I definitely have the feeling of perspective change this morning, not just about the MHRA but having a tangible time line to first vaccination near me - vaccines are really coming.

First - a moment of celebration - we have three vaccines that have reported, consistent with their Phase III plans, safety and efficacy success. One of these vaccines has been approved by an established large regulatory agency (MHRA in the UK)

It seems very likely that these vaccines will all be approved and many more are coming. We will move to the wonderful position of having many vaccines (which we will need - there are a lot of humans on this planet!)

The challenge - and it is a serious challenge - is the manufacture, distribution, communication and logistics about vaccines. None of the above is easy; each country needs a plan that will work for them.

Some waypoints inside each country and worldwide to think about.

Waypoint #1 is when the majority of healthcare workers are vaccinated. This has two major benefits; the first is that infection control inside hospitals is a nightmare - hospitals +carehomes absolutely have high risk individuals in them and this virus has asymptomatic carriage >>

<< ie, otherwise healthy doctors and nurses can have the infection without knowing and unwittingly pass this on to their patients or carehome residents.

The second benefit for healthcare worker vaccination is that hotspots or dramatic acceleration of the epidemic impacts an unvaccinated workforce - ie, doctors and nurses isolating and off due to the virus itself. This has been a major complication in healthcare capacity

Waypoint #2 is when the majority of the acutely at risk population has been vaccinated. This will happen progressively presumably early next year. As this happens the pressure on the health service will diminish, and lower the risk of a hotspot leading to healthcare failure.

It's worth noting that "at risk" extends earlier in life due to LongCOVID, the poorly understood long term chronic disease post COVID that some people have. This will complicate the decision space for how much NPIs are needed over time.

Waypoint #3 is when the number of vaccinated individuals plus to the people who have gotten the infection is high enough to impact transmission with the levels of TTI and NPIs. This will allow one to reduce NPIs progressively.

It's going to be a complex titration issue about this phase, but it is why we will need situational awareness of infection levels in countries and the ability to add or remove NPIs alongside the improvements of TTI (one can never not improve TTI!)

Again, this will be a sliding scale somewhat, but it is likely that as this "bites" it will just get better and better because more and more vaccination will likely happen. For me, this will be the point where I will really breath easy

Waypoint #4 is when this number really gets to "community immunity" inside a country, and one goes to monitoring the infection, aiming to vaccinate people who are at risk and reluctant to vaccinate - this should really feel like close to "normality"

However, people will be testing for COVID lots (to ensure there is not some escape or something weird) and the exploration and management of LongCOVID will be seriously underway I suspect. In addition the economic impacts will be starting to seriously hit.

(so, sadly, I think there will be plenty more twists and turns in this story - it is going to be a long journey).

Waypoint #5 is this situation of community immunity occurring in the majority of countries - developed, developing, worldwide. This is no easy job. There are funding/pricing issues but sheer logistics issues.

It's going to take sustained effort to achieve global community immunity, and in some sense we will move to handling this virus as an endemic virus most likely, and part of the public health process. A huge host of questions here, some scientific, some healthcare delivery.

It's a long road, but I can feel us stepping down it.

[BTW - I consider the difference in timings of regulators largely in the noise - the majority will be this month, and this is a many-month process. Logistics + communication should be more of a concern than regulatory agency timing].