UK trial to mix and match Covid vaccines to try to improve potency

A trial is likely to go ahead in January to find out whether mixing and matching Covid vaccines gives better protection than two doses of the same one, the head of the British government’s taskforce has said.

Sarah Boseley 

The trial will begin if the University of Oxford/AstraZeneca vaccine is approved in the coming weeks, as is hoped. The treatment can only be administered with licensed vaccines.

The news comes as the first British patients begin receiving coronavirus vaccinations from Tuesday, a jab made by Pfizer/BioNTech, a week after the UK became the first country in the western world to approve a Covid vaccine.

Those who take part in January’s trial will get one shot of AstraZeneca’s vaccine and one of the Pfizer injection. A vaccine from US biotech firm Moderna will also be included if it gets approval.

Pfizer’s and Moderna’s vaccines have both been shown to have 95% efficacy at protecting people against the virus. For AstraZeneca’s, efficacy was 62% among the largest cohort given two doses, but rose to 90% among a smaller group given half a dose initially, followed by a full dose.

Kate Bingham, outgoing chair of the UK’s vaccine taskforce, said the “mix and match” trials were not about making limited supplies of the vaccines go further. The UK government has ordered 40m doses of the Pfizer vaccine and 100m of Oxford/AstraZeneca’s candidate.

“It’s not being done because of supplies,” said Bingham. “It’s to do with trying to trigger the immune response and the durability and nothing to do with what vaccines we’ve got.”

The concept is known as a heterologous prime-boost. “It means mix and matching vaccines,” said Bingham. “So you do a prime with one vaccine and then the second – whether it’s 28 days or two months or whatever the agreed periods would be – would be with a different vaccine.”

Viral-based vaccines such as the Oxford jab, which is based on a chimp common cold virus, give a much greater cellular response – prompting the T-cells to kill cells infected with the coronavirus. The mRNA vaccines, like Pfizer’s, tend to generate a bigger antibody response. So the idea is to combine them, in whichever order, to help the immune system respond more powerfully to Sars-CoV2.

“No one’s ever done it live and since we’ll have safe vaccines available we should do that study, because then we have the ability to actually produce better immune responses,” said Clive Dix, deputy chair of the taskforce.

“There is a slight benefit to it, too, in that if prime and boosting either way around work, it may help with the deployment, because it might just be simpler to deploy that way round, but the main reason is to get a stronger immune response.”

Bingham and Dix were speaking at the launch of a progress report on the first six months of the taskforce, which has secured deals for seven different vaccines for the UK.

Three of them – Oxford/AstraZeneca, Valneva and Novavax – are being manufactured in the UK. The first doses of the AstraZeneca vaccine have been made in the Netherlands and Germany, but 4m doses are already in the country and most of the rest of the supply will be UK-manufactured.

There remain questions over when the Oxford/AstraZeneca vaccine will be approved. The UK regulator has been asked by the government to appraise it following a rolling review, assessing all data and information on safety and efficacy and the quality of the product over recent months as it has become available. But the full data from the late-stage clinical trials, involving 24,000 people, have not yet been published and it is not known how the regulators will view the results.

Dix said the taskforce had no regrets over backing other types of vaccine over mRNA vaccines like Pfizer’s and Moderna’s, adding: “We certainly wouldn’t have got enough [of the Pfizer vaccine] to vaccinate everybody.”

They looked at Moderna but realised they could not get any doses until April, so did not sign a contract. On the day Moderna reported its results, a deal was agreed to buy 5m doses, which was later increased to 7m.

Dominic Cummings gag voted Christmas cracker joke of the year

Moments of light relief have been hard to come by this year but the annual ranking of topical Christmas cracker jokes provides some, with the top spot taken by one that has a punchline featuring a Chris Rea song and Dominic Cummings.

Lanre Bakare 

The TV channel Gold’s eighth annual ranking, which is chosen by a panel chaired by the comedy critic Bruce Dessau, was put to 2,000 voters who chose: “What is Dominic Cummings’ favourite Christmas song? Driving Home for Christmas”, as the best cracker joke this year.

Other entries riff on more Covid-related themes, with punchlines ranging from quips about pirates and the R number to festive groaners about reindeer and herd immunity.

Dessau said during one of the “strangest and most turbulent years yet, we can always rely on British humour to pull us through”.

The top 10 cracker jokes

1. What is Dominic Cummings’ favourite Christmas song? Driving Home for Christmas.

2. Did you hear that production was down at Santa’s workshop? Many of his workers have had to Elf isolate!

3. Why didn’t Mary and Joseph make it to Bethlehem? All Virgin flights were cancelled.

4. Why are Santa’s reindeer allowed to travel on Christmas Eve? They have herd immunity.

5. Why did the pirates have to go into lockdown? Because the “Arrrr!” rate had risen.

6. Why is it best to think of 2020 like a panto? Because eventually, it’s behind you.

7. Why couldn’t Mary and Joseph join their work conference call? Because there was no Zoom at the inn.

8. Why can’t Boris Johnson make his Christmas cake until the last minute? He doesn’t know how many tiers it should have.

9. What do the Trumps do for Christmas dinner? They put on a super spread.

10. Which Christmas film was 30 years ahead of its time? Home Alone.

UK Covid vaccine tsar to leave post

The government‘s coronavirus vaccine tsar will leave her post this month weeks after reports a public relations firm was paid £670,000 to advise her. 

Confirmation of her departure came as her deputy was announced as her replacement, on an interim basis.  

Kate Bingham was appointed as chairman of the government’s vaccine task force in May.  

Since then she has won praise from ministers for securing millions of doses of the three vaccines, so far, which scientists have found to be effective against Covid-19.  

But she faced criticism when it was reported that Ms Bingham, a former venture capitalist and the wife of Jesse Norman, a Tory minister, had used the services of eight consultants to advise her on media strategy.

Last month reports suggested that Ms Bingham’s contract was due to run out at the end of the year and that she had always intended to leave at that point. 

As her replacement was announced, Boris Johnson said he was “hugely grateful for the hard work and dedication of the vaccine task force, under Kate Bingham’s leadership … the country owes them a debt of gratitude.”  

In response Ms Bingham thanked the prime minister, saying the clear mandate he had given the taskforce had allowed them to strike deals for promising vaccines.  

Clive Dix, currently the deputy chair of the taskforce, will step into her role.  

He warned that although the UK now had vaccines against the virus there was “more for us to do.  

“We must continue to develop our research and response capabilities in the UK and finish the task of building an infrastructure to enable us to manufacture vaccines at scale.”  

Environment Agency faces questions over works on protected river

Environment agency officials were under pressure on Monday to explain exactly what consent they gave to carry out extensive work on the banks of a protected river in England.

Sandra Laville 

Officials from the EA, Natural England and the Forestry Commission moved in last week to stop the work along the River Lugg outside Kingsland, near Leominster in Herefordshire.

The officials – along with the police – issued a stop notice to the landowner, John Price, to halt the works, which the local wildlife trust said had devastated the river and would have dire consequences for wildlife and water quality.

The EA said a legal notice requiring the works to stop immediately was served on the landowner by Natural England earlier last week, the Forestry Commission issued a stop letter requiring an end to any further felling work and the Environment Agency requested no further works to be carried out on the river.

But the landowner Price, a potato and cattle farmer, has insisted that he was asked to do the work by the EA to try to tackle flooding in the area.

On Monday the local parish council told the Guardian it had been in discussion with the EA since July about tackling the flooding in the area. EA officials had attended parish council meetings and walked the site in September.

The EA wrote a short report seen by the Guardian. It said: “We have identified that some tree works are required on the left hand bank directly upstream of the bridge (see picture 0141) which we will again look to secure funding for and if successful make the land owner aware of our intentions.

“In addition the left hand bank directly upstream of the bridge could do some reprofiling due to bank slumping probably as a result of cattle poaching (see picture 0132) to ease conveyance as it is currently partially obstructing the 3rd arch of the bridge and will look to the land owner to carry out these works.”

The EA said on Monday it was continuing to investigate the damage to a river which is protected as a site of special scientific interest (SSSI), and a special area of conservation (SAC). As such no work should be carried out without permission from the EA.

Minutes of parish council meetings confirm that the EA was in discussions with the council about flooding and what work was required to alleviate it.

Minutes of Kingsland parish council meetings from July, September and October of this year contain items about the “maintenance of the Lugg”.

In minutes of a meeting in July concerns were expressed about the risk of river flooding and reference made to discussions with the EA on maintenance of the Lugg.

The minutes detail verbal discussions with the EA. “The levels reached during the floods earlier this year were the highest since 1976. Due to the Covid-19 situation, the riverbank has not been walked since the floods, however this is due to be done soon.

“Dredging can be done where there is a need, but need to keep in mind the dynamic nature of the river which moves the bed levels anyway (diverse nature of river flow).”

In October reference was made to the site visit in September with an EA official. “Cllr Rowsell reported on “a very useful” walkabout with the Environment Agency. Mr W Best, Environment Agency informed the meeting that riparian owners are responsible for maintenance but accepted that this may be beyond their capability at times and provided a helpline number.”

A spokesperson for the parish council said on Monday they were not aware whether the EA had given the landowner official permission to carry out the works.

He said: “We would not be told whether a permit had been issued for the works. The parish council supports work to improve the Lugg to help with flood alleviation measures. Environment Agency officials have been present in parish council meetings to discuss flood alleviation measures.”

Price, of Hay Farm, told the Daily Telegraph, he had acted with permission.

“I have watched this river all my life, and no one knows this river better than myself,” he said.

“I have always looked after the river. I was asked to stop the erosion because I’m the landowner so I’m responsible for the river.”

He said he had not uprooted any trees, but had only cleared those that had come down in floods.

He said flooding in the area had been getting worse over the last 10 years, and that he had the support of the village and parish council in doing the work.

The Environment Agency was asked for a comment. It had not been provided at the time of publication.