June 19, 2024

I, Science

The science magazine of Imperial College

A book review of Vaxxers by Sarah Gilberrt and Catherine Green. The authors retell their experiences January 2020 through April 2022 as they developed the Oxford AstraZeneca COVID-19 vaccine.

Review by Vanessa Hayes

18th November 2022

In their book Vaxxers, Sarah Gilbert and Catherine Green retell their experiences from January 2020 through April 2022 as they developed the Oxford AstraZeneca COVID-19 vaccine. While predominantly focused on the ins and outs of creating, scaling, and testing their vaccine, they occasionally inject their personal experiences of lockdowns and personal tribulations into the narrative—from dealing with wasp infestations to managing COVID Christmases—which brings their humanity to the forefront. The book quashes common myths and misunderstandings about vaccines (the AstraZeneca vaccine in particular), demonstrates the enormity of human effort put into the vaccine’s development, and recommends lessons to learn in the aftermath of the COVID-19 pandemic. While it is a reminder of the challenges and tragedy of the past few years, this book overwhelmingly stands as a testament to the mammoth feats that are possible when humans unite.  

The Summary 

Gilbert and Green start in January 2020, when they first heard the news of an unidentified disease outbreak in Wuhan, China. They explain how they quickly decided to use their existing vaccine platform, ChAdOx, to develop a vaccine specific to this new disease. What starts as exploratory work on a disease that might fizzle out before they even receive materials to start vaccine development rapidly becomes “the only story in the world,” with governments, the media, and all of humanity watching. Throughout the complicated process, Gilbert and Green share the challenges, triumphs, worries, and frustrations they faced to produce a vaccine faster than ever before. 

One of the predominant messages the authors aim to deliver is the presence of safety checks and balances in the process of vaccine development. By explaining each phase of development step by step—and often in much more detail than ever provided in the media—Gilbert and Green demystify vaccine development and dispel fears and misunderstandings. They specifically address myths about the AstraZeneca and other COVID vaccines—such as the myth that the vaccines cause infertility—worries about the ingredients (they include an annotated list of the ingredients in an appendix of the book), unfounded concerns about very decreased effectiveness in older adults, and more.  

One of the largest concerns they address is how the COVID-19 vaccines were able to be developed at such a rapid pace compared to previous vaccines. With the help of a huge team of people around the world, Gilbert and Green orchestrated the creation of the Oxford AstraZeneca vaccine, scaled up production to millions of doses, completed animal trials, and mounted three phases of clinical (human) trials on multiple continents. There were three key factors that allowed this process to take less than a year, which are reiterated throughout the book: abundant funding, decreased waiting times between trial phases, and prior development of vaccine platforms and technology.  

The urgency of the pandemic meant that governments and companies were throwing money at the issue in a way that had previously never been done. With abundant funding available, many of Gilbert and Green’s vaccine development phases did not need to wait for fundraising  before proceeding. Before there was abundant funding from grants or AstraZeneca early in the development process, Gilbert, Green, and Oxford University chose to take financial risks to continue with the next stages of development. They also prepared materials and vaccine doses in advance so that when a previous phase was successful, they could immediately move into the next phase. Thus, due to increased funding, taking financial risks before funding was available, and expert organizational foresight, there was very little waiting from one stage to the next. Additionally, much of the technology and platforms used for the COVID vaccines had been in development for years, propelled by research into vaccines for Ebola, influenza, and other diseases. Many of these developments in vaccine technology happened well before the first case of COVID-19 in a human and were already well tested, helping scientists avoid a lot of trial and error that would have slowed COVID vaccine development.  

In the final few chapters (including a new chapter published in April 2022), Gilbert and Green lay out many of the lessons the world must learn from this pandemic. They emphasize the importance of exploratory pandemic preparedness research and development—for vaccines, but also for diagnostic technology, disease surveillance, manufacturing techniques and facilities, and more. Investing in pandemic preparedness allows for discoveries to be made that can benefit many different aspects of pandemic management. Research we do now could help us produce vaccines even faster in the future, allow for better management and care of people during a future pandemic, and catch disease outbreaks before they become pandemics in the first place. Another pandemic is inevitable someday; Gilbert and Green urge readers and governments to prioritize pandemic funding so that when the next one comes, we are better prepared for it. 

The Verdict 

Gilbert and Green’s book demystifies and humanizes the process of vaccine development. As the book unfolds, the reader is faced with the sheer amount of people, resources, and time that was dedicated to this vaccine. While the book reminds the reader of dark times, it still leaves a sense of wonder and a tender heart for every person who had a part in creating a vaccine that helped the world return to normality. 

There are a few aspects of the writing and structure of the book that can make it difficult to follow. The timeline repeats itself often; this adds to the reader’s awareness of the organizational challenge of overlapping vaccine development steps, but also makes for a more confusing read. Occasionally, the authors get ahead of themselves explaining a particular issue, and then cover the same information in a later section. Perhaps a graphic timeline of events would have been a helpful appendix.  

While some sections describing technical aspects of making the vaccine are clearly written and easy to follow, others get wordy or require multiple rereads in order to fully comprehend what was done. Gilbert and Green use metaphors, with varying degrees of success, to describe techniques they used, define terms, or add a more artful touch to an otherwise mostly technical and explanatory work.  

Somehow, these signs of imperfection ultimately feed a sense of humanity that permeates the entire book. The COVID-19 vaccines that released us all from the confines of masks and social distancing were not produced by amorphous, abstract machines and companies. Of course, companies and machines were involved, but this book leaves the reader struck by the fact that the ideas and choices that ultimately led to our salvation were made by people.  

From the earliest news of a disease outbreak, there were real humans who were looking out for the world. In the face of continual setbacks and challenges, they persevered for the sake of people—even when some of those setbacks included false accusations and protests lobbied directly from those people they sought to protect. As the pandemic unfolded, humanity was repeatedly struck by loss of life, fear for family and friends, mental health struggles in lockdowns, and so much more. People threw blame and vitriol at each other as science became political, and frustrations and mistrust mounted between governments and their people, and between neighboring countries. For many, the pandemic has left us feeling sapped of energy and disillusioned with humanity. Yet, as Gilbert and Green demonstrate in their book, while it was our humanity that made a mess of the pandemic, it was also our humanity that got us out of it. 

Vaxxers is a reminder of the light in the darkness. Readers will be left with a sense of appreciation and awe for the thousands of people—including scientists, manufacturers, vaccine trial participants, and even some big pharma employees. The curtain has been raised on vaccine development, and what waits behind is not a horror film, but a feel-good movie.