How U.K. and Israel raced to global lead in covid vaccinations

Although new variants of the coronavirus are raising concern, the crash immunization programs show signs of working. Case numbers, hospitalizations and deaths are falling in both countries, allowing their governments to set out plans for reopening.

Bloomberg News spoke with Kate Bingham, former head of the U.K.'s Vaccine Taskforce, and Ran Balicer, chair of the covid advisory committee at Israel's Ministry of Health, about how these countries were able to move so quickly and what the world can do to prepare for future pandemic challenges. Their comments have been edited for clarity.

Q: When buying vaccines, you had to lock in supplies without knowing which shots would work. How did you decide what to acquire?

Bingham: Our approach was to build a portfolio of different vaccines. That meant blending the most clinically advanced vaccines, about which we knew the least -- which are the mRNA vaccines and the adenoviral-based vaccines -- with the more established vaccine formats. That's the protein adjuvant-based vaccines and the whole inactivated virus vaccines. So our approach was to pick the most promising across the different formats, with the hope that at least one or more of them would be successful.

A: In Israel you've done it largely with one vaccine so far. How did that come about?

Balicer: Israel was fortunate to get enough from Pfizer to allow a very wide vaccination campaign. The vast majority of our populations at risk have now been covered. We are beginning to see the benefits of this vaccination program as we see a massive decline in the rates of severe morbidity.

Q: Some people in the European Union are skeptical about the AstraZeneca vaccine, which the U.K. is relying on alongside the Pfizer shot. How well does it work?

Bingham: When you're running different trials in different places with different mutations, it may not be exactly apples to apples, but the evidence we're seeing out of Scotland is that the AstraZeneca vaccine is demonstrating a higher level of reduction in hospitalization versus the Pfizer vaccine. But the fact is both are effective, both are safe and if anyone gets offered those vaccines they should take them.

Q: How will the new variants affect strategies, and how well are we prepared to deal with them?

Bingham: Part of our strategy has been to make sure we are able to pivot quickly if there are serious mutations that evade the current vaccines. At the moment that's not the case. The evidence we have is that the vaccines we've got will address the U.K. variant and the South African variant and the Brazil variant. We have doses coming from Novavax, which shows very profound effects against those different variants.

Beyond that we have two different strategies. One is to explore mixing and matching different vaccines so as to provoke different immune responses. And we've invested in manufacturing so that we can pivot quickly to update the vaccines to address those potential variants if they evade the current responses.

Balicer: The U.K. variant was the key driver of the surge in new cases we've seen in recent months. We've been able to get it under control thanks at least in part to the massive vaccination campaign, which our data suggests has been highly effective. All of the data we have about vaccine effectiveness stems from the time when the new variant was the dominant strain of the virus, so this is good news.

At some point we will have strategies mixing and matching different vaccines, and I also believe both Pfizer and Moderna will be able to create new adapted vaccines that will be more appropriate for those new variants as they come along.

Q: Do you think that at some point we'll get so-called multivalent vaccines that work against whatever new variant comes along?

Balicer: We haven't been able to do that for flu, but flu is mutating in a different way from coronavirus. While I maintain the hopes, I'm not sure we'll be able to develop such a vaccine. We might need to update our vaccine campaign on a yearly basis or a seasonal basis depending on the variants that come in. I think the jury is still out on this question.

Q: How much of a responsibility do the U.K. or Israel have to ensure equitable vaccine distribution around the world?

Balicer: As a small country, there's fairly little that can be done. What we are trying to do is get evidence out about the effectiveness of the vaccine, and in that way help other countries tackle vaccine hesitancy.

Bingham: It was a core responsibility and one that we've taken very seriously. An important part of what we've done in the U.K. is to make sure that the clinical trials we've supported and run generate data that can then be used by regulators around the world to make sure those vaccines are approved as quickly as possible.

Q: This won't be the last pandemic the world faces. What can we do to respond even more quickly next time around?

Bingham: The current vaccines, albeit highly effective, are not particularly suitable for widespread distribution around the world. We have costly cold chains and storage, complicated logistics, we're using glass. We need to find formats that address all of that -- scalable, stable, cheap, ideally no health-care professionals involved, so no needles, no on-site dilutions. That is where we should be investing.

Balicer: We also need to improve our surveillance mechanisms. It's thanks to the tremendous efforts of the U.K. which has been doing massive, systematic sequencing that we have the information in time for other countries to prepare for whatever the variants will bring in. Our surveillance mechanisms need to be harmonized to allow us to reach conclusions in a quicker way.

We need to improve our ability to create less costly and less fastidious vaccines that we will be able to produce quickly and disseminate in all countries regardless of their ability to have more expensive logistics in place.