AstraZeneca’s triumph

Covid-19 A dose for the world

The Oxford-AstraZeneca vaccine has attracted lots of criticism. It is still a triumph

In a solemn prerecorded address, Boris Johnson warned Britons that a “tidal licrelations victory. On some measures, it manufactures the most successful covid wave” of Omicron was on its way, and that the best chance of escape lay in booster vaccines. All adults, the prime minister announced on December 12th, would be offered one by the end of 2021. Yet their choice is to be more limited than in the last vaccination push, with Moderna and Pfizer leading the way. Nearly a year after it was first approved, Britain’s flagship OxfordAstraZeneca jab will be rarely used.

It is the latest indignity for a vaccine that is both a national symbol—praised by royalty, hawked around the world by the prime minister, made by the country’s most famous university and biggest listed company—and a source of angst. AstraZeneca has taken flak for datapresentation issues, delayed deliveries and rare adverse events. The share prices of Moderna and Pfizer have soared since covid19 struck; AstraZeneca’s is pretty much back where it started (see chart 1 on next page).

Nor, to the bemusement of many involved, has the company won a great pubvaccine there is. According to Airfinity, a data firm, 2.2bn doses have been delivered, compared with 2bn by Pfizer and 0.5bn by Moderna (see chart 2). Because rich countries increasingly use other jabs, and poor countries mostly use their supply for initial doses rather than for boosters, AstraZeneca’s vaccine is almost certain to have saved more lives than any other. Yet it was always unlikely to be a big moneyspinner. Ministers were happy for it to be sold at a small profit; the University of Oxford, which came up with the vaccine, was not, both for humanitarian reasons and to avoid being “seen to be cashing in on what was inevitably going to be an enormous amount of human suffering”, says Sir John Bell, Regius professor of medicine at the university. A dose sells at less than $4, compared with more than $20 for Pfizer. “Do [AstraZeneca bosses] look at Pfizer’s [profit and loss] and say, ‘Oh, shit, how did that happen?’ You know, they might,” says Sir John. But it was agreed to be the right thing to do, he adds.

AstraZeneca’s vaccine has struggled for market share in the rich world. Relations with America’s Food and Drug Administration (fda) soured after the firm failed to notify the regulator about a possible adverse event in a trial elsewhere; the fda has still not approved the vaccine. After AstraZeneca failed to meet the European Union’s delivery targets, national leaders criticised it and the commission placed an enormous order with Pfizer. “The truth is AstraZeneca had signed an exclusivity deal with us and a bestefforts deal with the European Union,” says Matt Hancock, Britain’s health secretary at the time.

The vaccine, which uses an adenoviral vector, has proved less effective than its mrna rivals at stopping infection, further reducing demand in the rich world, and is perhaps marginally less effective at preventing death. Soon after it became available, evidence emerged that in rare cases it caused blood clots (as does Johnson & Johnson’s vaccine, another adenoviralvector jab). This helped persuade the jcvi, an expert body, to recommend using other vaccines in Britain’s booster round. Sir Me

→ Also in this section 22 Gay rights in Northern Ireland 23 The Marble Arch Mound 24 Bagehot: Meet Liz Truss