Many of us have been holding out hope that a Covid-19 vaccine will be the answer to all of our prayers come 2021 – but it won’t be an instant miracle.
In fact, more than half of the population probably won’t be vaccinated until 2022, according to a new report from the National Audit Office (NAO).
Kate Bingham, chairwoman of the UK Vaccine Taskforce, previously said she was hopeful that by 2022 there would be no need for people to wear face masks, and that family gatherings and parties could properly resume.
But what about 2021? Well, how quickly we can return to normal will depend on plenty of variables such as how many vaccines are approved by next year, how readily available they are, and the logistics of getting them to the UK and distributed to those who need them.
Each potential vaccine requires a different plan for rolling it out to the public because each has different characteristics. These include the temperature it should be stored at, its shelf-life once opened, and how it should be prepared before it is administered.
The return to normality will also depend on the vaccine itself and whether it can reduce transmission of the virus – at present, we know the Pfizer/BioNTech vaccine can reduce severe illness from the virus, but less is known about its ability to stop people from spreading the virus to others.
Both the Pfizer and Oxford vaccines reduce the incidence of symptomatic infection and so are “likely” to reduce the R value and contribute to an overall reduction in transmission, says Professor Paul Hunter, an expert in medicine at University of East Anglia. It’s important to note that we do not know this for certain. Further data is needed.
Older people, NHS and care workers, and those with underlying health conditions are prioritised for the first Covid-19 vaccines. More than 137,000 vulnerable people in the UK have received the first dose of the Pfizer/BioNTech Covid-19 vaccine in the first week of vaccination.
The UK government has so far signed deals for five vaccines providing up to 267 million doses at a cost of around £2.9bn. But the NHS England and NHS Improvement team believes it can only vaccinate up to 25 million people with two doses throughout 2021. The population of the UK is around 67 million.
Over the coming weeks and months, the rate of vaccination will increase as more doses become available and the programme continues to expand, with GPs also offering the jab. But how quickly it will accelerate remains unknown.
Writing in the journal Anaesthesia, Sir Jeremy Farrar, a member of the Scientific Advisory Group for Emergencies (SAGE), and Professor Tim Cook, a consultant in anaesthesia and intensive care, suggested that with 1,000 vaccination centres up and running, each vaccinating 500 people a day for five days a week, it would take almost a year to provide two doses to the UK population – and that’s without interruptions of supply or delivery.
On Wednesday, Professor Chris Whitty, England’s chief medical officer, told a press conference that if we lift social distancing measures too early, such as around March, people who are vulnerable – but not the most vulnerable – would get infected in large numbers, putting them at risk of severe illness or death.
He emphasised that herd immunity will only occur if we have vaccines that can reduce transmission between people – and at the moment, we don’t fully know if they do.
We will not get to the point where there is zero risk of catching Covid, Whitty said. Rather, there’ll be a point where the country’s leaders will have to ask: at what level of risk do we start to raise measures like social distancing and wearing face masks?
Professor John Edmunds, an expert from the Centre for the Mathematical Modelling of Infectious Diseases at London School of Hygiene & Tropical Medicine, reiterates that without knowing whether the vaccines reduce transmission, “it is very difficult to say how quickly we are likely to be able to return to something like normality, apart from it is likely to be quite a long time”.
He explains: “Remember, we are vaccinating relatively few people at the moment – we took receipt of enough Pfizer vaccine to cover 400,000 individuals, but there are 67 million of us in the UK – and we are targeting those that are least likely to contribute to community transmission (the elderly).
“Hence, there is a very long way to go before we will be sufficiently protected by vaccination to start to return to normal life in a safe way. Essentially, this will happen as we finish vaccination, not when we start it.”
Patients require two doses of thePfizer/BioNTech vaccine, 21 days apart, for the vaccine to be fully effective – a total of 40 million doses of this particular vaccine have been secured for the whole of the UK, which will be distributed over time.
Meanwhile, rolling reviews on the Oxford/AstraZeneca and Moderna vaccines are underway and, if authorised by the Medicines and Healthcare products Regulatory Agency (MHRA), will mean there are more doses available.
So, the matter of how many people will need to be vaccinated before we can get back to normal is currently impossible to answer.
Dr Stephen Baker, a molecular microbiologist and infectious disease expert at the University of Cambridge, says that while it’s “great” we’ve got a vaccine (and potentially more lined up), for true herd immunity to kick in, we will need to ensure a high enough proportion of the population had received the vaccination, or endured natural infection, and had a sustained degree of immunity to then reduce the transmission of the virus.
Levels of immunity will vary from person to person depending on what vaccine they end up having, too. So it’s quite tricky to calculate.
Herd immunity against measles requires about 95% of a population to be vaccinated. We may need around 90% of the population to achieve herd immunity for Covid, Dr Baker suggests, which is a lot. Other estimates suggest we’d need two thirds of the population to be vaccinated to achieve it.
“Can we reach that? Well it’s a big ask because there are lots of unknowns: we don’t know how long immunity will last for with a vaccine,” says Dr Baker.
“If it’s long-term that’s great, because it means we’ll be protected for some years. If it’s only short-term protection and it lasts 12-24 months, then we may need another vaccine again, and that will complicate things more.”
He also points out that the new Covid-19 variant could throw a spanner in the works. “It’s possible the virus could mutate slightly and therefore the vaccine may work less well – and therefore you have these problems called escape mutants ... where people could still become infected even though they’ve had a vaccine.”
A conservative estimate is that most of the extremely vulnerable people would be immunised by March 2021, he says, and if not, then certainly by summer. But then that leaves a large body of people – those aged 50 and under who are seemingly healthy – with some catching up to do.
“There’s no mention of young people receiving the vaccine yet,” he says. “We could argue that even though these people are probably not at the highest risk of severe disease or death, they’re probably at the highest risk of transmitting it between the age of 20 and 50.
“If none of those people are going to be immunised for some time and we start going back to normal, there’s going to be an enormous amount of transmission between those aged 20-50.”
This presents options, he adds. We either have to accept the situation and carry on as normal – potentially putting lots of younger people at risk of the long-term effects of the virus, dubbed long Covid – or we try to get everybody vaccinated as quickly as possible to stop the virus from spreading around. “It’s going to be complicated,” he says. “It’s not going to be as simple as we immunise everybody by the summer and it’s going to be gone.”
That’s not to say that 2021 won’t be without a likely easing of some restrictions – people will likely be able to spend time with loved ones, particularly outdoors over the summer months when transmission is expected to drop. But it likely won’t be a 2021 that is free from stricter coronavirus measures like social distancing, mask-wearing and working from home.
“We may be very lucky and get to the point where we eliminate it through immunisation – but actually we’ve only really managed that once before with smallpox,” says Dr Baker.
“It’s possible, but it’s going to take us a long time. The coronavirus is going to be with us for the long-term future unless we can truly immunise everyone and understand enough about how that works to stop it coming back.”