A year ago today, Margaret Keenan became the first person in the world to receive the Pfizer/BioNTech covid-19 vaccine outside of a clinical trial. 12 months and billions of shots later, several countries are already on a third round of coronavirus vaccinations
8 December 2021
The phenomenal covid-19 vaccine roll-out in 2021 demonstrates some of the best and worst aspects of modern medicine. It is now estimated that nearly 8 billion doses have been put into people’s arms in the past 12 months – an incredible effort by health services around the world. But the vaccines haven’t been distributed equally. While many people in high-income countries will have received three jabs by Christmas, only about 5 per cent of people in low-income countries are expected to have had at least one by the end of the year.
On 8 December 2020, Margaret Keenan in the UK became the first person in the world to receive the Pfizer/BioNTech vaccine outside of a clinical trial. But it was in January 2021 that immunisation started taking off in the UK and other wealthy nations, with limited initial supplies meaning shots had to be prioritised for the most vulnerable.
Figures on the real-world effectiveness of the vaccines are encouraging. In the UK, two shots of the Oxford/AstraZeneca or Pfizer/BioNTech versions reduced infections by the delta variant by 67 and 80 per cent respectively, hospitalisations by 92 and 96 per cent, and deaths by 91 and 90 per cent. If vaccinated people do get infected, they are 63 per cent less likely to pass the virus on to others. We do not know yet how different these figures might be for the omicron variant.
There have been serious, but rare, side effects from vaccination. In March, it became clear that the Oxford/AstraZeneca vaccine can cause a blood-clotting syndrome called vaccine-induced immune thrombotic thrombocytopenia, or VITT, which it turned out is also associated with the Johnson & Johnson vaccine, and is more likely in younger people.
In June, it emerged that the Moderna and Pfizer/BioNTech vaccines occasionally trigger a form of heart inflammation called myocarditis. This is more often seen in younger people, particularly males, although the incidence of myocarditis after covid-19 itself is six times greater.
The last few months of 2021 saw wealthy nations offering vaccine doses to under-16s, and in some countries, such as the US, to children as young as 5 years. Alongside this, a push for third or booster shots has formed the cornerstone of Israel’s efforts to tackle the delta variant and the UK’s plans to get through a difficult winter and prepare for the omicron variant.
Vaccines have also enabled countries that initially took tougher approaches to managing the pandemic to begin to reopen after lengthy lockdowns. New South Wales in Australia, for instance, kept its promise of easing restrictions, including in Sydney, once 70 per cent of people over 16 were fully vaccinated.
But the plan for wealthy countries to help low‑income ones through a vaccine delivery coalition called COVAX has made slow progress, hindered partly by high-income nations buying so much stock for themselves and by an export ban in India that stopped expected supplies from a large manufacturer there. “We hit many problems,” says Seth Berkley of the health body Gavi, one of the organisations leading COVAX.
Meanwhile, in high-income countries where supply is plentiful, a minority of people are still resisting vaccination, mainly due to mistaken beliefs about side effects. This helps drive circulation of the virus in the community, risking the lives of people who are vaccinated but still vulnerable due to age or ill health.
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