The book I didn't expect to read this year

Bedtime reading about vaccination was not something I planned this year. Night-time was for mentally getting away from the subject of my research, when it wasn’t spent sitting through Zoom meetings with people overseas.

Yet, as NSW began to emerge from the long winter lockdown in October, a luxurious wander through Abbey’s Bookshop in Sydney saw me encounter an intriguing title, “Vaxxers: The inside story of the Oxford AstraZeneca vaccine and the race against the virus (Hodder and Stockton, 2021).

Vaxxers begins with co-author Catherine Green on a camping trip last year with her nine-year-old daughter. She is taking a short break from the most intense period of her professional life; leading one of the teams developing the COVID-19 Oxford AstraZeneca vaccine. She finds herself chatting with a fellow camper and the conversation strays to the vaccines; the camper’s worry about the ‘mercury and other toxic chemicals’, her lack of trust, and her belief ‘they’ don’t tell the truth. As Catherine observed, “but I am ‘them’”, and standing in bare feet by a pizza van on a field in northwestern Wales, she decided to write this book.

Vaxxers tells the story of the race to prevent millions of infections and deaths from COVID-19. Green alternates chapters with her fellow scientist Dame Sarah Gilbert, Professor at Oxford University’s Jenner Institute, to explain the painstaking and methodical process of vaccine development, the massive workloads, funding struggles, and the suspenseful wait for clinical trial results.

A fast pace of development causes some people concern about the safety of the COVID-19 vaccines. But the adenoviral-vector technology on which this vaccine is built was years in the making through efforts to prevent other diseases like Ebola and MERS. Ebola is a devastating haemorrhagic virus that causes death in around 50% of people with it. Gilbert’s group were involved in the early vaccine trials. These looked promising but another vaccine was shown to be effective first, so their’s was put on hold. 

Still, they had advanced a vaccine technology. So by 2018, and after years of funding setbacks and slow progress, WHO had asked scientists to put forward a vaccine against Disease X and they had a candidate. Disease X was a hypothetical infectious disease that would inevitably emerge. We had already seen this potential with SARS, MERS, swine and bird flu, but Disease X could be even worse.

Gilbert and her team had an advantage: their adenoviral-vector platform was capable of being adapted to the pathogen instead of being made from new each time. They had already shown in the Ebola vaccine trials it was capable of giving a strong immune response and that manufacturers would be able to produce large quantities. It could also be stored at the more standard vaccine temperature of 2 to 8 degrees instead of the ultra-cold storage requiring special fridges that the mRNA vaccines needed in their cold chain. This made such vaccines easier to distribute to remote and resource-poor settings. By January 2020 they had carried out the steps needed to make a vaccine quickly. Then Disease X became a reality and Gilbert and Green got to work, later collaborating with Sir Andrew Pollard who led the trials. These showed the Oxford AstraZeneca COVID-19 vaccine to reach acceptable thresholds of efficacy and safety. It is now used in 178 nations.

Green and Gilbert treat the readers to refreshingly domestic analogies to explain how the vaccine is made. Instead of mounting battles, they formulate the recipe, bring the ingredients together and cook up the vaccines. Purifying an active vaccine is like putting together a “fancy layered cocktail” which, instead of throwing into the air and catching it behind their back, they centrifuge at high speed. These images recapture the metaphor of a vaccine as chemical cocktail from two centuries of anti-vaccination rhetoric.

Vaccines – their development and the way they work in the body – can often seem mysterious to people. This book takes us through the lab, down the test tube and into the DNA. It shows the care, fastidiousness, and exacting nature of a highly regulated process that is designed to produce the safest and most effective vaccines possible. For readers concerned about the vaccine ingredients, there are basic descriptions in the appendices. 

In July 2020, my friend Pete Lyon and I wrote a song about waiting for a new vaccine with the refrain, “it could be a long time”. Well, it wasn’t. Notwithstanding the current challenge with Omicron where a booster dose is needed to keep up our antibody levels, these #WomenInSTEM and many others have helped us get better control over this pandemic. Not a bad Christmas present.