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Sunday, December 5, 2021

AstraZeneca lost the vaccine battle in Europe and the US – but is now winning the war globally

But despite the company’s early success in producing a workable Covid vaccine, helping the UK to steal a march on the rest of Europe in vaccinating against the pandemic, it then all seemed to go horribly wrong. 

Astra fast became a political football in the outbreak of vaccine nationalism that took hold. EU resentment over Brexit became inextricably linked with European suspicion of the vaccine. Brussels sued for failure to meet delivery commitments; Emmanuel Macron, the French president, said the Oxford-AstraZeneca vaccine was “almost ineffective” in the over-65s, while his Europe minister accused the UK of taking “massive risks” by depending too heavily on its home-grown jab. 

Even today, with the delivery issues essentially resolved, Astra still struggles in many parts of Europe to overcome suspicion over the efficacy and safety of its vaccine. And it has yet to gain approval at all in the US, where American born shots are favoured.

Inexplicably, Britain’s Joint Committee on Vaccination and Immunisation (JCVI) has compounded the problem by focusing its entire booster vaccine programme on the rival, and much more expensive, Pfizer-BioNTech and Moderna mRNA vaccines.

That decision may have had more to do with an excess in stocks of the Pfizer jab – the Government hedged its bets by buying up far more vaccine doses than is needed from multiple different developers – than any deliberate bias against Astra. It left a sour taste in the mouth nonetheless, given Astra’s prior loyalty to the UK vaccination push and its huge investment in UK science. 

Fears over the Astra vaccine’s slight risk of causing blood clots seem to have fed into the decision to use the Pfizer alternative wherever possible in the UK’s booster programme. 

Announcing it in mid-September, the JCVI advised “a preference for the Pfizer-BioNTech vaccine for booster jabs, regardless of which vaccine brand someone received for their primary doses. This follows data from the COV-BOOST trial that indicates the Pfizer-BioNTech vaccine is well tolerated as a third dose and provides a strong booster response”.

That decision must now be revisited. The reality of the Astra vaccine is very different to the downbeat perceptions of it that have been allowed to gain traction in Europe and the US. 

Looked at globally, the Astra vaccine has in fact been a great deal more successful than any of its Western rivals. Largely unremarked, it is now the most applied vaccine in the world after China’s Sinovac Biotech, having already surpassed two billion doses. 

Pfizer is dominant in the US and Continental Europe, but the rest of the world outside China overwhelmingly uses Astra, which has licensed the product to facilities in multiple different jurisdictions from India to South Korea, Thailand and Brazil. More than 300 million doses a month are now being churned out.

What’s more, there is growing evidence, if admittedly as yet only circumstantial, that the Astra vaccine actually offers more durable protection than the rival mRNA products. 

Again, there is no hard data on this as yet, but one possible answer to the riddle of why the Netherlands, Belgium and Germany are experiencing lower infection rates than the UK but much higher hospitalisations, threatening once more to overwhelm public health systems, is because of the choice of vaccine and the age cohorts that were prioritised. 

If the Pfizer vaccine is less durable, it might explain why countries with apparently similar levels of vaccination to the UK – but with Pfizer the predominant jab – are now experiencing higher levels of hospitalisation and deaths. The seemingly better T-cell response that comes from the AstraZeneca vaccine may mean it gives longer protection, despite an apparently inferior initial antibody response. 

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