The Covid vaccine arrived quickly – but there's every reason to trust it
Most of us have had endured some very dark days in 2020, whether trying to juggle working from home alongside schooling children, worrying about how to pay the bills as a consequence of unemployment or, like me, attempting to balance scientific research alongside clinical work in the fight against Covid-19. As a scientist, I firmly believe that scientific progress will provide the exit strategy from this pandemic. But I’ve often worried that we may not be able to achieve what’s needed to prevent the spread of this virus, or that doing so would take a very long time. Never have I been happier to be proved wrong.
Britain is the first country to authorise emergency use of a vaccine for Sars-CoV-2, the virus that causes Covid-19. So how did we get here so quickly? To gain the seal of approval from the Medicines and Healthcare products Regulatory Agency, the UK body that makes sure medicines are safe, the vaccine, developed by Pfizer and BioNTech, has been through three phases of clinical trials. In the third phase, it was administered to more than 43,000 volunteers with no serious safety concern. The data shows that the vaccine is 95% effective at preventing the development of Covid, with similar efficacy observed across age, gender, race and ethnicity groups, including older adults.
The vaccine is a messenger RNA (mRNA) vaccine, which stands for “messenger ribonucleic acid”. Messenger RNA is essentially the blueprint that living cells use to turn gene sequences intothe proteins that form their fundamental structures. Once injected, the mRNA in the vaccine is translated into a viral protein, which our immune systems detect. The body generates an immune response in reaction to these viral proteins, which can’t by themselves cause disease, and this provides protection against developing Covid-19.
In the field of vaccine research, this kind of technology is entirely new. Some scientists were sceptical that mRNA vaccines could provide the key to controlling this pandemic. But mRNA vaccines are surprisingly straightforward: they’re just a smart way of getting a viral protein to generate an immune response, and after a few days the mRNA is degraded by the body, leaving behind only immunity to Covid.
To generate a good immune response, two doses of the vaccine will be given 21 days apart, with recipients protected from about a week after their second dose. To avoid unnecessary delays the MHRA, with advice from the Commission on Human Medicines, the government’s independent expert scientific advisory body, has undertaken a rigorous “rolling review” of data about the vaccine as it became available from continuing studies. This showed the vaccine was safe, and it has been approved for use in the UK population as of next week.
The European commission had recommended that member states wait for approval from the European Medicines Agency (EMA) before authorising the vaccine, which is expected to arrive later in December. But despite the claims of some ministers that Brexit played a role in the UK’s ability to quickly approve the vaccine, this isn’t true: under EU law, national agencies in Europe are permitted to use emergency procedures allowing them to domestically distribute a vaccine for temporary use. The MHRA, which is considered the world leader in the regulation of medicines and vaccines, confirmed this in a recent statement.
The UK has already purchased 40m doses of the vaccine, with 800,000 due to be rolled out to some of the most vulnerable people in our society through a network of more than 50 hospitals. The NHS and government departments have been working on the logistics of the programme for some time. First in line to receive the vaccine are people most at risk of mortality and morbidity from Covid-19.
The Joint Committee on Vaccination and Immunisation (JCVI) issued a revised vaccine priority list on 2 December, based on the phase of the pandemic we’re in. The JCVI has determined that the best strategy is for older adults – especially those in care homes and their carers, as well as frontline health and social care workers – to be the top priority in the first phase of the vaccination programme. Clinically extremely vulnerable adults, many of whom have spent this year shielding indoors, have been moved higher up this list since the JCVI’s last guidance was published, and will now be fourth in line to receive the vaccine.
Once the most vulnerable people have been vaccinated, the plan is to vaccinate those who are at increased risk of exposure to Covid-19 because of their jobs, such as first responders, teachers, transport workers and the military. This phase of the programme may alter over time as more data and information becomes available about the impact of the pandemic and the vaccine.
The greatest remaining challenge is whether we are all willing to accept and trust the vaccine. Some worry that, in order to have made a vaccine so fast, corners must have been cut. But they really haven’t been. Others have been concerned that mRNA vaccines represent a new technology that could potentially alter the DNA of the recipient – again, this is untrue. It’s certainly the case that vaccines have taken years to develop in the past, but most of that time was often not spent undertaking clinical trials, but raising the money for trials to take place, negotiating contracts and applying for regulatory approval. Historic vaccine trials have rarely taken place during a pandemic like this one, while millions of people are being exposed to infection on a daily basis and thousands of them are keen to participate in trials.
Despite the many horrors of 2020, there have been benefits – we have learned that if you divert an almost limitless amount of funding and focus a large proportion of the world’s scientists, regulatory bodies and other critical infrastructure towards a single endeavour, you can achieve extraordinary things very fast. For me, the question is not how have we managed to achieve a vaccination for Covid-19 in such a short period of time, but rather: why have we not yet managed to make the same impact on diseases such as tuberculosis, HIV and malaria, which have been killing millions of people for many years? And what could happen if we turned this urgent global effort towards the other challenges we face – such as environmental breakdown, or the insidious creep of antimicrobial resistance?
Much as we hate to admit it, humans are not entirely rational creatures. Many of our fears about vaccines will not be abated by people presenting us with scientific data. We make decisions like this based largely on whether we trust the advice we are being given. I could deluge you with research data about why the vaccine is safe, but I suspect the most useful thing that medics and scientists can do is to urge people to say yes to the vaccine when it is offered. And when my turn comes, you will find me waiting impatiently in the queue for my vaccination.
• Dr Charlotte Summers is a lecturer in intensive care medicine at the University of Cambridge
a QR code revealing an audio file of the actor Keira Knightley telling its history. “We are trying to give almost a backstage experience,” Pavlovsky said.The takeover of one of France’s top tourist attractions served as an effective reminder of Chanel’s status as a leader of French style, but the chateau’s place in the history of women in France is equally significant.
Known as the Chateau des Dames, after the women who designed it, much of its architecture was commissioned and conceived by Catherine de’ Medici. She was one of a roll call of formidable chatelaines including Louise Dupin, who employed Jean-Jacques Rousseau as a secretary and helped save the chateau from destruction during the French Revolution.
Chanel is a female-founded house and the uncompromising spirit of Coco Chanel– who pioneered comfortable clothing in which women could walk, ride and travel and once said “I decided who I wanted to be and that is who I am” – is back in the spotlight after the death of the larger-than-life character
Karl Lagerfeld. “Virginie [Viard, who replaced Lagerfeld as creative director,] is getting stronger and stronger,” said Pavlovsky. “She is a woman designing for women and that is very visible in her collections.”With the world in thrall to the chessboard chic of Netflix’s The Queen’s Gambit, the chalk-andslate checkerboard ballroom floor was a very on-trend setting for a collection that, like Viard’s wardrobe, was mostly monochrome and finished with rockchick black eyeliner. Elegant bouclé tweeds in the pale limestone shades of the Loire architecture were worn with black-velvet chokers and pearlstudded corset belts.Viard recently told Vogue that taking over from Lagerfeld, her boss of three decades, was “as if my grandparents had given me their fabric house and I wanted it to be the best – I wanted them to be happy. I’m often asking myself: ‘Karl, what do you think? Is it OK?’”Pavlovsky said Viard was “very flexible” and had taken this year’s complexities in her stride. He added that Lagerfeld “would have hated this year. Karl was a communicator. He would not have been happy to be stuck at home.”
watch something surely beats the alternative. “When I grew up, The Sound of Music played for eight weeks over the summer at the Folkestone Odeon. The following year it was The Battle of Britain.
“And then if you did find a film you felt really deeply about, you still probably only saw it once or twice. So you’d store it in your soul and say it was your favourite. Whereas I think younger people say: ‘That’s my favourite and I’m just going to watch it all the time.’”
matching opera gloves and a clutch bag, Mrs Eisenhower, “is an example of the homemaker in chief”, says DuBois Shaw. “She is all about wearing the Dior New Look, with cinched waists and full skirts, and putting pink doilies all over the White House. She is kind of a regressive antidote to the liberated work-empowered women that had come out of the war years; it’s a way to get women back in the kitchen. She models that for working-class and middle-class white women. A shade called Mamie pink became really popular in fashion in the 1950s.”
Mamie Eisenhower by Thomas Edgar Stephens, 1959
All the portraits illustrate something unique about each of the sitters and their approach to the role. Jacqueline Kennedy’s Time magazine cover, for example, speaks of the growing prominence of the role as a political celebrity. She stands in front of the White House portico, with a baby’s pram on the balcony. “It’s a really poignant image because it speaks to the young family she brought to the White House. She is the future.” It also foreshadows the unimaginable tragedy she would soon face when her third baby died two days after he was born, just months before her husband was assassinated.
Betty Ford by Everett Raymond
Kinstler, 1996.
Betty Ford’s steadfast bouffant, meanwhile, is represented in oils. During the course of her research, DuBois Shaw says Ford became “my new favourite”. During her time as first lady, she spoke openly about many taboo issues, notably breast cancer and mastectomy. After leaving the White House, she talked about her addiction to prescription painkillers and alcohol, and then memorably launched the Betty Ford clinic. “She initiated a national acceptance of addiction as a disease that is treatable, not shameful, not a moral failing,” says DuBois Shaw. “We have Betty Ford to thank for that.”
But while many first ladies have achieved extraordinary things, within the confines of this unpaid and unelected role, many more have been unsure how to use their power and prominence. Even Mrs Washington, says DuBois Shaw, had a “complicated” relationship with the position. “She was very unhappy about being put into this role because it confined her; she complained to her friends in letters that she hadn’t been able to go anywhere or do anything since her husband had been president.”
Edith and Ethel Roosevelt by Cecilia Beaux, 1902.
This was before the role was, to some extent, regularised by Edith Roosevelt, who established offices in the East Wing and hired a social secretary in 1902. Over the ensuing decades, a retinue of staff sprung up, “helping the first lady to meet the expectations of the public”. Still, over 250 years, there is no satisfactory answer to the question of exactly what a first lady should be. And perhaps that is appropriate: until there are more women in office, and there are routinely first gentlemen too, the role of first lady, and its assumed continuation of a gendered division of power, must remain uncomfortable.
Melania Trump by Régine MahauxVan Wassenhove, 2017.
Uncomfortable is certainly the sense you get from Mrs Trump, who publicly wears the perma-peeved expression of a person stuck in a gilded cage with an orange narcissist. A secret recording of her frustrations with the role was recently leaked, in which she complained about the public perception of her as “complicit” in her husband’s cruel immigration policies and the thankless months she had spent on the White House’s festive decorations with the immortal line: “Who gives a fuck about Christmas stuff?”
At least later first ladies have had the chance to create their own images. Since 2006, first lady portraits have been actively commissioned by the National Portrait Gallery, along with its long-running collection of presidential portraits. Hillary Clinton was the first, captured in side-profile, by Ginny Stanford, looking composed and regal, like the head of a coin, flanked by gold leaf panels, and wearing a hopeful shade of buttercup yellow. It is a rather poignant image, given what happened later of which, DuBois Shaw believes, the role of first lady played its part. “Much of the animosity towards her begins when she does not inhabit that role of first lady in the way that the sexist powers-that-be would have it.”
Hillary Rodham Clinton by Ginny Stanford, 2006.
Michelle Obama’s 2018 portrait, by Amy Sherald, reflects her openness and interest in contemporary art as well as her understanding of the power of her endorsements. Sherald and Kehinde Wiley, who painted Barack Obama’s portrait around at the same time, were the first black recipients of commissions from the National Portrait Gallery. There was some controversy when the portrait was released because Obama’s skin was represented in greyscale, which Sherald has used, she has said, “to exclude the idea of colour as race”. Obama was open to working with an artist with her own very strong ideas about how the finished portrait would look, says DuBois Shaw. The dress she wears, designed by Michelle Smith, was also thoughtfully chosen. Its patterns are reminiscent of “patterns and designs commonly found in American quilting, particularly African American quilting traditions, and references the history of women’s needlework and
American folk art, and that was something Mrs Obama was drawn to,” says DuBois Shaw.
Michelle Obama by Amy Sherald, 2018.
It will be the Trumps’ turn to be captured next for their exit portraits if, please God, they concede and vacate office (a process on which, sadly, DuBois Shaw would not comment). Until then, the White House provided Mrs Trump’s official photograph, for the exhibition. The current first lady’s razor-sharp jawline, tonged hair and HD eyebrows present a level of grooming that would have been alien to first ladies of yore. It is a highly structured portrait. “Mrs Trump was a model, so she really understands the camera and knows exactly how she wants to look. I think it reflects the desire she may have had – going into the White House back in 2017 – to present a composed and straightforward image of herself,” says DuBois Shaw.
Given that Mrs Trump has played close to a nonspeaking role over the past four years, the choices she makes for her official portrait, when it is released, will be worth a thousand words, and everyone will be listening.
county in 2016 by about 26 percentage points. In 2020, Trump carried the county by just 19 points.
Jay Tucker, the chair of the Pike county Democratic committee, said there was “no question” mail-in balloting helped improve Democrats’ performance this year. He said he and other organizers were able to closely track who had requested a ballot and regularly followed up with those who hadn’t returned a ballot.
“We worked our ass off on that,” Tucker said. “One of the biggest mistakes that Trump made in this election was not backing mail-in voting. Because I think a lot more people came out.”
In Michigan, one of the places that swung hardest towards Democrats was Kent county, home to Grand Rapids. Trump won the county by four points in 2016, but Biden carried it by six points this year. Eighty per cent of the people who requested mail-in ballots returned them, something that contributed to Democrats doing well there, said Gary Stark, the chairman of the county Democratic party.
“I think that the absentee voting was a factor in the higher turnout. I think a number of new voters did use absentee ballots or mail-in ballots this time. No way to prove that, but that would be my gut assumption,” he said.
‘Don’t trust the mailbox’: varying views on mail-in ballots
America saw the highest turnout in a presidential election since the turn of the 20th century. Nearly 160 million people – about 67% of those eligible – cast a ballot this year. And Michael McDonald, a professor at the University of Florida who closely tracks voter turnout, said there were signs that states that expanded vote by mail contributed more to the higher turnout than those that did not, though he cautioned he was still analyzing voter data.
But the repeated Republican attacks on the process appears to have shaken some voters’ faith in the process.
Deadlines for returning absentee ballots flipped back and forth as lawsuits made their way through the courts. There were hundreds of election-related cases brought in state and federal courts this year. The US supreme court declined to lift restrictions on mail-in voting in the handful of them that reached it. It took a federal lawsuit to get the United States Postal Service to be transparent and make detailed commitments about how it would guarantee the timely delivery of ballots.
“My mom was like, no, don’t put anything in the mail. Don’t trust the mailbox. Walk it inside and drop it in,” said Sonni King, who requested a mailin ballot and returned it in person at a satellite voting location in Philadelphia days ahead of the election.
“I’ve been hearing a lot about the whole mail issues and the breaching and all of that so I felt like this was a safer route,” said Brittany Davis, who voted in person on election day in Philadelphia.
“You just hear so much in the news, in the media, I don’t know how much is true and how much is false, just [about] the mail-in ballots being messed with, people not doing it the right way. So I just know if I was able to come in, even if I had to wait, just to make sure my vote was 100% counted, I was gonna do it,” said Shofolahan Da-silva, who also voted in person in Philadelphia.
There’s also the fact that some communities had a more difficult time voting by mail. As the election neared, Black voters in North Carolina overwhelmingly had their ballots flagged for potential rejection.
Native Americans also faced severe hurdles to voting by mail – postal service on reservations can be unreliable and the nearest post office might be hours away.
‘Habit-forming’: expanded access could be here to stay
The success of mail-in voting this year could mean that more people will vote by mail in the future, Bonier said. That could mean more election infrastructure that supports the sending and counting of these ballots – a process that caused some of the biggest legal fights of the election.
“Historically, generally when people vote by mail once, they do it again. It is habit-forming,” he said. “What we’ll see in terms of the trend line is this election represented a massive spike in interest in mail voting, and some of that will recede, but we’ll settle at a point where far more people in this country will vote by mail in future elections than did prior to 2020.”
In Georgia, for example, people who voted by mail in the 2018 midterm election were far more likely to vote by mail again in 2020, according to a Guardian analysis of data from the Georgia secretary of state. Of those who voted in both elections, about 78% of people who cast mail ballots in 2018 did so again in 2020. Just 34% of in-person voters in 2018 voted by mail in 2020.
Still, if states will continue to embrace the dramatic expansion of mailin voting after a record turnout election. Republicans in Georgia, as well as Lindsey Graham, the South Carolina senator, have already suggested revisiting the rules around mail-in voting. Such an approach would fit in with a well-documented Republican strategy of trying to make it harder to vote to preserve the party’s power.
“I think we could see some rolling back. It would be hard to justify that given how high turnout was, and the goal should be higher participation,” Bonier said. “But just given the polarization we’ve seen specifically on this issue of mail voting, it’s unreasonable to assume there won’t be at least some efforts to restrict mail voting in future elections.”