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A COVID19 vaccine is a
vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifi ...
intended to provide
acquired immunity The adaptive immune system (AIS), also known as the acquired immune system, or specific immune system is a subsystem of the immune system that is composed of specialized cells, organs, and processes that eliminate pathogens specifically. The ac ...
against severe acute respiratory syndrome coronavirus 2 (
SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19, the respiratory illness responsible for the COVID-19 pandemic. The virus previously had the Novel coronavirus, provisional nam ...
), the virus that causes coronavirus disease 2019 ( COVID19). Knowledge about the structure and function of previous
coronavirus Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans and birds, they cause respiratory tract infections that can range from mild to lethal. Mild illnesses in humans include some cases of the comm ...
es causing diseases like severe acute respiratory syndrome (
SARS Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the virus SARS-CoV-1, the first identified strain of the SARS-related coronavirus. The first known cases occurred in November 2002, and the ...
) and Middle East respiratory syndrome (
MERS Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by '' Middle East respiratory syndrome–related coronavirus'' (MERS-CoV). Symptoms may range from none, to mild, to severe depending on age and risk level. Typi ...
) accelerated the development of various vaccine platforms in early 2020. In 2020, the first COVID19 vaccines were developed and made available to the public through emergency authorizations and conditional approvals. However, immunity from the vaccines wanes over time, requiring people to get
booster dose A booster dose is an extra administration of a vaccine after an earlier ( primer) dose. After initial immunization, a booster provides a re-exposure to the immunizing antigen. It is intended to increase immunity against that antigen back to prote ...
s of the vaccine to maintain protection against COVID19. The COVID19 vaccines are widely credited for their role in reducing the spread of COVID19 and reducing the severity and death caused by COVID19. Many countries implemented phased distribution plans that prioritized those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. Common side effects of COVID19 vaccines include soreness, redness, rash, inflammation at the injection site, fatigue, headache,
myalgia Myalgia or muscle pain is a painful sensation evolving from muscle tissue. It is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another likely cause is viral infection, espec ...
(muscle pain), and
arthralgia Arthralgia () literally means ' joint pain'. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic reaction to medication Medication (also called medicament, medicine, pharmaceuti ...
(joint pain), which resolve without medical treatment within a few days. COVID19 vaccination is safe for people who are pregnant or are breastfeeding. , 13.72billion doses of COVID19 vaccines have been administered worldwide, based on official reports from
national public health agencies National may refer to: Common uses * Nation or country ** Nationality – a ''national'' is a person who is subject to a nation, regardless of whether the person has full rights as a citizen Places in the United States * National, Maryland, ce ...
. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population. Despite the extremely rapid development of effective
mRNA In molecular biology, messenger ribonucleic acid (mRNA) is a single-stranded molecule of RNA that corresponds to the genetic sequence of a gene, and is read by a ribosome in the process of Protein biosynthesis, synthesizing a protein. mRNA is ...
and
viral vector vaccine A viral vector vaccine is a vaccine that uses a viral vector to deliver genetic material (DNA) that can be transcribed by the recipient's host cells as mRNA coding for a desired protein, or antigen, to elicit an immune response. , six viral vector ...
s, worldwide
vaccine equity Vaccine equity means ensuring that everyone in the world has equal access to vaccines. The importance of vaccine equity has been emphasized by researchers and public health experts during the COVID-19 pandemic but is relevant to other illnesses and ...
has not been achieved. The development and use of
whole inactivated virus An inactivated vaccine (or killed vaccine) is a type of vaccine that contains pathogens (such as virus or bacteria) that have been killed or rendered inactive, so they cannot replicate or cause disease. In contrast, live vaccines use pathogens ...
(WIV) and protein-based vaccines have also been recommended, especially for use in
developing countries A developing country is a sovereign state with a less-developed Secondary sector of the economy, industrial base and a lower Human Development Index (HDI) relative to developed countries. However, this definition is not universally agreed upon. ...
. The 2023
Nobel Prize in Physiology or Medicine The Nobel Prize in Physiology or Medicine () is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, acco ...
was awarded to
Katalin Karikó Katalin "Kati" Karikó (, ; born 17 January 1955) is a Hungarian-American biochemist who specializes in ribonucleic acid (RNA)-mediated mechanisms, particularly in vitro-Transcription (biology), transcribed messenger RNA (mRNA) for protein repla ...
and
Drew Weissman Drew Weissman (born September 7, 1959) is an American physician and immunologist known for his contributions to RNA biology. Weissman is the inaugural Roberts Family Professor in Vaccine Research, director of the Penn Institute for RNA Innovatio ...
for the development of effective mRNA vaccines against COVID19.


Background

File:COVID-19 vaccine doses administered by continent.svg, COVID19 vaccine doses administered by continent as of October 11, 2021. For vaccines that require multiple doses, each individual dose is counted. As the same person may receive more than one dose, the number of doses can be higher than the number of people in the population. File:World map of share of people who received all doses prescribed by the initial COVID-19 vaccination protocol.png, Map showing share of population fully vaccinated against COVID-19 relative to a country's total population Prior to COVID19, a vaccine for an infectious disease had never been produced in less than several yearsand no vaccine existed for preventing a
coronavirus Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans and birds, they cause respiratory tract infections that can range from mild to lethal. Mild illnesses in humans include some cases of the comm ...
infection in humans. However, vaccines have been produced against several animal diseases caused by coronaviruses, including (as of 2003)
infectious bronchitis virus Infectious bronchitis virus (IBV) is a species of virus from the genus ''Gammacoronavirus'' that infects birds. It causes avian infectious bronchitis, a highly infectious disease that affects the respiratory tract, gut, kidney and reproductive ...
in birds,
canine coronavirus Canine coronavirus (CCoV) is an enveloped, positive-sense, single-stranded RNA virus which is a member of the species ''Alphacoronavirus suis''. It causes a highly contagious intestinal disease worldwide in dogs. The infecting virus enters it ...
, and
feline coronavirus Feline coronavirus (FCoV) is a positive-stranded RNA virus that infects cats worldwide. It is a coronavirus of the species ''Alphacoronavirus suis'', which includes canine coronavirus (CCoV) and porcine transmissible gastroenteritis coronaviru ...
. Previous projects to develop vaccines for viruses in the family ''
Coronaviridae ''Coronaviridae'' is a family (biology), family of Viral envelope, enveloped, positive-strand RNA viruses which infect fish, amphibians, birds, and mammals. The group includes the subfamilies ''Letovirinae,'' ''Orthocoronavirinae'', and ''Pitovir ...
'' that affect humans have been aimed at
severe acute respiratory syndrome Severe acute respiratory syndrome (SARS) is a viral respiratory disease of zoonotic origin caused by the virus SARS-CoV-1, the first identified strain of the SARS-related coronavirus. The first known cases occurred in November 2002, and the sy ...
(SARS) and
Middle East respiratory syndrome Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by '' Middle East respiratory syndrome–related coronavirus'' (MERS-CoV). Symptoms may range from none, to mild, to severe depending on age and risk level. Typi ...
(MERS). Vaccines against SARS and MERS have been tested in non-human
animals Animals are multicellular, eukaryotic organisms in the biological kingdom Animalia (). With few exceptions, animals consume organic material, breathe oxygen, have myocytes and are able to move, can reproduce sexually, and grow from a ...
. 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. There is no cure or protective vaccine proven to be safe and effective against SARS in humans. There is also no proven vaccine against MERS. 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. As of March 2020, there was one (DNA-based) MERS vaccine that completed PhaseI clinical trials in humans, and three others in progress, all being viral-vectored vaccines: two adenoviral-vectored (ChAdOx1-MERS, BVRS-GamVac) and one MVA-vectored (MVA-MERS-S). Vaccines that use an inactive or weakened virus that has been grown in eggs typically take more than a decade to develop. In contrast, mRNA is a molecule that can be made quickly, and research on mRNA to fight diseases was begun decades before the COVID19 pandemic by scientists such as
Drew Weissman Drew Weissman (born September 7, 1959) is an American physician and immunologist known for his contributions to RNA biology. Weissman is the inaugural Roberts Family Professor in Vaccine Research, director of the Penn Institute for RNA Innovatio ...
and
Katalin Karikó Katalin "Kati" Karikó (, ; born 17 January 1955) is a Hungarian-American biochemist who specializes in ribonucleic acid (RNA)-mediated mechanisms, particularly in vitro-Transcription (biology), transcribed messenger RNA (mRNA) for protein repla ...
, who tested on mice.
Moderna Moderna, Inc. ( ) is an American pharmaceutical and biotechnology company based in Cambridge, Massachusetts, that focuses on RNA therapeutics, primarily mRNA vaccines. These vaccines use a copy of a molecule called messenger RNA (mRNA) to carry inst ...
began human testing of an
mRNA vaccine An mRNA vaccine is a type of vaccine that uses a copy of a molecule called messenger RNA (mRNA) to produce an immune response. The vaccine delivers molecules of antigen-encoding mRNA into cells, which use the designed mRNA as a blueprint to b ...
in 2015.
Viral vector vaccine A viral vector vaccine is a vaccine that uses a viral vector to deliver genetic material (DNA) that can be transcribed by the recipient's host cells as mRNA coding for a desired protein, or antigen, to elicit an immune response. , six viral vector ...
s were also developed for the COVID19 pandemic after the technology was previously cleared for Ebola. As multiple COVID19 vaccines have been authorized or licensed for use, real-world vaccine effectiveness (RWE) is being assessed using case control and observational studies. A study is investigating the long-lasting protection against SARS-CoV-2 provided by the mRNA vaccines.


Vaccine technologies

The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic, often severe, illness. Most of the first COVID19 vaccines were two-dose vaccines, with the exception single-dose vaccines Convidecia and the Janssen COVID‑19 vaccine, and vaccines with three-dose schedules, Razi Cov Pars and Soberana. As of July 2021, at least nine different technology platforms were under research and development to create an effective vaccine against COVID19. Most of the platforms of vaccine candidates in clinical trials are focused on the coronavirus spike protein (S protein) and its variants as the primary
antigen In immunology, an antigen (Ag) is a molecule, moiety, foreign particulate matter, or an allergen, such as pollen, that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune response. ...
of COVID19 infection, since the S protein triggers strong B-cell and T-cell immune responses. However, other coronavirus proteins are also being investigated for vaccine development, like the
nucleocapsid A capsid is the protein shell of a virus, enclosing its genetic material. It consists of several oligomeric (repeating) structural subunits made of protein called protomers. The observable 3-dimensional morphological subunits, which may or ma ...
, because they also induce a robust T-cell response and their genes are more conserved and recombine less frequently. Future generations of COVID19 vaccines targeting more conserved genomic regions could be used to treat future variations of SARS-CoV-2, or any similar coronavirus epidemic/pandemic. Platforms developed in 2020 involved
nucleic acid Nucleic acids are large biomolecules that are crucial in all cells and viruses. They are composed of nucleotides, which are the monomer components: a pentose, 5-carbon sugar, a phosphate group and a nitrogenous base. The two main classes of nuclei ...
technologies (
nucleoside-modified messenger RNA A nucleoside-modified messenger RNA (modRNA) is a synthetic messenger RNA (mRNA) in which some nucleosides are replaced by other naturally modified nucleosides or by synthetic nucleoside analogues. modRNA is used to induce the production of a des ...
and
DNA Deoxyribonucleic acid (; DNA) is a polymer composed of two polynucleotide chains that coil around each other to form a double helix. The polymer carries genetic instructions for the development, functioning, growth and reproduction of al ...
), non-replicating
viral vector A viral vector is a modified virus designed to gene delivery, deliver genetic material into cell (biology), cells. This process can be performed inside an organism or in cell culture. Viral vectors have widespread applications in basic research, ...
s,
peptide Peptides are short chains of amino acids linked by peptide bonds. A polypeptide is a longer, continuous, unbranched peptide chain. Polypeptides that have a molecular mass of 10,000 Da or more are called proteins. Chains of fewer than twenty am ...
s,
recombinant protein Protein production is the biotechnological process of generating a specific protein. It is typically achieved by the manipulation of gene expression in an organism such that it expresses large amounts of a recombinant gene. This includes the ...
s, live
attenuated virus Attenuation is the gradual loss in intensity of any kind of flux through a medium, including: * Acoustic attenuation, the loss of sound energy in a viscous medium * Anelastic attenuation factor, a way to describe attenuation of seismic energy in ...
es, and inactivated viruses. Many vaccine technologies being developed for COVID19 use "next-generation" strategies for precise targeting of COVID19 infection mechanisms. Several of the synthetic vaccines use a 2P mutation to lock the
spike protein In virology, a spike protein or peplomer protein is a protein that forms a large structure known as a spike or peplomer projecting from the surface of an viral envelope, enveloped virus. as cited in The proteins are usually glycoproteins that ...
into its prefusion configuration, stimulating an
adaptive immune response The adaptive immune system (AIS), also known as the acquired immune system, or specific immune system is a subsystem of the immune system that is composed of specialized cells, organs, and processes that eliminate pathogens specifically. The ac ...
to the virus before it attaches to a human cell. Vaccine platforms in development may improve flexibility for antigen manipulation and effectiveness for targeting mechanisms of COVID19 infection in susceptible population subgroups, such as healthcare workers, the elderly, children,
pregnant women Pregnancy is the time during which one or more offspring gestates inside a woman's uterus. A multiple pregnancy involves more than one offspring, such as with twins. Conception usually occurs following vaginal intercourse, but can also ...
, and people with weakened
immune system The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as Tumor immunology, cancer cells, Parasitic worm, parasitic ...
s.


mRNA vaccines

Several COVID19 vaccines, such as the Pfizer–BioNTech and
Moderna Moderna, Inc. ( ) is an American pharmaceutical and biotechnology company based in Cambridge, Massachusetts, that focuses on RNA therapeutics, primarily mRNA vaccines. These vaccines use a copy of a molecule called messenger RNA (mRNA) to carry inst ...
vaccines, use
RNA Ribonucleic acid (RNA) is a polymeric molecule that is essential for most biological functions, either by performing the function itself (non-coding RNA) or by forming a template for the production of proteins (messenger RNA). RNA and deoxyrib ...
to stimulate an immune response. When introduced into human tissue, the vaccine contains either self-replicating RNA or
messenger RNA In molecular biology, messenger ribonucleic acid (mRNA) is a single-stranded molecule of RNA that corresponds to the genetic sequence of a gene, and is read by a ribosome in the process of synthesizing a protein. mRNA is created during the ...
(mRNA), which both cause cells to express the SARS-CoV-2
spike protein In virology, a spike protein or peplomer protein is a protein that forms a large structure known as a spike or peplomer projecting from the surface of an viral envelope, enveloped virus. as cited in The proteins are usually glycoproteins that ...
. This teaches the
immune system The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as Tumor immunology, cancer cells, Parasitic worm, parasitic ...
how to identify and destroy the corresponding pathogen. RNA vaccines often use
nucleoside-modified messenger RNA A nucleoside-modified messenger RNA (modRNA) is a synthetic messenger RNA (mRNA) in which some nucleosides are replaced by other naturally modified nucleosides or by synthetic nucleoside analogues. modRNA is used to induce the production of a des ...
. The
delivery Delivery may refer to: Biology and medicine *Childbirth *Drug delivery *Gene delivery Business and law *Delivery (commerce), of goods, e.g.: **Pizza delivery ** Milk delivery ** Food delivery ** Online grocer *Deed ("delivery" in contract law), a ...
of mRNA is achieved by a coformulation of the molecule into
lipid nanoparticle Lipid-based nanoparticles are very small spherical particles composed of lipids. They are a novel pharmaceutical drug delivery system (part of nanoparticle drug delivery), and a novel pharmaceutical formulation. There are many subclasses of ...
s, which protect the RNA strands and help their absorption into the cells. RNA vaccines are the first COVID19 vaccines to be authorized in the United Kingdom, the United States, and the European Union. Authorized vaccines of this type include the Pfizer–BioNTech and Moderna vaccines. The
CVnCoV The CureVac COVID-19 vaccine (abbreviated CVnCoV) was a COVID-19 vaccine candidate developed by CureVac N.V. and the Coalition for Epidemic Preparedness Innovations (CEPI). The vaccine showed inadequate results in its Phase III trials with o ...
RNA vaccine from
CureVac CureVac N.V. is a German biopharmaceutical company. It develops therapies based on messenger RNA (mRNA). Headquartered in Tübingen, Germany, the company was founded in 2000 by Ingmar Hoerr (CEO), Steve Pascolo (CSO), Florian von der Mulbe ( ...
failed in clinical trials. Severe allergic reactions are rare. In December 2020, 1,893,360 first doses of Pfizer–BioNTech COVID19 vaccine administration resulted in 175 cases of severe allergic reactions, of which 21 were
anaphylaxis Anaphylaxis (Greek: 'up' + 'guarding') is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site. It typicall ...
. For 4,041,396 Moderna COVID19 vaccine dose administrations in December 2020 and January 2021, only ten cases of anaphylaxis were reported.
Lipid nanoparticles Lipid-based nanoparticles are very small spherical particles composed of lipids. They are a novel pharmaceutical drug delivery system (part of nanoparticle drug delivery), and a novel pharmaceutical formulation. There are many subclasses o ...
(LNPs) were most likely responsible for the allergic reactions.


Adenovirus vector vaccines

These vaccines are examples of non-replicating
viral vector vaccine A viral vector vaccine is a vaccine that uses a viral vector to deliver genetic material (DNA) that can be transcribed by the recipient's host cells as mRNA coding for a desired protein, or antigen, to elicit an immune response. , six viral vector ...
s using an
adenovirus Adenoviruses (members of the family ''Adenoviridae'') are medium-sized (90–100 nm), nonenveloped (without an outer lipid bilayer) viruses with an icosahedral nucleocapsid containing a double-stranded DNA genome. Their name derives from t ...
shell containing DNA that encodes a SARS‑CoV‑2 protein. The viral vector-based vaccines against COVID19 are non-replicating, meaning that they do not make new virus particles but rather produce only the antigen that elicits a systemic immune response. Authorized vaccines of this type include the Oxford–AstraZeneca COVID‑19 vaccine, the Sputnik V COVID‑19 vaccine, Convidecia, and the Janssen COVID‑19 vaccine. Convidecia and Janssen are both single dose vaccines that can be stored under ordinary refrigeration for several months.
Sputnik V Sputnik V (, the brand name from the Russian Direct Investment Fund or RDIF) or Gam-COVID-Vac (, the name under which it is legally registered and produced) is an adenovirus viral vector vaccine for COVID-19 developed by the Gamaleya Resea ...
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. In 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) as a booster shot.


Inactivated virus vaccines

Inactivated vaccine An inactivated vaccine (or killed vaccine) is a type of vaccine that contains pathogens (such as virus or bacteria) that have been killed or rendered inactive, so they cannot replicate or cause disease. In contrast, live vaccines use pathogens ...
s consist of virus particles that are grown in
culture Culture ( ) is a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...
and then killed using a method such as heat or
formaldehyde Formaldehyde ( , ) (systematic name methanal) is an organic compound with the chemical formula and structure , more precisely . The compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde. It is stored as ...
to lose disease-producing capacity while still stimulating an immune response. Inactivated virus vaccines authorized in China include the Chinese
CoronaVac CoronaVac, also known as the Sinovac COVID-19 vaccine, was a whole inactivated virus COVID-19 vaccine developed by the Chinese company Sinovac Biotech. It was phase III clinically trialled in Brazil, Chile, Indonesia, the Philippines, and ...
and the Sinopharm BIBP and WIBP vaccines; there is also the Indian
Covaxin Covaxin (list of pharmaceutical compound number prefixes, development name, BBV152) is a Inactivated vaccine, whole inactivated virus-based COVID-19 vaccine developed by Bharat Biotech in collaboration with the Indian Council of Medical Res ...
, the Russian CoviVac, the Kazakh vaccine QazVac, and the Iranian COVIran Barekat. Vaccines in clinical trials include the Valneva COVID19 vaccine.


Subunit vaccines

Subunit vaccine A subunit vaccine is a vaccine that contains purified parts of the pathogen that are antigenic, or necessary to elicit a protective immune response. Subunit vaccine can be made from dissembled viral particles in cell culture or recombinant DNA expr ...
s present one or more
antigen In immunology, an antigen (Ag) is a molecule, moiety, foreign particulate matter, or an allergen, such as pollen, that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune response. ...
s without introducing whole pathogen particles. The antigens involved are often
protein subunit In structural biology, a protein subunit is a polypeptide chain or single protein molecule that assembles (or "''coassembles''") with others to form a protein complex. Large assemblies of proteins such as viruses often use a small number of t ...
s, but they can be any molecule fragment of the pathogen. The authorized vaccines of this type include the peptide vaccine EpiVacCorona, ZF2001, MVC-COV1901,
Corbevax Corbevax is a protein subunit COVID-19 vaccine developed by Texas Children's Hospital Center for Vaccine Development and Baylor College of Medicine in Houston, Texas and Dynavax technologies based in Emeryville, California. It is licensed t ...
, the Sanofi–GSK vaccine, Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged. and
Soberana 02 Soberana 02 or Soberana 2, technical name FINLAY-FR-2, is a COVID-19 vaccine produced by the Finlay Institute, a Cuban epidemiological research institute. The vaccine is known as PastoCovac () in Iran, where it has been developed in collaborati ...
(a
conjugate vaccine A conjugate vaccine is a type of subunit vaccine which combines a weak antigen with a strong antigen as a carrier so that the immune system has a stronger response to the weak antigen. Vaccines are used to prevent diseases by invoking an immune ...
).
Bimervax A COVID19 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, COVID19). Knowledge about the structure ...
(selvacovatein) was approved for use as a booster vaccine in the European Union in March 2023. The V451 vaccine was in clinical trials that were terminated after it was found that the vaccine may potentially cause incorrect results for subsequent HIV testing.


Virus-like particle vaccines

The authorized vaccines of this type include the Novavax COVID‑19 vaccine.


Other types

Additional types of vaccines that are in clinical trials include multiple DNA plasmid vaccines, at least two lentivirus vector vaccines, a
conjugate vaccine A conjugate vaccine is a type of subunit vaccine which combines a weak antigen with a strong antigen as a carrier so that the immune system has a stronger response to the weak antigen. Vaccines are used to prevent diseases by invoking an immune ...
, and a
vesicular stomatitis virus ''Indiana vesiculovirus'', formerly ''Vesicular stomatitis Indiana virus'' (VSIV or VSV) is a virus in the family ''Rhabdoviridae''; the well-known '' Rabies lyssavirus'' belongs to the same family. VSIV can infect insects, cattle, horses and pig ...
displaying the SARS‑CoV‑2 spike protein. Scientists investigated whether existing vaccines for unrelated conditions could prime the immune system and lessen the severity of COVID19 infections. There is experimental evidence that the
BCG vaccine The Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis or leprosy is common, one dose is recom ...
for tuberculosis has non-specific effects on the immune system, but there is no evidence that this vaccine is effective against COVID19.


List of authorized vaccines


Delivery methods

Most coronavirus vaccines are administered by
intramuscular injection Intramuscular injection, often abbreviated IM, is the medical injection, injection of a substance into a muscle. In medicine, it is one of several methods for parenteral, parenteral administration of medications. Intramuscular injection may be ...
, with further vaccine delivery methods being studied for future coronavirus vaccines.


Intranasal

Intranasal vaccines target mucosal immunity in the
nasal mucosa The nasal mucosa lines the nasal cavity. It is part of the respiratory mucosa, the mucous membrane lining the respiratory tract. The nasal mucosa is intimately adherent to the periosteum or perichondrium of the nasal conchae. It is continuous w ...
, which is a portal for viral entry into the body. These vaccines are designed to stimulate nasal
immune factor The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as cancer cells, parasitic worms, and also objects such as w ...
s, such as
IgA IGA or IgA may refer to: Businesses and organizations * IGA (supermarkets) (initially Independent Grocers Alliance), a name used by many independent supermarkets throughout the world ** IGA (Australian supermarket group), the local Australian v ...
. In addition to inhibiting the virus, nasal vaccines provide ease of administration because no needles (or
needle phobia Fear of needles, known in medical literature as needle phobia, is the extreme fear of medical procedures involving injections or hypodermic needles. It is occasionally referred to as ''aichmophobia'', although this term may also refer to a more ...
) are involved. A variety of intranasal COVID19 vaccines are undergoing clinical trials. The first authorised intranasal vaccine was Razi Cov Pars in Iran at the end of October 2021. The first viral component of
Sputnik V vaccine Sputnik V (, the brand name from the Russian Direct Investment Fund or RDIF) or Gam-COVID-Vac (, the name under which it is legally registered and produced) is an adenovirus viral vector vaccine for COVID-19 developed by the Gamaleya Resear ...
was authorised in Russia as Sputnik Nasal in April 2022. In September 2022, India and China approved two
nasal Nasal is an adjective referring to the nose, part of human or animal anatomy. It may also be shorthand for the following uses in combination: * With reference to the human nose: ** Nasal administration, a method of pharmaceutical drug delivery * ...
COVID19 vaccines ( iNCOVACC and Convidecia), which may (as boosters) also reduce transmission (potentially via sterilizing immunity). In December 2022, China approved a second intranasal vaccine as a booster, trade name Pneucolin.


Autologous

Aivita Biomedical is developing an experimental autologous
dendritic cell A dendritic cell (DC) is an antigen-presenting cell (also known as an ''accessory cell'') of the mammalian immune system. A DC's main function is to process antigen material and present it on the cell surface to the T cells of the immune system ...
COVID19 vaccine kit where the vaccine is prepared and incubated at the point-of-care using cells from the intended recipient. The vaccine is undergoing small phase I and phase II clinical studies.


Universal vaccine

A universal coronavirus vaccine would be effective against all coronaviruses and possibly other viruses. The concept was publicly endorsed by
NIAID The National Institute of Allergy and Infectious Diseases (NIAID, ) is one of the 27 institutes and centers that make up the National Institutes of Health (NIH), an agency of the United States Department of Health and Human Services. NIAID's mis ...
director
Anthony Fauci Anthony Stephen Fauci ( ; born December 24, 1940) is an American physician-scientist and immunologist who served as the director of the National Institute of Allergy and Infectious Diseases (NIAID) from 1984 to 2022, and the chief medical ...
,
virologist Virology is the scientific study of biological viruses. It is a subfield of microbiology that focuses on their detection, structure, classification and evolution, their methods of infection and exploitation of host cells for reproduction, the ...
Jeffery K. Taubenberger, and David M. Morens. In March 2022, the
White House The White House is the official residence and workplace of the president of the United States. Located at 1600 Pennsylvania Avenue Northwest (Washington, D.C.), NW in Washington, D.C., it has served as the residence of every U.S. president ...
released the "National COVID19 Preparedness Plan", which recommended accelerating the development of a universal coronavirus vaccine. One attempt at such a vaccine is being developed at the
Walter Reed Army Institute of Research The Walter Reed Army Institute of Research (WRAIR) is the largest biomedical research facility administered by the U.S. Department of Defense (DoD). The institute is centered at the Forest Glen Annex, in the Forest Glen Park part of the u ...
. It uses a spike ferritin-based nanoparticle (SpFN). This vaccine began a Phase I clinical trial in April 2022. Results of this trial were published in May 2024. Other universal vaccines that have entered clinical trial include OVX033 (France), PanCov (France), pEVAC-PS (UK), and
VBI-2902 N VBI-2902 is a COVID-19 vaccine candidate developed by Variation Biotechnologies from the United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North Ameri ...
(Canada). Another strategy is to attach vaccine fragments from multiple strains to a
nanoparticle A nanoparticle or ultrafine particle is a particle of matter 1 to 100 nanometres (nm) in diameter. The term is sometimes used for larger particles, up to 500 nm, or fibers and tubes that are less than 100 nm in only two directions. At ...
scaffold. One theory is that a broader range of strains can be vaccinated against by targeting the receptor-binding domain, rather than the whole
spike protein In virology, a spike protein or peplomer protein is a protein that forms a large structure known as a spike or peplomer projecting from the surface of an viral envelope, enveloped virus. as cited in The proteins are usually glycoproteins that ...
.


Formulation

, eleven of the vaccine candidates in clinical development use
adjuvants In pharmacology, an adjuvant is a drug or other substance, or a combination of substances, that is used to increase the efficacy or potency of certain drugs. Specifically, the term can refer to: * Adjuvant therapy in cancer management * Analge ...
to enhance immunogenicity. An immunological adjuvant is a substance formulated with a vaccine to elevate the immune response to an
antigen In immunology, an antigen (Ag) is a molecule, moiety, foreign particulate matter, or an allergen, such as pollen, that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune response. ...
, such as the COVID19 virus or influenza virus. Specifically, an adjuvant may be used in formulating a COVID19 vaccine candidate to boost its immunogenicity and efficacy to reduce or prevent COVID19 infection in vaccinated individuals. Adjuvants used in COVID19 vaccine formulation may be particularly effective for technologies using the inactivated COVID19 virus and recombinant protein-based or vector-based vaccines. Aluminum salts, known as "
alum An alum () is a type of chemical compound, usually a hydrated double salt, double sulfate salt (chemistry), salt of aluminium with the general chemical formula, formula , such that is a valence (chemistry), monovalent cation such as potassium ...
", were the first adjuvant used for licensed vaccines and are the adjuvant of choice in some 80% of adjuvanted vaccines. The alum adjuvant initiates diverse molecular and cellular mechanisms to enhance immunogenicity, including the release of proinflammatory cytokines. In June 2024, the US
Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...
advised the manufacturers of the licensed and authorized COVID-19 vaccines that the COVID-19 vaccines (2024-2025 Formula) for use in the United States beginning in fall 2024 should be monovalent JN.1 vaccines. As of May 2025, the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
recommends that monovalent JN.1 or KP.2 vaccines remain appropriate vaccine antigens and that monovalent LP.8.1 is a suitable alternative vaccine antigen. The
European Medicines Agency The European Medicines Agency (EMA) is an agency of the European Union (EU) in charge of the evaluation and supervision of pharmaceutical products. Prior to 2004, it was known as the European Agency for the Evaluation of Medicinal Products ...
recommends updating COVID-19 vaccines to target LP.8.1 for the 2025/2026 vaccination campaign.


Planning and development

Since January 2020, vaccine development has been expedited via unprecedented collaboration in the multinational pharmaceutical industry and between governments. Multiple steps along the entire development path are evaluated, including: * 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 COVID19 vaccine development. Timelines for conducting clinical researchnormally a sequential process requiring yearsare being compressed into safety, efficacy, and dosing trials running simultaneously over months, potentially compromising safety assurance. For example, Chinese vaccine developers and the
Chinese Center for Disease Control and Prevention The Chinese Center for Disease Control and Prevention (CCDC; ) is an institution directly under the National Health Commission, based in Changping District, Beijing, China. Established in 1983, it works to protect public health and safety ...
began their efforts in January 2020, and by March they were pursuing numerous candidates on short timelines. The rapid development and urgency of producing a vaccine for the COVID19 pandemic were expected to increase the risks and failure rate of delivering a safe, effective vaccine. Additionally, research at universities is obstructed by
physical distancing Physical may refer to: *Physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical co ...
and the closing of laboratories. Vaccines must progress through several phases of
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...
s to test for safety,
immunogenicity Immunogenicity is the ability of a foreign substance, such as an antigen, to provoke an immune response in the body of a human or other animal. It may be wanted or unwanted: * Wanted immunogenicity typically relates to vaccines, where the injecti ...
, effectiveness, dose levels, and
adverse effect An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term compli ...
s of the candidate vaccine. Vaccine developers have to invest resources internationally to find enough participants for PhaseII–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. Clinical trial organizers may also encounter people unwilling to be vaccinated due to
vaccine hesitancy Vaccine hesitancy is a delay in acceptance, or refusal of vaccines despite availability and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using ce ...
or disbelief in the science of the vaccine technology and its ability to prevent infection. As new vaccines are developed during the COVID19 pandemic, licensure of COVID19 vaccine candidates requires submission of a full dossier of information on development and manufacturing quality.


Organizations

Internationally, the Access to COVID‑19 Tools Accelerator is a
G20 The G20 or Group of 20 is an intergovernmental forum comprising 19 sovereign countries, the European Union (EU), and the African Union (AU). It works to address major issues related to the global economy, such as international financial stabil ...
and
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO) initiative announced in April 2020. 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 COVID-19 Vaccines Global Access, abbreviated as COVAX, is a worldwide initiative aimed at equitable access to COVID-19 vaccines directed by the GAVI vaccine alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the World He ...
"), Diagnostics, Therapeutics, and Health Systems Connector. 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 PhaseII andIII clinical trials and determine harmonized PhaseIII protocols for all vaccines achieving the
pivotal trial A pivotal trial is typically a Phase III clinical trial in the multi-year process of clinical research intended to demonstrate and confirm the safety and efficacy of a treatment – such as a drug candidate, medical device or clinical diagnost ...
stage. National governments have also been involved in vaccine development. Canada announced funding for 96 projects for the development and production of vaccines at Canadian companies and universities, with plans to establish a "vaccine bank" that could be used if another coronavirus outbreak occurs, support clinical trials, and develop manufacturing and supply chains for vaccines.
China China, officially the People's Republic of China (PRC), is a country in East Asia. With population of China, a population exceeding 1.4 billion, it is the list of countries by population (United Nations), second-most populous country after ...
provided low-rate loans to one vaccine developer through its
central bank A central bank, reserve bank, national bank, or monetary authority is an institution that manages the monetary policy of a country or monetary union. In contrast to a commercial bank, a central bank possesses a monopoly on increasing the mo ...
and "quickly made land available for the company" to build production plants. Three Chinese vaccine companies and research institutes are supported by the government for financing research, conducting clinical trials, and manufacturing. The United Kingdom government formed a COVID19 vaccine
task force A task force (TF) is a unit or formation established to work on a single defined task or activity. Originally introduced by the United States Navy, the term has now caught on for general usage and is a standard part of NATO terminology. Many ...
in April 2020 to stimulate local efforts for accelerated development of a vaccine through collaborations between industries, universities, and government agencies. The UK's
Vaccine Taskforce The Vaccine Taskforce in the United Kingdom of Great Britain and Northern Ireland was set up in April 2020 by the Second Johnson ministry, in collaboration with Chief Scientific Advisor Patrick Vallance and Chief Medical Officer Professor Chr ...
contributed to every phase of development, from research to manufacturing. In the United States, the
Biomedical Advanced Research and Development Authority The Biomedical Advanced Research and Development Authority (BARDA) is a center within the Administration for Strategic Preparedness and Response (ASPR) located within the U.S. Department of Health and Human Services (HHS) responsible for the p ...
(BARDA), a federal agency funding disease-fighting technology, announced investments to support American COVID19 vaccine development and the manufacturing of the most promising candidates. In May 2020, the government announced funding for a fast-track program called
Operation Warp Speed Operation Warp Speed (OWS) was a public–private partnership initiated by the United States government to facilitate and accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics. The firs ...
. By March 2021, BARDA had funded an estimated $19.3 billion in COVID19 vaccine development. Large pharmaceutical companies with experience in making vaccines at scale, including
Johnson & Johnson Johnson & Johnson (J&J) is an American multinational pharmaceutical, biotechnology, and medical technologies corporation headquartered in New Brunswick, New Jersey, and publicly traded on the New York Stock Exchange. Its common stock is a c ...
,
AstraZeneca AstraZeneca plc () (AZ) is a British-Swedish multinational pharmaceutical and biotechnology company with its headquarters at the Cambridge Biomedical Campus in Cambridge, UK. It has a portfolio of products for major diseases in areas includi ...
, and
GlaxoSmithKline GSK plc (an acronym from its former name GlaxoSmithKline plc) is a British Multinational corporation, multinational Pharmaceutics, pharmaceutical and biotechnology company with headquarters in London. It was established in 2000 by a Mergers an ...
(GSK), formed alliances with
biotechnology Biotechnology is a multidisciplinary field that involves the integration of natural sciences and Engineering Science, engineering sciences in order to achieve the application of organisms and parts thereof for products and services. Specialists ...
companies, governments, and universities to accelerate progress toward effective vaccines.


Clinical research


Post-vaccination complications


History

In November 2021, the full nucleotide sequences of the AstraZeneca and Pfizer/BioNTech vaccines were released by the UK
Medicines and Healthcare products Regulatory Agency The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department of Health and Social Care in the United Kingdom which is responsible for ensuring that medicines and medical devices work and are accepta ...
in response to a freedom of information request.


Effectiveness

An analysis involving more than 20 million adults found that vaccinated people had a lower risk of
long COVID Long may refer to: Measurement * Long, characteristic of something of great duration * Long, characteristic of something of great length * Longitude (abbreviation: long.), a geographic coordinate * Longa (music), note value in early music mens ...
compared to those who had not had a COVID-19 vaccine.


Duration of immunity

As of 2021, available evidence shows that fully vaccinated individuals and those previously infected with SARS-CoV-2 have a low risk of subsequent infection for at least six months. There is insufficient data to determine an antibody titer threshold that indicates when an individual is protected from infection. Multiple studies show that antibody titers are associated with protection at the population level, but individual protection titers remain unknown. For some populations, such as the elderly and the
immunocompromised Immunodeficiency, also known as immunocompromise, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that affe ...
, protection levels may be reduced after both vaccination and infection. Available evidence indicates that the level of protection may not be the same for all variants of the virus. As of December 2021, there are no FDA-authorized or approved tests that providers or the public can use to determine if a person is protected from infection reliably. As of March 2022, elderly residents' protection against severe illness, hospitalization, and death in English care homes was high immediately after vaccination, but protection declined significantly in the months following vaccination. Protection among care home staff, who were younger, declined much more slowly. Regular boosters are recommended for older people, and boosters for care home residents every six months appear reasonable. The US
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
(CDC) recommends a fourth dose of the Pfizer mRNA vaccine for "certain immunocompromised individuals and people over the age of 50".


Immune evasion by variants

In contrast to other investigated prior variants, the
SARS-CoV-2 Omicron variant Omicron (B.1.1.529) is a Variants of SARS-CoV-2, variant of SARS-CoV-2 first reported to the World Health Organization (WHO) by the Network for Genomics Surveillance in South Africa on 24 November 2021. It was first detected in Botswana and has ...
and its BA.4/5 subvariants have evaded immunity induced by vaccines, which may lead to
breakthrough infection A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen (currently only viruses). Breakthrough infections ha ...
s despite recent vaccination. Nevertheless, vaccines are thought to provide protection against severe illness, hospitalizations, and deaths due to Omicron.


Vaccine adjustments


Effectiveness against transmission

As of 2022, fully vaccinated individuals with
breakthrough infection A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen (currently only viruses). Breakthrough infections ha ...
s with the SARS-CoV-2 delta (B.1.617.2) variant were found to have a peak viral load similar to unvaccinated cases and could transmit infection in household settings.


Mix and match

According to studies, the combination of two different COVID19 vaccines, also called heterologous vaccination, cross-vaccination, or the mix-and-match method, provides protection equivalent to that of mRNA vaccines, including protection against the
Delta variant The Delta variant (B.1.617.2) was a variant of SARS-CoV-2, the virus that causes COVID-19. It was first detected in India on 5 October 2020. The Delta variant was named on 31 May 2021 and had spread to over 179 countries by 22 November 202 ...
. Individuals who receive the combination of two different vaccines produce strong immune responses, with side effects no worse than those caused by standard regimens.


Drug interactions

Methotrexate Methotrexate, formerly known as amethopterin, is a chemotherapy agent and immunosuppressive drug, immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancy, ectopic pregnancies. Types of cancers it is u ...
reduces the immune response to COVID-19 vaccines, making them less effective. Pausing methotrexate for two weeks following COVID-19 vaccination may result in improved immunity. Not taking the medicine for two weeks might result in a minor increase of inflammatory disease flares in some people.


Adverse events

For most people, the side effects, also called ''
adverse effects An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complic ...
'', from COVID19 vaccines are mild and can be managed at home. The adverse effects of the COVID19 vaccination are similar to those of other vaccines, and severe adverse effects are rare. Adverse effects from the vaccine are higher than placebo, but placebo arms of vaccine trials still reported adverse effects that can be attributed to the
nocebo effect A nocebo effect is said to occur when a patient's expectations for a treatment cause the treatment to have a worse effect than it otherwise would have. For example, when a patient anticipates a side effect of a medication, they can experience that ...
. A February 2022 study which examined a potential causal link between COVID-19 vaccines and excess deaths found that out of more than 250 million americans vaccinated only 55 cases of death after COVID-19 vaccination were reported and in 17 of these a causal relationship had been excluded. The
Paul Ehrlich Institute The Paul Ehrlich Institute (German: ''Paul-Ehrlich-Institut – Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel'', PEI) is a German Federal agency (Germany), federal agency, medical regulatory body and research institution for vacc ...
has recorded 31 cerebral venous sinus thromboses (CVST) and nine deaths out of 2.7 million vaccinated in Germany with the AZD1222. The UK
Medicines and Healthcare products Regulatory Agency The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department of Health and Social Care in the United Kingdom which is responsible for ensuring that medicines and medical devices work and are accepta ...
(MHRA) recorded 73 deaths out of nearly 50 million doses of AstraZeneca given in UK. All vaccines that are administered via
intramuscular injection Intramuscular injection, often abbreviated IM, is the medical injection, injection of a substance into a muscle. In medicine, it is one of several methods for parenteral, parenteral administration of medications. Intramuscular injection may be ...
, including COVID19 vaccines, have side effects related to the mild trauma associated with the procedure and the introduction of a foreign substance into the body. These include soreness, redness, rash, and inflammation at the injection site. Other common side effects include fatigue, headache,
myalgia Myalgia or muscle pain is a painful sensation evolving from muscle tissue. It is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another likely cause is viral infection, espec ...
(muscle pain), and
arthralgia Arthralgia () literally means ' joint pain'. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic reaction to medication Medication (also called medicament, medicine, pharmaceuti ...
(joint pain), all of which generally resolve without medical treatment within a few days. Like any other vaccine, some people are
allergic Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, alle ...
to one or more ingredients in COVID19 vaccines. Typical side effects are stronger and more common in younger people and in subsequent doses, and up to 20% of people report a disruptive level of side effects after the second dose of an mRNA vaccine. These side effects are less common or weaker in
inactivated vaccine An inactivated vaccine (or killed vaccine) is a type of vaccine that contains pathogens (such as virus or bacteria) that have been killed or rendered inactive, so they cannot replicate or cause disease. In contrast, live vaccines use pathogens ...
s. COVID19 vaccination-related enlargement of lymph nodes happens in 11.6% of those who received one dose of the vaccine and in 16% of those who received two doses. Experiments in mice show that intramuscular injections of lipid
excipient An excipient is a substance formulated alongside the active ingredient of a medication. They may be used to enhance the active ingredient’s therapeutic properties; to facilitate drug absorption; to reduce viscosity; to enhance solubility; to i ...
nanoparticles (an inactive substance that serves as the vehicle or medium) cause particles to enter the blood plasma and many organs, with higher concentrations found in the liver and lower concentrations in the spleen, adrenal glands, and ovaries. The highest concentration of nanoparticles was found at the injection site itself. COVID19 vaccination is safe for breastfeeding people. Temporary changes to the
menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eg ...
in young women have been reported. However, these changes are "small compared with natural variation and quickly reverse." In one study, women who received both doses of a two-dose vaccine during the same menstrual cycle (an atypical situation) may see their next period begin a couple of days late. They have about twice the usual risk of a clinically significant delay (about 10% of these women, compared to about 4% of unvaccinated women). Cycle lengths return to normal after two menstrual cycles post-vaccination. Women who received doses in separate cycles had approximately the same natural variation in cycle lengths as unvaccinated women. Other temporary menstrual effects have been reported, such as heavier than normal menstrual bleeding after vaccination. Serious
adverse events In pharmaceuticals, an adverse event (AE) is any unexpected or harmful medical occurrence that happens to a patient during medical treatment or a clinical trial. Unlike direct side effects, an adverse event does not necessarily mean the medicatio ...
associated COVID19 vaccines are generally rare but of high interest to the public. The official databases of reported adverse events include * the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
's VigiBase; * the United States Vaccine Adverse Events Reporting System (VAERS); * the United Kingdom's
Yellow Card Scheme The Yellow Card Scheme is the United Kingdom's system for collecting information on suspected adverse drug reactions (ADRs) to medicines. The scheme allows the safety of the medicines and vaccines that are on the market to be monitored. Histor ...
; * the
European Medicines Agency The European Medicines Agency (EMA) is an agency of the European Union (EU) in charge of the evaluation and supervision of pharmaceutical products. Prior to 2004, it was known as the European Agency for the Evaluation of Medicinal Products ...
's
EudraVigilance EudraVigilance (European Union Drug Regulating Authorities Pharmacovigilance) is the European data processing network and management system for reporting and evaluation of suspected Adverse event, adverse reactions to medicines or devices which hav ...
system, which operates a regular transfer of data on suspected adverse drug reactions occurring in the EU to WHO's Uppsala Monitoring Centre. Increased public awareness of these reporting systems and the extra reporting requirements under US FDA Emergency Use Authorization rules have increased reported adverse events. Serious side effects are an ongoing area of study, and resources have been allocated to try to better understand them. Research currently indicates that the rate and type of side effects are lower-risk than infection. For example, although vaccination may trigger some side effects, the effects experienced from an infection could be worse. Neurological side effects from getting COVID19 are hundreds of times more likely than from vaccination. Documented rare serious effects include: *
anaphylaxis Anaphylaxis (Greek: 'up' + 'guarding') is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site. It typicall ...
, a severe type of
allergic reaction Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...
. Anaphylaxis affects one person per 250,000 to 400,000 doses administered. According to a 2022 systematic review, the mortality rate of people with anaphylaxis following COVID‐19 vaccination was 0.5%. *
blood clots A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulati ...
(''thrombosis''). These vaccine-induced immune thrombocytopenia and thrombosis are associated with vaccines using an adenovirus system (Janssen and Oxford-AstraZeneca). These affect about one person per 100,000. *
myocarditis Myocarditis is inflammation of the cardiac muscle. Myocarditis can progress to inflammatory cardiomyopathy when there is associated ventricular remodeling and cardiac dysfunction due to chronic inflammation. Symptoms can include shortness of bre ...
and
pericarditis Pericarditis () is inflammation of the pericardium, the fibrous sac surrounding the heart. Symptoms typically include sudden onset of sharp chest pain, which may also be felt in the shoulders, neck, or back. The pain is typically less severe whe ...
, or inflammation of the heart. There is a rare risk of myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the membrane covering the heart) after the mRNA COVID19 vaccines (Moderna or Pfizer-BioNTech). The risk of myocarditis after COVID19 vaccination is estimated to be 0.3 to 5 cases per 100,000 persons, with the highest risk in young males. In an Israeli nation-wide population-based study (in which the Pfizer-BioNTech vaccine was exclusively given), the incidence rate of myocarditis was 54 cases out of 2.5 million vaccine recipients, with an overall incidence rate of 2 cases per 100,000 persons, with the highest incidence seen in young males (aged 16 to 29) at 10 cases per 100,000 vaccine recipients. Of the cases of myocarditis seen, 76% were mild in severity, with one case of cardiogenic shock (heart failure) and one death (in a person with a preexisting heart condition) reported within the 83-day follow-up period. COVID19 vaccines may protect against myocarditis due to subsequent COVID19 infection. The risk of myocarditis and pericarditis is significantly higher (up to 11 times higher with respect to myocarditis) after COVID19 infection as compared to COVID19 vaccination, with the possible exception of younger men (less than 40 years old) who may have a higher risk of myocarditis after the second Moderna mRNA vaccine (an additional 97 cases of myocarditis per 1 million persons vaccinated). The mortality rate from myocarditis post-vaccination is extremely low. According to a 2022 study, of patients diagnosed with myocarditis (in both vaccination and COVID-19 cohort) 1.07% were hospitalized and 0.015% died. * thrombotic thrombocytopenia and other autoimmune diseases, which have been reported as adverse events after the COVID19 vaccine. There are rare reports of subjective hearing changes, including
tinnitus Tinnitus is a condition when a person hears a ringing sound or a different variety of sound when no corresponding external sound is present and other people cannot hear it. Nearly everyone experiences faint "normal tinnitus" in a completely ...
, after vaccination.


Society and culture


Distribution

''Note about the table in this section: number and percentage of people who have received at least one dose of a COVID19 vaccine (unless noted otherwise). May include vaccination of non-citizens, which can push totals beyond 100% of the local population. The table is updated daily by a bot.The table data is automatically updated daily by a bot; see Template:COVID-19 data for more information. Scroll down past the table to find the documentation and the main reference. See also: :Automatically updated COVID-19 pandemic table templates.''


Access

Countries have extremely unequal access to the COVID19 vaccine.
Vaccine equity Vaccine equity means ensuring that everyone in the world has equal access to vaccines. The importance of vaccine equity has been emphasized by researchers and public health experts during the COVID-19 pandemic but is relevant to other illnesses and ...
has not been achieved or even approximated. The inequity has harmed both countries with poor access and countries with good access. Nations pledged to buy doses of the COVID19 vaccines 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. In January 2021, WHO Director-General
Tedros Adhanom Ghebreyesus Tedros Adhanom Ghebreyesus (, sometimes spelled ; born 3 March 1965) is an Ethiopian public health official, researcher, diplomat, and the DGWHO, Director-General of the World Health Organization since 2017. He is the first African to become W ...
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." In March 2021, it was revealed that the US attempted to convince Brazil not to purchase the
Sputnik V Sputnik V (, the brand name from the Russian Direct Investment Fund or RDIF) or Gam-COVID-Vac (, the name under which it is legally registered and produced) is an adenovirus viral vector vaccine for COVID-19 developed by the Gamaleya Resea ...
COVID19 vaccine, fearing "Russian influence" in Latin America. Some nations involved in long-standing territorial disputes have reportedly had their access to vaccines blocked by competing nations;
Palestine Palestine, officially the State of Palestine, is a country in West Asia. Recognized by International recognition of Palestine, 147 of the UN's 193 member states, it encompasses the Israeli-occupied West Bank, including East Jerusalem, and th ...
has accused Israel of blocking vaccine delivery to
Gaza Gaza may refer to: Places Palestine * Gaza Strip, a Palestinian territory on the eastern coast of the Mediterranean Sea ** Gaza City, a city in the Gaza Strip ** Gaza Governorate, a governorate in the Gaza Strip Mandatory Palestine * Gaza Sub ...
, while
Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia. The main geography of Taiwan, island of Taiwan, also known as ''Formosa'', lies between the East China Sea, East and South China Seas in the northwestern Pacific Ocea ...
has suggested that China has hampered its efforts to procure vaccine doses. A single dose of the COVID19 vaccines by
AstraZeneca AstraZeneca plc () (AZ) is a British-Swedish multinational pharmaceutical and biotechnology company with its headquarters at the Cambridge Biomedical Campus in Cambridge, UK. It has a portfolio of products for major diseases in areas includi ...
would cost 47
Egyptian pound The Egyptian pound ( ; abbreviations: £, E£, £E, LE, or EGP in Latin alphabet, Latin, and in Arabic script, Arabic, ISO 4217, ISO code: EGP) is the official currency of Egypt. It is divided into 100 piastres, (or qirsh, ; ''plural'' ; abb ...
s (EGP), and the authorities are selling them for between 100 and 200 EGP. A report by the 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 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 vaccinations free of charge to all members of the public. According to immunologist
Anthony Fauci Anthony Stephen Fauci ( ; born December 24, 1940) is an American physician-scientist and immunologist who served as the director of the National Institute of Allergy and Infectious Diseases (NIAID) from 1984 to 2022, and the chief medical ...
, mutant strains of the virus and limited vaccine distribution pose continuing risks, and he said, "we have to get the entire world vaccinated, not just our own country." Edward Bergmark and
Arick Wierson Arick Wierson (born November 23, 1971) is an American columnist who writes on politics and business for CNN and Newsweek. He is also a regular contributor to several other major US publications including ''Vice'', ''The New York Observer'', '' ...
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. In March 2021, the United States, Britain, European Union member states, and some other members of the
World Trade Organization The World Trade Organization (WTO) is an intergovernmental organization headquartered in Geneva, Switzerland that regulates and facilitates international trade. Governments use the organization to establish, revise, and enforce the rules that g ...
(WTO) blocked a push by more than eighty developing countries to waive COVID19 vaccine patent rights in an effort to boost production of vaccines for poor nations. On 5 May 2021, the US government under President Joe Biden announced that it supports waiving intellectual property protections for COVID19 vaccines. The Members of the European Parliament have backed a motion demanding the temporary lifting of intellectual property rights for COVID19 vaccines. In a meeting in April 2021, the World Health Organization's emergency committee addressed concerns of persistent inequity in global vaccine distribution. 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. In March 2021, Brazilian journalism agency
Agência Pública Agência Pública is a Brazilian investigative and independent journalism agency. It was founded in 2011 by the reporters Marina Amaral, Natália Viana and Tatiana Merlino. It is currently run by Marina Amaral and Natália Viana. Agência Públic ...
reported that the country vaccinated about twice as many people who declare themselves white than black and noted that mortality from COVID19 is higher in the black population. In May 2021,
UNICEF UNICEF ( ), originally the United Nations International Children's Emergency Fund, officially United Nations Children's Fund since 1953, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Development a ...
made an urgent appeal to industrialized nations to pool their excess COVID19 vaccine capacity to make up for a 125-million-dose gap in the
COVAX COVID-19 Vaccines Global Access, abbreviated as COVAX, is a worldwide initiative aimed at equitable access to COVID-19 vaccines directed by the GAVI vaccine alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the World He ...
program. The program mostly relied on the Oxford–AstraZeneca COVID‑19 vaccine produced by the
Serum Institute of India Serum Institute of India (SII) is an Indian multinational biotechnology and biopharmaceuticals company, based in Pune. It is the world's largest manufacturer of vaccines by volume. It was founded by Cyrus Poonawalla in 1966 and is a part of Cy ...
, 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 is due to a lack of expedient donations by richer nations. International aid organizations have pointed at Nepal, Sri Lanka, and the Maldives, as well as Argentina, Brazil, and some parts of the Caribbean, as problem areas where vaccines are in short supply. In mid-May 2021, UNICEF was also critical of the fact that most proposed donations of Moderna and Pfizer vaccines were not slated for delivery until the second half of 2021 or early in 2022. In July 2021, the heads of the World Bank Group, the International Monetary Fund, the World Health Organization, and the World Trade Organization said in a joint statement: "As many countries are struggling with new variants and a third wave of COVID19 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." In July 2021, ''
The BMJ ''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...
'' reported that countries had thrown out over 250,000 vaccine doses as supply exceeded demand and strict laws prevented the sharing of vaccines. A survey by ''
The New York Times ''The New York Times'' (''NYT'') is an American daily newspaper based in New York City. ''The New York Times'' covers domestic, national, and international news, and publishes opinion pieces, investigative reports, and reviews. As one of ...
'' 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. Furthermore, doses donated close to expiration often cannot be administered quickly enough by recipient countries and end up having to be discarded. To help overcome this problem, the Prime Minister of India,
Narendra Modi Narendra Damodardas Modi (born 17 September 1950) is an Indian politician who has served as the Prime Minister of India, prime minister of India since 2014. Modi was the chief minister of Gujarat from 2001 to 2014 and is the Member of Par ...
, announced that they would make their digital vaccination management platform,
CoWIN Kaiyi Auto (official name Yibin Kaiyi Automobile Co., Ltd., Chinese: 凯翼, ''Kǎiyì'') is a Chinese car manufacturer founded in 2014, as a subsidiary of Chery. The brand is specialized on offering low cost models with the goal of attracting y ...
, open to the global community. He also announced that India would also release the source code for the contact tracing app
Aarogya Setu Aarogya Setu (translation from Sanskrit: ''the bridge to health'') is an Indian COVID-19 "contact tracing, syndromic mapping and self-assessment" digital service, primarily a mobile app, developed by the National Informatics Centre under the Mi ...
for developers around the world. Around 142 countries, including Afghanistan, Bangladesh, Bhutan, the Maldives, Guyana, Antigua and Barbuda, St. Kitts and Nevis, and Zambia, expressed their interest in the application for COVID management.
Amnesty International Amnesty International (also referred to as Amnesty or AI) is an international non-governmental organization focused on human rights, with its headquarters in the United Kingdom. The organization says that it has more than ten million members a ...
and
Oxfam International Oxfam is a British-founded confederation of 21 independent non-governmental organizations (NGOs), focusing on the alleviation of global poverty, founded in 1942 and led by Oxfam International. It began as the Oxford Committee for Famine Relief ...
have criticized the support of vaccine monopolies by the governments of producing countries, noting that this is dramatically increasing the dose price by five times and often much more, creating an economic barrier to access for poor countries.
Médecins Sans Frontières (MSF; pronounced ), known in some English-speaking settings as Doctors Without Borders, is a charity that provides humanitarian medical care. It is a non-governmental organisation (NGO) of French origin known for its projects in conflict zo ...
(Doctors without Borders) has also criticized vaccine monopolies and repeatedly called for their suspension, supporting the
TRIPS waiver The TRIPS Agreement waiver (officially titled the Waiver from certain provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19) is a joint intervention communication by South Africa and India to the TRIPS counc ...
. The waiver was first proposed in October 2020 and has support from most countries, but was delayed by opposition from the EU (especially Germany; major EU countries such as France, Italy, and Spain support the exemption), the UK, Norway, and Switzerland, among others. MSF called for a Day of Action in September 2021 to put pressure on the
WTO The World Trade Organization (WTO) is an intergovernmental organization headquartered in Geneva, Switzerland that regulates and facilitates international trade. Governments use the organization to establish, revise, and enforce the rules that g ...
Minister's meeting in November, which was expected to discuss the TRIPS IP waiver. In August 2021, to reduce unequal distribution between rich and poor countries, the WHO called for a moratorium on
booster dose A booster dose is an extra administration of a vaccine after an earlier ( primer) dose. After initial immunization, a booster provides a re-exposure to the immunizing antigen. It is intended to increase immunity against that antigen back to prote ...
s at least until the end of September. However, in August, the United States government announced plans to offer booster doses eight 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 had 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. In September 2021, more than 140 former world leaders and Nobel laureates, including former President of France
François Hollande François Gérard Georges Nicolas Hollande (; born 12 August 1954) is a French politician who served as President of France from 2012 to 2017. Before his presidency, he was First Secretary of the Socialist Party (France), First Secretary of th ...
, former Prime Minister of the United Kingdom
Gordon Brown James Gordon Brown (born 20 February 1951) is a British politician who served as Prime Minister of the United Kingdom and Leader of the Labour Party (UK), Leader of the Labour Party from 2007 to 2010. Previously, he was Chancellor of the Ex ...
, former Prime Minister of New Zealand
Helen Clark Helen Elizabeth Clark (born 26 February 1950) is a New Zealand politician who served as the 37th prime minister of New Zealand from 1999 to 2008 and was the administrator of the United Nations Development Programme from 2009 to 2017. She was ...
, and Professor
Joseph Stiglitz Joseph Eugene Stiglitz (; born February 9, 1943) is an American New Keynesian economist, a public policy analyst, political activist, and a professor at Columbia University. He is a recipient of the Nobel Memorial Prize in Economic Sciences (2 ...
, called on the candidates to be the next German chancellor to declare themselves in favor of waiving intellectual property rules for COVID19 vaccines and transferring vaccine technologies. In November 2021, nursing unions in 28 countries filed a formal appeal with the United Nations over the refusal of the UK, EU, Norway, Switzerland, and Singapore to temporarily waive patents for COVID19 vaccines. During his first international trip, the
President of Peru The president of Peru (), officially the constitutional president of the Republic of Peru (), is the head of state and head of government of Peru. The president is the head of the executive branch and is the supreme head of the Peruvian Armed ...
,
Pedro Castillo José Pedro Castillo Terrones (; born 19 October 1969) is a Peruvian politician, former elementary school teacher, and union leader who served as the President of Peru from 28 July 2021 until Third impeachment and removal of Pedro Castillo, he ...
, spoke at the
seventy-sixth session of the United Nations General Assembly The Seventy-sixth session of the United Nations General Assembly was the session of the United Nations General Assembly which ran from 14 September 2021 to 13 September 2022. The President of the UN General Assembly is from Asia-Pacific Group. ...
on 21 September 2021, proposing the creation of an international
treaty A treaty is a formal, legally binding written agreement between sovereign states and/or international organizations that is governed by international law. A treaty may also be known as an international agreement, protocol, covenant, convention ...
signed by world leaders and
pharmaceutical companies The pharmaceutical industry is a Medicine, medical industry that discovers, develops, produces, and markets pharmaceutical goods such as medications and medical devices. Medications are then administered to (or Self-medicate, self-administered b ...
to guarantee universal vaccine access, arguing that "The battle against the pandemic has shown us the failure of the international community to cooperate under the principle of solidarity." 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 booster doses was extended to vaccinate as many people as early as possible. Many countries are starting to give an additional booster shot to the immunosuppressed and the elderly, and research predicts an additional benefit of personalizing vaccine doses in the setting of limited vaccine availability when a wave of virus Variants of Concern hits a country. Despite the extremely rapid development of effective
mRNA In molecular biology, messenger ribonucleic acid (mRNA) is a single-stranded molecule of RNA that corresponds to the genetic sequence of a gene, and is read by a ribosome in the process of Protein biosynthesis, synthesizing a protein. mRNA is ...
and
viral vector vaccine A viral vector vaccine is a vaccine that uses a viral vector to deliver genetic material (DNA) that can be transcribed by the recipient's host cells as mRNA coding for a desired protein, or antigen, to elicit an immune response. , six viral vector ...
s,
vaccine equity Vaccine equity means ensuring that everyone in the world has equal access to vaccines. The importance of vaccine equity has been emphasized by researchers and public health experts during the COVID-19 pandemic but is relevant to other illnesses and ...
has not been achieved. The World Health Organization called for 70 percent of the global population to be vaccinated by mid-2022, but as of March 2022, it was estimated that only one percent of the 10 billion doses given worldwide had been administered in low-income countries. An additional 6 billion vaccinations may be needed to fill vaccine access gaps, particularly in developing countries. Given the projected availability of newer vaccines, the development and use of
whole inactivated virus An inactivated vaccine (or killed vaccine) is a type of vaccine that contains pathogens (such as virus or bacteria) that have been killed or rendered inactive, so they cannot replicate or cause disease. In contrast, live vaccines use pathogens ...
(WIV) and protein-based vaccines are also recommended. Organizations such as the
Developing Countries Vaccine Manufacturers Network The Developing Countries Vaccine Manufacturers Network (DCVMN International) is a voluntary non-partisan public health alliance of health organizations and vaccine manufacturers. DCVMN aims to protect people globally against known and emerging in ...
could help to support the production of such vaccines in developing countries, with lower production costs and greater ease of deployment. While vaccines substantially reduce the probability and severity of infection, it is still possible for fully vaccinated people to contract and spread COVID19. 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.


Economics

Vaccine inequity damages the global economy, disrupting the global
supply chain A supply chain is a complex logistics system that consists of facilities that convert raw materials into finished products and distribute them to end consumers or end customers, while supply chain management deals with the flow of goods in distri ...
. Most vaccines were reserved for wealthy countries; , some countries have more vaccines than are needed to fully vaccinate their populations. When people are under-vaccinated, needlessly die, experience disability, and live under lockdown restrictions, they cannot supply the same goods and services. This harms the economies of under-vaccinated and over-vaccinated countries alike. Since rich countries have larger economies, rich countries may lose more money to vaccine inequity than poor ones, though the poor ones will lose a higher percentage of
GDP Gross domestic product (GDP) is a monetary measure of the total market value of all the final goods and services produced and rendered in a specific time period by a country or countries. GDP is often used to measure the economic performance o ...
and experience longer-term effects. High-income countries would profit an estimated US$4.80 for every $1 spent on giving vaccines to lower-income countries. The
International Monetary Fund The International Monetary Fund (IMF) is a major financial agency of the United Nations, and an international financial institution funded by 191 member countries, with headquarters in Washington, D.C. It is regarded as the global lender of las ...
sees the vaccine divide between rich and poor nations as a serious obstacle to a global economic recovery. Vaccine inequity disproportionately affects refuge-providing states, as they tend to be poorer, and refugees and displaced people are economically more vulnerable even within those low-income states, so they have suffered more economically from vaccine inequity.


Liability

Several governments agreed to shield pharmaceutical companies like
Pfizer Pfizer Inc. ( ) is an American Multinational corporation, multinational Pharmaceutical industry, pharmaceutical and biotechnology corporation headquartered at The Spiral (New York City), The Spiral in Manhattan, New York City. Founded in 184 ...
and
Moderna Moderna, Inc. ( ) is an American pharmaceutical and biotechnology company based in Cambridge, Massachusetts, that focuses on RNA therapeutics, primarily mRNA vaccines. These vaccines use a copy of a molecule called messenger RNA (mRNA) to carry inst ...
from
negligence Negligence ( Lat. ''negligentia'') is a failure to exercise appropriate care expected to be exercised in similar circumstances. Within the scope of tort law, negligence pertains to harm caused by the violation of a duty of care through a neg ...
claims related to COVID19 vaccines (and treatments), as in previous pandemics, when governments also took on liability for such claims. In the US, these liability shields took effect on 4 February 2020, when the US Secretary of Health and Human Services,
Alex Azar Alex Michael Azar II (; born June 17, 1967) is an American attorney, businessman, lobbyist, and former pharmaceutical executive who served as the 24th U.S. secretary of health and human services from 2018 to 2021. He was also chairman of the W ...
, published a notice of declaration under the
Public Readiness and Emergency Preparedness Act In public relations and communication science, publics are groups of individual people, and the public (a.k.a. the general public) is the totality of such groupings. This is a different concept to the sociological concept of the ''Öffentlichkei ...
(PREP Act) for medical countermeasures against COVID19, covering "any vaccine, used to treat, diagnose, cure, prevent, or mitigate COVID19, 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 cannot be sued for
money damages At common law, damages are a remedy in the form of a monetary award to be paid to a claimant as compensation for loss or injury. To warrant the award, the claimant must show that a breach of duty has caused foreseeable loss. To be recognized at l ...
for any injuries that occur between 2020 and 2024 from the administration of vaccines and treatments related to COVID19. The declaration is effective in the United States through 1October 2024. In December 2020, the UK government granted Pfizer legal
indemnity In contract law, an indemnity is a contractual obligation of one party (the ''indemnitor'') to compensate the loss incurred by another party (the ''indemnitee'') due to the relevant acts of the indemnitor or any other party. The duty to indemni ...
for its COVID19 vaccine. In the European Union, the COVID19 vaccines were granted a conditional marketing authorization, which does not exempt manufacturers from civil and administrative liability claims. The EU conditional marketing authorizations were changed to standard authorizations in September 2022. 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. The
Bureau of Investigative Journalism The Bureau of Investigative Journalism, typically abbreviated to TBIJ or "the Bureau", is a nonprofit news organisation based in London that was founded in 2010 to pursue "public interest" investigations. The Bureau works with publishers and bro ...
, 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 what was expected from other countries, such as the US. 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. On 13 December 2022, the governor of Florida,
Ron DeSantis Ronald Dion DeSantis (; born September 14, 1978) is an American politician, attorney, and former United States Navy, naval officer serving as the 46th List of governors of Florida, governor of Florida since 2019. A member of the Republican Pa ...
, said that he would petition the state supreme court to convene a grand jury to investigate possible violations in respect to COVID19 vaccines, and declared that his government would be able to get "the data whether they he companieswant to give it or not". In November 2023, the US state of Texas sued Pfizer under section 17.47 of the Texas Deceptive Trade Practices Act, alleging that the company misled the public about its COVID-19 vaccine by hiding risks while making false claims about its effectiveness. In June 2024, the US state of Kansas similarly sued Pfizer under the Kansas Consumer Protection Act, making similar allegations.


Controversy

In June 2021, a report revealed that the
UB-612 UB-612 is a COVID-19 vaccine candidate developed by , and Vaxxinity, Inc. It is a peptide vaccine. It is composed of SARS-CoV-2 S1-RBD protein and synthetic peptides representing T cell ( Th and CTL) epitopes on the nucleocapsid, spike and ...
vaccine, developed by the US-based Covaxx, was a for-profit venture initiated by Blackwater founder
Erik Prince Erik Dean Prince (born June 6, 1969) is an American businessman, investor, author, and former U.S. Navy SEAL officer, and the founder of the private military company Blackwater. He served as Blackwater's CEO until 2009 and as its chairman u ...
. In a series of text messages to Paul Behrends, the close associate recruited for the Covaxx project, Prince described the profit-making possibilities of selling the COVID19 vaccines. Covaxx provided no data from the clinical trials on safety or efficacy it conducted in Taiwan. 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 firm's sole shareholder, who handled "professional, scientific and technical activities", was Erik Prince. In March 2021, Covaxx raised $1.35 billion in a private placement.


Misinformation and hesitancy

The
United States Department of Defense The United States Department of Defense (DoD, USDOD, or DOD) is an United States federal executive departments, executive department of the federal government of the United States, U.S. federal government charged with coordinating and superv ...
(DoD) undertook a
disinformation Disinformation is misleading content deliberately spread to deceive people, or to secure economic or political gain and which may cause public harm. Disinformation is an orchestrated adversarial activity in which actors employ strategic dece ...
campaign in the Philippines, later expanded to Central Asia and the Middle East, which sought to discredit China, in particular its
Sinovac Sinovac Biotech Ltd. () is a Chinese biopharmaceutical company based in Haidian District, Beijing that focuses on the research, development, manufacture, and commercialization of vaccines that protect against human infectious diseases. The com ...
vaccine, disseminating hashtags of #ChinaIsTheVirus and posts claiming that the Sinovac vaccine contained gelatin from pork and therefore was ''
haram ''Haram'' (; ) is an Arabic term meaning 'taboo'. This may refer to either something sacred to which access is not allowed to the people who are not in a state of purity or who are not initiated into the sacred knowledge; or, in direct cont ...
'' or forbidden for purposes of Islamic law.


See also

* COVID‑19 drug development * COVID‑19 drug repurposing research


Notes


References


Further reading

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Vaccine protocols

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External links

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