Update for people with liver disease on the Covid-19 vaccine

Whilst the vaccine trials have not looked specifically at safety in patients with liver disease, there is no data to suggest harm for people with chronic liver disease. Vaccines are, in general, less effective in patients with chronic liver disease and those post-liver transplant. But, there is no data specifically with the COVID-19 vaccines.

The British Society of Gastroenterology and BASL have advised that they recommend that patients with chronic liver disease, autoimmune hepatitis and those post-liver transplant should strongly consider vaccination for COVID-19 with any of the available vaccines. However, although it is likely that the vaccine will offer some level of protection, they do not know whether the vaccines will be equally effective in transplant patients or those who are  immunosuppressed.

It is important that everyone who has the Covid vaccine,  does not change their behaviours and continues to take precautions against catching Covid 19. No vaccine is 100% effective and the government  also does not know whether having the vaccine stops people passing coronavirus on to others. It is particularly important for those who are immunosuppressed  or who have had a transplant continue to continue to keep themselves safe after vaccination.

We will only get good information about the full safety and effectiveness in those who have been transplanted and are immunosuppressed once these vaccines start being used in clinical practice. The Government will be undertaking ongoing active surveillance on the effectiveness of the vaccine and will be gathering data as the vaccination programme is implemented. When enough of the UK population have been vaccinated, then the COVID-19 pandemic should start to ease. This is likely to be the most important way in which the vaccine helps those who are immunosuppressed.

Patients who have autoimmune hepatitis and are worried that being vaccinated may make their condition worse or cause a ‘flair up’ should have an individual conversation with their consultant clinician.

Please note that the nurses on the Helpline are only able to provide the general information outlined above and are not able to advise you on whether a particular vaccine would be safe or effective for you as an individual.

The only vaccines that are ‘live’ are Oxford Uni/Astra Zeneca and Janssen. DHSC have indicated to us verbally that they are not ‘live’ in the ‘conventional’ sense (they don’t replicate) and that “it is unlikely that anyone would be contra indicated for any of the live vaccines that are currently being developed unless they have a specific allergy to that vaccine.

Each of the vaccines are tested on tens of thousands of people across the world. They are tested on both men and women, on people from different ethnic backgrounds, representative of the UK population and of all ages between 18-84.

Pfizer/BioNTech trials took place in the US, Europe, Turkey, South Africa and South America. Approximately 42% of global participants and 30% of U.S. participants had racially and ethnically diverse backgrounds.

AstraZeneca also included a trial in South Africa of 2,130 participants, and another in the US including African American, Hispanic and Native American participants.

In the AstraZeneca trials, the non-white demographic in the UK trial was 8%.In the Brazil trial it was 34.2% and in South Africa it was 87.5%.

• The trials for both vaccines have involved people with chronic underlying conditions deliberately, and they have involved people from very broad age ranges and quite a lot of people in the elderly bracket. The JCVI have looked at this, there’s no indication that there should be any difficulty in giving it to people with chronic underlying conditions.
• The JCVI has picked out, not just by age, but people 18 to 65 with at-risk conditions. And, and the reason for that is that they are at extremely high risk from coronavirus compared with the general population.

The NHS is now offering vaccines to people aged 50 and above and those who are at risk due to underlying health conditions (see PHE Green Book, p.10), which includes a wider group of people at higher clinical risk and young adults in residential settings. This also includes those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill.

The JCVI defines clinically vulnerable people as those with:

• chronic respiratory disease, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and severe asthma
• chronic heart disease (and vascular disease)
• chronic kidney disease
• chronic liver disease
• chronic neurological disease including epilepsy
• Down’s syndrome
• severe and profound learning disability
• diabetes
• solid organ, bone marrow and stem cell transplant recipients
• people with specific cancers
• immunosuppression due to disease or treatment
• asplenia and splenic dysfunction
• morbid obesity
• severe mental illness

If you are taking medication, please bring a list of these with you to the vaccination centre. Do not bring the medicines themselves.

If you are taking a blood thinner called 'warfarin' you will also be going for regular blood tests to monitor the thickness of your blood using a test called INR. The INR test result is a number (for example 2.5). Please make sure you know your latest INR reading and when that was last checked.

If you don't know this, you can get if from your GP surgery. If you are taking warfarin but we don't know your INR reading it can sometimes mean your vaccination cannot go ahead. The vaccination computers at the centre do not link back to your medical records so we can't look up your result on the day.

What to bring

You'll need to bring:

• a face covering, unless you cannot wear one for a health or disability reason.
• your booking reference numbers if your appointment is at a vaccination centre

If you need a carer, you can bring them with you on the day.

Protection from any vaccine takes time to build up. In general, the older you are the longer it takes. It will take at least two weeks in younger people and at least three weeks in older people before you can expect to have a good antibody response. Even then, you must return when called for your second dose. Vaccines offer important protection to reduce risk but they do not make you invincible. No vaccine offers 100% protection against any disease.

All of the vaccine trials for Covid-19 vaccines have given half of the volunteers the vaccine and half a dummy or substitute. The rates of Covid-19 in each group are then monitored. The difference between those vaccinated and those unvaccinated can be used to calculate percentage vaccine efficacy.

Therefore in the trials, vaccine efficacy reports how good a vaccine is at preventing disease - counted as having symptoms and a positive test result.

The trials are not large enough to report how effective the vaccines are at reducing hospitalisation and deaths. We will only know this after the vaccines have been rolled out. However, a vaccine that is highly effective (as these are) is very likely to have a big impact on hospitalisations and deaths.

The Pfizer / BioNTech and Astra Zeneca (Oxford) vaccines have been shown to provide a high level of protection from symptomatic COVID-19. We do not yet know the impact of the vaccine on transmission and so we are vaccinating those who are at highest risk of serious illness and death.

As vaccination programmes roll out globally, our understanding of the effectiveness of each vaccine on disease, serious disease, death and transmission will increase, and these data will be used to develop advice on the next phase of the programme.

Every single vaccine authorised for use in the UK has been authorised by the MHRA and the three parts of authorisation are a safety assessment, an effectiveness assessment and a manufacturing quality assessment.

• Every single vaccine authorised for use in the UK has been authorised by the MHRA. The three components of authorisation are a safety assessment, an effectiveness assessment and a manufacturing quality assessment.
• Like all medicines, vaccines can cause side effects. Most of these are mild and short-term, and not everyone gets them.
• These are important details which the MHRA always consider when assessing candidate vaccines for use.
• For the Pfizer/BioNTech vaccine, like lots of others, they have identified that some people might feel slightly unwell, but they report that no significant side effects have been observed in the over 43,000 people involved in trials.
• All patients will be provided with information on the vaccine they have received, how to look out for any side effects, and what to do if they do occur, including reporting them to the MHRA.

Some side effects may include:

• a sore arm where the needle went in
• feeling tired
• a headache
• feeling achy
• feeling or being sick
• All patients are given information on the vaccine they have received, how to look out for any side effects, and what to do if they do occur, including reporting them to the Medicines and Healthcare products Regulatory Agency (MHRA).

Healthcare professionals are asked to report any suspected side effects to COVID-19 vaccines. Report using the dedicated Coronavirus Yellow Card reporting site or the Yellow Card app.

More info here on patient information leaflets from PHE

https://www.gov.uk/government/publications/covid-19-vaccination-guide-for-older-adults

More information on the vaccination from NHS

https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/?priority-taxon=774cee22-d896-44c1-a611-e3109cce8eae

Every single vaccine authorised for use in the UK has been authorised by the MHRA and the three components of authorisation are a safety assessment, an effectiveness assessment and a manufacturing quality assessment.

• You cannot catch Covid from the vaccines. But it is possible to have caught Covid and not realise you have the symptoms until after your vaccination appointment.
• If you have any of the symptoms of Covid, stay at home and arrange to have a test.
• If you need more information on symptoms visit: nhs.uk/conditions/coronavirus-COVID-19/symptoms/

• Vaccination to at-risk groups till take place at the most appropriate settings to encourage uptake. This includes administering vaccination to at risk individuals in their usual place of residence. The three models of delivery are:
• Hospital Hubs - NHS providers vaccinating staff onsite.
• Local Vaccination Services – Community and primary care-led service based on local and logistical considerations but is likely to include GP practices, local authority sourced buildings or other local facilities, and potentially roving teams if vaccines are transportable in this way.
• Vaccination Centres - Large scale centres such as sports and conference venues set up for high volumes of people.

• Both Pfizer/BioNTech and Oxford/AstraZeneca are very effective vaccines. Comparisons between the vaccine efficacies are unhelpful due to the different methodologies used.
• Both vaccines have been approved because they pass the MHRA’s tests on safety and efficacy, so people should be assured that whatever vaccine they get will be highly effective and protect them from Coronavirus.

• Any vaccines that are available will have been approved because they pass the MHRA’s tests on safety and efficacy, so people should be assured that whatever vaccine they get will be highly effective and protect them from coronavirus.
• The Pfizer/BioNTech vaccine is being rolled out as fast as possible by the NHS across the UK. Now authorised, the AstraZeneca/Oxford vaccine will be deployed alongside the Pfizer/BioNTech vaccine to increase the pace and volume of the UK programme. There are no current plans to mix these vaccines.
• The vaccines people are offered will be appropriate for them. This decision is based on clinical judgement supported by the advice of Joint Committee on vaccination and immunisation. This will take into account individual vaccine characteristics, which may mean they are more suitable for some groups of people, and not others – for example, some may be less well tolerated or effective in certain age groups.

• The Pfizer/BioNTech vaccine is rapidly being rolled out across the UK, starting with the highest priority groups.
• The AstraZeneca/Oxford vaccine and other candidates will be deployed alongside the Pfizer/BioNTech vaccine to increase the pace and volume of the UK programme.
• More evidence is needed to understand whether a seasonal vaccination or booster dose might be needed.
• The vaccines people are offered will be appropriate for them. This decision is based on clinical judgement supported by the advice of Joint Committee on vaccination and immunisation. This will take into account individual vaccine characteristics, which may mean they are more suitable for some groups of people, and not others – for example, some may be less well tolerated or effective in certain age groups.

Vaccination numbers are published daily:

https://coronavirus.data.gov.uk/details/healthcar

• Full protection should begin 7-10 days after the second injection.

You can still carry the virus on your body and clothes if you come into contact with it. You will therefore still need to follow the guidance in your workplace, including wearing the correct personal protection equipment and taking part in any screening programmes.

To continue to protect yourself, your residents, your family, friends and colleagues you should follow the general advice at work, at home and when you are out and about:
practise:

• social distancing
• wear a face mask
• wash your hands carefully and frequently
• follow the current guidance
• Guidance is at gov.uk/coronavirus

• The MHRA will publish information on the ingredients in a summary of product characteristics (SpC) or equivalent. See here for more details.

The vaccines that are authorised have been through three stages of clinical trials and have been tested on tens of thousands of people around the world.

The trial phases were organised to overlap, speeding up the overall time of vaccine production, but without cutting any corners on trialling the vaccine and ensuring it meets strict standards of safety and effectiveness.

Time has also been gained because:

Vaccine trial volunteers were recruited at the start of the process, so they were ready to go once the vaccine was ready for trial

In the UK trials, the National Institute for Health Research (NIHR) made this their top priority

Plans were made for the next phase of trials by the companies without having to wait for investor decisions.

Companies made decisions to begin large scale production of vaccines which were still in trials. So, if vaccines were found to be safe and effective, they would be ready to be distributed.

The University of Oxford, created a video about 'How to make a vaccine in record time'

Every single vaccine authorised for use in the UK has been authorised by the MHRA and the three components of authorisation are a safety assessment, an effectiveness assessment and a manufacturing quality assessment.

• The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK’s independent regulator. Their role is to ensure medicines, devices and vaccines work effectively and are safe for use.
• Each COVID-19 vaccine candidate is assessed on a case by case basis and will only be authorised once it has met robust standards of effectiveness, safety and quality.
• Teams of scientists and clinicians carefully, methodically, scientifically rigorously review all data on safety, effectiveness and quality as soon as they become available, and have done so throughout all tests and trials
• The data looked at includes all the results from laboratory studies, clinical trials, manufacturing and quality controls and testing the product. The public on that basis should be very confident that all tests are done to the very highest standards, and only then will a COVID-19 vaccine be made available.

• Nurses, paramedics, pharmacists, GPs and other NHS staff are working hard to get the vaccine to those most vulnerable.
• Recruitment of workforce has focused on those who already have experience in handling vaccinations but may currently work outside of NHS settings, for example, independent nurses or allied health care professionals.
• Existing schemes such as NHS Bring Back scheme have also been utilised in order to fill roles.
• A comprehensive training package has been put together by NHS England and NHS Improvement (NHSE-I), with professional groups and Public Health England (PHE). New vaccinators will have undergone both a comprehensive training programme and competency assessment to ensure they can safely administer vaccines to patients under the clinical supervision of an experienced health care professional. This training will include how to deal with possible adverse reactions to a vaccine.

Yes, if they are in a priority group identified by JCVI. The MHRA have looked at this and decided that getting vaccinated is just as important for those who have already had Covid-19 as it is for those who haven’t.

In line with other NHS services, all services are required to ensure they take all necessary infection prevention and control measures such as social distancing, use of PPE and regular cleaning of chairs, table and other touchpoints. Patients are also asked to wear face coverings unless they are unable to.

The UK COVID-19 Vaccines Delivery Plan sets out how the Government will work with the NHS, devolved administrations, local councils and the Armed Forces to deliver the largest vaccination programme in British history.

The plan is split into four main areas:

• Supply - including the development and manufacturing of vaccines, ensuring their safety and effectiveness;
• Prioritisation - insight into the first two phases of deployment;
• Places - ensuring simple, fair and convenient access to vaccinations for the public, regardless of where they live; and
• People - mobilising the workforce and providing information on vaccinations to local communities.

There is no evidence that the vaccine affects fertility. The theory that immunity to the spike protein could lead to fertility problems is not supported by any evidence. Most people who contract COVID-19 will develop antibody to the spike and there is no evidence of fertility problems after Covid-19 disease.

Read the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives response to misinformation around Covid-19 vaccine and fertility.  

The latest advice, from the Joint Committee on Vaccination and Immunisation (JCVI) is that the vaccine should be considered for pregnant women when their risk of exposure to the virus infection is high and cannot be avoided, or if the woman has underlying conditions that place her at a very high risk of serious complications of Covid-19.

Women should discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances. Women who are breastfeeding can also be given the vaccine.

• The RCOG has prepared an information sheet to help pregnant women who are eligible for and have been offered vaccination make an informed choice.
• Please also read the Royal College of Obstetricians and Gynaecologists Q&As on COVID-19 vaccination, pregnancy and breastfeeding.
• Public Health England has produced advice in a range of formats for pregnant, breastfeeding and women of childbearing age.

The MHRA has confirmed that the COVID-19 Vaccine AstraZeneca and Pfizer/BioNTech COVID-19 vaccine do not contain any components of animal origin.

There is a trace amount of ethanol in the vaccine, which is less than the quantity found in bread. We have worked closely with Imams who have reviewed the ingredients of the AstraZeneca vaccine and confirmed that it is Halal.

Pfizer/BioNTech: A full list of ingredients for the qualitative and quantitative composition of the Pfizer/BioNTech vaccine can be found here.

AstraZeneca/Oxford: A full list of ingredients for the qualitative and quantitative composition of the vaccine can be found here.

• To help NHS organisations and communications teams with rolling out a COVID-19 vaccine campaign, there is a range of free print, digital and social campaign materials available on PHE’s Campaign Resource Centre.
• Various versions of the leaflets and posters have been developed, with different call-to-actions to be used depending on vaccine availability. Large print, braille and Easy read versions and translated versions are also available for download. There will be BSL videos for the ‘adults’, ‘what to expect’ and ‘pregnancy’ leaflets shortly.
• The easiest way to book a vaccination appointment once you receive an invite to book is through the National Booking Service online. The 119 telephone service also has BSL and text relay facilities. The booking service is sending out letters to those who have yet to receive a vaccine, with letters, phone calls and text messages to follow up anyone who still doesn’t reply.
• GPs are using a range of methods to contact their patients and are responsible for ensuring that they do this in a way that is accessible – including providing translations and alternative formats.

You can also place orders for these resources via the health publications website

The BSL videos are also available to download or view on the Health Publications website: https://www.healthpublications.gov.uk/Home.html

For training advice and guidance please see the training resources section here: https://www.gov.uk/government/collections/covid-19-vaccination-programme

The Easy Read leaflet

https://www.gov.uk/government/publications/covid-19-vaccination-easy-read-resources

Daily data summary

https://coronavirus.data.gov.uk/?_ga=2.218839707.329771229.1610380715-938063789.1606390656

Government vaccination programme information

https://www.gov.uk/government/collections/covid-19-vaccination-programme

All patient leaflets and translated leaflets can be viewed, downloaded or ordered as paper copies via the Health Publications order line website

https://www.healthpublications.gov.uk/Login.html

The Easy Read leaflet

https://www.gov.uk/government/publications/covid-19-vaccination-easy-read-resources

Vaccination deployment plan

https://www.gov.uk/government/publications/uk-covid-19-vaccines-delivery-plan

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/951284/UK_COVID-19_vaccines_delivery_plan.pdf

Vaccine uptake plan published 13 February 2021. Sets out the government's approach to making sure that as many people as possible take up the offer of vaccination.

https://www.gov.uk/government/publications/covid-19-vaccination-uptake-plan

NHS England vaccination sites

https://www.england.nhs.uk/coronavirus/hospital-hubs-and-local-vaccination-services/

Joint letter from four CMOs

https://www.gov.uk/government/publications/letter-to-the-profession-from-the-uk-chief-medical-officers-on-the-uk-covid-19-vaccination-programmes/letter-to-the-profession-from-the-uk-chief-medical-officers-regarding-the-uk-covid-19-vaccination-programmes

Green book - Coronavirus (COVID-19) vaccination information for public health professionals

Daily data summary

https://www.gov.uk/government/publications/covid-19-the-green-book-chapter-14a

MHRA – latest monitoring data confirms safety of Vocid-19 vaccines

https://www.gov.uk/government/news/latest-monitoring-data-confirms-safety-of-covid-19-vaccines

• Effective vaccines will be the best way to protect the most vulnerable from coronavirus and the biggest breakthrough since the pandemic began. A huge step forward in our fight against coronavirus, potentially saving tens of thousands of lives.
• We will closely monitor the impact of vaccinations on individuals, on NHS pressures and on the spread of the virus.

• The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK’s independent regulator. Their role is to ensure medicines, devices and vaccines work effectively and are safe for use.
• Each COVID-19 vaccine candidate is assessed on a case-by-case basis and will only be authorised once it has met robust standards of effectiveness, safety and quality.
• Teams of scientists and clinicians carefully, methodically, scientifically rigorously review all data on safety, effectiveness and quality as soon as they become available, and have done so throughout all tests and trials
• The data looked at includes all the results from laboratory studies, clinical trials, manufacturing and quality controls and testing the product. The public on that basis should be very confident that all tests are done to the very highest standards, and only then will a COVID-19 vaccine be made available

There are currently no plans in place to make the Covid-19 vaccine compulsory. The UK operates a system of informed consent for vaccinations.

The only vaccines that are ‘live’ are Oxford Uni/Astra Zeneca and Janssen. DHSC have indicated to us verbally that they are not ‘live’ in the ‘conventional’ sense (they don’t replicate) and that “it is unlikely that anyone would be contra indicated for any of the live vaccines that are currently being developed unless they have a specific allergy to that vaccine”.

• It can take 10-15 years to develop a vaccine, but scientists recognised years ago the threat of a pandemic such as Covid-19 so had already researched how the right vaccine could be used. Because the scientists knew how to make a vaccine that should work, they could begin trials to find a vaccine that would work and more quickly than usual.
• They have spent the last year working on what the right vaccines will be and trialling with human volunteers all over the world.
• This science has been backed by considerable resources including investment by the UK government and commercial partnerships to fast track production.
• The final step is for the independent regulator to confirm that the vaccines are safe as well as an effective way for people to protect themselves and their families.

• The Joint Committee on Vaccination and Immunisation (JCVI) are the independent experts who advise the Government on which vaccine/s the UK should use and provide advice on who should be offered the vaccination first.
• JCVI will consider each vaccine and provide their advice to the Government once detailed information on the characteristics and clinical properties of the approved vaccine becomes available.
• The current phase they recommend is a phase where the most vulnerable individuals in society are prioritised, particularly those who are most likely to die from severe Covid infection.
• The UK has focused on vaccines that are expected to generate an immune response among the over 65’s. Currently, over three-quarters of deaths caused by SARS-CoV-2 infection are in this older population, so it is essential that any vaccine is able to protect this group. The reason for this is because age is by far the strongest risk factor associated with severe Covid disease.
• The JCVI has advised that the vaccine first be given to care home residents and staff, followed by people over 80 and health and social workers, then to the rest of the population in order of age and risk. The prioritisation could change substantially if the first available vaccines were not considered suitable for, or effective in, older adults.

• The government has invested significantly to scale up manufacturing capabilities to ensure we are in a position to manufacture a successful vaccine in large quantities. The government has funded several UK vaccine manufacturing sites.
• The government is working closely with the devolved administrations to ensure successful delivery across the whole of the UK. We have also announced an additional £100 million investment to fund a state-of-the-art Manufacturing Innovation Centre in collaboration with the Cell and Gene Therapy Catapult, to accelerate the mass production of a successful COVID-19 vaccine in the UK.
• The government has invested £93 million additional funding to ensure the UK’s first dedicated Manufacturing and Innovation Centre will open 12 months earlier than planned, in summer 2021. While this centre is being built, the government has established a ‘rapid deployment facility’ thanks to a further investment of £38 million to begin manufacturing at scale from this summer.
• Collaboration between government, academia and industry is essential to manufacturing vaccine candidates at pace and scale. The UK’s leading life sciences industry knows how to develop, manufacture and distribute vaccines to global markets. The fact that the University of Oxford has signed a global licencing deal with UK-based AstraZeneca is testament to this.

The UK government will make vaccinations available for all of the UK, plus the Crown Dependencies and Overseas Territories.

Vaccination will be managed by the health services in each nation: NHS England and NHS Improvement, NHS Wales, NHS Scotland, and Health and Social Care Northern Ireland. The UK government is working closely with the Devolved Administrations to ensure an aligned approach to COVID-19 vaccine deployment across the UK.

The UK government has agreed to buy these vaccines on behalf of the Devolved Administrations, Crown Dependencies and Overseas Territories at no charge.

• False information about COVID-19 vaccines could cost lives.
• The government is working with health experts to provide information and advice at every possible opportunity.
• The Government’s Counter Disinformation Unit, led by DCMS works to tackle disinformation and misinformation relating to COVID-19.
• The Unit works closely with social media platforms to help them identify and take action to remove incorrect claims about coronavirus, and to promote authoritative advice and information.
• The Government published the Full Government Response to the Online Harms White Paper consultation in December 2020, which sets out new expectations on companies to keep their users safe online.
• The new laws will have robust and proportionate measures to deal with disinformation that could cause significant physical or psychological harm to an individual, such as false information about Covid-19 and COVID-19 vaccines.
• We have developed the SHARE checklist which aims to increase audience resilience by educating and empowering those who see, inadvertently share and are affected by false and misleading information. The checklist provides the public with five easy steps to identify false content, encouraging users to stop and think before they share content online.
• We have also partnered with the University of Cambridge to create a game called “Go Viral!”. Our aim is to build the public’s resilience to false information, mitigating the risk of undermining the uptake of Covid-19 vaccines, treatments and diagnostics.

• The encouraging news about vaccines is thanks to clinical study participants volunteering to take part and shows the importance of this vaccine research.
• Clinical trials into the vaccines against COVID continue at pace, and it is essential that these do so. We will need data about a number of vaccines and their safety and effectiveness, in order to protect the population. No one vaccine is likely to be suitable for everyone, the first vaccine may not be the most effective and easiest to use, and we must make sure that the other studies continue to allow us to have a selection of vaccines to protect the whole population. We are likely to need several vaccines to provide enough doses for everyone at risk, as early as possible.
• Once a vaccine is available, there will be a process in place so people on vaccine studies are not disadvantaged. People taking part in the vaccine research will still be able to have an approved vaccine when this is available. Taking part in a study is the best way to help effective vaccines to be identified and made available to everyone earlier and may even give you early access to a vaccine later found to be effective.

• All the vaccines will be tested on between 15,000 to 50,000 people across the world. They are tested on both men and women, on people from different ethnic backgrounds, and of all ages between 18-84.
• The studies have also looked at if the vaccines work on people with certain medical conditions and in older people, as their immune responses can work less effectively and therefore give them less protection through vaccines. As a result of this testing on a representative sample of the population, we can be confident that an approved vaccine will be effective for the wider population in the UK.
• Research and vaccine development will not end with the first approved vaccine, there will be a process of continuous improvement.

Once a vaccine is available, we will have a process in place so people on vaccine studies are not disadvantaged. People taking part in the vaccine research will still be able to have an approved vaccine when this is available. Taking part in a study is the best way to help effective vaccines to be identified and made available to everyone earlier and may even give you early access to a vaccine later found to be effective.

There is currently no evidence to suggest that the Pfizer or Oxford/AstraZeneca vaccine would not protect people against the new strain. Further laboratory work is currently being undertaken to understand this.