It's possible that AstraZeneca has preemptively saved my life by inoculating me against the novel coronavirus SARS-CoV-2. I'm just not sure I can trust them, or that possibility.
I was still in pajamas on the Saturday in mid-November when I saw an ad online: “We are now looking for participants in your area. Find out if you may be able to join the Covid-19 vaccine study.”
The coffee went cold as I clicked further and further, digging up as much detail as I could. After a long, strained year of feeling helpless as Covid ravaged the people of my country, here was a way to help.
I’m not an essential worker — not a scientist, not a nurse, not a hospital orderly or even a mortician. “Inessential” had come to define my sense of self as I sheltered at home over the months. My main responsibility in this pandemic has simply been to keep my body out of the way.
AstraZeneca’s call for volunteers offered a chance for me to put my body on the line. By lunchtime, I’d completed the online screening. Within two days I got a follow-up email; three days, a phone call. On day four, I walked into a local research clinic to sign my informed consent and get a syringeful of something in the arm.
“Informed consent” is a tricky topic in studies like this, though: I can’t know what that “something” was.
I was one of the first rounds of Americans to join this phase III double-blind, placebo-controlled study of AZD1222. “Phase III” indicates us, the volunteers: the 40,000 humans (eventually) whose health will be monitored. “Double-blind” indicates what we, the volunteers, cannot know: exactly what the researchers put into our bodies. Not even the study’s medical staff are aware what each injection contains. Two-thirds hold AZD1222, the Covid-19 vaccine developed by pharmaceutical giant AstraZeneca in partnership with the UK’s Oxford University. The other third are simply saltwater, as innocuous as the drugstore saline I use as eye-drops.
After hours of in-person paperwork and a medical exam, I received my first injection on Wednesday, November 18. I left with an appointment card reminding me to return in mid-December for a booster shot.
The following day, I developed chills and a mild fever. These symptoms would have horrified me at any other point in this pandemic; in this context, they thrilled me. This was it! This was the telltale immune response the nurse had warned me I might experience if I received the active vaccine. I’m officially “blind” as to what my syringe contained, but as my temperature throbbed around 100.2°F for a few hours and gradually returned to normal, I walked on air. As far as I was concerned, my veins may as well have held a new elixir of life.
On Monday, November 23, AstraZeneca announced that preliminary results from overseas clinical trials were promising. AZD1222 joined the Pfizer and Moderna formulae in boasting efficacy of up to 90 percent. My delight heightened: not only was I probably vaccinated against Covid-19, but my vaccine was probably 90 percent efficacious! Thoughts like “It’s possible that AstraZeneca has preemptively saved my life” flooded me with gratitude and glee.
The glee didn’t last, though. AstraZeneca’s results came with an asterisk: Their formula’s efficacy depended on what size dose researchers had administered. The vaunted “90 percent” protection was found in volunteers who got a half-dose at their first appointment, followed by a full dose later. As the New York Times reported, it “was less effective when people were given a standard full dose upfront.” So far, the US trial has not included the more efficacious half-dose/full-dose regimen. American volunteers like myself are following a regimen that was reported to be significantly less effective.
After a few days of naively feeling invincible, I revised my estimation downward: I might only be 62 percent protected from Covid-19, once I get my booster.
Could I trust even this less optimistic figure? In the days following AstraZeneca’s jubilant press release, more and more asterisks materialized. We learned that the two different dosing regimens weren’t implemented deliberately, but materialized due to a “manufacturing error” that affected the concentration of the vaccine. The resulting “fluke” only affected 2,741 British volunteers — a fraction of the total testing pool. Furthermore, these 2,741 participants were all under age 55 and thus not a representative sample compared with the rest of the study’s participants.
That shining, glee-inducing figure of “90 percent efficacy” came from this smaller, younger group. As I mentioned, I’m no scientist. What was I supposed to make of this muddled data?
Over the course of a few more mornings, I let my coffee go cold all over again as I clicked and clicked. It became clear that experts around the world were increasingly skeptical of how AstraZeneca has handled this whole situation, from the original manufacturing error, to the mistake that allowed incorrect doses to be injected into volunteers, to the limited data that this “fluke” produced, to the opaque way that they announced their results.
By Thanksgiving, my gratitude had given way to confusion. I lay awake at night, back in that familiar place of powerless not-knowing. When I can’t sleep, I often meditate on my own heartbeat. Now, that meditation led me to wonder what was pulsing through me.
At a time when Americans’ trust in expertise has eroded, and when basic science gets politicized left and right, we need scientific institutions to demonstrate rigor and transparency more than ever. After all, a vaccine’s effectiveness doesn’t just depend on the concentration of each dose; it also depends on whether individuals are willing to roll up their sleeves to get an injection in the first place.
I mulled this the Thursday after my shot as I baked pumpkin pie for a single-household holiday dinner. It had been a whirlwind of a ten-day period. I’d learned about the study, arrived at the clinic, and walked out with a Band-Aid over my injection site; I’d celebrated my fever and then AstraZeneca’s press release, only to feel my brow gradually furrow again as the announcement was overshadowed by doubt.
Would some volunteers in my position lose trust in the trial? Would they decline to return for their second injection? When we signed our consent, we acknowledged that we were willing to remain uninformed as to what each syringe contained. Still, there’s a difference between agreeing to participate in a blind study and offering our bodies to a company that’s (barely, belatedly) acknowledged that its own errors have measurably affected what happened to others’ bodies.
It took some cold coffee and pumpkin pie, but my mood rebounded. I’ve made my peace with yet another iteration of relative ignorance. I cannot know for sure what’s happening in my body. I cannot know what’s happening in my neighbors’ bodies, either; I cannot know where SARS-CoV-2 lurks in my community, who at the park is unwittingly contagious, which local store clerk is blessedly already immune thanks to their own antibodies. Nature didn’t request my consent on this matter. I may as well accept that I’ll always be more or less uninformed in the world.
I hold pharmaceutical giants to a higher standard than nature, in general. I expect researchers to demonstrate ethics and transparency. AstraZeneca can and should be held accountable for whatever ways they fell short in the race to implement their vaccine trials.
Maybe this reflects the same non-scientist naïveté with which I celebrated that initial fever and felt invincible for a few days, but whenever I picture the researchers involved in every aspect of this study, I keep returning to a simple maxim: We’re all only human.
To err is human. It’s also human to forgive, to correct, to collaborate.
It’s human for doctors and nurses to work double shifts in the intensive care unit, wearing N-95 respirators until they dig purple outlines into their cheeks. It’s human for people like me to spend holidays apart from family this year rather than risk endangering strangers by traveling to see them. It’s human for vaccine researchers, with the burden of other people’s lives and deaths looming over them as they work for months on end, to get exhausted and slip up now and then. At least, that’s how I’ve come to see it.
Humanity is flawed; we often fumble. We’re also a species of individuals who step in when called and put their bodies on the line for one another in whatever ways we’re able. The fact that thousands of people volunteer for studies like this, unable to know exactly what side effects or consequences they may experience, is evidence of our capacity for good.
So, has AstraZeneca preemptively saved my life?
My brief moment of unbridled glee was a welcome break during this long, hard year. I’m ready to be realistic again. I probably got a dose of AZD1222. It was probably a full dose, unlike the 2,741 British volunteers who accidentally got a regimen that might prove more effective, once researchers collect more data. That means I’m probably on my way to having some degree of protection against Covid-19, particularly after I’ve gotten my booster shot.
There’s no doubt in my mind that I’m returning for that second injection as scheduled. The point of signing my consent wasn’t to be rewarded with guaranteed immunity. It was to offer my body as one of thousands of data points, so that, collectively, we can work toward securing the best possible vaccination regimen. I knew from the start that I might not get any vaccine at all, let alone a good one. I just hope that I can help the rest of humanity secure itself against this pandemic and save as many lives as we can along the way.
My gratitude goes to the researchers at AstraZeneca who have developed this vaccine and are working to test it around the world — asterisks and all.