News of Forthcoming COVID-19 Vaccines

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A link was eventually established to an adjuvant, or booster, in the Pandemrix vaccine which was intended to strengthen the immune response.

Research in context
Evidence before this study

Narcolepsy is a severe immune-related disorder characterized by an inability to control sleep and wakefulness. The number of young diagnosed with narcolepsy rose sharply following immunization with the swine flu influenza A (H1N1) pdm09 vaccine Pandemrix 2009–2010. Spontaneous and Pandemrix-induced narcolepsy was known to be strongly associated with HLA-DQB1*06:02. A weaker association between immune-related T-cell receptor alpha joining (TRAJ) genes and both spontaneous and Pandemrix-induced narcolepsy had also been seen.
Added value of this study

Since only 0.02% of carriers of HLA-DQB1*06:02 developed narcolepsy after vaccination with Pandemrix, we sought to determine whether other genetic factors contribute to the risk. As expected, we detected a strong association between Pandemrix-induced narcolepsy and HLA-DQB1*06:02.

After correction for this HLA-haplotype, narcolepsy was significantly associated with GDNF-AS1.This gene may regulate the expression of GDNF, which is a neurotrophic factor essential for the maintenance and survival of neurons. The candidate immune gene locus, TRAJ, was also associated with narcolepsy to a lower extent.
Implications of all the available evidence for practice

Variation in genes related to immunity and neuronal survival may interact to increase the susceptibility to Pandemrix-induced narcolepsy. This finding may also increase the understanding of disease mechanisms underlying spontaneous narcolepsy.

Many of us are desperately hoping new and effective coronavirus vaccines will soon transport us back to our pre-Covid lives. But many scientists are warning that their arrival probably won't mean throwing our face masks in the bin anytime soon.

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Overall, the WHO estimates that between 65% and 70% of people will need to be immune before transmission is interrupted, herd protection achieved and everyone and everywhere declared safe.

Prof Azra Ghani, an epidemiologist at Imperial College London who specialises in the mathematical modelling of infectious diseases, thinks we need to reach 70% to be "on the safe side".

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German logistics giant Deutsche Post DHL has warned that large parts of Africa, Asia and South America have insufficient cooling facilities in the "last mile" delivery stages as well as not enough storage, which would "pose the biggest challenge" to delivering a vaccine at scale.

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And there is yet another barrier that could slow the task of reaching enough people to protect the vulnerable.

Health officials will have to overcome a rising tide of "vaccine hesitancy" - growing numbers of people who are reluctant to have inoculations - a phenomenon regarded as one of the top 10 threats to global health by the WHO.

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The bad news is that it could well take months or possibly years to vaccinate enough of the global population to make the whole interconnected world safe and reach a point where we can all return to full normal.

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Suggestions that vaccines will be able to take us back to where we were pre-Covid by Easter next year have given people an unrealistic expectation, says Prof Salisbury, and such an outcome, in the absence of the interruption of transmission, is "unlikely".

Even countries with strong health infrastructure and experience of mass vaccination programmes - like the UK - will find reaching enough people to break the chain of transmission a challenge, he says.

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