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The news this week that the Pfizer / BioNTech vaccine protected more than 90% of recipients is of great significance. The efficacy of the vaccine is greater than we expected.
There appear to be no safety concerns, although final safety data along with other manufacturing data and full efficacy results will need to be submitted to the Medicines and Healthcare Products Regulatory Agency (MHRA) to review if it is safe enough to grant a temporary authorization. . This would allow the vaccine to be implemented before a full product license is issued.
RNA vaccines, never before produced, appear to work and can be developed against other infectious diseases. Very rare adverse effects cannot be known until millions of people have been vaccinated, and post-marketing surveillance of safety will be essential; and we do not know how long the immunity induced by the vaccine will last.
Does the availability of the first vaccine mean we can waive current restrictions and return to life before Covid? I am afraid the answer is no. We can only do that if the coronavirus disappears or turns into something like a cold, or if we vaccinate so many people that we achieve “herd” immunity from the population. Until we achieve that last state, the future will be “more vaccine”.
Now that high efficacy has been demonstrated, the duration of immunity and the overall proportion of the vaccinated population are critical. If immunity is not durable, the concept of regular annual revaccination for everyone is overwhelming and has huge repercussions on other services. Annual booster shots only for those in risk groups would be easy, if given in conjunction with seasonal flu vaccination, but it would also mean that those not in risk groups will risk Covid-19 or continue distancing. social and other measures.
If the virus continues to circulate among young people, those at risk who were not vaccinated or for whom the vaccine did not work remain vulnerable. This is almost exactly the situation we are currently facing with vaccination against seasonal influenza. We vaccinate those at risk and let the rest take their chances. The difference is that with seasonal flu we also vaccinate children because they get the flu, sometimes seriously, and they are “super contagious”.
Any vaccine campaign will be driven by the rate of supply of the product. In an ideal world, there are enough reserves stored in advance. With a new vaccine, anticipated stocks are rarely available and for now we need to have as much information as possible about the reported manufacturing that remains “at risk”.
Talking about 1 million doses a week for the UK sounds impressive. I doubt anyone ever told Health Secretary Matt Hancock that in 1994 school nurses vaccinated a million children a week in a campaign with the measles and rubella vaccine. Every week in the fall, GP nurses vaccinate one million older people. There are approximately 10 million people who are in risk groups for coronavirus, based on age and the presence of clinical risk factors, and they will need two doses. So after six weeks at 1 million doses per week, only 3 million of our 10 million will have been vaccinated.
This image will be the same everywhere. So I think we have to recognize that we will be in a “more vaccine” situation for quite some time. This is likely to be a period of time, hopefully short, but ultimately driven by the supply and uptake of vaccines, in which we will continue to wear masks, limit our social contacts, think carefully about travel (especially to countries where the virus is not under strict control), be very careful with public transport where there are a lot of people and work remotely as much as possible.
Of course, the situation can change as soon as more vaccines are put into operation once their 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 requires -70 ° C for storage and distribution; Other Covid-19 vaccines may only need standard “cold chain” management of 2-80C.
Trust in those who recommend vaccination is essential for high acceptance. We need to recognize that it will be a vaccine plus situation, not too 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 your scrutiny.
• David Salisbury is a former director of immunization in the Department of Health and an associate member of the Chatham House Global Health Program.
