COVID-19 vaccine

See also: List of COVID-19 vaccine authorizations

COVID-19 vaccination doses administered per 100 people

Map of countries by approval status

  Approved for general use, mass vaccination underway

  EUA (or equivalent) granted, mass vaccination underway

  EUA granted, limited vaccination

  Approved for general use, mass vaccination planned

  EUA granted, mass vaccination planned

  EUA pending

  No data available

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of April 2021, 13 vaccines are authorized by at least one national regulatory authority for public use: two RNA vaccines (Pfizer–BioNTech and Moderna), five conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, WIBP-CorV and CoviVac), four viral vector vaccines (Sputnik V, Oxford–AstraZeneca, Convidecia, and Johnson & Johnson), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates are in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. Stanley Plotkin and Neal Halsey wrote an article published by Oxford Clinical Infectious Diseases that urged single dose interim use in order to extend vaccination to as many people as possible until vaccine availability improved. Several other articles and media provided evidence for delaying second doses in the same line of reasoning.

As of 1 May 2021, 1.15 billion doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca anticipates producing 3 billion doses in 2021, Pfizer–BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidecia 500 million doses in 2021. By December 2020, more than ten 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.

Background

Fact sheet about COVID-19 vaccines

A US airman receiving a COVID-19 vaccine

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

According to studies published in 2005 and 2006, the identification and development of novel vaccines and medicines to treat SARS was a priority for governments and public health agencies around the world at that time. As of 2020, 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 may 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 which completed Phase I 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).

Planning and development

Main article: History of COVID-19 vaccine development

Since January 2020, vaccine development has been expedited via unprecedented collaboration in the multinational pharmaceutical industry and between governments. According to the Coalition for Epidemic Preparedness Innovations (CEPI), the geographic distribution of COVID‑19 vaccine development puts North American entities having about 40% of the activity compared to 30% in Asia and Australia, 26% in Europe, and a few projects in South America and Africa.

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 COVID-19 vaccine development.

The urgency to create a vaccine for COVID‑19 led to compressed schedules that shortened the standard vaccine development timeline, in some cases combining clinical trial steps over months, a process typically conducted sequentially over years.

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

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

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

Organizations

Internationally, the Access to COVID-19 Tools Accelerator is a G20 and World Health Organization (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"), 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 Phase II and III clinical trials, and determine harmonized Phase III protocols for all vaccines achieving the pivotal trial stage.

National governments have also been involved in vaccine development. Canada announced funding for 96 research vaccine research projects at Canadian companies and universities, with plans to establish a "vaccine bank" that could be used if another coronavirus outbreak occurs, and to support clinical trials and develop manufacturing and supply chains for vaccines. China provided low-rate loans to a vaccine developer through its central bank 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. Great Britain formed a COVID‑19 vaccine task force in April 2020 to stimulate local efforts for accelerated development of a vaccine through collaborations of industry, universities, and government agencies. It encompassed every phase of development from research to manufacturing. In the United States, the Biomedical Advanced Research and Development Authority (BARDA), a federal agency funding disease-fighting technology, announced investments to support American COVID‑19 vaccine development and manufacture of the most promising candidates. In May 2020, the government announced funding for a fast-track program called Operation Warp Speed.

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

History

This section is an excerpt from History of COVID-19 vaccine development[edit]

COVID‑19 vaccine research samples in a NIAID lab freezer (30 January 2020)

After the coronavirus was isolated in late 2019, its genetic sequence was published on 11 January 2020, triggering an urgent international response to prepare for an outbreak and hasten development of a preventive COVID-19 vaccine. Since early 2020, vaccine development has been expedited via unprecedented collaboration in the multinational pharmaceutical industry and between governments. By June 2020, tens of billions of dollars were invested by corporations, governments, international health organizations, and university research groups to develop dozens of vaccine candidates and prepare for global vaccination programs to immunize against COVID‑19 infection. According to the Coalition for Epidemic Preparedness Innovations (CEPI), the geographic distribution of COVID‑19 vaccine development puts North American entities having about 40% of the activity compared to 30% in Asia and Australia, 26% in Europe, and a few projects in South America and Africa.

In February 2020, the WHO said it did not expect a vaccine against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the causative virus, to become available in less than 18 months. The rapidly growing infection rate of COVID‑19 worldwide during early 2020 stimulated international alliances and government efforts to urgently organize resources to make multiple vaccines on shortened timelines, with four vaccine candidates entering human evaluation in March (see the table of clinical trials started in 2020, below).

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

The Pfizer–BioNTech partnership submitted an EUA request to the FDA for the mRNA vaccine BNT162b2 (active ingredient tozinameran) on 20 November 2020. On 2 December 2020, the United Kingdom's Medicines and Healthcare products Regulatory Agency (MHRA) gave temporary regulatory approval for the Pfizer–BioNTech vaccine, becoming the first country to approve this vaccine and the first country in the Western world to approve the use of any COVID‑19 vaccine. As of 21 December, many countries and the European Union have authorized or approved the Pfizer–BioNTech COVID‑19 vaccine. Bahrain and the United Arab Emirates granted emergency marketing authorization for BBIBP-CorV, manufactured by Sinopharm. On 11 December 2020, the United States Food and Drug Administration (FDA) granted an Emergency Use Authorization (EUA) for the Pfizer–BioNTech COVID‑19 vaccine. A week later, they granted an EUA for mRNA-1273, the Moderna vaccine.

On March 31, 2021, the Russian government announced that they had registered the first COVID-19 vaccine for animals.

Vaccine types

Conceptual diagram showing three vaccine types for forming SARS‑CoV‑2 proteins to prompt an immune response: (1) RNA vaccine, (2) subunit vaccine, (3) viral vector vaccine

Vaccine platforms being employed for SARS-CoV-2. Whole virus vaccines include both attenuated and inactivated forms of the virus. Protein and peptide subunit vaccines are usually combined with an adjuvant in order to enhance immunogenicity. The main emphasis in SARS-CoV-2 vaccine development has been on using the whole spike protein in its trimeric form or components of it, such as the RBD region. Multiple non-replicating viral vector vaccines have been developed, particularly focused on adenovirus; while there has been less emphasis on the replicating viral vector constructs.

As of January 2021, nine different technology platforms – with the technology of numerous candidates remaining undefined – are under research and development to create an effective vaccine against COVID‑19. Most of the platforms of vaccine candidates in clinical trials are focused on the coronavirus spike protein and its variants as the primary antigen of COVID‑19 infection. Platforms being developed in 2020 involved nucleic acid technologies (nucleoside-modified messenger RNA and DNA), non-replicating viral vectors, peptides, recombinant proteins, live attenuated viruses, and inactivated viruses.

Many vaccine technologies being developed for COVID‑19 are not like vaccines already in use to prevent influenza, but rather are using "next-generation" strategies for precision on COVID‑19 infection mechanisms. Several of the synthetic vaccines use a 2P mutation to lock the spike protein into its prefusion configuration, stimulating an immune response 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 COVID‑19 infection in susceptible population subgroups, such as healthcare workers, the elderly, children, pregnant women, and people with existing weakened immune systems.

RNA vaccines

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

An RNA vaccine contains RNA which, when introduced into a tissue, acts as messenger RNA (mRNA) to cause the cells to build the foreign protein and stimulate an adaptive immune response which teaches the body how to identify and destroy the corresponding pathogen or cancer cells. RNA vaccines often, but not always, use nucleoside-modified messenger RNA. The delivery of mRNA is achieved by a coformulation of the molecule into lipid nanoparticles which protect the RNA strands and help their absorption into the cells.

RNA vaccines were the first COVID-19 vaccines to be authorized in the United States and the European Union. As of January 2021, authorized vaccines of this type are the Pfizer–BioNTech COVID-19 vaccine and the Moderna COVID-19 vaccine. As of February 2021, the CVnCoV RNA vaccine from CureVac is awaiting authorization in the EU.

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

Adenovirus vector vaccines

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

As of January 2021, authorized vaccines of this type are the Oxford–AstraZeneca COVID-19 vaccine, the Sputnik V COVID-19 vaccine, Convidecia, and the Johnson & Johnson COVID-19 vaccine.

Convidecia and the Johnson & Johnson COVID-19 vaccine are both one-shot vaccines which offer less complicated logistics and can be stored under ordinary refrigeration for several months.

The Sputnik V COVID-19 vaccine uses Ad26 for the first dose, which is the same as the Johnson & Johnson vaccine's only dose, and Ad5 for the second dose. Convidecia uses Ad5 for its only dose.

Inactivated virus vaccines

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

As of January 2021, authorized vaccines of this type are the Chinese CoronaVac, BBIBP-CorV, and WIBP-CorV; the Indian Covaxin; and the Russian CoviVac. Vaccines in clinical trials include the Valneva COVID-19 vaccine.

Subunit vaccines

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

As of April 2021, the two authorized vaccines of this type are the peptide vaccine EpiVacCorona and RBD-Dimer. Vaccines with pending authorizations include the Novavax COVID-19 vaccine, SOBERANA 02 (a conjugate vaccine), and the Sanofi–GSK vaccine. The V451 vaccine was previously in clinical trials, which were terminated because it was found that the vaccine may potentially cause incorrect results for subsequent HIV testing.

Other types

Additional types of vaccines that are in clinical trials include virus-like particle vaccines, multiple DNA plasmid vaccines, at least two lentivirus vector vaccines, a conjugate vaccine, and a vesicular stomatitis virus displaying the SARS‑CoV‑2 spike protein.

Oral vaccines and intranasal vaccines are being developed and studied.

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

Efficacy

Cumulative incidence curves for symptomatic COVID‑19 infections after the first dose of the Pfizer–BioNTech vaccine (tozinameran) or placebo in a double-blind clinical trial. (red: placebo; blue: tozinameran)

Vaccine efficacy is the risk of getting the disease by vaccinated participants in a controlled trial compared with the risk of getting the disease by unvaccinated participants. An efficacy of 0% means that the vaccine does not work (identical to placebo). An efficacy of 50% means that there are half as many cases of infection as in unvaccinated individuals.

It is not straightforward to compare the efficacies of the different vaccines because the trials were run with different populations, geographies, and variants of the virus. In the case of COVID‑19, a vaccine efficacy of 67% may be enough to slow the pandemic, but this assumes that the vaccine confers sterilizing immunity, which is necessary to prevent transmission. Vaccine efficacy reflects disease prevention, a poor indicator of transmissibility of SARS‑CoV‑2 since asymptomatic people can be highly infectious. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) set a cutoff of 50% as the efficacy required to approve a COVID‑19 vaccine. Aiming for a realistic population vaccination coverage rate of 75%, and depending on the actual basic reproduction number, the necessary effectiveness of a COVID-19 vaccine is expected to need to be at least 70% to prevent an epidemic and at least 80% to extinguish it without further measures, such as social distancing.

In efficacy calculations, symptomatic COVID-19 is generally defined as having both a positive PCR test and at least one or two of a defined list of COVID-19 symptoms, although exact specifications vary between trials. The trial location also affects the reported efficacy because different countries have different prevalences of SARS-CoV-2 variants. Ranges below are 95% confidence intervals unless indicated otherwise, and all values are for all participants regardless of age, according to the references for each of the trials. By definition, the absence of a confidence interval means that the accuracy of the estimates without an associated confidence interval is unknown to the public. Efficacy against severe COVID-19 is the most important, since hospitalizations and deaths are a public health burden whose prevention is a priority. Authorized and approved vaccines have shown the following efficacies:

Vaccine	Efficacy by severity of COVID-19			Trial location	Refs
	Mild or moderate	Severe without hospitalization or death	Severe with hospitalization or death
Moderna	≈94% (89–97%)	≈100%	≈100%	United States
Pfizer–BioNTech	≈95% (90–98%)	Not reported	Not reported	Multinational
Sputnik V	≈92% (86–95%)	≈100% (94–100%)	≈100%	Russia
Oxford–AstraZeneca	≈81% (60–91%)	≈100% (97.5% CI, 72–100%)	≈100%	Multinational
	≈76% (68–82%)	≈100%	≈100%	United States
BBIBP-CorV	≈79%	≈100%	≈100%	Multinational
CoronaVac	≈78%	≈84% (58–94%)	≈100% (56–100%)	Brazil
Novavax	≈89% (75–95%)	≈100%	≈100%	United Kingdom
	≈60% (20–80%)	≈100%	≈100%	South Africa
Johnson & Johnson	≈66% (55–75%)	≈85% (54–97%)	≈100%	Multinational
	≈72% (58–82%)	≈86% (−9 to 100%)	≈100%	United States
	≈68% (49–81%)	≈88% (8–100%)	≈100%	Brazil
	≈64% (41–79%)	≈82% (46–95%)	≈100%	South Africa
Covaxin	≈78% (61–88%)	≈100%	≈100%	India
Convidecia	≈66%	≈91%	Not reported	Multinational

Effectiveness

The real-world studies of vaccine effectiveness measure to which extent a certain vaccine has succeeded in preventing COVID-19 infection, symptoms, hospitalization and death for the vaccinated individuals in a large population under routine conditions that are less than ideal.

• In Israel, among the 715,425 individuals vaccinated by the Moderna or Pfizer-BioNTech vaccines during the period 20 December 2020, to 28 January 2021, it was observed for the period starting seven days after the second shot, that only 317 people (0.04%) became sick with mild/moderate Covid-19 symptoms and only 16 people (0.002%) were hospitalized.
• The Pfizer-BioNTech and Moderna Covid-19 vaccines provide highly effective protection, according to a report from the US Centers for Disease Control and Prevention. Under real-world conditions, mRNA vaccine effectiveness of full immunization (≥14 days after second dose) was 90% against SARS-CoV-2 infections regardless of symptom status; vaccine effectiveness of partial immunization (≥14 days after first dose but before second dose) was 80%.
• 15,121 health care workers from 104 hospitals in England, that all had tested negative for COVID-19 antibodies prior of the study, were followed by RT-PCR tests twice a week from 7 December 2020 to 5 February 2021, during a time when lineage B.1.1.7 was in circulation as the dominant variant. The study compared the positive results for the 90.7% vaccinated share of their cohort with the 9.3% unvaccinated share, and found that the Pfizer-BioNTech vaccine reduced all infections (including asymptomatic), by 72% (58-86%) three weeks after the first dose and 86% (76-97%) one week after the second dose.
• A study of the general population in Israel conducted from 17 January to 6 March 2021, during a time when lineage B.1.1.7 was in circulation as the dominant variant, found that the Pfizer vaccine reduced asymptomatic COVID-19 infections by 94% and symptomatic COVID-19 infections by 97%.
• A study, among pre-surgical patients across the Mayo Clinic system in the United States, showed that mRNA vaccines were 80% protective against asymptomatic infections.
• The director of the China Center for Disease Control, Gao Fu, admitted that Chinese vaccines "don't have very high protection rates" at a conference held on 10 April 2021. The CoronaVac vaccine developed by Sinovac, a private company, was found to have an efficacy rate of just 50.4% in clinical trials in Brazil. Another trial in Turkey showed it was 83.5% effective. State-owned Sinopharm said its two vaccines have efficacy rates of 79.4% and 72.5%.

Vaccine	Effectiveness by severity of COVID-19			Study location	Refs
	Asymptomatic	Symptomatic	Death
Pfizer–BioNTech	≈86% (76–97%)		Not reported	United Kingdom
	≈90% (68–97%)		≈100%	United States
	≈94%	≈97%		Israel
Moderna	≈90% (68–97%)		≈100%	United States
CoronaVac	Not reported	≈67% (65–69%)	≈80% (73–86%)	Chile
Sputnik V	Not reported	≈98%	Not reported	Russia

Variants

Play media

World Health Organization video describing how variants proliferate in unvaccinated areas.

See also: Variants of SARS-CoV-2

Further information: 501.V2 variant § Vaccine evasion

The potential emergence of a SARS-CoV-2 variant that is moderately or fully resistant to the antibody response elicited by the current generation of COVID-19 vaccines may necessitate modification of the vaccines. Trials indicate many vaccines developed for the initial strain have lower efficacy for some variants against symptomatic COVID-19. As of February 2021, the US Food and Drug Administration believed that all FDA authorized vaccines remained effective in protecting against circulating strains of SARS-CoV-2.

B.1.1.7 variant

In December 2020, a new SARS‑CoV‑2 variant, B.1.1.7, was identified in the UK.

Early results suggest protection to the UK variant from the Pfizer-BioNTech and Moderna vaccines.

One study indicated that the Oxford–AstraZeneca COVID-19 vaccine had an efficacy of 42–89% against the B.1.1.7 variant, versus 71–91% against non-B.1.1.7 variants.

Preliminary data from a clinical trial indicates that the Novavax vaccine is ~96% effective for symptoms against the original variant and~86% against B.1.1.7.

An April 2021 letter to The New England Journal of Medicine stated that the level of neutralization for the CoronaVac vaccine against B.1.1.7 is 50% effective in comparaison with the original Wuhan strain. For comparaison, in the same study they analyzed that convalescents' (~5 months since contraction) B.1.1.7 neutralization was "similar" to Wuhan strain.

501.V2 variant

Moderna has launched a trial of a vaccine to tackle the South African 501.V2 variant (also known as B.1.351). On 17 February 2021, Pfizer announced neutralization activity was reduced by two-thirds for the 501.V2 variant, while stating that no claims about the efficacy of the vaccine in preventing illness for this variant could yet be made. Decreased neutralizing activity of sera from patients vaccinated with the Moderna and Pfizer-BioNTech vaccines against B.1.351 was latter confirmed by several studies. On 1 April 2021, an update on a Pfizer/BioNTech South African vaccine trial stated that the vaccine was 100% effective so far (i.e., vaccinated participants saw no cases), with six of nine infections in the placebo control group being the B.1.351 variant.

In January 2021, Johnson & Johnson, which held trials for its Ad26.COV2.S vaccine in South Africa, reported the level of protection against moderate to severe COVID-19 infection was 72% in the United States and 57% in South Africa.

On 6 February 2021, the Financial Times reported that provisional trial data from a study undertaken by South Africa's University of the Witwatersrand in conjunction with Oxford University demonstrated reduced efficacy of the Oxford–AstraZeneca COVID-19 vaccine against the 501.V2 variant. The study found that in a sample size of 2,000 the AZD1222 vaccine afforded only "minimal protection" in all but the most severe cases of COVID-19. On 7 February 2021, the Minister for Health for South Africa suspended the planned deployment of about a million doses of the vaccine whilst they examine the data and await advice on how to proceed.

In March 2021, it was reported that the "preliminary efficacy" of the Novavax vaccine (NVX-CoV2373) against B.1.351 for mild, moderate, or severe COVID-19 for HIV-negative participants is 51%.

In April 2021, it was reported that the level of neutralization for the CoronaVac vaccine was only 30% effective in comparison with the original Wuhan strain. For comparison, in the same study they analyzed that convalescents' (~5 months since contraction) B.1.351 neutralization was 50% effective.

P1 variant

The P1 variant (also known as 20J/501Y.V3), initially identified in Brazil, seems to partially escape vaccination with the Pfizer-BioNTech vaccine.

B.1.617 variant

Main article: Lineage B.1.617

In October 2020, a new double-mutation variant was discovered in India, which was named B.1.617. There were very few detections until January 2021 and by April it had spread to at least 20 countries in all continents except Antarctica and South America. Among some 15 defining mutations, it has spike mutations D111D (synonymous), G142D, P681R, E484Q and L452R, the latter two of which may cause it to easily avoid antibodies. In an update on 15 April 2021, PHE designated B.1.617 as a 'Variant under investigation', VUI-21APR-01.

Trial and authorization status

Phase I trials test primarily for safety and preliminary dosing in a few dozen healthy subjects, while Phase II trials – following success in Phase I – evaluate immunogenicity, dose levels (efficacy based on biomarkers) and adverse effects of the candidate vaccine, typically in hundreds of people. A Phase I–II trial consists of preliminary safety and immunogenicity testing, is typically randomized, placebo-controlled, while determining more precise, effective doses. Phase III trials typically involve more participants at multiple sites, include a control group, and test effectiveness of the vaccine to prevent the disease (an "interventional" or "pivotal" trial), while monitoring for adverse effects at the optimal dose. Definition of vaccine safety, efficacy, and clinical endpoints in a Phase III trial may vary between the trials of different companies, such as defining the degree of side effects, infection or amount of transmission, and whether the vaccine prevents moderate or severe COVID‑19 infection.

A clinical trial design in progress may be modified as an "adaptive design" if accumulating data in the trial provide early insights about positive or negative efficacy of the treatment. Adaptive designs within ongoing Phase II–III clinical trials on candidate vaccines may shorten trial durations and use fewer subjects, possibly expediting decisions for early termination or success, avoiding duplication of research efforts, and enhancing coordination of design changes for the Solidarity trial across its international locations.

List of authorized and approved vaccines

Further information: List of COVID-19 vaccine authorizations

National regulatory authorities have granted emergency use authorizations for thirteen vaccines. Six of those have been approved for emergency or full use by at least one WHO-recognized stringent regulatory authority.

RNA vaccines   Pfizer–BioNTech   Moderna Adenovirus vector vaccines   Sputnik V   Oxford–AstraZeneca   Johnson & Johnson   Convidecia Inactivated virus vaccines   Sinopharm (BBIBP)   CoronaVac   Covaxin   Sinopharm (WIBP)   CoviVac   QazVac Protein subunit vaccines   EpiVacCorona   RBD-Dimer

Vaccines authorized for emergency use or approved for full use

Vaccine, developers/sponsors	Country of origin	Type (technology)	Doses, interval	Storage temperature	Current phase (participants)	Authorization
Oxford–AstraZeneca COVID-19 vaccine (Vaxzevria, Covishield) University of Oxford, AstraZeneca, CEPI	United Kingdom, Sweden	Adenovirus vector (ChAdOx1)	2 doses 4–12 weeks	2–8 °C	Phase III (30,000) Interventional; randomized, placebo-controlled study for efficacy, safety, and immunogenicity. Overall efficacy of 76% after the first dose and 81% after a second dose taken 12 weeks or more after the first. May 2020 – Aug 2021, Brazil (5,000), United Kingdom, India	Full (1) Emergency (143)
Pfizer–BioNTech COVID-19 vaccine (Comirnaty) BioNTech, Pfizer	United States, Germany	RNA (modRNA in lipid nanoparticles)	2 doses 3–4 weeks	−70±10 °C (ULT)	Phase III (43,448) Randomized, placebo-controlled. Positive results from an interim analysis were announced on 18 November 2020 and published on 10 December 2020 reporting an overall efficacy of 95%. Jul–Nov 2020, Germany, United States	Full (4) Emergency (95)
Sputnik V COVID-19 vaccine (Gam-COVID-Vac) Gamaleya Research Institute of Epidemiology and Microbiology	Russia	Adenovirus vector (recombinant Ad5 and Ad26)	2 doses 3 weeks	≤−18 °C (freezer)	Phase III (40,000) Randomized double-blind, placebo-controlled to evaluate efficacy, immunogenicity, and safety. Interim analysis from the trial was published in The Lancet, indicating 91.6% efficacy without unusual side effects. Aug 2020 – May 2021, Russia, Belarus, India, Venezuela, UAE	Full (2) Emergency (66)
BBIBP-CorV Sinopharm: Beijing Institute of Biological Products	China	Inactivated SARS‑CoV‑2 (vero cells)	2 doses 3–4 weeks	2–8 °C	Phase III (48,000) Randomized, double-blind, parallel placebo-controlled, to evaluate safety and protective efficacy. Sinopharm's internal analysis indicated a 79% efficacy. Jul 2020 – Jul 2021, United Arab Emirates, Bahrain, Jordan, Argentina, Morocco, Peru	Full (4) Emergency (48)
Moderna COVID-19 vaccine Moderna, NIAID, BARDA, CEPI	United States	RNA (modRNA in lipid nanoparticles)	2 doses 4 weeks	−20±5 °C (freezer)	Phase III (30,000) Interventional; randomized, placebo-controlled study for efficacy, safety, and immunogenicity. Positive results from an interim analysis were announced on 15 November 2020 and published on 30 December 2020 reporting an overall efficacy of 94%. Jul 2020 – Oct 2022, United States	Full (2) Emergency (49)
Johnson & Johnson COVID-19 vaccine Janssen Vaccines (Johnson & Johnson), BIDMC	United States, Netherlands	Adenovirus vector (recombinant Ad26)	1 dose	2–8 °C	Phase III (40,000) Randomized, double-blinded, placebo-controlled Positive results from an interim analysis were announced on 29 January 2021. J&J reports an efficacy of 66% against mild and moderate symptoms, and 85% against severe symptoms. Further, the mild and moderate efficacy ranged from 64% in South Africa to 72% in the United States. Jul 2020 – ? 2023, United States, Argentina, Brazil, Chile, Colombia, Mexico, Peru, the Philippines, South Africa, Ukraine	Full (0) Emergency (46)
CoronaVac Sinovac	China	Inactivated SARS‑CoV‑2 (vero cells)	2 doses 2–3 weeks	2–8 °C	Phase III (33,620) Double-blind, randomized, placebo-controlled to evaluate efficacy and safety. Final Phase III results from Turkey showed an efficacy of 83.5%. A Chilean study showed 67% efficacy against symptoms, reduced hospitalizations by 85%, intensive care visits by 89%, and deaths by 80%. Brazil announced results showing 50.7% effective at preventing symptomatic infections, 83.7% effective in preventing mild cases, and 100% effective in preventing severe cases. July 2020 – Oct 2021, Brazil (15,000); Aug 2020 – January 2021, Indonesia (1,620); Chile (3,000); Turkey (13,000)	Full (1) Emergency (29)
BBV152 (Covaxin) Bharat Biotech, Indian Council of Medical Research	India	Inactivated SARS‑CoV‑2 (vero cells)	2 doses 4 weeks	2–8 °C	Phase III (25,800) Randomised, observer-blinded, placebo-controlled The interim efficacy rate is 81% as per third phase trial. All data from the animal, first, second phase trials have been made public through peer-reviewed journals. Phase III trials had shown 81% efficacy. Nov 2020 – Mar 2021, India.	Full (0) Emergency (14)
Ad5-nCoV (Convidecia) CanSino Biologics, Beijing Institute of Biotechnology of the Academy of Military Medical Sciences	China	Adenovirus vector (recombinant Ad5)	1 dose	2–8 °C	Phase III (40,000) Global multi-center, randomized, double-blind, placebo-controlled to evaluate efficacy, safety and immunogenicity. In February 2021, interim analysis from global trials showed an efficacy of 65.7% against moderate cases of COVID-19 and 90.98% efficacy against severe cases. Mar–Dec 2020, China; Sep 2020 – Dec 2021, Pakistan; Sep–Nov 2020, Russia, China, Argentina, Chile; Mexico; Pakistan; Saudi Arabia	Full (1) Emergency (5)
EpiVacCorona Vector Institute	Russia	Subunit (peptide)	2 doses 3 weeks	2–8 °C	Phase III (40,000) Randomized double-blind, placebo-controlled to evaluate efficacy, immunogenicity, and safety Nov 2020 – Dec 2021, Russia	Full (1) Emergency (2)
ZF2001 (RBD-Dimer) Anhui Zhifei Longcom Biopharmaceutical Co. Ltd.	China	Subunit (recombinant)	3 doses 30 days	2–8 °C	Phase III (29,000) Randomized, double-blind, placebo-controlled Dec 2020 – Apr 2022, China, Ecuador, Indonesia, Malaysia, Pakistan, Uzbekistan	Full (0) Emergency (2)
WIBP-CorV Sinopharm: Wuhan Institute of Biological Products	China	Inactivated SARS‑CoV‑2 (vero cells)	2 doses	2–8 °C	Phase III (51,600) Randomized, double-blind, placebo-controlled Jul 2020 – Mar 2021, Bahrain, Egypt, Jordan, United Arab Emirates; Sep 2020 – Sep 2021, Peru; Sep 2020 – Dec 2020, Morocco	Full (0) Emergency (2)
CoviVac The Chumakov Centre at the Russian Academy of Sciences	Russia	Inactivated SARS‑CoV‑2	2 doses 2 weeks	2–8 °C	Phase III (32,000) Double-blind, randomized, placebo-controlled to evaluate efficacy and safety. May 2021 – ?, Russia	Full (0) Emergency (1)
QazCovid-in (QazVac) Research Institute for Biological Safety Problems	Kazakhstan	Inactivated SARS‑CoV‑2	2 doses 3 weeks	2–8 °C	Phase III (3,000) Randomised, blind, placebo-controlled trial Mar 2021 – Jul 2021, Kazakhstan	Full (0) Emergency (1)

Vaccine candidates in human trials

COVID‑19 candidate vaccines in Phase I–III trials

Vaccine candidates, developers, and sponsors	Country of origin	Type (technology)	Current phase (participants) design	Completed phase (participants) Immune response	Pending authorization
Novavax COVID-19 vaccine (Covovax) Novavax, CEPI	United States	Subunit/virus-like particle (SARS‑CoV‑2 recombinant spike protein nanoparticle with adjuvant)	Phase III (45,000) Randomised, observer-blinded, placebo-controlled trial Sep 2020 – Jan 2021, UK (15,000); December 2020 – Mar 2021, US, Mexico, (30,000); India	Phase I–II (131) IgG and neutralizing antibody response with adjuvant after booster dose.	Emergency (8) Canada EU Ukraine USA UK Australia New Zealand South Korea
Sanofi–GSK COVID-19 vaccine (VAT00002) Sanofi Pasteur, GSK	France, United Kingdom	Subunit	Phase III (34,520) Efficacy, Immunogenicity, and Safety of SARS-CoV-2 Recombinant Protein Vaccine with Adjuvant in Adults 18 Years of Age and Older. Dec 2020 – Apr 2022, Kenya, United States	Phase I–II (1,160) Phase I-IIa (440): Immunogenicity and Safety of SARS-CoV-2 Recombinant Protein Vaccine Formulations (With or Without Adjuvant) in Healthy Adults 18 Years of Age and Older. Phase IIb (720): Immunogenicity and Safety of SARS-CoV-2 Recombinant Protein Vaccine With AS03 Adjuvant in Adults 18 Years of Age and Older. Sep 2020 – Apr 2022, United States	Emergency (4) EU Canada USA UK
CureVac COVID-19 vaccine (CVnCoV) CureVac, CEPI	Germany	RNA (unmodified RNA)	Phase III (40,400) Phase 2b/3 (36,500): Multicenter efficacy and safety trial in adults. Phase 3 (2,520): Randomized, observer-blinded, placebo-controlled. Phase 3 (180+1,200): Open-label. Nov 2020 – Sep 2021, Argentina, Belgium, Colombia, Dominican Republic, France, Germany, Mexico, Netherlands, Panama, Peru, Spain	Phase I–II (944) Phase I (284): Partially blind, controlled, dose-escalation to evaluate safety, reactogenicity and immunogenicity. Phase IIa (660):Partially observer-blind, multicenter, controlled, dose-confirmation. Jun 2020 – Oct 2021, Belgium (phase I), Germany (phase I), Panama (phase IIa), Peru (phase IIa)	Emergency (2) EU Switzerland
CoVLP Medicago, GSK	Canada, United Kingdom	Virus-like particles (recombinant, plant-based with AS03)	Phase III (30,918) Event-driven, randomized, observer blinded, placebo-controlled Nov 2020 – Dec 2021, Canada	Phase I (180) Neutralizing antibodies at day 42 after the first injection (day 21 after the second injection) were at levels 10x that of COVID-19 survivors. Jul 2020 – Sept 2021, Canada	Emergency (1) Canada
SOBERANA 02 (FINLAY-FR-2) Instituto Finlay de Vacunas	Cuba	Subunit (conjugate)	Phase III (44,010) Multicenter, adaptive, parallel-group, randomized, placebo-controlled, double-blind Mar–May 2021, Cuba, Iran, Venezuela	Phase I–II (950) Phase I (40): Non-randomized controlled trial. Masking: Open. Control group: Uncontrolled. Study design: Adaptive, sequential Phase II (910): Randomized controlled trial. Masking: Double Blind. Control group: Placebo. Study design: Parallel. Nov 2020 – Mar 2021, Cuba	Emergency (1) Cuba
VLA2001 Valneva	France	Inactivated SARS‑CoV‑2	Phase III (4,000) Randomized, observer-blind, controlled. Apr–Jul 2021, United Kingdom	Phase I–II (150) Randomized, multi-center, double-blinded Dec 2020 – Feb 2021, United Kingdom	Emergency (1) EU
COVIran Barakat Barakat Pharmaceutical Group, Shifa Pharmed Industrial Group	Iran	Inactivated SARS‑CoV‑2	Phase III (52,000) Phase II-IIIa (20,000): Randomized, double-blind, parallel arms, placebo-controlled. Phase IIIb (32,000) Mar–Jun 2021, Iran	Phase I (56) Randomized, double-blind, parallel arms, placebo-control. Dec 2020 – Feb 2021, Iran
CIGB-66 (ABDALA) Center for Genetic Engineering and Biotechnology	Cuba	Subunit	Phase III (48,000) Multicenter, randomized, double-blind, placebo-controlled. Mar–Jul 2021, Cuba	Phase I–II (132) Randomized, double-blind, placebo-controlled, factorial. Nov 2020 – May 2021, Cuba
Chinese Academy of Medical Sciences COVID-19 vaccine Chinese Academy of Medical Sciences	China	Inactivated SARS‑CoV‑2	Phase III (34,020) Randomized, double-blinded, single-center, placebo-controlled Jan–Sep 2021, Brazil, Malaysia	Phase I–II (942) Randomized, double-blinded, single-center, placebo-controlled May–Sep 2020, Chengdu
ZyCoV-D Cadila Healthcare, Biotechnology Industry Research Assistance Council	India	DNA (plasmid expressing SARS‑CoV‑2 S protein)	Phase III (28,216) Randomised, blind, placebo-controlled trial Jan–May 2021, India	Phase I–II (1,000) Interventional; randomized, double-blind, placebo-controlled Jul 2020 – Jan 2021, India
Walvax COVID-19 vaccine (ARCoV) PLA Academy of Military Science, Walvax Biotech, Suzhou Abogen Biosciences	China	RNA	Phase III (28,000) Multi-center, Randomized, Double-blind, Placebo-controlled May–Oct 2021, China	Phase I–II (588) Phase I (168) Phase II (420) Jun 2020 – Mar 2022, China
Minhai COVID-19 vaccine Minhai Biotechnology Co., Shenzhen Kangtai Biological Products Co. Ltd.	China	Inactivated SARS‑CoV‑2 (vero cell)	Phase III (28,000) Multi-national, Randomized, Double-blind, Placebo-controlled. May–Nov 2021, China	Phase I–II (1,180) Randomized, double-blind, placebo parallel-controlled. Oct 2020 – Jun 2021, China
Nanocovax Nanogen Pharmaceutical Biotechnology JSC	Vietnam	Subunit (SARS‑CoV‑2 recombinant spike protein with aluminum adjuvant)	Phase III (15,000) May–Sep 2021, Vietnam	Phase I–II (620) Phase (60): Open label, dose escalation. Phase II (560): Randomization, double-blind, multicenter, placebo-controlled. Dec 2020 – Jun 2021, Vietnam
Bio E COVID-19 (BECOV2D) Biological E. Limited, Baylor College of Medicine, CEPI	India, United States	Subunit (using an antigen)	Phase III (1,268) Apr 2021 – ?, India	Phase I–II (360) Randomized, Parallel Group Trial Nov 2020 – Feb 2021, India
SCB-2019 Clover Biopharmaceuticals, CEPI	China	Subunit (spike protein trimeric subunit with combined CpG 1018 and aluminium adjuvant)	Phase II–III (22,000) Randomized, double-blind, controlled Mar 2021 – Jul 2022, Belgium, Brazil, Colombia, Dominican Republic, Germany, Nepal, Panama, the Philippines, Poland, South Africa	Phase I (150) Jun–Oct 2020, Perth
UB-612 United Biomedical,Inc, COVAXX, DASA	Brazil, United States	Subunit	Phase II–III (11,170) Phase IIa (3,850): Placebo-controlled, Randomized, Observer-blind Study. Phase IIb-III (7,320): Randomized, Multicenter, Double-Blind, Placebo Controlled, Dose-Response. Jan 2021 – Mar 2023, Taiwan	Phase I (60) Open-label study Sep 2020 – Jan 2021, Taiwan
GRAd-COV2 ReiThera, Lazzaro Spallanzani National Institute for Infectious Diseases	Italy	Adenovirus vector (modified gorilla adenovirus vector, GRAd)	Phase II–III (10,300) Randomized, stratified, observer-blind, placebo-controlled. Mar–May 2021, Italy	Phase I (90) Subjects (two groups: 18–55 and 65–85 years old) randomly receiving one of three escalating doses of GRAd-COV2 or a placebo, then monitored over a 24-week period. 93% of subjects who received GRAd-COV2 developed anti-bodies. Aug–Dec 2020, Rome
West China Hospital COVID-19 vaccine Jiangsu Province Centers for Disease Control and Prevention, West China Hospital	China	Subunit (recombinant with Sf9 cell)	Phase II (4,960) Phase IIa (960):Single-center, Randomized, Double-Blinded, Placebo-Controlled. Phase IIb (4,000):Single-center, Randomized, Double-Blinded, Placebo-Controlled. Nov 2020 – May 2021, China	Phase I (45) Single-center, Randomized, Placebo-controlled, Double-blind. Aug–Oct 2020, China
MVC-COV1901 Medigen Vaccine Biologics	Taiwan	Subunit	Phase II (4,100) Phase IIa (3,700): Prospective, double-blinded, multi-center, multi-regional. Phase IIb (400): Prospective, randomized, double-blind, dose-comparison, multi-center. Dec 2020 – Sep 2021, Taiwan, Vietnam (phase IIa)	Phase I (45) Prospective, open-labeled, single-center Oct 2020 – Jan 2021, Taiwan
V-01 Livzon Mabpharm, Inc.	China	Subunit	Phase II (880) Randomized, double-blind, and placebo-controlled. Mar–May 2021, China	Phase I (180) Single-center, randomized, double-blind and placebo-controlled. Feb–Mar 2021, China
DelNS1-2019-nCoV-RBD-OPT Beijing Wantai Biological Pharmacy	China	Viral vector	Phase II (720) Nov 2020 – Dec 2021, China	Phase I (60) Sep 2020 – Oct 2021, China
Razi Cov Pars Razi Vaccine and Serum Research Institute	Iran	Subunit	Phase II (500) Two parallel groups, randomized, double blind, placebo controlled. Apr–Jun 2021, Iran	Phase I (133) Randomized, double blind, placebo controlled. Jan–Mar 2021, Iran
Zhongyianke Biotech–Liaoning Maokangyuan Biotech COVID-19 vaccine Zhongyianke Biotech, Liaoning Maokangyuan Biotech, Academy of Military Medical Sciences	China	Subunit (Recombinant)	Phase II (480) Single-center, randomized, double blinded, placebo controlled. Mar–Jul 2021, China	Phase I (216) Randomized, placebo-controlled, double-blind. Oct 2020 – Apr 2021, China
ERUCOV-VAC Health Institutes of Turkey	Turkey	Inactivated SARS‑CoV‑2	Phase II (250) Phase 2 Study for the Determination of Efficacy, Immunogenicity and Safety of Two Different Strengths of the Inactivated COVID-19 Vaccine ERUCOV-VAC, in a Placebo Controlled, Randomized, Double Blind Study Design. Feb–Apr 2021, Turkey	Phase I (44) Study for the Determination of Safety and Immunogenicity of Two Different Strengths of the Inactivated COVID-19 Vaccine ERUCOV-VAC, Given Twice Intramuscularly to Healthy Volunteers, in a Placebo Controlled Study Design. Nov 2020 – Mar 2021, Turkey
INO-4800 Inovio, CEPI, Korea National Institute of Health, International Vaccine Institute	South Korea, United States	DNA vaccine (plasmid delivered by electroporation)	Phase II–III (7,218) Phase II/III (6,578): Randomized, placebo-controlled, multi-center. Phase IIa (640): Randomized, double-blinded, placebo-controlled, dose-finding. Nov 2020 – Sep 2022, United States (phase II/III) China (phase IIa)	Phase I–II (280) Phase Ia (120): Open-label trial. Phase Ib-IIa (160): Dose-Ranging Trial. April 2020 – Feb 2022, United States, South Korea (phase Ib-IIa)
AG0302-COVID‑19 AnGes Inc., AMED	Japan	DNA vaccine (plasmid)	Phase II–III (500) Randomized, double-blind, placebo controlled Nov 2020 – Apr 2021, Japan	Phase I–II (30) Randomized/non-randomized, single-center, two doses Jun–Nov 2020, Osaka
Unnamed National Vaccine and Serum Institute, Lanzhou Institute of Biological Products Co., Ltd., Beijing Zhong Sheng Heng Yi Pharmaceutical Technology Co., Ltd., Zhengzhou University	China	Subunit (Recombinant)	Phase I–II (3,580) Phase I/II Clinical Trial to Evaluate the Safety, Tolerability and Immunogenicity of Recombinant SARS-CoV-2 Vaccine (CHO Cell) in Healthy People Aged 3 Years and Older. Apr 2021 – Oct 2022, China	Preclinical
IIBR-100 (Brilife) The Israel Institute for Biological Research	Israel	Vesicular stomatitis vector (recombinant)	Phase I–II (1,040) Oct 2020 – May 2021, Israel	Preclinical
Arcturus COVID-19 vaccine (ARCT-021) Arcturus Therapeutics, Duke–NUS Medical School	United States, Singapore	RNA	Phase I–II (798) Phase I/II (92): Randomized, double-blinded, placebo controlled Phase IIa (106): Open label extension Phase IIb (600): Randomized, observer-blind, placebo-controlled Aug 2020 – Apr 2022, Singapore, United States (phase IIb)	Preclinical
VBI-2902 Variation Biotechnologies	United States	Virus-like particle	Phase I–II (780) Randomized, observer-blind, dose-escalation, placebo-controlled Mar 2021 – Jun 2022, Canada	Preclinical
NDV-HXP-S Mahidol University, University of Texas at Austin	Thailand, United States	Viral vector	Phase I–II (460) Randomized, placebo-controlled, observer-blind. Mar 2021 – Apr 2022; Brazil, Mexico, Thailand, Vietnam	Preclinical
Sanofi–Translate Bio COVID-19 vaccine (MRT5500) Sanofi Pasteur and Translate Bio	France, United States	RNA	Phase I–II (415) Immunogenicity and Safety of the First-in-Human SARS-CoV-2 mRNA Vaccine Formulation in Healthy Adults 18 Years of Age and Older. Mar 2021 – May 2022, United States	Preclinical
COVIVAC Institute of Vaccines and Medical Biologicals	Vietnam	Viral vector/Egg-based, inactivated, whole chimeric Newcastle Disease Virus (NDV) expressing membrane-anchored pre-fusion-stabilized trimeric SARS-CoV-2 S protein (Hexapro) + CpG 1018.	Phase I–II (420) Phase I-II (120-300):Randomized, placebo-controlled, observer-blind. Mar 2021 – May 2022, Vietnam	Preclinical
EuCorVac-19 EuBiologics Co	South Korea	Subunit	Phase I–II (280) Dose-exploration, randomized, observer-blind, placebo-controlled Feb 2021 – Mar 2022, South Korea	Preclinical
RBD SARS-CoV-2 HBsAg VLP SpyBiotech	United Kingdom	Virus-like particle	Phase I–II (280) Randomized, placebo-controlled, multi-center. Aug 2020 – ?, Australia	Preclinical
GX-19 (GX-19N) Genexine consortium, International Vaccine Institute	South Korea	DNA vaccine	Phase I–II (380) Phase I-II (170-210): Multi-center, randomized, double-blind, placebo-controlled Jun 2020 – Mar 2021, Seoul	Preclinical
AV-COVID-19 AIVITA Biomedical, Inc., Ministry of Health (Indonesia)	United States, Indonesia	Viral vector	Phase I–II (202) Adaptive. Dec 2020 – Jul 2021, Indonesia (phase I), United States (phase I/II)	Preclinical
TAK-919 Takeda	Japan	RNA	Phase I–II (200) Randomized, observer-blind, placebo-controlled Jan 2021 – Mar 2022, Japan	Preclinical
TAK-019 Takeda	Japan	Subunit	Phase I–II (200) Randomized, observer-blind, placebo-controlled. Feb 2021 – April 2022, Japan	Preclinical
COVID-eVax Takis Biotech	Italy	DNA	Phase I–II (160) Phase I:First-in-human, dose escalation. Phase II: Open-label, randomize, dose expansion. Feb–Sep 2021, Italy	Preclinical
ChulaCov19 Chulalongkorn University	Thailand	RNA	Phase I–II (96) Dose-finding Study. Jan–Mar 2021, Thailand	Preclinical
COVID‑19/aAPC Shenzhen Genoimmune Medical Institute	China	Lentiviral vector (with minigene modifying aAPCs)	Phase I (100) Mar 2020 – Jul 2023, Shenzhen	Preclinical
LV-SMENP-DC Shenzhen Genoimmune Medical Institute	China	Lentiviral vector (with minigene modifying DCs)	Phase I (100) Mar 2020 – Jul 2023, Shenzhen	Preclinical
ImmunityBio COVID-19 vaccine (hAd5) ImmunityBio	United States	Viral vector	Phase I–II (540) Phase 1/2 Study of the Safety, Reactogenicity, and Immunogenicity of a Subcutaneously- and Orally- Administered Supplemental Spike & Nucleocapsid-targeted COVID-19 Vaccine to Enhance T Cell Based Immunogenicity in Participants Who Have Already Received Prime + Boost Vaccines Authorized For Emergency Use. Oct 2020  – Sep 2021, South Africa, United States	Preclinical
COVAX-19 Vaxine Pty Ltd	Australia	Subunit (recombinant protein)	Phase I (40) Jun 2020 – Jul 2021, Adelaide	Preclinical
HGC019 Gennova Biopharmaceuticals, HDT Biotech Corporation	India, United States	RNA	Phase I (120) Jan 2021 – ?, India	Preclinical
Bangavax (Bancovid) Globe Biotech Ltd. of Bangladesh	Bangladesh	RNA	Phase I (100) Randomized, Parallel Group Trial Feb 2021 – Feb 2022, Bangladesh	Preclinical
PTX-COVID19-B Providence Therapeutics	Canada	RNA	Phase I (60) First-in-Human, Observer-Blinded, Randomized, Placebo Controlled. Jan–May 2021, Canada	Preclinical
COVAC-2 VIDO (University of Saskatchewan)	Canada	Subunit	Phase I (108) Randomized, observer-blind, dose-escalation. Feb 2021 – Oct 2022, Halifax	Preclinical
COVI-VAC Codagenix Inc.	United States	Attenuated	Phase I (48) First-in-human, randomised, double-blind, placebo-controlled, dose-escalation Dec 2020 – Jun 2021, United Kingdom	Preclinical
CoV2 SAM (LNP) GSK	United Kingdom	RNA	Phase I (40) Open-label, dose escalation, non-randomized Feb–Jun 2021, United States	Preclinical
COVIGEN University of Sydney	Australia	DNA	Phase I (150) Double-blind, dose-ranging, randomised, placebo-controlled. Feb 2021 – Jun 2022, Sydney	Preclinical
BBV154 Bharat Biotech	India	Adenovirus vector (intranasal)	Phase I (175) Randomized, double-blinded, multicenter. Mar 2021, India	Preclinical
MV-014-212 Meissa Vaccine Inc.	United States	Attenuated	Phase I (130) Randomized, double-blinded, multicenter. Mar 2021 – Oct 2022, United States	Preclinical
S-268019 Shionogi	Japan	Subunit	Phase I–II (214) Randomized, double-blind, placebo-controlled, parallel-group. Dec 2020 – Jun 2022, Japan	Preclinical
GBP510 SK Bioscience Co. Ltd.	South Korea	Subunit	Phase I–II (580) Phase I-II (260-320): Placebo-controlled, randomized, observer-blinded, dose-finding. Jan–Aug 2021, South Korea	Preclinical
KBP-201 Kentucky Bioprocessing	United States	Subunit	Phase I–II (180) First-in-human, observer-blinded, randomized, placebo-controlled, parallel group Dec 2020 – May 2021, United States	Preclinical
AdCLD-CoV19 Cellid Co	South Korea	Viral vector	Phase I–II (150) Phase I: Dose Escalation, Single Center, Open. Phase IIa: Multicenter, Randomized, Open. Dec 2020 – Mar 2021, South Korea	Preclinical
AdimrSC-2f Adimmune Corporation	Taiwan	Subunit	Phase I (70) Randomized, single center, open-label, dose-finding. Aug–Nov 2020, Taiwan	Preclinical
AKS-452 University Medical Center Groningen	Netherlands	Subunit	Phase I–II (130) Non-randomized, Single-center, open-label, combinatorial. Apr–Jun 2021, Netherlands	Preclinical
GLS-5310 GeneOne Life Science Inc.	South Korea	DNA	Phase I–II (345) Multicenter, Randomized, Combined Phase I Dose-escalation and Phase IIa Double-blind. Dec 2020 – Jul 2022, South Korea	Preclinical
Covigenix VAX-001 Entos Pharmaceuticals Inc.	Canada	DNA	Phase I–II (72) Placebo-controlled, randomized, observer-blind, dose ranging adaptive. Mar–Aug 2021, Canada	Preclinical
COH04S1 City of Hope Medical Center	United States	Viral vector	Phase I (129) Dose Escalation Study. Dec 2020 – Nov 2022, California	Preclinical
FAKHRAVAC (MIVAC) Organization of Defensive Innovation and Research	Iran	Inactivated SARS‑CoV‑2	Phase I (135) Randomized, double blind, controlled trial with factorial design. Mar–Apr 2021, Iran	Preclinical
NBP2001 SK Bioscience Co. Ltd.	South Korea	DNA	Phase I (50) Placebo-controlled, Randomized, Observer-blinded, Dose-escalation. Dec 2020 – Apr 2021, South Korea	Preclinical
CoVac-1 University of Tübingen	Germany	Subunit	Phase I (36) Placebo-controlled, Randomized, Observer-blinded, Dose-escalation. Nov 2020 – Sep 2021, Germany	Preclinical
bacTRL-Spike Symvivo	Canada	DNA	Phase I (24) Randomized, observer-blind, placebo-controlled. Nov 2020 – Feb 2022, Australia	Preclinical
CORVax12 Providence Health & Services	United States	DNA	Phase I (36) Open-label. Dec 2020 – May 2021, United States	Preclinical
ChAdV68-S (SAM-LNP-S) NIAID, Gritstone Oncology	United States	Viral vector	Phase I (130) Open-label, dose and age escalation, parallel design. Mar 2021 – Sep 2022, United States	Preclinical
AdCOVID Altimmune Inc.	United States	Viral vector	Phase I (180) Double-blind, randomized, placebo-controlled, first-in-Human. Feb 2021 – Feb 2022, United States	Preclinical
VXA-CoV2-1 Vaxart	United States	Viral vector	Phase I (35) Double-blind, randomized, placebo-controlled, first-in-Human. Sep 2020 – May 2021, United States	Preclinical
SpFN COVID-19 vaccine United States Army Medical Research and Development Command	United States	Subunit	Phase I (72) Randomized, double-blind, placebo-controlled. Apr 2021 – Oct 2022, United States	Preclinical
MVA-SARS-2-S University Medical Center Hamburg-Eppendorf	Germany	Viral vector	Phase I (30) Open, Single-center. Oct 2020 – May 2021, Germany	Preclinical
ReCOV Jiangsu Rec-Biotechnology Co Ltd	China	Subunit	Phase I (160) First-in-human, randomized, double-blind, placebo-controlled, dose-finding. Apr–Jul 2021, New Zealand	Preclinical
DelNS1-nCoV-RBD LAIV University of Hong Kong	Hong Kong	Attenuated	Phase I (115) Randomized, double-blinded, placebo-controlled, dose-escalation, and dose-expansion. Mar 2021 – Sep 2022, Hong Kong	Preclinical
SARS-CoV-2 VLP vaccine Ihsan Gursel, Scientific and Technological Research Council of Turkey	Turkey	Virus-like particle	Phase I (36) double-blinded, randomised, placebo controlled. Mar 2021 – Jan 2022, Turkey	Preclinical
Koçak-19 Inaktif Adjuvanlı COVID-19 vaccine Kocak Farma	Turkey	Inactivated SARS‑CoV‑2	Phase I (38) Phase 1 Study for the Determination of Safety and Immunogenicity of Different Strengths of Koçak-19 Inaktif Adjuvanlı COVID-19 Vaccine, Given Twice Intramuscularly to Healthy Volunteers, in a Placebo Controlled Study Design. Mar–Jun 2021, Turkey	Preclinical
mRNA-1283 Moderna	United States	RNA	Phase I (125) Randomized, observer-blind, dose-ranging study. Mar 2021 – Apr 2022, United States	Preclinical
DS-5670 Daiichi Sankyo	Japan	RNA	Phase I–II (152) A Phase 1/2 Study to Assess the Safety, Immunogenicity and Recommended Dose of DS-5670a (COVID-19 Vaccine) in Japanese Healthy Adults and Elderly Subjects. Mar 2021 – Jul 2022, Japan	Preclinical
Adenovirus Type-5 Vectored COVID-19 vaccine Jiangsu Province Centers for Disease Control and Prevention	China	Viral vector	Phase I (89) Single-center, open-label. Sep–Oct 2020, China	Preclinical
KD-414 KM Biologics Co	Japan	Inactivated SARS‑CoV‑2	Phase I–II (210) Mar 2021 – ?, Japan	Preclinical
CoVepiT OSE Immunotherapeutics	France	Subunit	Phase I (48) Apr 2021 – ?, France	Preclinical
ABNCoV2 Bavarian Nordic. Radboud University Nijmegen	Denmark, Netherlands	Virus-like particle	Phase I (42) Single center, sequential dose-escalation, open labelled trial. Mar–Dec 2021, Netherlands	Preclinical
HDT-301 Senai Cimatec	Brazil	RNA	Phase I (78) Randomized, open-label, dose-escalation. May–Sep 2021, Brazil	Preclinical
SC-Ad6-1 Tetherex Pharmaceuticals	United States	Viral vector	Phase I (40) First-In-Human, Open-label, Single Ascending Dose and Multidose. Jun–Dec 2021, Australia	Preclinical
Unnamed Osman ERGANIS, Scientific and Technological Research Council of Turkey	Turkey	Inactivated SARS‑CoV‑2	Phase I (50) Phase I Study Evaluating the Safety and Efficacy of the Protective Adjuvanted Inactivated Vaccine Developed Against SARS-CoV-2 in Healthy Participants, Administered as Two Injections Subcutaneously in Two Different Dosages. Apr–Oct 2021, Turkey	Preclinical
EXG-5003 Elixirgen Therapeutics, Fujita Health University	Japan, United States	RNA	Phase I–II (60) First in Human, randomized, placebo-controlled. Apr 2021 – Jan 2023, Japan	Preclinical
Patria Laboratorio Avimex, National Council of Science and Technology	Mexico	Viral vector	Phase I (90) Dose-escalation, open-label, non-randomized. Apr–Aug 2021, Mexico	Preclinical
LNP-nCoVsaRNA MRC clinical trials unit at Imperial College London	United Kingdom	RNA	Terminated (105) Randomized trial, with dose escalation study (15) and expanded safety study (at least 200) Jun 2020 – Jul 2021, United Kingdom	?
TMV-083 Institut Pasteur	France	Viral vector	Terminated (90) Randomized, Placebo-controlled. Aug 2020 – Jun 2021, Belgium, France	?
SARS-CoV-2 Sclamp/V451 UQ, Syneos Health, CEPI, Seqirus	Australia	Subunit (molecular clamp stabilized spike protein with MF59)	Terminated (120) Randomised, double-blind, placebo-controlled, dose-ranging. False positive HIV test found among participants. Jul–Oct 2020, Brisbane	?
V590 and V591/MV-SARS-CoV-2 Merck & Co. (Themis BIOscience), Institut Pasteur, University of Pittsburgh's Center for Vaccine Research (CVR), CEPI	United States, France	Vesicular stomatitis virus vector / Measles virus vector	Terminated In phase I, immune responses were inferior to those seen following natural infection and those reported for other SARS-CoV-2/COVID-19 vaccines.

Formulation

As of September 2020, eleven of the vaccine candidates in clinical development use adjuvants to enhance immunogenicity. An immunological adjuvant is a substance formulated with a vaccine to elevate the immune response to an antigen, such as the COVID‑19 virus or influenza virus. Specifically, an adjuvant may be used in formulating a COVID‑19 vaccine candidate to boost its immunogenicity and efficacy to reduce or prevent COVID‑19 infection in vaccinated individuals. Adjuvants used in COVID‑19 vaccine formulation may be particularly effective for technologies using the inactivated COVID‑19 virus and recombinant protein-based or vector-based vaccines. Aluminum salts, known as "alum", 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 release of proinflammatory cytokines.

Distribution

[show all]

[collapse]

COVID-19 vaccine distribution by location
(as of 3 May 2021)

Location	Vaccinated	% of pop.
World	904,516,098	7.8%
China	275,338,000	--
United States	147,047,012	44.0%
India	126,704,151	9.2%
EU	109,537,497	24.6%
United Kingdom	34,505,380	50.8%
Brazil	29,421,191	13.8%
Germany	23,492,053	28.0%
France	15,782,608	23.2%
Italy	14,593,168	24.1%
Turkey	13,800,405	16.4%
Canada	12,696,698	33.6%
Mexico	12,572,997	9.8%
Indonesia	12,469,406	4.6%
Russia	12,431,003	8.5%
Spain	11,763,360	25.2%
United Arab Emirates	10,634,693	--
Saudi Arabia	9,557,948	--
Poland	8,917,338	23.6%
Chile	8,112,125	42.4%
Argentina	7,025,492	15.5%
Bangladesh	5,819,656	3.5%
Israel	5,403,739	62.4%
Netherlands	5,265,860	--
Morocco	5,055,239	13.7%
Hungary	4,073,149	42.2%
Colombia	3,412,223	6.7%
South Korea	3,396,864	6.6%
Romania	3,336,830	17.4%
Belgium	3,070,545	26.5%
Portugal	2,513,836	24.6%
Sweden	2,511,121	24.9%
Japan	2,493,961	2.0%
Austria	2,341,905	26.0%
Australia	2,254,074	--
Czech Republic	2,195,779	20.5%
Greece	2,170,847	20.8%
Pakistan	2,100,000	0.9%
Nepal	2,091,511	7.2%
Serbia	2,028,302	29.8%
Switzerland	1,703,819	19.7%
Finland	1,694,744	30.6%
Philippines	1,656,643	1.5%
Cambodia	1,422,722	8.5%
Singapore	1,364,124	23.3%
Denmark	1,350,867	23.3%
Norway	1,343,500	24.8%
Kazakhstan	1,293,379	6.9%
Nigeria	1,229,733	0.6%
Dominican Republic	1,185,502	10.9%
Peru	1,176,645	3.2%
Uruguay	1,165,904	33.6%
Ireland	1,159,083	23.6%
Slovakia	1,115,253	20.4%
Thailand	1,099,460	1.6%
Qatar	1,017,019	35.3%
Myanmar	1,000,000	1.8%
Kuwait	1,000,000	--
Azerbaijan	975,208	9.6%
Hong Kong	952,119	12.7%
Mongolia	947,529	28.9%
Sri Lanka	928,107	4.3%
Malaysia	898,094	2.8%
Iran	858,296	1.0%
Kenya	853,081	1.6%
Ghana	849,527	2.7%
El Salvador	839,870	12.9%
Ecuador	791,651	4.5%
Ukraine	755,101	1.7%
Bahrain	717,024	42.1%
Croatia	708,137	17.2%
Jordan	699,328	6.8%
Lithuania	691,403	25.4%
Egypt	660,000	0.6%
Bolivia	614,600	5.3%
Bulgaria	608,428	8.8%
Uzbekistan	600,369	1.8%
Costa Rica	538,682	10.6%
Vietnam	506,435	0.5%
Panama	496,449	11.5%
Albania	494,028	--
Bhutan	480,498	62.3%
Angola	456,349	1.4%
Zimbabwe	430,068	2.9%
Ethiopia	430,000	--
Slovenia	427,449	20.6%
Senegal	413,031	2.5%
Rwanda	350,131	2.7%
Estonia	339,651	25.6%
Uganda	339,607	0.7%
South Africa	318,670	0.5%
Tunisia	305,484	2.6%
Iraq	298,377	0.7%
Maldives	296,961	54.9%
Malawi	296,127	1.6%
Lebanon	294,945	4.3%
Latvia	263,964	14.0%
Oman	253,000	5.0%
Venezuela	250,000	0.9%
Belarus	244,000	2.6%
Afghanistan	240,000	0.6%
Malta	231,511	52.4%
Cyprus	176,082	20.1%
New Zealand	172,564	3.6%
Palestine	170,109	3.3%
Guatemala	169,369	0.9%
Ivory Coast	163,176	0.6%
Togo	160,000	1.9%
Luxembourg	140,495	22.4%
Sudan	140,227	0.3%
Jamaica	135,473	4.6%
Nicaragua	135,130	2.0%
Moldova	130,218	3.2%
Laos	126,072	1.7%
Guyana	124,000	15.8%
Somalia	117,567	0.7%
Mauritius	117,323	9.2%
Iceland	109,409	32.1%
Guinea	95,312	0.7%
Paraguay	92,926	1.3%
Algeria	75,000	--
Barbados	74,608	26.0%
Curaçao	72,861	44.4%
Macau	70,655	10.9%
Seychelles	67,680	68.8%
Equatorial Guinea	64,646	4.6%
Bosnia and Herzegovina	63,376	1.9%
North Macedonia	61,603	3.0%
Northern Cyprus	60,642	15.9%
Taiwan	58,252	--
Mozambique	57,305	0.2%
Isle of Man	56,849	66.9%
Fiji	56,000	6.2%
Sierra Leone	55,083	0.7%
Honduras	55,000	0.6%
Aruba	54,306	50.9%
Jersey	52,405	51.9%
Mali	49,903	0.2%
Botswana	47,160	2.0%
Georgia	45,338	1.1%
Trinidad and Tobago	42,455	3.0%
Belize	42,100	10.6%
Montenegro	40,215	6.4%
Suriname	39,953	6.8%
Gibraltar	37,504	111.3%
Cayman Islands	35,774	54.4%
Eswatini	34,897	3.0%
Guernsey	32,969	49.2%
Bermuda	32,129	51.6%
Zambia	32,034	0.2%
Antigua and Barbuda	29,754	30.4%
Kyrgyzstan	27,000	0.4%
Bahamas	25,692	6.5%
Saint Lucia	24,426	--
Kosovo	22,096	1.1%
Andorra	21,733	28.1%
Gambia	20,922	0.9%
San Marino	20,269	59.7%
Namibia	18,837	0.7%
Dominica	18,498	25.7%
Lesotho	16,000	0.8%
Turks and Caicos Islands	15,039	38.8%
Faroe Islands	14,458	29.6%
Congo	14,297	0.3%
Saint Vincent and the Grenadines	13,852	--
Monaco	12,758	32.5%
Grenada	12,666	11.3%
Saint Kitts and Nevis	11,848	22.3%
Brunei	10,715	2.5%
Djibouti	10,246	1.0%
São Tomé and Príncipe	9,724	4.4%
Greenland	8,867	15.6%
Liechtenstein	8,044	21.1%
Mauritania	7,038	0.1%
Gabon	6,895	0.3%
Anguilla	6,115	40.8%
Samoa	5,880	--
Tonga	5,367	5.1%
Solomon Islands	4,890	0.7%
Saint Helena	3,563	58.7%
Papua New Guinea	2,900	0.0%
Falkland Islands	2,632	75.6%
East Timor	2,629	0.2%
Syria	2,500	0.0%
Cape Verde	2,184	0.4%
DR Congo	1,700	0.0%
Montserrat	1,293	25.9%
Niger	1,366	0.0%
South Sudan	947	0.0%
Libya	750	0.0%
Nauru	700	6.5%
Armenia	565	0.0%
Cameroon	400	0.0%
F.S. Micronesia	20,945	20.2%
Marshall Islands	14,790	25.3%
Palau	12,655	70.7%
Vatican City	22	2.7%
Sources List of sources by country. Notes

These paragraphs are an excerpt from Deployment of COVID-19 vaccines[edit]

As of 3 May 2021, 1.18 billion COVID-19 vaccine doses had been administered worldwide based on official reports from national health agencies collated by Our World in Data.

During a pandemic on the rapid timeline and scale of COVID‑19 infections during 2020, international organizations like the WHO and CEPI, vaccine developers, governments, and industry are evaluating the distribution of the eventual vaccine(s). Individual countries producing a vaccine may be persuaded to favor the highest bidder for manufacturing or provide first-service to their own country. Experts emphasize that licensed vaccines should be available and affordable for people at the frontline of healthcare and having the greatest need. In April 2020, it was reported that the UK agreed to work with 20 other countries and global organizations including France, Germany and Italy to find a vaccine and to share the results and that UK citizens would not get preferential access to any new COVID‑19 vaccines developed by taxpayer-funded UK universities. Several companies plan to initially manufacture a vaccine at artificially low pricing, then increase prices for profitability later if annual vaccinations are needed and as countries build stock for future needs.

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

The WHO, CEPI, and GAVI have expressed concerns that affluent countries should not receive priority access to the global supply of eventual COVID‑19 vaccines, but rather protecting healthcare personnel and people at high risk of infection are needed to address public health concerns and reduce economic impact of the pandemic. WHO Director General Tedros Adhanom referred to subsequent inequities in the distribution as "a catastrophic moral failure". A March 2021 survey of 77 epidemiologists concluded that mutations would render existing vaccines ineffective within one year — a window which wealthy nations were on pace to meet. Conversely, an Economist Intelligence Unit report from earlier in the year estimated that a similar level of herd immunity would not be achieved globally until 2024.

Inequity concerns

In a meeting in April 2021, the World Health Organization's emergency committee addressed concerns of persistent inequity in the global vaccine distribution.

Liability

On 4 February 2020, US Secretary of Health and Human Services Alex Azar published a notice of declaration under the Public Readiness and Emergency Preparedness Act for medical countermeasures against COVID‑19, covering "any vaccine, used to treat, diagnose, cure, prevent, or mitigate COVID‑19, or the transmission of SARS-CoV-2 or a virus mutating therefrom", and stating that 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". The declaration is effective in the United States through 1 October 2024.

In the European Union, the COVID‑19 vaccines are licensed under a Conditional Marketing Authorisation which does not exempt manufacturers from civil and administrative liability claims. 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.

Pfizer has been criticised for demanding far-reaching liability waivers and other guarantees from countries such as Argentina and Brazil, which go beyond what was expected from other countries such as the US (above).

Preventive measures after vaccination

While vaccines substantially reduce the probability of infection, is possible for fully vaccinated people to contract and spread COVID-19. 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 spead. Governments have indicated that such recommendations will be reduced as vaccination rates increase and community spread declines.

Society and culture

Access

Main article: Deployment of COVID-19 vaccines § Equitable access

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

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

Production of Sputnik V vaccine in Brazil

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

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

According to immunologist Dr. Anthony Fauci, mutant strains of virus and limited vaccine distribution pose continuing risks and he said: "we have to get the entire world vaccinated, not just our own country." Edward Bergmark and Arick Wierson are calling for an 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 current vaccines could be less effective.

On 10 March 2021, the United States, Britain, European Union nations and other WTO members, blocked a push by more than eighty developing countries to waive COVID‑19 vaccine patent rights in an effort to boost production of vaccines for poor nations.

Misinformation

Main article: COVID‑19 misinformation § Vaccines

Anti-vaccination activists and other people spread a variety of rumors, including overblown claims about side effects, a story about COVID-19 being spread by childhood vaccines, misrepresentations about how the immune system works, and when and how COVID-19 vaccines are made.

Vaccine hesitancy

Some 10% of the public perceives vaccines as unsafe or unnecessary, refusing vaccination – a global health threat called vaccine hesitancy – which increases the risk of further viral spread that could lead to COVID‑19 outbreaks. As of May 2020, estimates from two surveys were that 67% or 80% of people in the U.S. would accept a new vaccination against COVID‑19, with wide disparity by education level, employment status, ethnicity, and geography. As of March 2021, 19% of US adults claim to have been vaccinated and 50% of US adults plan to get vaccinated.

In an effort to demonstrate the vaccine's safety, prominent politicians have received it on camera, with others pledging to do so.

Encouragement by public figures and celebrities

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

Politicians and heads of state

Peru's interim President Francisco Sagasti gets vaccinated against COVID-19 at a military hospital in Lima

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

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

Musicians

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

Actresses and actors

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

TV personalities

Martha Stewart, Jonathan Van Ness, Al Roker and Dan Rather released photographs of themselves getting vaccinated and encouraged others to do the same. Stephen Fry also shared a photograph of being vaccinated; he wrote, "It's a wonderful moment, but you feel that it's not only helpful for your own health, but you know that you're likely to be less contagious if you yourself happen to carry it ... It's a symbol of being part of society, part of the group that we all want to protect each other and get this thing over and done with." Sir David Attenborough announced that he has been vaccinated.

Athletes

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

Specific communities

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

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

See also

• 2009 swine flu pandemic vaccine
• COVID‑19 drug development
• COVID‑19 drug repurposing research

Further reading

• Funk CD, Laferrière C, Ardakani A (2020). "A Snapshot of the Global Race for Vaccines Targeting SARS-CoV-2 and the COVID-19 Pandemic". Frontiers in Pharmacology. 11: 937. doi:10.3389/fphar.2020.00937. PMC 7317023. PMID 32636754.
• Kyriakidis NC, López-Cortés A, González EV, Grimaldos AB, Prado EO (February 2021). "SARS-CoV-2 vaccines strategies: a comprehensive review of phase 3 candidates". NPJ Vaccines. 6 (1): 28. doi:10.1038/s41541-021-00292-w. PMC 7900244. PMID 33619260.
• Development and Licensure of Vaccines to Prevent COVID-19: Guidance for Industry (Report). U.S. Food and Drug Administration. June 2020.
• Khandekar, Gauri (1 March 2021). "How to quickly ramp up global vaccine production". Politico.
• Ramsay M, ed. (2020). "Chapter 14a: COVID-19". Immunisation against infectious disease. Public Health England.
• Levine H (23 September 2020). "The 5 Stages of COVID-19 Vaccine Development: What You Need to Know About How a Clinical Trial Works". Johnson & Johnson.
• Ware G (18 February 2021). "How patent laws get in the way of the global coronavirus vaccine rollout". The Conversation.
• Zimmer C, Sheikh K, Weiland N (20 May 2020). "A New Entry in the Race for a Coronavirus Vaccine: Hope". The New York Times.

Vaccine protocols

• "Protocol mRNA-1273-P301" (PDF). Moderna.
• "Protocol C4591001 PF-07302048 (BNT162 RNA-Based COVID-19 Vaccines)" (PDF). Pfizer.
• "Protocol AZD1222 – D8110C00001" (PDF). AstraZeneca.
• "Protocol VAC31518COV3001; Phase 3 (ENSEMBLE)" (PDF). Janssen Vaccines & Prevention.
• "Protocol VAC31518COV3009; Phase 3 (ENSEMBLE 2)" (PDF). Janssen Vaccines & Prevention.

External links

• "The COVID-19 candidate vaccine landscape". World Health Organization (WHO).
• COVID‑19 Vaccine Tracker. Regulatory Focus
• "STAT's Covid-19 Drugs and Vaccines Tracker". Stat.
• "COVID-19 vaccines: development, evaluation, approval and monitoring". European Medicines Agency.
• "Vaccine Development – 101". U.S. Food and Drug Administration.
• "Coronavirus Variants and Mutations". The New York Times.
• M.I.T. Lecture 10: Kizzmekia Corbett, Vaccines" on YouTube