Dame Kate Bingham: The regulator moved from being a policeman to an air traffic controller

Matthew

Hello and welcome to another edition of Health on the Line.

In a few moments, you'll hear a fascinating interview that I had with Kate Bingham. But before we turn to that, I'm speaking to you during a week that has seen the most disruptive health strikes so far.

We at the Confed have been warning that whilst NHS leaders have managed the impact of the individual strike days very well, they're now growing increasingly restless about the impact the dispute is having on patient care. At a time when everyone in the NHS has been making solid progress to recover services after the pandemic.

In particular, we've been talking about the four key risks that our leaders identified.

Firstly, the risk to recovery of performance. Leaders are hopeful they'll be able to meet the government's target of ensuring everyone waiting over 18 months for an elective procedure gets one by the 1st of April. But that's a real challenge. And the longer the industrial action goes on, the more challenging it becomes. According to the latest national data from November last year, nearly 49,000 people remained on the waiting list. But also, now 10,700 operations, and that's before this week's action, have had to be postponed as a direct result of the strikes. Elsewhere, health leaders are also committed to the recently published and very welcome urgent emergency care recovery plan. But progress there again is likely to be hindered if strikes lead to delays in emergency calls being responded to.

Another point is that primary care leaders and community leaders are reporting that the impact of the strikes on their services in the community have not been fully acknowledged. So, as well as the risk to recovery, there's also a risk in terms of patients coming forward. As we've seen during the peak of the COVID-19 pandemic, the public have responded to industrial action quite often by not accessing services at the same level on those days of strike action. Now, in some ways, we're grateful to the public for that. It makes those days more manageable. But there's a real worry that if people are holding back day after day, then this increases the level of sickness in the community. And it might particularly impact certain groups, disadvantaged people, people with mental health problems. So, we reinforced the call from NHS England to the public to use services in the same way as they would normally do on strike day. But there is a concern that if the public is holding back, it will be storing up trouble in terms of wider community health.

A third aspect to this, which at the moment thankfully is small, but there is a worry, is the impact of the strikes on local staff relations. Generally speaking, those relations have been really positive, including agreements on derogation and in staff crossing picket lines to respond to life critical situations. But there is a worry that as this goes on, some of the national tensions might start to emerge locally. One leader we spoke to said that 300 members of staff had joined the union since the strikes began. Now, that's not a bad thing. We at the Confed support trade union membership, but it does, for example, mean that the impact of the strike will grow as more workers take part in walkouts.

And then finally, there's the impact of all of this on our capacity to reform and innovate. There's a lot of talk about the NHS needing to transform and to improve. A lot of emphasis on things like virtual wards. And now again, this is important, this is welcome. But if you're a leader and you're having to spend time cancelling operations, redoing staff rotas, agreeing derogations, that's time that could have been spent innovating, reforming, thinking about doing things differently.

So, the industrial action cannot be allowed to become business as usual. And so, we've repeated our call to the government to open negotiations, try to find some basis for us to resolve these disputes. And we've also repeated our call on the trade unions that once the door has been open for them to push through that door so that we can end this increasingly damaging strike action and all of this all the things that we do in the NHS to recover urgent and emergency care we do, despite the fact that covid is still there, the fact that we've stopped talking about it doesn't mean that it's not still there. In the seven days up to Monday, the 30 January, 4,621 patients were admitted to hospital with covid. On Wednesday, the 1 February, over 6,000 covid patients were still in hospital. And in the seven days leading up to and including the 28 January, 550 people died within 28 days of a positive covid test. So covid is still out there. It's still adding to the challenges. The people who are sick, the need to think about infection control.

But of course, there's also the good news. And the good news is that the total number of people who have received their first dose of COVID-19 vaccine is now a staggering 45,398,000. And the total who received their second dose was nearly as high, 43 million. And the people who've received their COVID-19 booster or third dose was 34 million. These are staggering numbers. And the course, the vaccine rollout continues to be a success story.

And that's a great point to turn to our conversation, our interview today. And that's with my guest, Kate Bingham.

Matthew

I'm delighted to be joined by Dame Kate Bingham. Kate, as I'm sure everybody knows, was chair of the UK Vaccine Task Force from the crucial months of May to December 2020. After that, Kate returned to her day job managing partner SV Health Investors where she leads on SV’s Biotech franchise. Amongst other things, Kate is a board member of the Francis Crick Institute and has helped found Dementia Discovery Fund, the largest venture fund to develop treatments for the disease.

Kate, welcome to Health on the Line.

Kate

Thank you for having me, Matthew.

Matthew

Are you in your beautiful rural idyll? In your book it features a great deal because of course it's lockdown during most of the book. And so, you're trying to perform this incredible act of bringing together the vaccine from your farmhouse.

Kate

No, sadly, I'm in central London in an urban-built environment which is much less conducive to being creative and working hard.

Matthew

Can we just start with the dementia work, which is not covered in the book at all. We've heard quite recently, haven't we, have what looks like a breakthrough in relation to dementia treatment? And I noticed that some of the experts were saying to us, let's not get too carried away with this, even though it is a breakthrough. What's your perspective on how important that breakthrough is and how close we are to accelerating our effective treatment of forms of dementia?

Kate

Okay. So for your listeners who don't know the detailed data that's come through, is a new drug called Lecanemab, which has been jointly developed, led by Eisai, the Japanese company, together with Biogen. And it's another antibody that removes the plaque in certain Alzheimer brains. And what they've shown is a statistically significant reduction that has quite a small clinical effect. So, while it is a real improvement, it's a small real improvement.

So, net/net, this is incredibly positive news because it's the first time we've actually had proof that a drug is able to modify the course of this particular form of Alzheimer's disease. But it is only a very small step forward. There's still a vast amount of work that needs to be done to actually improve the lives of patients, many of whom will not have diseases driven by this particular mechanism. So, I think it is positive, but we've got a long way to go.

Matthew

And I guess the question is, is that breakthrough, that particular drug, is it your view that in a sense we're looking at the right place now? Because I think the thing about the history of Alzheimer's research is that we spent a lot of time looking in the wrong places, hoping that we one particular approach would crack it, and it hasn't. Is there confidence that whilst this drug's efficacy might be relatively limited, it's directing our attention to the right place?

Kate

Very good question. The real trick is to make sure that you include the right patients in the clinical trial for the mechanism of the drug you're trying to test. So in the early Alzheimer trials, which included these amyloid beta antibodies, as it turned out, up to half the patients included in the trials did not have plaques. So of course they were never going to show a positive result. So as imaging has got better and as the characterisation of patients becomes more precise, it's then become easier and better in terms of patient inclusion in the trial, so you can really demonstrate that the drug is doing something.

In this case, what it shows is you probably need a very high level of drug to remove the plaque, but it doesn't have a huge clinical effect, but it's much like cancer.

So, if you go back 20 years ago in cancer, we used to talk about people having breast cancer or lung cancer or colorectal cancer, and now we talk about patients having triple negative breast or HER2 positive, and we basically talk about the drivers of the particular types of cancer. And then drugs are developed specifically against those drivers of different forms of cancer, which has led to an explosion in new cancer treatments and a vastly better management of these different patients because we can define what are the underlying disease processes that are causing the disease

And where we are probably ten or 20 years behind that in Alzheimer's disease where we're still talking about sort of a generic Alzheimer diagnosis rather than what are the individual mechanisms that drive a patient's individual disease. And that's where we need to get to.

And we've made vast, vast progress. We're still not anywhere close to having cures for everybody. And remember, historically, the only drugs for Alzheimer's are and broadly dementia, are symptomatic drugs. And what we need to get to for all diseases are drugs that are actually alter the course of the disease and ultimately stop the disease and if possible, to reverse the disease. So that is the Holy grail. And in some cases, we've been able to do that. But that is what we all seek to do.

Matthew

Okay. I'm going to come on to the work you did on the vaccine and your splendid book in a minute. But this is so fascinating. I want to just explore it a bit further. What are the limits on the new kind of treatments that are being developed, particularly in relation to this characteristic that you've described, which is that we're becoming more and more targeted in terms of understanding the specific nature of cancer and the relationship it has to the individual person and their genetic profile. What does that mean for the finances? Because, of course, you know, in in the of traditional pharmaceutical model, what you want is a drug that that billions of, millions and millions of people want and that you can give them the same drug. And it's all very straightforward. But when you're talking about a drug which works with a pretty small group of people in relation to a pretty narrowly defined type of cancer, how does that change the economics in terms of R&D?

Kate

So, what we're talking about here is precision medicine. Matching the right drug to the right patient at the right time of their disease. And all the evidence shows that if you can do that effectively, then the costs of developing the drug is much, much lower than if you are less targeted as to which patients should receive your drug.

If you just think about it, if you can be pretty sure that 90 per cent of the patients, or 100 per cent of the patients, you enrol in a clinical trial will have a disease caused by that particular mechanism, Then if you can show that it works, then you know that that drug will work for those patients. But you haven't wasted time and patients joining clinical trials where they will have no chance of ever responding.

And the example is in Lynparza which is a PARP inhibitor called olaparib, which we developed in or discovered in one of our biotech companies called Kudos Pharmaceuticals, which AstraZeneca then acquired.

And initially we developed it showing that this worked exquisitely well in patients with a particular genetic background and AZ initially started developing it in all patients because that goes with your idea of give the same drug to everybody, except that didn't work.

So, when they went back and looked at the data, it was as you'd expect it to be, which was that those patients that had the genetic background did incredibly well and responded. And those patients without the genetic background did not respond at all.

And so, this for us was a beautiful example of precision medicine in action such that those patients with the genetic background have done incredibly well, whether they're in breast cancer, ovarian and now prostate cancer, as well.

So, this is where we need to get to. And the costs of development will be lower because the failure rate should be lower and the chances of success should be higher. So just the fact that you're selling to many fewer patients is not a bad thing economically. I think it's a good thing both for the patients and for the drug developers because they cannot waste money testing a drug on patients that will never respond to this particular mechanism.

So, the world is moving to a much more targeted pharmaceutical approach rather than the stack ‘em high selling cheap to everybody where only a small portion of patients will actually respond.

Matthew

And I want to come back to clinical trials later on in our conversation because that's one of the lessons to draw from your vaccine experience.

But let's just talk about the book, The Long Shot, which I enjoyed reading. It's got moments of kind of exhilarating, almost like thriller quality at certain points when the vaccines are travelling down the motorway and a lorry breaks down, that kind of stuff, it's edge of the seat stuff.

But also, I just wanted to say to you, one of the things that I really liked about the book was the time that you spend giving credit to just about everybody else. You could have written this book in which you would have been the hero. And actually, you spend a lot of time telling us about all the people that work with you in your team, across government, in pharma companies; there are there are two or three people who get described in much less positive terms. But generally, you really want the credit to go out to the team. It was it was a team effort, wasn't it?

Kate

I mean, it's an incredibly positive story.

Here are a group of people that are thrown together in the middle of this sort of wartime lockdown. We meet on Zoom, and it was a phenomenal bringing together of talent where people just got on with it, used the expertise they had and the relationships they had to achieve some goals very, very quickly.

So the reason to be positive and to give credit widely is that's the truth. This isn't a one-person gig. This is very, very much a team effort and one that we should be replicating much more broadly because it really was a very positive relationship between industry, academia and government. And that is not something that I think has been widely demonstrated before and really should form a blueprint for what can be done in the future and actually think it was an incredibly positive experience. And the people involved, I think, really enjoyed it.

Matthew

And there were so many things that could have gone wrong. That's what you feel when you read it. I mean, obviously the science might not have worked. But I guess when I picked up the book, I thought, well in the end, this is about whether or not the vaccine worked. And then you have to find a way of distributing it.

But I hadn't I hadn't thought about what about the manufacturing and the challenges of manufacturing. What about the challenges of the containers that it has to go into, moving it around, all of that kind of logistical stuff, which I guess for you, that was one of your great strengths, it seems to me, as the chair, was that, you know, because you come from a commercial background, you had some awareness of the complexity of the process that takes something from a laboratory and puts it in someone's arm.

Kate

Yeah. I spent 30 years doing that for therapeutics. I deal with patients and we're trying to cure or at least stop their disease.

The whole thesis of running trials to test whether or not these, in this case vaccines are safe and effective, is something that I've been doing for a very long time.

The manufacturing was a was a massive, massive challenge. And it wasn't that it couldn't be done, but trying to do it really, really quickly was the bit that was difficult. And these are vaccines that are being grown basically in, in biological cells. So, it's not something you can speed up at all quickly. What you're taking is you're starting at lab based or bench-scale equipment and you're scaling up into these, you know, hundreds to thousands of litre sophisticated bioreactors, and it's not linear.

There was a lot of judgement and a lot of experts trying to make sure that the quality and the scale up was being done correctly such that what you ended up with in 1,000 or 2,000 litre bioreactor was the same as what you started off with when you're in the lab.

And so those are very, very sophisticated skills and we had a phenomenal group of people supporting, supporting all of the manufacturing and scale up. And that, of course, is a core part of regulatory approval. So of course, you have the clinical side to show that in this case the vaccines were safe and effective. But you've also got to show that every single batch you produce is identical and meets the quality specs as approved by the regulator. And that was a non-trivial task.

Matthew

And I think one of the things that was really impressive in the book was the way the regulators themselves operated, that they really threw the rulebook out of the window in the face of this national emergency. And they adopted a very different kind of model of a collaborative model of regulation, really.

Kate

Yes. So, June Raine, who is the head of the MHRA, which is the UK regulator, basically describes it as moving from being a policeman to an air traffic controller.

My experience historically of the regulators, whether it's in the UK or in the US or Europe, was a very scary time whenever you met the regulator and you had to absolutely make sure you had the answers to everything. And in any submission, you had your T's crossed, your I’s dotted and everything was in perfect order.

And what June and her team did was to say, that's not going to be the quickest way to get vaccines or therapeutics regulated and approved. So why don't the companies start consulting with us as soon as they've got any anything to share whatsoever, and we can offer advice and assess what is there and we can continue doing that on a rolling basis so that when the final data is ready, they can just look at the final, you know, phase three pivotal data or the final batch release data and everything else will have been assessed and reviewed at that point, which means they can then take a very, very quick decision as opposed to the sort of six to 12 months decision which it would normally take a regulator to approve a new drug or a new vaccine.

So, this collaborative approach or the rolling review process was masterful. The EMA followed suit, as did the FDA. And I think it was, again, one of the key reasons why the UK did so well.

And even though, for example, the Pfizer BioNTech vaccine had not been trialled in the UK, because of the very close relationship with the regulator and the fact that they had assessed all the data, you know, closely as they went along, the MHRA was able to approve the Pfizer vaccine a week before any other regulator in the world.

Now that is an astonishing achievement and they've continued to act nimbly and quickly, but without any shortcuts whatsoever in safety testing. And that's the bit that I think we just need to reinforce. This idea of tearing up the rulebook. Yes, in terms of how they regulate, but not in terms of what they regulate. So, the phase one and the safety testing was expanded from normal safety testing and there was no acceleration or abbreviation of the safety testing whatsoever. So that remained the same. And then it was the efficacy testing that was basically accelerated and expanded and run in parallel. And that's what was unusual.

Matthew

Towards the end of your book, you draw out some of the lessons of your experience and one of them will be recognisable to anyone who's dealt with Whitehall, which is try to focus on the outcome and not on the process. Whether or not one can do that in normal times, of course, is the great challenge.

This conversation, Kate, is all about your ideas and your book but I'll just share with you an insight that I learnt in sociology many, many years ago, and it's always been useful to me, which is that Max Weber, the sociologist, identified the distinction between substantive and procedural rationality. So substantive rationality is about ends, the rationality in terms of ends. What are we trying to achieve here? What is sensible in view of that? Procedural rationality is rationality in terms of rules. And what Weber argued, because of course he was the first person to really wrestle with the concept of bureaucracy, was that bureaucracies systematically replace substantive goals with procedural goals. They systematically end up being organisations where what matters is adherence to the rules rather than adherence to the ultimate outcome. And I guess the lesson of your book is it takes an emergency, like covid to shift that tendency within bureaucracies to make rule adherence more important than ultimate outcome.

Kate

I completely get that and I recognise that in my time in government. Having said that, we didn't change the rules per se. What we did is we just dramatically sped them up.

If you think about it, I was a person brought in on a on a six-month, or it turned out to be a seven-month, secondment. My job and the team team's job from the VTF was to make recommendations to government. Whitehall's job was to make sure that our recommendations were lawful and they fitted in with the government process. But the people that made the spending decisions were the ministers.

Now, none of that is different from what normally happens, is just we did it much, much, much more quickly than normal. And that's why I don't think it does require a sort of a tearing up of the rulebook as to how governments work. And I think rules do need to be followed because I think it is important that there are checks and balances and that there aren't ridiculous initiatives that are started that make no sense. But having the focus on outcomes really matters and outcomes with deadlines really matters.

So, I signed up for six months. I ended up doing seven. But I was very clear that we had goals that had to be delivered before I left because it wouldn't make sense to be, you know, chair of the Vaccine Task Force and actually not produce any vaccines.

So, I think it's the combination of, of goals with deadlines, but being done in the right way, which is what we should all strive to achieve.

Matthew

Yes. The book is overwhelmingly positive. And I guess there's just a few examples of a couple of tendencies that we see. So, one is treating something that is urgent in the way that you would treat something that is routine. And there were various times at which you just kind of had to ring up officials or ministers or even the prime minister and say, look this is being treated as if we've got all the time in the world. And it's actually really urgent to get on with it.

And then a kind of a failure to recognise that the risk of doing something, is often much smaller than the risk of not doing something. That's another kind of thing that one sees a little bit in Whitehall is that you can, it's I think it's a problem with human imagination. You know, we can see the risk of commission, but we can't see the risk of omission, as it were. And again, something that you had to do was to remind people of the fact that that this was not a journey that was going to be accomplished without taking some risks, including, spending an enormous amount of money on things that may never have delivered the goods. And that's what felt different about this.

Kate

Yes. And I think if you look at the two countries that did the best in terms of getting ahead of vaccine procurement, development, scale up, manufacturing development and so on, the two countries were the ones with the two sort of most maverick leaders. So, Donald Trump and Boris Johnson.

Each of them understood that if you didn't put cash up front to support the scale up development of vaccines, you wouldn't get the vaccines. And that, I think, was a pretty ballsy decision from each of them. And other countries did not do the same thing by and large, and were slower to procure and develop the vaccines.

So, actually in my time, we spent in in terms of cash that was committed, which could have been lost during 2020, it was £900 million. But in the scale of the whole pandemic and the economic cost of lockdown, actually that was a bar bill compared with what, what was being spent elsewhere. So actually, the vaccine itself was pretty cheap. I mean, we ended up spending on it, I think about a little over £10 a dose.

Matthew

Oh yeah, of course. But look, but when I was in government, you know, you could see very important things held up for the want of approval for a few thousand pounds. So, in a sense it's not how much - that's the point, isn't it? It's about people being able to grasp the whole project rather than trying to adhere to processes.

But anyway, it's an overwhelmingly positive story. But what I want to turn to is right at the end of the book, there does there is an air of weariness to an extent, disappointment comes in, which is that your third objective that the Prime Minister said was to create the capacity to ensure the resilience of the UK going forward in relation to other pandemics. And you admit and I think it's really impressive again, that that you are willing to admit this, you don't need to admit anything because you are a national hero and for what you achieved in the book. But you admit that in the end you don't think you did really deliver on that third objective.

And so let's look at a couple of elements that I mean, we talked about manufacturing. You really wanted to create a greater manufacturing capacity when it came to vaccinate antibodies in the UK, and we haven't accomplished that, have we?

Kate

No. I certainly think on manufacturing we are a bit better than we were. We did start going into the pandemic with a vibrant but low-scale manufacturing industry. So what we did at the VTF was basically to supercharge those companies that were already manufacturing and just scaling them up. So, they've got had greater capacity to start manufacturing sort of at bulk population scales.

So, some of that is in place, but some of that had basically has been, in the case of the Vaccine Manufacturing and Innovation Centre that was sold to a US company that has now mothballed it. Now that's not helpful.

We did so much to get manufacturing scaled up and working well that then to lose that ability to actually continue to engage with industry… because these vaccines have been phenomenally successful at treating and preventing severe disease and death, but they haven't been successful in preventing transmission. They're still expensive. The durability is questionable. So, we have to be giving boosters and so on. So, we've got a massive need to continue to innovate and to continue to develop next generation, better vaccines.

Now, if we start selling off our manufacturing capability and don't have leadership to engage with industry and work to explore which of the, the new formats or the new designs can actually develop better, more durable, more robust clinical protection, we're going backwards. And so my main criticism is actually the lack of ongoing leadership in government to deal with the new innovation.

I mean government is very good at continuing to order, you know, more vaccines. So, the programme management, I think is exceptional and their ability to continue to crank the wheel once it's clear which wheel you need to move. But it's the innovative risk taking, exploring new products and new, in this case, vaccines that is missing. And that applies both to manufacturing scale-up formulation, but it also applies to clinical development. So that's why I'm critical because we did put lots of that in place. Now, it wasn't finished and it needed to continue to be led and continue to be developed. And that's what's not happening.

Matthew

Let's turn to another area where I sense that you feel that the potential that you created has not been as fully exploited as it should. And that is in kind of clinical trials. The NHS is a massive resource and you built through your work, the register of people wanting and willing to participate in those clinical trials. We talked earlier in our conversation about the importance of having as many people as possible available for trials as we move to more precision medicine.

We're still in a good position here potentially, but I think you're a bit frustrated at the pace of change?

Kate

In 2020, if you remember, the lockdown in the summer well from March was pretty effective at reducing viral transmission. And it meant that that some, you know, early companies like Pfizer didn't want to run the trials in the UK because we didn't have enough infection going on. But our view was we felt that it was highly likely we would have a big increase in infection in September - the autumn when schools and universities went back. So, we wanted to be able to say to the vaccine companies, Look, come and run your trials in the UK because we will have a group of volunteers who will be ready to be enrolled in trials just at the time when we're going to have infection spikes coming back into UK.

We spent a lot of time trying to get and build a registry of people, not of fit 25-year-olds, but of those people who were most vulnerable to the disease. So, we needed to be sure that the vaccines that we were going to be trialling would actually be effective in those people that needed the vaccines most. So that meant the elderly and the people with underlying diseases and so on.

And so, we did succeed in that. And, you know, as of today, the vaccine registry is about 550,000 people, of which over a third are over the age of 60. We've got a terrific pool of socially-minded volunteers who have agreed to be contacted about clinical trials, it's different, they haven't enrolled in the trials yet. They need to be told what is available. But these are people who have signed up to help. And over the course of the pandemic they were involved in 18 different trials across seven different vaccines. So, it has been hugely, hugely helpful.

But the key thing was that we asked everybody as they signed up, would they be willing to be contacted about clinical trials outside covid vaccine studies. And 94 per cent said yes. And the reason we asked that question is we saw this as a potential cornerstone for a much bigger registry of patients to allow anybody with any clinical diagnosis where their disease was not properly managed with existing treatments to be told about, well, here are the clinical trials that you could be eligible for. You know, talk to your doctor and see whether or not this makes sense.

Because fundamentally, if we're going to make advances in the treatment of, you know, chronic disease, Alzheimer's disease, cardiovascular, lung disease, kidney, all the different major chronic diseases that we face in an ageing society. We need to get better drugs to patients. And we can only do that by running clinical trials, and where better to do it than in the UK?

Everybody has an NHS number. We're a highly diverse society and the quality of our healthcare is very high. We have very committed and experienced physicians and research nurses and trial set ups. So, I do think that UK could be a testbed for innovative new medicines for the world.

And of course, we were that in part for vaccines. So, the vaccine trials that we ran, the data will have supported clinical registrations around the world to get those vaccines approved in countries that needed them. And we should be doing the same thing for pharmaceuticals.

I would really like to see the scale of clinical trials that are being run in the UK go up orders of magnitude. I think anybody that has a diagnosis where their disease is not properly managed should be thinking about clinical trials because it's only by testing these new drugs that we will make steps and really help both the patients and their families.

Matthew

And I think there's a lot of enthusiasm for that out in the service. Unfortunately, I think clinical trials have been impacted in the same way as almost everything has been impacted by the kind of gap that currently exists between the demand the health service faces and the capacity we've got. But it is important to have a positive story about the future of the health service, and I think that the scope the NHS has, the role that you've described is very much part of that story.

So, Kate, one last question before I let you go. And you know, this is a podcast that’s listened to by NHS leaders. In terms of your leadership journey, what did you learn about leadership from the period of chairing the task force? How are you a different leader after that than you were before?

Kate

Well, I think I'm a grateful leader that I was able to work with such fantastic people because the key role I played was to make sure that we had the right people responsible for the right different aspects of what we were trying to deliver. So that's picking the right vaccine. So that's the scientific understanding, the relationship with industry to make sure that they did consider the UK as a potential partner with whom to work. It was manufacturing, clinical development. And then of course the whole issue with other countries because this was not a race between countries, we were highly collaborative working with countries around the world and we wanted to make sure that anything that we had learned we could share. And then, you know, again, programme management, commercial negotiation. There were so many aspects where having the right people in the right jobs, where I've not even met all the people in my group yet, we were incredibly efficient on team calls, but not in person.

So, I guess for me the reflection is get the structures in place so that we had a very transparent process of communications. We had very clear goals which were articulated and understood and widely shared, and make sure you get the right people to deliver against those goals.

You know, we don't micromanage people if they if they're getting on with it and they're good and they're communicating, that is just fine. You just continue to allow them and give them the space and the support to deliver and make sure that, from my perspective, that the expectations are set correctly. So, what I didn't want was that everybody, from a political perspective, to think this was just a slam dunk and buying vaccines is the same as buying PPE equipment, which it manifestly is not. So, it was very important to have clear communication about what to expect and where the risks are so that there were no huge surprises.

Matthew

From my perspective, the leadership side is about building the team, setting the goals, setting the time frame and letting great people get on and do the job.

Sounds like very good advice, Kate. Well, The Long Shot, the inside story of the race to vaccinate Britain is available in all good bookshops and online book retailers, and I can strongly recommend it.

Kate, thanks so much for joining us on Health on the Line.

Kate

Thank you so much for having me.