Rapid COVID-19 vaccine rollout: immense success but challenges ahead
Authors: Frank G Sandmann, Mark Jit
Journal: The Lancet Infectious Diseases (2021)

In The Lancet Infectious Diseases, Eric Haas and colleagues1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar estimated the benefits of the rapid mass roll-out of the Pfizer–BioNTech vaccine in Israel between Dec 20, 2020, and April 10, 2021. They found substantial benefits of the vaccine in terms of preventing thousands of deaths, hospitalisations, and new SARS-CoV-2 infections in individuals aged 16 years and older.1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar Thanks to the successful vaccination programme, non-pharmaceutical restrictions were gradually lifted in Israel in February–March, 2021,1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar, 2Muhsen K Cohen D COVID-19 vaccination in Israel.Clin Microbiol Infect. 2021; (published online Aug 9.)https://doi.org/10.1016/j.cmi.2021.07.041Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar and the national economy is reported to have recovered in April–June 2021, with an estimated economic growth of more than 5·5% forecasted for 2021.3Scheer S Post lockdown, Israel's economy rebounds sharply in Q2. Reuters, Aug 16, 2021https://www.reuters.com/world/middle-east/israel-economy-rebounds-q2-grows-annualised-154-2021-08-16/Date accessed: August 29, 2021Google Scholar The mass COVID-19 vaccination roll-out in Israel has been followed with great interest internationally because it was the fastest roll-out globally, and achieved high levels of vaccine uptake within a few months.1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar The vaccination programme was introduced at the beginning of a new outbreak wave in Israel in December, 2020, when the alpha (B.1.1.7) variant was predominant.1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar, 2Muhsen K Cohen D COVID-19 vaccination in Israel.Clin Microbiol Infect. 2021; (published online Aug 9.)https://doi.org/10.1016/j.cmi.2021.07.041Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar The authors report that nearly 74% of individuals aged 16 years or older in Israel had received two vaccine doses by April 10, 2021,1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar increasing to 81% by June 1, 2021.2Muhsen K Cohen D COVID-19 vaccination in Israel.Clin Microbiol Infect. 2021; (published online Aug 9.)https://doi.org/10.1016/j.cmi.2021.07.041Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar Despite a new outbreak wave caused by the delta (B.1.617.2) variant in Israel, with case numbers in August, 2021, being at similar levels to those in October, 2020, and January, 2021,4Dong E Du H Gardner L An interactive web-based dashboard to track COVID-19 in real time.Lancet Infect Dis. 2020; 20: 533-534Summary Full Text Full Text PDF PubMed Scopus (6657) Google Scholar the number of new cases are not translating into similar numbers of deaths.4Dong E Du H Gardner L An interactive web-based dashboard to track COVID-19 in real time.Lancet Infect Dis. 2020; 20: 533-534Summary Full Text Full Text PDF PubMed Scopus (6657) Google Scholar This situation underlines the continued importance of individuals being fully vaccinated despite emerging variants, which is also supported by the experience of other countries with high uptake of COVID-19 vaccines, like the UK.4Dong E Du H Gardner L An interactive web-based dashboard to track COVID-19 in real time.Lancet Infect Dis. 2020; 20: 533-534Summary Full Text Full Text PDF PubMed Scopus (6657) Google Scholar Haas and colleagues found that, when they looked at the direct benefits of vaccination, COVID-19 vaccines were far more effective at preventing deaths than mild infections.1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar Other countries have also seen substantial decreases in mortality after the introduction of COVID-19 vaccination programmes, which have shifted the disease burden from mortality to morbidity.5Briggs A Vassall A Count the cost of disability caused by COVID-19.Nature. 2021; 593: 502-505Crossref PubMed Scopus (56) Google Scholar Combined with the growing concern about COVID-19 cases with persistent symptoms (often called long COVID), this shift in the disease burden highlights the need to better understand non-fatal COVID-19 and its effects on health-related quality of life. Notably, Israel started vaccinating individuals aged 12–15 years in June, 2021,2Muhsen K Cohen D COVID-19 vaccination in Israel.Clin Microbiol Infect. 2021; (published online Aug 9.)https://doi.org/10.1016/j.cmi.2021.07.041Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar who are at lower risk of COVID-19-related mortality than older individuals. The study excluded individuals with previous laboratory-confirmed SARS-CoV-2 infection.1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar By Jan 1, 2021, more than 400 000 individuals were reported to have recovered from COVID-19 in Israel.2Muhsen K Cohen D COVID-19 vaccination in Israel.Clin Microbiol Infect. 2021; (published online Aug 9.)https://doi.org/10.1016/j.cmi.2021.07.041Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar Hence, the direct benefits of the vaccination programme are a conservative estimate because previous infection does not guarantee perfect protection, and one dose of the Pfizer–BioNTech vaccine after a previous SARS-CoV-2 infection leads to similar antibody levels as two vaccine doses.6Eyre DW Lumley SF Wei J et al.Quantitative SARS-CoV-2 anti-spike responses to Pfizer–BioNTech and Oxford–AstraZeneca vaccines by previous infection status.Clin Microbiol Infect. 2021; (published online June 7.)https://doi.org/10.1016/j.cmi.2021.05.041Summary Full Text Full Text PDF PubMed Scopus (87) Google Scholar Additionally, the effect of COVID-19 vaccination extends beyond the direct benefits of the vaccination programme, with reductions in COVID-19 cases being reported in all age groups and among unvaccinated individuals in Israel.2Muhsen K Cohen D COVID-19 vaccination in Israel.Clin Microbiol Infect. 2021; (published online Aug 9.)https://doi.org/10.1016/j.cmi.2021.07.041Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar Haas and colleagues acknowledge that the indirect effects and the long-term benefits of vaccination were outside the scope of the analysis.1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar Additional indirect benefits that have been reported elsewhere include the alleviated effect of COVID-19 on the mental health of health-care workers and the general public,7Aharon AA Dubovi I Ruban A Differences in mental health and health-related quality of life between the Israeli and Italian population during a COVID-19 quarantine.Qual Life Res. 2021; 30: 1675-1684Crossref PubMed Scopus (28) Google Scholar, 8DeKock JH Latham HA Leslie SJ et al.A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being.BMC Public Health. 2021; 21: 104Crossref PubMed Scopus (504) Google Scholar the recovery of the national economy,3Scheer S Post lockdown, Israel's economy rebounds sharply in Q2. Reuters, Aug 16, 2021https://www.reuters.com/world/middle-east/israel-economy-rebounds-q2-grows-annualised-154-2021-08-16/Date accessed: August 29, 2021Google Scholar and freeing up vital resources like hospital beds and staff for other patients without COVID-19. Challenges remain and new challenges will undoubtedly continue to arise. For instance, more variants are likely to emerge that increase the potential for breakthrough infections in vaccinated individuals, which will force manufacturers to adapt the vaccines. Similarly, in light of newly emerging variants, the duration of vaccine-induced protection against both symptomatic disease and asymptomatic infection is unclear, raising questions of the need for (and appropriateness of) regular booster doses (which started to be offered in Israel in August, 2021).9Mahase E COVID-19 booster vaccines: what we know and who's doing what.BMJ. 2021; 374n2082Crossref PubMed Scopus (35) Google Scholar Many countries also use different COVID-19 vaccine dosing intervals from the officially licensed interval used in Israel, and combine different vaccine products in the national vaccination programmes, including in heterologous vaccination schedules. From a global perspective, other issues outside the scope of this Article1Haas EJ McLaughlin JM Khan F et al.Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study.Lancet Infect Dis. 2021; (published online Sept 22.)https://doi.org/10.1016/S1473-3099(21)00566-1Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar are vaccine equity, access, and affordability.10WHOVaccine inequity undermining global economic recovery. World Health Organization, GenevaJuly 22, 2021https://www.who.int/news/item/22-07-2021-vaccine-inequity-undermining-global-economic-recoveryDate accessed: August 29, 2021Google Scholar Despite the challenges ahead, Haas and colleagues' research documents the immense success that rapid COVID-19 vaccine roll-out had in terms of reducing COVID-19-related morbidity and mortality at the population level. FGS and MJ are supported by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, a partnership between Public Health England (PHE), Imperial College London, and the London School of Hygiene & Tropical Medicine (grant code NIHR200908). MJ was supported by the NIHR HPRU in Immunisation at LSHTM in partnership with PHE (grant reference code NIHR200929). MJ has also received funding from the EU's Horizon 2020 research and innovation programme SC1-PHE-CORONAVIRUS-2020 - project EpiPose (No 101003688). The views expressed in this Comment are those of the authors and not necessarily those of the EU, NIHR, PHE, or the UK Department of Health and Social Care. Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer–BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance studyWithout the national vaccination campaign, Israel probably would have had triple the number of hospitalisations and deaths compared with what actually occurred during its largest wave of the pandemic to date, and the health-care system might have become overwhelmed. Indirect effects and long-term benefits of the programme, which could be substantial, were not included in these estimates and warrant future research. Full-Text PDF