Revealed: EVERYTHING you need to know about Pfizer’s Covid vaccine, from the science behind how the 95% effective jab works, how it costs five times more than Oxford’s, and the list of the 50 hospitals ready to begin roll-out next week

Britain’s regulators today approved Pfizer/BioNTech’s Covid vaccine, paving the way for mass-vaccination to start within days.

Officials said the jab will be made available ‘from next week’ as Health Secretary Matt Hancock declared the end of the pandemic was now ‘in sight’.

Here, MailOnline answers all the questions about the jab, including who will get it first, how much it costs and where people will be vaccinated.

How many doses of the Pfizer has the UK bought?  

The UK has secured 40million doses of the Pfizer/BioNTech vaccine, with 10million due in the UK by the end of the year. Matt Hancock revealed 800,000 doses will be available next week.

Patients need two doses, meaning Number 10 has only secured enough doses for around a third of Britain. 

However, it is likely other vaccines, including one from Oxford University that the UK has bought 100million doses of, will be approved in the coming weeks and months.

How long does it protect you for?

Regulators today said there was evidence of ‘partial immunity’ just seven days after the first dose, offering a glimmer of hope that the roll-out beginning next week may have an effect before Christmas.

But they insisted the best immunity comes seven days after the second dose, which is given three weeks after the first.

It remains a mystery as to how long immunity against Covid lasts for, with top scientists warning that people may need to be vaccinated against the disease every winter, like the flu. 

How will a vaccine be rolled out?

Work was going on behind the scenes to ensure that NHS staff were ready to start delivering vaccines to the most vulnerable from the start of December. 

Nightingale Hospitals and sports stadiums have been prepared as sites for mass vaccination clinics, while GPs and pharmacists will also be involved in the mammoth Army-backed operation to deliver the jab.

Mr Hancock also told Sky News that ’50 hospitals across the country are already set up and waiting to receive the vaccine as soon as it’s approved’.   

New regulations allowing more healthcare workers — and NHS volunteers — to administer flu and potential Covid-19 vaccines have also been introduced by the Government. They will be supervised by a healthcare professional.

NHS England last night published its full contract specification for GP practices delivering Covid jabs.This stated that they must be able to operate from 8am to 8pm, seven days a week including bank holidays when required for reasons such as needing to use up supplies of a vaccine without wasting any.

A letter sent to all practices suggests that it may be necessary for some staff to vaccinate patients on Christmas Day. Vaccination sites are expected to be able to deliver at least around 1,000 jabs per week. The contract to vaccinate begins next Tuesday and GPs will be paid £25.16 for every two jabs they administer.

Volunteers without medical training can put themselves forward through the GoodSAM app to give injections working with St John Ambulance. The role description states: ‘Volunteer vaccinators will be trained to deliver a vaccination to a patient. They will also be ready to act if a patient has an adverse reaction.’

People are also being sought to act as vaccination care volunteers. They will help patients get to the right place for their jab and be on hand to provide first aid if anyone becomes unwell.

Volunteer patient advocates, the third type of helper, will ‘concentrate on the welfare of patients through their experience’. 

What type of vaccine is this?

The jab is known as a messenger RNA (mRNA) vaccine.

Conventional vaccines are produced using weakened forms of the virus, but mRNAs use only the virus’s genetic code.

An mRNA vaccine is injected into the body where it enters cells and tells them to create antigens. These antigens are recognised by the immune system and prepare it to fight coronavirus.

What are the advantages of this type of vaccine?

No actual virus is needed to create an mRNA vaccine. This means the rate at which it can be produced is dramatically accelerated. As a result, mRNA vaccines have been hailed as potentially offering a rapid solution to new outbreaks of infectious diseases.

In theory, they can also be modified reasonably quickly if, for example, a virus develops mutations and begins to change. mRNA vaccines are also cheaper to produce than traditional vaccines, although both will play an important role in tackling Covid-19.

Are there any downsides? 

One downside to mRNA vaccines is that they need to be stored at ultra-cold temperatures and cannot be transported easily.

Pfizer’s Covid vaccine must be stored at minus 70C — about four times colder than a household freezer — in special suitcase-like storage boxes. Special GPS trackers will mean that the temperature of the Pfizer/BioNTech vaccine can be remotely monitored to ensure it stays at the correct heat to keep it effective.

Details of how the vaccine could be transported and stored emerged following concerns that the NHS may face difficulties handling a vaccine which needs to be stored at minus 70C.

Chris Hopson, chief executive of NHS Providers, said: ‘The logistics of administering the Pfizer/BioNTech jab are formidable.’  

Mr Hancock said while rollout was not ‘easy’, he was confident that the NHS can deliver the vaccine despite the logistics involved.

Pfizer has designed a suitcase-sized container that will keep the doses at minus 70C for up to 10 days using dry ice.

Each of the containers, dubbed ‘shippers’, holds around 1,000 doses and will be fitted with thermal sensors to enable the pharmaceutical giant to track the location and temperature of the frozen vaccine vials.

The thermal shipping systems can be recharged with dry ice if needed, Pfizer said. Vaccines will be shipped by air and road, but not boat due to the time constraints.

And once the vaccine has been transported it can be stored in a fridge for up to five days at 2-8C – which is entirely feasible in a standard medicine fridge at a GP practice. 

Are they safe?

All vaccines undergo rigorous testing and have oversight from experienced regulators.

Some believe mRNA vaccines are safer for the patient as they do not rely on any element of the virus being injected into the body. mRNA vaccines have been tried and tested in the lab and on animals before moving to human studies.

The human trials of mRNA vaccines – involving tens of thousands of people worldwide – have been going on since early 2020 to show whether they are safe and effective.

Pfizer will continue to collect safety and long-term outcomes data from participants for two years.

 

WHICH HOSPITALS WILL GET THE VACCINE FIRST? 

Who is top of the list to get a coronavirus vaccine?

The Joint Committee on Vaccination and Immunisation (JCVI) has examined data on who suffers the worst outcomes from coronavirus and who is at highest risk of death. 

The JCVI’s guidance says the order of priority should be the below.

1. Residents in a care home for older adults and their carers 

2. All those who are 80 years of age and over and frontline health and social care workers

3. All those who are 75 years of age and over

4. All those who are 70 years of age and over and clinically extremely vulnerable individuals, excluding pregnant women and those under 18 years of age

5. All those who are 65 years of age and over

6. Adults aged 18 to 65 years in an at-risk group, such as the morbidly obese

7. All those aged 60 and over

8. All those aged 55 and over

9. All those aged 50 and over

Don’t vaccines take a long time to produce?

In the past it has taken years, sometimes decades, to produce a vaccine.

Traditionally, vaccine development includes various processes, including design and development stages followed by clinical trials – which in themselves need approval before they even begin.

But in the trials for a Covid-19 vaccine, things look slightly different. A process which usually takes years has been condensed to months.

While the early design and development stages look similar, the clinical trial phases overlap, instead of taking place sequentially.

And pharmaceutical firms have begun manufacturing before final approval has been granted – taking on the risk that they may be forced to scrap their work.

The new way of working means that regulators around the world can start to look at scientific data earlier than they traditionally would do.

Aren’t there other vaccines?

Yes, recent data from the Oxford/AstraZeneca, and Moderna vaccine trials suggests their candidates also have high efficacy.

Oxford data indicates the vaccine has 62 per cent efficacy when one full dose is given followed by another full dose.

But when people were given a half dose followed by a full dose at least a month later, its efficacy rose to 90 per cent, according to data. But the breakthrough results from trials of Oxford University’s vaccine were based on ‘shaky science’, experts have warned.

The combined analysis from both dosing regimes resulted in an average efficacy of 70.4 per cent.

Final results from the trials of Moderna’s vaccine suggest it has 94.1 per cent efficacy, and 100 per cent efficacy against severe Covid-19.

Nobody who was vaccinated with the vaccine known as mRNA-1273 developed severe coronavirus.

Pictured: A graph showing vaccine orders made by the EU, US, Canada, UK, Japan and Australia. The UK has ordered 40 million units of the Pfizer/BioNTech vaccine

Which jab is best?

The early contenders all have high efficacy rates, but researchers say it is difficult to make direct comparisons because it is not yet known exactly what everyone is measuring in the trials.

Analysis shows the Pfizer vaccine can prevent 95 per cent of people from getting Covid-19, including 94 per cent in older age groups. 

A technician inspects vials of coronavirus disease (COVID-19) vaccine candidate BNT162b2 at a Pfizer manufacturing site in manufacturing site in St. Louis, Missouri

The vaccine has been tested on 43,500 people in six countries and no safety concerns were raised. Approval means the UK can begin rolling out the vaccine to those most in need, including frontline NHS workers. 

How many doses has the UK secured?

The UK has secured access to 100million doses of the AstraZeneca/Oxford University vaccine, which is almost enough for most of the population.

It also belatedly struck a deals for seven million doses of the jab on offer from Moderna in the US.

The deals for 357million doses of seven different vaccines cover four different classes: adenoviral vaccines, mRNA vaccines, inactivated whole virus vaccines and protein adjuvant vaccines.  

HOW DO THE OXFORD, MODERNA AND PFIZER/BIONTECH VACCINES COMPARE? 

Moderna and Pfizer/BioNTech have both released interim results of the final stage clinical trials of their vaccines, with both suggesting they are extremely effective. 

Oxford University has published the findings from its second phase, which show the jab provokes an immune response and is safe to use – it is not yet clear how well it protects against coronavirus in the real world.

Here’s how they compare: 

CREATOR:

MODERNA (US)

PFIZER (US) & BIONTECH (DE)

OXFORD UNIVERSITY (UK)

How it works: 

mRNA vaccine – Genetic material from coronavirus is injected to trick immune system into making ‘spike’ proteins and learning how to attack them.

mRNA vaccine – both Moderna’s and Pfizer and BioNTech’s vaccines work in the same way.

Recombinant viral vector vaccine – a harmless cold virus taken from chimpanzees was edited to produce the ‘spike’ proteins and look like the coronavirus.

How well does it work?

94.5% effective (90 positive in placebo group, 5 positive in vaccine group) .

95% effective (160 positive in placebo group, 8 positive in vaccine group).

62% – 90% effective, depending on dosing.

How much does it cost?

Moderna confirmed it will charge countries placing smaller orders, such as the UK’s five million doses, between £24 and £28 per dose. US has secured 100million doses for $1.525billion (£1.16bn), suggesting it will cost $15.25 (£11.57) per dose.

The US will pay $1.95bn (£1.48bn) for the first 100m doses, a cost of $19.50 (£14.80) per dose.

Expected to cost £2.23 per dose. The UK’s full 100m dose supply could amount to just £223million.

Can we get hold of it?

UK has ordered five million doses which will become available from March 2021. Moderna will produce 20m doses this year, expected to stay in the US. 

UK has already ordered 40million doses, of which 10million could be available in 2020. First vaccinations expected in December.

UK has already ordered 100million doses and is expected to be first in line to get it once approved.

What side effects does it cause? 

Moderna said the vaccine is ‘generally safe and well tolerated’. Most side effects were mild or moderate but included pain, fatigue and headache, which were ‘generally’ short-lived. 

Pfizer and BioNTech did not produce a breakdown of side effects but said the Data Monitoring Committee ‘has not reported any serious safety concerns’.

Oxford said there have been no serious safety concerns. Mild side effects have been relatively common in small trials, with many participants reporting that their arm hurt after the jab and they later suffered a headache, exhaustion or muscle pain. More data is being collected.

How much does it cost?

Pfizer/BioNTech is making its vaccine available not-for-profit.

According to reports, the Moderna vaccine could cost about 38 dollars (£28) per dose and the Pfizer candidate could cost around 20 dollars (£15).

Researchers suggest the Oxford vaccine could be relatively cheap to produce, with some reports indicating it could be about £3 per dose.

AstraZeneca said it will not sell it for a profit, so it can be available to all countries.

However, the details of the deals made by the UK Government have not been made public.

How has this come about so quickly? 

Traditionally vaccines can take years to research and develop.

The timetable for developing and approving a Covid vaccine has been condensed due to the coronavirus crisis.

What is the usual process for developing a vaccine?

Traditionally vaccine development takes several years and includes various processes, including design and development stages followed by clinical trials – which in themselves need approval before they even begin.

The trials take place in three sequential stages – also known as phases. The research will show whether a vaccine generates antibodies but also protects people from disease. They will also identify any safety issues.

Once the trials are complete, the information gathered by researchers is sent to regulators for review. This is thoroughly analysed by clinicians and scientists before being approved for widespread use. Then, after approval from regulators, people can start to receive the vaccine.

Is this different because of the pandemic?

The process looks slightly different in the trials for a Covid vaccine.

While the early design and development stages look similar, the clinical trial phases have overlapped – instead of taking place sequentially.

But won’t that mean that safety is compromised?

Even though some phases of the clinical trial process have run in parallel rather than one after another, the safety checks have still been the same as they would for any new medicine.

The Medicines and Healthcare products Regulatory Agency (MHRA) has adopted the phrase ‘safety is our watchword’.

Regulators have said they will ‘rigorously assess’ the data and evidence submitted on the vaccine’s safety, quality and effectiveness.

And, in most clinical trials, any safety issues are usually identified in the first two to three months – a period which has already lapsed for most vaccine front-runners.

How are regulators acting so quickly?

Regulators have been carrying out ‘rolling reviews’, which means that instead of going through reams of information at the conclusion of the trials, they have been given access to the data as the scientists work.

A rolling review of the vaccine data started several months ago.

This means regulators can start to look at scientific data earlier than they traditionally would do, which in turn means the approval process can be sped up. Regulators sometimes have thousands of pages of information to go over with a fine-tooth comb – which understandably takes time.

Once all the data available on the vaccine is submitted, MHRA experts will carefully and scientifically review the safety, quality and effectiveness data – how it protects people from Covid-19 and the level of protection it provides.

After this has been done, advice is sought from the Government’s independent advisory body, the Commission on Human Medicines (CHM).

What does ‘approved for use’ mean?

For a medicine to be used in the UK it has to be granted a licence. This means that it has been through all the rigorous safety and efficacy checks and regulators are confident in the findings of the clinical trials.

By reviewing the data as they become available, the MHRA can reach its opinion sooner on whether or not the medicine or vaccine should be licensed without compromising the thoroughness of their review.

So what data would the regulator have looked at?

The information provided to the MHRA will have included what the vaccine contains, how it works in the body, how well it works and its side-effects, and who it is meant to be used for.

This data must include the results of all animal studies and clinical trials in humans, manufacturing and quality controls, consistency in batch production, and testing of the final product specification.

The factories where the vaccines are made are also inspected before a licence can be granted to make sure that the product supplied will be of the same consistent high standard.

Husband and wife Ugur Sahin and Oezlem Tuereci are behind the Pfizer Covid-19 vaccine that could change the world

Regulators look at stacks of data before approving any vaccines (stock)

What is the difference between the MHRA and the CHM? 

The MHRA is the British regulator of medicines and medical devices, ensuring their safety, quality and effectiveness.

The CHM advises ministers on medicinal products. It is made up of an independent group of advisers responsible for advising on the need for, and content of, risk management plans for new medicines.

It also advises officials on the impact of new safety issues on the balance of risks and benefits of licensed medicines.

The CHM also offer advice on ‘applications for both national and European marketing authorisations’.

Haven’t pharmaceutical companies already started making vaccines?

Yes. Usually large-scale production and distribution begins only after regulatory approval. But in the case of Covid-19 vaccines, pharmaceutical firms have begun manufacturing before final approval had been granted – taking on the risk that they may be forced to scrap their work.

WHAT OTHER VACCINES ARE IN DEVELOPMENT ACROSS THE WORLD?

The approval of the Pfizer/BioNTech coronavirus vaccine is the first of what experts hope will be one of many options. Since the start of the pandemic, scientists around the world have been racing to develop a jab that prevents Covid-19.

There have already been a host of positive preliminary trial results for other candidates, including by AstraZeneca and Oxford University and US company Moderna.

So what do we know about other vaccine candidates being developed?

The Oxford vaccine is up to 60 per cent effective when given in two full doses, the study shows

Oxford/AstraZeneca (100million doses)

Many people are eagerly awaiting the regulatory approval of the vaccine being developed by the University of Oxford and pharmaceutical giant AstraZeneca.

The UK has placed orders for 100million doses of the Oxford vaccine – enough to vaccinate most of the population – with a rollout expected in the coming weeks if the jab is approved by the MHRA.

Oxford data indicates the vaccine has 62 per cent efficacy when one full dose is given followed by another full dose, but when people were given a half dose followed by a full dose at least a month later, its efficacy rose to 90 per cent.

The combined analysis from both dosing regimes resulted in an average efficacy of 70.4 per cent.

Moderna (7million doses)

Final results from the trials of Moderna’s vaccine suggest it has 94.1 per cent efficacy, and 100 per cent efficacy against severe Covid-19.

Nobody who was vaccinated with the vaccine known as mRNA-1273 developed severe coronavirus.

Moderna said the trial results indicate the jab is generally well tolerated with no serious safety concerns.

The US company is in the process of seeking regulatory approval for its vaccine with regulators across the world. If approved for use in the UK, it could be rolled out in the spring.

This vaccine is still in clinical trials and is yet to be approved

Novavax (60million doses)

The UK is supporting and providing infrastructure to Novavax in running a phase three clinical trial. The plans are to manufacture the vaccine in the UK with Fujifilm Diosynth Biotechnologies.

Clinical data for early phases of the trial suggested the vaccine triggers an immune response greater than that in patients who have recovered from the disease.

The company’s ongoing phase three clinical trial in the UK to evaluate the efficacy, safety and immunogenicity of NVX-CoV2373 is expected to be fully enrolled by the end of November.

Depending on the overall Covid-19 attack rate, interim data in the UK trial, which is also event-driven, are expected as soon as in the first quarter of next year.

Janssen (30million doses)

Phase three trials of the Janssen vaccine started in mid-November with the aim of enrolling 6,000 people in the UK, and a total of 30,000 globally.

The jab has already undergone phase one and two trials, and interim analysis of the single-dose study suggests the Covid-19 vaccine candidate induces a robust immune response and is generally well-tolerated.

The UK researchers say the timing of results for their study will depend on global recruitment to the trial and the incidence of Covid-19.

They add that recent vaccine trials suggest it generally takes six to nine months to get an outcome, but it could be longer for trials starting out now.

Imperial College London (no doses)

The Imperial College London vaccine is in phase one of clinical testing, where doses are being given to a small group of people to determine whether it is safe and to learn more about the immune response it provokes.

Professor Robin Shattock, who is leading Imperial’s vaccine effort, said data on its efficacy will be available in the middle of next year.

Valneva (60million doses)

Valneva’s site in Livingston, West Lothian, will manufacture the vaccine, and clinical trials are expected to start before the end of the year. The company anticipates that it could potentially reach a first regulatory approval in the second half of 2021.

Russia (no doses)

Second interim trial data for Russia’s Sputnik V vaccine suggests the jab provides 91.4 per cent protection 28 days after the first dose and the researchers say the figure is as high as 95 per cent 42 days after the first dose.

The Russian Direct Investment Fund – which is the country’s sovereign wealth fund – said that the vaccine will cost less than 10 dollars (£7) per dose for international markets and is expected to become available in February 2021.

The findings, which are yet to be peer-reviewed, are from new clinical trial data based on 39 confirmed cases and 18,794 patients.

It is not clear when the Sinovac vaccine will be available

China (no doses)

Preliminary studies suggest a Chinese coronavirus vaccine candidate appears to be safe and induces an immune response in healthy volunteers.

Phase one/two trials of an inactivated Sars-CoV-2 vaccine candidate – CoronaVac – involved more than 700 healthy volunteers aged 18-59 recruited in China between April 16 and May 5.

According to preliminary results, the vaccine appeared to be safe and well tolerated at all tested doses.

Phase three trials of the vaccine are continuing. 

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