is also being conducted in four other countries, with a view to finding treatments that are appropriate for a wide range of patients and healthcare systems.
The trial, which is jointly led by the Oxford BRC’s Co-them Lead for Clinical Informatics and Big Data, Professor Martin Landray, has received widespread praise for its efficient, streamlined design and clear results, based on reliable, large-scale data. It is being seen as a promising basis for future trials in other acute infections.
Covid-19 UK Infection Survey and antibody test
Senior NIHR Oxford BRC researcher Professor Sarah Walker was chosen to lead a major UK population-level infection study with the Office for National Statistics (ONS), which has proved important in helping scientists and the government manage the pandemic.
The aim of the Covid-19 infection study is to find out how many people from a representative cross-section of the UK population have COVID-19 at a given time and how many have had COVID-19 in the past. The ongoing survey has delivered important findings, which has been especially important as vaccinations are rolled out across the country.
The study, launched in April 2020 had a total of around 300,000 participants during its first 12 months. The study has helped to improve understanding around current rates of infection and how many people are likely to have developed antibodies to the virus through the use of an antibody test developed by researchers supported by the Oxford BRC.
Professor Derrick Crook from the BRC’s Antimicrobial Resistance and Modernising Microbiology Theme co-led the development of this high-throughput test to detect COVID-19 antibodies from blood samples. The test, initially developed in Professor Gavin Screaton’s lab, is based on the commonly used enzyme-linked immunosorbent assay (ELISA) and uses a COVID-19-specific protein to capture COVID-19 antibodies that are present in the blood and so indicate which individuals are likely to have come into contact with the virus previously and developed an immune response.
Investigating the long-term impacts of COVID-19 on multiple organs
Prof Stefan Neubauer and Dr Betty Raman, from the BRC’s Imaging theme, led the C-MORE study, which found that a significant proportion of COVID-19 patients discharged from hospital reported symptoms of breathlessness, fatigue and depression and had limited exercise capacity several weeks after leaving hospital.
The researchers used advanced state-of-the art imaging to investigate the impact of the virus on patients’ organs, and to assess its effects on exercise tolerance, quality of life and mental health. They found that at two to three months after the onset of the disease, 64% of patients continued to experience breathlessness and 55% reported fatigue. MRI scans revealed abnormalities in the lungs of 60% of participants, in the hearts of 26%, in the livers of 10% and in the kidneys of 29% of patients.
The C-MORE study is a key part of the national PHOSP-COVID platform, led by the University of Leicester, which is investigating the long-term effects of COVID-19 on hospitalised patients. Around 10,000 patients are expected to take part, making it one of the largest comprehensive studies in the world to understand and improve the health of survivors after hospitalisation from COVID-19.
Creating a COVID-19 risk prediction model
Professor Julia Hippisley-Cox, of the University of Oxford’s Nuffield Department of Primary Care Health Sciences, led the development of a risk assessment tool to identify people at highest risk of serious illness from COVID-19.
The risk prediction model, called QCovid, was developed using anonymised data from more than 8 million adults. The researchers found that there are several health and personal factors which, when combined, could mean someone is at a higher risk from COVID-19. These include characteristics like age, ethnicity and BMI, as well as certain medical conditions and treatments.
NHS Digital has now used this model to develop a population risk assessment. The risk assessment predicts on a population basis whether registered patients with a combination of risk factors may be at more serious risk from COVID-19, enabling the government to prioritise them for vaccination, and provide appropriate advice and support.
The STOIC study: Treating COVID-19 with asthma inhalers
Researchers led by Professor Mona Bafadhel, from the University of Oxford’s Nuffield Department of Medicine, found that early treatment with a common asthma medication appears to significantly reduce the need for urgent care and hospitalisation in people with COVID-19. The STOIC study found that inhaled budesonide given to patients with COVID-19 within seven days of the onset of symptoms also reduced recovery time. Budesonide is a corticosteroid used in the long-term management of asthma and chronic obstructive pulmonary disease (COPD).
The trial was inspired by the fact that, in the early days of the pandemic, patients with chronic respiratory disease, who are often prescribed inhaled steroids, were significantly under-represented among those admitted to hospital with COVID-19.