The news this week that the Pfizer/BioNTech vaccine protected more than 90% of recipients is of huge importance. The vaccine efficacy is higher than we had hoped for.
There appear to be no safety concerns, although the final safety data along with other data on manufacturing and the full efficacy results will need to be submitted to the Medicines and Healthcare products Regulatory Agency (MHRA) to review whether it’s safe enough to grant temporary authorisation. This would allow the vaccine to be rolled out before a full product licence is issued.
RNA vaccines, never produced before, appear to work, and may be developed against other infectious diseases. We cannot know about very rare adverse effects until millions of people have been vaccinated, and post-marketing surveillance for safety will be essential; and we don’t know for how long vaccine-induced immunity will last.
Does the availability of the first vaccine mean that we can give up present restrictions and go back to life before Covid? I fear the answer is no. We can only do that if the coronavirus disappears or turns into something like a cold, or we vaccinate so many people that we achieve population “herd” immunity. Until we achieve that latter state, the future is going to be “vaccine plus”.
Now that high efficacy has been demonstrated, the duration of immunity and the overall proportion of the population vaccinated are critical. If immunity is not long-lasting, the concept of regular annual revaccination of everybody is daunting with huge impacts on other services. Annual boosting vaccinations just for those in risk groups would be easy, if given alongside seasonal flu vaccination, but would also mean those not in risk groups taking their chances with Covid-19 or continuing with social distancing and other measures.
If the virus continues to circulate among young people, those at risk who were not vaccinated or for whom the vaccine didn’t work are still vulnerable. This is almost exactly the situation that we currently face with seasonal flu vaccination. We vaccinate those at risk and leave the rest to take their chances. The difference is that with seasonal flu we also vaccinate children because they do get flu, sometimes badly, and are “super-spreaders”.
Any vaccine campaign will be driven by the pace of product supply. In an ideal world, there are sufficient stockpiles held in advance. With a new vaccine, advance stockpiles are rarely available, and for now we need to have as much information as possible about the reported manufacturing that has gone on “at risk”.
Talk of 1 million doses a week for the UK sounds impressive. I doubt that anyone has told health secretary Matt Hancock that in 1994 school nurses vaccinated 1 million children a week in a campaign with a measles/rubella vaccine. Every week in the autumn, nurses in general practice vaccinate a million older people. There are roughly 10 million people who are in the coronavirus risk groups – based on age and presence of clinical risk factors – and they are going to need two doses. So after six weeks at 1 million doses a week, only 3 million of our 10 million will have been vaccinated.
This picture will be the same everywhere. Hence I believe that we do have to acknowledge that we will be in a “vaccine plus” situation for quite a while. This would likely be a period of time – hopefully short but ultimately driven by vaccine supply and uptake – when we will continue to wear masks, limit our social contacts, think carefully about travel (especially to countries where the virus is not under tight control), be very cautious about public transport where there is crowding, and work remotely as much as possible.
Of course, the situation can change as soon as more vaccines come on stream after efficacy and safety have been demonstrated. But having different vaccines in a campaign when everyone needs two doses of the same product adds to the complexity. The Pfizer vaccine needs -70C for storage and distribution; other Covid-19 vaccines may only need standard 2-80C “cold chain” handling.
Trust in those recommending vaccination is essential for high uptake. We need acknowledgement that it will be a vaccine plus situation, not far removed from many of the measures already in place, until it is safe to relax. We also need the full details of the government’s plans for implementation to be available for scrutiny.
• David Salisbury is a former director of immunisation at the Department of Health and associate fellow of Chatham House’s Global Health Programme