AstraZeneca Moves From Favored Child To Problem Child Among Vaccines

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AstraZeneca Moves From Favored Child To Problem Child Among Vaccines

In span of a 12 months, Astra has gone from favored baby to drawback baby in household of coronavirus vaccines.

Mene Pangalos, head of biopharmaceuticals analysis for AstraZeneca Plc, went to mattress on Monday, March 22, feeling good for the primary time shortly. After working across the clock by means of the weekend, he’d simply introduced better-than-expected interim outcomes from the corporate’s giant U.S. vaccine trial: The shot was protected and 79% efficient at stopping instances of symptomatic Covid-19. Constructive information, ultimately, after months of questions on every part together with security and provide shortfalls.

However at round 5 the following morning, Pangalos was jolted away from bed within the U.Ok. by a name from AstraZeneca Chief Government Officer Pascal Soriot, ringing from Australia to ask what on earth was taking place. The U.S. Nationwide Institute of Allergy and Infectious Ailments (Niaid) had simply issued a late-night assertion asserting that the protection board overseeing the trial was involved AstraZeneca “might have included outdated info” in its outcomes, which “might have supplied an incomplete view of the efficacy knowledge.” Niaid, which is a part of the Nationwide Institutes of Well being, urged the corporate to launch up-to-date figures as quickly as doable.

Whereas they had been asleep in Europe, Pangalos and his staff had obtained a harsh e-mail from the Knowledge and Security Monitoring Board, the impartial committee of consultants appointed by the NIH to supervise the trial. The DSMB accused the corporate of releasing “probably deceptive” figures, saying the information had been “essentially the most favorable for the examine versus the latest and most full.” The consultants added that “choices like this are what erode public belief within the scientific course of.” Astra executives had been surprised. Nobody had reached out to them to debate the issues first, and Niaid’s resolution to publicize the impartial committee’s critique of the interim outcomes was unprecedented.

The contents of the DSMB’s letter rapidly leaked to the Washington Publish and the New York Instances. Inside hours, Anthony Fauci, director of Niaid, was on Good Morning America, speaking concerning the flap. “It truly is unlucky that this occurred,” he mentioned. “That is actually what you name an unforced error, as a result of the actual fact is that is very doubtless an excellent vaccine, and this sort of factor does nothing however actually solid some doubt.”

Astra had obtained approval the Friday earlier than from the protection board to conduct its interim evaluation, based mostly on 141 verified Covid instances relationship to Feb. 17. The board had suggested the Astra staff to be conscious of the unverified instances that had are available since then, to make sure they would not produce a considerably totally different efficacy determine, based on folks aware of the discussions. The staff had appeared on the instances, however, believing that their potential impact on the efficacy quantity was negligible, they hadn’t talked about of their assertion that the ultimate share would possibly change.

Now, with the DSMB’s letter public information, the trial staff raced to evaluate the extra 49 instances, a course of that usually takes weeks. Two days later, AstraZeneca introduced the up to date outcomes. The variations had been statistically insignificant: Total efficacy dropped three share factors, to 76%, although it really rose 5 share factors in seniors, to 85%. The vaccine was 100% efficient at stopping hospitalization and extreme illness. This time, AstraZeneca was cautious to notice that there have been nonetheless 14 extra doable or possible Covid instances to be assessed, which may trigger the numbers to fluctuate. The corporate’s executives had been deeply upset by the occasions of the week. “It is simply vastly irritating,” one says. “Actually, it breaks our hearts.”

The week after the up to date outcomes got here out, Fauci downplayed the drama. “I did not query their knowledge in any respect,” he mentioned when requested concerning the incident by Bloomberg Businessweek at a White Home briefing on March 31. “It is a good vaccine that’s going to have a vital position within the international response to this outbreak.”

The story of the vaccine that AstraZeneca developed with the College of Oxford is marked by noble intentions, communication blunders, messy trials, manufacturing nightmares, and political and financial rivalry. Most significantly, the shot is going through a spate of reviews {that a} small quantity of people that obtained it, most of them youthful than 60, developed a uncommon type of cerebral blood clotting. The World Well being Group and British and European regulators mentioned that they’d discovered a doable hyperlink between the vaccine and the clots however that the advantages of getting the shot outweigh the dangers. The EU regulator has beneficial that clotting be listed as a uncommon facet impact, whereas the U.Ok. is advising that the vaccine not be used on folks beneath 30. Some governments have already halted the shot’s use in youthful folks. Regardless of all the problems, many European Union leaders have been clamoring for doses, complaining that AstraZeneca has failed to fulfill its provide guarantees and even threatening to dam vaccines made or bottled within the EU from being exported.

Within the span of a 12 months, Astra has gone from favored baby to drawback baby within the household of coronavirus vaccines. “There’s this little cloud that is adopted it round in all places it goes, which I believe is barely unfair,” says John Bell, the Canadian-born Oxford professor of medication overseeing relations between the college and AstraZeneca. “If folks maintain beating this vaccine up, no one’s going to have the arrogance to make use of the darn factor, after which we have got a large problem-because it is deployable, it is low-cost, you should utilize it globally, and it is clearly extremely efficient.”

As Bell suggests, Astra’s vaccine is extra simply transported and saved than the mRNA-based vaccines from Moderna and Pfizer-BioNTech. The U.Ok. firm has promised to ship as many as three billion photographs in 2021, promoting them on a not-for-profit foundation, at a number of {dollars} a dose. Solely the single-shot vaccine from Johnson & Johnson, which has additionally agreed to promote doses for no revenue, is anticipated to make a comparable contribution to ending the pandemic, but it surely’s far behind Astra’s on manufacturing. Against this the Pfizer-BioNTech vaccine is anticipated to herald $15 billion in income this 12 months, whereas Moderna Inc. is forecasting $18 billion for its shot. Greater than 135 million Astra doses have to this point been distributed world wide, and the shot has grow to be the workhorse of Covax, the WHO-backed program that gives vaccines to low- and middle-income nations.

AstraZeneca and Oxford have had their share of unhealthy luck, however in addition they made a collection of missteps that derailed their front-runner standing. “It is surprising that they made so many errors,” says Ezekiel Emanuel, a medical ethics and well being coverage professor on the College of Pennsylvania who suggested President Biden’s Covid transition staff. For all of the blunders, the world desperately wants Astra’s shot to finish the pandemic. That is the way it’s gone flawed.

Final spring, scientists at Oxford had been advancing rapidly by means of lab and animal testing of their vaccine candidate, which they had been planning to ship in a single dose. They had been beneath stress to staff up with an enormous pharmaceutical firm, on condition that manufacturing at scale would require months of intensive planning and huge logistical capability. Early talks with U.S.-based Merck & Co. floor to a halt after U.Ok. officers, cautious that American nationalism may depart them with out entry to doses, mentioned they needed to maintain improvement and manufacturing in British palms. GlaxoSmithKline Plc, a serious U.Ok. vaccine developer, handed on the chance to hitch forces. That left the one different British participant of any dimension, AstraZeneca.

Astra was on a roll beneath Soriot, who’d fended off a $117 billion hostile bid from Pfizer Inc. in 2014 and developed a popularity as a miracle employee in getting new medication, particularly therapies for most cancers, to market. When Bell spoke with Soriot final April, he mentioned Oxford had two situations: the vaccine needed to be offered on a not-for-profit foundation not less than for the primary 12 months, and Astra had to assist make sure the growing world bought doses. Bell says Soriot did not hesitate to agree, replying, “I am fully with you.” Astra would get a large public relations coup and, down the street, tons extra enterprise if booster or annual photographs proved obligatory.

Aside from a nasal spray for flu, although, Astra had virtually no expertise in vaccines. “They’re on this sport for the primary time, so that they’re making their approach,” Bell says. “They do not have 5 authoritative large weapons within the vaccine world to face up and say, ‘Hey guys, take note of this. That is actually great things.’ ”

Some potential for dysfunction was baked into the method from the beginning. By the tip of April, when it reached the ultimate partnership settlement with Astra, Oxford had already begun human trials, whose protocols would grow to be fairly advanced. It had giant Section III trials set to begin within the U.Ok. and Brazil, together with a smaller Section I-II in South Africa. For the U.S. Section III trial, Astra took cost, designing a simple two-arm protocol.

With the backing of the U.Ok. authorities, the partnership moved swiftly on manufacturing, constructing on the college’s early work with Oxford Biomedica, a small close by biotech firm, to get home manufacturing off the bottom. In mid-Might, the British authorities introduced it had preordered 100 million doses, and Operation Warp Velocity, former President Donald Trump’s vaccine program, pledged as a lot as $1.2 billion to speed up the shot’s improvement and safe 300 million doses for the U.S. Oxford quickly began its Section III trial within the U.Ok. Every part appeared to be coming alongside.

Out of the general public eye, although, the scientists at Oxford realized they’d miscalculated the focus of the vaccine, which had led some Section III trial individuals to obtain a half-dose. Across the similar time, the staff determined to maneuver from a one-shot to a two-shot routine after seeing indicators it might produce higher safety, deciding on a dosing interval of about 4 weeks. The U.Ok. regulator approved them to proceed with the half-dose group and comply with up with a full dose, however the miscalculation and the choice so as to add a second shot meant the staff would wish to make extra vaccine. That in flip delayed the second jab for a lot of volunteers.

Persevering with with the half-dose group appeared justifiable to a lot of these within the loop, on condition that the pandemic was accelerating, a vaccine was urgently wanted, and it is regular to strive totally different dosage regimens, if not often on the fly. However some U.S. officers heard concerning the modifications to the protocol and thought, “What are these guys doing?” based on a former senior Trump administration determine. The strikes undermined American confidence within the British developers-just because the NIH was working with AstraZeneca on establishing the U.S. Section III trial.

Astra’s staff had been hoping to begin the U.S. trial in July, which ended up being concerning the time Moderna and Pfizer started their Section IIIs. However U.S. officers needed to ensure manufacturing of the vaccine could possibly be scaled up and examined earlier than an costly trial started, and that took longer than anticipated, based on three former senior officers. Additionally, the Meals and Drug Administration and a few Warp Velocity officers had been asking for detailed immune-response knowledge in over 65s, folks aware of the state of affairs say; Oxford had been sluggish to recruit older adults to its giant U.Ok. trial. With the delays, AstraZeneca wasn’t in a position to start dosing volunteers within the U.S. till the tip of August.

Solely every week later, the well being information service Stat reported that the U.S. trial had been paused after a volunteer within the U.Ok. skilled an unspecified sickness. It quickly emerged that vaccination had been suspended in all of the partnership’s international trials because the state of affairs was investigated. It is not unusual for medical trials to be halted as a precaution, particularly within the large-scale last phase-it’s an indication that security is being taken significantly. However this wasn’t a traditional trial; it was one of the carefully watched scientific initiatives in historical past.

The primary reported pause to a coronavirus vaccine trial set off a media storm. Below big stress to reveal additional particulars, the builders refused, citing participant confidentiality-standard apply with such occasions and one which often goes unnoticed. A throwaway remark by Matt Hancock, the U.Ok. well being secretary, then revealed that Oxford’s Section III trial had been paused over a security concern as soon as earlier than.

Throughout a subsequent personal investor name, Soriot revealed a number of the particulars journalists and scientists had been demanding. The participant was a girl who’d begun affected by neurological signs per transverse myelitis, an irritation of the spinal twine that may be attributable to a viral an infection. Soriot mentioned it was unclear whether or not this particular situation had been identified and whether or not the vaccine was guilty. Once more, the knowledge leaked, and once more, a storm ensued.

Soriot’s selective disclosure renewed the calls for for particulars, which the corporate as soon as extra refused to reveal. The lady who suffered from the antagonistic response was complaining that her well being was being dissected within the media world wide, based on folks aware of the state of affairs. Releasing extra details about her situation earlier than a full investigation was carried out may even have compromised the integrity of the trial and probably inspired different individuals to report comparable points the place none had been occurring.

Regulators in Brazil and the U.Ok. cleared Oxford to renew its trial roughly every week after the pause started, however the U.S. stored the examine there on maintain for nearly seven weeks as Pfizer and Moderna zipped forward with theirs. American officers had been asking Astra for detailed info on each neurological occasion in any participant who’d ever obtained the vaccine, based on folks aware of the request. Three former senior U.S. officers say they grew pissed off at how lengthy Astra was taking to offer them the information they requested. The FDA had no need to sluggish issues down given the urgency of the pandemic, one former official says. Different corporations had been in a position to reply rapidly to FDA requests, and several other U.S. officers started to imagine AstraZeneca and Oxford had been having issues speaking.

Some engaged on the U.Ok. authorities’s vaccine effort had been baffled by the holdup. On Oct. 12, Stat reported that Johnson & Johnson had paused its trial due to an unexplained sickness. Like AstraZeneca, the American firm did not announce the pause beforehand and declined to launch particulars, citing affected person privateness; it later revealed in a report back to the FDA {that a} 25-year-old male volunteer had suffered blood clotting in his mind, leading to cerebral hemorrhage. After concluding that the occasion was unrelated to the vaccine, J&J resumed its U.S. trial, saying it might begin again up lower than two weeks after the pause started.

By then some American officers had soured on the AstraZeneca vaccine, protected within the assumption that they had Pfizer and Moderna within the bag, with Johnson & Johnson not far behind. “AstraZeneca appeared just like the gang that could not shoot straight,” says the previous senior Trump administration determine. “It was virtually an perspective of: In the event that they make it, they make it; if they do not, they do not. However we’re not going to exit of our technique to make AstraZeneca profitable. That is for certain. That they had fumbled the ball so many instances.”

By November, Pfizer and Moderna had produced a set of clear outcomes for his or her vaccines in U.S. trials, displaying efficacy of about 95%-better than anybody had dared hope for. When Oxford reported interim outcomes from its Section III U.Ok. and Brazil trials on Nov. 23, they had been additionally good, however they appeared messy by comparability.

Whereas Pfizer had enrolled greater than 40,000 individuals, and Moderna had greater than 30,000, Oxford reported interim efficacy knowledge on fewer than 12,000. Oxford additionally did not produce a single efficacy determine, as an alternative popping out with two that appeared counterintuitive-an concern that traced to the now-public indisputable fact that one group had been given a half-dose for his or her first shot. The vaccine was 62% efficient in a single cohort who bought two full doses spaced a couple of month aside. Surprisingly, within the smaller group of about 2,700 individuals who’d obtained the half-dose for his or her first shot, the quantity rose to 90%.

Initially, Oxford and AstraZeneca supplied conflicting tales about what had occurred with the dosing. Sarah Gilbert, the Oxford scientist who led the vaccine’s improvement, defined it away as a perform of experimentation. “We do not wish to keep on with a really low dose and uncover we have now an immune response that’s too low,” she informed Bloomberg Information. “Then again, we want a vaccination routine that is well-tolerated.” The following day, Pangalos informed Reuters the Oxford scientists had really “underpredicted the dose by half.” He solid the decrease dose’s relative success as “serendipity.”

The muddled trial, coupled with Oxford and Astra’s lack of ability to coherently clarify what had occurred, overshadowed the sturdy efficacy quantity for the smaller group in many individuals’s minds. As one former senior U.Ok. official says, it “wasn’t their most interesting hour.”

Though relations between AstraZeneca and Oxford did not seem strained by means of all this, a typical chorus emerged. When AstraZeneca executives talked concerning the U.Ok. trial, they’d say, “Effectively, it is Oxford’s trial. We had nothing to do with it.” When Oxford scientists had been requested about delays to the U.S. trial, they’d say, “Effectively, that is AstraZeneca’s trial. We’re not concerned.” Bell says the connection is nice. “We’re nonetheless in there swinging with AstraZeneca, attempting to assist. We have been fused on the hip from the start.”

The U.Ok. regulator approved the Oxford vaccine on Dec. 30, recommending going so long as 12 weeks between photographs. Its consultants concluded that the upper efficacy quantity for individuals who’d obtained the half dose for his or her preliminary shot doubtless owed to the elevated interval earlier than the second dose, moderately than to the quantity of the primary one. Manufacturing within the U.Ok. was by then up and working at a number of websites. The nation was getting ready for a serious rollout beginning on Jan. 4, a couple of month right into a nationwide vaccination program that had begun with the shot from Pfizer-BioNTech. Oxford Biomedica had labored for months to iron out the kinks within the manufacturing course of for the AstraZeneca shot, overcoming yield points and studying to develop cell banks that may show able to producing 2 million doses every week. By early spring, Astra would account for somewhat greater than half of all doses administered within the U.Ok., with knowledge displaying that it was driving down deaths and hospitalizations.

The rollout was a lot slower elsewhere in Europe. In late January, a number of days earlier than the European Medicines Company granted its approval for Astra’s shot, the corporate introduced that it might have the ability to ship solely 31 million of the 120 million doses it had initially deliberate to provide the EU within the first quarter. The bloc hadn’t signed its contract, for as many as 400 million doses, till the tip of August, leaving European manufacturing months behind the U.Ok.’s. Output at Astra’s Belgian subcontractor was proving decrease than anticipated, and the EMA would not grant authorization for an additional facility, within the Netherlands, to start manufacturing till the tip of March.

Information of the shortfall enraged officers in Brussels. Thierry Breton, a former businessman who serves because the EU’s inside market commissioner, tried to influence his fellow Frenchman, Soriot, to spice up deliveries, to no avail. Making the optics worse, Soriot wasn’t bodily current in Europe. He’d been working from Sydney, the place his household lives, since earlier than Christmas. Breton informed a French radio station he awoke on daily basis at 4:30 a.m. to name Soriot. “I am not criticizing him. Every of us has to handle this example as greatest they’ll,” Breton mentioned on Europe1 radio on March 14. “However you see, practically each week I’m going to 2 or three factories. I am not saying I do know their factories higher than they do, however I’m on website.” (AstraZeneca says Soriot is working across the clock from Australia.)

In mid-March, European Fee President Ursula von der Leyen renewed an earlier menace to ban the export of all vaccines manufactured within the EU. Paranoia that Astra doses had been being siphoned off from Europe to the U.Ok. crested a number of days later, when Brussels ordered Italian leaders to have police raid a vial-filling manufacturing unit within the city of Anagni that had 29 million doses on-site. The inventory turned out to be destined for Europe and Covax.

The provision stress got here whilst European leaders had been elevating efficacy and security issues concerning the vaccine. In early February, not less than 10 European nations had restricted use of the shot in over 65s, given the dearth of knowledge for that group from Oxford’s Section III trial. Extra unhealthy information would comply with from South Africa, the place the Oxford trial confirmed the vaccine supplied minimal safety towards the dominant variant there. Then, in mid-March, Denmark, Norway, and Iceland introduced they had been quickly suspending the Astra shot to research a uncommon type of blood clotting that had been detected in a number of vaccine recipients, not less than one among whom had died. A number of days later, Germany mentioned it might droop use of the shot, with a number of European nations following swimsuit even because the EMA beneficial persevering with. Most resumed use after the company reviewed the information once more and concluded that the advantages of the shot far outweighed the dangers, but it surely wasn’t lengthy earlier than extra instances appeared. On the finish of March, Canada halted AstraZeneca photographs for folks 55 and youthful, and Germany reimposed its suspension for beneath 60s. “We should have the ability to belief the vaccines,” German Chancellor Angela Merkel mentioned, wanting exhausted. “These are findings we can not ignore.”

She was referring to 31 German instances of a type of clotting, referred to as cerebral venous sinus thrombosis (CVST), that had been reported out of about 2.7 million doses administered-an incidence price increased than regular. Among the instances had been accompanied by low platelet ranges; most concerned youthful and middle-aged girls. 9 sufferers died.

The EMA investigated 86 instances of blood clots, 18 of them deadly, in Europe and elsewhere that had been reported as of March 22, out of 25 million individuals who’d obtained the vaccine. On April 7 the company mentioned that it had obtained a complete of 222 reported instances of mind and belly clots and that the information did not point out a trigger or particular affected person profile. The state of affairs “clearly demonstrates one of many challenges posed by large-scale vaccination campaigns,” mentioned Emer Cooke, the EMA’s govt director. “When hundreds of thousands of individuals obtain these vaccines, very uncommon occasions can happen that weren’t recognized throughout the medical trials.”

The UK regulator mentioned the general incidence of cerebral clots was about Four instances for each 1 million individuals who’d obtained the vaccine. The reported danger in Europe is 1 in 100,000, based on the EMA.

(The a lot decrease quantity within the U.Ok. could possibly be as a result of the nation has but to begin vaccinating beneath 50s, although the EMA has mentioned there is not any proof the clots are related to age or gender.) The Johns Hopkins College Faculty of Medication estimates that usually 1 in each 200,000 folks of all ages develop CVST in a given 12 months.

In an April 7 assertion responding to the newest regulatory findings, AstraZeneca mentioned it might be making beneficial modifications to the vaccine’s label, and it was “already working to grasp the person instances, epidemiology and doable mechanisms that might clarify these extraordinarily uncommon occasions.”

Any hope AstraZeneca executives might have harbored that their bigger and extra strong U.S. trial would reassure the world that their vaccine was protected and efficient had been dealt a serious setback when the protection board’s letter leaked. The runup to the interim knowledge launch had been fraught-even by the requirements of the pandemic. Astra was beneath stress from European regulators, who needed extra perception into the vaccine’s efficacy in seniors, after which into the specter of clotting. Executives had been additionally conscious about the warmth the corporate had obtained up to now for not being forthcoming, and most significantly, Astra was beneath strict obligations, as a publicly traded firm, to report materials knowledge rapidly. On March 21, the day earlier than the interim outcomes had been set to come back out, executives bought an emotional curveball once they discovered that Astra’s head of oncology analysis, José Baselga, had abruptly died.

That very same Sunday, AstraZeneca knowledgeable some U.S. officers about their evaluation that the later instances would not appreciably change the outcomes. In a video name attended by Fauci, NIH Director Francis Collins, and different U.S. well being officers (however nobody from the DSMB), the corporate introduced its outcomes and stepped everybody by means of the unvalidated extra instances, noting that the ultimate efficacy quantity would possibly drop by a few share factors and would really go up for the aged. There was no pushback, based on folks aware of the dialogue.

In asserting the interim outcomes on Monday, Pangalos did point out that extra instances had are available, however Astra’s resolution to not acknowledge in its assertion how this would possibly have an effect on its efficacy determine stood in stark distinction to what Pfizer and Moderna had accomplished months earlier than. In Pfizer’s case, the preliminary estimate of 90% efficacy was upgraded two weeks later to 95%-a win on each the efficacy and public-relations fronts. The DSMB’s letter, against this, mentioned that Astra’s efficacy may drop to between 69% and 74% as soon as all of the instances had been validated-a calculation it did not share with the corporate till after it had issued its launch. In itself, that wasn’t uncommon; what was uncommon was calling out the corporate publicly for its quantity. The DSMB is primarily chargeable for reviewing security knowledge and deciding when a trial has met a threshold for efficacy. Closing figures are usually determined by impartial statisticians working with the corporate on pre-agreed phrases, and disagreements with the DSMB are often labored out behind closed doorways.

Polly Roy, a professor of virology on the London Faculty of Hygiene and Tropical Medication, says this was a case the place precision ought to have been paramount for AstraZeneca. “They need to not have mentioned a selected quantity in the event that they weren’t certain,” she says. “There’s nothing flawed with the vaccine itself. It is the best way they reported on the medical trial. That was the flawed technique to do it. Communication is the issue.”

Different consultants say Niaid’s public intervention was pointless and intensely damaging. “It was grossly irresponsible for the Nationwide Institutes of Well being to publish statements that there was one thing improper about the best way the information had been collected and subsequently you could not belief it, which is the way it can have been learn it doesn’t matter what it really mentioned,” says Peter English, former chair of the British Medical Affiliation’s public well being medication committee. The inference, he provides, is “that issues might need been horrible. This brings the entire vaccine into disrepute. It makes folks suppose there’s one thing dodgy about it. It should have an effect on confidence within the AstraZeneca vaccine but in addition vaccines normally.”

Astra’s subsequent main hurdle shall be to safe an emergency use authorization from the FDA. The corporate plans to submit knowledge for evaluate within the first half of April, however a last ruling may take weeks. Astra executives are beneath no phantasm that the method shall be easy. They have to proceed to work with the DSMB, and so they have one of the advanced datasets of any Covid vaccine developer, with thrombotic occasions and real-world proof from hundreds of thousands of individuals vaccinated. In addition they bought a brand new problem on the finish of March when one among their essential subcontractors within the U.S., Emergent BioSolutions Inc., blended up substances from Johnson & Johnson and AstraZeneca, a serious manufacturing error. Emergent will now solely produce J&J doses whereas U.S. officers work to seek out AstraZeneca new manufacturing capability.

Many individuals inside Astra are deeply distressed by the extent of the criticism they’ve taken whereas attempting to prepared the ground to a nonprofit vaccine that might assist finish the pandemic. As one govt places it when requested in the event that they’d do it once more: “Not in 1,000,000 years. All we have had is grief.”

(Apart from the headline, this story has not been edited by NDTV employees and is revealed from a syndicated feed.)

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