Covid-19 vaccine UK approval: The beginning of the end or the end of the beginning

Today’s announcement that the UK regulator has approved the Pfizer/BioNtech vaccine marks a significant milestone in the fight against Covid-19. The first vaccine for mass use has been given the green light and within a week, it is expected that the first doses will have been injected.

The UK has 40 million doses of this jab on order, with the first 800,000 available from next week. As a two-dose jab, the UK will have enough Pfizer/BioNtech vaccine for 20million people in total.  But it is anticipated that other vaccines will soon receive approval from UK regulators to take the number of doses available well-beyond the size of the population.

So is this the beginning of the end of the pandemic? Perhaps it is more the end of the beginning. The challenges of mass vaccination are significant, but if the last year has shown us anything, it is that through a partnership of government, business and communities, these adversities can be overcome.

The three issues that we now face are: the logistical challenge of injecting millions of people across the country, potentially with different vaccines; the time lag between vaccination and immunity, as well as the relationship between immunity and infectivity; and the need for people to continue to accept restrictions to their everyday life to supress this virus while the vaccine is rolled out.

But perhaps, the first and most obvious question is who gets the vaccine first?

This has been much discussed and the UK Government has already released a draft of its vaccine priority list, and who makes-up Phase 1 of the roll-out program was confirmed this morning. Top priority will be people in care homes and the staff who care for them. Over-80s and the wider health and care workforce follow closely behind. Alongside these top two groups, the clinically extremely vulnerable and older people are all set to be vaccinated in this first phase.

The UK Government has calculated that this initial tranche of prioritised people covers 90-99% of individuals at risk of dying from Covid-19.

But the logistics of getting the vaccine to these people is not simple. The fact that it needs to be stored at -70C means jabs are initially likely to take place at hospitals.

And then there is the lag between injection and immunity. Partial immunity is said to happen after the first jab, but the ‘95%’ immunity promised by this vaccine will only be achieved after the second injection – meaning all in all that it will reportedly take a minimum of 28 days after the first dose before the full effect of the vaccine is felt.

The process of vaccinating the entire population (or as large a portion of the population as is needed for a vaccine to be effective) will clearly take a significant period of time – and even longer before people become immune.

The number of vaccines approved, the speed at which they can be produced, how quickly people can access the vaccine and the rate of take-up will all define how long the whole process will take. The added complexity of different types of vaccines being rolled out at the same time, all of which likely require multiple jabs at different intervals, will make this the most complicated government-led logistics programme of any kind since the war.  

Throughout this period, measures such as social distancing will need to continue, and individuals will still need to be tested and self-isolate where necessary in order to supress the circulation of the virus. This will be particularly important until those who are most vulnerable (Phase 1 of the UK’s priority list) are able to be vaccinated.

This is all the more so because it is not yet clear that any of the vaccines will deliver sterilising immunity – in other words, whether a vaccine stops the immunised individual from being able to pass on the virus, as well as granting immunity. If vaccines do not have this effect – or if only a certain number of vaccines in use do – it is possible that people who are vaccinated will still need to self-isolate to stop them spreading the virus, even if they are immune from it. That said, it is worth noting that researchers behind a number of vaccines have indicated their analysis suggests that a certain level of sterilising immunity is likely if they follow a similar pattern to other vaccines.

This throws up a huge challenge for compliance with continued virus suppression measures – individuals (or households) who have been vaccinated, but do not have sterilising immunity, may feel less obliged to self-isolate as the risk to themselves would be mitigated.

The vaccine is our way out of this pandemic and to obtaining the prize we always took for granted - normality. This pandemic has shown that through effective partnership and leveraging the best of talent across all sectors, even under huge pressure new public services can be delivered.

Today is clearly a day to be optimistic, but we cannot be complacent nor lose sight of the challenge that still lies ahead. We can mark the beginning of a new period in the fight against the pandemic with the approval of a vaccine, but with it also comes new battles. However, through continued innovation, resolve and dedication, we will soon find ourselves at the end of this pandemic.  

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