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COVID-19 vaccine

From Wikipedia, the free encyclopedia

Map showing share of population fully vaccinated against COVID-19 relative to a country's total population
Map of countries by approval status
  Approved for general use, mass vaccination underway
  EUA (or equivalent) granted, mass vaccination underway
  EUA granted, limited vaccination
  Approved for general use, mass vaccination planned
  EUA granted, mass vaccination planned
  EUA pending
  No data available
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A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020.[1] The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic, often severe illness.[2] On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.[3] The COVID‑19 vaccines are widely credited for their role in reducing the spread, severity, and death caused by COVID-19.[4]

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. Twenty vaccines are authorized by at least one national regulatory authority for public use: one DNA vaccine (ZyCoV-D) two RNA vaccines (Pfizer–BioNTech and Moderna), nine conventional inactivated vaccines (BBIBP-CorV, Chinese Academy of Medical Sciences, CoronaVac, Covaxin, CoviVac, COVIran Barekat, Minhai-Kangtai, QazVac, and WIBP-CorV), five viral vector vaccines (Sputnik Light, Sputnik V, Oxford–AstraZeneca, Convidecia, and Janssen), and five protein subunit vaccines (Abdala, EpiVacCorona, MVC-COV1901, Soberana 02, and ZF2001).[5][6] In total, 330 vaccine candidates are in various stages of development, with 102 in clinical research, including 30 in Phase I trials, 30 in Phase I–II trials, 25 in Phase III trials, and 8 in Phase IV development.[5]

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers.[7] Single dose interim use is under consideration to extend vaccination to as many people as possible until vaccine availability improves.[8][9][10][11]

As of 29 August 2021, 5.25 billion doses of COVID‑19 vaccine have been administered worldwide based on official reports from national public health agencies.[12] AstraZeneca anticipates producing 3 billion doses in 2021, Pfizer–BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Janssen 1 billion doses each. Moderna targets producing 600 million doses and Convidecia 500 million doses in 2021.[13][14] By December 2020, more than 10 billion vaccine doses had been preordered by countries,[15] with about half of the doses purchased by high-income countries comprising 14% of the world's population.[16]

Background

A CDC Fact sheet about COVID-19 vaccines
A US airman receiving a COVID-19 vaccine, December 2020

Prior to COVID‑19, a vaccine for an infectious disease had never been produced in less than several years – and no vaccine existed for preventing a coronavirus infection in humans.[17] However, vaccines have been produced against several animal diseases caused by coronaviruses, including (as of 2003) infectious bronchitis virus in birds, canine coronavirus, and feline coronavirus.[18] Previous projects to develop vaccines for viruses in the family Coronaviridae that affect humans have been aimed at severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Vaccines against SARS[19] and MERS[20] have been tested in non-human animals.

According to studies published in 2005 and 2006, the identification and development of novel vaccines and medicines to treat SARS was a priority for governments and public health agencies around the world at that time.[21][22][23] There is no cure or protective vaccine proven to be safe and effective against SARS in humans.[24][25] There is also no proven vaccine against MERS.[26] When MERS became prevalent, it was believed that existing SARS research might provide a useful template for developing vaccines and therapeutics against a MERS-CoV infection.[24][27] As of March 2020, there was one (DNA-based) MERS vaccine which completed Phase I clinical trials in humans,[28] and three others in progress, all being viral-vectored vaccines: two adenoviral-vectored (ChAdOx1-MERS, BVRS-GamVac) and one MVA-vectored (MVA-MERS-S).[29]

As multiple COVID-19 vaccines have been authorized or licensed for use, real-world vaccine effectiveness (RWE) is now being assessed using case control and observational studies.[30] A study is investigating the long-lasting protection against SARS-CoV-2 provided by the mRNA vaccines.[31] On 10 August, a study showed that the full vaccination coverage rate is correlated inversely to the SARS-CoV-2 delta variant mutation frequency in 16 countries (R-squared=0.878).[32]

Clinical research

Main article: COVID-19 vaccine clinical research
COVID-19 vaccine clinical research is the clinical research on COVID-19 vaccines, including their effectiveness and safety. There are 22 vaccines authorized for use by national governments, with six vaccines being approved for emergency or full use by at least one WHO-recognised stringent regulatory authority; and five of them are in Phase IV. 204 vaccines under clinical trials that have not yet been authorized. There are also nine clinical trials on heterologous vaccination courses.

Vaccine types

Conceptual diagram showing three vaccine types for forming SARS‑CoV‑2 proteins to prompt an immune response: (1) RNA vaccine, (2) subunit vaccine, (3) viral vector vaccine
Vaccine platforms being employed for SARS-CoV-2. Whole virus vaccines include both attenuated and inactivated forms of the virus. Protein and peptide subunit vaccines are usually combined with an adjuvant in order to enhance immunogenicity. The main emphasis in SARS-CoV-2 vaccine development has been on using the whole spike protein in its trimeric form, or components of it, such as the RBD region. Multiple non-replicating viral vector vaccines have been developed, particularly focused on adenovirus, while there has been less emphasis on the replicating viral vector constructs.[33]

At least nine different technology platforms are under research and development to create an effective vaccine against COVID‑19.[5][34] Most of the platforms of vaccine candidates in clinical trials are focused on the coronavirus spike protein and its variants as the primary antigen of COVID‑19 infection.[34] Platforms being developed in 2020 involved nucleic acid technologies (nucleoside-modified messenger RNA and DNA), non-replicating viral vectors, peptides, recombinant proteins, live attenuated viruses, and inactivated viruses.[17][34][35][36]

Many vaccine technologies being developed for COVID‑19 are not like vaccines already in use to prevent influenza, but rather are using "next-generation" strategies for precise targeting of COVID‑19 infection mechanisms.[34][35][36] Several of the synthetic vaccines use a 2P mutation to lock the spike protein into its prefusion configuration, stimulating an adaptive immune response to the virus before it attaches to a human cell.[37] Vaccine platforms in development may improve flexibility for antigen manipulation, and effectiveness for targeting mechanisms of COVID‑19 infection in susceptible population subgroups, such as healthcare workers, the elderly, children, pregnant women, and people with weakened immune systems.[34][35]

RNA vaccines

Further information: RNA vaccine
Diagram of the operation of an RNA vaccine. Messenger RNA contained in the vaccine enters cells and is translated into foreign proteins, which trigger an immune response.

Several COVID-19 vaccines, including the Pfizer–BioNTech and Moderna vaccines, have been developed to use RNA to stimulate an immune response. When introduced into human tissue, the RNA contained in the vaccine acts as messenger RNA (mRNA) to cause cells to build the SARS-CoV-2 spike protein. This teaches the body how to identify and destroy the corresponding pathogen. RNA vaccines often, but not always, use nucleoside-modified messenger RNA. The delivery of mRNA is achieved by a coformulation of the molecule into lipid nanoparticles which protect the RNA strands and help their absorption into the cells.[38][39][40][41]

RNA vaccines were the first COVID‑19 vaccines to be authorized in the United Kingdom, the United States and the European Union.[42][43] Authorized vaccines of this type are the Pfizer–BioNTech[44][45][46] and Moderna vaccines.[47][48] The CVnCoV RNA vaccine from CureVac failed in clinical trails.[49]

Severe allergic reactions are rare. In December 2020, 1,893,360 first doses of Pfizer–BioNTech COVID‑19 vaccine administration resulted in 175 cases of severe allergic reaction, of which 21 were anaphylaxis.[50] For 4,041,396 Moderna COVID‑19 vaccine dose administrations in December 2020 and January 2021, only ten cases of anaphylaxis were reported.[50] The lipid nanoparticles were most likely responsible for the allergic reactions.[50]

Adenovirus vector vaccines

These vaccines are examples of non-replicating viral vector vaccines, using an adenovirus shell containing DNA that encodes a SARS‑CoV‑2 protein.[51][52] The viral vector-based vaccines against COVID‑19 are non-replicating, meaning that they do not make new virus particles, but rather produce only the antigen which elicits a systemic immune response.[51]

Authorized vaccines of this type are the Oxford–AstraZeneca COVID-19 vaccine,[53][54][55] the Sputnik V COVID-19 vaccine,[56] Convidecia, and the Janssen COVID-19 vaccine.[57][58]

Convidecia and the Janssen COVID-19 vaccine are both one-shot vaccines which offer less complicated logistics and can be stored under ordinary refrigeration for several months.[59][60]

Sputnik V uses Ad26 for its first dose, which is the same as Janssen's only dose, and Ad5 for the second dose, which is the same as Convidecia's only dose.[61]

On 11 August 2021, the developers of Sputnik V proposed, in view of the Delta case surge that Pfizer test the Ad26 component (termed its ‘Light’ version)[62] as a booster shot:

Delta cases surge in US & Israel shows mRNA vaccines need a heterogeneous booster to strengthen & prolong immune response. #SputnikV pioneered mix&match approach, combo trials & showed 83.1% efficacy vs Delta. Today RDIF offers Pfizer to start trial with Sputnik Light as booster.[63]

Inactivated virus vaccines

Inactivated vaccines consist of virus particles that have been grown in culture and then are killed using a method such as heat or formaldehyde to lose disease producing capacity, while still stimulating an immune response.[64]

Authorized vaccines of this type are the Chinese CoronaVac,[65][66][67] BBIBP-CorV,[68] and WIBP-CorV; the Indian Covaxin; later this year the Russian CoviVac;[69] the Kazakhstani vaccine QazVac;[70] and the Iranian COVIran Barekat.[71] Vaccines in clinical trials include the Valneva COVID-19 vaccine.[72][unreliable source?][73]

Subunit vaccines

Subunit vaccines present one or more antigens without introducing whole pathogen particles. The antigens involved are often protein subunits, but can be any molecule that is a fragment of the pathogen.[74]

The two authorized vaccines of this type are the peptide vaccine EpiVacCorona[75] and ZF2001.[5] Vaccines with pending authorizations include the Novavax COVID-19 vaccine,[76] Soberana 02 (a conjugate vaccine), and the Sanofi–GSK vaccine.

The V451 vaccine was previously in clinical trials, which were terminated because it was found that the vaccine may potentially cause incorrect results for subsequent HIV testing.[77][78]

Other types

Additional types of vaccines that are in clinical trials include virus-like particle vaccines, multiple DNA plasmid vaccines,[79][80][81][82][83][84] at least two lentivirus vector vaccines,[85][86] a conjugate vaccine, and a vesicular stomatitis virus displaying the SARS‑CoV‑2 spike protein.[87]

Oral vaccines and intranasal vaccines are being developed and studied.[88]

Scientists investigated whether existing vaccines for unrelated conditions could prime the immune system and lessen the severity of COVID‑19 infection.[89] There is experimental evidence that the BCG vaccine for tuberculosis has non-specific effects on the immune system, but no evidence that this vaccine is effective against COVID‑19.[90]

Planning and development

Main article: History of COVID-19 vaccine development

Since January 2020, vaccine development has been expedited via unprecedented collaboration in the multinational pharmaceutical industry and between governments.[34]

Multiple steps along the entire development path are evaluated, including:[17][91]

  • the level of acceptable toxicity of the vaccine (its safety),
  • targeting vulnerable populations,
  • the need for vaccine efficacy breakthroughs,
  • the duration of vaccination protection,
  • special delivery systems (such as oral or nasal, rather than by injection),
  • dose regimen,
  • stability and storage characteristics,
  • emergency use authorization before formal licensing,
  • optimal manufacturing for scaling to billions of doses, and
  • dissemination of the licensed vaccine.

Challenges

There have been several unique challenges with COVID‑19 vaccine development.

The urgency to create a vaccine for COVID‑19 led to compressed schedules that shortened the standard vaccine development timeline, in some cases combining clinical trial steps over months, a process typically conducted sequentially over years.[92] Public health programs have been described as in "[a] race to vaccinate individuals" with the early wave vaccines.[93]

Timelines for conducting clinical research – normally a sequential process requiring years – are being compressed into safety, efficacy, and dosing trials running simultaneously over months, potentially compromising safety assurance.[92][94] As an example, Chinese vaccine developers and the government Chinese Center for Disease Control and Prevention began their efforts in January 2020,[95] and by March were pursuing numerous candidates on short timelines, with the goal to showcase Chinese technology strengths over those of the United States, and to reassure the Chinese people about the quality of vaccines produced in China.[92][96]

The rapid development and urgency of producing a vaccine for the COVID‑19 pandemic may increase the risks and failure rate of delivering a safe, effective vaccine.[35][36][97] Additionally, research at universities is obstructed by physical distancing and closing of laboratories.[98][99]

Vaccines must progress through several phases of clinical trials to test for safety, immunogenicity, effectiveness, dose levels and adverse effects of the candidate vaccine.[100][101] Vaccine developers have to invest resources internationally to find enough participants for Phase II–III clinical trials when the virus has proved to be a "moving target" of changing transmission rates across and within countries, forcing companies to compete for trial participants.[102] Clinical trial organizers also may encounter people unwilling to be vaccinated due to vaccine hesitancy[103] or disbelief in the science of the vaccine technology and its ability to prevent infection.[104] As new vaccines are developed during the COVID‑19 pandemic, licensure of COVID‑19 vaccine candidates requires submission of a full dossier of information on development and manufacturing quality.[105][106][107]

Organizations

Internationally, the Access to COVID-19 Tools Accelerator is a G20 and World Health Organization (WHO) initiative announced in April 2020.[108][109] It is a cross-discipline support structure to enable partners to share resources and knowledge. It comprises four pillars, each managed by two to three collaborating partners: Vaccines (also called "COVAX"), Diagnostics, Therapeutics, and Health Systems Connector.[110] The WHO's April 2020 "R&D Blueprint (for the) novel Coronavirus" documented a "large, international, multi-site, individually randomized controlled clinical trial" to allow "the concurrent evaluation of the benefits and risks of each promising candidate vaccine within 3–6 months of it being made available for the trial." The WHO vaccine coalition will prioritize which vaccines should go into Phase II and III clinical trials, and determine harmonized Phase III protocols for all vaccines achieving the pivotal trial stage.[111]

National governments have also been involved in vaccine development. Canada announced funding for 96 research vaccine research projects at Canadian companies and universities, with plans to establish a "vaccine bank" that could be used if another coronavirus outbreak occurs,[112] and to support clinical trials and develop manufacturing and supply chains for vaccines.[113]

China provided low-rate loans to one vaccine developer through its central bank, and "quickly made land available for the company" to build production plants.[94] Three Chinese vaccine companies and research institutes are supported by the government for financing research, conducting clinical trials, and manufacturing.[114]

Great Britain formed a COVID‑19 vaccine task force in April 2020 to stimulate local efforts for accelerated development of a vaccine through collaborations of industry, universities, and government agencies. It encompassed every phase of development from research to manufacturing.[115]

In the United States, the Biomedical Advanced Research and Development Authority (BARDA), a federal agency funding disease-fighting technology, announced investments to support American COVID‑19 vaccine development, and manufacture of the most promising candidates.[94][116] In May 2020, the government announced funding for a fast-track program called Operation Warp Speed.[117][118] By March 2021, BARDA had funded an estimated $19.3 billion in COVID-19 vaccine development.[119]

Large pharmaceutical companies with experience in making vaccines at scale, including Johnson & Johnson, AstraZeneca, and GlaxoSmithKline (GSK), formed alliances with biotechnology companies, governments, and universities to accelerate progression towards effective vaccines.[94][92]

History

This section is an excerpt from History of COVID-19 vaccine development.[]
COVID‑19 vaccine research samples in a NIAID lab freezer (30 January 2020)

COVID-19's caused virus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), was isolated in late 2019.[120] Its genetic sequence was published on 11 January 2020, triggering an urgent international response to prepare for an outbreak and hasten development of a preventive COVID-19 vaccine.[121][122][123] Since 2020, vaccine development has been expedited via unprecedented collaboration in the multinational pharmaceutical industry and between governments.[124] By June 2020, tens of billions of dollars were invested by corporations, governments, international health organizations, and university research groups to develop dozens of vaccine candidates and prepare for global vaccination programs to immunize against COVID‑19 infection.[122][125][126][127] According to the Coalition for Epidemic Preparedness Innovations (CEPI), the geographic distribution of COVID‑19 vaccine development shows North American entities to have about 40% of the activity, compared to 30% in Asia and Australia, 26% in Europe, and a few projects in South America and Africa.[121][124]

In February 2020, the World Health Organization (WHO) said it did not expect a vaccine against SARS‑CoV‑2 to become available in less than 18 months.[128] Virologist Paul Offit commented that, in hindsight, the development of a safe and effective vaccine within 11 months was a remarkable feat.[129] The rapidly growing infection rate of COVID‑19 worldwide during 2020 stimulated international alliances and government efforts to urgently organize resources to make multiple vaccines on shortened timelines,[130] with four vaccine candidates entering human evaluation in March (see COVID-19 vaccine § Trial and authorization status).[121][131]

On 24 June 2020, China approved the CanSino vaccine for limited use in the military, and two inactivated virus vaccines for emergency use in high-risk occupations.[132] On 11 August 2020, Russia announced the approval of its Sputnik V vaccine for emergency use, though one month later only small amounts of the vaccine had been distributed for use outside of the phase 3 trial.[133]

The Pfizer–BioNTech partnership submitted an Emergency Use Authorization (EUA) request to the U.S. Food and Drug Administration (FDA) for the mRNA vaccine BNT162b2 (active ingredient tozinameran) on 20 November 2020.[134][135] On 2 December 2020, the United Kingdom's Medicines and Healthcare products Regulatory Agency (MHRA) gave temporary regulatory approval for the Pfizer–BioNTech vaccine,[136][137] becoming the first country to approve the vaccine and the first country in the Western world to approve the use of any COVID‑19 vaccine.[138][139][140] As of 21 December 2020, many countries and the European Union[141] had authorized or approved the Pfizer–BioNTech COVID‑19 vaccine. Bahrain and the United Arab Emirates granted emergency marketing authorization for BBIBP-CorV, manufactured by Sinopharm.[142][143] On 11 December 2020, the FDA granted an EUA for the Pfizer–BioNTech COVID‑19 vaccine.[144] A week later, they granted an EUA for mRNA-1273 (active ingredient elasomeran), the Moderna vaccine.[145][146][147][148]

On 31 March 2021, the Russian government announced that they had registered the first COVID‑19 vaccine for animals.[149] Named Carnivac-Cov, it is an inactivated vaccine for carnivorous animals, including pets, aimed at preventing mutations that occur during the interspecies transmission of SARS-CoV-2.[150]

In June 2021, a report revealed that the UB-612 vaccine, developed by the US-based COVAXX, was a venture initiated for profits by the Blackwater founder Erik Prince. In a series of text messages to Paul Behrends, the close associate recruited for the COVAXX project, Prince described the profit-making possibilities in selling the COVID‑19 vaccines. COVAXX provided no data from the clinical trials on safety or efficacy. The responsibility of creating distribution networks was assigned to an Abu Dhabi-based entity, which was mentioned as "Windward Capital" on the COVAXX letterhead but was actually Windward Holdings. The sole shareholder of the firm, which handled "professional, scientific and technical activities", was Erik Prince. In March 2021, COVAXX raised $1.35 billion in a private placement.[151]

Society and culture

Distribution

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COVID-19 vaccine distribution by location[152]
Location Vaccinated[a] %[b]
World[c] 3,128,591,289 39.7%
China China 1,114,475,000 77.2%
India India 488,153,607 35.0%
European Union European Union 286,757,895 64.1%
United States United States[d] 204,435,968 60.8%
Brazil Brazil 133,647,690 62.5%
Japan Japan 70,699,480 56.1%
Indonesia Indonesia 61,654,676 22.3%
Mexico Mexico 57,440,626 44.1%
Germany Germany 53,965,720 64.3%
United Kingdom United Kingdom 48,001,316 70.4%
France France 47,990,852 71.0%
Turkey Turkey 47,797,199 56.2%
Russia Russia 43,523,101 29.8%
Italy Italy[e] 42,316,748 70.1%
Pakistan Pakistan 39,951,787 17.7%
Spain Spain 36,237,517 77.5%
South Korea South Korea 28,641,079 55.8%
Canada Canada 27,842,441 73.1%
Argentina Argentina 27,750,181 60.9%
Colombia Colombia 22,978,676 44.8%
Saudi Arabia Saudi Arabia 22,061,992 62.4%
Thailand Thailand 21,669,955 31.0%
Malaysia Malaysia 19,384,218 59.1%
Poland Poland 19,219,260 50.9%
Philippines Philippines 18,697,647 16.8%
Morocco Morocco 18,226,896 48.8%
Bangladesh Bangladesh 18,131,561 10.9%
Iran Iran 16,986,882 20.0%
Vietnam Vietnam 16,822,691 17.1%
Chile Chile 14,380,538 74.8%
Sri Lanka Sri Lanka 12,309,254 57.3%
Netherlands Netherlands 11,965,985 69.7%
Australia Australia 11,934,098 46.3%
Cambodia Cambodia 10,308,435 60.8%
Peru Peru 10,046,728 30.1%
Taiwan Taiwan 10,005,255 41.9%
Ecuador Ecuador 9,984,903 55.8%
South Africa South Africa 9,026,420 15.0%
Uzbekistan Uzbekistan 8,569,841 25.2%
Portugal Portugal 8,568,377 84.3%
United Arab Emirates United Arab Emirates 8,485,738 84.9%
Belgium Belgium 8,388,904 72.1%
Sweden Sweden 6,853,407 67.5%
Kazakhstan Kazakhstan 6,592,369 34.7%
Greece Greece 6,010,270 58.0%
Venezuela Venezuela 6,006,270 20.9%
Israel Israel 5,962,271 67.8%
Czech Republic Czechia 5,929,893 55.3%
Dominican Republic Dominican Republic 5,790,794 52.9%
Hungary Hungary 5,740,136 59.6%
Austria Austria 5,488,676 60.7%
Cuba Cuba 5,416,339 47.9%
Ukraine Ukraine 5,308,725 12.2%
Romania Romania 5,226,706 27.3%
Egypt Egypt 5,109,996 4.9%
Nepal Nepal 5,063,522 17.1%
Switzerland Switzerland 4,916,420 56.4%
Singapore Singapore 4,590,629 77.8%
Myanmar Myanmar 4,456,857 8.1%
Denmark Denmark 4,399,904 75.7%
Hong Kong Hong Kong 4,096,421 54.2%
Azerbaijan Azerbaijan 4,042,976 39.5%
Finland Finland 4,013,569 72.3%
Norway Norway 3,837,331 70.2%
Bolivia Bolivia 3,825,802 32.3%
Tunisia Tunisia 3,686,470 30.9%
Republic of Ireland Ireland 3,669,454 73.6%
El Salvador El Salvador 3,478,958 53.4%
Jordan Jordan 3,433,313 33.4%
Algeria Algeria 3,421,279 7.7%
Guatemala Guatemala 3,257,037 17.9%
Iraq Iraq 3,118,411[f]
Costa Rica Costa Rica 3,029,514 59.0%
Serbia Serbia 2,916,835 42.9%
Panama Panama 2,703,694 61.7%
Honduras Honduras 2,694,923 26.8%
Kuwait Kuwait 2,668,082 61.6%
Uruguay Uruguay 2,657,269 76.2%
Nigeria Nigeria 2,550,390 1.2%
Zimbabwe Zimbabwe 2,530,181 16.8%
Ethiopia Ethiopia 2,394,866 2.0%
Slovakia Slovakia 2,366,226 43.3%
Oman Oman 2,336,980 44.7%
Qatar Qatar 2,309,734 78.8%
Paraguay Paraguay 2,266,494 31.4%
Mongolia Mongolia 2,236,363 67.2%
Laos Laos 2,109,937 28.6%
Kenya Kenya 1,894,240 3.4%
Tajikistan Tajikistan 1,891,850 19.4%
New Zealand New Zealand 1,882,106 38.7%
Croatia Croatia 1,718,925 42.1%
Lithuania Lithuania 1,648,441 61.3%
Belarus Belarus 1,561,907 16.5%
Lebanon Lebanon 1,337,749 19.8%
Ivory Coast Ivory Coast 1,297,822 4.8%
Rwanda Rwanda 1,242,465 9.4%
Mozambique Mozambique 1,207,600 3.8%
Senegal Senegal 1,147,553 6.7%
Bahrain Bahrain 1,143,653 65.4%
Angola Angola 1,110,558 3.3%
Bulgaria Bulgaria 1,089,066 15.8%
Slovenia Slovenia 986,643 47.5%
Uganda Uganda 901,900 1.9%
Ghana Ghana 865,422 2.8%
Latvia Latvia 852,751 45.7%
Libya Libya 837,907 12.0%
Albania Albania 812,555 28.3%
Mauritius Mauritius 791,795 62.2%
Georgia (country) Georgia 780,948 19.6%
Afghanistan Afghanistan 770,542 1.9%
Guinea Guinea 729,160 5.4%
Estonia Estonia 722,288 54.5%
North Macedonia North Macedonia 703,578 33.8%
Kyrgyzstan Kyrgyzstan 678,388 10.2%
Malawi Malawi 662,638 3.4%
State of Palestine Palestine 648,395 12.4%
Sudan Sudan 643,569 1.4%
Moldova Moldova 573,001 14.2%
Cyprus Cyprus 570,003 64.2%
Bosnia and Herzegovina Bosnia and Herzegovina 567,198 17.4%
Bhutan Bhutan 561,411 72.0%
Fiji Fiji 543,254 60.2%
Trinidad and Tobago Trinidad and Tobago 505,067 36.0%
Nicaragua Nicaragua 443,053 6.6%
Malta Malta 413,174 80.3%
Luxembourg Luxembourg 405,000 63.8%
Niger Niger 404,104 1.6%
Kosovo Kosovo 388,422 20.1%
Maldives Maldives 381,745 70.2%
East Timor Timor-Leste 375,372 27.9%
Jamaica Jamaica 372,876 12.5%
Togo Togo 356,897 4.2%
Cameroon Cameroon 343,672 1.3%
Macau Macao 320,034 48.6%
Zambia Zambia 309,993 1.6%
Guyana Guyana 308,758 39.1%
Yemen Yemen 298,161 1.0%
Iceland Iceland 279,121 81.3%
Botswana Botswana 252,722 10.5%
Syria Syria 230,510 1.3%
Mauritania Mauritania 228,536 4.8%
Tanzania Tanzania 218,621 0.4%
Cape Verde Cabo Verde 212,766 37.9%
Montenegro Montenegro 209,434 33.4%
Brunei Brunei 205,051 46.4%
Namibia Namibia 204,142 7.9%
Suriname Suriname 201,209 34.0%
Equatorial Guinea Equatorial Guinea 197,657 13.6%
Somalia Somalia 188,765 1.1%
Republic of the Congo Congo 184,812 3.3%
The Gambia Gambia 178,481 7.2%
Armenia Armenia 176,552 6.0%
Comoros Comoros 175,038 19.7%
Mali Mali 173,242 0.9%
Northern Cyprus Northern Cyprus 160,361 42.0%
Belize Belize 152,484 37.7%
French Polynesia French Polynesia 119,413 42.3%
Barbados Barbados 106,178 36.9%
Liberia Liberia 104,545 2.0%
Guernsey Guernsey 99,443[f]
Eswatini Eswatini 96,175 8.3%
Curaçao Curaçao 95,893 58.2%
Papua New Guinea Papua New Guinea 91,962 1.0%
Samoa Samoa 87,436 43.7%
Central African Republic Central African Republic 82,083 1.7%
Democratic Republic of the Congo Democratic Republic of the Congo 82,039 0.1%
Aruba Aruba 78,345 73.1%
Gabon Gabon 77,761 3.4%
New Caledonia New Caledonia 77,705 27.0%
Jersey Jersey 75,860 75.0%
Seychelles Seychelles 73,777 75.0%
The Bahamas Bahamas 73,726 18.6%
Lesotho Lesotho 71,597 3.3%
Isle of Man Isle of Man 65,639 76.8%
Benin Benin 54,367 0.4%
Burkina Faso Burkina Faso 53,814 0.2%
South Sudan South Sudan 52,226 0.5%
Cayman Islands Cayman Islands 51,078 76.8%
Andorra Andorra 51,044 66.0%
Solomon Islands Solomon Islands 48,883 6.9%
Bermuda Bermuda 42,826 69.0%
Antigua and Barbuda Antigua and Barbuda 39,808 40.3%
Gibraltar Gibraltar 39,596 117.5%
Greenland Greenland 39,425 69.3%
Faroe Islands Faroe Islands 36,625 74.7%
Saint Lucia Saint Lucia 36,623 19.9%
Djibouti Djibouti 35,396 3.5%
Chad Chad 33,525 0.2%
Turkmenistan Turkmenistan 32,240 0.5%
São Tomé and Príncipe Sao Tome and Principe 32,114 14.4%
Vanuatu Vanuatu 29,321 9.3%
Tonga Tonga 28,841 27.0%
Guinea-Bissau Guinea-Bissau 28,097 1.4%
Haiti Haiti 26,208 0.2%
Turks and Caicos Islands Turks and Caicos Islands 25,621 65.3%
Sint Maarten Sint Maarten 25,005 57.6%
Monaco Monaco 24,454 62.3%
Saint Kitts and Nevis Saint Kitts and Nevis 24,208 45.2%
San Marino San Marino 23,954 70.4%
Liechtenstein Liechtenstein 22,629 59.1%
Grenada Grenada 22,307 19.7%
Dominica Dominica 21,942 30.4%
British Virgin Islands British Virgin Islands 16,826 55.3%
Saint Vincent and the Grenadines Saint Vincent and the Grenadines 16,417 14.8%
Kiribati Kiribati 13,970 11.7%
Cook Islands Cook Islands 10,931 62.2%
Anguilla Anguilla 9,493 62.8%
Nauru Nauru 7,533 69.5%
Caribbean Netherlands Caribbean Netherlands 5,726 21.8%
Wallis and Futuna Wallis and Futuna 4,899 44.2%
Tuvalu Tuvalu 4,772 40.5%
Saint Helena, Ascension and Tristan da Cunha St. Helena, Ascension, Tristan 4,361 71.8%
Falkland Islands Falkland Islands 2,632 75.6%
Montserrat Montserrat 1,460 29.2%
Niue Niue 1,184 73.2%
Tokelau Tokelau 968 70.8%
Pitcairn Islands Pitcairn 47 100.0%
  1. ^ Number of people who have received at least one dose of a COVID-19 vaccine (unless noted otherwise).
  2. ^ Percentage of population that has received at least one dose of a COVID-19 vaccine. May include vaccination of non-citizens, which can push totals beyond 100% of the local population.
  3. ^ Countries which do not report the number of people who have received at least one dose are not included in the world total.
  4. ^ Includes Freely Associated States
  5. ^ Includes Vatican City
  6. ^ Jump up to: a b This country's data are the number of vaccine doses administered, not the first dose only.
These paragraphs are an excerpt from Deployment of COVID-19 vaccines.[]

As of 23 August 2021, 5 billion COVID-19 vaccine doses had been administered worldwide based on official reports from national health agencies collated by Our World in Data.[153]

During a pandemic on the rapid timeline and scale of COVID-19 cases in 2020, international organizations like the World Health Organization (WHO) and Coalition for Epidemic Preparedness Innovations (CEPI), vaccine developers, governments, and industry evaluated the distribution of the eventual vaccine(s).[154] Individual countries producing a vaccine may be persuaded to favor the highest bidder for manufacturing or provide first-service to their own country.[155][156][157][158] Experts emphasize that licensed vaccines should be available and affordable for people at the frontline of healthcare and having the greatest need.[155][156][158]

In April 2020, it was reported that the UK agreed to work with 20 other countries and global organizations including France, Germany and Italy to find a vaccine and to share the results, and that UK citizens would not get preferential access to any new COVID‑19 vaccines developed by taxpayer-funded UK universities.[159] Several companies planned to initially manufacture a vaccine at artificially low pricing, then increase prices for profitability later if annual vaccinations are needed and as countries build stock for future needs.[158]

An April 2020 CEPI report stated: "Strong international coordination and cooperation between vaccine developers, regulators, policymakers, funders, public health bodies, and governments will be needed to ensure that promising late-stage vaccine candidates can be manufactured in sufficient quantities and equitably supplied to all affected areas, particularly low-resource regions."[160] The WHO and CEPI are developing financial resources and guidelines for global deployment of several safe, effective COVID‑19 vaccines, recognizing the need is different across countries and population segments.[154][161][162][163] For example, successful COVID‑19 vaccines would be allocated early to healthcare personnel and populations at greatest risk of severe illness and death from COVID‑19 infection, such as the elderly or densely-populated impoverished people.[164][165]

  • Share of people who have received at least one dose of a COVID-19 vaccine relative to a country's total population. Date is at the bottom of the map. Commons source.

  • COVID-19 vaccine doses administered per 100 people by country. Date is at the bottom of the map. Commons source.

Access

Further information: Deployment of COVID-19 vaccines § Equitable access

Nations pledged to buy doses of COVID‑19 vaccine before the doses were available. Though high-income nations represent only 14% of the global population, as of 15 November 2020, they had contracted to buy 51% of all pre-sold doses. Some high-income nations bought more doses than would be necessary to vaccinate their entire populations.[16]

Production of Sputnik V vaccine in Brazil, January 2021.
An elderly man receiving second dose of CoronaVac vaccine in Brazil, April 2021.

On 18 January 2021, WHO Director-General Tedros Adhanom Ghebreyesus warned of problems with equitable distribution: "More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25."[166]

In March, it was revealed the US attempted to convince Brazil not to purchase the Sputnik V COVID-19 vaccine, fearing "Russian influence" in Latin America.[167] Some nations involved in long-standing territorial disputes have reportedly had their access to vaccines blocked by competing nations; Palestine has accused Israel of blocking vaccine delivery to Gaza, while Taiwan has suggested that China has hampered its efforts to procure vaccine doses.[168][169][170]

A single dose of the COVID‑19 vaccine by AstraZeneca would cost 47 Egyptian pounds (EGP) and the authorities are selling it between 100 and 200 EGP. A report by Carnegie Endowment for International Peace cited the poverty rate in Egypt as around 29.7 percent, which constitutes approximately 30.5 million people, and claimed that about 15 million of the Egyptians would be unable to gain access to the luxury of vaccination. A human rights lawyer, Khaled Ali, launched a lawsuit against the government, forcing them to provide vaccination free of cost to all members of the public.[171]

According to immunologist Dr. Anthony Fauci, mutant strains of virus and limited vaccine distribution pose continuing risks and he said: "we have to get the entire world vaccinated, not just our own country."[172] Edward Bergmark and Arick Wierson are calling for a global vaccination effort and wrote that the wealthier nations' "me-first" mentality could ultimately backfire, because the spread of the virus in poorer countries would lead to more variants, against which the vaccines could be less effective.[173]

On 10 March 2021, the United States, Britain, European Union nations and other WTO members blocked a push by more than eighty developing countries to waive COVID‑19 vaccine patent rights in an effort to boost production of vaccines for poor nations.[174] On 5 May 2021, the Biden administration announced that it supports waiving intellectual property protections for COVID-19 vaccines.[175] The Members of the European Parliament have backed a motion demanding the temporary lifting of intellectual properties rights for COVID‑19 vaccines.[176] Commission vice-president Valdis Dombrovskis, stressed that while the EU is ready to discuss the issue of patent waivers, its proposed solutions include limiting export restrictions, resolving production bottlenecks, looking into compulsory licensing, investing in manufacturing capacity in developing countries and increasing contributions to the COVAX scheme.[177]

COVID-19 mass vaccination queue in Finland, June 2021.
A drive-thorugh COVID-19 vaccination center in Iran, August 2021.

In a meeting in April 2021, the World Health Organization's emergency committee addressed concerns of persistent inequity in the global vaccine distribution.[178] Although 9 percent of the world's population lives in the 29 poorest countries, these countries had received only 0.3% of all vaccines administered as of May 2021.[179] On March 15, Brazilian journalism agency Agência Pública reported that the country vaccinated about twice as many people who declare themselves white than black and noted that mortality from COVID-19 is higher in the black population.[180]

In May 2021, UNICEF made an urgent appeal to industrialised nations to pool their excess COVID-19 vaccine capacity to make up for a 125-million-dose gap in the COVAX program. The program mostly relied on the Oxford–AstraZeneca COVID-19 vaccine produced by SRI, which faced serious supply problems due to increased domestic vaccine needs in India from March to June 2021. Only a limited amount of vaccines can be distributed efficiently, and the shortfall of vaccines in South America and parts of Asia are due to a lack of expedient donations by richer nations. International aid organisations have pointed at Nepal, Sri Lanka, and Maldives as well as Argentina and Brazil, and some parts of the Caribbean as problem areas, where vaccines are in short supply. UNICEF has also been critical towards proposed donations of Moderna and Pfizer vaccines since these are not slated for delivery until the second half of 2021, or early 2022.[181]

On 1 July 2021, the heads of the World Bank Group, International Monetary Fund, World Health Organization and World Trade Organization said in a joint statement: "As many countries are struggling with new variants and a third wave of COVID-19 infections, accelerating access to vaccines becomes even more critical to ending the pandemic everywhere and achieving broad-based growth. We are deeply concerned about the limited vaccines, therapeutics, diagnostics, and support for deliveries available to developing countries."[182][183] In July 2021, The BMJ reported that countries have thrown out over 250,000 vaccine doses as supply exceeded demand and strict laws prevented the sharing of vaccines.[184] A survey by The New York Times found that over a million doses of vaccine had been thrown away in ten U.S. states because federal regulations prohibit recalling them, preventing their redistribution abroad.[185] Furthermore, doses donated close to expiration often cannot be administered quickly enough by recipient countries and end up having to be discarded.[186]

Amnesty International and Oxfam International have criticized the support of vaccine monopolies by the governments of producing countries, noting that this is dramatically increasing the dose price by 5 times and often much more, creating an economic barrier to access for poor countries.[187][188]

On 4 August 2021, to reduce unequal distribution between rich and poor countries, the WHO called for a moratorium on a booster dose at least until the end of September. However, on 18 August, the United States government announced plans to offer booster doses 8 months after the initial course to the general population, starting with priority groups. Before the announcement, the WHO harshly criticized this type of decision, citing the lack of evidence for the need for boosters, except for patients with specific conditions. At this time, vaccine coverage of at least one dose was 58% in high-income countries and only 1.3% in low-income countries, and 1.14 million Americans already received an unauthorized booster dose. US officials argued that waning efficacy against mild and moderate disease might indicate reduced protection against severe disease in the coming months. Israel, France, Germany and the United Kingdom have also started planning boosters for specific groups.[189][190][191]

Optimizing the societal benefit of vaccination may benefit from a strategy that is tailored to the state of the pandemic, the demographics of a country, the age of the recipients, the availability of vaccines, and the individual risk for severe disease: In the UK, the interval between prime and boost dose was extended to vaccinate as many persons as early as possible,[192] many countries are starting to given an additional booster shot to the immunosuppressed[193][194] and the elderly,[195] and research predicts an additional benefit of personalizing vaccine dose in the setting of limited vaccine availabilty when a wave of virus Variants of Concern hits a country.[196]

While vaccines substantially reduce the probability of infection, it is still possible for fully vaccinated people to contract and spread COVID-19.[197] Public health agencies have recommended that vaccinated people continue using preventive measures (wear face masks, social distance, wash hands) to avoid infecting others, especially vulnerable people, particularly in areas with high community spread. Governments have indicated that such recommendations will be reduced as vaccination rates increase and community spread declines.[198]

Inside of a vaccination center in Brussels, Belgium, February 2021.

Liability

There are liability shields in place to protect pharmaceutical companies like Pfizer and Moderna from negligence claims related to COVID-19 vaccines (and treatments). These liability shields took effect on 4 February 2020, when the US Secretary of Health and Human Services Alex Azar published a notice of declaration under the Public Readiness and Emergency Preparedness Act (PREP Act) for medical countermeasures against COVID‑19, covering "any vaccine, used to treat, diagnose, cure, prevent, or mitigate COVID‑19, or the transmission of SARS-CoV-2 or a virus mutating therefrom". The declaration precludes "liability claims alleging negligence by a manufacturer in creating a vaccine, or negligence by a health care provider in prescribing the wrong dose, absent willful misconduct". In other words, absent "willful misconduct", these companies can not be sued for money damages for any injuries that occur between 2020 and 2024 from the administration of vaccines and treatments related to COVID-19.[199] The declaration is effective in the United States through 1 October 2024.[199]

In December 2020, the UK government granted Pfizer legal indemnity for its COVID-19 vaccine.[200]

In the European Union, the COVID‑19 vaccines are licensed under a Conditional Marketing Authorisation which does not exempt manufacturers from civil and administrative liability claims.[201] While the purchasing contracts with vaccine manufacturers remain secret, they do not contain liability exemptions even for side-effects not known at the time of licensure.[202]

The Bureau of Investigative Journalism, a nonprofit news organization, reported in an investigation that unnamed officials in some countries, such as Argentina and Brazil, said that Pfizer demanded guarantees against costs of legal cases due to adverse effects in the form of liability waivers and sovereign assets such as federal bank reserves, embassy buildings or military bases, going beyond the expected from other countries such as the US.[203] During the pandemic parliamentary inquiry in Brazil, Pfizer's representative said that its terms for Brazil are the same as for all other countries with which it has signed deals.[204]

Misinformation

Further information: COVID‑19 misinformation § Vaccines
Anti-vaccination activists and other people spread a variety of unfounded conspiracy theories, including overblown claims about side effects, a story about COVID-19 being spread by childhood vaccines, misrepresentations about how the immune system works, and when and how COVID-19 vaccines are made.

Fake vaccines containing salt water have also been administered in some countries.[205][206][207]

Vaccine hesitancy

Further information: Vaccine hesitancy

Estimates from two surveys were that 67% or 80% of people in the U.S. would accept a new vaccination against COVID‑19, with wide disparity by education level, employment status, ethnicity, and geography.[208] A US study conducted in January 2021 found that trust in science and scientists was strongly correlated with likelihood to get vaccinated for COVID-19 among those who had not already gotten vaccinated.[209] In March 2021, 19% of US adults claimed to have been vaccinated while 50% announced plans to get vaccinated.[210][211]

Encouragement by public figures and celebrities

See also: Celebrities who have received the COVID-19 vaccine

Many public figures and celebrities have publicly declared that they have been vaccinated against COVID‑19, and encouraged people to get vaccinated. Many have made video recordings or otherwise documented their vaccination. They do this partly to counteract vaccine hesitancy and COVID‑19 vaccine conspiracy theories.[212][213][214][215]

Politicians

Several current and former heads of state and government ministers have released photographs of their vaccinations, encouraging others to be vaccinated, including Kyriakos Mitsotakis, Zdravko Marić, Olivier Véran, Joe Biden, Barack Obama, George W. Bush, Bill Clinton, the Dalai Lama, Narendra Modi, Justin Trudeau, Alexandria Ocasio-Cortez, Nancy Pelosi and Kamala Harris.[216][217]

Elizabeth II and Prince Philip announced they had the vaccine, breaking from protocol of keeping the British royal family's health private.[212] Pope Francis and Pope Emeritus Benedict both announced they had been vaccinated.[212]

Media personalities

Today was a good day. I have never been happier to wait in a line. If you’re eligible, join me and sign up to get your vaccine. Come with me if you want to live!

Arnold Schwarzenegger[218]

Dolly Parton recorded herself getting vaccinated with the Moderna vaccine she helped fund, she encouraged people to get vaccinated and created a new version of her song "Jolene" called "Vaccine".[212] Several other musicians like Patti Smith, Yo-Yo Ma, Carole King, Tony Bennett, Mavis Staples, Brian Wilson, Joel Grey, Loretta Lynn, Willie Nelson, and Paul Stanley have all released photographs of them being vaccinated and encouraged others to do so.[216] Grey stated "I got the vaccine because I want to be safe. We've lost so many people to COVID. I've lost a few friends. It's heartbreaking. Frightening."[216]

Many actors including Amy Schumer, Rosario Dawson, Arsenio Hall, Danny Trejo, Mandy Patinkin, Samuel L. Jackson, Arnold Schwarzenegger, Sharon Stone, Kate Mulgrew, Jeff Goldblum, Jane Fonda, Anthony Hopkins, Bette Midler, Kim Cattrall, Isabella Rossellini, Christie Brinkley, Cameran Eubanks, Hugh Bonneville, Alan Alda, David Harbour, Sean Penn, Amanda Kloots, Ian McKellen and Patrick Stewart have released photographs of themselves getting vaccinated and encouraging others to do the same.[212][216] Dame Judi Dench and Joan Collins announced they have been vaccinated.[212]

Please and reassure yourself why getting vaxxed is the move. Save a life or two. Who knows?

Ariana Grande[218]

Other TV personalities such as Martha Stewart, Jonathan Van Ness, Al Roker and Dan Rather released photographs of themselves getting vaccinated and encouraged others to do the same.[212][216] Stephen Fry also shared a photograph of being vaccinated; he wrote, "It's a wonderful moment, but you feel that it's not only helpful for your own health, but you know that you're likely to be less contagious if you yourself happen to carry it ... It's a symbol of being part of society, part of the group that we all want to protect each other and get this thing over and done with."[212] Sir David Attenborough announced that he has been vaccinated.[212] Dutch TV personality Beau van Erven Dorens got his vaccination on live TV in his late-night talkshow on 3 June 2021.[219]

Athletes

Magic Johnson and Kareem Abdul-Jabbar released photographs of themselves getting vaccinated and encouraged others to do the same; Abdul-Jabbar said, "We have to find new ways to keep each other safe."[216]

Specific communities

Romesh Ranganathan, Meera Syal, Adil Ray, Sadiq Khan and others produced a video specifically encouraging ethnic minority communities in the UK to be vaccinated including addressing conspiracy theories stating "there is no scientific evidence to suggest it will work differently on people from ethnic minorities and that it does not include pork or any material of fetal or animal origin."[220]

Oprah Winfrey and Whoopi Goldberg have spoken about being vaccinated and encouraged other black Americans to be so.[216] Stephanie Elam volunteered to be a trial volunteer stating "a large part of the reason why I wanted to volunteer for this COVID‑19 vaccine research – more Black people and more people of color need to be part of these trials so more diverse populations can reap the benefits of this medical research."[216]

See also

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Further reading

Vaccine protocols

External links

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