December 8, the United Kingdom began to be vaccinated against the novel coronavirus on a large scale, becoming the first country in the world to be vaccinated. The United States also began the first round of vaccination on December 14.
A nurse in the intensive care unit in New York was vaccinated for the first shot on December 14. U.S. President Trump later tweeted: Congratulations to the United States and the world.
The first round of the same vaccine was vaccinated by the United Kingdom and the United States. It was a mRNA vaccine jointly developed by BioNTech Biotechnology in Germany and Pfizer Pharmaceuticals of the United States.
November 9, it became the first vaccine in the world to release the results of three trials, with a 95% efficiency, far exceeding expectations.
Both the United Kingdom and the United States have approved vaccines through the “emergency authorization” of the drug administration, which has become a “wartime” move in most countries in the vision of people eager to end the coronavirus pandemic. The United States urgently approved the mRNA vaccine developed by Moderna on December 17, with an efficiency of 94.5%.
At this point, the United States became the first country in the world to approve two vaccines. On December 19, five days after vaccination in the United States, the Information Office of the State Council of China held a press conference and announced China’s vaccination strategy, although no vaccine has been officially approved for market at this time.
The world has entered the era of vaccines, and whether there are enough vaccines is only the first question. Inoculation priorities, dose selection, storage, transportation and distribution of vaccines, and people’s willingness to inoculate, each link may face many new problems, which also determines how long it will take us to get back to the past.
Chen Xi, an associate professor of global health policy and economics at Yale University in the United States, described the world after the advent of vaccines to China Newsweek as follows: “Every day, two things still happen at the same time in the world.
At one end of the tunnel is the light brought by vaccines, which is expanding, but at the other end, the darkness of death has not diminished. “
Who should be given priority?
In the UK, a 90-year-old became the first vaccinated, but the first vaccinated in the United States was a nurse. The strategy adopted by the United States is to vaccinate medical staff first.
According to the data of the U.S. Centers for Disease Control and Prevention, there are currently about 21 million medical staff in the United States, and it will take about three weeks to complete the vaccination. After that, people over 65 years old in all long-term care institutions will be vaccinated, and this group of people is about 3 million.
Chen Xi explained that the medical resources in the United States are now very tight. The occupancy rate of ICU beds has reached 90%, but compared with hospital beds, the shortage is more medical staff.
Since the U.S. entered the third wave, the virus has spread across the country in communities, unlike in March and April, where medical staff can be deployed between regions with different severity of the epidemic.” Now that it is impossible to mobilize, medical staff are equivalent to the core strategic resources for the next step of epidemic prevention. Chen Xi said. Therefore, the vaccination of medical staff is more important than that of the elderly.
Cluster infections outbreaks in nursing homes have always been one of the reasons for the high mortality rate in developed countries. Between February and July 2020, 65% of the number of coronavirus deaths in the UK were 75+.
Therefore, according to the order of vaccination in the UK, the elderly in nursing homes will be vaccinated first, and then other elderly people will be covered. Moreover, the United Kingdom has a more detailed classification of age, strictly requiring people starting with people over 80 years old, and then ranking them by age decreasing, in groups of five years old, with priority from high to low.
Lu Mengji, a German Chinese virologist and professor of the Institute of Virology of the University of Essen Medical School, told China Newsweek that the first goal of the first round of vaccination is not to eliminate the novel coronavirus, but to reduce the mortality rate as soon as possible, control the spread of the novel coronavirus among the elderly, and reduce medical machines.
The burden of construction. In some countries in Europe and the United States, the number of infections in nursing homes has been increasing. The vaccination of medical staff is to ensure the normal operation of the medical system.
As for when China will start vaccination, there is no official timetable. However, according to the South China Morning Post, according to the video and teleconference on the mobilization and work arrangement of the emergency vaccination of COVID-19 vaccine held by the National Health Commission on December 16, China will complete the vaccination of 50 million people before the Lunar New Year, and will complete the first injection by January 15.
February Complete the second stitch 5 days ago. According to analysis, there may be three vaccines in China’s first round of vaccination, that is, two of the Chinese Medicine Zhongsheng Company, which has been authorized to “emergency use” before, and one of Kexing, are inactivated vaccines.
Compared with Europe and the United States, China has already been very good at controlling the overall control of the internal epidemic. At present, the focus is on foreign defense input. Therefore, at the press conference on December 19, Zeng Yixin, deputy director of the National Health Commission, said that China’s vaccination strategy is mainly divided into two steps.
The first step is mainly for some “key people”, including imported cold chain, port quarantine, ship pilotage, aviation air handling, fresh food market, public transportation, medical disease control and other infections. Staff with high risks, as well as those who go to medium and high-risk countries or regions to work or study, try their best to relieve the pressure of imported epidemic prevention and control. The second step is to promote “take-all” as soon as possible as more vaccines are on the market and vaccine production is gradually increasing.
At present, for Britain and the United States, the real problem of vaccination is a few weeks later. When medical staff and the elderly in long-term care institutions complete the vaccination, there is a lot of controversy about the choice of the second priority vaccination population in the United States.
In accordance with the “Vaccine Distribution Program” released by the U.S. Centers for Disease Control and Prevention in early December, the second phase of vaccination is for employees in basic positions, such as teachers, police, firefighters, prison guards and staff on public transportation facilities, and the third stage is for people at high risk of basic diseases and people over 65 years old. But this is only a suggestion. At the federal level, only the first stage of vaccination is mandatory, and the subsequent vaccination order is up to the states themselves.
In the United States, unlike the recommendations of the CDC, six states have already made prison inmates the first to be vaccinated in the second phase.
Since the outbreak of the novel coronavirus in the United States, mass infections have emerged in several local prisons. As of December 2, there were 223,397 coronavirus patients in prisons in the United States, and 1,534 people died.
In addition, different groups have their own views on which industries belong to “basic jobs” and which industries should be given higher priority in vaccination in “basic jobs”.
Relevant interest groups have also begun to lobby, including firefighter groups, postal service personnel groups, organizations such as the American Heart Association and the American Diabetes Association, as well as American unions. At present, teachers are not a much controversial profession, because the spread of the virus between teachers and students is worrying.
The UK’s next phase of vaccination strategy is similar to that of the United States. After completing the first phase of vaccination to reduce mortality, the goal of the second stage is to reduce the hospitalization rate of COVID-19 and to vaccinate high-risk groups providing major public services, including the military, judicial system-related personnel, teachers, transportation workers, etc.
“Who should be saved first and who should be saved later? What kind of strategy is the highest cost-benefit ratio? The situation varies from state to state, and it is also very difficult to make decisions.
It is necessary to balance epidemic prevention and ethical goals, but also the demands of different interest groups to appease the public. Any problems in the process will affect the progress of vaccination later. Chen Xi said.
Lu Mengji also pointed out that in the selection of vaccination priorities, it is also necessary to balance the number of priority vaccination populations and vaccine production. If the gap is too big, it is not conducive to overall epidemic prevention, because if other groups wait too long just to cover one group of people, it will prolong the cycle of herd immunity for the whole society.
Therefore, the formulation of vaccination strategies should not only take into account the spread and control of the epidemic in the country, but also look at the future accessibility space and the overall vaccination efficiency.
“For example, if you want to vaccinate cold chain transport personnel, how many such people in the country are in total, how many vaccines are available, and how effective the vaccine is, all of which must be estimated.” He said.
Another controversial question is whether children and adolescents should be vaccinated? At present, the vaccination age set for Pfizer vaccine is 16 years old, and the lower age for Moderna vaccination is set at 18.
Chen Zhengming, professor of epidemiology at Oxford University, suggested to China Newsweek that individual vaccination clinical trials for children under the age of 16 should be considered to observe their antibody levels and side effects to obtain more data.
At present, Pfizer vaccine is the only vaccine to conduct clinical trials for minors under the age of 16. The trial began in mid-October. By the end of November, 400 teenagers aged 16 to 17 and 100 teenagers aged 12 to 15 years had participated in the clinical trial at Cincinnati Children’s Hospital.
About 13% of the subjects had mild side effects and 87% had no side effects. “So far, the safety of vaccines after giving teens is very similar to that of adults,” said Robert Frenke, director of the hospital’s clinical research center.
“With limited availability of vaccines, to some extent, optimal use of existing vaccines will directly determine which stage the UK is in the pandemic.” This is a crucial summary in the UK’s recommendations for the priority vaccination of COVID-19 groups. This sentence also applies to the whole world.
How to ensure supply?
Pfizer’s mRNA vaccine is very special and requires extremely high transportation and storage environment. It must be stored at ultra-low temperatures of -70 °C for a long time, while ordinary vaccines only need 2 °C to 8 °C. Once the vaccine is taken out, it can be stored for six months in an ultra-low temperature freezer, but only for five days in an environment of 2 °C to 8 °C. This poses a very big challenge to the cold chain transportation of various countries.
For some developing countries that are already backward in the construction of the cold chain, the vast and the transportation time is long, this alone puts the Pfizer vaccine almost “stuck”. According to the WHO report, more than 50% of the global vaccine is wasted every year, in part because some poor or rural medical institutions are unable to support cold chain demand.
In response to the ultra-low temperature storage and transportation restrictions of Pfizer vaccine-70°C, the current strategy for countries is to establish multiple immunization centers in each region, which is equivalent to centralized vaccination points, most of which are directly requisitioned from large local hospitals.
According to Lu Mengji, in Germany’s immunization centers, the underground layer of the hospital is usually opened up and many ultra-low temperature refrigerators are placed for storage; or many small spaces are spaced out in places such as exhibitions with huge space, similar to “square cabin hospitals”. After the inoculated patients enter the compartment, they are questioned, injected, Observe and record data, one-stop service.
The same is true of the United States. Take New York State as an example, there are 10 vaccination sites in the state, all of which are large hospitals with vaccine storage conditions.
However, unlike Germany, the distribution of medical resources in the United States is relatively uneven. Not all vaccination sites can cover the first batch of priority vaccinations in the local area, and it also needs to be appropriately distributed to lower-level medical institutions, such as some small community hospitals.
Chen Xi pointed out that not all community hospitals have ultra-cryogenic refrigerators. For some inadequate community hospitals, medical personnel must complete all the people in need of vaccination in the community within a few days, which requires a high organizational, coordination and dispatching ability of hospitals, which is very difficult to practice. It is very difficult for some farmers in the United States. This is especially true for village community hospitals.
In the central rural areas with a population of more than 60% to 70% of the United States, the land is wide and sparsely populated, the transportation time is long, and the infrastructure of rural hospitals is also weak. Many hospitals even have only one doctor, with insufficient supporting facilities. In the past few years, a large number of rural hospitals have closed down.
He believes that the storage and transportation requirements of Moderna vaccine are relatively lower, only -20 °C, can be stored for six months in ordinary refrigerators for a long time, and can be stored for 12 hours at room temperature, which is a good thing for rural community hospitals in the Midwest of the United States. But compared with Pfizer, Moderna is a small innovation company with much weaker size and industrial chain capacity, and limited production.
In addition to Pfizer and Moderna vaccines, the third candidate vaccine that has been highly expected worldwide is the adenovirus vector vaccine developed in cooperation with Oxford/AstraZeneca.
Compared with the first two mRNA vaccines, the advantage of this vaccine is that it is easy to store and transport, and can be stored in ordinary refrigerators at 2°C to 8°C for a long time, which is easy to be widely promoted in community hospitals. And it’s cheap, with Pfizer vaccine $20 per dose and Moderna vaccine priced between $15 and $25, but Oxford/AstraZeneca vaccines are priced at only $2.50 per dose, which is one-tenth of the first two.
In Lu Mengji’s view, the Oxford/AstraZeneca vaccine can play a more important role in the next phase of the universal vaccination program, because it has stronger accessibility. But its Phase III clinical trial data show that the effectiveness is only 70%, which is far lower than the first two mRNA vaccines.
He therefore suggested that the vaccine could be applied to people under the age of 30, which has a low mortality rate. The goal of vaccination is to reduce the spread of the virus between people, and there is no need to achieve one-on-one protection through ultra-high efficiency, as in high-risk groups such as the elderly.
Lu Mengji pointed out that in the subsequent vaccination strategy selection, vaccines with different protective powers can be selected according to the characteristics of different groups of people, and more targeted vaccine recommendation plans can be formulated for each group of people.
What other variables are there?
In nearly two weeks, Pfizer and Moderna vaccines are being shipped to the first batch of vaccines as planned. The UK has ordered 40 million doses of vaccine from Pfizer, enough to vaccinate 20 million people.
But by the end of December, only about 4.8 million vaccines are expected to arrive in the UK, compared with 2.5 million people over 80 years old in the UK. Although the United States has ordered 100 million doses of Pfizer vaccine, according to the FDA, some hospitals still have no confidence in future supplies.
Pfizer pointed out on November 9 that due to the non-standard batch of raw materials purchased in the early stage and the longer than expected expansion of the raw material supply chain, global vaccine shipments this year can only reach half of the original target, from 100 million doses to 50 million doses.
Many experts and hospitals are worried about how the second injection will be delivered on time after the first injection is given to the emergency priority population. According to the vaccination program provided by Pfizer, the interval between the two shots is only 21 days.
In Chen Xi’s view, there is still a lot of uncertainty about the future. He pointed out that the current debate is whether a second injection is necessary, because according to the data, the effectiveness of the first Pfizer vaccine can also reach about 80%. This debate comes from concerns about the production capacity of subsequent vaccines on the one hand, and from people’s strong desire to accelerate the realization of herd immunity in the whole society on the other.
Whether to give all people the first injection in accordance with the priority of vaccination, instead of the second injection for the time being, or to inoculate the priority population after two injections before inocating the later sequence, two different strategies will also lead to completely different speeds of achieving herd immunity. A recent review in The New York Times pointed out that research on the efficacy of single-dose vaccines should be launched immediately to facilitate timely adjustment of vaccination strategies. This suggestion has been responded to by many experts.
“We must start clinical trials from now,” Michael Meiner, an assistant professor of epidemiology at Harvard School of Public Health, told China Newsweek. He pointed out that two data should be observed, one is the effectiveness of a single-dose vaccine, and the other is durability. How long does it take to have antibodies to drop rapidly after the first injection, such as four months or six months, and the antibody level in the human body may drop to 60%.
There is a window period in the middle. You can vacculate the first injection in more people as soon as possible without considering the second injection. So far, the third phase of clinical trials of Pfizer and other vaccines have only been carried out for two months, which is a good time to start to observe the antibody changes in the third phase of subjects in the next two months from now on.
“This is a contingency plan, and if it is confirmed that a single-dose strategy is effective, it will have a significant impact not only in developed countries but also on the spread of COVID-19 worldwide, as other developing countries may get the vaccine earlier.” He said.
Another variable comes from vaccine mutation. On 19 December, British Prime Minister Boris Johnson abruptly announced that “a mutant novel coronavirus has been found in the UK, which may be 70% more capable of transmitting than the original virus.”
Britain then “locked down”. Starting from December 20, the southeastern, eastern and London regions of England where the mutant virus is prevalent has been raised to the highest alert level – level 4, requiring people to work remotely, not traveling and traveling, and all non-essential shops, barbershops and indoor leisure places are closed. For the long-awaited Christmas, people are also required to stay at home and not to party with other families.
These measures are in response to the sharp rise in the number of new infections brought about by virus variants in recent weeks. According to the data, the epidemic curve in the UK originally fell from mid-November after peaking in September to November.
But starting on December 9, the number of new daily confirmed cases in the United Kingdom began to rise rapidly on average, with an average of 24,000 new dailys in the week of 19, an increase of nearly 40% over a week ago. Just a few days before the “lockdown”, the number of new people in a single day on December 17 reached 35,000, 10,000 more than the number a day earlier.
As of December 20, more than 1,100 cases of COVID-19 infection have been identified in the UK. Chris Whitty, England’s chief medical officer, pointed out at a press conference on December 19 that the data of the past week showed that the number of new virus mutant infections already accounted for more than 60% of the new cases in London, compared with only 28% in mid-November.
After the news was announced, London staged a “Great Escape”. According to many British media reports, nearly 300,000 people fled London by rail, road and other means before midnight.
As of December 20, Italy, the Netherlands, Belgium and Austria have planned to ban flights from the United Kingdom. Other countries are “thinking carefully”.
So far, at least three countries outside the UK have found confirmed cases related to this mutant novel coronavirus. Among them, nine cases appeared in Denmark and one case each in the Netherlands and Australia. A day later, WHO Director-General Tedros Tedros stressed that there is no evidence that the mutant virus is more pathogenic.
Lu Mengji said that COVID-19 is an RNA virus that is easy to mutate during transmission, but it is difficult to assess whether these mutations will affect the protective effect of the vaccine.
He further explained that the human immune system is diverse, with both antibody immunity and T cell immunity. Antibodies are not only a single antibody, but may neutralize different sites on the surface of the virus.
If the immune response stimulated by a vaccine is relatively simple. For example, inactivated vaccine mainly stimulates antibody responses and weak immune stimulation to T cells, viral mutations are easy to bypass such immune barriers.
The mRNA vaccine can not only stimulate antibody response, but also induce strong T cell immunity, so the possibility of vaccine failure is very small. Generally speaking, vaccines can stimulate diversified immune responses, and a single mutation does not necessarily lead to immune failure.
But the risks still exist. Experts generally believe that when mutations accumulate to a certain extent, it may be enough to change the transmission mechanism of the virus, just like changing a new vaccine every time a seasonal flu.
When will the world return to calm?
As Chen Zhengming pointed out, the novel coronavirus may evolve into a seasonal epidemic in the future, starting to be vaccinated in September and October, but only specific groups such as the elderly need to be vaccinated.
As for how often you need to be vaccinated, once a year or twice a year, it depends on the duration of the antibodies produced by the vaccine and the immune level of T cells.
In Lu Mengji’s view, this requires the most comprehensive possible tracking of everyone’s post-vaccination situation. Germany has established a top-down information sharing system. Any report of adverse reactions after vaccination will appear on the system.
Hospitals will evaluate whether these side effects are normal side effects or serious adverse reactions, and whether they are related to vaccination. When a certain amount of data is collected, it can be In order to judge what problems such situations reflect.
This provides an important basis for the further improvement of subsequent vaccine technology, an in-depth understanding of the antibody response stimulated by vaccines in the human body, and the adjustment of vaccination strategies. In addition, Germany will also sample and track some people, such as testing neutralizing antibody levels on the 14th or 28th day after vaccination.
Several experts pointed out that even if large-scale vaccinations are started before next summer, the epidemic prevention strategies of Europe and the United States will not be adjusted much.
Depending on the change of the epidemic, the control of entertainment or commercial places may be moderately relaxed, but personal protection measures should be maintained all the time.
Lu Mengji especially reminded that after vaccination, the virus can still replicate and spread out of the upper respiratory tract. If sampled from the respiratory tract at this time, there is still a possibility of positive, but because the inoculated person has antibodies in the body, the virus will be eliminated after continuing to enter the human body.” There is a time lag in between, in the process the virus may spread to others, and the virus’s transmission power has not decreased.” He said.
He suggested that unless herd immunity is achieved, vaccinators still wear masks in public places and maintain social distancing, relaxing vigilance due to vaccination will lead to wider spread.
The official start of vaccination does not mean that countries will soon achieve herd immunity. This week, a total of 7.9 million doses of vaccine will be distributed to various vaccination sites in the United States, but there will be some delay when the vaccine is actually received.
Because both vaccines require two injections, only 3.95 million people can be reached by 7.9 million doses, accounting for about one percent of the total population of the United States.
The United States is the country with the most vaccine reservations in the world so far. Anthony Fauci, the country’s chief infectious disease expert, predicts that, ideally, the United States will not initially achieve herd immunity until the end of August 2021. Developing countries that failed in the global “order grab” of vaccines will have to wait until later to achieve this goal.
For the global pandemic of COVID-19, as long as the virus is still prevalent in any country, the world will not be completely open, and for developed countries that have achieved herd immunity by then, the impact is equally huge. Experts analyze that for at least the next two to three years, human beings will have to coexist with the virus for a long time. In this process, the spread of the virus and vaccination will become the decisive forces of the two fluctuations.
As of December 22, 2020, the number of confirmed cases of COVID-19 worldwide has exceeded 77.31 million, with 1.7 million deaths, according to data from Johns Hopkins University.
The United States still ranks first in the world in confirmed cases and deaths, with 18.01 million confirmed cases and about 320,000 deaths. The number of confirmed cases in the UK has risen from seventh to sixth in the world, approaching 2.08 million, and the death toll has reached nearly 70,000.
