In order to truly bring COVID-19 under control, vaccines must prevent infection, disease progression, and transmission, say experts.
In a new editorial published in the journal Anaesthesia, a member of the UK’s SAGE committee has said that a global COVID-19 vaccination programme will only be successful if the available vaccines can prevent infection becoming established in an individual, prevent disease progression, and prevent onward transmission.
The editorial has been co-authored by Professor Sir Jeremy Farrar, Scientific Advisory Group for Emergencies (SAGE) and director of the Wellcome Trust, London, UK, and Professor Tim Cook, Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, and Honorary Professor, School of Medicine, University of Bristol.
Improved vaccinations in 2021 and beyond
These three goals must be met in order to achieve a truly a successful vaccination programme, say the authors, who emphasise that the most vulnerable and healthcare workers must be prioritised for vaccination before the general population.
They authors say that preventing onward transmission – referred to as ‘sterilising immunity’ is particularly important as it is epidemic modifying: “Whether all three of these goals will be met by ‘first generation’ vaccines is not known but is vital to the long-term success of the programme. It is possible that the first vaccines, including those being released now, may be more effective in preventing disease progression and hospitalisation and less effective in preventing transmission. Knowledge of their performance in pre-approval trials and in surveillance trials after licensure will enable further modifications such that improved second and third generation vaccines may be available later in 2021 and beyond.
“Vaccination is a global rather than a national necessity. The WHO ACT-accelerator and COVAX initiatives both emphasise the importance of vaccines reaching the most vulnerable and healthcare workers in all countries at a similar time. Widespread vaccination of one or a few countries without addressing this need globally is in no one’s interests and will not provide the protection we all need.”
The challenges of vaccination
The authors highlight the vast scale of this first-in-history vaccination effort, noting that no country has ever vaccinated a whole population in living memory.
“The scale of the UK vaccination programme should not be underestimated: 1,000 vaccination centres each vaccinating 500 people a day five days a week, without interruptions of supply or delivery, would take almost a year to provide two doses to the UK population. No country has mounted a whole population vaccination campaign in living memory, and it will need to be undertaken with local leadership and cultural sensitivity.”
Rights of the individual versus collective responsibility
The authors highlight that safe and effective vaccines will change the trajectory of the pandemic, but that the vaccine is not a total solution to the pandemic and COVID-19 can only be brought under control by continuing to adapt our behaviour and improve access to diagnostics and treatments, for example.
There will also be the challenge of those who chose not to get vaccinated, for example, it has been estimated that 20% of the UK population may decline to receive the vaccine.
The authors state that: “If 80% were to be successfully vaccinated there would finally be the prospect of a degree of population (herd) immunity, which would reduce virus transmission in the community to very low levels and protect both those who are vaccinated and those who are not. In contrast to population immunity following natural infection, this would be achieved without the cost of an estimated half a million UK deaths.
“Will a certificate of vaccination (a vaccine passport) be a requirement for patients and their families before elective surgery, or to work in health or social care, to travel abroad, or to attend medical conferences, or even to participate in the Olympics? On the one hand, these may seem trivial questions, but they expose important ethical challenges about balancing the rights of the individual with our collective responsibility for public health. What sacrifices will those who choose not to be vaccinated be asked to accept? How will adherence be monitored and how will refusal in settings where public safety requires vaccination (for example in healthcare delivery) be managed?”
They add: “There is no merit or safety in creating high rates of vaccination and low rates of disease inside one country’s borders if this is not replicated throughout the rest of the world. We really are all in this together.”