1. How soon will vaccinations start to have an impact at the population level, and how will this vary by country?
•This depends both on the vaccine and how quickly it is rolled out. The Pfizer BioNtech vaccine starts to give people some immunity about 12 days after their first dose; three weeks after the first dose patients get a second dose; and a week after that they achieve full immunity. Other vaccines might take a few weeks longer to reach this immunity level.
2. Is there anything in place to stop richer countries buying up supplies of vaccines before poorer countries?
•There are no global rules to stop rich countries from buying up large amounts of vaccine supply. The EU, US, UK, and Canada have already purchased four or five doses for every person in their country or region, this is done in case some leading candidates fail, and because they want to ensure they have their choice of the best and earliest vaccines, as more information on them becomes available. There is a facility called COVAX which is purchasing and allocating vaccines to countries across the world, with priority given to those countries that do not already have deals with pharmaceutical companies. But recent reports suggest there are problems getting this facility up, because countries might decide not to purchase the vaccines COVAX has already bought, putting COVAX at financial risk and making it hard for it to negotiate deals with manufacturers.
3. As more vaccines come to market, who will decide who gets which vaccine—both internationally and within countries?
•Different countries will have different needs, and as more vaccines come to market, we expect that this will play a large part in different purchasing decisions. For example, vaccines requiring an ultra-cold chain like Pfizer BioNTech’s will likely not be deployable in resource-constrained settings, as deployment will require advanced and reliable infrastructure. Countries are unlikely to buy vaccines that are not suitable for them, but their options will be limited by which candidates they can get their hands on.
4. How does each country decide the order of priority in which people will be vaccinated, and how does that differ by country?
•Each country will come up with a framework for who should get the vaccine first. Health staff and people in care homes are likely to be the two highest-priority groups, followed by other older people, those with comorbidities that make them at a greater risk of contracting the illness ,and other front line staff. The US CDC has recommended that “Healthcare personnel and residents of long-term care facilities should be offered the first doses of COVID-19 vaccines.” The New York Times has a tracker estimating when different individuals are likely to get access to vaccines, which has used data from the Surgo Foundation and Ariadne Labs (who have their own tracker). The UK government has outlined 10 priority groups for receiving the vaccine, starting with “residents in a care home for older adults and their carers,” followed by other adults over 80 and healthcare workers. Some countries will have different priorities though, New Zealand which has very low infection rates and keeps new arrivals in quarantine for two weeks, is prioritising its border force, who are the most likely people to interact with COVID-19 in that country. If you are interested to learn more about your own country, we recommend checking the department of health’s guidance in your country of residence.
5. Have the clinical trials tested whether vaccines limit asymptomatic spread?
•All vaccine producers will eventually release information on whether being vaccinated prevents the recipient from asymptomatically spreading the disease to other people, but whether they release that data alongside other results depends on the trial. Pfizer BioNTech has not released data on asymptomatic people yet; it says this information is currently being collected but it will be several months before this is released. Moderna has said they have not completed full analysis on the efficacy against asymptomatic infection, but early indications suggest that it does provide protection. The Oxford AstraZenica vaccine significantly reduces asymptomatic cases, but it appears that it reduces these by less than it reduces symptomatic infections.
Answers & Comments
1. How soon will vaccinations start to have an impact at the population level, and how will this vary by country?
•This depends both on the vaccine and how quickly it is rolled out. The Pfizer BioNtech vaccine starts to give people some immunity about 12 days after their first dose; three weeks after the first dose patients get a second dose; and a week after that they achieve full immunity. Other vaccines might take a few weeks longer to reach this immunity level.
2. Is there anything in place to stop richer countries buying up supplies of vaccines before poorer countries?
•There are no global rules to stop rich countries from buying up large amounts of vaccine supply. The EU, US, UK, and Canada have already purchased four or five doses for every person in their country or region, this is done in case some leading candidates fail, and because they want to ensure they have their choice of the best and earliest vaccines, as more information on them becomes available. There is a facility called COVAX which is purchasing and allocating vaccines to countries across the world, with priority given to those countries that do not already have deals with pharmaceutical companies. But recent reports suggest there are problems getting this facility up, because countries might decide not to purchase the vaccines COVAX has already bought, putting COVAX at financial risk and making it hard for it to negotiate deals with manufacturers.
3. As more vaccines come to market, who will decide who gets which vaccine—both internationally and within countries?
•Different countries will have different needs, and as more vaccines come to market, we expect that this will play a large part in different purchasing decisions. For example, vaccines requiring an ultra-cold chain like Pfizer BioNTech’s will likely not be deployable in resource-constrained settings, as deployment will require advanced and reliable infrastructure. Countries are unlikely to buy vaccines that are not suitable for them, but their options will be limited by which candidates they can get their hands on.
4. How does each country decide the order of priority in which people will be vaccinated, and how does that differ by country?
•Each country will come up with a framework for who should get the vaccine first. Health staff and people in care homes are likely to be the two highest-priority groups, followed by other older people, those with comorbidities that make them at a greater risk of contracting the illness ,and other front line staff. The US CDC has recommended that “Healthcare personnel and residents of long-term care facilities should be offered the first doses of COVID-19 vaccines.” The New York Times has a tracker estimating when different individuals are likely to get access to vaccines, which has used data from the Surgo Foundation and Ariadne Labs (who have their own tracker). The UK government has outlined 10 priority groups for receiving the vaccine, starting with “residents in a care home for older adults and their carers,” followed by other adults over 80 and healthcare workers. Some countries will have different priorities though, New Zealand which has very low infection rates and keeps new arrivals in quarantine for two weeks, is prioritising its border force, who are the most likely people to interact with COVID-19 in that country. If you are interested to learn more about your own country, we recommend checking the department of health’s guidance in your country of residence.
5. Have the clinical trials tested whether vaccines limit asymptomatic spread?
•All vaccine producers will eventually release information on whether being vaccinated prevents the recipient from asymptomatically spreading the disease to other people, but whether they release that data alongside other results depends on the trial. Pfizer BioNTech has not released data on asymptomatic people yet; it says this information is currently being collected but it will be several months before this is released. Moderna has said they have not completed full analysis on the efficacy against asymptomatic infection, but early indications suggest that it does provide protection. The Oxford AstraZenica vaccine significantly reduces asymptomatic cases, but it appears that it reduces these by less than it reduces symptomatic infections.
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