The UK’s COVID Inquiry has praised the speed with which the Oxford/AstraZeneca COVID vaccine was developed and the rapid set-up of the Oxford-led RECOVERY trial, which identified the first effective treatment for COVID.
The Inquiry was publishing its fourth report, this one on vaccines and therapeutics. It said the infrastructure established by the National Institute for Health and Care Research (NIHR) was critical to the successful delivery of clinical trials during the pandemic.
A number of University of Oxford academics who were supported by the NIHR Biomedical Research Centre: Oxford and played key roles in the response to the pandemic gave witness statements to the Inquiry.
Describing the roll-out of vaccines across the UK as an “extraordinary feat”, the Inquiry praised said the rapid discovery and development of vaccines and therapeutics was based on the UK’s position as a world-leader in biomedical science. It praised the rapid establishment of specialist vaccine and therapeutics taskforces, and the coordinated and efficiently managed whole-population delivery of vaccines, according to a clear order of prioritisation.
At the beginning of the pandemic, Oxford BRC research funding was quickly reallocated to ‘pump-prime’ emerging high-impact COVID-19-related research. The Oxford BRC provided crucial early funding to accelerate the development of the COVID-19 vaccine, work led by researchers in its Vaccines Theme, and contributed to a clinical trial to evaluate the safety of the vaccine.
The BRC was also one of the institutions that contributed to RECOVERY, a large platform trial that identified a number of treatments for patients hospitalised with COVID-19. The Inquiry praised the trial for establishing the effectiveness of dexamethasone, one of four successful treatments it found, but also for identifying ineffective treatments such as hydroxychloroquine or convalescent plasma.
The RECOVERY trial, which was co-led by the then-Oxford BRC Theme Lead Professor Sir Martin Landray, was rolled out rapidly; within a week of being designated an urgent public health research study it had been set up in hospitals across the UK. It reported its first findings three months later.
The Inquiry praised a key design feature of RECOVERY and other similar trials such as REMAP-CAP, PANORAMIC and PRINCIPLE in that they were ‘adaptive platform trials’, where multiple drugs could be tested simultaneously and allowed for real time information as the pandemic evolved.
The Oxford/ AstraZeneca vaccine was also praised for its rapid development. The report noted that the basis for the vaccine, an innovative adenoviral vector vaccine technology, was already under development in Oxford for another coronavirus, MERS. The clinical trial was set up just three months after researchers in Oxford received the genetic sequence of the COVID virus, and following rapid ethics approval by the regulatory authorities.
Another important factor that was noted by the Inquiry was that the different phases of the vaccine trials were carried out concurrently, allowing quick progression, but without compromising safety. The first effective COVID-19 vaccines were administered in the UK less than 12 months after the World Health Organization’s declared it a public health emergency.
Among the more negative aspects of the Inquiry report were that those taking part in the vaccine trials in the UK were not sufficiently representative of ethnic minority populations; more than 90% of the participants in the UK-based Oxford/AstraZeneca trials identified as ‘white’.
Similarly, there was a lower uptake of vaccinations in communities with greater levels of deprivation and in some ethnic minority groups. The report advocates targeted action to build confidence with these communities and also urged steps to counter vaccine hesitancy and misinformation.
The Inquiry reported on the association between the Oxford/AstraZeneca vaccine and the rare but potentially fatal thrombosis with thrombocytopenia syndrome, when blood clots occur together with a low platelet count. It found that the UK’s regulatory and advisory systems responded appropriately to this issue when weighing up the risks and benefits of the vaccine.
Although the vast majority of people vaccinated had minimal or no side effects, with regard to those who experienced serious injury or death, the Inquiry said the current Vaccine Damage Payment Scheme was not sufficiently supportive and urged the government to reform it urgently.
Read the full Inquiry report on vaccines and therapeutics.