Covid-19: Immunology Research

Nadhim Zahawi Excerpts

Thursday 9th September 2021 Westminster Hall

[The Minister for Covid Vaccine Deployment (Nadhim Zahawi)]

Thank you very much, Dr Huq. It is a pleasure to be here, in person, to serve under your chairship. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate, and of course the hon. Members for Tooting (Dr Allin-Khan) and for Airdrie and Shotts (Anum Qaisar-Javed).

The shadow Minister referred to Edward Jenner and Blossom, and of course we all owe a huge debt of gratitude to Dame Sarah Gilbert, who now has a Barbie from Mattel in her image. I hope that will encourage many young kids to take up science, as a number of us in this Chamber have done. As I am sure colleagues here know, I am a proud chemical engineer from University College London. I think it appropriate, on a day like this, to congratulate the behind-the-scenes group—as the shadow Minister referred to them—of incredible scientists, whose incredible work has allowed us to deal with this pandemic. I am sure the whole House would want to join me in that.

I also congratulate Sir Shankar Balasubramanian and Sir David Klenerman. They have just received the $3 million Breakthrough Prize, which is referred to as the “Oscars of science” for their work at Cambridge on next-generation genome sequencing. To bring that to life for the House, it took $3 billion and about 10 years to sequence the first human genome. Their work on next-generation genome sequencing now allows that same work to take an hour and about $1,000, which makes a real contribution to future discovery.

For those who do not know her, I would also encourage people to look at the work of Professor Katalin Karikó, who has also been awarded the Breakthrough Prize today. She is not from the United Kingdom, but has had to travel a long journey, from Hungary to the USA and the University of Pennsylvania. Her personal struggle and her work on mRNA allowed BioNTech and Moderna, using her patents, to develop those incredible vaccines.

By calling this debate, the hon. Member for Strangford has really provided us with an opportunity to discuss the world-leading contributions that UK researchers have made by increasing our ability to tackle this disease. Investment by the Government has assisted the science underpinning the development of many of the tools we need to harness to ultimately defeat this virus.

UK-based research has provided insights that are crucial to improving surveillance, patient care and management, and developing new diagnostics, therapies and vaccines. Identifying how the immune system responds to covid-19 is critical to understanding so many of the unknowns around this novel virus. For example, why does it make some people sick and not others? What constitutes effective immunity and how long might that immunity last?

The immune system is extremely complex. To make rapid and effective progress in our knowledge, a nationally co-ordinated approach was needed, as the hon. Member for Strangford referred to. That is why £6.5 million of funding has been provided from UK Research and Innovation and the National Institute for Health Research to the UK Coronavirus Immunology Consortium. The UK is world leading in the quality of its immunology research, and this innovative project has enabled us in Government to commission at pace the research needed to understand the immunology of covid-19, and as a result successfully deliver real benefits to patients and public health. The key themes identified by UK-CIC included the understanding of primary immunity, and describing the body’s immune response to covid-19 and how this might explain the different risks presented by the virus to individuals. In other words, why do some get sicker than others?

What constitutes protective immunity? Identifying how an effective immune response can be generated and how it can be maintained to prevent re-infection was essential for the development of effective vaccines and understanding why some people remain vulnerable even after vaccination. Unpicking the mechanism of the disease caused by immunopathology—how the body’s own immune response to the virus can cause damage to tissues and organs, and how that can be stopped—is essential knowledge for the development of effective treatments, along with identifying immune vaccine evasion and how the virus might evade the body’s protective immune response through natural infection or vaccination, leaving people vulnerable to re-infection.

I want to highlight some further research that we have commissioned and funded in the field of diagnostics. The COVID-19 National DiagnOstic Research and Evaluation Platform—the CONDOR study—is accelerating how quickly promising diagnostics make it out of the lab and into real-world use. This will support the diagnosis of infection and the management of patients with suspected covid-19, which is important for the subsequent waves of infection in the post-pandemic setting.

On vaccine development and deployment, we all know the benefits that both doses of the vaccine can bring to many people. Indeed, colleagues have mentioned that today. Data from Public Health England suggests that two doses of the covid vaccine offer protection against hospitalisation of around 96%. The United Kingdom has been at the forefront of vaccine development, helped by the investment that we have made in this vital research. The ChAdOx1 vaccine platform—already shown to be safe and effective through a previously funded phase 1 trial against the middle east respiratory syndrome, or MERS, which the hon. Member for Strangford rightly referred to in his speech—was quickly adapted to develop a vaccine candidate against covid-19 and launched human trials in April 2020.

In parallel, project funding was also provided to investigate and develop more efficient vaccine manufacturing processes, enabling vaccines to be made more rapidly. However, the development of an effective vaccine is just the first step, and I commend the efforts of the NHS in the world-class roll-out of the vaccine programme among adults and young people across our four nations. Our efforts in understanding why some people do not develop a protective response even after receiving two doses of the vaccine are an important next step in our research portfolio, hence the Government have commissioned important studies to understand vaccine responses among the most vulnerable in our society.

However, despite the success of the current vaccination campaign, we are doing more by investing in research that will inform us about how to deliver vaccinations in the future and to help us to understand why some immunosuppressed people are not fully protected. I regularly meet charities that support clinically extremely vulnerable patients, and I share their concerns about the risks to this group from contracting covid-19.

There is a breadth of research activity being funded in order to look at vaccine response in immunocompromised individuals. The OCTAVE—observational cohort trial T cells antibodies and vaccine efficacy in SARS-CoV-2—study is examining covid-19 vaccine responses in clinically at-risk groups, including patients with certain immunosuppressed conditions. Building on the work that we did with the OCTAVE trial, we are funding OCTAVE DUO, which is a new clinical trial to determine whether a third dose of a vaccine will improve the immune response in people who have weakened immune systems. Additionally, the UKRI-funded research to be commissioned following the recent research on vaccine immune failure will investigate the strength and durability of the immune response, which I know colleagues are interested in understanding better in a wide range of people, including those with conditions that result in a weakened immune system, such as HIV.

The development of novel treatments for covid-19 has been made possible by the work and funding that we have provided for immunology research. As referred to by a number of hon. Members, that includes the UKRI and NIHR-funded projects looking at the immune response generated during infection with covid-19, which revealed that the body produces harmful immune responses that attack its own tissues and organs. That leads to severe disease and may underlie some forms of long covid, but further research is needed to better understand this. Research of this type has helped the development of new and effective treatment options, including the recently approved novel monoclonal antibody treatment Ronapreve. This novel treatment development was also supported by a UKRI and NIHR-funded trial.

I will briefly turn to some of the questions that hon. Members asked. The hon. Member for Strangford asked about long covid, which can have very serious and debilitating long-term effects for thousands of people across the UK. It can make daily life extremely challenging. We are providing significant funding for several studies in order to better understand the long covid problem, improve diagnosis and find new treatments. In July, the Department provided just shy of £20 million—I think it was £19.6 million—of funding towards an extensive programme of 15 new research studies, which will allow researchers across the UK to draw together their expertise from analysing long covid among people suffering long-term effects and the health and care professionals supporting them. The projects will better understand the condition and how to identify it, evaluate the effectiveness of different care services on people with long covid, identify effective treatments, such as drugs and rehabilitation, to treat people suffering from long covid, and improve home monitoring, which is a key issue.

[Jim Shannon]

I am very encouraged by that. Is it the intention of the Minister’s Department to share the results of those studies with all the different regions of the United Kingdom, so that we can all benefit? As health matters are devolved, the evidential base and final conclusion of the studies will be very important for us all.

[Nadhim Zahawi]

I completely share the hon. Gentleman’s concerns about that issue, and it is important that we look at it very seriously. He also asked whether we have enough supply of monoclonal antibody treatments. I can tell him that the regulatory approval and clinical policy will provide information on which patients could benefit from the treatments and how much supply is needed. We are working with the companies to ensure that we have a supply of those products in the coming months. Which patients are likely to have access to those treatments? Again, the NHS England antibody expert group is currently designing clinical guidance on how the NHS should use the treatments, which includes defining and identifying the eligible patient cohorts that are likely to benefit following a positive covid test.

In terms of deploying the treatments, part of the work of the NHS England expert group is on the clinical guidance on identifying potential deployment in hospital and possible pathways, especially through clinics and at-home services following a positive test. The hon. Gentleman also asked what research is looking at long-term immune response in individuals who are vaccinated. The Department is funding a number of important studies into immune response: the SARS-CoV-2 immunity and reinfection evaluation, or SIREN, study in healthcare workers; the Vivaldi study in care home residents and workers; and the coronavirus infection survey led by the Office for National Statistics, with repeat household visits looking at who has antibodies to covid from either vaccination or previous infection.

The hon. Gentleman asked about vaccine manufacturing in the longer term. I can tell him that in 2018, UKRI announced £66 million for the UK’s first dedicated vaccine manufacturing and innovation centre, VMIC. The goal was to promote, develop and accelerate the growth of the UK vaccine industry. When the pandemic began, UKRI reacted at unparalleled scale and speed to ensure that all investments were ready and able to respond to the challenge, and that they were plugged in to the UK’s wider vaccine, life science and pharmaceutical ecosystem. An additional £131 million was made available as an investment in, I think, May 2020, bringing the total for VMIC to just shy of £200 million, at £196 million. VMIC will be able to deliver about 200 million doses of vaccine, of any technology, at scale per annum, so it is a big investment.

The hon. Gentleman also asked what the Government are doing to support the development, production and procurement of vaccines for the future. As well as VMIC, we are planning for all scenarios in the fight against covid and its variants. Some of the recent analysis supports our understanding that both the Pfizer BioNTech and AstraZeneca vaccines currently being deployed in the UK appear to work well against the current dominant variants of covid, and continuing to administer those vaccines at scale remains our key to bringing the virus under control.

We are also assessing our existing portfolio against current variants, working closely with vaccine manufacturers and Public Health England, to understand the efficacy of our portfolio. We think we are in a good place vis-à-vis the interim advice from JCVI on the booster campaign, which we hope to begin later this month.

Finally, the hon. Gentleman asked whether there was any existing research that had helped to accelerate the development of vaccines. He quite rightly cited the work of the Oxford team, but even before the covid-19 pandemic, they were already doing that research because of funding from UKRI—and thank goodness for that.

To conclude, I fully recognise the tremendous impact that the pandemic has had on so many people. Commissioning high-quality immunology research is an essential part of our armoury in fighting this virus. We will continue to implement research findings and, at the same time, commission and fund new projects that will deepen our understanding of the disease and identify further defences that will keep us safe. Throughout this pandemic, the Government have been there to support and invest in research. As we shift our focus from the initial impact of the pandemic, we intend to continue to provide funding and support for covid-19 research, underlining precisely why the UK has long been, and continues to be, a great place for world-leading research and researchers.

[Dr Rupa Huq (in the Chair)]

Finally, in this debate where all hon. Members have demonstrated quality, if not quantity, I call Jim Shannon to wind up.