Barbara Nel: How Benefits of AstraZeneca Vaccine Outweighs the Risk

Barbara Nel is AstraZeneca’s Country President for the African Cluster, with responsibility for South Africa, sub Sahara and French speaking Africa. She initiated the extension of AstraZeneca’s Phakamisa programme, an access to care initiative currently focused on specifically addressing early detection of disease, promotion of primary prevention, and access to care in the public sector among others. In this virtual interview with REBECCA EJIFOMA, she encouraged Nigerians and Africans to get vaccinated while emphasising that the benefits outweigh the risks. And following the arrival of about a million doses into Nigeria, she assures that the AstraZeneca vaccine efficacy and protection against hospitalisation and severe disease gives it an edge over the virus

Could you share with us how the journey of AstraZeneca vaccine has been so far in Africa?

What we saw in Africa is that, in February this year, we saw the first AstraZeneca vaccine through COVAX arriving in the country. We are very proud of the partnership with COVAX. We are the first multinational pharmaceutical company that signed up to COVAX and if we look at it globally, we have already distributed more than a billion vaccines with a big chunk of that through COVAX and into Africa. So, around February and March we saw our first doses arriving into Nigeria.

Nigeria was one of the first countries that received vaccines, and I actually remember being in Abuja in one of the hospitals and seeing healthcare professionals sitting there and waiting to be vaccinated.

And one of the things that happened a couple of months ago was the scarcity of the vaccine from the Serum Institute in India. We couldn’t get any more vaccines into Africa because of the export ban that was placed by the Indian government. But we did see a significant step change in the last couple of weeks and last couple of months and due two main events that happened. One was the Japan summit held in June, where several governments, NGOs, and public private organisations donated money to the tune of $2.4 billion to fund vaccine doses for low and middle income countries. We also saw during the G7 Summit that a billion doses of vaccines were promised as a pledge.

And what is really great is that we are actually seeing those pledges coming through just to Nigeria alone; we’ve seen nearly a million doses arriving as donations from the UK government. So, at the moment, the situation is quite critical in Africa, but we continue to work on both sides, with the governments of the countries that need to receive the vaccine. We’re working very closely with the Federal Ministry of Health, as well as the Nation Agency for Food and Drug Administration and Control (NAFDAC).

What has been the acceptability of the vaccine in the countries with major outbreaks?

We’ve seen a very good acceptability; it is effective and safe. The AstraZeneca vaccine has been used in more than 170 countries globally. It has by far the widest reach, of which 38 of those countries are in Africa. We are working very closely with most of the governments in Africa to secure more doses, and to ensure that we can get the upgraded population in the very vulnerable populations vaccinated as soon as possible.

What are the possible side effects of the AstraZeneca vaccine?

I think one of the key things to look out for as the countries are rolling out the AstraZeneca vaccine is something called active surveillance where the vaccines are being administered. We are tracking responses from the people. The key thing is that we know that the vaccine is very safe, and the most common side effect people will see will always be flu-like symptoms. Sometimes it might be a headache, the side they got vaccinated might feel a bit sore for a day or two. Sometimes the flu-like symptoms might be a bit of fever, maybe sometimes not that great for a day or two after being vaccinated.

If you do see any of those side effects, it is a sign that the vaccine is working, that your body is actually generating the antibodies against the COVID-19 antigen. Generally speaking, we are seeing a very good safety profile.

There have been complaints of blood clots for those who have been vaccinated with the AstraZeneca vaccine. How do you reconcile this to the benefits of being vaccinated?

So once again, let’s go back and look at what the World Health Organisation (WHO) said. And what they continue to say is that the benefits of the vaccine as well as the effect of the vaccine were against the original strain of the COVID-19 which saw 100 per cent protection against hospitalisation and severe disease. And now for instance with the Delta Variant which is a major concern at the moment in Africa, we are seeing a 92 per cent efficacy and protection against hospitalisation and severe disease. So, the benefits still far outweigh the risks.

And I think that is also what the WHO has said that when countries have the approved AstraZeneca vaccine available they need to ensure that people get vaccinated. And I think that is a very important message that we need to carry. So, if you have the opportunity and if you get offered a vaccine, you should take it.

Can we say that the AstraZeneca vaccine is effective against the variants of COVID-19?

Very recently there was a study published from the UK; it was done by the Public Health England; it was a real world-evidence study where they looked at the use of the AstraZeneca vaccine during the infections that they recently saw which was driven by the Delta variant. In the data, we saw a 92 per cent protection against severe disease and hospitalisation of people who received the AstraZeneca vaccine. That is actually astounding. If you think about it, you know if you have been fully vaccinated by the AstraZeneca vaccine. It gives you this very high level of protection against the Delta variant.

Currently, Nigerians have begun to see children come down with the Delta variant. How is the AstraZeneca vaccine tackling this?

This is definitely something that we are seeing in other countries as well and I think the first thing is that we continue to follow the science. We continue to do the research. We continue to work very closely with organisations such as WHO, NAFDAC, the Federal Ministry of Health in Nigeria to ensure that they have all the data they need. That way, they can make informed decisions in terms of which groups they should prioritise (who should receive the vaccine first or second. It will then be up to the Federal Ministry of Health together with their advisors and NAFDAC to make the decision around what they want to do in Nigeria and the guidance they would give around the vaccination or the management of children.

Which group of people are not qualified to take the AstraZeneca vaccine?

Once again, they are all certain groups of very vulnerable patients that we know that vaccination may not be as effective as it is in the general public. So, this for instance will be individuals where maybe they have certain blood disorders or for instance people who are receiving dialysis treatment for kidney failure. What we do know is that if those individuals take the vaccine, it is just not a very strong immune response that it creates. And so, the vaccines won’t give such a high level of protection. But what is very good in this is once again where AstraZeneca is also following the science is, you do get molecules. And we are currently in the process of developing one of these golden long active antibodies.

For instance the recent data that has been published for the AstraZeneca long active antibody shows more than 70 per cent protection and prophylactic protection against symptomatic disease.

A lot of people have complained that after being vaccinated, they still got infected. What do you have to say about this?

We do know that with the Delta variant, and this is not just the AstraZeneca vaccine, it is all the vaccines, you can get some breakthrough infections. But what is paramount is that between 90 to 92 per cent of people who have been fully vaccinated with the AstraZeneca vaccine, even if they do contract the Delta variant or COVID-19, the vaccine provides a 92 per cent protection against severe disease and hospitalisation.

So, what can happen is that people can contract COVID-19 even if they have been vaccinated. However, it will be a very mild form of COVID that they will be getting because of the protection that the vaccine is giving to them. But the main thing is that the vaccines we know are very effective at keeping people out of hospital or ventilators, and basically preventing severe disease.

How long does the immunity from the vaccine last?

This is where the science is still emerging and if we think of when the studies were done, the initial efficacy studies, we know that up to a certain number of months we are seeing that the protection is lasting. There is obviously also a lot of research that is being done in areas such as booster vaccinations. Can we mix and match vaccines? What about if there is a longer interval between my first vaccine and my second shot of the vaccine? And the good thing is that as this data is emerging, we can also work with NAFDAC, WHO, and the Ministry of Health in Nigeria to ensure that they’ve got the information that they can then make the right decisions in terms of deciding what they want to do around if somebody has had for instance an AstraZeneca vaccine first vaccine; would they be allowed to take another vaccine or is it the same vaccine they must get for the second shot? What about if there’s a slightly longer waiting period and then also what about booster shots? But at the moment, what we are seeing is that there is a strong immune response that continues for the period of time when people have been vaccinated.

Are you saying when people get COVID-19 vaccine, they may not need to be vaccinated again forever?

What we do know is that, all of the data shows that for the AstraZeneca vaccine, we need to get two shots. There is data emerging around booster doses, and it does show a benefit. At the moment for us in Africa, the main thing is to get a wider population vaccinated with the first and second doses so that they are fully vaccinated, and then we will see how the data emerges and what will be needed in Africa.