By Tyler McManus
Special to Boston Irish

Adrian Hill, an Ireland-born immunologist and Director of the Jenner Institute at the University of Oxford,  was a key leader behind the development of the Oxford-AstraZeneca COVID-19 vaccine. But he would not have been prepared for such a feat, he says, without his prior experience developing vaccines against other viruses and infectious diseases.

The Oxford-AstraZeneca vaccine requires only one dose, and it is being sold and distributed in the UK and low income countries. So far, results reportedly indicate high efficacy.

A Dublin native, Hill was raised with five siblings in the southside city neighborhood of Ranelagh. He went to secondary school at Dublin’s Jesuit-sponsored Belvedere College, where he played rugby. His university years began at Trinity College Dublin.

 “In a big family, if you could get into medical school and you worked hard enough or were smart enough, your parents were very keen on that,” he said. “So I ended up going to medical school because I could, and then I really liked the scientific part of it.”

At 20, he transferred to the University of Oxford for a year because of its neuroscience program for undergraduates. After accepting a scholarship to stay at Oxford and finish his medical degree, Hill worked on his PhD and became an intern for David Weatherall, a famous British hematologist and head of Oxford’s department of medicine.

Hill was tasked with studying the human genetics of hemoglobin in Vanuatu, but he ended up researching molecular anthropology there and in other parts of Melanesia. Then in 1988, he spent the so-called ‘malaria season’ in The Gambia.

“[There] was this huge outbreak of malaria every year after the rains,” he said in an interview. “I was studying the genetics of malaria… The technology was new and exciting. We were applying it to low-income country diseases... I really became convinced that if you’re going to make a big impact on malaria, you needed a vaccine, and nobody really had any idea how to make a vaccine against malaria. 30 years later, we’ve made a lot of progress, but we still haven’t got a licensed malaria vaccine.”

After years of studying malaria, in 2005 Hill and his colleagues established Oxford’s Jenner Institute, which designs and develops vaccines against infectious diseases of global health importance. In 2014 his group led the first clinical trial of an Ebola vaccine, with partners GSK and the NIH, targeting the major outbreak in West Africa.

 “I think a lot of people [then] began to understand that there are loads of viruses out there that we don’t have vaccines against,” he said. “We had a list of 10 that the WHO came up with, and nobody was making vaccines against any of them. Then you ask yourself, ‘Well, why aren’t they making a vaccine against the Lassa fever?’ And the answer was simple, that it might never be needed.”

According to Hill, GSK started to spend millions on an Ebola vaccine before having to stop. Johnson & Johnson started later in 2014, and eventually got licensure about 18 months ago.

“So [when COVID-19 broke out] there was this track record of big pharma not doing very much on these kind of little known outbreak pathogens,” he said. “When they did, they either lost money or gave up or didn’t get licensure because there was only one [short] outbreak and they didn’t get to test their vaccine… it’s a terrible situation... We don’t know if and when [the vaccines will be needed].. there’s no business case for doing them.”

Fortuitously, the Jenner Institute teams had practice with an effective vaccine technology in anticipation of Disease X, the unknown disease that may break out and cause mayhem. From 2007, they had been doing trials with a new chimpanzee adenovirus (ChAd) vaccine technology for malaria.

“By 2014, we had done lots of trials,” Hill said. “So we knew [the ChAds] were likely to be safe…Then Ebola, a lot more people were vaccinated, thousands… [with] good [safety] in Africans, and including potent T cells and antibodies.”

To accomplish the task of making up to three billion doses of the ChAd- based COVID-19 vaccine in a year, Hill and his team worked with the Serum Institute of India, the world’s biggest vaccine manufacturer and largest supplier to developing countries.

 “That was an amazing move because they are producing more COVID vaccine today, I understand, than any manufacturer on the planet,” he said. “Most of that vaccine is going to low income countries, [and] they’re targeting 200 million doses a month… We trusted them because we’d worked together for several years on malaria vaccines, and [the COVID-19 work] went forward very, very quickly.”

The Jenner Institute also learned a lot about the challenge of distributing equitably to the global population of eight billion people. In recent weeks, numerous low income countries have started receiving vaccines costing $3 a dose through the international COVAX initiative.

 “Frankly, it’s in everyone’s interest that the world is supplied, rather than [just] rich countries, because we have to tame this virus,” Hill said. “We’ve got to bring it under control everywhere. This is a global problem. It needs a global solution... The challenge is to vaccinate the world [as quickly as possible].”

Early on, Oxford ruled out partnering with any company trying to make a profit from the pandemic. The Oxford-AstraZeneca vaccine is being manufactured in 15 countries, more than for any other vaccine, and it should be coming to the US soon. Oxford and AstraZeneca are filing for an EUA from the FDA.

Meanwhile, Ireland is one of the European Union countries that decided to limit the Oxford-AstraZeneca vaccine to adults under 65. Recently he was on Irish radio if Ireland should raise the limit, and he cited research showing 80- 94% single dose efficacy among older adults in  England and Scotland. Based on those studies, he said he believes his native land will soon change its plans.