A lot has changed since Margaret Keenan arrived at University Hospital Coventry a year ago today. She was the first person on Earth to receive a coronavirus vaccine outside clinical trials; now the number is about four billion.
“The best Christmas present I could have is being in good health, having had the jab and feeling free from this horrible virus,” Keenan, 91, said on her return to the hospital to mark the anniversary. “It’s amazing how many people don’t want it. I don’t know why because they should have it . . . Everybody should have the jab. I keep saying this over and over again.”
About 50 million Britons have followed Keenan’s example, but the campaign is far from over. How should we think about the vaccine today?
What we know
There have been so many numbers and so many variables. There has been efficacy against infection, efficacy against hospitalisation, efficacy against death. There have been half doses and full doses, mixed doses and delayed doses. We have become experts on adenovirus vectors and mRNA lipids and the relative merits of both.
Really, though, all of it has been about just one set of numbers. Yesterday we recorded about 50,000 cases, the rolling average of daily deaths was a bit over 100 and we had just over 7,000 people in hospital.
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On January 12, we also recorded about 50,000 cases. Then, in the dark midwinter of our second wave, there were 1,200 deaths and 37,000 people in hospital.
That is what vaccines have done. They have cut the risk of dying from Covid tenfold. They have cut the risk of catching it too. But they haven’t, and perhaps this is a lesson we have learnt the hard way, eliminated either.
Last year Keenan received an injection of Pfizer-branded mRNA. At the same time, in the nation, we received an injection of hope. Here at last, sooner than we had dared believe and in defiance of many who said it might never happen, was our exit strategy.
The winter that followed was a curious mixture of triumph and disaster. Disaster because more people died in those three months than in the whole pandemic before. Triumph because the NHS also managed to get more injections into people than most other comparable countries. Europe caught up, but it took time.
Yet the exit has not come quite as some expected. Antibodies wane, just as hope wanes. Scientists always told us infections were inevitable in the vaccinated. So too was serious illness: no vaccine is perfect. Scientists also told us that if we did not vaccinate globally and try to stop transmission everywhere, the pandemic would not be over anywhere. These two messages did not always go in.
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In retrospect, though, it was not absurd to have hoped for a bit more. With Keenan’s injection this time last year humanity crossed a threshold in its response to the virus. At around the same time, silently, the virus crossed a threshold in its response to humanity. It mutated to become what we then called the Kent variant.
In horror movies, just when you think the monster is finally dead, it returns for one final scare. A year into the pandemic, that was what this variant felt like. But it was a beginning rather than an end: alpha, not omega. It, and the Delta variant that followed, changed everything.
By raising the herd immunity threshold, they all but guaranteed we could not vaccinate our way out of transmission. Cases would continue at a high level.
A year on, the monster is still with us and still mutating. With luck, Omicron really will be its final scare. But if it isn’t, even if we have to wearily go once more unto the breach, nothing has changed. Whatever comes next our best weapon has been, and will remain, the vaccine.
A year of breakthroughs
December 8, 2020: the arms race begins
Keenan, a 90-year-old British grandmother becomes the first person in the world to receive the Pfizer-BioNTech jab who is not part of a clinical trial. After being vaccinated at University Hospital in Coventry, she urges the nation to follow her lead. It is the “best thing that has ever happened,” she says. “If I can do it, you can.”
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Sir Simon Stevens, head of NHS England, calls it a “decisive turning point in the battle with the pandemic”.
The initial aim is to double-jab everyone over 18. By the end of the month 786,000 doses will have been given to over-80s, care home residents and frontline health and social care workers.
But a new virus variant means that the campaign soon has to be modified. The Joint Committee on Vaccination and Immunisation, which advises ministers, recommends that the gap between doses be extended to 12 weeks, from 8. The shift is designed to protect as many people as possible as the fast-spreading Alpha strain, first identified in Kent, sends cases soaring and casts a shadow over Christmas.
January 4, 2021: AZ arrives
Brian Pinker, an 82-year-old dialysis patient, becomes the first person to receive the Oxford-AstraZeneca vaccine. The retired maintenance manager gets his jab at Churchill Hospital, Oxford.
The AstraZeneca jab is much easier to handle than the Pfizer version, which requires ultra-cold storage. It is cheaper as well, raising hopes that it can be used widely in the developing world.
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January 29: Spat with Macron
Misinformation on the AstraZeneca vaccine provokes diplomatic tensions when President Macron of France claims that it is “quasi-ineffective” for people older than 65 — hours before the European Union drugs regulator approves it for all adults. The EU has come under fire for the sluggish start of its own immunisation campaign.
March 11
Several European nations suspend use of the AstraZeneca vaccine following reports of blood clots.
March 20
Britain sets a daily record for doses delivered at 844,285, equivalent to vaccinating all of Nottinghamshire in a day.
March 24
Boris Johnson credits the profit motive of drugmakers for the swift development of the jabs. “The reason we have the vaccine success is because of capitalism, because of greed, my friends,” he tells his party’s backbenchers in a Zoom call.
March 23
A transatlantic row flares up over the AstraZeneca vaccine as Dr Anthony Fauci, President Biden’s chief medical adviser, rebukes the British drugmaker for releasing inaccurate data. Fauci adds that the AstraZeneca jab is probably “very good”, but relations between US medical regulators and the drugmaker are strained. Even now, the jab is not used in America.
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April 7
The UK decides to offer people under 30 alternatives to the AstraZeneca jab as more evidence suggests a possible link with a rare type of blood clotting. The drugs regulator says that by the end of March, 79 people had suffered an unusual subtype of clot after vaccination, 19 of whom had died. Jonathan Van-Tam describes the decision as a “course correction” that should not slow down the wider rollout.
June 6
Boris Johnson urges G7 leaders to “defeat Covid” by vaccinating the world by the end of 2022.
June 9
Fifty per cent of Britons aged 12 and over are confirmed to be double jabbed.
June 21
Seventy-five per cent are recorded to have received a first dose.
June 28
Public Health England estimates that 7 million infections and 27,000 lives have been saved in England alone thanks to the vaccination programme so far.
August 4
The JCVI advises that all 16 and 17-year-olds should be offered a first dose of the Pfizer vaccine.
September 2
Seventy-five per cent of over-12s are double jabbed
September 13
The chief medical officers of England, Wales, Scotland and Northern Ireland decide that 12-15 year olds should get a first dose of the Pfizer jab. The build-up is unusual, with the JCVI — which would normally make the call — having said 11 days earlier that the “benefits from vaccination are marginally greater than the potential known harms” but that the margin of benefit was too small “to support advice on a universal programme of vaccination of otherwise healthy 12 to 15-year-old children at this time”. Experts voice frustration that the go-ahead was not given earlier as cases stay stubbornly high, driven largely by infections among children.
Boosters begin
September 16
Nine months after the very first doses were administered, booster shots begin but are restricted to the over-50s and other vulnerable groups. The levels of protection given by the first two doses are waning but trial results will show that a third shot rallies the immune system, with levels of antibodies (which can prevent infections) and T-cells (which help guard against severe disease) both increasing. The effects will soon be seen in falling hospitalisation rates. But the booster campaign is criticised for a slow start, with the numbers receiving the jab falling far short of those eligible.
November 29
Days after a new variant is discovered with, in the words of one South African scientist, a “constellation” of troubling mutations, Albert Bourla, the CEO of Pfizer, says his company is working on a tweaked version of the vaccine. It will target the newly-designated Omicron variant, and the company claims it can be ready in 100 days.
November 30
The government says that all adults will be given boosters and that the interval between the second and third doses will be cut from six to three months. The aim is to offer all adults a booster by the end of January 2022, although the new policies have not yet been acted on. Second doses will also be available to 12-15 year olds, twelve weeks after their first dose. Boris Johnson promises that “temporary vaccine centres will be popping up like Christmas trees”, adding that 400 military personnel and a “jabs army of volunteers” will help.
December 8
The heavily-mutated Omicron variant appears to be spreading quickly. About 90 per cent of over-12s have had at least one dose; 81 per cent have had two and 36 per cent have had three. The promised acceleration of the booster campaign is yet to reach full speed.