July 25, 2021 • 37 mins
We are honoured to welcome Professor Sir Andrew Pollard to the Not Mini Adults Podcast this week. Sir Andrew is Professor of Paediatric Infection and Immunity at the University of Oxford, Director of the Oxford Vaccine Group, Fellow of St Cross College and Honorary Consultant Paediatrician at the Oxford Children’s Hospital, Oxford, UK.
Andrew trained in Paediatrics at Birmingham Children’s Hospital, specialising in Paediatric Infectious Diseases at St Mary’s Hospital, London, UK and at British Columbia Children’s Hospital, Vancouver, Canada.
He chairs the UK Department of Health’s Joint Committee on Vaccination and Immunisation and the European Medicines Agency scientific advisory group on vaccines, he is also a member of World Health Organisation’s SAGE.
Andrew was knighted in 2021 by Her Majesty the Queen for services to public health, particularly during the COVID-19 pandemic. Sir Andrew played a crucial role in the development of the Oxford coronavirus vaccine and led the global clinical trials that started in the spring of 2020.
There is one word to describe our conversation with Sir Andrew and that is 'IMPACT'. This was truly an inspiring conversation and we of course discuss Andrew’s work in developing a COVID-19 vaccination, but just as importantly his work in helping to develop vaccines for children all over the world.
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–
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sir Andrew Pollard (00:00):
For much of what we do in science, we make
(00:02):
discoveries that that may takedecades before they actually
turn into an important buildingblock of a change. So I really
like this working at thetranslational space, where you
can see the way in which it cantransform people's health. I'm
just a few years down the line.
You know, I look back over mycareer as a doctor over 30 years
now, just over 30 years, andmany of the diseases that I
(00:28):
dealt with in the 1990s or as Isaw as a medical student in the
1980s, we just don't see inpaediatrics anymore because
we've prevented them throughimmunisation. That's an
incredibly exciting field to bein.
David (00:49):
This is episode six of the third season of the Not Mini
Adults podcast - Pioneers forChildren's Healthcare and
Wellbeing. Once again, my nameis David Cole and I am joined by
my wife Hannah, and together weare the co-founders of UK
children's charity Thinking ofOscar on this week's podcast, we
are thrilled to say that we haveProfessor Sir Andrew Pollard. So
(01:09):
Andrew is Professor ofPaediatric Infection and
Immunity at the University ofOxford. He is Director of the
Oxford Vaccine Group, Fellow ofSt Cross College and Honorary
Consultant Paediatrician at theOxford Children's Hospital.
Andrew trained in paediatrics atBirmingham Children's Hospital
specialising in paediatricinfectious diseases, and at St.
Mary's Hospital London, and alsoat British Columbia Children's
(01:33):
Hospital Vancouver in Canada. Hechairs the UK Department of
Health's Joint Committee onVaccination and Immunisation and
the European Medicines AgencyScientific Advisory Group on
Vaccines, and is also a memberof the World Health
Organization's Sage. Andrew wasknighted in 2021 by Her Majesty
the Queen for services to publichealth, particularly during the
(01:56):
Covid-19 pandemic. He has playeda crucial role in the
development of the OxfordCoronavirus vaccine and led the
global clinical trials thatstarted in the Spring of 2020.
There is one word to describeour conversation with Andrew and
that is impact. This was trulyan inspiring conversation. And
we of course discuss Andrewswork in developing a Covid-19
(02:16):
vaccination. But just asimportantly, his work in helping
to develop vaccines for childrenall over the world.
Hannah (02:26):
Andrew, good morning, welcome to the Not Mini Adults
podcast. Good morning. So, wherewe often start with our guests,
is just to ask them to talk usthrough how they got to where
they are today and the path thatthey have taken.
Sir Andrew Pollard (02:40):
Well, I'm at this moment sitting in my office
at the Vaccine Centre at theUniversity of Oxford. And it
feels like a long journey tohave got to this point and
particularly with the last year,which seems to have been about
10 years of my life, and verymuch dominates all thinking at
the moment as it does for mostof us. My background is as a
paediatrician and my main way inwhich I defined myself as a
(03:04):
children's doctor, and I spentmy training specialising in
infectious diseases of children.
And that naturally led me intowanting to work in a research
area around the prevention ofthose infections. And of course,
because the biggest burden ofinfectious diseases is in the
most resource poor settingsaround the world into global
(03:27):
health, and so immunisation sitsextremely well within that in
preventing the diseases I see inthe hospital, as well as trying
to promote better child healthin lower middle income countries
around the world. And so that'sreally how I spent the last 30
years of my career training ininfection and then working in
(03:49):
research areas to try to improvechild health through
immunisation.
Hannah (03:56):
Thank you. And we first became aware of the Vaccine
Group when we were in the earlyfew years of our charity. But of
course, the rest of the worldknows about you now as well.
Could you talk specificallyabout the mission for the group?
And then which you've alreadytouched on briefly, but to
elaborate on that a littlefurther? And, of course, it's
interesting to have your view onthe last 10 years squeezed into
(04:20):
one year, as you describe thisas well.
Sir Andrew Pollard (04:22):
Yeah, I mentioned that the mission of
the Oxford vaccine group which Idirect is to improve child
health through immunisation andwe have different aspects of
that which we work on. One isobviously the development of new
vaccines and the testing of themand evaluation here in Oxford,
but also working with partnersin other countries around the
(04:44):
world, particularly in SouthAsia and, and in Africa, to
generate data that will helpsupport use of vaccines to
protect children in thosesettings. So that's really our
core mission, but we also knowWork on public information about
vaccines. We have a website, thevaccine knowledge website to
(05:06):
provide information for thepublic and take a major role
locally in educating generalpractitioners and practice
nurses about immunisation topromote child health for
immunisation through education.
So there's there's sort of abroad remit that has at the core
of it is the research and on newvaccines, but also about how to
(05:27):
help people's understandingabout vaccines, both
professionally and for thepublic. And then those of us who
are clinicians also work in thelocal hospital, the John
Radcliffe Hospital, either asadult physicians or in my case
as a paediatrician. So we have aservice element of, of our role,
as well. And there's about 160people here in the paediatric
(05:50):
department working on vaccines.
So it's a very big operation.
And of course, it always is indevelopment around teams, rather
than individuals. Over the lastyear, we've got a number of
individuals have been veryprominent in the media,
including myself. And the behindthis is a wonderful talented
team of people who actually doall of the interdisciplinary
(06:13):
activities that are required tomake and test and develop
vaccines. So I guess to come toyour second point about the last
year and a half has been a veryunusual in a sense, but in many
ways, it's just been business asnormal, because we've been
coming to work everyday doingwhat we do, which is testing
vaccines, doing the laboratorywork to see how well they work,
(06:37):
what the immune responses looklike. And so that, broadly is
what I've been doing for thelast 20 years here in Oxford,
and so has the team. And what'sbeen different about it is the
intensity, we've been workingseven days a week, and then very
long hours every day. And alsoevery time we look out the
window, the the media are there,and there's so much public
(06:58):
interest in what we're doing,that it's been a completely
different experience from thenormal work we do, which is
largely under the radar, justgetting on trying to do our
business as normal. So thatclearly has its challenges as
well. And I think adds a newelement of pressure because of
(07:18):
the importance of theactivities. But in the end, we
have to do to take the same cooland calm approach because we're
doing developing a biologicalproduct that's been given to now
many hundreds of millions ofpeople. So it has to be done
very carefully and following theusual protocols.
Hannah (07:38):
And we've been so interested to imagine how the
building blocks of the work thatyou've been doing over the last
few decades, both with thebasics of developing vaccines on
the one hand, and then on theother side, with a focus on
childhood immunisation, howthose building blocks enabled, I
appreciate this answer, by theway will apply to the other
(08:00):
teams that have also developedvaccines. Nobody was starting
from scratch. But in layman'sterms, could you describe to us
how you were over and above thehours that you have in the
extraordinary effort that hasbeen put in, how you've been
able to develop vaccines soquickly in what the accelerators
were?
Sir Andrew Pollard (08:20):
Well, I think that the way in which the
building blocks were there arejust because we have been making
vaccines for a long period oftime. So all of the steps that
are required, right from how youdesign the vaccine through to
the very large scale tampertrials, and the authorization
processes working with in ourcase with AstraZeneca has been
(08:44):
what we normally do. So they'rethe building blocks were there,
just because it's what we doeach step has already been
tested before, it just hasn'tbeen tested under the quite the
same pressures as over the lastyear. The reason why things
could move so quickly, partlywas around the funding
available, which normally weknow do a little bit and then
(09:07):
you wait for a year andsometimes several years before
the next funding comes to do thenext bit. So that's one of the
reasons why it's been quicker.
The other is that the many ofthe bureaucratic timelines have
very much been shortened. Sowhen we put in our our
application for the ethicalreview, normally you would wait
a month to even get to thecommittee. And in our case, it
(09:28):
took just four days to get thecommittee to meet and to review
all of the paperwork for thestart of the trials. And
similarly with with the UKregulator, the MHRA before you
start any clinical trial, theydo a very detailed scrutiny of
the clinical trial protocol, themanufacturing quality and so on.
(09:50):
And the regulator recognisingthe emergency situation puts a
big team on all vaccines. Sothat that timeline, which again,
is usually around about a monthfrom submission, through to
review, and they did theirreview in seven days. And so the
each of those steps, whetherit's the funding or the other
(10:12):
review processes to make surethat everything is in order has
been very much accelerated. Ithink one other critical piece
here has been aroundmanufacturing, usually the
hardest bit of all, this isn'tthat clever stuff, designing the
vaccine or, or the clinicaltrials to test them is actually
being able to make the vaccineat scale. And because that's so
(10:34):
difficult, and so expensive, isusually left, right until the
end until you're absolutely sureyou've got a product that works.
And whereas here, quite rightly,the investment and the financial
risk was taken very early on, tomake sure that the work to
upscale to make very largequantities have been done by the
(10:55):
time that organisation camethrough. And that has, I think
dramatically changed thetimelines, usually that process
would take a year or more. Andbecause the process started,
long before the authorization,it meant that essentially
AstraZeneca ready to distributea couple of days after the
vaccine was authorised. So thatthe all those things have been
(11:18):
quite astonishing. But there isa another bit here, which makes
me quite nervous. And that isthat we were dealing with a
virus that we knew about. And sowe knew how to make the vaccine,
we knew exactly what to do. Weknew that the spike protein,
this protein on the surface ofthe virus that binds on to
(11:38):
ourselves, was the key targetfor the immune response. And we
actually even knew where to putit in our vaccine platform, the
viral vector that we use,because we'd had previous
Coronavirus vaccines that thatwe were working on here in
Oxford. So if it had been adifferent virus, one that we
didn't know about, we didn'tunderstand this biology. I'm
very worried that we would stillbe here today. puzzling about
(12:02):
how do you actually design thevaccine in the first place. So I
think we've also been veryfortunate, I mean, I don't
think, of course, not fortunatein having a pandemic, but
fortunate that the pandemic waswith a virus that we really
understand.
David (12:18):
And we're going to, obviously need to touch on the
kind of Child Health elements ofthis and where we are with that.
But it struck us when we werethinking about and preparing for
the conversation that first ofall, maybe not everyone realises
that the Oxford vaccine groupconcentrate so much on
paediatrics, so that in itself,I think is from the stories that
we like to share is a wonderfulstory in itself, but also has
(12:41):
that element of it has theworking with children working
with the physiologicaldifferences that you have in in
that kind of paediatricspectrum. Has that allowed you?
Or have you seen that that'sallowed you to, you know, kind
of make gains or be in a betterposition than maybe you would
have done ordinarily?
Sir Andrew Pollard (12:58):
Well, I think it's a really interesting
point that the immune system andit definitely is a bit different
in the the youngest infants, ofcourse, most vaccines are given
to very young children. And sowe've had to work over many
decades to understand more aboutthe immune system in young
children. But in some ways thatthat's been a particular
challenge for understanding howwe might approach the pandemic,
(13:22):
because one of the real fearslast year was that the vaccines
might work very well in youngeradults and in children, because
we know how their immune systemswork. But there's so much less
research been done in theelderly. And most vaccines don't
work very well in that agegroup. And I think we've been
incredibly fortunate here. Butall of the vaccines that are
(13:45):
being deployed at the moment, doappear to work even in the
oldest adults. And so one of thereally interesting questions is
not really about know whetherwe've learned from children, but
the realisation that we have alot more to do to work on why
most vaccines don't workparticularly well in older
adults. And these ones,generally speaking, are working
(14:07):
well. So we need to probe theimmune system in older adults as
well. And I think one of thethings that our work on children
can do is provide the approachesand the techniques that we've
learned from having to evaluatethe immune system in children,
and to understand more aboutolder adults. And I guess with
an expanding older adultpopulation, globally, this is
(14:31):
going to become increasinglyimportant in the future.
David (14:33):
I think it's such a fascinating topic, because we
talk so much, you know, on a dayto day basis, not just on the
podcast with people thatpotentially are thinking about
investing in child health thatare looking at new solutions,
new drugs, new digitaltherapies, whatever it might be.
And it always comes back to youknow, the population is not big
enough, the return on investmentisn't necessarily there. Whereas
(14:55):
actually, there's some there'ssome elements here that we're
discussing, which gives thempositive vibes, I guess or
positive stories that, you know,maybe others we should be we
should be spreading more interms of actually starting in
the paediatric community toallow us to then look at the
rest of, because of thecomplications and then allowing
us to look at the rest of therest of society as
Sir Andrew Pollard (15:17):
I think that's absolutely right.
Hannah (15:19):
You've also talked about, you know, how you had to
operate organisationally and howyou were able to work so fast.
Clearly, that's not desirable tohave to work at that level of
intensity over a sustainedperiod of time, but interested
in what aspects of how thingshave changed over the last 12 to
(15:39):
15 months? Now? You know, what,what of that? Would you like to
keep?
Sir Andrew Pollard (15:44):
Well, I think the intensity would be
good to dial down. And I mean, Ithink there is some dialling
down already of that. But itstill remains pretty busy. I
think one of the things is thatthe whole team has had to learn
quite a lot of resilience. And Ithink probably, that's a whole
area where we need more focus inthe workplace to help people
(16:07):
with with resilience, becausethere is enormous strain on
teams normally, anyway. Buthere, I think we've seen the
pressures that that people areunder having to work so hard,
and feeling the responsibilityto do so. So I think I'm not
sure we want to keep that, forme, it does raise the issue of
what can we do to support peoplebetter to continue the important
(16:32):
work that they do. So that's onearea, I think, certainly things
like being able to talk withpeople on zoom, or on one team,
which is the system we use mostin the university really has
improved our ability to reacharound the world to add to
different groups over the pastyear, there are definitely
(16:52):
disadvantages of that of notbeing in the same room, not
being able to beat a meetingwhere you can have the important
discussion over coffee and abreak, set all of those things,
I think, last year, it does comeinto that part of supporting
staff that if you're only everseeing someone on a screen, it's
very much more difficult to pickup all of the signals that you
(17:15):
need to provide adequatesupport. So I think we do miss
being in the same room as otherpeople. But I think it has made
us able to, to be much moreefficient. And I've been I think
about our clinical trials,working with colleagues in South
Africa and in Kenya and, and inBrazil over the last year. And
regularly talking with themreally would have been much more
(17:37):
difficult to have the type ofinteraction that we have, if we
were doing this just by phonecalls, or having to fly there
and not be able to continue withday job whilst having those
those meetings, I think there'sbeen some real advantages in
using the technology. But Ispeak at a lot of conferences,
(17:57):
and always have done. But it'smuch more difficult to sit
through a whole day of aconference where it's on a
screen than if you'reinteracting with people in the
real world. So I think there arevarious aspects which have
advantages, but then they're notall how we do I'd like it to be
all the time.
David (18:14):
It just makes me remember actually. So member of your
team, Dominic Kelly, when he waslooking after Oscar in hospital,
one of the things that we wetalk about a lot was just, he
was waiting for colleagues onthe other side of the world to
wake up, you know, to so that hecould start to question them
about whether or not they'd seena diagnosis such as the one that
(18:34):
Oscar had. And you know, any anythoughts on that. And, you know,
we talk a lot and in my workwith IBM talk a lot about the
democratisation of data andbeing able to share data more
easily, but actually just beingable to have those conversations
more easily as well. And I thinkalso a benefit to what's
happened over the course of thelast 15 months, 18 months.
Sir Andrew Pollard (18:52):
Yes, I think we've also enabled collaboration
much more easily. I mean, rightat the beginning of our
development back in February, orMarch last year, one of the
Chinese companies was a littlebit ahead of us in development.
And so we got together on on azoom call, just to discuss our
(19:13):
shared experiences. And I haveto say, for me, that was
incredibly helpful, because theyhad already started their
clinical trials and could givesome information. And right back
there at the beginning, therewas so much uncertainty about
everything, that it really was,for me quite a boost that we had
colleagues in China who workvery open sharing their, their
(19:34):
latest data, that helps. And Ithink that would have been
almost impossible without thenew ways of being able to
connect to people and share ascreen and look at data
together.
David (19:45):
I think that's such a positive statement to make
because I think some of thepress may have either not
covered it or kind of not let itbe known that there has been
collaboration across boundariesacross you know, organisations,
whatever it might be So, sothat's kind of Great. Great to
hear. You've touched upon acouple of times, you know, all
the other work that you've thatyou do. And I think we should
really kind of maybe move tothat in a second. Because
(20:07):
obviously, even though COVID hashit other things didn't stop.
So, you know, looking atcreating vaccinations and new
solutions from that point ofviews, I guess, not stopped. But
just before we move that just asa kind of final thing from a
COVID perspective, there's a fewthoughts in terms of where
children are in the in thebalance of vaccination, not
vaccination. I know you've gotsome, you know, strong, strong
(20:28):
points, as you've kind ofalready started to address in
terms of making sure that thevulnerable are prioritised. And
there's still, you know, littleevidence to say that the
children get it in such acritical way, shall we say, as
the adult population, but maybewe could just kind of cover that
off? And I think we're reallykeen to think about some of the
other stuff that you're workingon as well.
Sir Andrew Pollard (20:47):
Yes. I mean, I think that's absolutely right.
You summarised it very well,better than I could probably.
But I think for me, the issueabout children is that we need
to have good data about whoshould be vaccinated and whether
children should be vaccinated.
And the sorts of things that weneed to take into account, there
are other groups of children whoare at particular risk. And so
(21:08):
far, there are some groups wherevaccine has been recommended for
children here in the UK. I thinkthat's straightforward. But
actually, for most children, therisk of severe disease ending up
in hospital is so incrediblylow, that you wouldn't really
need to be looked at carefullyto see whether there is actually
a benefit in vaccinating thewhole childhood population, for
(21:31):
that very low rate of disease.
So I think that observations doso that needs looking at
carefully. Now, the second oneis obviously around long COVID.
And I don't really like the termbecause it encompasses a whole
range of different conditionsmight be better that we rather
than lumping them all togetherto try and understand each one
individually. But if vaccinescan prevent long COVID, that
(21:54):
might be another good reason tovaccinate. And then of course,
there's this other conditioncalled PIMS TS, which is an
inflammatory condition, whichoccurs after COVID, particularly
in younger children, we'relearning more and more about
that, and it may be the vaccinescould prevent that condition. So
there's definitely could be areally important role for
vaccinating children inpreventing most of these
(22:15):
conditions. The main reason whypeople are asking for children
be vaccinated is to protectother people not to reduce
transmission and protect adultsat this stage. You know, if we
were looking back to six monthsago, it might make a lot of
sense to do that, because weknow that vaccines would have a
major impact on reducingtransmission, we have the data
(22:36):
from trials and from the firstevidence in the UK from the
alphabet read. I think theproblem though going forwards is
that with the virus evolving,it's evolving to transmit even
in vaccinated populations. Andso vaccinating children about
transmission will in time overthe next six months or a year
become less and less viable asan option. And so it may be that
(23:00):
we need to understand more aboutthe role of vaccination,
actually having any impact inreducing spread. And of course,
at this moment with a Deltavariant, we're seeing lots of
spread in people who arevaccinated. And so vaccinating
children isn't isn't going tostop that. So I think that
definitely needs a good reviewof all of the data are around
that. We also need to look atthe potential risks. Now, are
(23:23):
there any safety concerns fromvaccinating children, and there
are some emerging data aroundheart inflammation associated
with the RNA vaccines,particularly with the second
dose. And so we before launchinginto that we need to review that
carefully and make sure thatthere's there's no harm. And
particularly if the benefits arevery minor for vaccinating
(23:47):
children, you really want to besure that you've weighed out
those benefits and those riskscarefully. So from my
perspective, I, you know, I'moverall very much in favour of
vaccinating children, if it canreduce disease burden for them.
But it doesn't feel an urgentthing to make the decision
today, when we will have a lotmore data in the next few
(24:07):
months. And so for me, it's notso much a question of not
vaccinating children, whichwhich may well be the right
decision. It is just aboutgathering the data to make sure
it's the right or a gooddecision. But there is another
point about why timing iscritical in that vaccinating
just teenagers here in the UK,which is would be somewhere
(24:29):
around six to 8 million childrenor teenagers. That's enough
doses to vaccinate the whole ofthe older adult population in
quite a large number of lowincome countries, and certainly
those who are vulnerable. Sothose doses today would prevent
10s of 1000s of lives sorts or10s of 1000s of deaths, if they
(24:50):
were deployed today in countrieswhere there are vulnerable older
adults, rather than children whoare very unlikely to even get a
cold with the virus. So that forme is that sort of global equity
question is the key driver forsaying, this isn't the moment to
vaccinate children, we should beprotecting people who we know
will die this year.
Hannah (25:11):
You've brought us smoothly along to our next
question, which was, ourunderstanding of the work of
your group had started with theexisting immunisation programme
that we have in the UK forinfants and very young children
and the sequence of vaccine setsadministered. But you've touched
just now on the work that you doin low income countries with
(25:33):
respect to children and adults.
And I'd love to understand moreabout the focus there, please.
Sir Andrew Pollard (25:38):
Yes, I mean, just as you introduce that the
one thing that strikes me aboutthe last year, really is the
children have been relativelyunaffected directly by this
virus. But the indirect impactby the effect it has had on
their families and economies ishuge. And so that's why I think
(25:59):
actually vaccinating the adultsin these low income settings is
the most critical thing to dobecause we've got to get them
their economies back to normal.
But there's another bit whichchildren have been particularly
affected by this. And this isthe disruption of health
services, which means thechildhood vaccination has really
stalled in many countries and inlow income countries
particularly. And we're nowseeing outbreaks of measles,
(26:21):
rising again, in countries wheremeasles was under control.
measles is one of the biggestkillers are very young children.
And so this is an absolutetragedy that Coronavirus is not
really affecting children, butvaccine preventable diseases are
because of the impact it's hadon health systems. So to come to
(26:41):
our work, I mean, we've, we'veparticularly have worked on
bacterial infections in childrenin low and middle income
countries. And the real focusover the last 16-17 years has
been on pneumonia, which is thebiggest cause of death in the
under fives and in low incomecountries and generating data,
(27:03):
particularly in South Asia, toprovide information about burden
of disease and about vaccinestrategies that might help to
control severe disease caused bythe pneumococcus one of the
commonest causes of pneumonia inyoung children. And that work
really led on for me to studyingtyphoid, which is spread through
(27:26):
the water, and in circumstanceswhere there's very poor hygiene,
poor sanitation. And the realchallenge with with typhoid,
this this bacterial infection isthat we can solve it if we can
put in clean water in those manybig cities in low income
(27:47):
countries. But unfortunately,the engineering works to do that
require huge investment, hugeamounts of money, and political
will over probably more than adecade in many different
countries. So the children todayneed protecting from this
disease. And so we've beenworking with an Indian vaccine
developer to generate the datato support use of typhoid
(28:10):
vaccines and that's nowhappening we were seeing rollout
of typhoid vaccines number ofcountries, quite amazingly this
year in February. In Pakistan,they managed to start a
programme where they vaccinateda million children per day
against typhoid because of anoutbreak of a strain of typhoid,
which was resistant to almostall antibiotics. And so the work
(28:35):
that we've been doing ontyphoid, the trials involved
100,000 children in Africa andAsia, so huge programme of work,
and then has led to now rolloutof that vaccine, which is
protecting people from theseantibiotic resistant bacteria.
So that's been a real exciting10 years of work on typhoid,
(28:56):
particularly for children inthose settings.
Hannah (29:02):
Thank you and changing tack slightly, one of the trends
that we've read about in thepress has been the events of the
past 18 months, causing moreschool leavers to choose to sign
up for medical degree coursesinspired by the work of
yourselves and others across theNHS. So the question we had was
(29:26):
around, how do you see thepipeline of new new talent
coming into your field? Is it isit an area that has been
difficult or easy to attractfolk into and where does that
come from?
Sir Andrew Pollard (29:38):
Well, I think one of my hopes, really is
that science and publicunderstanding of science will be
part of the legacy of thepandemic. I mean, it's it is, I
think, quite astonishing to methat to talk to members of the
public, who knows so much aboutvaccines and vaccine development
and different vaccine platformsand phases of clinical trials.
(30:00):
It's even a year ago that no onewould have had much of a clue
about any of it. So I think wehave really had a huge increase
in sort of general understandingand awareness about science. And
I certainly hope that that willinspire young people to go into
medicines and medicine andscience degrees, and through
(30:20):
their university education. Ofcourse, at this moment, it takes
a while for those people to comethrough the pipeline to become
researchers and cliniciansworking in those areas. But we
certainly have always had lotsof applications from junior
doctors and scientists to comeand work in, in our area of
(30:40):
science, because it's so unusualthat you can work in a research
area where in the course of yourcareer, you see impact on an
almost daily basis. And for me,just here for 20 years in
Oxford, about half of thevaccines used in the UK, have at
least had some of the data thatsupported their use has come
from from the work here in mygroup. And, you know, I
(31:04):
mentioned several of the othervaccines, typhoid and pneumonia
and meningococcal, and nowCOVID, where we've had global
policy impact by the researchthat we've been undertaking. And
I think for people coming towork in this setting, that's
incredibly inspiring to actuallywork on something where you see
that direct impact, just in amatter of a few years from the
(31:28):
time you're working on it. Formuch of what we do in science.
Now we make discoveries thatthere may take decades before
they actually turn into animportant building block of a
change. So I really like thisworking in the translational
space. That way, you can see theway in which it transformed
(31:48):
people's health. I'm just a fewyears down the line. And I you
know, I look back over my careeras a doctor over 30 years now,
just over 30 years, many of thediseases that I dealt with in
the 1990s, or as I saw as amedical students in the 1980s,
we just don't see in paediatricsanymore, because we've prevented
(32:10):
them through immunisation.
That's incredibly exciting fieldto be,
David (32:14):
I think the the word that I'm going to remember this
conversation by is impact. Andthat's one of the main things
that we try to do from acharitable perspective is what
impact can we have on childrenthat are in hospital, and we
could talk to you for so longabout and we feel like we've
only just touched on the workthat you do outside of COVID.
And we discussed a little bitabout the pneumonia, vaccines
(32:35):
and what have you. But thethere's so much else more has to
do in it. But I do hope thatthere will be at least someone
listening to this, who wouldfeel that actually, there is an
opportunity for them to moveinto healthcare to move into
medicine and to and to have thathave that impact. It's so good
to hear that you get lots ofapplications coming to your
group. And we can totallyunderstand why. But I think for
the for the wider paediatricpopulation and people moving
(32:58):
into Child Health space, that'sstill probably underserved. So
absolutely no doubts, yourinspiration and the impact that
your group does. And all thework that you do will allow them
to do that. So you know, thankyou.
Sir Andrew Pollard (33:08):
I mean, I think David, just picking up on
that, I think that there is oneissue, which is I mean, lots of
people go into medicine. Andfortunately, we were very well
served by people wanting to dopaediatrics and to care for
children. But the one of theshortages though, is a
paediatricians who then do anacademic training. And we've
actually, I mean, this is aslightly different topic. But
(33:31):
over the last couple of decades,we've seen a reduction in the
number of academicpaediatricians, and that isn't
just here in the UK, it's, it'sin many other countries. And
that is quite a worry for thefuture of research in child
health, if those numbers andthat's not just in my field, but
in in a broad range of those, infact, I suspect in my field, we
(33:53):
won't be such a problem becauseof the legacy of the pandemic.
But for many other areas ofchild health, we really need to
work more to attract people intoa research area to make sure
that we can better support andchildren's health in the future
with good research.
David (34:13):
And we will spread your message as wide as we as we can,
from from that point of view,very conscious of your time. And
so you know, first of all, thankyou so much for that, as we do
with everyone that we have onthe podcast, I kind of final
question is if you could changeanything within child health,
what would it be?
Sir Andrew Pollard (34:31):
Well, I think I touched on it before,
which is clean water. It canhave the biggest transformation
on Child Health apart fromvaccines, which we're doing. And
the one other thing that is themost important public health
intervention is it provision ofclean water. We're fortunate
(34:52):
here in the UK that in VictorianEngland, the money was made
available to towns to put insewage works and to provide
clean water Dealing with choleraand typhoid, which I mentioned,
which we don't see here in theUK anymore. And that was an
incredible, cities were givenloans to pay back over 100
(35:14):
years. And to put that in place,and of course, that was a time
when populations were relativelysmall. And so getting started,
meant that we are where we arenow with a very healthy
childhood population. But inmany parts of the world, cities
have 10s of millions of peoplewith no adequate water supply or
(35:35):
sanitation. The reengineering ofmunicipal water and sanitation
is incredibly expensive. Andthat is, I think one of the
biggest challenges that there isin child health at this moment,
is protecting young childrenfrom the consequences of
David (35:55):
Andrew, thank you so much for joining us today. Thank you,
exposure to dirty water.
especially for all the all thework that you've done. And it's
just been such a privilege totalk to you. So we really,
really appreciate you taking thetime. Thank you for inviting me.
We cannot thank you enough forjoining us on today's not many
heroes podcast and taking sometime out from his what must be
(36:17):
very busy schedule given wherewe still aren't within the
global pandemic, as I'm sure youwill all agree the impact that
his work has had not only on theglobal population given
COVID-19, but especially thepaediatric population, given the
work that he's done over manyyears is something to inspire us
all. Over the next few weeks ofthe nominee Adams podcast we
will be talking again aboutmental health and also about the
(36:39):
importance of empathy and play.
For children that are beinglooked after in hospital. Please
do subscribe to the podcast. Andif you're enjoying it, please do
leave us a review as well. Wehope you'll join us again next
week.
For much of what we do in science, we make
(00:02):
discoveries that that may takedecades before they actually
turn into an important buildingblock of a change. So I really
like this working at thetranslational space, where you
can see the way in which it cantransform people's health. I'm
just a few years down the line.
You know, I look back over mycareer as a doctor over 30 years
now, just over 30 years, andmany of the diseases that I
(00:28):
dealt with in the 1990s or as Isaw as a medical student in the
1980s, we just don't see inpaediatrics anymore because
we've prevented them throughimmunisation. That's an
incredibly exciting field to bein.
David (00:49):
This is episode six of the third season of the Not Mini
Adults podcast - Pioneers forChildren's Healthcare and
Wellbeing. Once again, my nameis David Cole and I am joined by
my wife Hannah, and together weare the co-founders of UK
children's charity Thinking ofOscar on this week's podcast, we
are thrilled to say that we haveProfessor Sir Andrew Pollard. So
(01:09):
Andrew is Professor ofPaediatric Infection and
Immunity at the University ofOxford. He is Director of the
Oxford Vaccine Group, Fellow ofSt Cross College and Honorary
Consultant Paediatrician at theOxford Children's Hospital.
Andrew trained in paediatrics atBirmingham Children's Hospital
specialising in paediatricinfectious diseases, and at St.
Mary's Hospital London, and alsoat British Columbia Children's
(01:33):
Hospital Vancouver in Canada. Hechairs the UK Department of
Health's Joint Committee onVaccination and Immunisation and
the European Medicines AgencyScientific Advisory Group on
Vaccines, and is also a memberof the World Health
Organization's Sage. Andrew wasknighted in 2021 by Her Majesty
the Queen for services to publichealth, particularly during the
(01:56):
Covid-19 pandemic. He has playeda crucial role in the
development of the OxfordCoronavirus vaccine and led the
global clinical trials thatstarted in the Spring of 2020.
There is one word to describeour conversation with Andrew and
that is impact. This was trulyan inspiring conversation. And
we of course discuss Andrewswork in developing a Covid-19
(02:16):
vaccination. But just asimportantly, his work in helping
to develop vaccines for childrenall over the world.
Hannah (02:26):
Andrew, good morning, welcome to the Not Mini Adults
podcast. Good morning. So, wherewe often start with our guests,
is just to ask them to talk usthrough how they got to where
they are today and the path thatthey have taken.
Sir Andrew Pollard (02:40):
Well, I'm at this moment sitting in my office
at the Vaccine Centre at theUniversity of Oxford. And it
feels like a long journey tohave got to this point and
particularly with the last year,which seems to have been about
10 years of my life, and verymuch dominates all thinking at
the moment as it does for mostof us. My background is as a
paediatrician and my main way inwhich I defined myself as a
(03:04):
children's doctor, and I spentmy training specialising in
infectious diseases of children.
And that naturally led me intowanting to work in a research
area around the prevention ofthose infections. And of course,
because the biggest burden ofinfectious diseases is in the
most resource poor settingsaround the world into global
(03:27):
health, and so immunisation sitsextremely well within that in
preventing the diseases I see inthe hospital, as well as trying
to promote better child healthin lower middle income countries
around the world. And so that'sreally how I spent the last 30
years of my career training ininfection and then working in
(03:49):
research areas to try to improvechild health through
immunisation.
Hannah (03:56):
Thank you. And we first became aware of the Vaccine
Group when we were in the earlyfew years of our charity. But of
course, the rest of the worldknows about you now as well.
Could you talk specificallyabout the mission for the group?
And then which you've alreadytouched on briefly, but to
elaborate on that a littlefurther? And, of course, it's
interesting to have your view onthe last 10 years squeezed into
(04:20):
one year, as you describe thisas well.
Sir Andrew Pollard (04:22):
Yeah, I mentioned that the mission of
the Oxford vaccine group which Idirect is to improve child
health through immunisation andwe have different aspects of
that which we work on. One isobviously the development of new
vaccines and the testing of themand evaluation here in Oxford,
but also working with partnersin other countries around the
(04:44):
world, particularly in SouthAsia and, and in Africa, to
generate data that will helpsupport use of vaccines to
protect children in thosesettings. So that's really our
core mission, but we also knowWork on public information about
vaccines. We have a website, thevaccine knowledge website to
(05:06):
provide information for thepublic and take a major role
locally in educating generalpractitioners and practice
nurses about immunisation topromote child health for
immunisation through education.
So there's there's sort of abroad remit that has at the core
of it is the research and on newvaccines, but also about how to
(05:27):
help people's understandingabout vaccines, both
professionally and for thepublic. And then those of us who
are clinicians also work in thelocal hospital, the John
Radcliffe Hospital, either asadult physicians or in my case
as a paediatrician. So we have aservice element of, of our role,
as well. And there's about 160people here in the paediatric
(05:50):
department working on vaccines.
So it's a very big operation.
And of course, it always is indevelopment around teams, rather
than individuals. Over the lastyear, we've got a number of
individuals have been veryprominent in the media,
including myself. And the behindthis is a wonderful talented
team of people who actually doall of the interdisciplinary
(06:13):
activities that are required tomake and test and develop
vaccines. So I guess to come toyour second point about the last
year and a half has been a veryunusual in a sense, but in many
ways, it's just been business asnormal, because we've been
coming to work everyday doingwhat we do, which is testing
vaccines, doing the laboratorywork to see how well they work,
(06:37):
what the immune responses looklike. And so that, broadly is
what I've been doing for thelast 20 years here in Oxford,
and so has the team. And what'sbeen different about it is the
intensity, we've been workingseven days a week, and then very
long hours every day. And alsoevery time we look out the
window, the the media are there,and there's so much public
(06:58):
interest in what we're doing,that it's been a completely
different experience from thenormal work we do, which is
largely under the radar, justgetting on trying to do our
business as normal. So thatclearly has its challenges as
well. And I think adds a newelement of pressure because of
(07:18):
the importance of theactivities. But in the end, we
have to do to take the same cooland calm approach because we're
doing developing a biologicalproduct that's been given to now
many hundreds of millions ofpeople. So it has to be done
very carefully and following theusual protocols.
Hannah (07:38):
And we've been so interested to imagine how the
building blocks of the work thatyou've been doing over the last
few decades, both with thebasics of developing vaccines on
the one hand, and then on theother side, with a focus on
childhood immunisation, howthose building blocks enabled, I
appreciate this answer, by theway will apply to the other
(08:00):
teams that have also developedvaccines. Nobody was starting
from scratch. But in layman'sterms, could you describe to us
how you were over and above thehours that you have in the
extraordinary effort that hasbeen put in, how you've been
able to develop vaccines soquickly in what the accelerators
were?
Sir Andrew Pollard (08:20):
Well, I think that the way in which the
building blocks were there arejust because we have been making
vaccines for a long period oftime. So all of the steps that
are required, right from how youdesign the vaccine through to
the very large scale tampertrials, and the authorization
processes working with in ourcase with AstraZeneca has been
(08:44):
what we normally do. So they'rethe building blocks were there,
just because it's what we doeach step has already been
tested before, it just hasn'tbeen tested under the quite the
same pressures as over the lastyear. The reason why things
could move so quickly, partlywas around the funding
available, which normally weknow do a little bit and then
(09:07):
you wait for a year andsometimes several years before
the next funding comes to do thenext bit. So that's one of the
reasons why it's been quicker.
The other is that the many ofthe bureaucratic timelines have
very much been shortened. Sowhen we put in our our
application for the ethicalreview, normally you would wait
a month to even get to thecommittee. And in our case, it
(09:28):
took just four days to get thecommittee to meet and to review
all of the paperwork for thestart of the trials. And
similarly with with the UKregulator, the MHRA before you
start any clinical trial, theydo a very detailed scrutiny of
the clinical trial protocol, themanufacturing quality and so on.
(09:50):
And the regulator recognisingthe emergency situation puts a
big team on all vaccines. Sothat that timeline, which again,
is usually around about a monthfrom submission, through to
review, and they did theirreview in seven days. And so the
each of those steps, whetherit's the funding or the other
(10:12):
review processes to make surethat everything is in order has
been very much accelerated. Ithink one other critical piece
here has been aroundmanufacturing, usually the
hardest bit of all, this isn'tthat clever stuff, designing the
vaccine or, or the clinicaltrials to test them is actually
being able to make the vaccineat scale. And because that's so
(10:34):
difficult, and so expensive, isusually left, right until the
end until you're absolutely sureyou've got a product that works.
And whereas here, quite rightly,the investment and the financial
risk was taken very early on, tomake sure that the work to
upscale to make very largequantities have been done by the
(10:55):
time that organisation camethrough. And that has, I think
dramatically changed thetimelines, usually that process
would take a year or more. Andbecause the process started,
long before the authorization,it meant that essentially
AstraZeneca ready to distributea couple of days after the
vaccine was authorised. So thatthe all those things have been
(11:18):
quite astonishing. But there isa another bit here, which makes
me quite nervous. And that isthat we were dealing with a
virus that we knew about. And sowe knew how to make the vaccine,
we knew exactly what to do. Weknew that the spike protein,
this protein on the surface ofthe virus that binds on to
(11:38):
ourselves, was the key targetfor the immune response. And we
actually even knew where to putit in our vaccine platform, the
viral vector that we use,because we'd had previous
Coronavirus vaccines that thatwe were working on here in
Oxford. So if it had been adifferent virus, one that we
didn't know about, we didn'tunderstand this biology. I'm
very worried that we would stillbe here today. puzzling about
(12:02):
how do you actually design thevaccine in the first place. So I
think we've also been veryfortunate, I mean, I don't
think, of course, not fortunatein having a pandemic, but
fortunate that the pandemic waswith a virus that we really
understand.
David (12:18):
And we're going to, obviously need to touch on the
kind of Child Health elements ofthis and where we are with that.
But it struck us when we werethinking about and preparing for
the conversation that first ofall, maybe not everyone realises
that the Oxford vaccine groupconcentrate so much on
paediatrics, so that in itself,I think is from the stories that
we like to share is a wonderfulstory in itself, but also has
(12:41):
that element of it has theworking with children working
with the physiologicaldifferences that you have in in
that kind of paediatricspectrum. Has that allowed you?
Or have you seen that that'sallowed you to, you know, kind
of make gains or be in a betterposition than maybe you would
have done ordinarily?
Sir Andrew Pollard (12:58):
Well, I think it's a really interesting
point that the immune system andit definitely is a bit different
in the the youngest infants, ofcourse, most vaccines are given
to very young children. And sowe've had to work over many
decades to understand more aboutthe immune system in young
children. But in some ways thatthat's been a particular
challenge for understanding howwe might approach the pandemic,
(13:22):
because one of the real fearslast year was that the vaccines
might work very well in youngeradults and in children, because
we know how their immune systemswork. But there's so much less
research been done in theelderly. And most vaccines don't
work very well in that agegroup. And I think we've been
incredibly fortunate here. Butall of the vaccines that are
(13:45):
being deployed at the moment, doappear to work even in the
oldest adults. And so one of thereally interesting questions is
not really about know whetherwe've learned from children, but
the realisation that we have alot more to do to work on why
most vaccines don't workparticularly well in older
adults. And these ones,generally speaking, are working
(14:07):
well. So we need to probe theimmune system in older adults as
well. And I think one of thethings that our work on children
can do is provide the approachesand the techniques that we've
learned from having to evaluatethe immune system in children,
and to understand more aboutolder adults. And I guess with
an expanding older adultpopulation, globally, this is
(14:31):
going to become increasinglyimportant in the future.
David (14:33):
I think it's such a fascinating topic, because we
talk so much, you know, on a dayto day basis, not just on the
podcast with people thatpotentially are thinking about
investing in child health thatare looking at new solutions,
new drugs, new digitaltherapies, whatever it might be.
And it always comes back to youknow, the population is not big
enough, the return on investmentisn't necessarily there. Whereas
(14:55):
actually, there's some there'ssome elements here that we're
discussing, which gives thempositive vibes, I guess or
positive stories that, you know,maybe others we should be we
should be spreading more interms of actually starting in
the paediatric community toallow us to then look at the
rest of, because of thecomplications and then allowing
us to look at the rest of therest of society as
Sir Andrew Pollard (15:17):
I think that's absolutely right.
Hannah (15:19):
You've also talked about, you know, how you had to
operate organisationally and howyou were able to work so fast.
Clearly, that's not desirable tohave to work at that level of
intensity over a sustainedperiod of time, but interested
in what aspects of how thingshave changed over the last 12 to
(15:39):
15 months? Now? You know, what,what of that? Would you like to
keep?
Sir Andrew Pollard (15:44):
Well, I think the intensity would be
good to dial down. And I mean, Ithink there is some dialling
down already of that. But itstill remains pretty busy. I
think one of the things is thatthe whole team has had to learn
quite a lot of resilience. And Ithink probably, that's a whole
area where we need more focus inthe workplace to help people
(16:07):
with with resilience, becausethere is enormous strain on
teams normally, anyway. Buthere, I think we've seen the
pressures that that people areunder having to work so hard,
and feeling the responsibilityto do so. So I think I'm not
sure we want to keep that, forme, it does raise the issue of
what can we do to support peoplebetter to continue the important
(16:32):
work that they do. So that's onearea, I think, certainly things
like being able to talk withpeople on zoom, or on one team,
which is the system we use mostin the university really has
improved our ability to reacharound the world to add to
different groups over the pastyear, there are definitely
(16:52):
disadvantages of that of notbeing in the same room, not
being able to beat a meetingwhere you can have the important
discussion over coffee and abreak, set all of those things,
I think, last year, it does comeinto that part of supporting
staff that if you're only everseeing someone on a screen, it's
very much more difficult to pickup all of the signals that you
(17:15):
need to provide adequatesupport. So I think we do miss
being in the same room as otherpeople. But I think it has made
us able to, to be much moreefficient. And I've been I think
about our clinical trials,working with colleagues in South
Africa and in Kenya and, and inBrazil over the last year. And
regularly talking with themreally would have been much more
(17:37):
difficult to have the type ofinteraction that we have, if we
were doing this just by phonecalls, or having to fly there
and not be able to continue withday job whilst having those
those meetings, I think there'sbeen some real advantages in
using the technology. But Ispeak at a lot of conferences,
(17:57):
and always have done. But it'smuch more difficult to sit
through a whole day of aconference where it's on a
screen than if you'reinteracting with people in the
real world. So I think there arevarious aspects which have
advantages, but then they're notall how we do I'd like it to be
all the time.
David (18:14):
It just makes me remember actually. So member of your
team, Dominic Kelly, when he waslooking after Oscar in hospital,
one of the things that we wetalk about a lot was just, he
was waiting for colleagues onthe other side of the world to
wake up, you know, to so that hecould start to question them
about whether or not they'd seena diagnosis such as the one that
(18:34):
Oscar had. And you know, any anythoughts on that. And, you know,
we talk a lot and in my workwith IBM talk a lot about the
democratisation of data andbeing able to share data more
easily, but actually just beingable to have those conversations
more easily as well. And I thinkalso a benefit to what's
happened over the course of thelast 15 months, 18 months.
Sir Andrew Pollard (18:52):
Yes, I think we've also enabled collaboration
much more easily. I mean, rightat the beginning of our
development back in February, orMarch last year, one of the
Chinese companies was a littlebit ahead of us in development.
And so we got together on on azoom call, just to discuss our
(19:13):
shared experiences. And I haveto say, for me, that was
incredibly helpful, because theyhad already started their
clinical trials and could givesome information. And right back
there at the beginning, therewas so much uncertainty about
everything, that it really was,for me quite a boost that we had
colleagues in China who workvery open sharing their, their
(19:34):
latest data, that helps. And Ithink that would have been
almost impossible without thenew ways of being able to
connect to people and share ascreen and look at data
together.
David (19:45):
I think that's such a positive statement to make
because I think some of thepress may have either not
covered it or kind of not let itbe known that there has been
collaboration across boundariesacross you know, organisations,
whatever it might be So, sothat's kind of Great. Great to
hear. You've touched upon acouple of times, you know, all
the other work that you've thatyou do. And I think we should
really kind of maybe move tothat in a second. Because
(20:07):
obviously, even though COVID hashit other things didn't stop.
So, you know, looking atcreating vaccinations and new
solutions from that point ofviews, I guess, not stopped. But
just before we move that just asa kind of final thing from a
COVID perspective, there's a fewthoughts in terms of where
children are in the in thebalance of vaccination, not
vaccination. I know you've gotsome, you know, strong, strong
(20:28):
points, as you've kind ofalready started to address in
terms of making sure that thevulnerable are prioritised. And
there's still, you know, littleevidence to say that the
children get it in such acritical way, shall we say, as
the adult population, but maybewe could just kind of cover that
off? And I think we're reallykeen to think about some of the
other stuff that you're workingon as well.
Sir Andrew Pollard (20:47):
Yes. I mean, I think that's absolutely right.
You summarised it very well,better than I could probably.
But I think for me, the issueabout children is that we need
to have good data about whoshould be vaccinated and whether
children should be vaccinated.
And the sorts of things that weneed to take into account, there
are other groups of children whoare at particular risk. And so
(21:08):
far, there are some groups wherevaccine has been recommended for
children here in the UK. I thinkthat's straightforward. But
actually, for most children, therisk of severe disease ending up
in hospital is so incrediblylow, that you wouldn't really
need to be looked at carefullyto see whether there is actually
a benefit in vaccinating thewhole childhood population, for
(21:31):
that very low rate of disease.
So I think that observations doso that needs looking at
carefully. Now, the second oneis obviously around long COVID.
And I don't really like the termbecause it encompasses a whole
range of different conditionsmight be better that we rather
than lumping them all togetherto try and understand each one
individually. But if vaccinescan prevent long COVID, that
(21:54):
might be another good reason tovaccinate. And then of course,
there's this other conditioncalled PIMS TS, which is an
inflammatory condition, whichoccurs after COVID, particularly
in younger children, we'relearning more and more about
that, and it may be the vaccinescould prevent that condition. So
there's definitely could be areally important role for
vaccinating children inpreventing most of these
(22:15):
conditions. The main reason whypeople are asking for children
be vaccinated is to protectother people not to reduce
transmission and protect adultsat this stage. You know, if we
were looking back to six monthsago, it might make a lot of
sense to do that, because weknow that vaccines would have a
major impact on reducingtransmission, we have the data
(22:36):
from trials and from the firstevidence in the UK from the
alphabet read. I think theproblem though going forwards is
that with the virus evolving,it's evolving to transmit even
in vaccinated populations. Andso vaccinating children about
transmission will in time overthe next six months or a year
become less and less viable asan option. And so it may be that
(23:00):
we need to understand more aboutthe role of vaccination,
actually having any impact inreducing spread. And of course,
at this moment with a Deltavariant, we're seeing lots of
spread in people who arevaccinated. And so vaccinating
children isn't isn't going tostop that. So I think that
definitely needs a good reviewof all of the data are around
that. We also need to look atthe potential risks. Now, are
(23:23):
there any safety concerns fromvaccinating children, and there
are some emerging data aroundheart inflammation associated
with the RNA vaccines,particularly with the second
dose. And so we before launchinginto that we need to review that
carefully and make sure thatthere's there's no harm. And
particularly if the benefits arevery minor for vaccinating
(23:47):
children, you really want to besure that you've weighed out
those benefits and those riskscarefully. So from my
perspective, I, you know, I'moverall very much in favour of
vaccinating children, if it canreduce disease burden for them.
But it doesn't feel an urgentthing to make the decision
today, when we will have a lotmore data in the next few
(24:07):
months. And so for me, it's notso much a question of not
vaccinating children, whichwhich may well be the right
decision. It is just aboutgathering the data to make sure
it's the right or a gooddecision. But there is another
point about why timing iscritical in that vaccinating
just teenagers here in the UK,which is would be somewhere
(24:29):
around six to 8 million childrenor teenagers. That's enough
doses to vaccinate the whole ofthe older adult population in
quite a large number of lowincome countries, and certainly
those who are vulnerable. Sothose doses today would prevent
10s of 1000s of lives sorts or10s of 1000s of deaths, if they
(24:50):
were deployed today in countrieswhere there are vulnerable older
adults, rather than children whoare very unlikely to even get a
cold with the virus. So that forme is that sort of global equity
question is the key driver forsaying, this isn't the moment to
vaccinate children, we should beprotecting people who we know
will die this year.
Hannah (25:11):
You've brought us smoothly along to our next
question, which was, ourunderstanding of the work of
your group had started with theexisting immunisation programme
that we have in the UK forinfants and very young children
and the sequence of vaccine setsadministered. But you've touched
just now on the work that you doin low income countries with
(25:33):
respect to children and adults.
And I'd love to understand moreabout the focus there, please.
Sir Andrew Pollard (25:38):
Yes, I mean, just as you introduce that the
one thing that strikes me aboutthe last year, really is the
children have been relativelyunaffected directly by this
virus. But the indirect impactby the effect it has had on
their families and economies ishuge. And so that's why I think
(25:59):
actually vaccinating the adultsin these low income settings is
the most critical thing to dobecause we've got to get them
their economies back to normal.
But there's another bit whichchildren have been particularly
affected by this. And this isthe disruption of health
services, which means thechildhood vaccination has really
stalled in many countries and inlow income countries
particularly. And we're nowseeing outbreaks of measles,
(26:21):
rising again, in countries wheremeasles was under control.
measles is one of the biggestkillers are very young children.
And so this is an absolutetragedy that Coronavirus is not
really affecting children, butvaccine preventable diseases are
because of the impact it's hadon health systems. So to come to
(26:41):
our work, I mean, we've, we'veparticularly have worked on
bacterial infections in childrenin low and middle income
countries. And the real focusover the last 16-17 years has
been on pneumonia, which is thebiggest cause of death in the
under fives and in low incomecountries and generating data,
(27:03):
particularly in South Asia, toprovide information about burden
of disease and about vaccinestrategies that might help to
control severe disease caused bythe pneumococcus one of the
commonest causes of pneumonia inyoung children. And that work
really led on for me to studyingtyphoid, which is spread through
(27:26):
the water, and in circumstanceswhere there's very poor hygiene,
poor sanitation. And the realchallenge with with typhoid,
this this bacterial infection isthat we can solve it if we can
put in clean water in those manybig cities in low income
(27:47):
countries. But unfortunately,the engineering works to do that
require huge investment, hugeamounts of money, and political
will over probably more than adecade in many different
countries. So the children todayneed protecting from this
disease. And so we've beenworking with an Indian vaccine
developer to generate the datato support use of typhoid
(28:10):
vaccines and that's nowhappening we were seeing rollout
of typhoid vaccines number ofcountries, quite amazingly this
year in February. In Pakistan,they managed to start a
programme where they vaccinateda million children per day
against typhoid because of anoutbreak of a strain of typhoid,
which was resistant to almostall antibiotics. And so the work
(28:35):
that we've been doing ontyphoid, the trials involved
100,000 children in Africa andAsia, so huge programme of work,
and then has led to now rolloutof that vaccine, which is
protecting people from theseantibiotic resistant bacteria.
So that's been a real exciting10 years of work on typhoid,
(28:56):
particularly for children inthose settings.
Hannah (29:02):
Thank you and changing tack slightly, one of the trends
that we've read about in thepress has been the events of the
past 18 months, causing moreschool leavers to choose to sign
up for medical degree coursesinspired by the work of
yourselves and others across theNHS. So the question we had was
(29:26):
around, how do you see thepipeline of new new talent
coming into your field? Is it isit an area that has been
difficult or easy to attractfolk into and where does that
come from?
Sir Andrew Pollard (29:38):
Well, I think one of my hopes, really is
that science and publicunderstanding of science will be
part of the legacy of thepandemic. I mean, it's it is, I
think, quite astonishing to methat to talk to members of the
public, who knows so much aboutvaccines and vaccine development
and different vaccine platformsand phases of clinical trials.
(30:00):
It's even a year ago that no onewould have had much of a clue
about any of it. So I think wehave really had a huge increase
in sort of general understandingand awareness about science. And
I certainly hope that that willinspire young people to go into
medicines and medicine andscience degrees, and through
(30:20):
their university education. Ofcourse, at this moment, it takes
a while for those people to comethrough the pipeline to become
researchers and cliniciansworking in those areas. But we
certainly have always had lotsof applications from junior
doctors and scientists to comeand work in, in our area of
(30:40):
science, because it's so unusualthat you can work in a research
area where in the course of yourcareer, you see impact on an
almost daily basis. And for me,just here for 20 years in
Oxford, about half of thevaccines used in the UK, have at
least had some of the data thatsupported their use has come
from from the work here in mygroup. And, you know, I
(31:04):
mentioned several of the othervaccines, typhoid and pneumonia
and meningococcal, and nowCOVID, where we've had global
policy impact by the researchthat we've been undertaking. And
I think for people coming towork in this setting, that's
incredibly inspiring to actuallywork on something where you see
that direct impact, just in amatter of a few years from the
(31:28):
time you're working on it. Formuch of what we do in science.
Now we make discoveries thatthere may take decades before
they actually turn into animportant building block of a
change. So I really like thisworking in the translational
space. That way, you can see theway in which it transformed
(31:48):
people's health. I'm just a fewyears down the line. And I you
know, I look back over my careeras a doctor over 30 years now,
just over 30 years, many of thediseases that I dealt with in
the 1990s, or as I saw as amedical students in the 1980s,
we just don't see in paediatricsanymore, because we've prevented
(32:10):
them through immunisation.
That's incredibly exciting fieldto be,
David (32:14):
I think the the word that I'm going to remember this
conversation by is impact. Andthat's one of the main things
that we try to do from acharitable perspective is what
impact can we have on childrenthat are in hospital, and we
could talk to you for so longabout and we feel like we've
only just touched on the workthat you do outside of COVID.
And we discussed a little bitabout the pneumonia, vaccines
(32:35):
and what have you. But thethere's so much else more has to
do in it. But I do hope thatthere will be at least someone
listening to this, who wouldfeel that actually, there is an
opportunity for them to moveinto healthcare to move into
medicine and to and to have thathave that impact. It's so good
to hear that you get lots ofapplications coming to your
group. And we can totallyunderstand why. But I think for
the for the wider paediatricpopulation and people moving
(32:58):
into Child Health space, that'sstill probably underserved. So
absolutely no doubts, yourinspiration and the impact that
your group does. And all thework that you do will allow them
to do that. So you know, thankyou.
Sir Andrew Pollard (33:08):
I mean, I think David, just picking up on
that, I think that there is oneissue, which is I mean, lots of
people go into medicine. Andfortunately, we were very well
served by people wanting to dopaediatrics and to care for
children. But the one of theshortages though, is a
paediatricians who then do anacademic training. And we've
actually, I mean, this is aslightly different topic. But
(33:31):
over the last couple of decades,we've seen a reduction in the
number of academicpaediatricians, and that isn't
just here in the UK, it's, it'sin many other countries. And
that is quite a worry for thefuture of research in child
health, if those numbers andthat's not just in my field, but
in in a broad range of those, infact, I suspect in my field, we
(33:53):
won't be such a problem becauseof the legacy of the pandemic.
But for many other areas ofchild health, we really need to
work more to attract people intoa research area to make sure
that we can better support andchildren's health in the future
with good research.
David (34:13):
And we will spread your message as wide as we as we can,
from from that point of view,very conscious of your time. And
so you know, first of all, thankyou so much for that, as we do
with everyone that we have onthe podcast, I kind of final
question is if you could changeanything within child health,
what would it be?
Sir Andrew Pollard (34:31):
Well, I think I touched on it before,
which is clean water. It canhave the biggest transformation
on Child Health apart fromvaccines, which we're doing. And
the one other thing that is themost important public health
intervention is it provision ofclean water. We're fortunate
(34:52):
here in the UK that in VictorianEngland, the money was made
available to towns to put insewage works and to provide
clean water Dealing with choleraand typhoid, which I mentioned,
which we don't see here in theUK anymore. And that was an
incredible, cities were givenloans to pay back over 100
(35:14):
years. And to put that in place,and of course, that was a time
when populations were relativelysmall. And so getting started,
meant that we are where we arenow with a very healthy
childhood population. But inmany parts of the world, cities
have 10s of millions of peoplewith no adequate water supply or
(35:35):
sanitation. The reengineering ofmunicipal water and sanitation
is incredibly expensive. Andthat is, I think one of the
biggest challenges that there isin child health at this moment,
is protecting young childrenfrom the consequences of
David (35:55):
Andrew, thank you so much for joining us today. Thank you,
exposure to dirty water.
especially for all the all thework that you've done. And it's
just been such a privilege totalk to you. So we really,
really appreciate you taking thetime. Thank you for inviting me.
We cannot thank you enough forjoining us on today's not many
heroes podcast and taking sometime out from his what must be
(36:17):
very busy schedule given wherewe still aren't within the
global pandemic, as I'm sure youwill all agree the impact that
his work has had not only on theglobal population given
COVID-19, but especially thepaediatric population, given the
work that he's done over manyyears is something to inspire us
all. Over the next few weeks ofthe nominee Adams podcast we
will be talking again aboutmental health and also about the
(36:39):
importance of empathy and play.
For children that are beinglooked after in hospital. Please
do subscribe to the podcast. Andif you're enjoying it, please do
leave us a review as well. Wehope you'll join us again next
week.
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