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{ content: '\e01f'; } .gelicon--degraded::before { content: '\e020'; } .gelicon--calendar-mini::before { content: '\e021'; } .gelicon--calendar::before { content: '\e022'; } .gelicon--mail::before { content: '\e023'; } .gelicon--location::before { content: '\e024'; } .gelicon--load::before { content: '\e025'; } .gelicon--settings::before { content: '\e026'; } .gelicon--embed::before { content: '\e027'; } .gelicon--external::before { content: '\e028'; } .gelicon--traffic::before { content: '\e029'; } .gelicon--refresh::before { content: '\e02a'; } .gelicon--link::before { content: '\e02b'; } .gelicon--point::before { content: '\e02c'; } .gelicon--upload::before { content: '\e02d'; } .gelicon--download::before { content: '\e02e'; } .gelicon--finder::before { content: '\e02f'; } .gelicon--stations::before { content: '\e030'; } .gelicon--untitled::before { content: '\42'; } .gelicon--untitled-2::before { content: '\43'; } .gelicon--quote::before { content: '\22'; } .gelicon--playlister-add::before { content: '\e031'; } .gelicon--calendar-30::before { content: '\e032'; } .gelicon--download-desktop::before { content: '\e033'; } .gelicon--map::before { content: '\e034'; } .gelicon--previous-alternative::before { content: '\e035'; } .gelicon--next-alternative::before { content: '\e036'; } .gelicon--arrow-down::before { content: '\e038'; } /* Media icons */ .gelicon--menu, .gelicon--live, .gelicon--subtitles, .gelicon--ws, .gelicon--sd, .gelicon--hd, .gelicon--bsl, .gelicon--ad, .gelicon--3d, .gelicon--tv, .gelicon--radio, .gelicon--mobile, .gelicon--desktop, .gelicon--game, .gelicon--tablet, .gelicon--quiz, .gelicon--guidance, .gelicon--record, .gelicon--listen, .gelicon--play, .gelicon--pause, .gelicon--rewind, .gelicon--forward, .gelicon--restart, .gelicon--image, .gelicon--document, .gelicon--slideshow, .gelicon--activity, .gelicon--360, .gelicon--podcast, .gelicon--newsletter, .gelicon--rss, .gelicon--fullscreen, .gelicon--expand, .gelicon--popout, .gelicon--mute, .gelicon--music-on, .gelicon--music-off, .gelicon--windows, .gelicon--apple, .gelicon--interactive { font-family: 'gelicons-media' !important; } /* Begin Icons */ .gelicon--menu::before { content: '\e900'; } .gelicon--live::before { content: '\e100'; } .gelicon--subtitles::before { content: '\e101'; } .gelicon--ws::before { content: '\e102'; } .gelicon--sd::before { content: '\e103'; } .gelicon--hd::before { content: '\e104'; } .gelicon--bsl::before { content: '\e105'; } .gelicon--ad::before { content: '\e106'; } .gelicon--3d::before { content: '\e107'; } .gelicon--tv::before { content: '\e108'; } .gelicon--radio::before { content: '\e109'; } .gelicon--mobile::before { content: '\e10a'; } .gelicon--desktop::before { content: '\e10b'; } .gelicon--game::before { content: '\e10c'; } .gelicon--tablet::before { content: '\e10d'; } .gelicon--quiz::before { content: '\e10e'; } .gelicon--guidance::before { content: '\e10f'; } .gelicon--record::before { content: '\e110'; } .gelicon--listen::before { content: '\e111'; } .gelicon--play::before { content: '\e112'; } .gelicon--pause::before { content: '\e113'; } .gelicon--rewind::before { content: '\e114'; } .gelicon--forward::before { content: '\e115'; } .gelicon--restart::before { content: '\e116'; } .gelicon--image::before { content: '\e117'; } .gelicon--document::before { content: '\e118'; } .gelicon--slideshow::before { content: '\e119'; } .gelicon--activity::before { content: '\e11a'; } .gelicon--360::before { content: '\e11b'; } .gelicon--podcast::before { content: '\e11c'; } .gelicon--newsletter::before { content: '\e11d'; } .gelicon--rss::before { content: '\e11e'; } .gelicon--fullscreen::before { content: '\e11f'; } .gelicon--expand::before { content: '\e120'; } .gelicon--popout::before { content: '\e121'; } .gelicon--mute::before { content: '\e122'; } .gelicon--music-on::before { content: '\e123'; } .gelicon--music-off::before { content: '\e124'; } .gelicon--windows::before { content: '\e125'; } .gelicon--apple::before { content: '\e126'; } .gelicon--interactive::before { content: '\e900'; } /* Social Icons */ .gelicon--share, .gelicon--recommend, .gelicon--comments, .gelicon--blog, .gelicon--smiley, .gelicon--love, .gelicon--twitter, .gelicon--facebook, .gelicon--google-plus, .gelicon--google, .gelicon--spotify, .gelicon--pinterest, .gelicon--tumblr, .gelicon--stumbleupon, .gelicon--linkedin, .gelicon--reddit, .gelicon--digg, .gelicon--instagram, .gelicon--whatsapp { font-family: 'gelicons-social' !important; } /* GEL */ .gelicon--share::before { content: '\e200'; } .gelicon--recommend::before { content: '\e201'; } .gelicon--comments::before { content: '\e202'; } .gelicon--blog::before { content: '\e203'; } .gelicon--smiley::before { content: '\e204'; } .gelicon--love::before { content: '\e205'; } /* THIRD PARTY */ .gelicon--twitter::before { content: '\e300'; } .gelicon--facebook::before { content: '\e301'; } .gelicon--google-plus::before { content: '\e700'; } .gelicon--google::before { content: '\e701'; } .gelicon--spotify::before { content: '\e304'; } .gelicon--pinterest::before { content: '\e305'; } .gelicon--tumblr::before { content: '\e306'; } .gelicon--stumbleupon::before { content: '\e307'; } .gelicon--linkedin::before { content: '\e308'; } .gelicon--reddit::before { content: '\e309'; } .gelicon--digg::before { content: '\e30a'; } .gelicon--instagram::before { content: '\e30b'; } .gelicon--whatsapp::before { content: '\e600'; } .mapboxgl-map { font: 12px/20px Helvetica Neue,Arial,Helvetica,sans-serif; overflow: hidden; position: relative; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); } .mapboxgl-canvas { position: absolute; left: 0; top: 0; } .mapboxgl-map:-webkit-full-screen { width: 100%; height: 100%; } .mapboxgl-canary { background-color: salmon; } .mapboxgl-canvas-container.mapboxgl-interactive, .mapboxgl-ctrl-group button.mapboxgl-ctrl-compass { cursor: -webkit-grab; cursor: grab; -moz-user-select: none; -webkit-user-select: none; -ms-user-select: none; user-select: none; } .mapboxgl-canvas-container.mapboxgl-interactive.mapboxgl-track-pointer { cursor: pointer; } .mapboxgl-canvas-container.mapboxgl-interactive:active, .mapboxgl-ctrl-group button.mapboxgl-ctrl-compass:active { cursor: -webkit-grabbing; cursor: grabbing; } .mapboxgl-canvas-container.mapboxgl-touch-zoom-rotate, .mapboxgl-canvas-container.mapboxgl-touch-zoom-rotate .mapboxgl-canvas { -ms-touch-action: pan-x pan-y; touch-action: pan-x pan-y; } .mapboxgl-canvas-container.mapboxgl-touch-drag-pan, .mapboxgl-canvas-container.mapboxgl-touch-drag-pan .mapboxgl-canvas { -ms-touch-action: pinch-zoom; touch-action: pinch-zoom; } .mapboxgl-canvas-container.mapboxgl-touch-zoom-rotate.mapboxgl-touch-drag-pan, .mapboxgl-canvas-container.mapboxgl-touch-zoom-rotate.mapboxgl-touch-drag-pan .mapboxgl-canvas { -ms-touch-action: none; touch-action: none; } .mapboxgl-ctrl-bottom-left, .mapboxgl-ctrl-bottom-right, .mapboxgl-ctrl-top-left, .mapboxgl-ctrl-top-right { position: absolute; pointer-events: none; z-index: 2; } .mapboxgl-ctrl-top-left { top: 0; left: 0; } .mapboxgl-ctrl-top-right { top: 0; right: 0; } .mapboxgl-ctrl-bottom-left { bottom: 0; left: 0; } .mapboxgl-ctrl-bottom-right { right: 0; bottom: 0; } .mapboxgl-ctrl { clear: both; pointer-events: auto; -webkit-transform: translate(0); transform: translate(0); } .mapboxgl-ctrl-top-left .mapboxgl-ctrl { margin: 10px 0 0 10px; float: left; } .mapboxgl-ctrl-top-right .mapboxgl-ctrl { margin: 10px 10px 0 0; float: right; } .mapboxgl-ctrl-bottom-left .mapboxgl-ctrl { margin: 0 0 10px 10px; float: left; } .mapboxgl-ctrl-bottom-right .mapboxgl-ctrl { margin: 0 10px 10px 0; float: right; } .mapboxgl-ctrl-group { border-radius: 4px; background: #fff; } .mapboxgl-ctrl-group:not(:empty) { -webkit-box-shadow: 0 0 2px rgba(0, 0, 0, 0.1); box-shadow: 0 0 0 2px rgba(0, 0, 0, 0.1); } @media (-ms-high-contrast: active) { .mapboxgl-ctrl-group:not(:empty) { -webkit-box-shadow: 0 0 0 2px ButtonText; box-shadow: 0 0 0 2px ButtonText; } } .mapboxgl-ctrl-group button { width: 29px; height: 29px; display: block; padding: 0; outline: none; border: 0; -webkit-box-sizing: border-box; box-sizing: border-box; background-color: transparent; cursor: pointer; } .mapboxgl-ctrl-group button + button { border-top: 1px solid #ddd; } .mapboxgl-ctrl button .mapboxgl-ctrl-icon { display: block; width: 100%; height: 100%; background-repeat: no-repeat; background-position: 50%; } @media (-ms-high-contrast: active) { .mapboxgl-ctrl-icon { background-color: transparent; } .mapboxgl-ctrl-group button + button { border-top: 1px solid ButtonText; } } .mapboxgl-ctrl button::-moz-focus-inner { border: 0; padding: 0; } .mapboxgl-ctrl-group button:focus { -webkit-box-shadow: 0 0 2px 2px #0096ff; box-shadow: 0 0 2px 2px #0096ff; } .mapboxgl-ctrl button:disabled { cursor: not-allowed; } .mapboxgl-ctrl button:disabled .mapboxgl-ctrl-icon { opacity: .25; } .mapboxgl-ctrl button:not(:disabled):hover { background-color: rgba(0, 0, 0, 0.05); } .mapboxgl-ctrl-group button:focus:focus-visible { -webkit-box-shadow: 0 0 2px 2px #0096ff; box-shadow: 0 0 2px 2px #0096ff; } .mapboxgl-ctrl-group button:focus:not(:focus-visible) { -webkit-box-shadow: none; box-shadow: none; } .mapboxgl-ctrl-group button:focus:first-child { border-radius: 4px 4px 0 0; } .mapboxgl-ctrl-group button:focus:last-child { border-radius: 0 0 4px 4px; } .mapboxgl-ctrl-group button:focus:only-child { border-radius: inherit; } .mapboxgl-ctrl button.mapboxgl-ctrl-zoom-out .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23333'%3E%3Cpath d='M10 13c-.75 0-1.5.75-1.5 1.5S9.25 16 10 16h9c.75 0 1.5-.75 1.5-1.5S19.75 13 19 13h-9z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-zoom-in .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23333'%3E%3Cpath d='M14.5 8.5c-.75 0-1.5.75-1.5 1.5v3h-3c-.75 0-1.5.75-1.5 1.5S9.25 16 10 16h3v3c0 .75.75 1.5 1.5 1.5S16 19.75 16 19v-3h3c.75 0 1.5-.75 1.5-1.5S19.75 13 19 13h-3v-3c0-.75-.75-1.5-1.5-1.5z'/%3E%3C/svg%3E"); } @media (-ms-high-contrast: active) { .mapboxgl-ctrl button.mapboxgl-ctrl-zoom-out .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23fff'%3E%3Cpath d='M10 13c-.75 0-1.5.75-1.5 1.5S9.25 16 10 16h9c.75 0 1.5-.75 1.5-1.5S19.75 13 19 13h-9z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-zoom-in .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23fff'%3E%3Cpath d='M14.5 8.5c-.75 0-1.5.75-1.5 1.5v3h-3c-.75 0-1.5.75-1.5 1.5S9.25 16 10 16h3v3c0 .75.75 1.5 1.5 1.5S16 19.75 16 19v-3h3c.75 0 1.5-.75 1.5-1.5S19.75 13 19 13h-3v-3c0-.75-.75-1.5-1.5-1.5z'/%3E%3C/svg%3E"); } } @media (-ms-high-contrast: black-on-white) { .mapboxgl-ctrl button.mapboxgl-ctrl-zoom-out .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg'%3E%3Cpath d='M10 13c-.75 0-1.5.75-1.5 1.5S9.25 16 10 16h9c.75 0 1.5-.75 1.5-1.5S19.75 13 19 13h-9z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-zoom-in .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg'%3E%3Cpath d='M14.5 8.5c-.75 0-1.5.75-1.5 1.5v3h-3c-.75 0-1.5.75-1.5 1.5S9.25 16 10 16h3v3c0 .75.75 1.5 1.5 1.5S16 19.75 16 19v-3h3c.75 0 1.5-.75 1.5-1.5S19.75 13 19 13h-3v-3c0-.75-.75-1.5-1.5-1.5z'/%3E%3C/svg%3E"); } } .mapboxgl-ctrl button.mapboxgl-ctrl-fullscreen .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23333'%3E%3Cpath d='M24 16v5.5c0 1.75-.75 2.5-2.5 2.5H16v-1l3-1.5-4-5.5 1-1 5.5 4 1.5-3h1zM6 16l1.5 3 5.5-4 1 1-4 5.5 3 1.5v1H7.5C5.75 24 5 23.25 5 21.5V16h1zm7-11v1l-3 1.5 4 5.5-1 1-5.5-4L6 13H5V7.5C5 5.75 5.75 5 7.5 5H13zm11 2.5c0-1.75-.75-2.5-2.5-2.5H16v1l3 1.5-4 5.5 1 1 5.5-4 1.5 3h1V7.5z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-shrink .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg'%3E%3Cpath d='M18.5 16c-1.75 0-2.5.75-2.5 2.5V24h1l1.5-3 5.5 4 1-1-4-5.5 3-1.5v-1h-5.5zM13 18.5c0-1.75-.75-2.5-2.5-2.5H5v1l3 1.5L4 24l1 1 5.5-4 1.5 3h1v-5.5zm3-8c0 1.75.75 2.5 2.5 2.5H24v-1l-3-1.5L25 5l-1-1-5.5 4L17 5h-1v5.5zM10.5 13c1.75 0 2.5-.75 2.5-2.5V5h-1l-1.5 3L5 4 4 5l4 5.5L5 12v1h5.5z'/%3E%3C/svg%3E"); } @media (-ms-high-contrast: active) { .mapboxgl-ctrl button.mapboxgl-ctrl-fullscreen .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23fff'%3E%3Cpath d='M24 16v5.5c0 1.75-.75 2.5-2.5 2.5H16v-1l3-1.5-4-5.5 1-1 5.5 4 1.5-3h1zM6 16l1.5 3 5.5-4 1 1-4 5.5 3 1.5v1H7.5C5.75 24 5 23.25 5 21.5V16h1zm7-11v1l-3 1.5 4 5.5-1 1-5.5-4L6 13H5V7.5C5 5.75 5.75 5 7.5 5H13zm11 2.5c0-1.75-.75-2.5-2.5-2.5H16v1l3 1.5-4 5.5 1 1 5.5-4 1.5 3h1V7.5z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-shrink .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23fff'%3E%3Cpath d='M18.5 16c-1.75 0-2.5.75-2.5 2.5V24h1l1.5-3 5.5 4 1-1-4-5.5 3-1.5v-1h-5.5zM13 18.5c0-1.75-.75-2.5-2.5-2.5H5v1l3 1.5L4 24l1 1 5.5-4 1.5 3h1v-5.5zm3-8c0 1.75.75 2.5 2.5 2.5H24v-1l-3-1.5L25 5l-1-1-5.5 4L17 5h-1v5.5zM10.5 13c1.75 0 2.5-.75 2.5-2.5V5h-1l-1.5 3L5 4 4 5l4 5.5L5 12v1h5.5z'/%3E%3C/svg%3E"); } } @media (-ms-high-contrast: black-on-white) { .mapboxgl-ctrl button.mapboxgl-ctrl-fullscreen .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg'%3E%3Cpath d='M24 16v5.5c0 1.75-.75 2.5-2.5 2.5H16v-1l3-1.5-4-5.5 1-1 5.5 4 1.5-3h1zM6 16l1.5 3 5.5-4 1 1-4 5.5 3 1.5v1H7.5C5.75 24 5 23.25 5 21.5V16h1zm7-11v1l-3 1.5 4 5.5-1 1-5.5-4L6 13H5V7.5C5 5.75 5.75 5 7.5 5H13zm11 2.5c0-1.75-.75-2.5-2.5-2.5H16v1l3 1.5-4 5.5 1 1 5.5-4 1.5 3h1V7.5z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-shrink .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg'%3E%3Cpath d='M18.5 16c-1.75 0-2.5.75-2.5 2.5V24h1l1.5-3 5.5 4 1-1-4-5.5 3-1.5v-1h-5.5zM13 18.5c0-1.75-.75-2.5-2.5-2.5H5v1l3 1.5L4 24l1 1 5.5-4 1.5 3h1v-5.5zm3-8c0 1.75.75 2.5 2.5 2.5H24v-1l-3-1.5L25 5l-1-1-5.5 4L17 5h-1v5.5zM10.5 13c1.75 0 2.5-.75 2.5-2.5V5h-1l-1.5 3L5 4 4 5l4 5.5L5 12v1h5.5z'/%3E%3C/svg%3E"); } } .mapboxgl-ctrl button.mapboxgl-ctrl-compass .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23333'%3E%3Cpath d='M10.5 14l4-8 4 8h-8z'/%3E%3Cpath d='M10.5 16l4 8 4-8h-8z' fill='%23ccc'/%3E%3C/svg%3E"); } @media (-ms-high-contrast: active) { .mapboxgl-ctrl button.mapboxgl-ctrl-compass .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg' fill='%23fff'%3E%3Cpath d='M10.5 14l4-8 4 8h-8z'/%3E%3Cpath d='M10.5 16l4 8 4-8h-8z' fill='%23999'/%3E%3C/svg%3E"); } } @media (-ms-high-contrast: black-on-white) { .mapboxgl-ctrl button.mapboxgl-ctrl-compass .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 29 29' xmlns='http://www.w3.org/2000/svg'%3E%3Cpath d='M10.5 14l4-8 4 8h-8z'/%3E%3Cpath d='M10.5 16l4 8 4-8h-8z' fill='%23ccc'/%3E%3C/svg%3E"); } } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23333'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate:disabled .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23aaa'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3Cpath d='M14 5l1 1-9 9-1-1 9-9z' fill='red'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-active .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%2333b5e5'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-active-error .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23e58978'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-background .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%2333b5e5'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-background-error .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23e54e33'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-waiting .mapboxgl-ctrl-icon { -webkit-animation: mapboxgl-spin 2s linear infinite; animation: mapboxgl-spin 2s linear infinite; } @media (-ms-high-contrast: active) { .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23fff'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate:disabled .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23999'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3Cpath d='M14 5l1 1-9 9-1-1 9-9z' fill='red'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-active .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%2333b5e5'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-active-error .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23e58978'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-background .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%2333b5e5'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate.mapboxgl-ctrl-geolocate-background-error .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23e54e33'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3C/svg%3E"); } } @media (-ms-high-contrast: black-on-white) { .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3C/svg%3E"); } .mapboxgl-ctrl button.mapboxgl-ctrl-geolocate:disabled .mapboxgl-ctrl-icon { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='29' height='29' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill='%23666'%3E%3Cpath d='M10 4C9 4 9 5 9 5v.1A5 5 0 005.1 9H5s-1 0-1 1 1 1 1 1h.1A5 5 0 009 14.9v.1s0 1 1 1 1-1 1-1v-.1a5 5 0 003.9-3.9h.1s1 0 1-1-1-1-1-1h-.1A5 5 0 0011 5.1V5s0-1-1-1zm0 2.5a3.5 3.5 0 110 7 3.5 3.5 0 110-7z'/%3E%3Ccircle cx='10' cy='10' r='2'/%3E%3Cpath d='M14 5l1 1-9 9-1-1 9-9z' fill='red'/%3E%3C/svg%3E"); } } @-webkit-keyframes mapboxgl-spin { 0% { -webkit-transform: rotate(0deg); } to { -webkit-transform: rotate(1turn); } } @keyframes mapboxgl-spin { 0% { -webkit-transform: rotate(0deg); transform: rotate(0deg); } to { -webkit-transform: rotate(1turn); transform: rotate(1turn); } } a.mapboxgl-ctrl-logo { width: 88px; height: 23px; margin: 0 0 -4px -4px; display: block; background-repeat: no-repeat; cursor: pointer; overflow: hidden; background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='88' height='23' viewBox='0 0 88 23' xmlns='http://www.w3.org/2000/svg' xmlns:xlink='http://www.w3.org/1999/xlink' fill-rule='evenodd'%3E%3Cdefs%3E%3Cpath id='a' d='M11.5 2.25c5.105 0 9.25 4.145 9.25 9.25s-4.145 9.25-9.25 9.25-9.25-4.145-9.25-9.25 4.145-9.25 9.25-9.25zM6.997 15.983c-.051-.338-.828-5.802 2.233-8.873a4.395 4.395 0 013.13-1.28c1.27 0 2.49.51 3.39 1.42.91.9 1.42 2.12 1.42 3.39 0 1.18-.449 2.301-1.28 3.13C12.72 16.93 7 16 7 16l-.003-.017zM15.3 10.5l-2 .8-.8 2-.8-2-2-.8 2-.8.8-2 .8 2 2 .8z'/%3E%3Cpath id='b' d='M50.63 8c.13 0 .23.1.23.23V9c.7-.76 1.7-1.18 2.73-1.18 2.17 0 3.95 1.85 3.95 4.17s-1.77 4.19-3.94 4.19c-1.04 0-2.03-.43-2.74-1.18v3.77c0 .13-.1.23-.23.23h-1.4c-.13 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height='100%25' fill='%23fff'/%3E%3Cuse xlink:href='%23a'/%3E%3Cuse xlink:href='%23b'/%3E%3C/mask%3E%3Cg opacity='.3' stroke='%23000' stroke-width='3'%3E%3Ccircle mask='url(%23c)' cx='11.5' cy='11.5' r='9.25'/%3E%3Cuse xlink:href='%23b' mask='url(/web/20220116003725im_/https://www.bbc.com/future/columns/immune-response/%23c)'/%3E%3C/g%3E%3Cg opacity='.9' fill='%23fff'%3E%3Cuse xlink:href='%23a'/%3E%3Cuse xlink:href='%23b'/%3E%3C/g%3E%3C/svg%3E"); } a.mapboxgl-ctrl-logo.mapboxgl-compact { width: 23px; } @media (-ms-high-contrast: active) { a.mapboxgl-ctrl-logo { background-color: transparent; background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='88' height='23' viewBox='0 0 88 23' xmlns='http://www.w3.org/2000/svg' xmlns:xlink='http://www.w3.org/1999/xlink' fill-rule='evenodd'%3E%3Cdefs%3E%3Cpath id='a' d='M11.5 2.25c5.105 0 9.25 4.145 9.25 9.25s-4.145 9.25-9.25 9.25-9.25-4.145-9.25-9.25 4.145-9.25 9.25-9.25zM6.997 15.983c-.051-.338-.828-5.802 2.233-8.873a4.395 4.395 0 013.13-1.28c1.27 0 2.49.51 3.39 1.42.91.9 1.42 2.12 1.42 3.39 0 1.18-.449 2.301-1.28 3.13C12.72 16.93 7 16 7 16l-.003-.017zM15.3 10.5l-2 .8-.8 2-.8-2-2-.8 2-.8.8-2 .8 2 2 .8z'/%3E%3Cpath id='b' d='M50.63 8c.13 0 .23.1.23.23V9c.7-.76 1.7-1.18 2.73-1.18 2.17 0 3.95 1.85 3.95 4.17s-1.77 4.19-3.94 4.19c-1.04 0-2.03-.43-2.74-1.18v3.77c0 .13-.1.23-.23.23h-1.4c-.13 0-.23-.1-.23-.23V8.23c0-.12.1-.23.23-.23h1.4zm-3.86.01c.01 0 .01 0 .01-.01.13 0 .22.1.22.22v7.55c0 .12-.1.23-.23.23h-1.4c-.13 0-.23-.1-.23-.23V15c-.7.76-1.69 1.19-2.73 1.19-2.17 0-3.94-1.87-3.94-4.19 0-2.32 1.77-4.19 3.94-4.19 1.03 0 2.02.43 2.73 1.18v-.75c0-.12.1-.23.23-.23h1.4zm26.375-.19a4.24 4.24 0 00-4.16 3.29c-.13.59-.13 1.19 0 1.77a4.233 4.233 0 004.17 3.3c2.35 0 4.26-1.87 4.26-4.19 0-2.32-1.9-4.17-4.27-4.17zM60.63 5c.13 0 .23.1.23.23v3.76c.7-.76 1.7-1.18 2.73-1.18 1.88 0 3.45 1.4 3.84 3.28.13.59.13 1.2 0 1.8-.39 1.88-1.96 3.29-3.84 3.29-1.03 0-2.02-.43-2.73-1.18v.77c0 .12-.1.23-.23.23h-1.4c-.13 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viewBox='0 0 88 23' xmlns='http://www.w3.org/2000/svg' xmlns:xlink='http://www.w3.org/1999/xlink' fill-rule='evenodd'%3E%3Cdefs%3E%3Cpath id='a' d='M11.5 2.25c5.105 0 9.25 4.145 9.25 9.25s-4.145 9.25-9.25 9.25-9.25-4.145-9.25-9.25 4.145-9.25 9.25-9.25zM6.997 15.983c-.051-.338-.828-5.802 2.233-8.873a4.395 4.395 0 013.13-1.28c1.27 0 2.49.51 3.39 1.42.91.9 1.42 2.12 1.42 3.39 0 1.18-.449 2.301-1.28 3.13C12.72 16.93 7 16 7 16l-.003-.017zM15.3 10.5l-2 .8-.8 2-.8-2-2-.8 2-.8.8-2 .8 2 2 .8z'/%3E%3Cpath id='b' d='M50.63 8c.13 0 .23.1.23.23V9c.7-.76 1.7-1.18 2.73-1.18 2.17 0 3.95 1.85 3.95 4.17s-1.77 4.19-3.94 4.19c-1.04 0-2.03-.43-2.74-1.18v3.77c0 .13-.1.23-.23.23h-1.4c-.13 0-.23-.1-.23-.23V8.23c0-.12.1-.23.23-.23h1.4zm-3.86.01c.01 0 .01 0 .01-.01.13 0 .22.1.22.22v7.55c0 .12-.1.23-.23.23h-1.4c-.13 0-.23-.1-.23-.23V15c-.7.76-1.69 1.19-2.73 1.19-2.17 0-3.94-1.87-3.94-4.19 0-2.32 1.77-4.19 3.94-4.19 1.03 0 2.02.43 2.73 1.18v-.75c0-.12.1-.23.23-.23h1.4zm26.375-.19a4.24 4.24 0 00-4.16 3.29c-.13.59-.13 1.19 0 1.77a4.233 4.233 0 004.17 3.3c2.35 0 4.26-1.87 4.26-4.19 0-2.32-1.9-4.17-4.27-4.17zM60.63 5c.13 0 .23.1.23.23v3.76c.7-.76 1.7-1.18 2.73-1.18 1.88 0 3.45 1.4 3.84 3.28.13.59.13 1.2 0 1.8-.39 1.88-1.96 3.29-3.84 3.29-1.03 0-2.02-.43-2.73-1.18v.77c0 .12-.1.23-.23.23h-1.4c-.13 0-.23-.1-.23-.23V5.23c0-.12.1-.23.23-.23h1.4zm-34 11h-1.4c-.13 0-.23-.11-.23-.23V8.22c.01-.13.1-.22.23-.22h1.4c.13 0 .22.11.23.22v.68c.5-.68 1.3-1.09 2.16-1.1h.03c1.09 0 2.09.6 2.6 1.55.45-.95 1.4-1.55 2.44-1.56 1.62 0 2.93 1.25 2.9 2.78l.03 5.2c0 .13-.1.23-.23.23h-1.41c-.13 0-.23-.11-.23-.23v-4.59c0-.98-.74-1.71-1.62-1.71-.8 0-1.46.7-1.59 1.62l.01 4.68c0 .13-.11.23-.23.23h-1.41c-.13 0-.23-.11-.23-.23v-4.59c0-.98-.74-1.71-1.62-1.71-.85 0-1.54.79-1.6 1.8v4.5c0 .13-.1.23-.23.23zm53.615 0h-1.61c-.04 0-.08-.01-.12-.03-.09-.06-.13-.19-.06-.28l2.43-3.71-2.39-3.65a.213.213 0 01-.03-.12c0-.12.09-.21.21-.21h1.61c.13 0 .24.06.3.17l1.41 2.37 1.4-2.37a.34.34 0 01.3-.17h1.6c.04 0 .08.01.12.03.09.06.13.19.06.28l-2.37 3.65 2.43 3.7c0 .05.01.09.01.13 0 .12-.09.21-.21.21h-1.61c-.13 0-.24-.06-.3-.17l-1.44-2.42-1.44 2.42a.34.34 0 01-.3.17zm-7.12-1.49c-1.33 0-2.42-1.12-2.42-2.51 0-1.39 1.08-2.52 2.42-2.52 1.33 0 2.42 1.12 2.42 2.51 0 1.39-1.08 2.51-2.42 2.52zm-19.865 0c-1.32 0-2.39-1.11-2.42-2.48v-.07c.02-1.38 1.09-2.49 2.4-2.49 1.32 0 2.41 1.12 2.41 2.51 0 1.39-1.07 2.52-2.39 2.53zm-8.11-2.48c-.01 1.37-1.09 2.47-2.41 2.47s-2.42-1.12-2.42-2.51c0-1.39 1.08-2.52 2.4-2.52 1.33 0 2.39 1.11 2.41 2.48l.02.08zm18.12 2.47c-1.32 0-2.39-1.11-2.41-2.48v-.06c.02-1.38 1.09-2.48 2.41-2.48s2.42 1.12 2.42 2.51c0 1.39-1.09 2.51-2.42 2.51z'/%3E%3C/defs%3E%3Cmask id='c'%3E%3Crect width='100%25' height='100%25' fill='%23fff'/%3E%3Cuse xlink:href='%23a'/%3E%3Cuse xlink:href='%23b'/%3E%3C/mask%3E%3Cg stroke='%23fff' stroke-width='3' fill='%23fff'%3E%3Ccircle mask='url(%23c)' cx='11.5' cy='11.5' r='9.25'/%3E%3Cuse xlink:href='%23b' mask='url(/web/20220116003725im_/https://www.bbc.com/future/columns/immune-response/%23c)'/%3E%3C/g%3E%3Cuse xlink:href='%23a'/%3E%3Cuse xlink:href='%23b'/%3E%3C/svg%3E"); } } .mapboxgl-ctrl.mapboxgl-ctrl-attrib { padding: 0 5px; background-color: rgba(255, 255, 255, 0.5); margin: 0; } @media screen { .mapboxgl-ctrl-attrib.mapboxgl-compact { min-height: 20px; padding: 0; margin: 10px; position: relative; background-color: #fff; border-radius: 3px 12px 12px 3px; } .mapboxgl-ctrl-attrib.mapboxgl-compact:hover { padding: 2px 24px 2px 4px; visibility: visible; margin-top: 6px; } .mapboxgl-ctrl-bottom-left > .mapboxgl-ctrl-attrib.mapboxgl-compact:hover, .mapboxgl-ctrl-top-left > .mapboxgl-ctrl-attrib.mapboxgl-compact:hover { padding: 2px 4px 2px 24px; border-radius: 12px 3px 3px 12px; } .mapboxgl-ctrl-attrib.mapboxgl-compact .mapboxgl-ctrl-attrib-inner { display: none; } .mapboxgl-ctrl-attrib.mapboxgl-compact:hover .mapboxgl-ctrl-attrib-inner { display: block; } .mapboxgl-ctrl-attrib.mapboxgl-compact:after { content: ""; cursor: pointer; position: absolute; background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='24' height='24' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill-rule='evenodd'%3E%3Cpath d='M4 10a6 6 0 1012 0 6 6 0 10-12 0m5-3a1 1 0 102 0 1 1 0 10-2 0m0 3a1 1 0 112 0v3a1 1 0 11-2 0'/%3E%3C/svg%3E"); background-color: rgba(255, 255, 255, 0.5); width: 24px; height: 24px; -webkit-box-sizing: border-box; box-sizing: border-box; border-radius: 12px; } .mapboxgl-ctrl-bottom-right > .mapboxgl-ctrl-attrib.mapboxgl-compact:after { bottom: 0; right: 0; } .mapboxgl-ctrl-top-right > .mapboxgl-ctrl-attrib.mapboxgl-compact:after { top: 0; right: 0; } .mapboxgl-ctrl-top-left > .mapboxgl-ctrl-attrib.mapboxgl-compact:after { top: 0; left: 0; } .mapboxgl-ctrl-bottom-left > .mapboxgl-ctrl-attrib.mapboxgl-compact:after { bottom: 0; left: 0; } } @media screen and (-ms-high-contrast: active) { .mapboxgl-ctrl-attrib.mapboxgl-compact:after { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='24' height='24' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill-rule='evenodd' fill='%23fff'%3E%3Cpath d='M4 10a6 6 0 1012 0 6 6 0 10-12 0m5-3a1 1 0 102 0 1 1 0 10-2 0m0 3a1 1 0 112 0v3a1 1 0 11-2 0'/%3E%3C/svg%3E"); } } @media screen and (-ms-high-contrast: black-on-white) { .mapboxgl-ctrl-attrib.mapboxgl-compact:after { background-image: url("data:image/svg+xml;charset=utf-8,%3Csvg width='24' height='24' viewBox='0 0 20 20' xmlns='http://www.w3.org/2000/svg' fill-rule='evenodd'%3E%3Cpath d='M4 10a6 6 0 1012 0 6 6 0 10-12 0m5-3a1 1 0 102 0 1 1 0 10-2 0m0 3a1 1 0 112 0v3a1 1 0 11-2 0'/%3E%3C/svg%3E"); } } .mapboxgl-ctrl-attrib a { color: rgba(0, 0, 0, 0.75); text-decoration: none; } .mapboxgl-ctrl-attrib a:hover { color: inherit; text-decoration: underline; } .mapboxgl-ctrl-attrib .mapbox-improve-map { font-weight: 700; margin-left: 2px; } .mapboxgl-attrib-empty { display: none; } .mapboxgl-ctrl-scale { background-color: rgba(255, 255, 255, 0.75); font-size: 10px; border: 2px solid #333; border-top: #333; padding: 0 5px; color: #333; -webkit-box-sizing: border-box; box-sizing: border-box; } .mapboxgl-popup { position: absolute; top: 0; left: 0; display: -ms-flexbox; display: flex; will-change: transform; pointer-events: none; } .mapboxgl-popup-anchor-top, .mapboxgl-popup-anchor-top-left, .mapboxgl-popup-anchor-top-right { -ms-flex-direction: column; flex-direction: column; } .mapboxgl-popup-anchor-bottom, .mapboxgl-popup-anchor-bottom-left, .mapboxgl-popup-anchor-bottom-right { -ms-flex-direction: column-reverse; flex-direction: column-reverse; } .mapboxgl-popup-anchor-left { -ms-flex-direction: row; flex-direction: row; } .mapboxgl-popup-anchor-right { -ms-flex-direction: row-reverse; flex-direction: row-reverse; } .mapboxgl-popup-tip { width: 0; height: 0; border: 10px solid transparent; z-index: 1; } .mapboxgl-popup-anchor-top .mapboxgl-popup-tip { -ms-flex-item-align: center; -ms-grid-row-align: center; align-self: center; border-top: none; border-bottom-color: #fff; } .mapboxgl-popup-anchor-top-left .mapboxgl-popup-tip { -ms-flex-item-align: start; align-self: flex-start; border-top: none; border-left: none; border-bottom-color: #fff; } .mapboxgl-popup-anchor-top-right .mapboxgl-popup-tip { -ms-flex-item-align: end; align-self: flex-end; border-top: none; border-right: none; border-bottom-color: #fff; } .mapboxgl-popup-anchor-bottom .mapboxgl-popup-tip { -ms-flex-item-align: center; -ms-grid-row-align: center; align-self: center; border-bottom: none; border-top-color: #fff; } .mapboxgl-popup-anchor-bottom-left .mapboxgl-popup-tip { -ms-flex-item-align: start; align-self: flex-start; border-bottom: none; border-left: none; border-top-color: #fff; } .mapboxgl-popup-anchor-bottom-right .mapboxgl-popup-tip { -ms-flex-item-align: end; align-self: flex-end; border-bottom: none; border-right: none; border-top-color: #fff; } .mapboxgl-popup-anchor-left .mapboxgl-popup-tip { -ms-flex-item-align: center; -ms-grid-row-align: center; align-self: center; border-left: none; border-right-color: #fff; } .mapboxgl-popup-anchor-right .mapboxgl-popup-tip { -ms-flex-item-align: center; -ms-grid-row-align: center; align-self: center; border-right: none; border-left-color: #fff; } .mapboxgl-popup-close-button { position: absolute; right: 0; top: 0; border: 0; border-radius: 0 3px 0 0; cursor: pointer; background-color: transparent; } .mapboxgl-popup-close-button:hover { background-color: rgba(0, 0, 0, 0.05); } .mapboxgl-popup-content { position: relative; background: #fff; border-radius: 3px; -webkit-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.1); box-shadow: 0 1px 2px rgba(0, 0, 0, 0.1); padding: 10px 10px 15px; pointer-events: auto; } .mapboxgl-popup-anchor-top-left .mapboxgl-popup-content { border-top-left-radius: 0; } .mapboxgl-popup-anchor-top-right .mapboxgl-popup-content { border-top-right-radius: 0; } .mapboxgl-popup-anchor-bottom-left .mapboxgl-popup-content { border-bottom-left-radius: 0; } .mapboxgl-popup-anchor-bottom-right .mapboxgl-popup-content { border-bottom-right-radius: 0; } .mapboxgl-popup-track-pointer { display: none; } .mapboxgl-popup-track-pointer * { pointer-events: none; -webkit-user-select: none; -moz-user-select: none; -ms-user-select: none; user-select: none; } .mapboxgl-map:hover .mapboxgl-popup-track-pointer { display: -ms-flexbox; display: flex; } .mapboxgl-map:active .mapboxgl-popup-track-pointer { display: none; } .mapboxgl-marker { position: absolute; top: 0; left: 0; will-change: transform; } .mapboxgl-user-location-dot, .mapboxgl-user-location-dot:before { background-color: #1da1f2; width: 15px; height: 15px; border-radius: 50%; } .mapboxgl-user-location-dot:before { content: ""; position: absolute; -webkit-animation: mapboxgl-user-location-dot-pulse 2s infinite; animation: mapboxgl-user-location-dot-pulse 2s infinite; } .mapboxgl-user-location-dot:after { border-radius: 50%; border: 2px solid #fff; content: ""; height: 19px; left: -2px; position: absolute; top: -2px; width: 19px; -webkit-box-sizing: border-box; box-sizing: border-box; -webkit-box-shadow: 0 0 3px rgba(0, 0, 0, 0.35); box-shadow: 0 0 3px rgba(0, 0, 0, 0.35); } @-webkit-keyframes mapboxgl-user-location-dot-pulse { 0% { -webkit-transform: scale(1); opacity: 1; } 70% { -webkit-transform: scale(3); opacity: 0; } to { -webkit-transform: scale(1); opacity: 0; } } @keyframes mapboxgl-user-location-dot-pulse { 0% { -webkit-transform: scale(1); transform: scale(1); opacity: 1; } 70% { -webkit-transform: scale(3); transform: scale(3); opacity: 0; } to { -webkit-transform: scale(1); transform: scale(1); opacity: 0; } } .mapboxgl-user-location-dot-stale { background-color: #aaa; } .mapboxgl-user-location-dot-stale:after { display: none; } .mapboxgl-user-location-accuracy-circle { background-color: rgba(29, 161, 242, 0.2); width: 1px; height: 1px; border-radius: 100%; } .mapboxgl-crosshair, .mapboxgl-crosshair .mapboxgl-interactive, .mapboxgl-crosshair .mapboxgl-interactive:active { cursor: crosshair; } .mapboxgl-boxzoom { position: absolute; top: 0; left: 0; width: 0; height: 0; background: #fff; border: 2px dotted #202020; opacity: .5; } @media print { .mapbox-improve-map { display: none; } } /* stylelint-disable property-no-unknown */ .partner-module { border-bottom: 1px solid #472479; border-top: 0; } .partner-module__link, .partner-module__link:visited { -ms-flex-align: center; align-items: center; color: #444; display: -ms-flexbox; display: flex; -ms-flex-pack: justify; justify-content: space-between; padding: 0; text-decoration: none; } .partner-module__link:hover { background-color: #f5f5f5; } .partner-module__heading { display: inline-block; font-size: 16px; line-height: 22px; margin: 16px 0; } .partner-module__partner-name { font-weight: bold; } .partner-module__partner-logo { display: block; height: 31px; margin: 12px 0; margin-left: 17px; width: 88px; } /* stylelint-disable property-no-unknown */ .author-unit { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; font-size: 14px; letter-spacing: -0.1px; line-height: 35px; } .author-unit--small-mobile { line-height: 30px; } .author-unit .author-unit__container { color: #4a4a4a; margin: 0 auto; } .author-unit .author-unit__container--desktop { margin: 0; } .author-unit__container { -ms-flex-align: baseline; align-items: baseline; display: -ms-flexbox; display: flex; padding: 10px 0; } .author-unit__text { font-style: italic; font-weight: 600; padding-right: 10px; text-decoration: none; } .author-unit__icon { color: #6a6a6a; padding-right: 14px; position: relative; text-decoration: none; top: 1px; } .author-unit__icon:hover { color: #00bbf2; } /* stylelint-disable property-no-unknown */ .uppercase-label { color: #8f8d8d; font-size: 12px; font-style: condensed; font-weight: bold; letter-spacing: 1px; line-height: 16px; margin: 0; padding: 0; text-transform: uppercase; -webkit-transition: color 0.4s; transition: color 0.4s; } .uppercase-label--small { font-size: 11px; font-weight: 400; line-height: 14px; margin: 0; } .uppercase-label--medium { font-size: 14px; line-height: 18px; } .uppercase-label--reith-condensed { font-weight: 400; } .uppercase-label--white { color: #ebebeb; } .uppercase-label--light-grey { color: #999; } .uppercase-label--dark-grey { color: #444; } .uppercase-label--large { font-size: 16px; line-height: 18px; } .uppercase-label--true-white { color: #fff; text-shadow: 0 1px 1px #193e6d; } .uppercase-label--arial { font-family: Arial; } .label-with-line { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; } .label-with-line__label { margin: 0 16px 0 0; } .body-text-card-inline-video { margin: 24px 0; position: relative; } /* stylelint-disable property-no-unknown */ @-webkit-keyframes spin { 0% { -webkit-transform: rotate(0deg); transform: rotate(0deg); } 100% { -webkit-transform: rotate(360deg); transform: rotate(360deg); } } @keyframes spin { 0% { -webkit-transform: rotate(0deg); transform: rotate(0deg); } 100% { -webkit-transform: rotate(360deg); transform: rotate(360deg); } } .spinner { fill: #444; } .spinner__image { -webkit-animation: spin 1s linear infinite; animation: spin 1s linear infinite; } .spinner--worklife { fill: #8beed9; } .spinner--future { fill: #ffc857; } .spinner--culture { fill: #472479; } .spinner--travel { fill: #002856; } .spinner--earth { fill: #002856; } .spinner--white { fill: #fff; } .spinner--audio { height: 32px; width: 32px; } /* stylelint-disable property-no-unknown */ /* stylelint-disable property-no-unknown */ .inline-video { height: 100%; } .inline-video__container { position: relative; } .inline-video__border-line { padding: 0 10px; } .inline-video .play-button__inline-video { bottom: 0; left: 0; position: absolute; z-index: 1000; } .inline-video__smp { background-color: #000; padding-bottom: 56.25%; } .inline-video__smp--loaded { background-color: unset; padding-bottom: unset; } .inline-video__description { border-bottom: 1px solid rgba(106, 106, 106, 0.43); color: #737373; font-size: 16px; font-style: italic; line-height: 24px; margin: 0 10px 0 3%; padding: 20px 0 12px; } .inline-video__description--desktop { border-bottom: 1px solid rgba(106, 106, 106, 0.43); margin: 0 18px; padding: 28px 0 18px; } /* stylelint-disable property-no-unknown */ .inline-image__description { border-bottom: 1px solid rgba(106, 106, 106, 0.43); font-style: italic; margin: 0 10px; padding: 20px 0 12px; } .inline-image__description--desktop { border-bottom: 1px solid rgba(106, 106, 106, 0.43); margin: 0 18px; padding: 20px 0 18px; } .inline-image img { border-radius: 0; } /* stylelint-disable property-no-unknown */ .inline-quote { border-left: 3px solid #575757; color: #575757; font-style: italic; letter-spacing: -1.69px; line-height: 32px; margin: 0; padding-left: 22px; } .inline-quote--worklife { border-left: 3px solid #8beed9; } .inline-quote--future { border-left: 3px solid #ffc857; } .inline-quote--culture { border-left: 3px solid #472479; } .inline-quote--earth { border-left: 3px solid #002856; } .inline-quote h2 { font-weight: 300; } /* stylelint-disable property-no-unknown */ .inline-audio-player { background: none; } .inline-audio-player__smp-container { display: inline-block; width: 100%; } .inline-audio-player__smp-container > div { /* CreateSMPAudio */ display: inline-block; width: 100%; } .inline-audio-player__smp-container > div > div { height: 50px; position: relative; /* stylelint-disable-next-line selector-max-compound-selectors */ } .inline-audio-player__smp-container > div > div > div { padding: 0 !important; } .inline-audio-player__container { display: -ms-flexbox; display: flex; } .inline-audio-player__cta-holder { -ms-flex-align: center; align-items: center; background-color: #ededed; display: -ms-flexbox; display: flex; padding-right: 8px; } .inline-audio-player__cta-container { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; } .inline-audio-player__cta-container.initialising * { cursor: initial; pointer-events: none; -webkit-user-select: none; -moz-user-select: none; -ms-user-select: none; user-select: none; } .inline-audio-player__cta-container.initialising button { opacity: 0.6; } .inline-audio-player__text { background: none; border: 0; color: #222; cursor: pointer; font-size: 18px; height: 25px; letter-spacing: -0.1px; line-height: 25px; margin-left: 12px; outline: inherit; padding: 0; } .inline-audio-player__text--offline { cursor: default; pointer-events: none; } .inline-audio-player__disclaimer { background-color: #e6711b; color: #fff; cursor: pointer; height: 25px; left: -110px; line-height: 12px; margin-left: 0; padding: 0 7px; position: relative; top: 25px; width: 66px; } .inline-audio-player__disclaimer:hover .inline-audio-player__arrow { -webkit-transform: rotate(45deg); transform: rotate(45deg); } .inline-audio-player__inner-arrow { color: #4d4d49; font-size: 10px; } .inline-audio-player__arrow-button { background-color: transparent; border: 0; margin-left: auto; outline: none; -webkit-transition: all 0.5s ease; transition: all 0.5s ease; } .inline-audio-player__arrow-button__open { -webkit-transform: rotate(180deg); transform: rotate(180deg); } .inline-audio-player__disclaimer-copy { color: #444; display: block; font-size: 12px; letter-spacing: 0; line-height: 17px; margin-top: 16px; } .inline-audio-player__arrow { border: solid #fff; border-width: 0 2px 2px 0; display: inline-block; padding: 3px; position: relative; top: -1px; -webkit-transform: rotate(-45deg); transform: rotate(-45deg); -webkit-transition: 0.4s; transition: 0.4s; } .inline-audio-player__hidden { display: none; } .inline-audio-player .collapsible-container { background-color: #ededed; color: #444; font-size: 16px; line-height: 24px; padding: 1rem; } .inline-audio-player .collapsible-container__hide { display: none; } .inline-audio-player .previous-button__inline-audio { margin-right: 1px; } .inline-audio-player__line { margin-top: 16px; } .inline-audio-player .previous-media-button { height: 50px; margin-right: 1px; width: 50px; } .inline-audio-player .previous-button__inline-audio { margin-right: 1px; } .copyright__text { color: #737373; font-size: 16px; font-style: italic; line-height: 24px; margin-bottom: 10px; text-align: center; } @media (max-width: 767px) { .copyright__text { margin-top: 12px; } } .content-embed { width: 100%; } .infographic-embed__frame { width: 100%; } /* stylelint-disable property-no-unknown */ .article-video { height: 100%; position: relative; } .article-video img { bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; object-fit: cover; position: absolute; right: -100%; top: -100%; width: 100%; } .article-video__overlay { display: -ms-flexbox; display: flex; height: 100%; -ms-flex-pack: center; justify-content: center; top: 0; width: 100%; } .article-video__play-button { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; left: 50%; padding: 0; position: absolute; top: 50%; -webkit-transform: translate(-50%, -50%); transform: translate(-50%, -50%); z-index: 1500; } .article-video__label { margin-bottom: 16px; } .article-video__image { bottom: 0; height: 100%; position: absolute; top: 0; width: 100%; } .article-video__image--hide { opacity: 0; } .article-video__playercore { display: block; } .article-video__playercore--mobile { display: none; position: absolute; top: 0; width: 100%; } .article-video__playercore--show { display: block; } .article-video--bordered { border-radius: 4px; overflow: hidden; } /* stylelint-disable property-no-unknown */ .hero-video { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; height: 180px; -ms-flex-pack: center; justify-content: center; position: relative; z-index: 1; } .hero-video__video { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; height: 80%; -ms-flex-pack: center; justify-content: center; position: relative; width: 80%; z-index: 2; } .hero-video__video--desktop { left: 0; top: 65px; width: 71.5% !important; } .hero-video__video--mobile { height: 100%; width: 100%; } .hero-video__video--small-desktop { height: 70%; left: 0; top: 78px; width: 67%; } .hero-video--small-desktop, .hero-video--desktop { display: block; height: 720px; } .hero-video img { bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; object-fit: cover; position: absolute; right: -100%; top: -100%; width: 100%; -webkit-filter: brightness(40%); filter: brightness(40%); } @media all and (-ms-high-contrast: none), (-ms-high-contrast: active) { .hero-video img { opacity: 0.5; } } .hero-video--mobile { height: 280px; } .hero-video--medium-mobile { height: 430px; } .hero-video--tablet { height: 574px; } .hero-video--tablet .hero-video__video { margin-bottom: 10px; } .hero-video__play-button { position: absolute; z-index: 100; } .hero-video__video div div { position: inherit !important; position: unset !important; } .share-tools-popout { -ms-flex-align: center; align-items: center; background-color: #fff; border: 1px solid #979797; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; padding: 30px 0 20px; position: relative; width: 300px; } .share-tools-popout__text { color: #444; font-size: 12px; font-weight: bold; letter-spacing: 3px; margin: 0 18px 18px; text-align: center; text-transform: uppercase; } .share-tools-popout__url-container { padding: 0 18px; width: 100%; } .share-tools-popout__articleurl { border: 1px solid #979797; -webkit-box-sizing: border-box; box-sizing: border-box; color: #a39f9f; font-size: 12px; letter-spacing: -0.5px; margin-bottom: 8px; margin-top: 0; padding: 12px 10px; text-align: center; width: 262px; } .share-tools-popout__close { -ms-flex-align: center; align-items: center; background-color: unset; border: unset; cursor: pointer; display: -ms-flexbox; display: flex; position: absolute; right: 8px; top: 20px; } .share-tools-popout__close:hover .share-tools-popout__close-icon { color: #888; -webkit-transform: rotate(90deg); transform: rotate(90deg); } .share-tools-popout__close-icon { color: #000; font-size: 16px; -webkit-transition: 0.4s; transition: 0.4s; } .share-tools-popout__border-arrow { background-color: #fff; border: 1px solid #979797; border-bottom: 0; border-right: 0; height: 12px; left: 40px; position: absolute; top: -7px; -webkit-transform: rotate(45deg); transform: rotate(45deg); width: 12px; } .share-tools-popout__tools { margin-bottom: 13px; } .share-tools-popout__details { -ms-flex-item-align: normal; -ms-grid-row-align: normal; align-self: normal; color: #444; font-size: 12px; letter-spacing: 0; line-height: 16px; margin: 0; max-width: 180px; padding-left: 14px; } .share-tools-popout__copied, .share-tools-popout__copy { background-color: #000; border: unset; color: #fff; cursor: pointer; font-size: 12px; font-weight: bold; letter-spacing: 3px; margin-bottom: 18px; padding: 12px 6px; text-transform: uppercase; -webkit-transition: 0.4s; transition: 0.4s; width: 110px; } .share-tools-popout__copy:hover { background-color: #555; } .share-tools-popout__copied .gelicon--yes { color: #ff9700; margin-left: 8px; } .share-button-with-popout { position: relative; z-index: 9999; } .share-button-with-popout__popout { max-width: 330px; padding-right: 8px; position: absolute; top: 53px; width: 100%; } .share-button-with-popout__popout--desktop { width: auto; } .article-end__line--long { margin-bottom: 24px; } .article-end__share-tools { margin-bottom: 0; } .article-end--tablet .article-end__line--long { margin-bottom: 36px; } .article-end--desktop .article-end__line--long { margin-bottom: 44px; } .article-end--desktop .article-end__share-tools { display: -ms-flexbox; display: flex; margin-bottom: 50px; } .article-end--desktop .article-end__share { margin-top: 0; } .article-end__share { margin-top: 5px; } /* stylelint-disable property-no-unknown */ .article-share-tools { display: -ms-flexbox; display: flex; } .article-share-tools a, .article-share-tools button { background-color: transparent; border: 1px solid #e4e4e4; border-radius: 0; -webkit-box-sizing: border-box; box-sizing: border-box; color: #979797; display: -ms-flexbox; display: flex; height: 52px; margin-right: 2px; width: 52px; } .article-share-tools--dark a, .article-share-tools--dark button { color: #444; height: 54px; width: 54px; } .article-share-tools--dark a svg, .article-share-tools--dark button svg { stroke: #444; } .article-share-tools a:hover, .article-share-tools button:hover { background-color: #fff; } .article-share-tools .facebook-icon:hover { color: #3b5898; } .article-share-tools .email-icon:hover { color: #615f5d; } .article-share-tools .twitter-icon:hover { color: #47c7fa; } .article-share-tools .linkedin-icon:hover { color: #0077b5; } .article-share-tools .whatsapp-icon:hover { color: #25d366; } .article-share-tools .facebook-messenger { color: #0184ff; } .article-share-tools .ticked-icon { background-color: transparent; border: 1px solid #e4e4e4; border-radius: 0; -webkit-box-shadow: none; box-shadow: none; font-size: 11px; margin-right: 2px; padding: 3px; } .article-share-tools--popout > *, .article-share-tools--popout a { color: #020203; margin-bottom: 3px; -webkit-transition: 0.4s; transition: 0.4s; } .domestic-disclaimer { background-color: #333; position: relative; } .domestic-disclaimer__content { display: -ms-flexbox; display: flex; -ms-flex-pack: justify; justify-content: space-between; margin: auto; max-width: 990px; } .domestic-disclaimer__content--desktop-small { max-width: 976px; } .domestic-disclaimer__content--desktop { max-width: 1248px; } .domestic-disclaimer__text { color: #d8d8d8; font-size: 13px; line-height: 14px; margin: auto; padding: 8px 16px; } .domestic-disclaimer__text--tablet { font-size: 14px; line-height: 19px; padding: 16px 54px 16px 16px; } .domestic-disclaimer__text--desktop { font-size: 14px; line-height: 19px; margin-left: 0; max-width: 890px; padding: 14px 16px; } .domestic-disclaimer__close-button { -ms-flex-align: center; align-items: center; background-color: unset; border: unset; cursor: pointer; display: -ms-flexbox; display: flex; padding: 0 16px 0 0; position: relative; } .domestic-disclaimer__close-button--desktop { padding: 0 16px 0 0; } .domestic-disclaimer__close-icon { color: #d8d8d8; font-size: 16px; } .domestic-disclaimer__close-icon--desktop { font-size: 22px; } /* stylelint-disable property-no-unknown */ .section-header-text__text { background-color: #fff; border-radius: 4px; -webkit-box-shadow: 0 0 20px 0 rgba(153, 153, 153, 0.5), 0 2px 5px 0 rgba(153, 153, 153, 0.5); box-shadow: 0 0 20px 0 rgba(153, 153, 153, 0.5), 0 2px 5px 0 rgba(153, 153, 153, 0.5); margin: 0 8px; opacity: 0.95; padding: 16px; position: relative; z-index: 3; } .section-header-text__text--no-margin { margin: 0; } .section-header-text__ad { display: -ms-flexbox; display: flex; -ms-flex-pack: end; justify-content: flex-end; margin: 0 8px 8px; position: relative; top: unset; } .section-header-text__ad--desktop { margin: 0 0 8px; } .section-header-text__title { display: inline-block; } .section-header-text__title--large-margin { margin: 0 40px 16px 0; } .section-header-text__title--premium { border: 1.78px solid; padding: 8px; } .section-header-text__title-content { color: #444; font-size: 22px; font-weight: bold; margin: unset; } .section-header-text__title-content--tablet { font-size: 24px; } .section-header-text__title-content--desktop { font-size: 28px; } .section-header-text__description { color: #555; font-size: 14px; line-height: 20px; margin: 0; } .section-header-text__description--large { font-size: 16px; line-height: 24px; } /* stylelint-disable property-no-unknown */ .section-header-unit { max-width: 1280px; position: relative; } .section-header-unit--tablet { height: 320px; } .section-header-unit--desktop { border-radius: 4px; height: 320px; overflow: hidden; } .section-header-unit__image { height: 320px; max-height: 320px; overflow: hidden; position: relative; } .section-header-unit__image img { left: 50%; position: relative; top: 50%; -webkit-transform: translate(-50%, -50%); transform: translate(-50%, -50%); } .section-header-unit__image--right img { left: unset; min-width: 100%; right: 0; width: unset; } .section-header-unit__image--left img { left: unset; min-width: 100%; right: unset; width: unset; } .section-header-unit__content { position: relative; -webkit-transform: translateY(-50%); transform: translateY(-50%); } .section-header-unit__content--desktop { bottom: 0; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; -ms-flex-pack: center; justify-content: center; max-width: 420px; position: absolute; right: 32px; top: 0; -webkit-transform: none; transform: none; } .section-header-unit__content--advert { -webkit-transform: translateY(calc(-50% - 28px)); transform: translateY(calc(-50% - 28px)); /* - half the height of the advert so the text is still centered. */ } /* stylelint-disable property-no-unknown */ .label-list { display: -ms-flexbox; display: flex; -ms-flex-direction: row; flex-direction: row; position: relative; } .label-list__line { width: 100%; } .label-list__content { margin: 30px 0 0 16px; width: 100%; } .label-list__content--tablet { margin: 34px 0 0 38px; } .label-list__content--desktop { margin: 42px 0 0 32px; } .label-list__list-item { margin: 0; padding: 0; } .label-list__link { color: #444; font-size: 18px; line-height: 24px; text-decoration: none; } .label-list__link:hover { color: #adadad; } .label-list__link--large { font-size: 22px; line-height: 29px; } .label-list__link:not(:first-of-type) { margin-top: 8px; } .label-list__link--large:not(:first-of-type) { margin-top: 12px; } .label-list__list-items { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; margin-top: 36px; } .label-list__list-items--tablet { margin-top: 52px; } .label-list__list-items--desktop { margin-top: 46px; } /* stylelint-disable property-no-unknown */ .offline-reading { font-family: 'CuriousSansBold'; -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; } .offline-reading__header { font-size: 14px; line-height: 20px; margin: 0 0 16px; max-width: 220px; text-align: center; } .offline-reading__header--desktop { font-size: 18px; max-width: 460px; } .offline-reading__buttons { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; text-align: center; } .offline-reading__buttons--desktop { -ms-flex-align: center; align-items: center; -ms-flex-direction: row; flex-direction: row; } .offline-reading__top-stories { margin-bottom: 24px; } .offline-reading__top-stories--desktop { margin: 0 16px 0 0; } .offline-reading__icon { display: block; height: auto; margin-bottom: 24px; width: 120px; } /* stylelint-disable property-no-unknown */ .rectangle-image { background-size: cover; height: 74px; max-width: 100%; overflow: hidden; position: relative; width: 132px; } .rectangle-image img { height: 100%; left: 50%; position: absolute; top: 50%; -webkit-transform: translate(-50%, -50%); transform: translate(-50%, -50%); width: auto; } .rectangle-image--small { -webkit-box-sizing: border-box; box-sizing: border-box; height: 32px; width: 56px; } .rectangle-image--large { -webkit-box-sizing: border-box; box-sizing: border-box; height: 162px; width: 288px; } .rectangle-image--medium { -webkit-box-sizing: border-box; box-sizing: border-box; height: 126px; width: 222px; } .rectangle-image--full-screen { padding-top: 56.25%; width: 100%; } .rectangle-image img { -webkit-transition: all 0.4s ease; transition: all 0.4s ease; } .rectangle-image__overlay { background-color: rgba(0, 0, 0, 0.6); bottom: 0; height: 100%; left: 0; opacity: 0; pointer-events: none; position: absolute; right: 0; top: 0; width: 100%; } .rectangle-image__overlay--culture { background-color: rgba(72, 41, 120, 0.6); } .rectangle-image:hover .rectangle-image__overlay { opacity: 1; } .rectangle-image:hover img { height: 108%; } /* stylelint-disable property-no-unknown */ .rectangle-story-item { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; height: 100%; -ms-flex-pack: justify; justify-content: space-between; margin: auto; max-width: 100%; width: 288px; } .rectangle-story-item__image-container:hover .rectangle-image__overlay { opacity: 1; } .rectangle-story-item__image-container:hover .rectangle-story-item__icon { background-color: #000; } .rectangle-story-item__image-container--culture:hover .rectangle-story-item__icon { background-color: #482978; } .rectangle-story-item__image-container:hover .rectangle-image img { height: 108%; } .rectangle-story-item__image-container { position: relative; width: 100%; } .rectangle-story-item--tablet { width: 222px; } .rectangle-story-item__container { display: -ms-flexbox; display: flex; -ms-flex: 1 1 auto; flex: 1 1 auto; -ms-flex-direction: column; flex-direction: column; -ms-flex-pack: justify; justify-content: space-between; margin-top: 3px; width: 100%; } .rectangle-story-item__label { color: #4a4a4a; display: block; font-size: 12px; font-weight: bold; letter-spacing: 3px; line-height: 16px; margin-right: auto; margin-top: 20px; padding-bottom: 3px; text-decoration: none; text-transform: uppercase; } .rectangle-story-item__label--worklife:hover, .rectangle-story-item__label--future:hover, .rectangle-story-item__label__travel:hover { background-image: none; } .rectangle-story-item__label--worklife > span:hover, .rectangle-story-item__label--future > span:hover, .rectangle-story-item__label__travel > span:hover { border-bottom: 1px solid #4a4a4a; } .rectangle-story-item__label--culture:hover { background-image: none; } .rectangle-story-item__label--culture > span:hover { border-bottom: 1px solid #482978; } .rectangle-story-item__line { display: block; margin: 16px 0; } .rectangle-story-item__author { color: #4a4a4a; display: block; font-size: 14px; font-style: italic; letter-spacing: 0.1px; line-height: 35px; text-decoration: none; } .rectangle-story-item__title { color: rgba(46, 46, 46, 0.85); display: block; font-size: 18px; letter-spacing: -0.21px; line-height: 30px; text-decoration: none; } .rectangle-story-item__icon { background-color: #000; bottom: 0; color: #fff; font-size: 14px; height: 44px; line-height: 44px; position: absolute; text-align: center; -webkit-transition: 0.4s ease; transition: 0.4s ease; width: 44px; } .rectangle-story-item__title--white, .rectangle-story-item__author--white, .rectangle-story-item__label--white { color: #fff; } .rectangle-story-item__label--white:hover { border-bottom: 0; } .rectangle-story-item__label--white > span:hover { border-bottom: 1px solid #fff; } .rectangle-article-group { display: -ms-flexbox; display: flex; -ms-flex: 1 1; flex: 1 1; -ms-flex-direction: column; flex-direction: column; -ms-flex-wrap: wrap; flex-wrap: wrap; -ms-flex-pack: center; justify-content: center; position: relative; } .rectangle-article-group--tablet, .rectangle-article-group--desktop { -ms-flex-direction: row; flex-direction: row; } .rectangle-article-group__article { display: inline-block; padding-top: 12px; } .rectangle-article-group__article--tablet { padding: 0 16px 0 0; } .rectangle-article-group__article--desktop { padding: 0 24px 0 0; } .fake-ad { -ms-flex-line-pack: center; align-content: center; -ms-flex-align: center; align-items: center; background: #f6f6f6; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; -ms-flex-pack: center; justify-content: center; padding: 8px; } .fake-ad__body { -ms-flex-align: center; align-items: center; background: #5ae9cb; color: #fff; display: -ms-flexbox; display: flex; -ms-flex: 0 0 auto; flex: 0 0 auto; font-family: Arial, sans-serif; -ms-flex-pack: center; justify-content: center; } .fake-ad__text { -ms-flex-item-align: center; -ms-grid-row-align: center; align-self: center; color: #444; font-family: Arial, sans-serif; font-size: 12px; font-weight: bold; line-height: 1.5; text-align: right; text-transform: uppercase; } .fake-ad--mpu .fake-ad__body { height: 320px; width: 320px; } .fake-ad--mpu .fake-ad__text { width: 320px; } .fake-ad--mobile-leaderboard .fake-ad__body { height: 50px; width: 300px; } .fake-ad--mobile-leaderboard .fake-ad__text { width: 300px; } .fake-ad--leaderboard .fake-ad__body { height: 90px; width: 728px; } .fake-ad--leaderboard .fake-ad__text { width: 728px; } .body-text-card-inline-image { margin: 24px 0; position: relative; } /* stylelint-disable property-no-unknown */ .body-text-card { color: #444; display: block; font-size: 16px; line-height: 1.5; } .body-text-card__image, .body-text-card__video { margin: 24px 0; } .body-text-card__text { display: block; } .body-text-card__advert { margin: 20px 0; } .body-text-card__text div a { cursor: pointer; font-weight: bold; text-decoration: none; } .body-text-card__text a:hover { text-decoration: underline; } .body-text-card__text > div > p { margin: 0 20px 16px; } .body-text-card__text > div > p:last-child { margin-bottom: 0; padding-bottom: 0; } .body-text-card__drop-capped { float: left; margin: 0 8px 0 20px; padding-top: 6px; } .body-text-card__text--drop-capped p:first-of-type::first-letter { color: transparent; font-size: 0; } .body-text-card__text--flush-text > div > p { margin-left: 0; margin-right: 0; } .body-text-card__text--future div a:visited { color: #666; } .body-text-card__text--future div a { color: #002856; -webkit-text-decoration-color: #002856; text-decoration-color: #002856; } .body-text-card__text--travel div a { color: #589e50; -webkit-text-decoration-color: #589e50; text-decoration-color: #589e50; } .body-text-card__text--worklife div a { color: #0052a1; -webkit-text-decoration-color: #0052a1; text-decoration-color: #0052a1; } .body-text-card__text--earth div a { color: #0fbb56; -webkit-text-decoration-color: #0fbb56; text-decoration-color: #0fbb56; } .body-text-card__text--culture div a { color: #472479; -webkit-text-decoration-color: #472479; text-decoration-color: #472479; } /* stylelint-disable property-no-unknown */ .branding { -webkit-box-sizing: content-box !important; box-sizing: content-box !important; display: inline-block; height: 24px; padding: 12px 16px; width: 100%; } .branding__icon { display: inline-block; height: 24px; width: 100%; } .branding__icon g { fill: #fff; } .branding--medium { padding: 16px; } .branding--large { padding: 16px 24px; } .branding--worklife { background-color: #0052a1; } .branding--future { background-color: #002856; } .branding--culture { background-color: #472479; } .branding--earth { background-color: #0fbb56; } .branding--travel { background-color: #589e50; } .branding--travel svg, .branding--earth svg, .branding--culture svg, .branding--future svg, .branding--worklife svg { height: 24px; } .branding--small, .branding--small svg { height: 17px; } .branding__icon--medium, .branding--medium, .branding--medium svg { height: 22px; } .branding__icon--large, .branding--large, .branding--large svg { height: 24px; } .branding__icon--largest, .branding--largest, .branding--largest svg { height: 32px; } .branding__icon--small, .branding--travel .branding__icon--small svg, .branding--earth .branding__icon--small svg, .branding--culture .branding__icon--small svg, .branding--future .branding__icon--small svg, .branding--worklife .branding__icon--small svg { height: 17px; } /* stylelint-disable property-no-unknown */ .swimlane-inner { background-position: center; background-repeat: no-repeat; background-size: auto 100%; display: block; padding: 24px 16px; } .swimlane-inner--small { padding: 24px 8px; } .swimlane-inner--tablet { padding: 28px 16px 42px; } .swimlane-inner--small-desktop { padding: 30px 16px 42px; } .swimlane-inner--desktop { padding: 38px 16px 42px; } .swimlane { overflow: hidden; position: relative; z-index: 0; } .swimlane__black { background-color: #0e0e0e; } .swimlane__background-image { height: 500px; position: absolute; right: 0; top: 0; width: 915px; z-index: -1; } .swimlane__background-image--mobile { height: 181px; width: 320px; } .swimlane__background-image--tablet { height: 421px; width: 752px; } .swimlane__background-image--desktop { height: 500px; width: 915px; } .swimlane__background-image--atb { background-color: rgba(51, 51, 51, 0.8); background-size: cover; height: 100%; width: 100%; } .swimlane__item { margin: 0 0 25px; width: 100%; } .swimlane__item--desktop { margin: 0; } .swimlane__item--tablet { margin: 0 16px 25px 0; width: calc((100% - 48px) / 3); } .swimlane__item--tablet:nth-of-type(3n + 3) { margin-right: 0; } .swimlane__item--two-columns { margin-right: 0 !important; max-width: 572px; width: 50%; } .swimlane__item--four-columns { -webkit-box-sizing: border-box; box-sizing: border-box; margin-bottom: 25px; margin-right: 16px; width: calc((100% - 48px) / 4); } .swimlane__item--four-columns:nth-of-type(4n + 4) { margin-right: 0; } .swimlane__items { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; margin-top: 24px; text-align: left; } .swimlane__items--desktop { -ms-flex-direction: row; flex-direction: row; -ms-flex-wrap: wrap; flex-wrap: wrap; -ms-flex-pack: center; justify-content: center; margin-top: 42px; } .swimlane__items--small-desktop { -ms-flex-direction: row; flex-direction: row; -ms-flex-wrap: wrap; flex-wrap: wrap; margin-top: 30px; } .swimlane__items--tablet { -ms-flex-direction: row; flex-direction: row; -ms-flex-wrap: wrap; flex-wrap: wrap; -ms-flex-pack: justify; justify-content: space-between; margin-top: 30px; } .swimlane__items--no-title { margin-top: 0; } .swimlane__content { margin: auto; max-width: 942px; text-align: center; } .swimlane__content--desktop { max-width: 1216px; } .swimlane__title { color: #fff; font-size: 14px; font-weight: bold; letter-spacing: 2.92px; line-height: 19px; text-transform: uppercase; } .swimlane__title--black { color: #010101; font-weight: 400; } .see-more-button-container-alt { color: #0e0e0e; } .follow-us-on { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; position: relative; } .follow-us-on__text { color: #fff; font-size: 16px; font-style: condensed; line-height: 20px; margin: 0 0 20px; padding: 0; text-transform: uppercase; } .follow-us-on__links { display: -ms-flexbox; display: flex; -ms-flex-direction: row; flex-direction: row; } .follow-us-on__link:first-child { margin-right: 16px; } /* stylelint-disable property-no-unknown */ .nav-bar { background-color: #fff; } .nav-bar__hidden-menu { display: none; } .nav-bar__visible-menu { display: block; } .nav-bar__no-scroll { max-height: 100vh; overflow: hidden; } /* stylelint-disable property-no-unknown */ .dot-with-label { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; } .dot-with-label__text { padding-left: 8px; } .dot-with-label__text a { text-decoration: none; } .dot-with-label__text:hover h2 { color: #adadad; } .sponsor-section { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; height: 100%; max-width: 530px; } .sponsor-section--menu { padding: 20px 0 16px 24px; } .sponsor-section__container { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; height: 100%; } .sponsor-section__container--desktop { -ms-flex-align: center; align-items: center; -ms-flex-direction: row; flex-direction: row; -ms-flex-pack: justify; justify-content: space-between; } .sponsor-section__sponsor { color: #fff; padding-right: 16px; } .sponsor-section__sponsor-name { font-family: 'CuriousSansBold'; color: #4e4e4e; font-size: 26px; margin: 0; white-space: nowrap; } .sponsor-section__sponsor-name--mobile { padding-bottom: 16px; } .sponsor-section__sponsor-name--desktop { font-size: 22px; } .sponsor-section__sponsor-name--menu { color: #fff; } .sponsor-section__sponsor-name--menu-desktop { font-size: 32px; } .sponsor-section__summary { color: #ebebeb; font-size: 16px; line-height: 24px; padding-top: 16px; } .sponsor-section__advert { display: inline-block; } .icon-with-label { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; } .icon-with-label__icon { padding-right: 10px; } .full-width-image-article { width: 100%; } .full-width-image-article__container { min-height: 325px; overflow: hidden; position: relative; } .full-width-image-article__container--desktop { min-height: 400px; } .full-width-image-article__image { height: 100%; overflow: hidden; position: absolute; width: 100%; } .full-width-image-article__image img { bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; object-fit: cover; position: absolute; right: -100%; top: -100%; width: 100%; } .full-width-image-article__text { -ms-flex-align: center; align-items: center; color: #fff; left: 50%; max-width: 488px; padding: 0 20px; position: absolute; text-align: center; top: 50%; -webkit-transform: translate(-50%, -50%); transform: translate(-50%, -50%); width: 100%; } .full-width-image-article__text a { color: #fff; text-decoration: none; } .full-width-image-article__text .full-width-image-article-text__label { display: inline-block; font-size: 14.4px; font-weight: bold; letter-spacing: 3.6px; line-height: 19px; margin-bottom: 11px; text-transform: uppercase; } .full-width-image-article__text .full-width-image-article-text__header { font-size: 24px; letter-spacing: -0.25px; line-height: 42px; margin: 0; padding: 0; } .full-width-image-article__text .full-width-image-article-text__header--desktop { font-size: 33.6px; } .full-width-image-article__text .full-width-image-article-text__author { font-size: 16.6px; font-style: italic; letter-spacing: -0.13px; line-height: 42px; margin-bottom: 0; margin-top: 28px; } .full-width-image-article__text .full-width-image-article-text__author--desktop { margin-top: 32px; } .full-width-image-article__background { background-image: radial-gradient(50% 49%, rgba(5, 36, 53, 0.37) 50%, rgba(0, 0, 0, 0) 83%); height: 100%; pointer-events: none; position: absolute; top: 0; width: 100%; } .full-width-image-article__link { color: #fff; text-decoration: none; } .more-articles { background-position: center; background-repeat: no-repeat; background-size: cover; -o-object-fit: cover; object-fit: cover; overflow: hidden; position: relative; -webkit-transition: background-image 0.4s; transition: background-image 0.4s; } .more-articles__heading { display: inline-block; margin: auto; max-width: 1272px; padding: 20px 0 0 16px; position: relative; z-index: 5; } .more-articles__stories { margin: 10px 16px 42px; max-width: 1232px; padding: 8px; position: relative; z-index: 4; } .more-articles__stories--small { padding: 0; } .more-articles__stories--tablet { margin: 24px 16px 72px; max-width: 1216px; } .more-articles__stories--desktop { margin: 56px 48px 92px; max-width: 1152px; } .more-articles__story-container:not(:first-of-type) { padding-top: 16px; } .more-articles__line { opacity: 0.3; padding-top: 16px; z-index: 5; } .more-articles__image-overlay { background-color: rgba(25, 62, 109, 0.3); bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; -o-object-fit: cover; object-fit: cover; pointer-events: none; position: absolute; right: -100%; top: -100%; width: 100%; z-index: 1; } .more-articles__image { opacity: 0; -webkit-transition: 0.6s; transition: 0.6s; } .more-articles__image img { bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; object-fit: cover; position: absolute; right: -100%; top: -100%; width: 100%; } .more-articles__image--right img { left: unset; min-width: 100%; right: 0; width: unset; } .more-articles__image--left img { left: unset; min-width: 100%; right: unset; width: unset; } .more-articles__image--visible { opacity: 1; } .more-articles__story--two-columns, .more-articles__story--three-columns { padding-right: 16px; width: 310px; } .more-articles__story-container:nth-child(even) .more-articles__story--two-columns { padding-right: 0; } .more-articles__story-container:nth-child(3n + 3) .more-articles__story--three-columns { padding-right: 0; } .more-articles__stories--two-columns, .more-articles__stories--three-columns { -ms-flex-align: end; align-items: flex-end; display: -ms-flexbox; display: flex; -ms-flex-wrap: wrap; flex-wrap: wrap; padding: 16px; } .more-articles__stories--two-columns .more-articles-item__link, .more-articles__stories--three-columns .more-articles-item__link { pointer-events: all; } .more-articles__story-container--two-columns { display: -ms-flexbox; display: flex; -ms-flex-pack: center; justify-content: center; width: 50%; } .more-articles__story-container--two-columns:nth-child(2) { padding-top: 0; } .more-articles__story-container--three-columns { display: -ms-flexbox; display: flex; -ms-flex-pack: center; justify-content: center; width: 33%; } .more-articles__story-container--three-columns:nth-child(-n + 3) { padding-top: 0; } .more-articles__heading--small { padding: 20px 0 0 8px; } .more-articles__heading--desktop { max-width: 1264px; padding: 38px 0 0 16px; } .more-articles__heading--tablet { max-width: 1264px; padding: 24px 0 0 16px; } /* stylelint-disable property-no-unknown */ .more-articles-item { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; position: relative; z-index: 5; } .more-articles-item__link { text-decoration: none; } .more-articles-item__container { display: -ms-flexbox; display: flex; width: 100%; } .more-articles-item__label { display: -ms-flexbox; display: flex; -ms-flex-wrap: wrap; flex-wrap: wrap; margin-top: 8px; } .more-articles-item__type { margin-right: 16px; position: relative; } .more-articles-item__icon { color: #fff; font-size: 12px; margin-right: 8px; } .more-articles-item__text { color: #fff; font-size: 20px; font-weight: bold; line-height: 24px; padding: 0; position: relative; text-shadow: 0 1px 2px rgba(25, 62, 109, 0.7); -webkit-transition: color 0.4s; transition: color 0.4s; } .more-articles-item__text--medium { font-size: 22px; line-height: 28px; } .more-articles-item__text--large { color: #ebebeb; font-size: 30px; line-height: 37px; } .more-articles-item__container--column { -ms-flex-direction: column; flex-direction: column; } .more-articles-item__image-container { position: relative; } .more-articles-item--two-columns { margin-right: 16px; } .more-articles-item__label--desktop { margin-top: 16px; } .more-articles-item__label--tablet { margin-top: 16px; } .more-articles-item__link:hover .more-articles-item__text { color: #adadad; } .most-popular { background-color: #f9f9f9; } .most-popular__inner { margin: 0 auto; max-width: 894px; padding: 45px 24px 21px; } .most-popular__inner--desktop { padding: 47px 0 86px; } .most-popular__header { color: #010101; font-size: 14px; letter-spacing: 2.92px; line-height: 19px; margin: 0; text-align: center; text-transform: uppercase; } .most-popular__items { display: block; } .most-popular__items--desktop { display: -ms-flexbox; display: flex; -ms-flex-wrap: wrap; flex-wrap: wrap; margin-top: 57px; } .most-popular-item { box-sizing: border-box; padding-top: 33px; } .most-popular-item:last-of-type { margin-bottom: 42px; } .most-popular-item--desktop { padding: 0 20px; width: calc(33.333%); } .most-popular-item--desktop:nth-child(3n + 2) { -ms-flex-order: 2; order: 2; padding: 38px 20px; } .most-popular-item--desktop:nth-child(3n + 3) { -ms-flex-order: 3; order: 3; } .most-popular-item--desktop:nth-child(n+4) { border-left: 1px solid #dadada; } .most-popular-item--desktop:last-of-type { margin-bottom: 0; } .most-popular-item a { text-decoration: none; } .most-popular-item__content { -ms-flex-align: end; align-items: flex-end; display: -ms-flexbox; display: flex; margin-top: 5px; } .most-popular-item__number { color: #cbcbcb; font-size: 40px; font-style: italic; font-weight: bold; line-height: 32px; margin: 0 20px 0 0; width: 25px; } .most-popular-item__label { color: #4a4a4a; font-size: 12px; font-weight: bold; letter-spacing: 3px; margin: 0 0 0 45px; text-transform: uppercase; } .most-popular-item__title { color: #2e2e2ecc; font-size: 14px; letter-spacing: -0.17px; line-height: 22px; margin-bottom: 0; margin-top: 0; } .most-popular-item__title--desktop { font-size: 16px; } .StickyElementContent { -webkit-transition: -webkit-transform 0.5s; transition: -webkit-transform 0.5s; transition: transform 0.5s; transition: transform 0.5s, -webkit-transform 0.5s; } .StickyElementContent--is-undocked { left: 0; position: fixed; top: 0; width: 100%; } .StickyElementContent--is-hidden { -webkit-transform: translateY(-100%); transform: translateY(-100%); } /* stylelint-disable property-no-unknown */ .error-page-header { position: relative; } .error-page-header__headers { margin-bottom: 16px; position: relative; z-index: 1; } .error-page-header__headers--tablet-plus { margin-bottom: 32px; } .error-page-header__description { color: #444; font-size: 16px; line-height: 20px; } .error-page-header__play-icon { margin-right: 16px; } .error-page-header__play-icon button { color: #adadad; } .error-page-header__dot-label { display: -ms-flexbox; display: flex; } /* stylelint-disable property-no-unknown */ .styled-list { list-style: none; margin: 0; padding: 0; } .styled-list__item { display: -ms-flexbox; display: flex; -ms-flex-direction: row; flex-direction: row; } .styled-list__item:not(:first-of-type) { padding-top: 8px; } .styled-list__item a { font-weight: bold; text-decoration: none; } .styled-list__item--worklife a { color: #8beed9; } .styled-list__item--future a { color: #ffc857; } .styled-list__item--culture a { color: #472479; } .styled-list__item--earth a { color: #002856; } .styled-list__item--travel a { color: #002856; } .styled-list__text { color: #444; font-size: 16px; line-height: 24px; padding-left: 20px; } .styled-list__dot { display: -ms-flexbox; display: flex; margin-top: 8px; } /* stylelint-disable property-no-unknown */ .image-gallery-item { margin: 26px 0; } .image-gallery-item img { height: 100%; -o-object-fit: cover; object-fit: cover; width: 100%; } .image-gallery-item__image--landscape { margin: 20px 0 20px -3%; width: 106%; } @media (max-width: 1000px) and (min-width: 767px) { .image-gallery-item__image--landscape { margin: 20px 0 20px -16%; width: 116%; } } @media (max-width: 1180px) and (min-width: 1024px) { .image-gallery-item__image--landscape { margin: 20px 0 20px -8%; width: 108%; } } @media (max-width: 1365px) and (min-width: 1280px) { .image-gallery-item__image--landscape { margin: 20px 0 20px -42%; width: 142%; } } @media (min-width: 1366px) { .image-gallery-item__image--landscape { margin: 20px 0 20px -55%; width: 155%; } } .image-gallery-item__image--portrait { margin: 20px 0; width: 100%; } @media (max-width: 599px) { .image-gallery-item__image--portrait { margin-left: -3%; width: 106%; } } .image-gallery-item__image--portrait, .image-gallery-item__image--portrait img { max-height: 507px; min-height: 463px; } @media (max-width: 1279px) and (min-width: 768px) { .image-gallery-item__image--portrait, .image-gallery-item__image--portrait img { min-height: 818px; } } .error-page { position: relative; } .error-page__container { margin-bottom: 16px; } .error-page__container--tablet-plus { margin-bottom: 32px; } .error-page__title { margin-bottom: 12px; } .error-page__title--desktop { margin-bottom: 24px; } /* stylelint-disable property-no-unknown */ .article-labels { font-size: 12px; line-height: 16px; text-transform: uppercase; } .article-labels a { color: #fff; letter-spacing: 1px; text-decoration: none; } .article-labels__text:first-child { font-weight: bold; } /* stylelint-disable property-no-unknown */ .rectangle-story-group { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; margin: auto; position: relative; } .rectangle-story-group__articles { display: -ms-flexbox; display: flex; -ms-flex: 1 1; flex: 1 1; -ms-flex-wrap: wrap; flex-wrap: wrap; -ms-flex-pack: center; justify-content: center; position: relative; } .rectangle-story-group__articles--small-tablet { -ms-flex-pack: unset; justify-content: unset; } .rectangle-story-group__articles--full-screen { display: block; } .rectangle-story-group__article { display: inline-block; padding-left: 18px; padding-top: 16px; } .rectangle-story-group__article--tablet { padding-left: 20px; padding-top: 22px; } .rectangle-story-group__article--desktop { padding-left: 22px; padding-top: 24px; } .rectangle-story-group__article--desktop:first-of-type { padding-left: 8px; } .rectangle-story-group__article--small-tablet { -webkit-box-sizing: border-box; box-sizing: border-box; width: 50%; } .rectangle-story-group__article--full-screen { display: block; padding: 16px; } .rectangle-story-group__article--full-screen:first-of-type { padding-top: 0; } .rectangle-story-group__article--small-desktop { padding-left: 10px; } .rectangle-story-group__article--small-desktop:last-of-type { padding-right: 8px; } .rectangle-story-group__articles-container { margin: auto; max-width: 950px; overflow: hidden; width: 100%; } .rectangle-story-group__advert-mpu { display: -ms-flexbox; display: flex; -ms-flex-pack: center; justify-content: center; margin-left: auto; margin-right: auto; padding: 16px 16px 24px; } .rectangle-story-group__advert-mpu--desktop { border-left: 1px solid #dadada; display: block; padding: 0 0 0 16px; padding-top: 0; } .rectangle-story-group__advert-mpu--small-desktop { display: block; padding: 0 0 0 8px; } .rectangle-story-group__hero--desktop { display: -ms-flexbox; display: flex; } .rectangle-story-group__article-hero--tablet { display: -ms-flexbox; display: flex; } .article-title-card-rectangle { width: 100%; } .article-title-card-rectangle__image:hover .article-title-card-rectangle__overlay { opacity: 1; } .article-title-card-rectangle__overlay { background-color: rgba(0, 0, 0, 0.6); bottom: 0; height: 100%; left: 0; opacity: 0; pointer-events: none; position: absolute; right: 0; top: 0; -webkit-transition: -webkit-transform 0.5s ease; transition: -webkit-transform 0.5s ease; transition: transform 0.5s ease; transition: transform 0.5s ease, -webkit-transform 0.5s ease; width: 100%; will-change: transform; } .article-title-card-rectangle__overlay--culture { background-color: rgba(72, 41, 120, 0.6); } .article-title-card-rectangle__image { margin-right: 40px; max-height: 390px; max-width: 620px; overflow: hidden; position: relative; width: auto; } .article-title-card-rectangle__image img { display: block; min-height: 194px; min-width: 344px; width: 100%; } .article-title-card-rectangle__image--tablet, .article-title-card-rectangle__image--desktop { margin-right: 0; width: 100%; } .article-title-card-rectangle__image--tablet img, .article-title-card-rectangle__image--desktop img { width: 110%; } .article-title-card-rectangle__image--preview-article { margin-right: 0; } .article-title-card-rectangle__image--index { margin-right: 0; max-width: 100%; } .article-title-card-rectangle__container { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; position: relative; } .article-title-card-rectangle__container--tablet, .article-title-card-rectangle__container--desktop { -ms-flex-align: center; align-items: center; -ms-flex-direction: row; flex-direction: row; } .article-title-card-rectangle__container--preview-article { margin-right: 8px; } .article-title-card-rectangle__container--index { -ms-flex-align: initial; align-items: initial; -ms-flex-direction: column; flex-direction: column; } .article-title-card-rectangle__text-box { background-color: #fff; margin-left: 40px; padding: 16px 22px 0; position: relative; top: -22px; } .article-title-card-rectangle__text-box__label { color: #4a4a4a; font-size: 12px; font-weight: bold; letter-spacing: 3px; line-height: 20px; margin: 0; text-transform: uppercase; width: -webkit-fit-content; width: -moz-fit-content; width: fit-content; } .article-title-card-rectangle__text-box__label--worklife:hover, .article-title-card-rectangle__text-box__label--future:hover { border-bottom: 1px solid #4a4a4a; } .article-title-card-rectangle__text-box__label--culture:hover { border-bottom: 1px solid #482978; } .article-title-card-rectangle__text-box__label--index { color: #000; font-size: 20px; font-weight: 300; letter-spacing: -0.53px; line-height: 30px; } .article-title-card-rectangle__text-box__label--index--tablet { font-size: 28px; letter-spacing: -0.74px; line-height: 44px; } .article-title-card-rectangle__text-box__label--index--desktop { font-size: 32px; letter-spacing: -0.84px; line-height: 44px; } .article-title-card-rectangle__text-box__header { color: #2e2e2e; font-size: 18px; letter-spacing: -0.21px; line-height: 30px; margin-bottom: 30px; margin-top: 12px; } .article-title-card-rectangle__text-box__header--desktop { font-size: 28px; } .article-title-card-rectangle__text-box__header--tablet { font-size: 26px; } .article-title-card-rectangle__text-box__header--index { color: #3d3d3d; font-family: Helvetica; font-size: 16px; letter-spacing: -0.12px; line-height: 31px; margin-top: 4px; } .article-title-card-rectangle__text-box__author { color: #4a4a4a; font-size: 14px; font-style: italic; letter-spacing: -0.1px; line-height: 35px; margin: 8px 0 0; } .article-title-card-rectangle__text-box__author--tablet { margin: 14px 0 0; } .article-title-card-rectangle__text-box--tablet, .article-title-card-rectangle__text-box--desktop { left: -40px; margin: 0; padding: 40px; top: 0; -webkit-transform: none; transform: none; } .article-title-card-rectangle__text-box--desktop { display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; -ms-flex-pack: center; justify-content: center; } .article-title-card-rectangle__text-box--tablet { padding: 35px 22px 22px; } .article-title-card-rectangle__text-box--index { left: 0; margin-right: 40px; } .article-title-card-rectangle__text-box--index--tablet { margin-left: 50px; margin-right: 50px; padding: 30px 36px 0; top: -80px; } .article-title-card-rectangle__text-box--index--desktop { margin-left: 50px; max-width: 560px; top: -88px; width: 100%; } .article-title-card-rectangle__link { color: #000; text-decoration: none; } .article-title-card-rectangle__text-container { display: block; max-width: 252px; } .article-title-card-rectangle__text-container--tablet, .article-title-card-rectangle__text-container--desktop { max-width: 320px; } .article-title-card-rectangle__preview-container { color: #4d4d4d; text-decoration: none; } .article-title-card-rectangle__preview-text { display: block; font-size: 16px; line-height: 24px; margin-top: 27px; max-width: 396px; } .article-title-card-rectangle__read-more { display: inline-block; font-size: 15px; letter-spacing: 4px; margin: 25px 16px 0 0; text-transform: uppercase; } .article-title-card-rectangle__arrow { color: #bababa; display: inline-block; -webkit-transform: rotate(-90deg); transform: rotate(-90deg); } .article-headline { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; padding: 43px 0; } .article-headline .article-labels { text-align: center; } .article-headline__line--short { margin-bottom: 40px; } .article-headline--largeTablet .article-headline__text { font-size: 32px; text-align: center; } .article-headline--tablet { padding: 31px 0; } .article-headline--tablet .article-headline__collection { margin-bottom: 24px; } .article-headline--tablet .article-headline__text { font-size: 32px; letter-spacing: -0.84px; margin: 0 15px 23px; text-align: center; } .article-headline--mobile { padding: 20px 0; } .article-headline--mobile .article-headline__text { font-size: 24px; letter-spacing: -0.63px; margin: 0 15px 15px; text-align: center; } .article-headline--mobile .article-headline__collection { margin-bottom: 15px; } .article-headline__collection { margin-bottom: 40px; } .article-headline__collection a { color: #242424; } .article-headline__text { font-size: 45px; letter-spacing: -1.26px; line-height: 30px; margin-bottom: 44px; } /* stylelint-disable property-no-unknown */ .loading-spinner { margin: 0 auto; text-align: center; } .loading-spinner__message { color: #002756; display: block; font-size: 1.2rem; font-weight: bold; margin: 12px 0; text-align: center; text-transform: uppercase; } .loading-spinner__image { display: block; margin: 0 auto; width: 48px; } @media only screen and (min-width: 1600px) { .hero-image { height: 900px; position: relative; } .hero-image img { bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; object-fit: cover; position: absolute; right: -100%; top: -100%; width: 100%; } } @media only screen and (max-width: 1600px) { .hero-image { height: 0; overflow: hidden; padding-top: 56.25%; position: relative; } .hero-image img { height: 100%; left: 0; position: absolute; top: 0; width: 100%; } } /* stylelint-disable property-no-unknown */ .article-hero { height: 672px; margin: 0; overflow: hidden; position: relative; width: 100%; } .article-hero--small-mobile { height: 373px; } .article-hero--mobile { height: 486px; } .article-hero--small-tablet { height: 433px; } .article-hero--tablet { height: 433px; } .article-hero--tablet .article-hero__content { padding: 60px 15px 0; } .article-hero__content { margin: auto; max-width: 1004px; pointer-events: none; position: relative; z-index: 1; } .article-hero--desktop { height: 573px; } .article-hero--desktop .article-hero__content { padding: 50px 30px 0; } .article-hero--large-desktop .article-hero__content { max-width: 1276px; } .article-hero--small-tablet .article-hero__content, .article-hero--mobile .article-hero__content, .article-hero--small-mobile .article-hero__content { padding: 60px 10px 0; } .article-hero--small-tablet .article-hero__content-title, .article-hero--mobile .article-hero__content-title, .article-hero--small-mobile .article-hero__content-title { font-size: 24px; line-height: 30px; max-width: 220px; } .article-hero--small-tablet .article-hero__content-line, .article-hero--mobile .article-hero__content-line, .article-hero--small-mobile .article-hero__content-line { margin-bottom: 16px; margin-top: 16px; } .article-hero--small-tablet .article-hero__content-labels, .article-hero--mobile .article-hero__content-labels, .article-hero--small-mobile .article-hero__content-labels { margin-bottom: 15px; } .article-hero--small-tablet .article-hero__content-cta, .article-hero--mobile .article-hero__content-cta, .article-hero--small-mobile .article-hero__content-cta { line-height: 22px; } .article-hero--small-tablet .article-hero__content-cta a, .article-hero--mobile .article-hero__content-cta a, .article-hero--small-mobile .article-hero__content-cta a { letter-spacing: 3px; } .article-hero__ambient-hidden { display: none; } .article-hero__background-ambient { bottom: 0; left: 0; position: absolute; right: 0; top: 0; z-index: -1; } .article-hero__background::after { background-image: linear-gradient(-63deg, rgba(0, 0, 0, 0) 0%, rgba(0, 0, 0, 0.06) 24%, rgba(0, 0, 0, 0.2) 51%, rgba(0, 0, 0, 0.32) 67%, rgba(0, 0, 0, 0.51) 100%); content: ''; height: 100%; left: 0; pointer-events: none; position: absolute; top: 0; width: 100%; } .article-hero__background img { bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; object-fit: cover; position: absolute; right: -100%; top: -100%; width: 100%; } .article-hero__background--parallax img { -webkit-transform: scale(1.1); transform: scale(1.1); } .article-hero a { color: #fff; letter-spacing: 3px; text-decoration: none; } .article-hero__content-cta { clear: both; font-size: 16px; font-weight: 400; letter-spacing: 4px; line-height: 20px; max-width: 170px; pointer-events: all; text-shadow: 0 2px 4px rgba(0, 0, 0, 0.5); text-transform: uppercase; } .article-hero__content-cta a { display: -ms-flexbox; display: flex; letter-spacing: 4px; } .article-hero__content-labels { font-size: 12px; letter-spacing: 1px; line-height: 16px; margin-bottom: 20px; pointer-events: all; } .article-hero__content-line { background-color: #fff; border: 0; display: block; float: left; height: 1px; margin-bottom: 18px; margin-right: 300px; margin-top: 25px; width: 120px; } .article-hero__content-right-arrow { position: relative; } .article-hero__content-right-arrow::before { background: #fff; content: ''; height: 2px; left: 5px; margin-top: -1px; opacity: 0.4; position: absolute; top: 50%; -webkit-transition: all 0.3s ease; transition: all 0.3s ease; width: 20px; } .article-hero__content-right-arrow::after { border-right: 2px solid #fff; border-top: 2px solid #fff; content: ''; display: inline-block; height: 10px; left: 16px; margin-top: 5px; opacity: 0.4; position: absolute; -webkit-transform: rotate(45deg); transform: rotate(45deg); width: 10px; } .article-hero__content-right-arrow--small::before { opacity: 1; } .article-hero__content-right-arrow--small::after { margin-top: 6px; opacity: 1; } .article-hero__content-right-arrow img { height: 11px; margin-left: 10px; width: 19px; } .article-hero__content-title { color: #fff; font-size: 50px; line-height: 54px; margin-top: 0; max-width: 450px; pointer-events: all; text-shadow: 0 1px 2px rgba(51, 51, 51, 0.7); } .article-hero__content-title a { letter-spacing: -1.32px; } .article-hero__title-text { display: inline; } .article-hero__content-title > a:hover > div, .article-hero__content-subtitle > a:hover { background-image: -webkit-gradient(linear, left top, right top, color-stop(100%, currentColor), color-stop(0%, transparent)); background-image: linear-gradient(to right, currentColor 100%, transparent 0%); background-position: 0 1.15em; background-repeat: repeat-x; background-size: 100% 2px; } .article-hero__content-subtitle { clear: both; color: #fff; font-size: 23px; font-weight: 500; line-height: 32px; margin-bottom: 16px; margin-top: 0; max-width: 440px; pointer-events: all; text-shadow: 0 1px 2px rgba(51, 51, 51, 0.5); } .article-hero__content-subtitle a { letter-spacing: -1px; } .article-hero__content-title--small { font-size: 30px; line-height: 35px; } .article-hero__content-title--tablet { clear: both; font-size: 32px; letter-spacing: -0.84px; line-height: 42px; max-width: 264px; } .article-hero__content-title--small a { letter-spacing: -0.63px; } .article-hero__down-arrow { background-color: transparent; border: 0; bottom: 0; color: #fff; cursor: pointer; display: inline-block; left: calc(50% - 29px); margin: 0; margin-bottom: 15px; padding: 0; position: absolute; -webkit-transform: scale(0.5); transform: scale(0.5); } .see-more-button-container { color: #fff; } /* stylelint-disable */ @media screen and (min-width: 1000px) { .similar-articles-story { max-width: 900px; } } @media screen and (min-width: 601px) and (max-width: 999px) { .similar-articles-story { max-width: 600px; } } @media screen and (max-width: 600px) { .similar-articles-story { max-width: 300px; } } .related-articles { position: relative; } .related-articles__header { text-align: center; background-color: #000; color: #fff; font-size: 14px; font-weight: normal; letter-spacing: 3px; margin: 0 0 20px; padding: 8px; text-transform: uppercase; } .related-articles__header--bright { margin: 20px 0 1.15ex; font-size: 13px; background-color: #d8d8d8; color: rgba(0, 0, 0, 0.7); letter-spacing: 2px; line-height: 3; } .related-articles__list { list-style: none; padding: 0 0 1.5ex 0; margin: 0; display: -ms-flexbox; display: flex; -ms-flex-flow: row wrap; flex-flow: row wrap; /* .with-numbers */ } .related-articles__list li { -ms-flex-preferred-size: 100%; flex-basis: 100%; display: -ms-flexbox; display: flex; -ms-flex-flow: row nowrap; flex-flow: row nowrap; -ms-flex-pack: start; justify-content: flex-start; -ms-flex-align: stretch; align-items: stretch; -ms-flex-line-pack: stretch; align-content: stretch; } .related-articles__list li > div { -ms-flex: 1 1; flex: 1 1; } .related-articles__list.with-numbers { counter-reset: related-numbers; list-style-image: url(data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7); margin: 0 35px; } .related-articles__list.with-numbers li::before { counter-increment: related-numbers; content: counter(related-numbers); font-weight: bold; font-size: 40px; -ms-flex-item-align: end; align-self: flex-end; line-height: 1.85; font-style: italic; letter-spacing: 0; color: rgba(0, 0, 0, 0.18); -ms-flex: 0.1 0.1; flex: 0.1 0.1; -ms-flex-preferred-size: 1ex; flex-basis: 1ex; padding-right: 1ex; text-align: center; display: block; } .related-articles__list.with-numbers li { margin-bottom: 10px; } .related-articles--wide-layout { background-color: initial; margin-top: 20px; } ul.related-articles__list:not(.list-wide) li { max-width: 100%; } ul.related-articles__list:not(.list-wide).with-borders li:not(:last-of-type) { border-bottom: 1px solid rgba(0, 0, 0, 0.1); } ul.related-articles__list.list-wide li { max-width: 49.8%; } ul.related-articles__list.list-wide.with-borders li { border-bottom: 1px solid rgba(0, 0, 0, 0.1); } .related-article { -ms-flex-align: stretch; align-items: stretch; display: -ms-flexbox; display: flex; -ms-flex-flow: row nowrap; flex-flow: row nowrap; -webkit-box-sizing: border-box; box-sizing: border-box; font-size: 16px; min-height: 90px; } .related-article__image { width: calc(90px + 0.5ex); -ms-flex: 0.3 0.3; flex: 0.3 0.3; min-width: 90px; max-width: calc(90px + 0.5ex); margin: 0; display: block; line-height: 0; -ms-flex-order: -1; order: -1; } .related-article__image img { width: 100%; border: 0; margin: 0 12px 0 0; } .related-article__text { display: -ms-flexbox; display: flex; -ms-flex-flow: column nowrap; flex-flow: column nowrap; width: 100%; -ms-flex-pack: start; justify-content: flex-start; -ms-flex-line-pack: start; align-content: flex-start; position: relative; padding: 12px 6px 12px 0; line-height: 1.5; } .related-article__text a { width: 100%; padding-left: 12px; display: -ms-flexbox; display: flex; text-decoration: none; } .related-article__text a + a { margin-top: 1ex; } .related-article__text br { display: none; } .related-article__title { color: rgba(46, 46, 46, 0.85); letter-spacing: -0.01em; -ms-flex: 1 1; flex: 1 1; } .related-article__title:hover { color: #2e2e2e; } .related-article__collection { display: block; color: #4a4a4a; font-size: 12px; font-weight: bold; letter-spacing: 2.5px; line-height: 1.2; text-decoration: none; text-transform: uppercase; } .related-article__collection span { display: none; } .related-articles__list.square-images .related-article { margin: 0.75ex 0; } .related-articles__list.square-images .related-article:hover { background-color: #f9f9f9; } .related-articles__list.square-images.list-wide .related-article { margin: 1.25ex 1.75ex; } .related-articles__list.round-images a:hover { color: #000; } .related-articles__list.round-images .related-article { margin: 1.25ex 1.75ex; } .related-articles__list.round-images .related-article__title { padding-left: 10px; } .related-articles__list.round-images .related-article__image { width: calc(90px + 15px); max-width: calc(90px + 15px); margin: 0; } .related-articles__list.round-images .related-article__image img { border-radius: 50%; } .related-articles__list.round-images.list-wide .related-article { margin: 1.75ex 1.75ex; } .vertical-story-card-item { cursor: pointer; font-family: 'ReithSans'; height: 456px; margin: 20px 10px; position: relative; width: 297px; } @media only screen and (max-width: 1007px) { .vertical-story-card-item { width: 276px; } } @media only screen and (max-width: 600px) { .vertical-story-card-item { width: 276px; } } .vertical-story-card-item img { width: 100%; } .vertical-story-card-item__content-box { background-color: #fff; bottom: 0; -webkit-box-shadow: 0 0 5px #d8d8d8; box-shadow: 0 0 5px #d8d8d8; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; height: 111px; -ms-flex-pack: center; justify-content: center; position: absolute; right: 0; width: 275px; } @media only screen and (max-width: 1007px) { .vertical-story-card-item__content-box { width: 261px; } } .vertical-story-card-item__content-box h1 { color: #4a4a4a; font-size: 0.75rem; font-weight: bold; letter-spacing: 3px; margin: 0; padding: 0 10px; text-transform: uppercase; } .vertical-story-card-item__content-box h2 { color: #3d3d3d; font-size: 1.3125rem; font-weight: lighter; letter-spacing: -0.06px; line-height: 42px; margin: 0; padding: 0 10px; } /* stylelint-disable property-no-unknown */ .see-more-button { border-bottom: 1px solid #979797; text-align: center; } .see-more-button__inner { background-color: transparent; border: 0; color: #6c6c6c; cursor: pointer; font-size: 14px; letter-spacing: 2.92px; line-height: 19px; margin-bottom: 13px; position: relative; text-transform: uppercase; -webkit-transition: linear 0.6s; transition: linear 0.6s; } .see-more-button__inner-arrow { color: #6c6c6c; font-size: 10px; position: absolute; right: 9px; top: 2px; -webkit-transition: linear 0.3s; transition: linear 0.3s; } .see-more-button__inner-text { margin-right: 24px; } .see-more-button__inner:hover { color: #4a4a4a; } .see-more-button__inner:hover .see-more-button__inner-arrow { color: #4a4a4a; -webkit-transform: rotate(90deg); transform: rotate(90deg); } .vertical-story-group { font-family: 'ReithSans'; position: relative; } .vertical-story-group img { -o-object-fit: cover; object-fit: cover; width: 100%; } .vertical-story-group__image-container { height: 370px; position: relative; width: 100%; } .vertical-story-group__image-container img { height: 100%; } .vertical-story-group__image-mask { background: -webkit-gradient(linear, left top, right top, from(rgba(0, 0, 0, 0.6)), to(rgba(0, 0, 0, 0))); background: linear-gradient(to right, rgba(0, 0, 0, 0.6), rgba(0, 0, 0, 0)); bottom: 0; left: 0; position: absolute; right: 0; top: 0; } .vertical-story-group__heading-container { color: #fff; left: 50%; position: absolute; text-align: center; top: 80px; -webkit-transform: translate(-50%, -50%); transform: translate(-50%, -50%); } @media only screen and (max-width: 599px) { .vertical-story-group__heading-container { top: 120px; } } .vertical-story-group__heading-container button { background-color: rgba(0, 0, 0, 0.8); border: 0; color: #fff; cursor: pointer; display: inline-block; font-size: 0.875rem; letter-spacing: 0.183rem; outline: none; padding: 15px 32px; text-align: center; text-decoration: none; } .vertical-story-group__heading-container h1 { font-size: 0.9rem; font-weight: bold; letter-spacing: 3.6px; margin-bottom: 20px; } .vertical-story-group__heading-container h2 { font-size: 2.1rem; font-weight: lighter; letter-spacing: -0.25px; line-height: 42px; } .vertical-story-group__heading-container-landscape { display: -ms-flexbox; display: flex; -ms-flex-pack: justify; justify-content: space-between; left: 0; margin-left: auto; margin-right: auto; position: absolute; right: 0; top: 65px; width: 70%; } @media only screen and (max-width: 599px) { .vertical-story-group__heading-container-landscape { -ms-flex-align: center; align-items: center; -ms-flex-direction: column; flex-direction: column; } } .vertical-story-group__heading-container-landscape h1 { color: #fff; font-size: 2.25rem; font-weight: lighter; letter-spacing: 0.95px; margin: 0; } .vertical-story-group__heading-container-landscape button { background-color: rgba(0, 0, 0, 0.8); border: 0; color: #fff; cursor: pointer; display: inline-block; font-size: 0.875rem; height: 60px; letter-spacing: 0.183rem; outline: none; padding: 15px 32px; text-align: center; text-decoration: none; width: 260px; } @media only screen and (max-width: 599px) { .vertical-story-group__heading-container-landscape button { margin-top: 50px; } } .vertical-story-group__container { display: -ms-grid; display: grid; grid-auto-rows: minmax(auto, auto); grid-template-columns: repeat(auto-fit, minmax(290px, 310px)); height: 100%; -ms-flex-pack: center; justify-content: center; justify-items: center; margin-top: -210px; width: 100%; } @media only screen and (max-width: 599px) { .vertical-story-group__container { margin-top: -120px; } } /* stylelint-disable property-no-unknown */ .mapContainer .mapTitle { background: transparent; color: #fff; display: block; font-family: 'curiousSans-Bold', Arial, sans-serif; font-size: 0.9rem; font-weight: bold; letter-spacing: 3.6px; line-height: 1.1875em; margin-top: 2%; min-width: 25%; padding: 2%; padding-bottom: 0.375em; padding-left: 8px; padding-right: 16px; padding-top: 0.375em; position: relative; text-align: center; z-index: 100; } @media only screen and (max-width: 600px) { .mapContainer .mapTitle { font-size: 2.4em; } } .mapContainer .styled-line { margin-left: auto; margin-right: auto; } .mapContainer button { background-color: rgba(255, 255, 255, 0.9); border: 0; -webkit-box-sizing: border-box; box-sizing: border-box; cursor: pointer; display: block; height: 60px; outline: none; padding: 2px; width: 60px; } .mapContainer button .gelicon { color: #589e50; font-size: 2.5em; vertical-align: middle; } .mapContainer button:hover { background-color: #f2f2f2; } @media only screen and (max-width: 600px) { .mapContainer button { height: 50px; width: 50px; } .mapContainer button .gelicon { font-size: 2em; } } .mapContainer .navigationPanel { -ms-flex-align: end; align-items: flex-end; bottom: 0; display: -ms-flexbox; display: flex; -ms-flex-pack: justify; justify-content: space-between; left: 50%; max-width: 1200px; padding: 10px; position: absolute; -webkit-transform: translate(-50%, 0); transform: translate(-50%, 0); width: 100%; } .mapContainer .zoomControls { background-color: #fff; } .mapContainer .mapboxgl-popup-content { border-radius: 0; -webkit-box-shadow: 0 3px 0 0 rgba(0, 0, 0, 0.1) !important; box-shadow: 0 3px 0 0 rgba(0, 0, 0, 0.1) !important; cursor: default; font-family: 'curiousSans-Bold', Arial, sans-serif; max-width: 300px; padding: 0 !important; text-align: left; } .mapContainer .mapboxgl-popup-content img { width: 300px; } @media only screen and (max-width: 600px) { .mapContainer .mapboxgl-popup-content { max-width: 190px; } .mapContainer .mapboxgl-popup-content img { width: 190px; } } .mapContainer .mapboxgl-ctrl-logo { display: none !important; } .mapContainer .map-marker svg { -webkit-transition: all 0.1s ease-out; transition: all 0.1s ease-out; } @media only screen and (max-width: 600px) { .mapContainer .map-marker svg { height: 52px; -webkit-transform: scale(0.75); transform: scale(0.75); } } .mapContainer .map-marker-active svg { -webkit-transform: scale(1.3); transform: scale(1.3); } @media only screen and (max-width: 600px) { .mapContainer .map-marker-active svg { height: 52px; -webkit-transform: scale(1); transform: scale(1); } } .mapContainer__articleInfo { padding: 0 18px; } .mapContainer__articleInfo .article-vertical a { color: #4a4a4a; display: block; font-size: 12px; font-weight: bold; letter-spacing: 3px; line-height: 16px; margin-right: auto; margin-top: 20px; text-decoration: none; text-transform: uppercase; } .mapContainer__articleInfo .article-title { font-size: 18px; letter-spacing: -0.21px; line-height: 30px; margin: 0.725em 0; } .mapContainer__articleInfo .article-title a { color: rgba(46, 46, 46, 0.85); text-decoration: none; } @media only screen and (max-width: 600px) { .mapContainer__articleInfo .article-title { font-size: 1.7em; } } .mapContainer__articleInfo .article-author { color: #4a4a4a; display: block; font-size: 14px; font-style: italic; letter-spacing: 0.1px; line-height: 35px; margin: 1.45em 0; text-decoration: none; } .location-header { font-size: 14px; letter-spacing: 2.92px; line-height: 19px; text-transform: uppercase; } .temperature-switcher { background: transparent; border: 0; cursor: pointer; font-size: 14px; font-style: italic; font-weight: 300; white-space: nowrap; } .temperature-switcher:active { color: currentColor; } .temperature-switcher__active { font-weight: bold; } .temperature-switcher span { margin: 0 0.2ex; } .day { --w-day-font-size: 14px; --w-day-temp-font-size: 20px; --w-day-temp-font-size-big: 32px; --w-day-temp-font-weight: 600; --w-day-name-font-weight: 500; -ms-flex-align: center; align-items: center; color: #959595; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; font-size: var(--w-day-font-size); } .day--desktop { --w-day-temp-font-size: 24px; --w-day-temp-font-weight: normal; --w-day-name-font-weight: 600; } .day:first-of-type { color: #4b4b4b; } .day__name { font-weight: var(--w-day-name-font-weight); line-height: 1; margin-bottom: 0.75em; text-transform: uppercase; } .day__symbol-header { display: block; height: 80px; margin: 7px 0 5px; width: 98px; } .day__symbol { display: block; height: 40px; margin: 7px 0 5px; width: 50px; } .day--desktop .day__symbol { height: 60px; margin-top: 15px; width: 70px; } .day__temp { font-size: var(--w-day-temp-font-size); font-weight: var(--w-day-temp-font-weight); line-height: 1.2; margin-top: 0.75em; text-transform: lowercase; } .day__temp--header { color: #4b4b4b; font-size: 32px; font-weight: bold; } .day--mobile:first-of-type { display: -ms-flexbox; display: flex; -ms-flex-flow: row wrap; flex-flow: row wrap; -ms-flex-pack: center; justify-content: center; margin-bottom: 3em; } .day--mobile:first-of-type .day__symbol { height: 60px; margin-right: 10px; overflow: visible; width: 80px; } .day--mobile:first-of-type .day__temp { font-size: var(--w-day-temp-font-size-big); font-weight: bold; margin-top: 0; } .day--mobile:first-of-type .day__location { font-size: 120%; font-weight: 500; margin: 1em 0; } .day--mobile:first-of-type .day__name { color: #959595; } .day--mobile:first-of-type .day__location, .day--mobile:first-of-type .day__name { text-align: center; width: 100%; } .weather { --w-height: 50px; --w-wrapper-margin: 24px; --w-days-flexbasis: 33%; margin-bottom: 2rem; } .weather--desktop { --w-height: 80px; --w-wrapper-margin: 50px; --w-days-flexbasis: initial; margin-bottom: 1rem; } .weather:not(.weather--desktop) .weather__days { -ms-flex-flow: row wrap; flex-flow: row wrap; } .weather:not(.weather--desktop) .day:first-of-type { -ms-flex-preferred-size: 100%; flex-basis: 100%; width: auto; } .weather__separator { border-right: 1px solid #dcdcdc; display: block; height: var(--w-height); } .weather__days { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-preferred-size: var(--w-days-flexbasis); flex-basis: var(--w-days-flexbasis); -ms-flex-pack: space-evenly; justify-content: space-evenly; margin-top: 2.5rem; } .weather__days--desktop { margin-top: 4rem; } .weather__header { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-flow: column; flex-flow: column; -ms-flex-pack: center; justify-content: center; margin-bottom: var(--w-wrapper-margin); } .weather__header button { margin-top: 1.5rem; } .weather__header--desktop { /* position the temperature switcher on desktop */ position: relative; } .weather__header--desktop button { margin: 0; position: absolute; right: 0; } /* stylelint-disable property-no-unknown */ .beta-btn { background-color: #e6711b; color: #fff; cursor: pointer; height: 25px; line-height: 12px; padding: 0 7px; width: 66px; } .beta-btn:hover .beta-btn__arrow { cursor: pointer; -webkit-transform: rotate(45deg); transform: rotate(45deg); } .beta-btn:hover .beta-btn__arrow--expanded { -webkit-transform: rotate(-35deg); transform: rotate(-35deg); } .beta-btn__copy { color: #444; display: block; font-size: 12px; letter-spacing: 0; line-height: 17px; margin: 16px auto; max-width: 50%; } .beta-btn__arrow { border: solid #fff; border-width: 0 2px 2px 0; display: inline-block; padding: 3px; position: relative; top: -1px; -webkit-transform: rotate(-45deg); transform: rotate(-45deg); -webkit-transition: 0.4s; transition: 0.4s; } .beta-btn__arrow--expanded { -webkit-transform: rotate(45deg); transform: rotate(45deg); } .image-card { position: relative; } .image-card img { -o-object-fit: cover; object-fit: cover; width: 100%; } .image-card__heading-container { color: #fff; left: 50%; position: absolute; text-align: center; top: 80px; -webkit-transform: translate(-50%, -50%); transform: translate(-50%, -50%); } .image-card__heading-container button { background-color: rgba(0, 0, 0, 0.8); border: 0; color: #fff; cursor: pointer; display: inline-block; font-size: 0.875rem; letter-spacing: 0.183rem; outline: none; padding: 15px 32px; text-align: center; text-decoration: none; } .image-card__heading-container h1 { font-size: 0.9rem; font-weight: bold; letter-spacing: 3.6px; margin-top: 0; } .image-card__heading-container h2 { font-size: 2.1rem; font-weight: lighter; letter-spacing: -0.25px; line-height: 42px; margin-top: 0; } .image-card__heading-container-landscape { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-pack: justify; justify-content: space-between; left: 50%; position: absolute; text-align: center; top: 50%; -webkit-transform: translate(-50%, -50%); transform: translate(-50%, -50%); width: 90%; } .image-card__heading-container-landscape__mobile { -ms-flex-align: center; align-items: center; -ms-flex-direction: column; flex-direction: column; } .image-card__heading-container-landscape h1 { color: #fff; font-size: 2.25rem; font-weight: lighter; letter-spacing: 0.95px; margin-top: 0; } .image-card__heading-container-landscape button { background-color: rgba(0, 0, 0, 0.8); border: 0; color: #fff; cursor: pointer; display: inline-block; font-size: 0.875rem; height: 60px; letter-spacing: 0.183rem; outline: none; padding: 15px 32px; text-align: center; text-decoration: none; width: 260px; } .destination-header { width: 100%; } .destination-header__container { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-pack: center; justify-content: center; min-height: 380px; overflow: hidden; padding: 0 16px; position: relative; } .destination-header__image { height: 100%; overflow: hidden; position: absolute; width: 100%; } .destination-header__image img { bottom: -100%; display: block; height: 100%; left: -100%; margin: auto; min-height: 100%; min-width: 100%; object-fit: cover; position: absolute; right: -100%; top: -100%; width: 100%; } .destination-header__text { color: #fff; font-size: 28px; letter-spacing: -0.95px; line-height: 37.4px; max-width: 488px; padding: 0 20px; position: relative; text-align: center; text-transform: uppercase; width: 100%; } .destination-header__text a { color: #fff; font-weight: 300; text-decoration: none; } .destination-header__text--desktop { font-size: 36px; } .destination-header__text-container { border-bottom: solid 1px #fff; display: inline-block; line-height: 1.3; padding-bottom: 17px; } .destination-header__text-container--desktop { padding-bottom: 0.75ex; } .destination-header__link-page, .destination-header__advert { color: #fff; font-size: 12px; letter-spacing: 0.5px; margin-top: 20px; position: relative; text-align: center; } .destination-header__link-page span, .destination-header__advert span { display: block; width: 100%; } .destination-header__link-page--desktop, .destination-header__advert--desktop { margin-top: 40px; } .destination-header__link-page { left: 14px; margin: 0; position: absolute; text-transform: uppercase; top: 20px; } .destination-header__link-page--desktop { left: 25px; top: 36px; } .destination-header__background { background-image: radial-gradient(50% 49%, rgba(5, 36, 53, 0.37) 50%, rgba(0, 0, 0, 0) 83%); height: 100%; pointer-events: none; position: absolute; top: 0; width: 100%; } .destination-header a { color: #fff; text-decoration: none; } .filter { display: inline-block; max-width: 160px; position: relative; } .filter__button { background-color: #000; border: 0; color: #fff; font-size: 16px; padding: 16px; width: 160px; } .filter__content { background-color: #000; display: none; position: absolute; width: 160px; z-index: 1; } .filter:focus .filter__content, .filter:hover .filter__content { display: block; } .filter__content--open { display: block; } .filter__content button { background-color: #000; border: 0; color: #fff; cursor: pointer; display: block; font-style: italic; padding: 12px 16px; text-decoration: none; width: 100%; } .filter__content button:hover { background-color: #494848; } .callout-box-card { background-color: #eaeaea; color: #4a4a4a; margin-left: auto; margin-right: auto; text-align: left; } .callout-box-card img { height: 100%; width: 100%; } .callout-box-card__container { padding: 0.2rem 1.5rem; } .callout-box-card__container h3 { font-size: 12px; font-weight: bold; letter-spacing: 3px; line-height: 16px; margin: 1rem 0; text-transform: uppercase; } .callout-box-card__container h4 { font-size: 28px; font-weight: lighter; letter-spacing: -0.21px; line-height: 35px; } .callout-box-card__container .body { font-size: 16px; font-weight: lighter; letter-spacing: -0.12px; line-height: 31px; } .callout-box-card__container .body a { color: #4a4a4a; font-weight: bold; text-decoration: none; } /* stylelint-disable property-no-unknown */ .see-more-button { border-bottom: 1px solid #979797; text-align: center; } .see-more-button-inner { background-color: transparent; border: 0; color: #6c6c6c; cursor: pointer; font-size: 14px; letter-spacing: 2.92px; line-height: 19px; margin-bottom: 13px; position: relative; text-transform: uppercase; } .see-more-button-inner--light { color: #b4b4b4; } .see-more-button-inner__arrow { color: #6c6c6c; font-size: 10px; position: absolute; right: 9px; top: 2px; } .see-more-button-inner__arrow--light { color: #b4b4b4; } .see-more-button-inner__text { margin-right: 24px; } /* stylelint-disable property-no-unknown */ .load-more-button { -webkit-box-sizing: border-box; box-sizing: border-box; } .load-more-button__refresh.gelicon--refresh { margin-right: 16px; -webkit-transform: rotate(90deg); transform: rotate(90deg); } .load-more-button__downarrow { color: #adadad; font-size: 22px; -webkit-transition: 0.6s; transition: 0.6s; } .load-more-button__loading .load-more-button__refresh.gelicon--refresh { -webkit-animation: spin 2s linear infinite; animation: spin 2s linear infinite; } .load-more-button__downarrow:first-of-type { padding-right: 16px; } .load-more-button__downarrow:not(:first-of-type) { padding-left: 16px; } @-webkit-keyframes spin { 0% { -webkit-transform: rotate(90deg); transform: rotate(90deg); } 100% { -webkit-transform: rotate(-270deg); transform: rotate(-270deg); } } @keyframes spin { 0% { -webkit-transform: rotate(90deg); transform: rotate(90deg); } 100% { -webkit-transform: rotate(-270deg); transform: rotate(-270deg); } } /* stylelint-disable property-no-unknown */ .basic-button { -ms-flex-align: center; align-items: center; background-color: #fff; border: 1px solid #adadad; border-radius: 4px; -webkit-box-shadow: inset 0 0 0 0 #fff, 0 2px 0 0 rgba(0, 0, 0, 0.08); box-shadow: inset 0 0 0 0 #fff, 0 2px 0 0 rgba(0, 0, 0, 0.08); color: #193e6d; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 20px; height: 54px; -ms-flex-pack: center; justify-content: center; min-width: 222px; text-align: center; -webkit-transition: 0.6s; transition: 0.6s; } .basic-button--worklife { color: #0052a1; } .basic-button--future { color: #002856; } .basic-button--culture { color: #472479; } .basic-button--earth { color: #0fbb56; } .basic-button--travel { color: #589e50; } .basic-button__text { color: #444; font-family: 'BBC Reith Sans Cd'; font-size: 18px; line-height: 24px; -webkit-transition: 0.6s; transition: 0.6s; } .basic-button__text--white { color: #fff; } .basic-button__text--curious { font-family: 'CuriousSansBold'; } .basic-button__text--worklife { color: #0052a1; } .basic-button__text--future { color: #002856; } .basic-button__text--culture { color: #472479; } .basic-button__text--earth { color: #0fbb56; } .basic-button__text--travel { color: #589e50; } .basic-button::before { padding-right: 16px; } .basic-button:hover { background-color: #dedede; } .basic-button--background-light-blue:hover { background-color: #dfe8ff; } .basic-button--background-worklife { background-color: #0052a1; } .basic-button--background-future { background-color: #002856; } .basic-button--background-culture { background-color: #472479; } .basic-button--background-earth { background-color: #0fbb56; } .basic-button--background-travel { background-color: #589e50; } .basic-button--background-worklife:hover { background-color: #4494e4; } .basic-button--background-future:hover { background-color: #ffc857; } .basic-button--background-culture:hover { background-color: #472479; } .basic-button--background-earth:hover { background-color: #002856; } .basic-button--background-travel:hover { background-color: #002856; } .basic-button__text--bold { font-weight: bold; } /* stylelint-disable property-no-unknown */ .read-more-button { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-direction: column; flex-direction: column; font-weight: bold; position: relative; width: 224px; } /* stylelint-disable property-no-unknown */ .AdFrame { display: -ms-inline-flexbox; display: inline-flex; } .AdFrame--default { background-color: #f6f6f6; } .AdFrame--dark-grey { background-color: rgba(26, 26, 26, 0.8); } .AdFrame--centre-aligned { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-pack: center; justify-content: center; } /* stylelint-disable property-no-unknown */ .text-with-styled-background { height: inherit; position: relative; width: 100%; } .text-with-styled-background--collection { display: inline-block; width: unset; } .text-with-styled-background--center-align { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; } .text-with-styled-background__text { font-family: 'CuriousSansBold'; color: #444; display: block; font-size: 20px; line-height: 24px; padding: 0 0 0 10px; position: relative; } .text-with-styled-background__text--large { font-size: 26px; line-height: 30px; padding: 0 0 0 24px; } .text-with-styled-background__text--medium { font-size: 22px; line-height: 28px; } .text-with-styled-background__text--remove-padding { padding: 0; width: 100%; } .text-with-styled-background__text--largest { font-size: 38px; line-height: 47px; } .text-with-styled-background__text--worklife { color: #0052a1; } .text-with-styled-background__text--future { color: #002856; } .text-with-styled-background__text--culture { color: #472479; } .text-with-styled-background__text--earth { color: #0fbb56; } .text-with-styled-background__text--travel { color: #589e50; } .text-with-styled-background__text--blue { color: #0052a1; } .text-with-styled-background__text--collection { font-size: 28px; line-height: 34px; padding: 0; } .text-with-styled-background__text--collection--medium { font-size: 32px; line-height: 38px; } .text-with-styled-background__text--collection--large { font-size: 38px; line-height: 47px; } .text-with-styled-background__line-container { bottom: 0; margin-left: 13px; position: absolute; width: calc(100% - 26px); } .text-with-styled-background__line { background-color: rgba(25, 62, 109, 0.05); height: 26px; max-width: 240px; position: relative; } .text-with-styled-background__line--large { bottom: -10px; height: 42px; max-width: 340px; } .text-with-styled-background__line--narrow { height: 26px; max-width: 100%; } .text-with-styled-background__line--medium { bottom: -10px; height: 36px; max-width: 340px; } .text-with-styled-background__line--largest { max-width: 100%; } .text-with-styled-background__line-container--collection { width: calc(100% + 26px); } .text-with-styled-background__line-container--no-margin { margin: 0; } .text-with-styled-background__line--collection { height: 26px; } /* stylelint-disable property-no-unknown */ .previous-media-button { -ms-flex-align: center; align-items: center; background-color: #000; border: 0; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 16px; height: 50px; -ms-flex-pack: center; justify-content: center; outline: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; } .previous-media-button__icon--white svg { fill: #fff; } .previous-media-button span { height: 18px; width: 16px; } /* stylelint-disable property-no-unknown */ .simple-header { color: #444; font-size: 18px; font-weight: bold; line-height: 24px; margin: 0; } .simple-header--large { font-size: 28px; line-height: 34px; } .simple-header--simple { font-size: 18px; line-height: 22px; } .simple-header--small { font-size: 18px; letter-spacing: -0.5px; line-height: 28px; } .simple-header--smallest { font-family: Helvetica; font-size: 14px; line-height: 24px; } .simple-header--medium { font-size: 24px; line-height: 28px; } .simple-header--regular { font-size: 22px; line-height: 28px; } .simple-header--condensed-bold { font-stretch: condensed; } .simple-header--condensed-bold.simple-header--large { line-height: 37px; } .simple-header--condensed-bold.simple-header--regular { line-height: 28px; } .simple-header--white { color: #fff; } /* stylelint-disable property-no-unknown */ .play-button__inline-audio, .play-button__inline-video { -ms-flex-align: center; align-items: center; background-color: #000; border: 0; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 16px; height: 49px; -ms-flex-pack: center; justify-content: center; outline: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 49px; } .play-button__inline-audio .gelicon--play, .play-button__inline-video .gelicon--play { color: #ececec; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; } .play-button__inline-audio--worklife .gelicon--play, .play-button__inline-video--worklife .gelicon--play { color: #8beed9; } .play-button__inline-audio--travel .gelicon--play, .play-button__inline-video--travel .gelicon--play { color: #002856; } .play-button__inline-audio--future .gelicon--play, .play-button__inline-video--future .gelicon--play { color: #ffc857; } .play-button__inline-audio--culture .gelicon--play, .play-button__inline-video--culture .gelicon--play { color: #472479; } .play-button__inline-audio--earth .gelicon--play, .play-button__inline-video--earth .gelicon--play { color: #002856; } .play-button__inline-video:hover { background-color: #ececec; } .play-button__inline-video:hover .gelicon--play { color: #000; } .play-button__inline-audio { color: #fff; font-size: 22px; height: 50px; padding: 0; width: 50px; } .play-button { -ms-flex-align: center; align-items: center; background-color: rgba(0, 0, 0, 0.2); border: 2px solid #5ae9cb; border-radius: 50%; -webkit-box-shadow: 0 2px 4px 0 rgba(0, 0, 0, 0.2); box-shadow: 0 2px 4px 0 rgba(0, 0, 0, 0.2); color: #fff; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 22px; height: 80px; -ms-flex-pack: center; justify-content: center; outline: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 80px; } .play-button:hover { color: #5ae9cb; } .play-button--white { border: 4px solid #fff; } .play-button--white:hover { color: #fff; } .play-button--white .gelicon--play { color: inherit; } .play-button--worklife { border: 2px solid #8beed9; } .play-button--worklife:hover { color: #8beed9; } .play-button--travel { border: 2px solid #002856; } .play-button--travel:hover { color: #002856; } .play-button--future { border: 2px solid #ffc857; } .play-button--future:hover { color: #ffc857; } .play-button--culture { border: 2px solid #472479; } .play-button--culture:hover { color: #472479; } .play-button--earth { border: 2px solid #002856; } .play-button--earth:hover { color: #002856; } .play-button--desktop { font-size: 30px; height: 76px; width: 76px; } .play-button--background-hover:hover { background-color: rgba(0, 0, 0, 0.6); } /* stylelint-disable property-no-unknown */ .error-button { -ms-flex-align: center; align-items: center; background-color: #000; border: 0; display: -ms-flexbox; display: flex; font-size: 22px; height: 50px; -ms-flex-pack: center; justify-content: center; outline: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; } .error-button .gelicon--alert { color: #ececec; } /* stylelint-disable property-no-unknown */ .simple-p-tag { color: #444; font-size: 18px; font-weight: bold; line-height: 24px; margin: 0; } .simple-p-tag--large { font-size: 28px; line-height: 34px; } .simple-p-tag--medium { font-size: 27px; letter-spacing: -1.69px; line-height: 32px; } .simple-p-tag--quote { color: #575757; } .simple-header--serif-light-italic { font-style: italic; line-height: inherit; } /* stylelint-disable property-no-unknown */ .text-summary__text { font-size: 16px; line-height: 24px; margin: 0; text-align: left; } .text-summary__text--blue { color: #193e6d; } .text-summary__text--black { color: #000; } .text-summary__text--grey { color: #6a6a6a; } .text-summary__text--dark-grey { color: #444; } .text-summary__text--left { text-align: left; } .text-summary__text--right { text-align: right; } .screen-reader-only { border: 0; clip: rect(1px, 1px, 1px, 1px); -webkit-clip-path: inset(50%); clip-path: inset(50%); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute !important; width: 1px; word-wrap: normal !important; } .inline-html { display: block; } /* stylelint-disable property-no-unknown */ .drop-capped { -ms-flex-align: center; align-items: center; border: 2px solid #444; color: #444; display: -ms-flexbox; display: flex; float: left; font-size: 58px; font-weight: bold; height: 84px; -ms-flex-pack: center; justify-content: center; margin: 8px 10px 4px 0; text-transform: uppercase; width: 84px; } .drop-capped--worklife { border-color: #8beed9; } .drop-capped--future { border-color: #ffc857; } .drop-capped--culture { border-color: #444; } .drop-capped--earth { border-color: #002856; } .drop-capped--travel { border-color: #002856; } .drop-capped--desktop { margin-right: 24px; } /* stylelint-disable property-no-unknown */ .close-nav { -ms-flex-align: center; align-items: center; background-color: unset; border: unset; cursor: pointer; display: -ms-flexbox; display: flex; position: relative; -webkit-transition: 0.4s; transition: 0.4s; } .close-nav__icon { color: #fff; display: -ms-flexbox; display: flex; font-size: 20px; -webkit-transition: 0.4s; transition: 0.4s; } .close-nav:hover .close-nav__icon { color: #cecece; -webkit-transform: rotate(90deg); transform: rotate(90deg); } .close-nav__label { display: inline-block; margin-right: 12px; } /* stylelint-disable property-no-unknown */ .nav-label { color: #4e4e4e; font-size: 16px; line-height: 22px; margin: auto; max-width: 1280px; -webkit-transition: 0.4s; transition: 0.4s; } .nav-label:hover { color: #8e8e8e; } .nav-label--menu { color: #ebebeb; } .nav-label--menu:hover { color: #cecece; } .nav-label--white { color: #fff; } .nav-label--curiousSans { font-family: 'CuriousSansBold'; } /* stylelint-disable property-no-unknown */ .nav-links__link { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; height: 100%; -ms-flex-pack: center; justify-content: center; padding-right: 24px; position: relative; text-decoration: none; white-space: nowrap; } .nav-links__link--active p { border-bottom: 2px solid #002856; font-weight: bold; } .nav-links__link--active--menu p { border-bottom: unset; } .nav-links__link--active--worklife p { border-bottom: 2px solid #0052a1; } .nav-links__link--active--culture p { border-bottom: 2px solid #472479; } .nav-links__link--active--earth p { border-bottom: 2px solid #0fbb56; } .nav-links__link--active--travel p { border-bottom: 2px solid #589e50; } .nav-links__icon { background-color: #0052a1; bottom: 10px; height: 2px; position: absolute; width: 80px; } .nav-links__link--menu { display: block; padding-right: unset; } .nav-links__icon--menu { display: none; } .nav-links__icon--menu-tablet { width: 60px; } .nav-links__icon--worklife { background-color: #0052a1; } .nav-links__icon--future { background-color: #002856; } .nav-links__icon--culture { background-color: #472479; } .nav-links__icon--earth { background-color: #0fbb56; } .nav-links__icon--travel { background-color: #589e50; } .nav-links__link--menu p { font-size: 26px; padding: 0 0 32px 24px; } .nav-links__link--menu-desktop p { font-size: 32px; line-height: 42px; padding: 0 0 44px 100px; } /* stylelint-disable property-no-unknown */ .burger-nav { background: transparent; border: 0; color: #0052a1; cursor: pointer; font-size: 20px; outline: none; padding: 0; } .burger-nav--worklife { color: #0052a1; } .burger-nav--future { color: #002856; } .burger-nav--culture { color: #472479; } .burger-nav--earth { color: #0fbb56; } .burger-nav--travel { color: #589e50; } .burger-nav--medium { font-size: 16px; } .burger-nav--small { font-size: 12px; } /* stylelint-disable property-no-unknown */ .nav-menu { background-color: #0052a1; display: block; height: 100%; left: 0; min-height: 100vh; opacity: 0.98; overflow: auto; position: fixed; top: 0; width: 100vw; } .nav-menu--worklife { background-color: #0052a1; } .nav-menu--future { background-color: #002856; } .nav-menu--culture { background-color: #472479; } .nav-menu--earth { background-color: #0fbb56; } .nav-menu--travel { background-color: #589e50; } .nav-menu__close-nav { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-pack: justify; justify-content: space-between; margin: auto; max-width: 1280px; padding: 16px 8px 60px; } .nav-menu__close-nav--desktop { padding: 20px 16px 70px; } .nav-menu__sponsored { background-color: rgba(34, 34, 34, 0.5); height: 100%; margin-bottom: 32px; } .nav-menu__sponsored--desktop { margin-bottom: 44px; } .nav-menu__sponsored-container { padding: 20px 16px 16px 24px; } .nav-menu__sponsored--desktop-container { margin: auto; max-width: 1264px; padding: 20px 16px 20px 100px; } .nav-menu__follow-us { padding: 52px 0 34px; } /* stylelint-disable property-no-unknown */ .ad-slot { display: inline-block; } .ad-slot__container { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; } .ad-slot__label { max-width: 120px; min-width: 112px; padding-right: 8px; text-align: right; } .ad-slot--leaderboard { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; -ms-flex-pack: center; justify-content: center; } .ad-slot__label--mpu, .ad-slot__label--leaderboard { margin-bottom: 8px; max-width: unset; padding-right: unset; text-align: right; } .ad-slot__container--mpu, .ad-slot__container--leaderboard { display: inline-block; -ms-flex-wrap: unset; flex-wrap: unset; } .ad-slot__fake--sponsor { background-color: #5ae9cb; height: 31px; min-width: 88px; } .ad-slot__fake--mpu { background-color: #5ae9cb; height: 250px; min-width: 300px; } .ad-slot__fake--mpu-large { background-color: #5ae9cb; height: 600px; min-width: 300px; } .ad-slot__fake--leaderboard-large { background-color: #5ae9cb; height: 90px; min-width: 728px; } .ad-slot__fake--leaderboard-medium { background-color: #5ae9cb; height: 50px; min-width: 320px; } .ad-slot__fake--leaderboard-small { background-color: #5ae9cb; height: 50px; min-width: 300px; } .ad-slot__label--dark { color: #dcdcdc; } .ad-slot--dark { background-color: #f6f6f6; padding: 8px; } .ad-slot--black { background-color: rgba(26, 26, 26, 0.8); padding: 8px; } .open-nav { -ms-flex-align: center; align-items: center; background-color: unset; border: unset; cursor: pointer; display: -ms-flexbox; display: flex; -ms-flex-pack: end; justify-content: flex-end; padding: 0; position: relative; -webkit-transition: 0.4s; transition: 0.4s; } .open-nav__icon { display: -ms-flexbox; display: flex; } .open-nav__label { display: inline-block; margin-right: 12px; } .play-icon { background: transparent; border: 0; color: #fff; font-size: 12px; outline: none; padding: 0; } .play-icon--red { color: #f00; } .play-icon--grey { color: #999; } .play-icon--medium { font-size: 16px; } .play-icon--large { font-size: 20px; } .camera-icon { background: transparent; border: 0; color: #fff; font-size: 12px; outline: none; padding: 0; } .camera-icon--red { color: #f00; } .camera-icon--grey { color: #999; } .camera-icon--medium { font-size: 16px; } .camera-icon--large { font-size: 20px; } /* stylelint-disable property-no-unknown */ .nav-build-bar { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; height: auto; margin: auto; max-width: 1280px; width: 100%; } .nav-build-bar--mobile { height: auto; -ms-flex-pack: justify; justify-content: space-between; } .nav-build-bar--mobile .nav-build-bar__title-content { white-space: pre-wrap; } .nav-build-bar--tablet { height: 58px; } .nav-build-bar--desktop { height: 60px; } .nav-build-bar__links { display: -ms-flexbox; display: flex; -ms-flex-wrap: wrap; flex-wrap: wrap; height: 100%; -ms-flex-pack: end; justify-content: flex-end; margin-left: auto; overflow: hidden; } .nav-build-bar__sponsored-brand { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; margin-left: 8px; text-decoration: none; white-space: nowrap; } .nav-build-bar__sponsored-brand--no-brand { margin-left: 0; } .nav-build-bar__branding { display: -ms-flexbox; display: flex; padding: 0 8px 0 0; } .nav-build-bar__branding--tablet { padding: 0 30px 0 0; } .nav-build-bar__branding--desktop { padding: 0 80px 0 0; } .nav-build-bar__title-content { border: 1.78px solid; color: #444; font-size: 22px; font-weight: bold; margin: unset; padding: 8px; width: -webkit-fit-content; width: -moz-fit-content; width: fit-content; } .nav-build-bar__title-content--tablet { font-size: 24px; white-space: nowrap; } .nav-build-bar__title-content--desktop { font-size: 28px; } .nav-build-bar__open-nav { display: -ms-flexbox; display: flex; height: 48px; } .nav-build-bar__open-nav-button { display: -ms-flexbox; display: flex; padding-left: 8px; } .nav-build-bar__sponsored { background-color: #f6f6f6; border: 1px solid #d3d3d3; height: 48px; padding: 0 16px; } .nav-build-bar__open-nav--desktop { padding-right: 16px; } .nav-build-bar__open-nav--mobile { -ms-flex-pack: end; justify-content: flex-end; max-width: 100px; width: 100%; } .info-icon { background: transparent; border: 0; color: #fff; font-size: 12px; outline: none; padding: 0; } .info-icon--red { color: #f00; } .info-icon--grey { color: #999; } .info-icon--medium { font-size: 16px; } .info-icon--large { font-size: 20px; } /* stylelint-disable property-no-unknown */ .styled-dot { background-color: #5ae9cb; border-radius: 50%; -webkit-box-shadow: 0 1px 2px 0 rgba(25, 62, 109, 0.5); box-shadow: 0 1px 2px 0 rgba(25, 62, 109, 0.5); cursor: pointer; display: inline-block; height: 6px; width: 6px; } .styled-dot--no-cursor { cursor: unset; } .styled-dot--medium { -webkit-box-shadow: unset; box-shadow: unset; height: 10px; width: 10px; } .styled-dot--dark-blue { background-color: #193e6d; } .styled-dot--purple { background-color: #362e67; -webkit-box-shadow: unset; box-shadow: unset; } .styled-dot--black { background-color: #000; -webkit-box-shadow: unset; box-shadow: unset; } .styled-dot--grey-green { background-color: #008e9b; -webkit-box-shadow: unset; box-shadow: unset; } .styled-dot--dark-green { background-color: #589e50; -webkit-box-shadow: unset; box-shadow: unset; } .styled-dot--worklife { background-color: #8beed9; } .styled-dot--future { background-color: #ffc857; } .styled-dot--culture { background-color: #472479; } .styled-dot--earth { background-color: #002856; } .styled-dot--travel { background-color: #002856; } .styled-dot--worklife-prime { background-color: #0052a1; } .styled-dot--future-prime { background-color: #002856; } .styled-dot--culture-prime { background-color: #472479; } .styled-dot--earth-prime { background-color: #0fbb56; } .styled-dot--travel-prime { background-color: #589e50; } .styled-dot--large { -webkit-box-shadow: 0 1px 1px 0 rgba(25, 62, 109, 0.5); box-shadow: 0 1px 1px 0 rgba(25, 62, 109, 0.5); height: 16px; width: 16px; } .styled-dot--small { -webkit-box-shadow: unset; box-shadow: unset; height: 8px; width: 8px; } .styled-dot--grey { background-color: rgba(0, 0, 0, 0.2); } /* stylelint-disable property-no-unknown */ .email-icon { -ms-flex-align: center; align-items: center; background-color: #193e6d; border-radius: 50%; color: #fff; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 11px; height: 50px; -ms-flex-pack: center; justify-content: center; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; z-index: 55; } .email-icon:hover { background-color: #000; } .email-icon--red:hover { background-color: #f00; } /* stylelint-disable property-no-unknown */ .facebook-icon { -ms-flex-align: center; align-items: center; background-color: #193e6d; border-radius: 50%; color: #fff; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 15px; height: 50px; -ms-flex-pack: center; justify-content: center; text-decoration: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; z-index: 55; } .facebook-icon:hover { background-color: #3b5998; } .facebook-icon--blue { background-color: transparent; border: 1px solid #3b5998; color: #3b5998; } .facebook-icon--blue:hover { background-color: #3b5998; color: #fff; } .facebook-icon--white { background-color: transparent; border: 1px solid #fff; color: #fff; } .facebook-icon--white:hover { background-color: #fff; color: #3b5998; } .facebook-icon--small { font-size: 20px; height: 38px; width: 38px; } /* stylelint-disable property-no-unknown */ .hero-header { -ms-flex-align: center; align-items: center; display: -ms-flexbox; display: flex; } .hero-header__header { font-family: 'CuriousSansBold'; color: #fff; font-size: 38px; line-height: 40px; margin: 0; text-shadow: 0 1px 2px rgba(25, 62, 109, 0.7); } .hero-header__header--large { font-size: 44px; line-height: 48px; } .hero-header__header--medium { font-size: 38px; line-height: 47px; } .hero-header__header--small { font-size: 28px; line-height: 34px; } .hero-header__header--black { color: #000; text-shadow: unset; } .hero-header__header--grey { color: #adadad; text-shadow: unset; } .ticked-icon { -ms-flex-align: center; align-items: center; background-color: #13de99; border-radius: 50%; -webkit-box-shadow: 0 2px 4px 0 rgba(0, 0, 0, 0.2); box-shadow: 0 2px 4px 0 rgba(0, 0, 0, 0.2); display: -ms-flexbox; display: flex; height: 50px; -ms-flex-pack: center; justify-content: center; width: 50px; z-index: 55; } .ticked-icon--small { font-size: 12px; height: 38px; width: 38px; } /* stylelint-disable property-no-unknown */ .google-plus-icon { -ms-flex-align: center; align-items: center; background-color: #193e6d; border-radius: 50%; color: #fff; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 26px; height: 50px; -ms-flex-pack: center; justify-content: center; text-decoration: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; z-index: 55; } .google-plus-icon:hover { background-color: #d34836; } .google-plus-icon--red:hover { background-color: #f00; } /* stylelint-disable property-no-unknown */ .reddit-icon { -ms-flex-align: center; align-items: center; background-color: #193e6d; border-radius: 50%; color: #fff; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 26px; height: 50px; -ms-flex-pack: center; justify-content: center; text-decoration: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; z-index: 55; } .reddit-icon:hover { background-color: #ff4500; } .reddit-icon__hide { display: none; } .reddit-icon--red:hover { background-color: #f00; } /* stylelint-disable property-no-unknown */ .linkedin-icon { -ms-flex-align: center; align-items: center; background-color: #193e6d; border-radius: 50%; color: #fff; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 13px; height: 50px; -ms-flex-pack: center; justify-content: center; text-decoration: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; z-index: 55; } .linkedin-icon:hover { background-color: #0077b5; } .linkedin-icon--red:hover { background-color: #f00; } .share-button { -ms-flex-align: center; align-items: center; background-color: #fff; border: 1px solid #e4e4e4; color: #444; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 12px; font-weight: bold; -ms-flex-pack: center; justify-content: center; letter-spacing: 3px; padding: 18px 16px; text-transform: uppercase; -webkit-transition: 0.6s; transition: 0.6s; width: 110px; z-index: 55; } .share-button .gelicon--share { margin-right: 10px; -webkit-transition: 0.3s ease-in; transition: 0.3s ease-in; } .share-button:hover .gelicon--share, .share-button .gelicon--share-sharing { -webkit-transform: rotate(-180deg); transform: rotate(-180deg); } /* stylelint-disable property-no-unknown */ .whatsapp-icon { -ms-flex-align: center; align-items: center; background-color: #193e6d; border-radius: 50%; color: #fff; cursor: pointer; display: -ms-flexbox; display: flex; font-size: 13px; height: 50px; -ms-flex-pack: center; justify-content: center; text-decoration: none; -webkit-transition-duration: 0.6s; transition-duration: 0.6s; width: 50px; z-index: 55; } .whatsapp-icon:hover { background-color: #25d366; } .whatsapp-icon--red:hover { background-color: #f00; } /* stylelint-disable property-no-unknown */ .twitter-icon { -ms-flex-align: center; align-items: center; background-color: #193e6d; border-radius: 50%; 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b-reith-sans-font latest-articles__editor--tablet">Immune Response</p><div class="latest-articles__articles latest-articles__articles--tablet latest-articles__articles--tablet-rectangle latest-articles__articles--mobile-rectangle"><div class="rectangle-story-group"><div class="rectangle-story-group__articles-container"><div><div data-bbc-container="latest-stories" data-bbc-title="The dash for new Covid-19 vaccines" data-bbc-metadata="{"APP":"latest-stories","CHD":"card::1"}" data-bbc-result="https://www.bbc.com/future/article/20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like" data-bbc-client-routed="true" class="rectangle-story-group__article-hero rectangle-story-group__article-hero--tablet"><div class="article-title-card-rectangle b-reith-sans-font"><div class="article-title-card-rectangle__container"><div class="article-title-card-rectangle__image"><a class="article-title-card-rectangle__link" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p0b7mgdg.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p0b7mgdg.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p0b7mgdg.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p0b7mgdg.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b7mgdg.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b7mgdg.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p0b7mgdg.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p0b7mgdg.jpg" type="image/jpeg"/><img draggable="false" title="A lab technician working on a vaccine at Sinovac Biotech in China (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b7mgdg.jpg" alt="A lab technician working on a vaccine at Sinovac Biotech in China (Credit: Getty Images)" id=""/></picture><span class="article-title-card-rectangle__overlay article-title-card-rectangle__overlay--future"></span></a></div><div class="article-title-card-rectangle__text-box"><a class="article-title-card-rectangle__link article-title-card-rectangle__text-container" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span class="article-title-card-rectangle__text-box__label article-title-card-rectangle__text-box__label--future">Immune Response</span></a><a class="article-title-card-rectangle__link article-title-card-rectangle__text-container" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like"><h2 class="article-title-card-rectangle__text-box__header b-font-weight-300 b-reith-sans-font b-font-weight-300">The dash for new Covid-19 vaccines</h2></a><span class="rectangle-story-item__line"><div class="styled-line styled-line--light-grey styled-line--height--small"></div></span><p class="article-title-card-rectangle__text-box__author b-font-family-serif b-reith-sans-font">By David Cox</p></div></div></div></div></div><div class="rectangle-story-group__articles rectangle-story-group__articles--full-screen"><div class="rectangle-story-group__article rectangle-story-group__article--tablet rectangle-story-group__article--full-screen"><div data-bbc-container="latest-stories" data-bbc-title="The virus that causes 'immune amnesia'" data-bbc-metadata="{"APP":"latest-stories","CHD":"card::2"}" data-bbc-result="https://www.bbc.com/future/article/20211112-the-people-with-immune-amnesia" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20211112-the-people-with-immune-amnesia"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p0b4cfm9.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p0b4cfm9.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p0b4cfm9.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p0b4cfm9.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b4cfm9.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b4cfm9.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p0b4cfm9.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p0b4cfm9.jpg" type="image/jpeg"/><img draggable="false" title="From left-right, drawings of measles, scarlet fever, and smallpox (Credit: Alamy)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b4cfm9.jpg" alt="From left-right, drawings of measles, scarlet fever, and smallpox (Credit: Alamy)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20211112-the-people-with-immune-amnesia"><span>The virus that causes 'immune amnesia'</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div><div class="rectangle-story-group__article rectangle-story-group__article--tablet rectangle-story-group__article--full-screen"><div data-bbc-container="latest-stories" data-bbc-title="The long history of vaccine mandates" data-bbc-metadata="{"APP":"latest-stories","CHD":"card::3"}" data-bbc-result="https://www.bbc.com/future/article/20211029-why-mandatory-vaccination-is-nothing-new" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20211029-why-mandatory-vaccination-is-nothing-new"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p0b1563y.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p0b1563y.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p0b1563y.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p0b1563y.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b1563y.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b1563y.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p0b1563y.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p0b1563y.jpg" type="image/jpeg"/><img draggable="false" title="Compulsory vaccination in Jersey City, New Jersey (Credit: Alamy)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p0b1563y.jpg" alt="Compulsory vaccination in Jersey City, New Jersey (Credit: Alamy)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20211029-why-mandatory-vaccination-is-nothing-new"><span>The long history of vaccine mandates</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Christine Ro</span></div></div></div><div class="rectangle-story-group__article rectangle-story-group__article--tablet rectangle-story-group__article--full-screen"><div data-bbc-container="latest-stories" data-bbc-title="Do we really need third vaccine doses?" data-bbc-metadata="{"APP":"latest-stories","CHD":"card::4"}" data-bbc-result="https://www.bbc.com/future/article/20210916-covid-19-how-effective-is-a-third-vaccine-dose" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210916-covid-19-how-effective-is-a-third-vaccine-dose"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p09w6d9z.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p09w6d9z.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p09w6d9z.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p09w6d9z.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09w6d9z.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09w6d9z.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p09w6d9z.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p09w6d9z.jpg" type="image/jpeg"/><img draggable="false" title="An Israeli health worker preparing to administer a booster shot (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09w6d9z.jpg" alt="An Israeli health worker preparing to administer a booster shot (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210916-covid-19-how-effective-is-a-third-vaccine-dose"><span>Do we really need third vaccine doses?</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div></div></div></div></div></div></div><div class="index__more-articles"></div><div class="index__stories-container"><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="Why some people don't want a vaccine" data-bbc-metadata="{"APP":"index-stories","CHD":"card::1"}" data-bbc-result="https://www.bbc.com/future/article/20210720-the-complexities-of-vaccine-hesitancy" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210720-the-complexities-of-vaccine-hesitancy"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p09pxj9r.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p09pxj9r.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p09pxj9r.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p09pxj9r.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09pxj9r.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09pxj9r.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p09pxj9r.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p09pxj9r.jpg" type="image/jpeg"/><img draggable="false" title="Queue of people and vaccine (Credit: Andriy Onufriyenko/Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09pxj9r.jpg" alt="Queue of people and vaccine (Credit: Andriy Onufriyenko/Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210720-the-complexities-of-vaccine-hesitancy"><span>Why some people don't want a vaccine</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By David Robson</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="The people with high Covid resistance" data-bbc-metadata="{"APP":"index-stories","CHD":"card::2"}" data-bbc-result="https://www.bbc.com/future/article/20210219-the-covid-resistant-patients-e-the-viruss-weak-spots" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210219-the-covid-resistant-patients-e-the-viruss-weak-spots"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p097j6yz.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p097j6yz.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p097j6yz.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p097j6yz.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p097j6yz.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p097j6yz.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p097j6yz.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p097j6yz.jpg" type="image/jpeg"/><img draggable="false" title="Studying people who show unusual levels of resistance or susceptiblity to Covid-19 may lead to new treatments (Credit: Ernesto Benavides/Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p097j6yz.jpg" alt="Studying people who show unusual levels of resistance or susceptiblity to Covid-19 may lead to new treatments (Credit: Ernesto Benavides/Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210219-the-covid-resistant-patients-e-the-viruss-weak-spots"><span>The people with high Covid resistance</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By David Cox</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="Can vaccinated people spread Covid-19?" data-bbc-metadata="{"APP":"index-stories","CHD":"card::3"}" data-bbc-result="https://www.bbc.com/future/article/20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p095xcsb.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p095xcsb.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p095xcsb.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p095xcsb.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p095xcsb.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p095xcsb.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p095xcsb.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p095xcsb.jpg" type="image/jpeg"/><img draggable="false" title="Voters in a socially distanced queue in Caracas (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p095xcsb.jpg" alt="Voters in a socially distanced queue in Caracas (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19"><span>Can vaccinated people spread Covid-19?</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="How effective is a single vaccine dose?" data-bbc-metadata="{"APP":"index-stories","CHD":"card::4"}" data-bbc-result="https://www.bbc.com/future/article/20210114-covid-19-how-effective-is-a-single-vaccine-dose" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210114-covid-19-how-effective-is-a-single-vaccine-dose"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p09413dd.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p09413dd.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p09413dd.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p09413dd.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09413dd.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09413dd.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p09413dd.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p09413dd.jpg" type="image/jpeg"/><img draggable="false" title="A scientist holding up a vial of Covid-19 vaccine (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p09413dd.jpg" alt="A scientist holding up a vial of Covid-19 vaccine (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/best-of-bbc-future"><span>Best of BBC Future</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20210114-covid-19-how-effective-is-a-single-vaccine-dose"><span>How effective is a single vaccine dose?</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="Here’s why vaccination beats infection" data-bbc-metadata="{"APP":"index-stories","CHD":"card::5"}" data-bbc-result="https://www.bbc.com/future/article/20201120-why-you-really-dont-want-to-catch-covid-19" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201120-why-you-really-dont-want-to-catch-covid-19"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08z2drw.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08z2drw.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08z2drw.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08z2drw.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08z2drw.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08z2drw.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08z2drw.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08z2drw.jpg" type="image/jpeg"/><img draggable="false" title="Man and child with anti-Covid helmets (Credit: Anadolu Agency/Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08z2drw.jpg" alt="Man and child with anti-Covid helmets (Credit: Anadolu Agency/Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201120-why-you-really-dont-want-to-catch-covid-19"><span>Here’s why vaccination beats infection</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="The cells that saved 10 million lives" data-bbc-metadata="{"APP":"index-stories","CHD":"card::6"}" data-bbc-result="https://www.bbc.com/future/article/20201103-the-controversial-cells-that-saved-10-million-lives" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201103-the-controversial-cells-that-saved-10-million-lives"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08x8pv9.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08x8pv9.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08x8pv9.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08x8pv9.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08x8pv9.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08x8pv9.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08x8pv9.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08x8pv9.jpg" type="image/jpeg"/><img draggable="false" title="The cells from WI-38 were never restricted, which means they could be shared freely with scientists around the world (Credit: Andrew Brookes/Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08x8pv9.jpg" alt="The cells from WI-38 were never restricted, which means they could be shared freely with scientists around the world (Credit: Andrew Brookes/Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201103-the-controversial-cells-that-saved-10-million-lives"><span>The cells that saved 10 million lives</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="The surprising ingredients in vaccines" data-bbc-metadata="{"APP":"index-stories","CHD":"card::7"}" data-bbc-result="https://www.bbc.com/future/article/20201027-what-is-added-to-vaccines" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201027-what-is-added-to-vaccines"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08wkcpx.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08wkcpx.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08wkcpx.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08wkcpx.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08wkcpx.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08wkcpx.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08wkcpx.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08wkcpx.jpg" type="image/jpeg"/><img draggable="false" title="Aqualene, an oil made from shark livers, is is a key ingredient in one leading squalene (Credit: Wildstanimal/Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08wkcpx.jpg" alt="Aqualene, an oil made from shark livers, is is a key ingredient in one leading squalene (Credit: Wildstanimal/Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201027-what-is-added-to-vaccines"><span>The surprising ingredients in vaccines</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="Why the elderly are harder to vaccinate" data-bbc-metadata="{"APP":"index-stories","CHD":"card::8"}" data-bbc-result="https://www.bbc.com/future/article/20201013-why-older-people-are-harder-to-vaccinate" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201013-why-older-people-are-harder-to-vaccinate"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08v4q9b.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08v4q9b.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08v4q9b.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08v4q9b.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08v4q9b.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08v4q9b.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08v4q9b.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08v4q9b.jpg" type="image/jpeg"/><img draggable="false" title="Older man in mask (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08v4q9b.jpg" alt="Older man in mask (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201013-why-older-people-are-harder-to-vaccinate"><span>Why the elderly are harder to vaccinate</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By William Park</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="How Covid-19 is changing the flu" data-bbc-metadata="{"APP":"index-stories","CHD":"card::9"}" data-bbc-result="https://www.bbc.com/future/article/20201009-could-social-distancing-make-the-flu-extinct" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201009-could-social-distancing-make-the-flu-extinct"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08trc3c.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08trc3c.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08trc3c.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08trc3c.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08trc3c.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08trc3c.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08trc3c.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08trc3c.jpg" type="image/jpeg"/><img draggable="false" title="Person stopping flu virus (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08trc3c.jpg" alt="Person stopping flu virus (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201009-could-social-distancing-make-the-flu-extinct"><span>How Covid-19 is changing the flu</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Zaria Gorvett</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="Why a vaccine is so hard to make" data-bbc-metadata="{"APP":"index-stories","CHD":"card::10"}" data-bbc-result="https://www.bbc.com/future/article/20201005-the-quest-to-make-a-global-vaccine-in-12-months" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201005-the-quest-to-make-a-global-vaccine-in-12-months"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08tdsqr.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08tdsqr.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08tdsqr.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08tdsqr.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08tdsqr.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08tdsqr.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08tdsqr.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08tdsqr.jpg" type="image/jpeg"/><img draggable="false" title="Vaccines need to be kept in a special variety of glass, and often need to be kept in ultra-cold refrigeration (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08tdsqr.jpg" alt="Vaccines need to be kept in a special variety of glass, and often need to be kept in ultra-cold refrigeration (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20201005-the-quest-to-make-a-global-vaccine-in-12-months"><span>Why a vaccine is so hard to make</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Peter Ray Allison</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="How the first vaccine was born" data-bbc-metadata="{"APP":"index-stories","CHD":"card::11"}" data-bbc-result="https://www.bbc.com/future/article/20200928-how-the-first-vaccine-was-born" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20200928-how-the-first-vaccine-was-born"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08ss7d5.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08ss7d5.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08ss7d5.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08ss7d5.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08ss7d5.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08ss7d5.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08ss7d5.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08ss7d5.jpg" type="image/jpeg"/><img draggable="false" title="Gillray cartoon on cowpox vaccine (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08ss7d5.jpg" alt="Gillray cartoon on cowpox vaccine (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20200928-how-the-first-vaccine-was-born"><span>How the first vaccine was born</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Richard Hollingham</span></div></div></div><div class="index-stories__story-item"><div data-bbc-container="index-stories" data-bbc-title="The warp-speed vaccine plan that failed" data-bbc-metadata="{"APP":"index-stories","CHD":"card::12"}" data-bbc-result="https://www.bbc.com/future/article/20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976" data-bbc-client-routed="true" class="rectangle-story-item b-reith-sans-font rectangle-story-item--tablet"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976"><div class="rectangle-story-item__image-container rectangle-story-item__image-container--future"><div class="rectangle-image rectangle-image--medium" style="background-image:url(https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/960x540/p077yzlp.jpg)"><picture><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08rw02w.webp" type="image/webp"/><source media="(min-width:1200px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1600x900/p08rw02w.jpg" type="image/jpeg"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08rw02w.webp" type="image/webp"/><source media="(min-width:880px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/1280x720/p08rw02w.jpg" type="image/jpeg"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08rw02w.webp" type="image/webp"/><source media="(min-width:576px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08rw02w.jpg" type="image/jpeg"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08rw02w.webp" type="image/webp"/><source media="(min-width:224px)" srcset="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/624x351/p08rw02w.jpg" type="image/jpeg"/><img draggable="false" title="The political handling of the swine flu fiasco had elements of farce (Credit: Getty Images)" src="https://web.archive.org/web/20220116003725im_/https://ychef.files.bbci.co.uk/976x549/p08rw02w.jpg" alt="The political handling of the swine flu fiasco had elements of farce (Credit: Getty Images)" id=""/></picture><span class="rectangle-image__overlay rectangle-image__overlay--future"></span></div></div></a><a class="rectangle-story-item__label b-reith-sans-font rectangle-story-item__label--tablet rectangle-story-item__label--future" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/columns/immune-response"><span>Immune Response</span></a><div class="rectangle-story-item__container"><a class="rectangle-story-item__title" target="" rel="" id="" href="/web/20220116003725/https://www.bbc.com/future/article/20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976"><span>The warp-speed vaccine plan that failed</span></a></div><div><span class="rectangle-story-item__line"><div class="styled-line styled-line--dark-grey styled-line--height--small"></div></span><span class="rectangle-story-item__author b-font-family-serif">By Richard Fisher</span></div></div></div></div></div><div class="index__load-more"><div data-bbc-container="load-more-btn" data-bbc-title="Latest Stories" data-bbc-metadata="{"APP":"load-more-btn","CHD":"card::1"}" data-bbc-result="" data-bbc-client-routed="true" class="load-more-button"><button class="basic-button basic-button--future"><span class="load-more-button__refresh gelicon--refresh"></span><span class="basic-button__text">Load more articles</span></button></div></div><div class="around-the-bbc-swimlane"><div class="swimlane"><div class="swimlane-inner swimlane-inner--small"><div class="swimlane__content"><span class="swimlane__title b-reith-sans-font">Around the BBC</span><div class="swimlane__items"></div></div></div><div class="swimlane__background-image swimlane__background-image--atb" style="background-image:linear-gradient(180deg, rgba(0,0,0,0.50) 0%, rgba(0,0,0,0.50) 100%), 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Images)","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08ss7d5.jpg","title":"cowpox_getty_1920.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08ss7d5","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08ss7d5.jpg","cacheLastUpdated":1642293446395},"p08rvzd0":{"urn":"urn:external:nitro:image:p08rvzd0","_id":"6183c0da45ceed161c60aba6","copyright":"Pascal Imperato","fileSizeBytes":140675,"mimeType":"image\u002Fjpeg","sourceHeight":1280,"sourceUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fs3-eu-west-1.amazonaws.com\u002Flive-galileo-interface-mt-resources-imagebucket-1a92e5tj3b5d6\u002Fp0\u002F8r\u002Fvz\u002Fp08rvzd0.jpg","sourceWidth":1024,"synopsisLong":"","synopsisMedium":"Pascal Imperato in the 1970s, who led New York City's swine flu vaccination drive (Credit: Pascal Imperato)","synopsisShort":"Pascal Imperato in the 1970s","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzd0.jpg","title":"imperato_cropped.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08rvzd0","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzd0.jpg","cacheLastUpdated":1642293446395},"p08rvzq9":{"urn":"urn:external:nitro:image:p08rvzq9","_id":"6183c0db45ceed2c197e23b2","copyright":"Getty 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A soldier there is given a standard vaccination a few years later (Credit: Getty Images)","synopsisShort":"Army soldier is vaccinated at Fort Dix","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzq9.jpg","title":"GettyImages-526761054.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08rvzq9","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzq9.jpg","cacheLastUpdated":1642293446395},"p08rvzv0":{"urn":"urn:external:nitro:image:p08rvzv0","_id":"6183c0c345ceed1974506915","copyright":"Getty 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Images)","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzv0.jpg","title":"GettyImages-509396600.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08rvzv0","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzv0.jpg","cacheLastUpdated":1642293446396},"p08rvzt3":{"urn":"urn:external:nitro:image:p08rvzt3","_id":"6183c0dd45ceed33900e1812","copyright":"Getty Images","fileSizeBytes":793948,"mimeType":"image\u002Fjpeg","sourceHeight":2071,"sourceUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fs3-eu-west-1.amazonaws.com\u002Flive-galileo-interface-mt-resources-imagebucket-1a92e5tj3b5d6\u002Fp0\u002F8r\u002Fvz\u002Fp08rvzt3.jpg","sourceWidth":3681,"synopsisLong":"","synopsisMedium":"President Gerald Ford invited the cameras for his own swine flu vaccination (Credit: Getty Images)","synopsisShort":"President Gerald Ford vaccinated","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzt3.jpg","title":"GettyImages-515575466.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08rvzt3","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzt3.jpg","cacheLastUpdated":1642293446396},"p08rvzwy":{"urn":"urn:external:nitro:image:p08rvzwy","_id":"6183c0e345ceed31691aa428","copyright":"Getty Images","fileSizeBytes":425252,"mimeType":"image\u002Fjpeg","sourceHeight":2563,"sourceUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fs3-eu-west-1.amazonaws.com\u002Flive-galileo-interface-mt-resources-imagebucket-1a92e5tj3b5d6\u002Fp0\u002F8r\u002Fvz\u002Fp08rvzwy.jpg","sourceWidth":2050,"synopsisLong":"","synopsisMedium":"Vaccination drives began all over the country, but fears were soon raised in the media (Credit: Getty Images)","synopsisShort":"Women at vaccination station (Credit: Getty Images)","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzwy.jpg","title":"GettyImages-161906406.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08rvzwy","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzwy.jpg","cacheLastUpdated":1642293446396},"p08rvzzq":{"urn":"urn:external:nitro:image:p08rvzzq","_id":"6183c0d745ceed2bfa156f48","copyright":"Getty Images","fileSizeBytes":903771,"mimeType":"image\u002Fjpeg","sourceHeight":1948,"sourceUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fs3-eu-west-1.amazonaws.com\u002Flive-galileo-interface-mt-resources-imagebucket-1a92e5tj3b5d6\u002Fp0\u002F8r\u002Fvz\u002Fp08rvzzq.jpg","sourceWidth":3462,"synopsisLong":"","synopsisMedium":"The media played a huge role in public perceptions of vaccines in 1976, and history is repeating itself (Credit: Getty Images)","synopsisShort":"A row of multiple cameras pointing to the left in 1976","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzzq.jpg","title":"GettyImages-98676037.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08rvzzq","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rvzzq.jpg","cacheLastUpdated":1642293446396},"p08rw02w":{"urn":"urn:external:nitro:image:p08rw02w","_id":"6183c0bf45ceed21c2133240","copyright":"Getty Images","fileSizeBytes":949029,"mimeType":"image\u002Fjpeg","sourceHeight":2064,"sourceUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fs3-eu-west-1.amazonaws.com\u002Flive-galileo-interface-mt-resources-imagebucket-1a92e5tj3b5d6\u002Fp0\u002F8r\u002Fw0\u002Fp08rw02w.jpg","sourceWidth":3668,"synopsisLong":"","synopsisMedium":"The political handling of the swine flu fiasco had elements of farce (Credit: Getty Images)","synopsisShort":"Old man closes eyes as vaccinated in 1976","templateUrl":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rw02w.jpg","title":"GettyImages-515404104.jpg","creationDateTime":"0001-01-01T00:00:00Z","entity":"image","guid":"","id":"p08rw02w","modifiedDateTime":"0001-01-01T00:00:00Z","project":"","slug":"","url":"https:\u002F\u002Fweb.archive.org\u002Fweb\u002F20220116003725\u002Fhttps:\u002F\u002Fychef.files.bbci.co.uk\u002F$recipe\u002Fp08rw02w.jpg","cacheLastUpdated":1642293446396}},"articles":{"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like","_id":"61a9604745ceed3b557e4ef1","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fdavid-cox"],"bodyIntro":"The first generation of Covid-19 vaccines was developed in record time. But now scientists have grander plans – for more potent immunity, easier transport, and mutation-proofing.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAs the news filtered through that the Covid-19 vaccine being developed by Pfizer and BioNTech was on the verge of being rolled out around the globe, Todd Zion could not help but feel slightly deflated.\u003C\u002Fp\u003E\n\u003Cp\u003EIt was November 2020, and for the first time, the news cycle was bringing tidings of hope in the fight against Covid-19. Not only Pfizer-BioNTech, but Moderna and then Oxford-AstraZeneca all reported Phase III clinical trial results for their vaccines with efficacies that \u003Ca href=\"https:\u002F\u002Fwww.statnews.com\u002F2020\u002F11\u002F09\u002Fcovid-19-vaccine-from-pfizer-and-biontech-is-strongly-effective-early-data-from-large-trial-indicate\u002F\"\u003Ewent beyond the expectations of\u003C\u002Fa\u003E the most optimistic of scientists. What followed was an onrush of political deal-making and vaccine diplomacy, as the world's leaders scrambled to be the first to get their hands on the new shots. \u003C\u002Fp\u003E\n\u003Cp\u003EWhile Zion, an entrepreneur and chief executive of a small start-up called Akston Biosciences, was personally relieved that the tide was turning against the global pandemic, he faced the unenviable task of trying to convince his employees that their hard graft had not been in vain.\u003C\u002Fp\u003E\n\u003Cp\u003ENine months earlier, Akston Biosciences had joined the global vaccine race as one of more than 40 teams vying to develop the world's first Covid-19 jab. Now, like dozens of others, they had been comprehensively beaten to the punch by the sheer speed and efficiency of their rivals' technologies, which had completed clinical trials while their own products were still in development.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200915-the-mystery-of-why-some-vaccines-are-doubly-beneficial\" target=\"_blank\"\u003EThe mystery of why some vaccines are doubly beneficial\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new\" target=\"_blank\"\u003EWhy mandatory vaccination is nothing new\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20211112-the-people-with-immune-amnesia\" target=\"_blank\"\u003EThe race to understand 'immune amnesia'\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EBut Zion still felt that the race was far from finished. \"Those vaccines helped tremendously, but if you're an innovator, you know that the products which come first tend to have lots of issues which aren't sustainable,\" he says. \"So for that reason I remained motivated. But it was a bit of a challenge as a small company to keep developing our vaccine while most of the world was thinking that the problem was solved.\"\u003C\u002Fp\u003E\n\u003Cp\u003ETwelve months later, Akston Biosciences is among a plethora of companies hoping to bring a second generation of Covid-19 vaccines to the clinic over the next year and a half. The challenges are plentiful – many vital vaccine raw materials are now in desperately short supply, while more than two years into the pandemic, they must convince regulators that there is still a need for new products.\u003C\u002Fp\u003E\n\u003Cp\u003EBut they come with a range of novel innovations. From French biotech company Valneva, whose vaccine \u003Ca href=\"https:\u002F\u002Fvalneva.com\u002Fpress-release\u002Fvalneva-reports-positive-phase-3-results-for-inactivated-adjuvanted-covid-19-vaccine-candidate-vla2001\u002F\"\u003Econtains an adjuvant\u003C\u002Fa\u003E – vaccine parlance for a chemical that can be added to the shot to boost the immune response – aimed at eliciting a better immune response from the elderly, to California-based Vaxart, who are developing a vaccine-in-a-pill which could tackle the issue of needlephobia, each second generation vaccine has its own specific target markets.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b7md2v"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIn addition, the emergence of new mutated versions of the Covid-19 virus over the past year, such as the Delta and now the Omicron variants, has created a potential requirement for different technologies which might be able to provide a more robust and widespread immune response.\u003C\u002Fp\u003E\n\u003Cp\u003E\"We have some data that your immune system's response to natural infection, but also to vaccination, wanes over time,\" says Andrew Ustianowski, clinical lead for the UK's National Institute for Health Research Covid Vaccine Research Programme. \"We can see the antibody responses, and to a degree, the T cell responses dropping over time. So, one of the hopes for second generation vaccines is that they can give us protection for a longer period than these first vaccines.\"\u003C\u002Fp\u003E\n\u003Cp\u003EThe stringent refrigeration requirements for many of the first generation vaccines have also posed significant problems in reaching many of the world's poorest communities. For example, at present \u003Ca href=\"https:\u002F\u002Fcoronavirus.jhu.edu\u002Fregion\u002Findia\"\u003Ejust 28%\u003C\u002Fa\u003E of India's population are fully vaccinated.\u003C\u002Fp\u003E\n\u003Cp\u003EAkston Biosciences have recently received approval to conduct a Phase II\u002FIII clinical trial – the second stage of human testing, to check an intervention's safety and efficacy – in India over the next year. It is hoped that the nature of its vaccine – which can be kept at room temperature for at least six months – could help reach regions with limited infrastructure needed to store and transport less stable vaccines. As such, while it may not become widely available until 2023, Zion is confident that it is still very relevant in the fight against Covid-19.\u003C\u002Fp\u003E\n\u003Cp\u003E\"We just signed a licensing and manufacturing development deal with an Indian company,\" he says. \"They have about 100 countries on their list that they're targeting, mostly in southeast Asia, the Middle East, and sub-Saharan Africa. We see primary vaccinations as still being an opportunity in some of the lesser served regions.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe Need\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EAt the start of 2020, Filip Dubovsky was working for AstraZeneca when he heard about another pharmaceutical company called Novavax, which was developing a particularly inventive way of creating a flu vaccine.\u003C\u002Fp\u003E\n\u003Cp\u003EThe company's scientists had discovered a \u003Ca href=\"https:\u002F\u002Fjournals.plos.org\u002Fplosone\u002Farticle?id=10.1371\u002Fjournal.pone.0041451\"\u003Epowerful adjuvant called Matrix-M\u003C\u002Fa\u003E, which comes from the inner bark of the Chilean soapbark tree, \u003Cem\u003EQuillaja saponaria\u003C\u002Fem\u003E. In a Phase III trial – usually the final stage of initial testing, involving large numbers of people – it not only yielded a stronger antibody response than existing influenza shots, but also provided cross-protection against multiple strains of flu.\u003C\u002Fp\u003E\n\u003Cp\u003EDubovsky was intrigued, so much so that by June 2020 he had joined Novavax as their chief medical officer, working on the company's Covid-19 vaccine. This recently became the first of the second generation jabs to hit the market, initially receiving emergency authorisation in \u003Ca href=\"https:\u002F\u002Fwww.nbcnews.com\u002Fnews\u002Fworld\u002Findonesia-first-country-authorize-novavax-covid-19-vaccine-n1282935\"\u003EIndonesia\u003C\u002Fa\u003E and the \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Fbusiness\u002Fhealthcare-pharmaceuticals\u002Fphilippines-approves-emergency-use-novavaxs-covid-19-vaccine-2021-11-17\u002F\"\u003EPhilippines\u003C\u002Fa\u003E. Dubovsky felt that the technology – \u003Ca href=\"https:\u002F\u002Fwww.pharmaceutical-technology.com\u002Ffeatures\u002Fnovavaxs-vaccine-covid19-results\u002F\"\u003Ewhich combines the adjuvant Matrix-M\u003C\u002Fa\u003E with a more traditional protein-based jab – was always going to take longer to develop than the messenger RNA (mRNA) and adenovirus methods, which comprised the first wave of Covid-19 vaccines. However, he says that being slightly later to the party may have given Novavax certain advantages.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-2"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b7mccb"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EWhile Novavax's clinical trials were underway, new variants of Covid-19 began to emerge, enabling them to prove that their vaccine was still effective against a range of different strains. So far, its data shows that their vaccine is \u003Ca href=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMoa2103055\"\u003E93% effective\u003C\u002Fa\u003E against the Alpha and Beta variants, although no efficacy has been published for the dominant Delta strain and it is still too early to say if it will be effective against Omicron.\u003C\u002Fp\u003E\n\u003Cp\u003EDubovsky says that, as with Novavax's flu vaccine, the use of the adjuvant means the vaccine stimulates the production of neutralising antibodies that are higher quality.\u003C\u002Fp\u003E\n\u003Cp\u003E\"It's not just how high your antibodies go, but how good they are,\" Dubovsky explains. \"We have data from early clinical studies showing that our vaccine was able to generate neutralising antibodies that are very high level. So these aren't just antibodies that can recognise the spike protein, but they can actually stop the virus from spreading.\"\u003C\u002Fp\u003E\n\u003Cp\u003EDubovsky hopes that their new adjuvant may help to prevent so-called \"breakthrough infections\", whereby fully vaccinated individuals can become infected.\u003C\u002Fp\u003E\n\u003Cp\u003EBreakthrough infections remain a major ongoing problem, particularly in the wake of the Delta variant, with \u003Ca href=\"https:\u002F\u002Fwww.hopkinsmedicine.org\u002Fhealth\u002Fconditions-and-diseases\u002Fcoronavirus\u002Fbreakthrough-infections-coronavirus-after-vaccination\"\u003Estudies estimating\u003C\u002Fa\u003E that breakthrough infection rates can range from 1 in 100 to 1 in 5,000, depending on the population. (Since the interview with Dubovsky, the heavily mutated Omicron variant has also emerged, which early signs suggest may also lead to a significantly higher rate of \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-021-03552-w\u002F\"\u003Ebreakthrough infections\u003C\u002Fa\u003E.)\u003C\u002Fp\u003E\n\u003Cp\u003EGenerating more, and better quality antibodies, is one of the main ways in which second generation vaccines are hoping to stand out, both as a potential booster option in the US and Europe, but also as a primary vaccine in many parts of the world. Brian Ward, medical officer at the Canadian biotech Medicago, told the BBC that they are preparing to release the data from their  Phase III clinical trial, and that they intend to apply for regulatory approval for their vaccine within weeks. Medicago claim that they can produce far higher antibody titers (a measure of antibody concentration) than current jabs.\u003C\u002Fp\u003E\n\u003Cp\u003E\"The mRNA vaccines [produce antibody titres that] are somewhere between two and a half to four times higher [than in someone who's recovering from Covid-19],\" says Ward. \"Novavax's and \u003Ca href=\"https:\u002F\u002Fmedicago.com\u002Fen\u002Fpress-release\u002F1751\u002F\"\u003Eour vaccine are 10\u003C\u002Fa\u003E to 15 times higher.\"\u003C\u002Fp\u003E\n\u003Cp\u003EVaccines which are further behind in development, such as Vaxart – who are currently enrolling for their Phase II trial – are hoping that offering new technologies or novel delivery mechanisms will still make them commercially viable. Vaxart's vaccine, which comes in tablet form, produces antibody responses in the nosewhich are thought to be better at preventing the virus from spreading. In addition, the company has \u003Ca href=\"https:\u002F\u002Finvestors.vaxart.com\u002Fstatic-files\u002Fcbf26eda-2ffa-4cb2-b031-0cb9b02fedac\"\u003Ecompiled survey data\u003C\u002Fa\u003E which found that 32% of Americans would be more likely to take a Covid-19 vaccine if it was offered as a pill.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b7md8q"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAccording to \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(21)02507-1\u002Ffulltext\"\u003Ethe Lancet\u003C\u002Fa\u003E, since January 2021, 20% of US adults have consistently reported that they will either get vaccinated only if required for work, or not get vaccinated at all. Vaxart's founder Sean Tucker believes that having an oral vaccine may help with this problem. \"When it comes down to it, a lot of people are afraid of needles,\" he says.\u003C\u002Fp\u003E\n\u003Cp\u003EAnother one key way in which these vaccines can compete with the first generation jabs is on price, undercutting the more expensive Pfizer\u002FBioNTech and Moderna vaccines. \"We're targeting $3-5 [£2.3-£3.8] a dose, and we think that's where everything happens going forward,\" says Zion. \"The amount of government subsidisation at \u003Ca href=\"https:\u002F\u002Fwww.bmj.com\u002Fcontent\u002F372\u002Fbmj.n281\"\u003Ethese $25-30 [£18.8-£22.5] per dose price ranges\u003C\u002Fa\u003E (for the mRNA vaccines) is just not going to be sustainable.\"\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, in such a competitive landscape, it remains to be seen whether there will be room for all the second generation vaccines in development. For one thing, the market for boosters in high income nationsis a highly uncertain one. Scientists are still unclear whether the emergence of further variants will make regular immunisations against the virus a necessity, or whether its threat will slowly wane in the coming years.\u003C\u002Fp\u003E\n\u003Cp\u003E\"Effectively the manufacturers of the newer vaccines have got to show a benefit above what we've already got,\" says Ustianowski. \"And that isn't a definite.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe Risks\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThe successful roll-out of Covid-19 vaccinations over the past year has been widely hailed as an \"\u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-021-01136-2\"\u003Eunprecedented\u003C\u002Fa\u003E\" achievement. Vaccine development is a notoriously precarious business, with two thirds of vaccines proving inadequate in clinical trials, however \u003Ca href=\"https:\u002F\u002Fwww.ft.com\u002Fcontent\u002F846c00e4-06ba-417d-978c-98caef7f605a\"\u003Eexperts have warned that\u003C\u002Fa\u003E the success of the first wave of Covid-19 jabs is no guarantee that the second wave will make it through.\u003C\u002Fp\u003E\n\u003Cp\u003EOne early casualty was German company CureVac, whose mRNA vaccine yielded disappointing results in a Phase III trial in June, proving \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-021-01661-0\"\u003Ejust 47% effective\u003C\u002Fa\u003E at preventing disease. The news was viewed as a setback as the vaccine – which utilised smaller doses of mRNA – was \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-021-01661-0\"\u003Eexpected to be cheaper, and last longer\u003C\u002Fa\u003E in storage than the Pfizer\u002FBioNTech and Moderna equivalents.\u003C\u002Fp\u003E\n\u003Cp\u003ECureVac are now pursuing a new Covid-19 vaccine in partnership with GSK, which attempts to target multiple coronavirus variants at one time. While this has shown \u003Ca href=\"https:\u002F\u002Fwww.curevac.com\u002Fen\u002F2021\u002F08\u002F16\u002Fsecond-generation-mrna-covid-19-vaccine-candidate-cv2cov-demonstrates-improved-immune-response-and-protection-in-preclinical-study\u002F\"\u003Ebetter results in animal studies\u003C\u002Fa\u003E and appears to elicit ten times more antibodies than their first attempt, Klaus Edvardsen, chief development officer at CureVac told the BBC that they would be unlikely to be in a position to apply for regulatory approval until the end of 2022 at the earliest.\u003C\u002Fp\u003E\n\u003Cp\u003EThis example serves to illustrate the multiple pitfalls and challenges faced by second generation vaccine developers. Many companies are already finding that the path to regulatory approval is much stiffer, with the US Food and Drug Administration announcing that there will be no more emergency use vaccine authorisations.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-6"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b7mcm6"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThe billions of doses of vaccines which have already been administered – \u003Ca href=\"https:\u002F\u002Fourworldindata.org\u002Fcovid-vaccinations\"\u003E29.92 million\u003C\u002Fa\u003E are now being given every day – are also putting unprecedented strain on the vaccine supply chain. With manufacturers of glass vials and other key raw materials choosing to prioritise first generation vaccines, second generation developers are finding it difficult to get hold of what they need.\u003C\u002Fp\u003E\n\u003Cp\u003E\"We're definitely in second class citizens when it comes to the supply chain,\" says Zion. \"Vials, glass, plastic, it's all being consumed by the approved vaccines. We had some filters on order, which were on the truck, and then they were diverted away from us to one of the approved vaccine companies through some governmental edict. It's like that all the time.\"\u003C\u002Fp\u003E\n\u003Cp\u003EFor Akston Biosciences and the other new challengers vying for a part of the market, the price of commercial failure is potentially very high. Two years ago Novavax saw a clinical trial for an RSV vaccine crash and burn. The process cost them tens of millions of dollars, resulted in employees being laid off, and the sell-off of two development and manufacturing facilities.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe Future\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003ETo date an \u003Ca href=\"https:\u002F\u002Fourworldindata.org\u002Fcovid-vaccinations\"\u003Eestimated 47.7%\u003C\u002Fa\u003E of the world's population, including large swathes of South America, Africa and Asia, is yet to receive even one coronavirus vaccine dose. The great hope for second generation vaccines is that they can make major inroads into this problem, especially as unvaccinated populations are at even greater risk from any new variants that might emerge.\u003C\u002Fp\u003E\n\u003Cp\u003EWilliam Hanage, an epidemiologist at the Harvard TH Chan School of Public Health, has been attempting to quantify the impact of the Delta variant on unvaccinated individuals, and recently uncovered a startling statistic. \"I was looking at mortality rates across the US, and Florida had a Delta wave after vaccines became available,\" he says. \"More than 30% of all Florida's Covid-19 deaths have happened since vaccines, because Delta is more dangerous and Florida has a lot of unvaccinated older people. And that's just the US. We know there are large parts of the world which are unvaccinated.\"\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b7mf9s"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EOne company which is specifically focusing on getting Covid-19 vaccines to low-income nations is Lund-based biotech Ziccum which has developed a technology to air-dry existing vaccines and convert them into powder forms which do not need to be stored or transported at cold temperatures. Ziccum are currently collaborating with Janssen – whose first generation Covid-19 vaccine was approved in February 2021 – to study whether it will be possible to create dry powder forms of one of Janssen's vaccine platforms. In the near future, this may be utilised to try and improve the vaccine situation across the African continent. Ziccum's CEO Göran Conradson told the BBC that talks are underway about using their technology in Rwanda, where \u003Ca href=\"https:\u002F\u002Fcoronavirus.jhu.edu\u002Fregion\u002Frwanda\"\u003Eless than 20%\u003C\u002Fa\u003E of the population are fully vaccinated.\u003C\u002Fp\u003E\n\u003Cp\u003E\"We have been invited to Rwanda to see what we can do,\" says Conradson. \"There's been a lot of initiatives in Africa at the moment. We've had so many contacts from the African CDC, African Development Bank, the African vaccine manufacturers, there's a whole bunch of initiatives.\"\u003C\u002Fp\u003E\n\u003Cp\u003EEven if some of the second generation vaccines never make it to market for Covid-19, the vast investments in research and accelerating manufacturing processes, may yet bring major health benefits in the realms of other diseases. Vaxart are also looking to create vaccine-based pills for \u003Ca href=\"https:\u002F\u002Finvestors.vaxart.com\u002Fnews-releases\u002Fnews-release-details\u002Fresults-influenza-challenge-study-published-lancet-infectious\"\u003Eflu\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Fvaxart.com\u002Fnorovirus\u002F\"\u003Enorovirus\u003C\u002Fa\u003E, while CureVac and GSK \u003Ca href=\"https:\u002F\u002Fwww.ft.com\u002Fcontent\u002F493e52c6-0361-4d63-8b85-45308df14fd7\"\u003Eare aiming to produce a jab\u003C\u002Fa\u003E which vaccinates against coronaviruses and influenza at the same time.\u003C\u002Fp\u003E\n\u003Cp\u003ECalifornia-based biotech Gritstone have \u003Ca href=\"https:\u002F\u002Fwww.clinicaltrialsarena.com\u002Fnews\u002Fgritstone-covid-vaccine-uk-phasei\u002F\"\u003Erecently launched\u003C\u002Fa\u003E a Phase I clinical trial in Manchester, using a method known as self-amplifying RNA (saRNA), a newer form of the mRNA technology. Initially designed for use against cancer, saRNA produces copies of itself once inside the body's cells, meaning that you can induce the same response as an mRNA vaccine, but with a dose that is 50 or 100 times smaller, making the vaccine cheaper and easier to make.\u003C\u002Fp\u003E\n\u003Cp\u003EAndrew Allen, president, chief executive and co-founder of Gritstone, says that the vaccine's technology, which aims to stimulate more durable, long lasting T cell responses against areas of Covid-19 which are conserved between coronaviruses, and so found in all viruses in this family, could also be utilised to help develop universal vaccines against other viruses such as the flu. It could even help accelerate its existing work on cancer vaccines, which uses biopsies to try and predict different targets for the immune system to attack, as the tumour evolves.\u003C\u002Fp\u003E\n\u003Cp\u003EBut one of the biggest legacies of this new wealth of vaccine research could be in making the world far more prepared for future coronavirus outbreaks, something many scientists believe is inevitable based on trends over the past two decades.\u003C\u002Fp\u003E\n\u003Cp\u003E\"We've had three coronavirus outbreaks in the last 20 years,\" says Allen. \"We had Sars in 2002 Mers in 2012, and then Covid-19. I think we can all agree that there will be another coronavirus outbreak, and we need to be ready for it. We need to be better prepared than we were last time.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E or \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E. \u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called \"The Essential List\" – a handpicked selection of stories from BBC \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002F\"\u003E\u003Cem\u003EFuture\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fculture\u002F\"\u003E\u003Cem\u003ECulture\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fworklife\u002F\"\u003E\u003Cem\u003EWorklife\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ftravel\u002F\"\u003E\u003Cem\u003ETravel\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E and \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Freel\"\u003E\u003Cem\u003EReel\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like-10"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-12-03T01:00:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"What will tomorrow's Covid-19 vaccines be like?","headlineShort":"The dash for new Covid-19 vaccines","image":["p0b7mgdg"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"The first generation of Covid-19 vaccines was developed in record time. But now scientists have grander plans – for more potent immunity, easier transport, and mutation-proofing.","summaryShort":"The next generation of Covid-19 vaccines might provide more potent immunity.","tag":["tag\u002Fvaccine","tag\u002Fcovid-19"],"textToSpeech":false,"creationDateTime":"2021-12-03T00:09:35.734448Z","entity":"article","guid":"bdc9bafa-0435-472d-bcc6-ff851b11b7f1","id":"future\u002Farticle\u002F20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like","modifiedDateTime":"2021-12-03T09:27:32.807103Z","project":"future","slug":"20211201-what-will-the-next-generation-of-covid-19-vaccines-be-like","cacheLastUpdated":1642293446376},"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20211112-the-people-with-immune-amnesia","_id":"619302ce45ceed39f3118132","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"Scientists have known for years that measles can alter the immune system – but the latest evidence suggests it's less of a mild tweaking, and more of a total reset.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumn\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIt was late at night on 15 November 2019, on the Samoan island of Upolu – a tiny jade-green splodge in the Pacific Ocean, somewhere between Hawaii and New Zealand. Government officials were rushing to attend a meeting in the sleepy harbourside capital to discuss an urgent public health issue. By the end of the evening they had \u003Ca href=\"https:\u002F\u002Fwww.samoaobserver.ws\u002Fcategory\u002Farticle\u002F53377\"\u003Edeclared a state of emergency\u003C\u002Fa\u003E, with immediate effect. \u003C\u002Fp\u003E\n\u003Cp\u003EThree months earlier, a member of the public had developed a characteristic red-brown blotchy rash after arriving on a flight from New Zealand, where there was an ongoing measles epidemic. They were swiftly diagnosed as a \"suspected\" case, but no further action was taken.\u003C\u002Fp\u003E\n\u003Cp\u003EBy \u003Ca href=\"https:\u002F\u002Freliefweb.int\u002Freport\u002Fsamoa\u002Fministry-health-press-release-1-measles-epidemic\"\u003E2 October\u003C\u002Fa\u003E, another seven measles cases had materialised. Schools – ideal environments for the virus to spread among its preferred victims – continued as normal, with the small concession that prize-giving ceremonies were banned. Even then, some \u003Ca href=\"https:\u002F\u002Fwww.samoaobserver.ws\u002Fcategory\u002Fsamoa\u002F53172?fbclid=IwAR1pbD8MO6gO3Z14q9wVvInmCxORAh6frsNjPa8OrfBNigYW8AlmfnGRdg8\"\u003Eignored this\u003C\u002Fa\u003E. Just over a month later, the outbreak had spiralled to alarming proportions – with \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2019\u002Fnov\u002F17\u002Fsamoa-declares-state-of-emergency-over-deadly-measles-epidemic\"\u003E716\u003C\u002Fa\u003E people infected, out of a total population of around \u003Ca href=\"https:\u002F\u002Fdatacommons.org\u002Fplace\u002Fcountry\u002FWSM?utm_medium=explore&mprop=count&popt=Person&hl=en\"\u003E197,000\u003C\u002Fa\u003E. \u003C\u002Fp\u003E\n\u003Cp\u003EBut with the new state of emergency in place, the country radically stepped up its efforts to halt the spread. Schools and businesses closed. Workers abandoned their offices. Residents were advised to stay in their homes. In a sinister echo of the red crosses marked on doors during medieval plague outbreaks, red flags popped up outside the homes of unvaccinated families across the country, draped on bushes, tied to columns and hung from trees. This allowed doctors to go house to house, administering compulsory vaccinations to \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fnews\u002Fworld-asia-50657716\"\u003Ethose who needed them\u003C\u002Fa\u003E. Otherwise, Samoa became a ghost island – with \u003Ca href=\"https:\u002F\u002Fwww.aljazeera.com\u002Fnews\u002F2019\u002F12\u002F5\u002Fsamoa-shuts-down-in-unprecedented-battle-against-measles\"\u003Eempty roads\u003C\u002Fa\u003E and cancelled flights.\u003C\u002Fp\u003E\n\u003Cp\u003EEventually infections slowed, and the state of emergency ended on 28 December 2019. In all, \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flaninf\u002Farticle\u002FPIIS1473-3099(20)30044-X\u002Ffulltext\"\u003E5,667\u003C\u002Fa\u003E people were infected – including 8% of the population under 15 years old. Of those, 81 died, including \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2019\u002Fnov\u002F30\u002Fthere-are-no-words-samoa-buries-its-children-as-measles-outbreak-worsens\"\u003Ethree children\u003C\u002Fa\u003E from the same family.\u003C\u002Fp\u003E\n\u003Cp\u003EThe epidemic was over – but the virus hadn't necessarily taken its last victim. \u003C\u002Fp\u003E\n\u003Cp\u003EEnter \"immune amnesia\", a mysterious phenomenon that's been with us for millennia, though it was only \u003Ca href=\"https:\u002F\u002Fjournals.plos.org\u002Fplospathogens\u002Farticle?id=10.1371\u002Fjournal.ppat.1002885\"\u003Ediscovered in 2012\u003C\u002Fa\u003E. Essentially, when you're infected with measles, your immune system abruptly forgets every pathogen it's ever encountered before – every cold, every bout of flu, every exposure to bacteria or viruses in the environment, every vaccination. The loss is near-total and permanent. Once the measles infection is over, current evidence suggests that your body has to re-learn what's good and what's bad almost from scratch.  \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b4cj7s"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\"In a way, infection of the measles virus basically sets the immune system to default mode,\" says Mansour Haeryfar, a professor of immunology at Western University, Canada, \"as if it has never encountered any microbes in the past\".\u003C\u002Fp\u003E\n\u003Cp\u003EHow does it work? How long does it last? And could it be driving other epidemics?\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA master contagion\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EMeasles is an ancient respiratory virus, transmitted via aerosols and droplets, that's thought to have first made the leap from cattle to humans around \u003Ca href=\"https:\u002F\u002Fwww.science.org\u002Fdoi\u002F10.1126\u002Fscience.aba9411\"\u003E2,500 years ago\u003C\u002Fa\u003E – possibly taking advantage of the crammed cities that were springing up across the globe.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy\" target=\"_blank\"\u003E\u003Cstrong\u003EWhy some people don't want a Covid-19 vaccine\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new\" target=\"_blank\"\u003E\u003Cstrong\u003EWhy mandatory vaccination is nothing new\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200915-the-mystery-of-why-some-vaccines-are-doubly-beneficial\" target=\"_blank\"\u003E\u003Cstrong\u003EThe mystery of why some vaccines are doubly beneficial\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EFor millennia, measles had free rein to plague the world's children – particularly in the first few years of life – infecting \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fmeasles\u002Fabout\u002Fhistory.html\"\u003Enearly everyone\u003C\u002Fa\u003E before their 15th birthday. In 1967, the year before the vaccine was introduced in the UK, there were \u003Ca href=\"https:\u002F\u002Fvk.ovg.ox.ac.uk\u002Fvk\u002Fmeasles\"\u003E460,407\u003C\u002Fa\u003E suspected cases. When European colonists first made it across the Atlantic, the virus is thought to have been one of the new imports – along with others such as \u003Ca href=\"https:\u002F\u002Fwww.taylorfrancis.com\u002Fchapters\u002Fedit\u002F10.4324\u002F9781315510491-7\u002Fnative-americans\"\u003Esmallpox and typhoid\u003C\u002Fa\u003E – that wiped out \u003Ca href=\"https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS0277379118307261\"\u003E90% of the indigenous population\u003C\u002Fa\u003E of the Americas within a century.\u003C\u002Fp\u003E\n\u003Cp\u003EScientists have known for decades that even after they recover, children who have been infected with measles are significantly more likely to fall ill and die from other causes. In fact, a study from 1995 found that vaccinating against the virus reduces the overall likelihood of death by between \u003Ca href=\"https:\u002F\u002Fwww.bmj.com\u002Fcontent\u002F311\u002F7003\u002F481?source=post_page---------------------------\"\u003E30% and 86%\u003C\u002Fa\u003E in the years afterwards.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, exactly why measles was such a potent driver of childhood illnesses wasn't clear.\u003C\u002Fp\u003E\n\u003Cp\u003EThen in 2002, a group of Japanese scientists discovered that the receptor the measles virus binds to – a kind of molecular lock that allows it to enter the body – isn't in the lungs, as you would expect for a respiratory virus. Instead, it's on \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F12008921\u002F\"\u003Ecells from the immune system\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E\"It was really quite a surprise if you compare it to what we knew at that time from the textbooks of how measles virus would enter our host,\" says Rik de Swart, an associate professor of Viroscience at Erasmus University Medical Center in the Netherlands. \u003C\u002Fp\u003E\n\u003Cp\u003EA decade later, an international team of researchers – including Swart – decided to \u003Ca href=\"https:\u002F\u002Fjournals.plos.org\u002Fplospathogens\u002Farticle?id=10.1371\u002Fjournal.ppat.1002885#ppat.1002885-Tatsuo1\"\u003Etake a closer look\u003C\u002Fa\u003E. They tagged measles with a green fluorescent protein, infected macaque monkeys with it – and tracked where the green viral particles ended up.\u003C\u002Fp\u003E\n\u003Cp\u003E\"[We saw that] it infects many cells systemically,\" says Swart. \"So, this virus causes a viremia, which means that then there's virus in the blood – actually, white blood cells become infected and bring the virus to all the lymphoid tissues, which are your lymph nodes and your spleen, your thymus [a gland in the chest that's part of the immune system],\" he says, explaining that this confirmed that measles is an infection of the immune system.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-2"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b4cm5m"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAn outbreak of measles in the Netherlands in 2013 provided an opportunity to test this theory. It started among an Orthodox Protestant community, who refused vaccination on religious grounds, and eventually infected 2,600 people. Years later, scientists investigated blood samples taken from patients – and confirmed that they \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41467-018-07515-0\"\u003Econtained memory T cells\u003C\u002Fa\u003E infected with measles.   \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA bewildering paradox\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EBut this was not the end of the story. The team mostly found the receptor measles binds to on a specific kind of immune cell, the memory T cell. Their job is to remain in the body for decades after an infection, quietly looking out for the specific pathogen each one was trained to target. So, measles actively infects the only cells that can remember what the body has encountered before.\u003C\u002Fp\u003E\n\u003Cp\u003EWhat happens next is still baffling scientists to this day – so much so that it's been called the \"measles paradox\".\u003C\u002Fp\u003E\n\u003Cp\u003E\"Measles suppresses the immune system, and activates it at the same time,\" says Swart. Though measles deletes immune memories, there is one exception to these losses. Oddly, the only virus you'll definitely be able to recognise after falling sick with measles is measles itself.\u003C\u002Fp\u003E\n\u003Cp\u003EMeasles infections generate a powerful immune response against the virus, leading to \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC5086614\u002F\"\u003Elifelong immunity\u003C\u002Fa\u003E in the vast majority of people. And though no one yet knows why, this may be what causes immune amnesia in the first place.\u003C\u002Fp\u003E\n\u003Cp\u003EFirst measles infects memory cells, then somehow the immune system learns how to identify the virus itself. Once it's started producing immune cells specific to measles, they travel around the body, \u003Ca href=\"https:\u002F\u002Fjournals.plos.org\u002Fplospathogens\u002Farticle?id=10.1371\u002Fjournal.ppat.1002885#ppat.1002885-Tatsuo1\"\u003Ehunting down infected memory cells\u003C\u002Fa\u003E  So you end up with cells that can identify measles systematically killing off cells that can identify other viruses. The virus leads us to destroy our own immune memories.  \u003C\u002Fp\u003E\n\u003Cp\u003EEventually, measles ends up replacing all your normal immune memory cells with ones that can identify it, and nothing else. This means you're only immune to measles – while all other pathogens are forgotten. It's a counter-intuitive strategy, especially from the virus' perspective, since it won't be able to sneak into the body again without being recognised.\u003C\u002Fp\u003E\n\u003Cp\u003E(Unfortunately there's no evidence this immune reset can be beneficial for those who have malfunctioning immune systems, such as people with autoimmune disorders – and even if it was, Swart points out that measles-based treatments would only work in those who had never encountered measles or the vaccine before.)\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b4cjrz"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\"Another virus that uses a similar strategy is HIV,\" says Swart. \"It infects cells of the immune system and as a consequence, breaks it [the immune system] down and makes it less competent. But the big difference there is that HIV does this slowly but persistently, chronically, so that decay goes on over a really long periods of time.\"\u003C\u002Fp\u003E\n\u003Cp\u003EIn fact, though HIV damages the immune system, the amnesia generated by measles is unique among human infections. In other animals, viruses such as canine distemper in dogs and dolphin morbillivirus (DMV) in dolphins also suppress the immune system, and might have a similar mechanism, says Swart.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA two-year gap\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003ESince the discovery of immune amnesia, the pieces have started to fit together.\u003C\u002Fp\u003E\n\u003Cp\u003EOnce the immune system has lost its memory cells, it has to painstakingly re-learn everything it once knew. One population-level study from 2015 suggests that this process of recovery can take up to \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC4823017\u002F\"\u003Ethree years\u003C\u002Fa\u003E – which intriguingly, is around the time it takes infants to acquire immunity to everyday pathogens in the first place.\u003C\u002Fp\u003E\n\u003Cp\u003E\"Children develop a lot of colds and gastrointestinal diseases and need quite a bit of time to develop their immune system,\" says Swart. \"So this is sort of in the same order of magnitude in terms of duration.\"\u003C\u002Fp\u003E\n\u003Cp\u003EIn the meantime, children are at risk from a broad range of pathogens their bodies would once have been able to recognise. \"Probably all those infections need to be experienced, again, to really repair all the damage there,\" says Swart. \"And every infection has another risk of disease development.\"\u003C\u002Fp\u003E\n\u003Cp\u003EIt's not surprising, then, that measles doesn't just increase the risk of illness, but also death. In fact, childhood mortality from other viruses is strongly linked \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC4823017\u002F\"\u003Eto the incidence of measles\u003C\u002Fa\u003E. The 2015 study showed that when childhood mortality in the UK, US, or Denmark goes up, this is usually because measles has become more prevalent.\u003C\u002Fp\u003E\n\u003Cp\u003EThe findings explain why vaccinating children against measles has the unexpected, beneficial side-effect of reducing deaths among children, way beyond the numbers who were ever at risk of dying from measles itself.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA surprising impact\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EAll this means that measles can have a profound impact on a population's health, even years after an outbreak has disappeared.\u003C\u002Fp\u003E\n\u003Cp\u003ETake Samoa. It's thought that the 2019 outbreak of measles on the island stems from a traumatic and exceptionally rare incident years before, when two nurses mixed a batch of the measles, mumps and rubella (MMR) vaccine incorrectly, and two children died. (The nurses were subsequently jailed.) This led to a widespread fear of vaccines, and as a result, just \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flaninf\u002Farticle\u002FPIIS1473-3099(20)30044-X\u002Ffulltext\"\u003E30%\u003C\u002Fa\u003E of the country's population had been fully immunised as of 2018.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-6"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b4ckw9"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBy the time measles – one of the most contagious viruses on the planet, with an R number of 12-18 (meaning each infected person infects that number of others, on average) – arrived, it found near-perfect conditions for its spread. \u003C\u002Fp\u003E\n\u003Cp\u003EAnd though the authorities did manage to get the measles epidemic under control, its impact may have lingered on. Just under a year after measles vanished from the island, another arrived – on the 27 November 2020, Samoa recorded its first case of Covid-19.\u003C\u002Fp\u003E\n\u003Cp\u003EAs it happens, Covid-19 was never given the opportunity to take off on the island – a comprehensive programme of vaccination and lockdowns prevented its spread. However, modelling suggests that had it been able to, the population would have been at \u003Ca href=\"https:\u002F\u002Flink.springer.com\u002Farticle\u002F10.1186\u002Fs12879-020-05469-7\"\u003Esignificantly higher risk\u003C\u002Fa\u003E as a result of the measles outbreak. According to these calculations, the islands' legacy of immune amnesia could have increased the total number of cases by 8% and deaths by more than 2%.  \u003C\u002Fp\u003E\n\u003Cp\u003EMeanwhile, other modelling work has found that measles outbreaks occurring after Covid-19 vaccine rollouts could \u003Ca href=\"https:\u002F\u002Froyalsocietypublishing.org\u002Fdoi\u002Ffull\u002F10.1098\u002Frsif.2021.0153\"\u003Ewipe out herd immunity\u003C\u002Fa\u003E to the coronavirus and lead to a resurgence of cases.   \u003C\u002Fp\u003E\n\u003Cp\u003E\"Maybe you underwent an infection with measles virus that you thought, okay, that's irrelevant, regarding my protection to Covid-19,\" says Miguel Muñoz, a professor of statistics at the University of Grenada who led the study. \"Maybe it's not, because if you get infected with measles, then your coverage is going to disappear. You're not safe anymore.\"\u003C\u002Fp\u003E\n\u003Cp\u003EAll this makes measles decidedly unappealing, if it weren't already. It also raises an important question – should people who have been infected with the virus get re-vaccinated?\u003C\u002Fp\u003E\n\u003Cp\u003EAccording to Swart, this is currently not standard practice – though it wouldn’t be a bad idea. \"In some cases that might be required. But on a programmatic basis, that is not being done now, as far as I'm aware,\" he says. Unfortunately, in practical terms, Swart points out that re-vaccinating people would only be useful to a minority.  \u003C\u002Fp\u003E\n\u003Cp\u003E\"So it would only apply to people that have been fully vaccinated, but just not to measles,\" says Swart. \"…that is such a small subgroup, that that's not really substantial enough, I think, to develop a programme like this on an individual basis.\"\u003C\u002Fp\u003E\n\u003Cp\u003ESo, while the jury is still out on re-vaccinating, one simple-yet-powerful thing people can do to protect their precious immune memories – painstakingly gathered over decades, until they're a kind of record of our interactions with the world – is to get vaccinated against measles. If you count immunity that's acquired naturally, it's really hundreds of inoculations for the price of one.\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EZaria Gorvett is a senior journalist for BBC Future and tweets @ZariaGorvett\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E or \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E. \u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called \"The Essential List\" – a handpicked selection of stories from BBC \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002F\"\u003E\u003Cem\u003EFuture\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fculture\u002F\"\u003E\u003Cem\u003ECulture\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fworklife\u002F\"\u003E\u003Cem\u003EWorklife\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ftravel\u002F\"\u003E\u003Cem\u003ETravel\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E and \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Freel\"\u003E\u003Cem\u003EReel\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia-8"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-11-16T01:00:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"The race to understand 'immune amnesia'","headlineShort":"The virus that causes 'immune amnesia'","image":["p0b4cfm9"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":["tag\u002Fcovid-19"],"summaryLong":"Scientists have known for years that measles can alter the immune system – but the latest evidence suggests it's less of a mild tweaking, and more of a total reset.","summaryShort":"Measles can continue taking lives for years, even after the virus has vanished.","tag":["tag\u002Fvirus"],"textToSpeech":false,"creationDateTime":"2021-11-16T01:00:55.023812Z","entity":"article","guid":"faa5a315-352e-48e4-b57a-01d20b6b3c96","id":"future\u002Farticle\u002F20211112-the-people-with-immune-amnesia","modifiedDateTime":"2021-12-01T10:10:27.703399Z","project":"future","slug":"20211112-the-people-with-immune-amnesia","cacheLastUpdated":1642293446377},"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new","_id":"6183c20b45ceed30246b372a","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fchristine-ro"],"bodyIntro":"Mandatory vaccinations have been with us for centuries, quietly saving lives – and they're often largely unopposed until something changes.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumn\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EFor Virginia Mason Franciscan Health, a medical centre in the US state of Washington, 18 October 2021 was the day of reckoning. Ten weeks earlier, the centre had declared that all of its staff would be required to be vaccinated against Covid-19 by that date in order to protect both those working at the medical centre and their patients from the disease. It was a potentially risky requirement, given the shortages of medical staff and the resistance to vaccination rocking other parts of the US medical sector.\u003C\u002Fp\u003E\n\u003Cp\u003EBut when 18 October arrived, 95% of staff had met the requirement through vaccination or an approved exemption. (The other 5%, including partially vaccinated staff, are currently on administrative leave.)\u003C\u002Fp\u003E\n\u003Cp\u003ECharleen Tachibana, an executive who has spent her entire career at Virginia Mason, believes that this high vaccination rate is partly because \"we have a long history of [a] vaccination requirement… it's pretty well been normalised\".\u003C\u002Fp\u003E\n\u003Cp\u003EBack in 2004, Virginia Mason reportedly became \u003Ca href=\"https:\u002F\u002Fwww.researchgate.net\u002Fpublication\u002F45284400_Mandatory_Influenza_Vaccination_of_Healthcare_Workers_A_5-Year_Study\"\u003Ethe first medical centre\u003C\u002Fa\u003E to require all of its staff to be vaccinated against influenza each year. The administration held focus groups and other activities, including quizzes and a party, to encourage discussion of the new requirement. The combined carrot-and-stick approach proved very successful, and the influenza vaccination rate of Virginia Mason staff shot up from 54% to 98% in two years.\u003C\u002Fp\u003E\n\u003Cp\u003EThe lessons learned from that experience informed the rollout of the coronavirus vaccine requirement. One aspect was ensuring that it was as convenient for staff to receive the jabs as possible. The other aspect was a heavy focus on communication around the new requirement, including information sessions and documents in multiple languages. \u003C\u002Fp\u003E\n\u003Cp\u003E\"We don’t take mandates lightly,\" says Tachibana. \"When there's such clear science to this – when the vaccine has been proven to be safe and highly, highly effective – we’ve moved forward with these.\" \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose\" target=\"_blank\"\u003E\u003Cstrong\u003ECovid-19: How effective is a third vaccine dose?\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20211011-covid-19-should-we-vaccinate-children\" target=\"_blank\"\u003E\u003Cstrong\u003EWhat we know about Covid-19 jabs for kids\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200915-the-mystery-of-why-some-vaccines-are-doubly-beneficial\" target=\"_blank\"\u003E\u003Cstrong\u003EThe mystery of why some vaccines are doubly beneficial\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EAs Virginia Mason's experience suggests, a vaccine mandate is a powerful tool for safeguarding public health. But it can also be a highly contested one. In some ways, attitudes towards the current Covid-19 vaccine requirements reflect the patterns of previous centuries, making it \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(21)00267-1\u002Ffulltext\"\u003Eimportant to understand the historical lessons of compulsory vaccination\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EPrecedents for vaccine mandates\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIn the 17th Century, \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200914-the-remarkable-power-of-inoculation\"\u003EChinese physicians\u003C\u002Fa\u003E found that when certain preparations of smallpox were blown up the nose, they could lead to a milder illness than a natural infection would, followed by immunity. Eventually the technique spread to Europe and the Americas, where it generally involved rubbing infectious material into a puncture in the skin. As \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3407399\u002F\" target=\"_blank\"\u003Eit spread around the globe\u003C\u002Fa\u003E, eventually some leaders mandated this kind of inoculation. For example, during the American Revolutionary War, in 1777, general George Washington \u003Ca href=\"https:\u002F\u002Feu.statesman.com\u002Fstory\u002Fnews\u002Fpolitics\u002Fpolitifact\u002F2021\u002F08\u002F02\u002Fdid-george-washington-mandate-vaccines-smallpox-continental-army-during-revolutionary-war\u002F5456106001\u002F\"\u003Erequired all troops\u003C\u002Fa\u003E to be inoculated against smallpox.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b14fzl"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EInoculation gave way to more sophisticated vaccination once the English doctor Edward Jenner developed a smallpox vaccine \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200928-how-the-first-vaccine-was-born\"\u003Ein 1796\u003C\u002Fa\u003E, based on the milder cowpox virus that infects cows. Mandatory vaccination began just a few years later. In 1806, Elisa Bonaparte, the ruler of Lucca and Piombino in present-day Italy (and sister to Napoleon), \u003Ca href=\"https:\u002F\u002Fwww.cairn.info\u002Frevue-napoleonica-la-revue-2017-3-page-38.htm\"\u003Emandated the vaccination of newborn babies and adults\u003C\u002Fa\u003E.\u003Cstrong\u003E \u003Cbr \u002F\u003E\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EAnother milestone occurred in 1853, when the Compulsory Vaccination Act required infants in England and Wales to be vaccinated against smallpox.\u003C\u002Fp\u003E\n\u003Cp\u003EThough some vaccines, like \u003Ca href=\"https:\u002F\u002Fwww.oah.org\u002Ftah\u002Fissues\u002F2015\u002Faugust\u002Fvaccination-resistance\u002F\"\u003Efor polio\u003C\u002Fa\u003E, were initially popular, one noticeable pattern is the public getting used to a particular vaccine requirement over time, then some people getting spooked by a novel vaccine.\u003C\u002Fp\u003E\n\u003Cp\u003E\"The United States has had vaccination mandates in place since the late 1970s,\" says Lee Hampton, a paediatrician and medical epidemiologist with \u003Ca href=\"https:\u002F\u002Fwww.gavi.org\u002F\"\u003EGavi, the Vaccine Alliance\u003C\u002Fa\u003E. And Italy requires children to be vaccinated against a \u003Ca href=\"https:\u002F\u002Fijponline.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs13052-018-0504-y\"\u003Erange of pathogens\u003C\u002Fa\u003E, such as hepatitis B, diphtheria, pertussis, poliovirus, tetanus, \u003Cem\u003EHaemophilus influenzae\u003C\u002Fem\u003E type b, measles, mumps, rubella and varicella.\u003C\u002Fp\u003E\n\u003Cp\u003EAccording to Hampton, \"the mandates themselves… \u003Ca href=\"https:\u002F\u002Ftheconversation.com\u002Fparents-were-fine-with-sweeping-school-vaccination-mandates-five-decades-ago-but-covid-19-may-be-a-different-story-168899\"\u003Ehadn't really caused any issues\u003C\u002Fa\u003E. What has caused changes over time in those types of contexts is when what’s being mandated changes.\" This pattern has been seen, for example, with new requirements for vaccination against hepatitis B, anthrax and of course now Covid-19.\u003C\u002Fp\u003E\n\u003Cp\u003EVaccination is now required in some cases for school attendance (for example, against hepatitis B in Slovenia), for \u003Ca href=\"https:\u002F\u002Fwww.washingtonpost.com\u002Fhealth\u002F2021\u002F10\u002F05\u002Fuchealth-transplant-unvaccinated\u002F\"\u003Eorgan transplants\u003C\u002Fa\u003E (some parts of the UK require them for kidney transplants) – and in one extreme case in Italy, to \u003Ca href=\"https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS0264410X20312342?via%3Dihub#s0080\"\u003Eretain custody of children\u003C\u002Fa\u003E. Penalties for non-compliance are most often educational or financial.\u003C\u002Fp\u003E\n\u003Cp\u003EVaccine mandates are especially common in high-income countries, according to Hampton. There also tends to be a link to the style of government, where \"the more authoritarian the government, the more likely it is to have vaccination mandates\". This may not be surprising, because it's easier for this style of government to impose new rules, including those in the public interest (in the case of vaccines).\u003C\u002Fp\u003E\n\u003Cp\u003EFor instance, The Gambia mandated childhood immunisations in 2007, during a period of authoritarian rule (and \u003Ca href=\"https:\u002F\u002Fopenknowledge.worldbank.org\u002Fhandle\u002F10986\u002F23008\"\u003Efollowing a drop in immunisation coverage\u003C\u002Fa\u003E). However, mandatory vaccination is also common in democratic countries in emergency situations, such as during pandemics – the US state of New York imposed mandatory flu vaccines on healthcare workers temporarily \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3020194\u002F\"\u003Eduring the swine flu pandemic in 2009\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe legacies of \"conscientious objection\"\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EOver the centuries, some objections have arisen over the components used to make vaccines. Certain vaccines include tiny amounts of animal products, \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201027-what-is-added-to-vaccines\"\u003Elike squalene, an oil from shark livers\u003C\u002Fa\u003E. The polio vaccine previously used \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives\"\u003Ecells from monkey kidneys\u003C\u002Fa\u003E. These types of ingredients have led to some vegetarian opposition.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-2"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b14k8q"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThe early smallpox vaccine involved cowpox lymph, taken from calf blisters. To parts of the growing vegetarian and anti-vivisectionist movement in Victorian Britain, \u003Ca href=\"https:\u002F\u002Ftheconversation.com\u002Fmeet-the-vegetarian-anti-vaxxers-who-led-the-smallpox-inoculation-backlash-in-victorian-britain-134173\"\u003Ethis was repugnant\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EThese vaccine objectors had various reasons, according to Sylvia Valentine, who's currently writing her PhD thesis on the subject at the University of Dundee. \"Some of the non-conformist denominations believed the human body should not be contaminated with animal material,\" Valentine explains. \"The anti-vivisection movement was also involved with anti-vaxxers and many objectors were 'anti' lots of other things too, including state interference in their lives. The anti-vivisectionists would have objected to the methods used to produce the calf lymph, which were rather gruesome if I am honest, and were concerned about animal welfare.\"\u003C\u002Fp\u003E\n\u003Cp\u003EPorcine tissue has also led some Muslims to worry about whether certain vaccines are halal – for instance, if they use pig-derived gelatine as a stabiliser. This challenged \u003Ca href=\"https:\u002F\u002Fwww.science.org\u002Fcontent\u002Farticle\u002Findonesian-vaccine-fatwa-sends-measles-immunization-rates-plummeting\"\u003Emeasles vaccination in Indonesia in 2018\u003C\u002Fa\u003E. More recently, Muslim clerics in Indonesia have declared that \u003Ca href=\"https:\u002F\u002Fabcnews.go.com\u002FHealth\u002FwireStory\u002Findonesia-resumes-astrazenecas-covid-19-vaccine-76553203\"\u003ECovid-19 vaccines are permissible\u003C\u002Fa\u003E, and Covid-19 vaccine manufacturers have stated that these vaccines do not contain pork products. Some Jewish authorities have also insisted there should be \u003Ca href=\"https:\u002F\u002Fassets.publishing.service.gov.uk\u002Fgovernment\u002Fuploads\u002Fsystem\u002Fuploads\u002Fattachment_data\u002Ffile\u002F933552\u002FVaccines_porcine_gelatine_2020_A4.pdf\" target=\"_blank\"\u003Eno problems with non-oral vaccines containing pork-derived ingredients\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EAnother contested component is \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives\"\u003Efoetal cell lines following abortions\u003C\u002Fa\u003E that were performed legally decades ago. These cell lines continue to be used in the testing of some vaccines and the development of others. Regardless, the Vatican has declared coronavirus vaccines \"\u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fworld-europe-55409693\"\u003Emorally acceptable\"\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EWhile there will be disagreement between sects and individuals, particularly where religion is highly decentralised – as among US evangelical Christians – there are no established religions that prohibit vaccination.\u003C\u002Fp\u003E\n\u003Cp\u003EIn fact, throughout history, religious officials have played \u003Ca href=\"https:\u002F\u002Fwww.cairn.info\u002Frevue-napoleonica-la-revue-2017-3-page-38.htm#no17\"\u003Eimportant roles\u003C\u002Fa\u003E in encouraging and implementing vaccination. After all, it's in their interest to safeguard the health of worshippers.\u003C\u002Fp\u003E\n\u003Cp\u003EAlong with spiritual objectors, a long thread of labour activism has been linked to vaccine opposition. During the Victorian era some English employers imposed smallpox vaccine mandates, which were particularly likely to affect – and especially resisted by – \u003Ca href=\"https:\u002F\u002Fwww.jstor.org\u002Fstable\u002F3070762\"\u003Ethe working class\u003C\u002Fa\u003E. Labour unions have been important sources of organised opposition (including, in 2004, unionised nurses \u003Ca href=\"https:\u002F\u002Fwww.researchgate.net\u002Fpublication\u002F45284400_Mandatory_Influenza_Vaccination_of_Healthcare_Workers_A_5-Year_Study\"\u003Echallenging the influenza vaccine requirement\u003C\u002Fa\u003E at the Virginia Mason medical centre).\u003C\u002Fp\u003E\n\u003Cp\u003EFrom 1898, England \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fuk-england-leicestershire-50713991\"\u003Eallowed conscientious objections\u003C\u002Fa\u003E to mandatory vaccinations. However, it \u003Ca href=\"https:\u002F\u002Fwww.jstor.org\u002Fstable\u002F3070762\"\u003Ewasn't until 1907\u003C\u002Fa\u003E that these exemptions became relatively easy to get – eventually extending to one-quarter of all births.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b14gmj"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThough the small minority of anti-vaxxers today are very vocal, \"the Victorian anti-vaccination movement was much larger\", believes Nadja Durbach, a historian of the body at the University of Utah. \"It was also more mainstream than anti-vaccinationism today. There were more unknowns in terms of the science of vaccination and because of a lack of sanitation, meant that the process could easily lead to infection.\"\u003C\u002Fp\u003E\n\u003Cp\u003EThere continue to be parallels between contemporary and historical vaccine protest. Anti-vaxx effigies \u003Ca href=\"https:\u002F\u002Fwww.independent.co.uk\u002Fnews\u002Fworld\u002Famericas\u002Fanti-vaxxers-vaccine-utah-demonstration-b1843372.html\"\u003Eeven continue to be burned\u003C\u002Fa\u003E in some places occasionally, such as in Utah, US, in May this year. But one difference is the occasionally carnival-like atmosphere of the Victorian protests. As Durbach \u003Ca href=\"https:\u002F\u002Facademic.oup.com\u002Fshm\u002Farticle-abstract\u002F13\u002F1\u002F45\u002F1628528?redirectedFrom=fulltext\"\u003Ehas written\u003C\u002Fa\u003E, \"a common anti-vaccination demonstration involved driving a newly-released anti-vaccinationist prisoner, often still in prison garb, around in a cart adorned with ribbons and banners and accompanied by a brass band\".\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA push vs. a nudge \u003Cbr \u002F\u003E\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003ECompulsory smallpox vaccination ended in the UK in 1947, amidst a broader trend toward optional vaccination (for example against diphtheria) with a \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fbooks\u002FNBK545998\u002F\"\u003Efocus on education and persuasion\u003C\u002Fa\u003E. Yet as we're seeing now \u003Ca href=\"https:\u002F\u002Fwww.bloomberg.com\u002Fnews\u002Farticles\u002F2021-10-15\u002Fthe-million-dollar-misfire-of-vaccine-lotteries\"\u003Ewith Covid-19\u003C\u002Fa\u003E, and as before \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(21)00267-1\u002Ffulltext\"\u003Ewith smallpox\u003C\u002Fa\u003E, vaccination mandates do increase uptake. For example, when France mandated 11 childhood vaccinations – against potentially lethal diseases – for those born after 2018, the number of fully vaccinated children \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC6607743\u002F\"\u003Eincreased significantly over previous years\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EWhen chosen carefully, there's no question that mandatory vaccinations can save lives. For example, one study found that patients were substantially less likely to die (with mortality rates of around 13.6% mortality verses 22.4%) in hospitals where healthcare workers had \u003Ca class=\"c-link\" tabindex=\"-1\" href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(99)05190-9\u002Ffulltext\" rel=\"noopener noreferrer\" target=\"_blank\" data-stringify-link=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(99)05190-9\u002Ffulltext\" data-sk=\"tooltip_parent\" data-remove-tab-index=\"true\"\u003Ehigher rates of flu vaccination\u003C\u002Fa\u003E compared to those with low rates, though patients were equally as likely to be infected with the virus.\u003Cbr \u002F\u003EAnother European study also found that in countries with mandatory measles vaccinations, and without non-medical exemptions, the disease incidence was \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC7011108\u002F\"\u003E86% lower\u003C\u002Fa\u003E than in countries without the mandates.   \u003C\u002Fp\u003E\n\u003Cp\u003EOne common tension is between obligation, which can increase hostility, and voluntary vaccination, which can increase transmission. Some health experts are nervous about mandatory vaccination because these policies \u003Ca href=\"https:\u002F\u002Fwhotogo-whoafroccmaster.newsweaver.com\u002F1911db22g7\u002F6uj4avcm9me1t84t8djpk5\"\u003Emay diminish trust in medical authorities\u003C\u002Fa\u003E over the long term. Vaccine mandates \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41590-019-0488-9\"\u003Ehave led to\u003C\u002Fa\u003E violent riots in Brazil and may have contributed to vociferous anti-vaccine movements all over Europe, for instance.\u003C\u002Fp\u003E\n\u003Cp\u003EIn France, one of the world's hotspots of vaccine hesitancy, the Ministry of Health has attempted to reduce the polarising effects of vaccine mandates by embedding mandates within a broader effort to build trust. This has led to \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41590-019-0488-9\"\u003Eimproved vaccine coverage, although a significant minority are still vaccine-hesitant\u003C\u002Fa\u003E – suggesting the importance of continuing to monitor attitudes and strengthening relationships between the medical establishment and the public.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-6"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p0b14ndy"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EHowever, \u003Ca href=\"https:\u002F\u002Fwww.tandfonline.com\u002Fdoi\u002Ffull\u002F10.1080\u002F15265160701795809\"\u003Enot everyone agrees on what counts as a \"mandate\"\u003C\u002Fa\u003E – there's an argument that many so-called mandated vaccinations are not technically mandates because people can usually opt out in certain circumstances, such as on religious grounds. And enforcement can be \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3216445\u002F\"\u003Eloose or even non-existent\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003ECoercive vaccination – which involves enforcing mandatory vaccination through physical force or intimidation – is different. And despite the beneficial effects of increasing vaccine uptake, there's more of a consensus that this strategy should be avoided. Yet, according to Yaqiu Wang, a China researcher for Human Rights Watch, \u003Ca href=\"https:\u002F\u002Fwww.hrw.org\u002Fnews\u002F2021\u002F09\u002F28\u002Fchinas-use-force-and-coercion-drive-its-covid-19-vaccination-rate-not-answer\"\u003Ecoercive tactics including harassment and spying\u003C\u002Fa\u003E are being reported in some parts of China. This isn't necessarily an official national policy, Wang explains. But the central government issues tough vaccination quotas for local governments, such as the September 2021 guidelines to vaccinate at least 90% of children in China. \"This kind of central government quota\u002Fdecree drives up vaccination rate, but sometimes this can result in coercive vaccinations at the local level,\" says Wang.\u003C\u002Fp\u003E\n\u003Cp\u003EEven in the absence of physical force, certain penalties for noncompliance with mandates \u003Ca href=\"https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS0264410X20312342?via%3Dihub#s0080\"\u003Ecan be counterproductive\u003C\u002Fa\u003E – for instance, if substantial fees are levied on people who already find it hard to take the time off work or travel to vaccination sites. This was a bone of contention among \u003Ca href=\"https:\u002F\u002Fwww.cairn.info\u002Frevue-napoleonica-la-revue-2017-3-page-38.htm\"\u003Esilkworm growers in the 19th Century\u003C\u002Fa\u003E and remains an obstacle for some people who have not yet been vaccinated today.\u003C\u002Fp\u003E\n\u003Cp\u003EVaccine mandates are \"something to be used sparingly\", with the minimal level of enforcement possible, according to Hampton. The conditions for their use should include \"the presence of a life-threatening disease, particularly a highly contagious life-threatening disease, and [a safe and] effective intervention for reducing transmission of that disease. That's usually a pretty good combination.\u003C\u002Fp\u003E\n\u003Cp\u003E\"It helps that the vaccines that we have for Covid-19 are on balance really, really safe,\" he adds. He remains optimistic that vaccination mandates will continue to be a useful way for protecting populations despite the opposition they face.\u003C\u002Fp\u003E\n\u003Cp\u003E\"With careful and judicious use, the benefit from using those mandates will outweigh the harms,\" he says. Whether that is enough to convince the sceptics, remains to be seen. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EThis article was updated on 16 November 2021. The original version incorrectly stated that Chinese inoculations involved applying cowpox to a wound. In fact, the technique involved smallpox and it was blown up the nose. \u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly \u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Ca href=\"http:\u002F\u002Fbbc.com\u002F\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003Ebbc.com\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003E features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called \"The Essential List\". A handpicked selection of stories from \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002F\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003EBBC Future\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fculture\u002F\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003ECulture\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fworklife\u002F\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003EWorklife\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ftravel\u002F\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003ETravel\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E and \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Freel\" target=\"_blank\"\u003E\u003Cstrong\u003E\u003Cem\u003EReel\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new-8"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-11-01T01:00:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"Why mandatory vaccination is nothing new","headlineShort":"The long history of vaccine mandates","image":["p0b1563y"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"Mandatory vaccinations have been with us for centuries, quietly saving lives – and they're often largely unopposed until something changes.","summaryShort":"Compulsory vaccinations have been with us for centuries","tag":["tag\u002Fcovid-19"],"textToSpeech":false,"creationDateTime":"2021-11-01T01:00:22.308671Z","entity":"article","guid":"c187843e-f368-4326-9f56-decf0eafd62c","id":"future\u002Farticle\u002F20211029-why-mandatory-vaccination-is-nothing-new","modifiedDateTime":"2021-11-19T20:24:47.212904Z","project":"future","slug":"20211029-why-mandatory-vaccination-is-nothing-new","cacheLastUpdated":1642293446378},"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose","_id":"6183c1f745ceed30707d70ba","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"From squandering global vaccine supplies to the possibility of undermining immunity from the first two doses, booster programmes are a surprisingly complicated business.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumn\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThe turning point came just after 6:30 on a Tuesday morning.\u003C\u002Fp\u003E\n\u003Cp\u003EIt was the 9 December 2020 and 91-year-old Margaret Keenan and 81-year-old William Shakespeare – who delighted the world by \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fuk-55233021\"\u003Ehailing from Warwickshire\u003C\u002Fa\u003E, like the poet – had just become the \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fuk-55227325\"\u003Efirst people\u003C\u002Fa\u003E to ever receive an initial dose of a Covid-19 vaccine outside clinical trials.\u003C\u002Fp\u003E\n\u003Cp\u003EThe entire room burst into applause. The day was named \"V-day\", and the atmosphere was giddy. One British newspaper celebrated with the whimsical headline \"\u003Ca href=\"https:\u002F\u002Fwww.independent.co.uk\u002Fnews\u002Fuk\u002Fhome-news\u002Fcovid-vaccine-william-shakespeare-second-person-b1767857.html\"\u003EThe taming of the flu\u003C\u002Fa\u003E\" – while footage of a particularly charismatic early vaccine recipient, who was more concerned about his \"rather nasty lunch\" than the needle went \u003Ca href=\"https:\u002F\u002Fmashable.com\u002Farticle\u002Fmartin-kenyon-uk-coronavirus-vaccine-interview\"\u003Eviral on Twitter\u003C\u002Fa\u003E. The pandemic was far from over, but this was the first step on the way out. \u003C\u002Fp\u003E\n\u003Cp\u003ENine months later, around \u003Ca href=\"https:\u002F\u002Fourworldindata.org\u002Fcovid-vaccinations\"\u003E5.7 billion doses\u003C\u002Fa\u003E of various vaccines have now been administered worldwide – with 41.8% of the global population at least partially protected. But the list of unknowns is growing by the day.\u003C\u002Fp\u003E\n\u003Cp\u003E\"One ghastly thing about this pandemic is that people get cross with us [scientists],\" says Danny Altmann, professor of immunology at University College London, \"because we change our minds, because it's such a moving target.\"\u003C\u002Fp\u003E\n\u003Cp\u003ENow that it's clear the world is likely to be riddled with Covid-19 – and its many variant successors – for years to come, the next big question is whether two doses of each vaccine is enough.\u003C\u002Fp\u003E\n\u003Cp\u003EAltmann explains that not that long ago – in April and May – he was writing articles and giving interviews saying that most vaccinated people had immunity that was so stupendous, there was no need to worry about booster doses.\u003C\u002Fp\u003E\n\u003Cp\u003E\"The expression I used was 'protective headroom',\" says Altmann. \"That you've got lots of protective headroom and even if variants come along that drop the effectiveness of your vaccine 10 times, say, because you've got a 1,000 times excess of antibodies, it wouldn't do any harm.\" The strong antibody response was initially reflected in their efficacy, too – while the World Health Organization (WHO) recommended \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Farticle\u002FS1473-3099(20)30773-8\u002Ffulltext\"\u003Eapproving any over 50%\u003C\u002Fa\u003E, in reality it was orders of magnitude higher.\u003C\u002Fp\u003E\n\u003Cp\u003EThen the Delta variant came rampaging – and though most people still have high levels of antibodies, breakthrough infections are not rare events. \"We're seeing breakthrough infections in the face of quite decent levels of neutralising antibodies,\" he says.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09w6f21"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBut are we likely to start seeing significant numbers of deaths? How effective are booster doses anyway – and what's the best way to administer them? From radically diverging immunity in different groups of people to the – small – hypothetical possibility that third doses of certain vaccines could actually decrease the amount of immunity we have, there are many scientific reasons that booster programmes are a very different endeavour to the initial vaccine rollout.\u003C\u002Fp\u003E\n\u003Cp\u003E\"At the beginning, it was very simple concepts – do we test or don't we? Do we have antibodies, or don't we?\" says Altmann. \"Now it's much more complex.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA fourth wave  \u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003ETake Israel – a country that vaccinated its population so widely and so early, the chief scientific officer at Pfizer recently called it \"\u003Ca href=\"https:\u002F\u002Fwww.timesofisrael.com\u002Fpfizer-exec-calls-israel-a-sort-of-laboratory-for-covid-vaccines\u002F\"\u003Ea sort of laboratory\u003C\u002Fa\u003E\". By mid-March – when the rest of the world was still scrambling for first doses – over 50% of the country's population was already fully vaccinated.\u003C\u002Fp\u003E\n\u003Cp\u003EIn May, the country had among the lowest rates of infection anywhere in the world. Things looked so good that a month later, the government began to dramatically scale back restrictions. There was no longer any limit to the \u003Ca href=\"https:\u002F\u002Fwww.timesofisrael.com\u002Fisrael-to-lift-all-covid-restrictions-on-gatherings-as-virus-fades\u002F\"\u003Esize of gatherings\u003C\u002Fa\u003E. Restaurants and other cultural venues opened up to both vaccinated and unvaccinated citizens. People were no longer required to \u003Ca href=\"https:\u002F\u002Fwww.nytimes.com\u002F2021\u002F04\u002F18\u002Fworld\u002Fisraelis-mask-mandate.html\"\u003Ewear masks outdoors\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EBut there was a major problem on the horizon – the arrival of the Delta variant. It snuck across the border sometime around early July – the first case was \u003Ca href=\"https:\u002F\u002Fwww.timesofisrael.com\u002Ffirst-case-of-delta-plus-covid-variant-found-in-israel-report\u002F\"\u003Edetected on 7 July\u003C\u002Fa\u003E – and soon cases were building to an alarming level. Within weeks, they numbered in the hundreds. Later that month, they were clocking several thousand.\u003C\u002Fp\u003E\n\u003Cp\u003EBy the time the country's Jewish majority began to prepare for the religious festival Yom Kippur in mid-September, there were at least \u003Ca href=\"https:\u002F\u002Fwww.timesofisrael.com\u002Fover-10000-new-virus-cases-on-saturday-as-transmission-rate-rises\u002F\"\u003E10,000 cases each day\u003C\u002Fa\u003E – per person, this was \u003Ca href=\"https:\u002F\u002Fwww.bloomberg.com\u002Fnews\u002Farticles\u002F2021-09-12\u002Fisrael-preparing-for-possible-fourth-covid-vaccine-dose\"\u003Emore than anywhere else on Earth\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003ETo begin with, the new variant was given most of the credit for this rapid unravelling. Then data emerged which creased the brows of experts around the world.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E\u003Cstrong\u003EYou might also like:\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"Why%20some%20people%20don't%20want%20a%20Covid-19%20vaccine\" target=\"_blank\"\u003E\u003Cstrong\u003EWhy some people don't want a Covid-19 vaccine\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives\" target=\"_blank\"\u003E\u003Cstrong\u003EThe controversial cells that saved 10 million lives \u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201027-what-is-added-to-vaccines\" target=\"_blank\"\u003E\u003Cstrong\u003EThe surprising ingredients found in vaccines\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EWhen a team of Israeli researchers looked at infections among vaccinated people in the country, they found that though they were significantly less likely to develop severe Covid-19 than unvaccinated individuals, the immunity had become less potent over time. For example, those received their second dose in January were \u003Ca href=\"https:\u002F\u002Fwww.medrxiv.org\u002Fcontent\u002F10.1101\u002F2021.08.24.21262423v1.full.pdf\"\u003E1.7 times more likely to develop severe Covid-19\u003C\u002Fa\u003E than those who had both vaccines just two months later.\u003C\u002Fp\u003E\n\u003Cp\u003E\"Luckily it's not a death dataset, simply because if you've vaccinated the population, you have far, far fewer deaths. So it's all about protection from symptomatic disease,\" says Altmann, \"…but there are lots of symptomatic cases, and the curves and the statistical values and things are very striking.\"\u003C\u002Fp\u003E\n\u003Cp\u003EToday the fourth wave has spread across much of the world. In recent weeks, the virus has surged to record levels in \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fuk-scotland-scotland-politics-58328945\"\u003EScotland\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2021\u002Faug\u002F19\u002Fjapan-sees-record-number-of-covid-cases-days-before-paralympics-begin\"\u003EJapan\u003C\u002Fa\u003E, and the \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Fworld\u002Fasia-pacific\u002Fphilippines-sees-record-22820-new-daily-coronavirus-cases-2021-09-09\u002F\"\u003EPhilippines\u003C\u002Fa\u003E, while many European countries have seen cases creep up again. And the evidence is mounting that waning immunity could be a global problem.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-2"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09w6fnb"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EOne \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fhealth-58322882\" target=\"_blank\"\u003Estudy in the UK\u003C\u002Fa\u003E found that two doses of the Pfizer\u002FBioNTech vaccine were 88% effective after one month, compared to 74% after five or six months. Meanwhile, the Oxford\u002FAstraZeneca version declined from being 77% to 67% effective.\u003C\u002Fp\u003E\n\u003Cp\u003EThe research is mirrored by analyses from Moderna and Pfizer, which have not yet been peer-reviewed. Moderna found that cases among fully vaccinated people jumped from 88 out of 11,431 people who received their second dose between December and March to 162 out of 16,747 people vaccinated five months earlier – a \u003Ca href=\"https:\u002F\u002Fwww.forbes.com\u002Fsites\u002Fjemimamcevoy\u002F2021\u002F09\u002F15\u002Fmoderna-vaccine-highly-effective-against-delta-but-protection-against-infection-may-wane-over-time-new-data-suggests\u002F\"\u003Ejump of around 36%\u003C\u002Fa\u003E. Meanwhile, Pfizer revealed that its vaccines decline from being \u003Ca href=\"https:\u002F\u002Fabcnews.go.com\u002FPolitics\u002Fpfizer-data-makes-case-booster-shots-months-primary\u002Fstory?id=80023544\"\u003E96% to 83.7%\u003C\u002Fa\u003E effective at preventing symptoms after four months.\u003C\u002Fp\u003E\n\u003Cp\u003EJust like the \u003Ca href=\"https:\u002F\u002Fwww.medrxiv.org\u002Fcontent\u002F10.1101\u002F2020.07.09.20148429v1\"\u003Eprotection gained through natural infection\u003C\u002Fa\u003E, it looks like vaccine-induced immunity gradually wears off – though it's not yet clear whether this matters (more on this later).\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EAnother vaccine scramble \u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EEnter booster vaccination programmes, which are rapidly springing up across the globe.\u003C\u002Fp\u003E\n\u003Cp\u003EIn Israel, third doses are already old news – they were approved for over-60s in late July, and the government has been gradually making them available to more and more people. The extra shot is currently available to \u003Ca href=\"https:\u002F\u002Fwww.cnbc.com\u002F2021\u002F08\u002F30\u002Fisrael-doubles-down-on-covid-booster-shots-as-breakthrough-cases-rise.html\"\u003Eeveryone over the age of 12\u003C\u002Fa\u003E, as long as it's been at least five months since they were vaccinated with the second dose.\u003C\u002Fp\u003E\n\u003Cp\u003EThe list of countries following suit is growing daily. The UK recently announced a booster programme for all over-50s and those with severely weakened immune systems, which is \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fhealth-58550833\"\u003Edue to start next week\u003C\u002Fa\u003E – \u003Ca href=\"https:\u002F\u002Fasia.nikkei.com\u002FSpotlight\u002FCoronavirus\u002FCOVID-vaccines\u002FSingapore-starts-booster-shots-as-COVID-cases-hit-1-year-high\"\u003Eas did Singapore\u003C\u002Fa\u003E (but for the immunocompromised and over-60s).\u003C\u002Fp\u003E\n\u003Cp\u003EIn the US, hundreds of thousands of extra doses have been given to clinically vulnerable people since 13 August, and the Biden administration has plans to provide them for all American adults once \u003Ca href=\"https:\u002F\u002Fwww.fda.gov\u002Fnews-events\u002Fpress-announcements\u002Ffda-authorizes-booster-dose-pfizer-biontech-covid-19-vaccine-certain-populations\" target=\"_blank\"\u003Esix months\u003C\u002Fa\u003E have elapsed since their second dose. Other nations with booster programmes include \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Fworld\u002Feurope\u002Fitaly-approves-booster-covid-19-shots-vulnerable-groups-2021-09-09\u002F\"\u003EItaly\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.bloomberg.com\u002Fnews\u002Farticles\u002F2021-08-27\u002Fchina-greenlights-covid-19-booster-shots-for-high-risk-residents\"\u003EChina\u003C\u002Fa\u003E, and \u003Ca href=\"https:\u002F\u002Fwww.rferl.org\u002Fa\u002Frussia-covid-delta-variant-revaccination-campaign\u002F31335476.html\"\u003ERussia\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EBut is this really necessary?\u003C\u002Fp\u003E\n\u003Cp\u003E\"This is a reminder:\" one doctor \u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FAbraarKaran\u002Fstatus\u002F1436540755556765702\"\u003Erecently warned on Twitter\u003C\u002Fa\u003E, \"if you have high risk folks at home who were vaccinated during the start of 2021, it is worth being extra careful around them.\" They went on to explain that they had treated several elderly and immunocompromised people in the last week who had been double vaccinated. Some of them had gone on to become seriously ill.\u003C\u002Fp\u003E\n\u003Cp\u003EIt's an alarming observation, but the wider picture may not be as dire as it sounds.\u003C\u002Fp\u003E\n\u003Cp\u003EIn the US, hospitalisations recently \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fus-news\u002F2021\u002Faug\u002F26\u002Fus-covid-hospitalisations-rise-cases-vaccines-delta\"\u003Erose above 100,000\u003C\u002Fa\u003E for the first time since January – and though there were 29 times as many unvaccinated as vaccinated people affected, inevitably some immunised people became seriously unwell because of the sheer numbers of cases. It's not yet clear whether there was indeed a higher probability of being hospitalised among people who were vaccinated earlier rather than later, as in Israel – however even if there were, there are a number of possible explanations other than waning immunity. For example, most countries vaccinated their most vulnerable citizens first.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, what is obvious is that the vaccines are still highly effective at shielding people from death, regardless of when you were inoculated – and it helps that the risk of vaccinated people being killed by Covid-19 was extremely small to start with. In the UK, there were \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fhealth-58545548\"\u003Ejust 256 fatalities\u003C\u002Fa\u003E linked to the virus among fully immunised people between January and July 2021, out of more than 51,000. These \"breakthrough deaths\" overwhelmingly occurred in the most vulnerable groups, such as elderly people with weakened immune systems.  \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09w6h66"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAs it happens, this is where a booster programme might be at its most useful. For example, a study of organ transplant recipients – who usually need to take drugs to suppress their immune system and prevent it from attacking the donated organ – found that some vaccinated patients had \u003Ca href=\"https:\u002F\u002Fjamanetwork.com\u002Fjournals\u002Fjama\u002Ffullarticle\u002F2779852\"\u003Estrikingly low antibody levels\u003C\u002Fa\u003E, which may not have been enough to protect them from Covid-19.\u003C\u002Fp\u003E\n\u003Cp\u003ESo, there is not yet any evidence that waning immunity is leading to more deaths in healthy people – though in some parts of the world it might put pressure on health services, if more people become seriously unwell.\u003C\u002Fp\u003E\n\u003Cp\u003EMaria Elena Bottazzi, professor of paediatrics, virology, and microbiology at Baylor College of Medicine in Texas, takes the view that current rates of hospitalisation provide a stronger argument for increasing vaccination rates overall, rather than providing third doses.\u003C\u002Fp\u003E\n\u003Cp\u003E\"I think the real question, in the context of the fact that certain areas of the world are still needing first and second doses,\" says \"is what is the real evidence that indicates that we should start adding a third dose – and when is it appropriate, which populations should we prioritise.\"\u003C\u002Fp\u003E\n\u003Cp\u003ESo, what evidence is there that booster shots work?\u003C\u002Fp\u003E\n\u003Cp\u003EAgain, it helps to turn to the Israel, which experimented with booster doses long before the rest of the world. One study of fully vaccinated over-60s found that those who had received a booster dose five months after their second shot had much more potent immunity – they were over \u003Ca href=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMoa2114255\"\u003E11 times less likely\u003C\u002Fa\u003E to be infected with Covid-19, and 19 times less likely to develop severe illness than those who had not received the third dose.\u003C\u002Fp\u003E\n\u003Cp\u003ELikewise, Pfizer's own data shows that booster shots can \u003Ca href=\"https:\u002F\u002Fwww.cnbc.com\u002F2021\u002F09\u002F15\u002Fcovid-boosters-pfizer-says-israel-data-shows-third-shot-restores-efficacy-to-95percent.html\"\u003Erestore their vaccine's efficacy\u003C\u002Fa\u003E to 95%. And there are other scraps of evidence from around the world.\u003C\u002Fp\u003E\n\u003Cp\u003EIn a recent trial of booster shots in organ transplant recipients, an international team of scientists found that providing an extra dose of the Moderna vaccine led to a \u003Ca href=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMc2111462\"\u003Esignificant jump in several markers of immunity\u003C\u002Fa\u003E, compared to receiving a placebo.\u003C\u002Fp\u003E\n\u003Cp\u003E\"As far as I know, it's the only randomised-controlled trial to look at a third dose,\" says Atul Humar, a senior scientist at Toronto General Hospital Research Institute. \"And it showed a very convincing benefit.\" Though the study didn't track the patients' disease outcomes, 60% of those who received the third dose reached the threshold for protective levels of neutralising antibodies, versus just 25% in the placebo group.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-6"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09w6hvn"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAnother hint at the immunological benefits of a third exposure to the Covid-19 spike protein comes from India, where a study of vaccinated healthcare workers – which is yet to be peer-reviewed – recently found that their levels of antibodies declined significantly after four months, unless they had been infected with the virus naturally – which the researchers suggest may have acted as a \u003Ca href=\"https:\u002F\u002Fwww.researchsquare.com\u002Farticle\u002Frs-888762\u002Fv1\"\u003Ekind of booster\u003C\u002Fa\u003E (though of course, this is not recommended).\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EAn (even more) complicated picture\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, even if waning immunity is a major global problem that booster shots can help to overcome it, there are still many things left to work out. In fact, the more you look at the detail, the more complicated it all becomes.\u003C\u002Fp\u003E\n\u003Cp\u003EFor example, what should a booster programme look like?\u003C\u002Fp\u003E\n\u003Cp\u003EIn Israel, where most people's first two vaccinations were by Pfizer, this is the vaccine that has been used so far for booster doses. The UK government is also currently planning to exclusively use the Pfizer version – however, the majority of the population received the Oxford\u002FAstraZeneca for their first and second doses.\u003C\u002Fp\u003E\n\u003Cp\u003EFor first and second doses, studies suggest that mixing and matching different Covid-19 vaccine technologies can provide \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-021-01359-3\"\u003Esuperior immunity\u003C\u002Fa\u003E to having the same one twice. However, though the UK began a \u003Ca href=\"https:\u002F\u002Fwww.gov.uk\u002Fgovernment\u002Fnews\u002Fworld-first-covid-19-vaccine-booster-study-launches-in-uk\"\u003Etrial on mix-and-match booster vaccines\u003C\u002Fa\u003E back in May, there is not yet any data to confirm that this works or is a good idea.\u003C\u002Fp\u003E\n\u003Cp\u003E\"Again, it's like so many other things – you know that expression, we're trying to build the aeroplane while we fly it, and doing it all as fast as we possibly can,\" says Altmann.\u003C\u002Fp\u003E\n\u003Cp\u003EWhile Altmann suspects that boosting with mRNA-based vaccines such as Pfizer and Moderna – which sneak mRNA containing the instructions to make the Covid-19 spike protein into cells, showing them what to look out for – work well, he does have mild concerns about the wisdom of boosting with another kind – the viral vector.\u003C\u002Fp\u003E\n\u003Cp\u003EIn contrast, vaccines like the Oxford\u002FAstraZeneca rely on a virus – in this case, a chimpanzee adenovirus – to smuggle the code for the Covid-19 spike protein into our bodies. And there's a theoretical possibility that reinfecting yourself with an (inactivated) virus several times could be a bad idea.\u003C\u002Fp\u003E\n\u003Cp\u003E\"We've never been there before… there's quite a big chance that you're going to induce inhibitory antibodies against the vaccine itself, and stop the vaccine working,\" says Altmann, who explains he's curious to know whether the UK's vaccine advisory committee – the JCVI – have taken this into consideration.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09w6hkh"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAnother question is whether the immunity we gain from booster programmes might last longer if they were designed with updated versions of the vaccines – such as those that can recognise new variants like Delta.\u003C\u002Fp\u003E\n\u003Cp\u003E\"You know, again, you could write a whole PhD on this sort of stuff,\" says Altmann, \"You have a complex world out there, you've got all these different people and all these different patterns of protective immunity.\" To begin with, we were all either people who had been infected or not infected – but out paths are rapidly diverging, and this makes vaccine development more complicated.\u003C\u002Fp\u003E\n\u003Cp\u003EAltmann explains that one person walking down the street might have been infected with the original Covid-19 variant, then received two doses of the Pfizer vaccine… then been reinfected with the Delta strain. Meanwhile, another person may have received a different brand of vaccine, and been infected with a different variant – such as the Alpha strain first identified in Kent.\u003C\u002Fp\u003E\n\u003Cp\u003E\"So how am I going to guess which spike sequence or mutations to stick into my vaccine to make something that might be useful for the next year or two?\" says Altmann. \"It's so incredibly not as simple as saying 'which is the last variant you last heard of, bung that one in' – it's so not as simple as that.\"\u003C\u002Fp\u003E\n\u003Cp\u003EIn an ideal world, Altmann would like to see governments taking this variability in a population's immunity into account – and perhaps even testing people's antibody levels to see if they actually need a third dose at all. \u003C\u002Fp\u003E\n\u003Cp\u003EOther lingering questions include how large the third dose should be – the UK is planning to experiment with giving people \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2021\u002Faug\u002F22\u002Fuk-scientists-look-at-halving-boosters-to-save-vaccine-for-rest-of-the-world\"\u003Eless vaccine in the booster shot\u003C\u002Fa\u003E, to make more doses available to developing countries – and how long after the second it should be administered. For example, while Israel has run with a five-month gap, the US plans to wait eight months between them.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA booster future\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, perhaps the most pressing question of all is how long a person's newly restored immunity from their booster shot will last – and here at least, there is a strong suspicion of what is to come.\u003C\u002Fp\u003E\n\u003Cp\u003E\"I don't think we know that,\" says Humar. \"But I think that that's a very real possibility. That's what it's starting to look like, especially as we see the waning antibodies and the decreased effectiveness against variants.\"\u003C\u002Fp\u003E\n\u003Cp\u003EAltmann could also see booster programmes eventually evolving into annual ones, however he's unsure whether the science would back it up. \"I think that would be a managerial logistics decision, not an immunological decision,\" he says, explaining that it seems unlikely population immunity – with all the antibodies and T cells that involves – would be low enough to justify it.\u003C\u002Fp\u003E\n\u003Cp\u003E\"But I could easily imagine Department of Health planners saying 'well, the easiest thing is to do it at the same time every autumn. So let's just fire up more doses in the world and do it',\" says Altmann.\u003C\u002Fp\u003E\n\u003Cp\u003EIt looks like Israel is already close to such a scenario. No sooner had they announced that they were providing third doses to all eligible citizens, than the country's \"virus czar\", Salman Zarka, suggested they should start preparing for fourth shots.\u003C\u002Fp\u003E\n\u003Cp\u003EZarka \u003Ca href=\"https:\u002F\u002Fwww.timesofisrael.com\u002Fvirus-czar-calls-to-begin-readying-for-eventual-4th-vaccine-dose\u002F\"\u003Etold the Times of Israel\u003C\u002Fa\u003E, \"This is our life from now on, in waves.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E*Zaria Gorvett is a senior journalist for BBC Future and tweets \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FZariaGorvett\"\u003E\u003Cstrong\u003E\u003Cem\u003E@ZariaGorvett\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EThis article was updated on 9\u002F11\u002F21. The original version incorrectly stated that the third dose programme in the US would be available to certain groups once eight weeks had elapsed since their second dose (it's actually six months).\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cem\u003E\u003Cstrong\u003EFacebook\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cem\u003E\u003Cstrong\u003ETwitter\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003C\u002Fem\u003E\u003Cstrong\u003E\u003Cem\u003E \u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cem\u003E\u003Cstrong\u003EInstagram\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003Esign up for the weekly \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Ca href=\"http:\u002F\u002Fbbc.com\u002F\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003Ebbc.com\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003E features newsletter\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called \"The Essential List\". A handpicked selection of stories from \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002F\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003EBBC Future\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fculture\u002F\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003ECulture\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fworklife\u002F\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003EWorklife\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ftravel\u002F\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003ETravel\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E and \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Freel\" target=\"_blank\"\u003E\u003Cem\u003E\u003Cstrong\u003EReel\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose-10"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-09-16T16:53:03.705Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"Covid-19: How effective is a third vaccine dose?","headlineShort":"Do we really need third vaccine doses?","image":["p09w6d9z"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"From squandering global vaccine supplies to the possibility of undermining immunity from the first two doses, booster programmes are a surprisingly complicated business.","summaryShort":"Deciding if booster shots are worth it is surprisingly messy","tag":["tag\u002Fcovid-19","tag\u002Fvirus","tag\u002Fhealth","tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2021-09-17T02:42:28.036169Z","entity":"article","guid":"c0924ecd-b209-418b-b7b9-87c6af0df6f1","id":"future\u002Farticle\u002F20210916-covid-19-how-effective-is-a-third-vaccine-dose","modifiedDateTime":"2021-11-19T20:25:37.584454Z","project":"future","slug":"20210916-covid-19-how-effective-is-a-third-vaccine-dose","cacheLastUpdated":1642293446378},"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy","_id":"6183c25b45ceed56a84f8379","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fdavid-robson"],"bodyIntro":"Social media is rife with posts disparaging the vaccine hesitant – but these reactions to a complex and nuanced issue are doing more harm than good.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\u003Cem\u003EAs we head towards the end of another extraordinary year, BBC Future is taking a look back at some of our favourite stories for our \"Best of 2021\" collection. \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumns\u002Fbest-of-bbc-future\"\u003EDiscover more of our picks here\u003C\u002Fa\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThere should be no doubt about it: Covid-19 vaccines are saving lives.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EConsider some recent statistics from the UK. In a study tracking more than 200,000 people, nearly every single participant had \u003Ca href=\"https:\u002F\u002Fwww.imperial.ac.uk\u002Fnews\u002F226413\u002Falmost-100-double-vaccinated-people-england\u002F\"\u003Edeveloped antibodies against the virus\u003C\u002Fa\u003E within two weeks of their second dose. And despite initial worries that the current vaccines may be less effective against the Delta variant, analyses suggest that both the \u003Ca href=\"https:\u002F\u002Fwww.gov.uk\u002Fgovernment\u002Fnews\u002Fvaccines-highly-effective-against-hospitalisation-from-delta-variant\"\u003EAstraZeneca and the Pfizer-BioNTech jabs reduce hospitalisation rates by 92-96%\u003C\u002Fa\u003E. As many health practitioners have repeated, the risks of severe side effects from a vaccine are \u003Ca href=\"https:\u002F\u002Fblogs.bmj.com\u002Fbmj\u002F2021\u002F05\u002F06\u002Fputting-risks-into-context-covid-19-vaccines-and-blood-clots\u002F\"\u003Etiny in comparison to the risk of the disease itself\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EYet a sizeable number of people are still reluctant to get the shots. According to a recent report by the International Monetary Fund, that \u003Ca href=\"https:\u002F\u002Fwww.imf.org\u002Fen\u002FPublications\u002FWP\u002FIssues\u002F2021\u002F05\u002F06\u002FWho-Doesnt-Want-to-be-Vaccinated-Determinants-of-Vaccine-Hesitancy-During-COVID-19-50244\"\u003Eranges from around 10-20% of people in the UK to around 50% in Japan and 60% in France\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe result is becoming something of a culture war on social media, with many online commentators claiming that the vaccine hesitant are simply ignorant or selfish. But psychologists who specialise in medical decision-making argue these choices are often the result of many complicating factors that need to be addressed sensitively, if we are to have any hope of reaching population-level immunity.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe 5Cs\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EFirst, some distinctions. While it is tempting to assume that anyone who refuses a vaccine holds the same beliefs, the fears of most vaccine hesitant people should not be confused with the \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fworld-us-canada-57374241\"\u003Ebizarre theories of staunch anti-vaxxers\u003C\u002Fa\u003E. \"They're very vocal, and they have a strong presence offline and online,\" says Mohammad Razai at the Population Health Research Institute, St George's, University of London, who has written about the \u003Ca href=\"https:\u002F\u002Fjournals.sagepub.com\u002Fdoi\u002Ffull\u002F10.1177\u002F01410768211018951\"\u003Evarious psychological and social factors that can influence people's decision-making\u003C\u002Fa\u003E around vaccines. \"But they’re a very small minority.\"\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210609-how-long-will-long-covid-last\"\u003ESolving the puzzle of long Covid\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19\"\u003ECan vaccinated people spread Covid-19?\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210119-covid-19-variants-how-the-virus-will-mutate-in-the-future\"\u003EHow Covid-19 will evolve in the future\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe vast majority of vaccine-hesitant people \u003Ca href=\"https:\u002F\u002Ftheconversation.com\u002Fanti-vaccination-beliefs-dont-follow-the-usual-political-polarization-81001\"\u003Edo not have a political agenda\u003C\u002Fa\u003E and are not committed to an \u003Ca href=\"https:\u002F\u002Fwww.tandfonline.com\u002Fdoi\u002Ffull\u002F10.1080\u002F14760584.2021.1889799\"\u003Eanti-scientific cause\u003C\u002Fa\u003E: they are simply undecided about their choice to take the injection.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe good news is that many people \u003Ca href=\"https:\u002F\u002Fwww.ucl.ac.uk\u002Fnews\u002F2021\u002Fmar\u002Fover-4-5-people-who-were-hesitant-would-now-take-covid-19-vaccine\"\u003Ewho were initially hesitant are changing their mind\u003C\u002Fa\u003E. \"But even a delay is considered a threat to health because viral infections spread very quickly,\" says Razai. This would have been problematic if we were still dealing with the older variants of the virus, but the higher transmissibility of the new Delta variant has increased the urgency of reaching as many people as quickly as possible.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09pxg7z"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EFortunately, scientists began studying vaccine hesitancy long before Sars-Cov-2 was first identified in Wuhan in December 2019, and they have explored various models which attempt to capture the differences in people's health behaviour. One of the most promising is known as the 5Cs model, which considers the following psychological factors:\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EConfidence\u003C\u002Fstrong\u003E\u003Cem\u003E: \u003C\u002Fem\u003Ethe person's trust in the vaccines efficacy and safety, the health services offering them, and the policy makers deciding on their rollout\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EComplacency\u003C\u002Fstrong\u003E\u003Cem\u003E: \u003C\u002Fem\u003Ewhether or not the person considers the disease itself to be a serious risk to their health\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ECalculation\u003C\u002Fstrong\u003E\u003Cem\u003E: \u003C\u002Fem\u003Ethe individual's engagement in extensive information searching to weigh up the costs and benefits\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EConstraints (or convenience)\u003C\u002Fstrong\u003E: how easy it is for the person in question to access the vaccine\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ECollective responsibility\u003C\u002Fstrong\u003E: the willingness to protect others from infection, through one's own vaccination\u003C\u002Fp\u003E\n\u003Cp\u003EIn 2018, Cornelia Betsch at the University of Erfurt in Germany and colleagues asked participants to rate \u003Ca href=\"https:\u002F\u002Fjournals.plos.org\u002Fplosone\u002Farticle?id=10.1371\u002Fjournal.pone.0208601#sec038\"\u003Ea series of statements that measured each of the 5Cs\u003C\u002Fa\u003E, and then compared the results with their actual uptake of relevant procedures, such as the influenza or the HPV vaccine. Sure enough, they found that the 5Cs could explain a large amount of the variation in people's decisions, and consistently outperformed many other potential predictors – such as questionnaires that focused more exclusively on issues of trust without considering the other factors.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"It is useful to examine the various cognitive biases that are known to sway our perceptions","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIn currently unpublished research, Betsch recently used the model to predict people's uptake of the Covid-19 vaccines, and her results so far suggest that the 5Cs model can explain the majority of the variation in people's decisions\u003Cstrong\u003E.\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThere will be other contributing factors, of course. A recent study from the University of Oxford suggests that \u003Ca href=\"https:\u002F\u002Fwww.cambridge.org\u002Fcore\u002Fjournals\u002Fpsychological-medicine\u002Farticle\u002Finjection-fears-and-covid19-vaccine-hesitancy\u002FA70D5D859CC25804B7AC4FB3AD54F68D\"\u003Ea fear of needles is a major barrier for around 10% of the population\u003C\u002Fa\u003E. But the 5Cs approach certainly seems to capture the most common reasons for vaccine hesitancy.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EConfirmation bias\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EWhen considering these different factors and the ways they may be influencing people's behaviour, it is also useful to examine the various cognitive biases that are known to sway our perceptions.\u003C\u002Fp\u003E\n\u003Cp\u003EConsider the first two Cs – the \u003Cem\u003Econfidence\u003C\u002Fem\u003E in the vaccine, the \u003Cem\u003Ecomplacency\u003C\u002Fem\u003E about the dangers of disease itself.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09pxfq3"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EJessica Saleska at the University of California, Los Angeles points out that humans have two seemingly contradictory tendencies – a \"negativity bias\" and an \"optimism bias\" that \u003Ca href=\"https:\u002F\u002Facademic.oup.com\u002Ftbm\u002Farticle\u002F11\u002F3\u002F821\u002F6187487?login=true\"\u003Ecan each skew people’s appraisals of the risks and benefits\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe negativity bias concerns the way you appraise events beyond your control. \"When you're presented with negative information, that tends to stick in your mind,\" says Saleska. The optimism bias, in contrast, concerns your beliefs about yourself – whether you think you are fitter and healthier than the average person. These biases may work independently, meaning that you may focus on the dangerous side effects of the vaccines while simultaneously believing that you are less likely to suffer from the disease, a combination that would reduce confidence and increase complacency.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"It is easy to dismiss someone else's decisions if you don't understand the challenges they face in their day-to-day lives","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThen there's the famous confirmation bias, which can also twist people's perceptions of the risks of the virus through the ready availability of misinformation from dubious sources that exaggerate the risks of the vaccines. This reliance on misleading resources means that people who score highly on the \"calculation\" measure of the 5Cs scale – the people who actively look for data – are often more vaccine hesitant than people who score lower. \"If you already think the vaccination could be risky, then you type in 'is this vaccination dangerous?', then all you are going find is the information that confirms your prior view,\" says Betsch. \u003C\u002Fp\u003E\n\u003Cp\u003ERemember that these psychological tendencies are extremely common. Even if you have accepted the vaccine, they have probably influenced your own decision making in many areas of life. To ignore them, and to assume that the vaccine hesitant are somehow wilfully ignorant, is itself a foolish stance.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09pxj25"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ENor should we forget the many social factors that might influence people's uptake – the \"constraints\u002Fconvenience\" factor in the 5Cs. Quite simply, the perception that a vaccine is difficult to access will only discourage people who are already sitting on the fence. When we spoke, Betsch suggested that this \u003Ca href=\"https:\u002F\u002Fwww.statista.com\u002Fstatistics\u002F1196071\u002Fcovid-19-vaccination-rate-in-europe-by-country\u002F\"\u003Emight have slowed the uptake in Germany\u003C\u002Fa\u003E, which has a very complicated system to identify who is eligible to receive the vaccine at any one time. People would respond much more quickly, she says, if they received automatic notifications.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ERazai agrees that we need to consider the question of convenience, particularly for those in poorer communities who may struggle with the time and expense of the journey to a vaccination centre. \"Travelling to and from that may be a huge issue for most people who are on minimum wage or unemployment benefits,\" he says. That's why it's often best for the vaccines to be administered in local community centres. \"I think there has been anecdotal evidence of it being more successful in places of worship, mosque, gurdwaras, and churches.\"\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EFinally, we need to be aware of the context of people's decisions, he says – such as the structural racism that might had led certain ethnic groups to have lower overall trust in medical authorities. It is easy to dismiss someone else's decisions if you don't understand the challenges they face in their day-to-day lives.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EOpening a dialogue\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003ESo what can be done?\u003C\u002Fp\u003E\n\u003Cp\u003EThere is no easy solution, but health authorities can continue to provide easy-to-digest, accurate information address the major concerns. According to \u003Ca href=\"https:\u002F\u002Fwww.imperial.ac.uk\u002Fnews\u002F221294\u002Fglobal-report-tracks-changing-health-behaviours\u002F\"\u003Ea recent report by Imperial College London's Institute of Global Health Innovation (IGHI)\u003C\u002Fa\u003E, the major barriers continue to be patient's concerns about the side effects and the fears that the vaccines haven’t been adequately tested.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"I would urge governments to stop thinking they can reach the mass of niches out there with one mass-market vaccine message – Sarah Jones","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EFor the former, \u003Ca href=\"https:\u002F\u002Fwintoncentre.maths.cam.ac.uk\u002Fnews\u002Fcommunicating-potential-benefits-and-harms-astra-zeneca-covid-19-vaccine\u002F\"\u003Egraphics showing the relative risks of the vaccines, compared to the actual disease\u003C\u002Fa\u003E, can provide some context. For the latter, Razai suggests that we need more education about the history of the vaccines' development. The use of mRNA in vaccines has been studied for decades, for instance – with long trials testing its safety. This meant \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fcoronavirus\u002F2019-ncov\u002Fvaccines\u002Fdifferent-vaccines\u002Fmrna.html\"\u003Ethe technique could be quickly adapted for the pandemic\u003C\u002Fa\u003E. \"None of the technology that has been used would be in any way harmful because we have used these technologies in other areas in healthcare and research,\" Razai says.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ESarah Jones, a doctoral researcher who co-led the IGHI report, suggests a targeted approach will be necessary. \"I would urge governments to stop thinking they can reach the mass of niches out there with one mass-market vaccine message, and work more creatively with many effective communications partners,\" she says. That might involve closer collaborations with the influencer role models within each community, she says, who can provide \"consistent and accurate information\" about the vaccines' risks and benefits.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-12"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09pxf92"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-13"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EHowever they choose to deliver the information, health services need to make it clear that they are engaging in an open dialogue, Razai says – rather than simply dismissing them out of hand. \"We have to listen to people's concerns, acknowledge them, and give them information so they can make an informed decision.\"\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ESaleska agrees that it's essential to engage in a two-way conversation – and that's something that we could all learn as we discuss these issues with our friends and family. \"Being respectful and recognising their concerns – I think that could actually be more important than just spitting out the facts or statistics,\" she says. \"A lot of the time, it's more about the personal connection than it is about the actual information that you provide.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E* \u003Ca href=\"https:\u002F\u002Fdavidrobson.me\u002F\"\u003EDavid Robson\u003C\u002Fa\u003E is the author of The Intelligence Trap: Why Smart People Do Dumb Things. His next book is The Expectation Effect: Transform Your \u003C\u002Fem\u003E\u003Cem\u003EHealth, \u003C\u002Fem\u003E\u003Cem\u003EFitness, \u003C\u002Fem\u003E\u003Cem\u003EProductivity, \u003C\u002Fem\u003E\u003Cem\u003EHappiness and \u003C\u002Fem\u003E\u003Cem\u003EAgeing, to be published in early 2022. He is \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fwww.twitter.com\u002Fd_a_robson\"\u003E\u003Cem\u003E\u003Cstrong\u003E@d_a_robson\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E on Twitter.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy-14"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-07-23T01:00:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"Why some people don't want a Covid-19 vaccine","headlineShort":"Why some people don't want a vaccine","image":["p09pxj9r"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":["tag\u002Fvaccine"],"summaryLong":"Social media is rife with posts disparaging the vaccine hesitant – but these reactions are doing more harm than good.","summaryShort":"The reasons for vaccine hesitancy are complex but may prevent herd immunity","tag":["tag\u002Fcovid-19","tag\u002Fvaccine","tag\u002Fpsychology"],"textToSpeech":false,"creationDateTime":"2021-07-23T00:00:00.555572Z","entity":"article","guid":"fd76e8ff-70d5-414a-ac7c-1438cf2abeeb","id":"future\u002Farticle\u002F20210720-the-complexities-of-vaccine-hesitancy","modifiedDateTime":"2021-12-24T15:51:49.355388Z","project":"future","slug":"20210720-the-complexities-of-vaccine-hesitancy","cacheLastUpdated":1642293446380},"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots","_id":"6183c1f845ceed30ab5270e9","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fdavid-cox"],"bodyIntro":"Some people are unusually resilient to the coronavirus, so scientists are now searching their genes and blood in the hope of finding the pandemic's Achilles' heel.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAs a young man, Stephen Crohn could only watch helplessly as one by one, his friends began dying from a disease which had no name. When his partner, a gymnast called Jerry Green, fell desperately ill in 1978 with what we now know as Aids, Crohn simply assumed he was next.\u003C\u002Fp\u003E\n\u003Cp\u003EBut instead as Green became blind and emaciated as the HIV virus ravaged his body, Crohn remained completely healthy. Over the following decade, dozens of friends and other partners would meet a similar fate.\u003C\u002Fp\u003E\n\u003Cp\u003EIn 1996, an immunologist called Bill Paxton, who worked at the Aaron Diamond Aids Research Center in New York, and had been looking for gay men who were apparently resistant to infection, discovered the reason why. When Paxton tried to infect Crohn's white blood cells with the HIV virus in a test tube, it proved impossible.\u003C\u002Fp\u003E\n\u003Cp\u003EIt transpired that Crohn had a genetic mutation – one which occurs in roughly 1% of the population – which prevents HIV from binding to the surface of his white blood cells. Over the following decade, scientists developed an anti-retroviral drug called maraviroc, which would transform the treatment of HIV by mimicking the effect of this mutation. It has proved crucial in helping to control the virus in infected people.\u003C\u002Fp\u003E\n\u003Cp\u003EWhile Crohn died in 2013 at the age of 66, his story left a legacy that has stretched well beyond HIV. Over the past two decades, it has inspired a whole new realm of medical science, where scientists look to identify so-called \"outliers\" like Crohn, who are either unusually resilient or susceptible to disease, and use them as the basis for discovering new treatments.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p097j6yz"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAs a geneticist at the Icahn School of Medicine in New York, Jason Bobe has spent much of the past decade studying people with unusual traits of resilience to illnesses ranging from heart disease to Lyme disease. So when the first wave of Covid-19 struck, his initial instinct was to wonder whether there were people out there who the virus was unable to infect.\u003C\u002Fp\u003E\n\u003Cp\u003E\"It just made me think of Stephen Crohn, and that somebody ought to be looking for these outliers in Covid,\" he says.\u003C\u002Fp\u003E\n\u003Cp\u003EBobe's idea was to try and find entire families where multiple generations had suffered severe cases of Covid-19, but one individual was asymptomatic. \"Having a whole family together makes it easier to understand the genetic factors at play, and identify genetic factors behind resilience,\" he says.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also be interested in:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210119-covid-19-variants-how-the-virus-will-mutate-in-the-future\"\u003EHow Covid-19 might mutate in the future\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210127-covid-19-variants-how-mutations-are-changing-the-pandemic\"\u003EWhat we know about the Covid-19 variants\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose\"\u003EHow effective is a single vaccine dose?\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EIn the past, identifying such families might have taken years or even decades, but the modern digital world offers ways of reaching people that were inconceivable at the height of the HIV pandemic. Since June 2020, Bobe has been working with the coordinators of Facebook groups for Covid-19 patients and their relatives such as \u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002Fgroups\u002FCOVID19survivorcorps\"\u003ESurvivor Corps\u003C\u002Fa\u003E to try and identify candidate families. He has also created an \u003Ca href=\"https:\u002F\u002Fwww.resilienceproject.com\u002Ftell-us-your-story\"\u003Eonline platform\u003C\u002Fa\u003E, where anyone who has had an asymptomatic case of Covid-19 can complete a survey to assess their suitability for inclusion in a study of Covid-19 resilience. \u003C\u002Fp\u003E\n\u003Cp\u003EOver the coming months, Bobe hopes to sequence the genomes of people who display signs of resilience to Covid-19, to see whether there are any common mutations that appear to help them evade the virus. If so, this may provide inspiration for antivirals which can protect against both Covid-19, and also future coronavirus outbreaks.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"The idea is to find why some people who are heavily exposed to the virus do not develop Covid-19 and remain serum negative with no antibodies – Mayana Zatz","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThere are some clues already. Researchers \u003Ca href=\"https:\u002F\u002Fwww.acpjournals.org\u002Fdoi\u002F10.7326\u002FM20-4511\"\u003Ehave identified\u003C\u002Fa\u003E an association between type O and rhesus negative blood groups, and a lower risk of severe disease. But while scientists have hypothesised that people with certain blood types may naturally have antibodies capable of recognising some aspect of the virus, the precise nature of the link remains unclear.   \u003C\u002Fp\u003E\n\u003Cp\u003EBut Bobe is far from the only scientist \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2020\u002F03\u002Fhow-sick-will-coronavirus-make-you-answer-may-be-your-genes\"\u003Eattempting to tease apart what makes Covid-19 outliers\u003C\u002Fa\u003E unique. Mayana Zatz, director of the Human Genome Research Centre at the University of São Paulo has identified 100 couples, where one person got Covid-19 but their partner was not infected. Her team is now studying them in the hope of identifying genetic markers of resilience. \"The idea is to try and find why some people who are heavily exposed to the virus do not develop Covid-19 and remain serum negative with no antibodies,\" she says. \"We found out that this is apparently relatively common. We received about 1,000 emails of people saying that they were in this situation.\"\u003C\u002Fp\u003E\n\u003Cp\u003EZatz is also analysing the genomes of 12 centenarians who have only been mildly affected by the coronavirus, including one 114-year-old woman in Recife who she believes to be the oldest person in the world to have recovered from Covid-19. While Covid-19 has been particularly deadly to the older generations, elderly people who are remarkably resistant could offer clues for new ways to help the vulnerable survive future pandemics.\u003C\u002Fp\u003E\n\u003Cp\u003EBut while cases of remarkable resilience are particularly eye-catching for some geneticists, others are much more interested in outliers at the other end of the spectrum. Over the past couple of months, studies of these patients have already yielded key insights into exactly why the Sars-CoV-2 virus can be so deadly.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EDisrupting the body's alarm system\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003ELast summer, Qian Zhang had arrived for a dental appointment when her dentist turned to her and asked, \"How come some people end up in intensive care with Covid-19, while my sister got it and didn't even know she was positive?\"\u003C\u002Fp\u003E\n\u003Cp\u003EAs a geneticist working at The Rockefeller University, New York, it was a question that Zhang was particularly well equipped to answer. Over the past 20 years, Rockefeller scientists have probed the human genome for clues as to why some people become unexpectedly and severely ill when infected by common viruses ranging from \u003Ca href=\"https:\u002F\u002Frupress.org\u002Fjem\u002Farticle\u002F208\u002F10\u002F2083\u002F54582\u002FHerpes-simplex-virus-encephalitis-in-a-patient\"\u003Eherpes\u003C\u002Fa\u003E to \u003Ca href=\"https:\u002F\u002Frupress.org\u002Fjem\u002Farticle\u002F216\u002F9\u002F2038\u002F120731\"\u003Einfluenza\u003C\u002Fa\u003E. \"In every infectious disease we've looked at, you can always find outliers who become severely ill, because they have genetic mutations which make them susceptible,\" says Zhang.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p097j7xd"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EWhen the Covid-19 pandemic began, it soon became clear that the elderly, especially those with underlying health conditions, were \u003Ca href=\"https:\u002F\u002Fbmcpublichealth.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs12889-020-09826-8\"\u003Edisproportionally affected\u003C\u002Fa\u003E. But the Rockefeller scientists were more interested in the unusual cases, such as the apparently healthy 30-year-olds who ended up on ventilators. In April, they launched an international collaboration called the \u003Ca href=\"https:\u002F\u002Fwww.covidhge.com\u002F\"\u003ECovid Human Genetic Effort\u003C\u002Fa\u003E, partnering with universities and medical centres from Belgium to Taiwan with the aim of identifying the cause.\u003C\u002Fp\u003E\n\u003Cp\u003EEven as the project began, Zhang already had a culprit in mind. In the 1960s, scientists discovered that our cells have an inbuilt alarm system to alert the rest of the body when it's being attacked by a new virus. \"When a virus enters a cell, the infected cell makes proteins called 'type one interferons', which it releases outside the cell,\" explains Zhang. \"All the surrounding cells receive that signal, and they devote everything to preparing to fight that virus. If the infection is serious, then cells will make enough type one interferon that it's released into the bloodstream, and so the entire body knows that it's under attack.\"\u003C\u002Fp\u003E\n\u003Cp\u003EBut sometimes genetic flaws mean that this system malfunctions. In 2015, Rockefeller scientists \u003Ca href=\"https:\u002F\u002Fscience.sciencemag.org\u002Fcontent\u002F348\u002F6233\u002F448?ijkey=d0d9703ce8f656375211e96e29ea149cac6573eb&keytype2=tf_ipsecsha\"\u003Eidentified mutations\u003C\u002Fa\u003E in young, otherwise healthy people which led to them developing severe pneumonia from influenza. The mutations meant that the interferon response was non-existent. \"If the alarm is silenced, then the virus can spread and proliferate much faster within the body,\" says Zhang.\u003C\u002Fp\u003E\n\u003Cp\u003EIt appears this also plays a role in making some people unexpectedly vulnerable to Covid-19. A series of scientific \u003Ca href=\"https:\u002F\u002Fwww.rockefeller.edu\u002Fnews\u002F29183-severe-covid-19-faulty-genes-autoimmune-condition\u002F\"\u003Epapers\u003C\u002Fa\u003E published in September 2020 compared 987 outliers – Covid-19 patients who developed severe pneumonia who were either younger than 50, or older than 50 and without any co-morbidities – to asymptomatic patients. Around 3.5% had a \u003Ca href=\"https:\u002F\u002Fscience.sciencemag.org\u002Fcontent\u002F370\u002F6515\u002Feabd4570\"\u003Emajor gene mutation\u003C\u002Fa\u003E which made it impossible for them to generate an interferon response.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"There's accumulating evidence that a significant fraction of patients with severe disease are making unusual amounts and types of autoantibodies - Ignacio Sanz","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAnother \u003Ca href=\"https:\u002F\u002Fscience.sciencemag.org\u002Fcontent\u002F370\u002F6515\u002Feabd4585\"\u003E10% were found to have self-targeted\u003C\u002Fa\u003E antibodies in their blood, known as autoantibodies, which bind to any interferon proteins released by cells and remove them from the bloodstream before the alert signal can be picked up by the rest of the body. According to Ignacio Sanz, an expert in immunology at Emory University, this confirms \u003Ca href=\"https:\u002F\u002Fwww.medrxiv.org\u002Fcontent\u002F10.1101\u002F2020.12.28.20248807v1\"\u003Eother findings\u003C\u002Fa\u003E that suggest autoantibodies play a key role in serious cases of Covid-19 by shutting down the body's ability to defend itself against viruses. \"There's accumulating evidence that a \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC7724273\u002F\"\u003Esignificant fraction\u003C\u002Fa\u003E of patients with severe disease are making unusual amounts and types of autoantibodies,\" he says.\u003C\u002Fp\u003E\n\u003Cp\u003ERockefeller scientists now want to use this information to detect people who might have an invisible vulnerability to Covid-19, as well as other respiratory viruses such as seasonal influenza or a new coronavirus pandemic. Zhang explains that anyone who is known to have a genetic mutation impairing their interferon response can be treated with type one interferons, either as a preventative measure or in the early stages of infection. \"Since doing the study, we've had three patients in Paris, who already knew they had these genetic mutations,\" she says. \"After testing positive for Covid-19, they received an injection of interferon, and all three outcomes were very good. No severe illness.\"\u003C\u002Fp\u003E\n\u003Cp\u003EThey are also collaborating with blood banks around the globe to try and identify the true prevalence of autoantibodies which act against type one interferon within the general population. If there is a significant percentage, then tests could be developed that can screen people to find out whether they are unknowingly at much greater risk from a viral infection. \"We need to find out just how many people are walking around with these autoantibodies,\" says Zhang. \"Because many of the people in our study looked totally normal, and had no other problems, until they got Covid.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ESusceptibility genes\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EBut autoantibodies and mutations that directly block interferon only seem to account for around \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2020\u002F09\u002Fhidden-immune-weakness-found-14-gravely-ill-covid-19-patients\"\u003E14% of unusually susceptible patients\u003C\u002Fa\u003E. For the remaining 86%, geneticists believe their vulnerability arises from a network of genetic interactions, which affect them in direct ways when a virus strikes.\u003C\u002Fp\u003E\n\u003Cp\u003E\"Only a small number of people get severely infected because they have a mutation in one main gene,\" says Alessandra Renieri, professor of medical genetics at the University of Siena. \"The majority of patients are following a more complex model in which many genes are co-operating between them, leading to susceptibility to severe Covid-19.\"\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p097j8fz"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ETo try and tease this apart, scientists at the University of Edinburgh have studied the genomes of 2,700 patients in intensive care units across the UK, and compared them with those of healthy volunteers. They found that \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41586-020-03065-y\"\u003Epeople vulnerable to Covid-19 have five genes\u003C\u002Fa\u003E – linked to interferon response and susceptibility to lung inflammation – which are either strikingly more or less active than the general population. \"This combination means that the virus is able to spread more easily through their body, and they are more likely to incur lung damage as a result,\" says Erola Pairo-Castineira, one of the geneticists who led the study.\u003C\u002Fp\u003E\n\u003Cp\u003EPairo-Castineira predicts that this knowledge will change the kind of first-line treatments that are offered to patients during future pandemics. In particular baricitinib – an anti-inflammatory typically used to treat rheumatoid arthritis was predicted to be an effective Covid-19 treatment by AI algorithms in February 2020. It is known to be effective at suppressing the activity of at least one of the genes driving lung inflammation. In December, a \u003Ca href=\"https:\u002F\u002Fwww.nih.gov\u002Fnews-events\u002Fnews-releases\u002Fbaricitinib-plus-remdesivir-shows-promise-treating-covid-19\"\u003Eclinical trial\u003C\u002Fa\u003E showed that a combination of baricitinib and the antiviral remdesivir reduces recovery times in Covid-19 patients.\u003C\u002Fp\u003E\n\u003Cp\u003EBoth the Rockefeller and Edinburgh scientists are now looking to conduct even larger studies of patients who have proved surprisingly susceptible to Covid-19, to try and identify further genetic clues regarding why the virus can strike down otherwise healthy people. This may yield explanations for why those with type A blood groups \u003Ca href=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMoa2020283\"\u003Eseem to have a higher risk factor\u003C\u002Fa\u003E for severe disease.\u003C\u002Fp\u003E\n\u003Cp\u003EStudying the Covid-19 outliers is also providing insights into other major mysteries of the pandemic, such as why men are markedly more susceptible than women.\u003C\u002Fp\u003E\n\u003Cp\u003E\"These studies have given us a number of ideas about that,\" says Renieri. \"They have shown us how important the interferon response is. This is interesting because after puberty, men experience an increase in testosterone, and testosterone is able to downregulate all the interferon genes. So, for men who already have a defect in these genes, this is going to make them far more vulnerable to a virus.\"\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-10"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p097j92n"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EWhile many of these answers are coming too late to make much of a difference during the current pandemic, understanding what makes people unusually resilient or vulnerable will almost certainly save lives during future outbreaks. As the Sars, H1N1, Ebola, and Mers epidemics of the past 20 years have shown us, it is inevitable that novel viruses will continue to spill over from nature, making it all the more vital to develop new ways of identifying those most at risk, and ways to treat them.\u003C\u002Fp\u003E\n\u003Cp\u003EWith this in mind, Zatz's study of Covid-19 resistant centenarians is not only focused on Sars-CoV-2, but other respiratory infections. Her team is using stem cells to convert blood samples from these centenarians into lung tissue, which they will then infect in the lab with multiple other viruses to see whether their genetic mutations also offer protection against these infections. If so, this could potentially yield completely new antiviral drugs, just like the study of Stephen Crohn's white blood cells, all those years ago.\u003C\u002Fp\u003E\n\u003Cp\u003E\"Our aim is to identify genetic variants that confer resilience, not only to Covid-19 but also to other viruses or adverse conditions,\" says Zatz. \"We hope that if we identify protective variants, and find out their role it could open new avenues for treatment.\"\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003EFacebook\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003ETwitter\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003EInstagram\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called \"The Essential List\". A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots-12"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-02-22T01:00:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"The disease-resistant patients exposing Covid-19's weak spots","headlineShort":"The people with high Covid resistance","image":["p097hsfw"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":["p097j6yz"],"relatedStories":null,"relatedTag":null,"summaryLong":"Some people are unusually resilient to the coronavirus, so scientists are now searching their genes and blood in the hope of finding the pandemic's Achilles' heel.","summaryShort":"The key to finding Covid-19's Achilles' heel might lie in some patients' blood","tag":["tag\u002Fcovid-19","tag\u002Fvirus","tag\u002Finfectiousdisease"],"textToSpeech":false,"creationDateTime":"2021-02-22T04:34:08.664724Z","entity":"article","guid":"1edb7157-82da-487d-beb9-54a7e7cf7976","id":"future\u002Farticle\u002F20210219-the-covid-resistant-patients-e-the-viruss-weak-spots","modifiedDateTime":"2022-01-10T12:32:18.615876Z","project":"future","slug":"20210219-the-covid-resistant-patients-e-the-viruss-weak-spots","cacheLastUpdated":1642293446382},"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19","_id":"6183c24745ceed5512754c56","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"There's no evidence that any of the current Covid-19 vaccines can completely stop people from being infected – and this has implications for our prospects of achieving herd immunity.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumn\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIt was 17 June 2009. An 11-year-old boy returned to the US from the UK – and inadvertently brought something with him. Later that week, while attending a religious education programme in Sullivan County, New York, he developed a mysterious swelling of his salivary glands. He had mumps, a respiratory infection spread by contact with droplets in the air.\u003C\u002Fp\u003E\n\u003Cp\u003EMeanwhile, the religious course continued. The 400 children in attendance spent hours each day engaging in prolonged face-to-face contact – specifically, a kind of Orthodox Jewish education involving facing a study partner, a \u003Cem\u003Echavrusa,\u003C\u002Fem\u003E across a narrow table, while analysing and debating text from the Talmud. By the time the programme ended, 22 others had been infected, along with three adults.\u003C\u002Fp\u003E\n\u003Cp\u003EAs the students went back to their homes, the virus spread to Brooklyn and Rockland County, then on to Ocean County and Orange County. In all, the outbreak lasted a year, and \u003Ca href=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMoa1202865\"\u003Eat least 3,502 people developed the disease\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EWhen scientists analysed what had happened, they suggested that the chavrusa style of learning might have allowed for \"particularly efficient transmission of mumps virus\". What might seem most surprising in this case is that the accidental super-spreader had received a full course of the MMR (measles, mumps and rubella) vaccine. It's likely that he did have some immunity – like the other vaccinated children, he developed relatively mild symptoms with no complications – but he was still able to carry the virus and transmit it to others.\u003C\u002Fp\u003E\n\u003Cp\u003EIn fact, most \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC7058279\u002F\"\u003Evaccines don't fully protect against infection\u003C\u002Fa\u003E, even if they can block symptoms from appearing. As a result, vaccinated people can unknowingly carry and spread pathogens. Occasionally, they can even start epidemics. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003E\"Effective\" or \"sterilising\" immunity \u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThere are two main types of immunity you can achieve with vaccines. One is so-called \"effective\" immunity, which can prevent a pathogen from causing serious disease, but can't stop it from entering the body or making more copies of itself. The other is \"sterilising immunity\", which can thwart infections entirely, and even prevent asymptomatic cases. The latter is the aspiration of all vaccine research, but surprisingly rarely achieved.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p095xd14"],"imageAlignment":"centre","imageAltText":"Quarantined children looking out of a window (Credit: Alamy)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ETake meningitis as an example. For the kind caused by the bacteria \u003Cem\u003ENeisseria meningitidis\u003C\u002Fem\u003E, there are many vaccines available for the tens of different strains. The three given in the US – MCV4, MPSV4 and MenB – can together prevent \u003Ca href=\"https:\u002F\u002Fwww.webmd.com\u002Fchildren\u002Fvaccines\u002Fmeningococcal-vaccine#1\"\u003E85-90% of disease cases\u003C\u002Fa\u003E. However, several have been shown to \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC5989891\u002F#:~:text=Transmission%20of%20N.,between%20individuals%20in%20close%20contact.&text=However%2C%20acquisition%20of%20N.,a%20phenomenon%20known%20as%20carriage.\"\u003Estill allow people to \"carry\" the bacteria\u003C\u002Fa\u003E involved.\u003C\u002Fp\u003E\n\u003Cp\u003EThey can hide out in the nose or the back of the throat, from where they are able to infect others via sneezing, coughing, kissing, or sharing cigarettes or utensils. In one study of university students in the United Kingdom, the vaccine had no effect on the proportion of people \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F25145775\u002F\"\u003Eharbouring the pathogen four weeks later\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E\"Two meningitis vaccines can have two very different effects on whether you can spread the disease,\" says Keith Neal, professor emeritus of epidemiology at the University of Nottingham. \"But only a minority of those people who get the germ go down with meningitis [in well-vaccinated communities] because they have immunity to it.\"\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose\" target=\"_blank\"\u003E\u003Cstrong\u003EHow effective is a single dose of the Covid-19 vaccines?\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210127-covid-19-variants-how-mutations-are-changing-the-pandemic\" target=\"_blank\"\u003E\u003Cstrong\u003EWhat we know about the new Covid-19 variants\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210119-covid-19-variants-how-the-virus-will-mutate-in-the-future\" target=\"_blank\"\u003E\u003Cstrong\u003EHow Covid-19 might evolve in the future\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct\" target=\"_blank\"\u003E\u003Cstrong\u003EHow Covid-19 is changing the flu\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EIt's also possible to be infected with \u003Ca href=\"https:\u002F\u002Foxford.universitypressscholarship.com\u002Fview\u002F10.1093\u002Foso\u002F9780198811879.001.0001\u002Foso-9780198811879-chapter-7\"\u003Epertussis\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.gastrojournal.org\u002Farticle\u002FS0016-5085(13)01134-7\u002Fpdf\"\u003Ehepatitis B\u003C\u002Fa\u003E, mumps, and (often, but not always) \u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Farticles\u002F10.3389\u002Ffimmu.2020.01166\u002Ffull\"\u003Einfluenza\u003C\u002Fa\u003E, regardless of whether you have been vaccinated – though all these immunisations are highly effective at preventing people from developing serious symptoms or needing to be hospitalised.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EHow sterilising immunity works\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EWhile effective immunity is usually provided by a combination of white blood cells – such as B and T cells – along with antibodies, sterilising immunity is \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02400-7#:~:text=Long%2Dterm%20immunity%20can%20vary,gaining%20ground%20in%20the%20body.\"\u003Etypically all about the latter\u003C\u002Fa\u003E. In particular, it relies on neutralising antibodies, which defend the body from pathogens by sticking to their outer surface and preventing them from interacting with their intended targets, such as the cells that line the nose, throat or lungs.\u003C\u002Fp\u003E\n\u003Cp\u003EIn the case of Covid-19, neutralising antibodies that recognise the virus bind to the spike protein on its surface, which it uses to enter cells. To achieve sterilising immunity, vaccines must stimulate enough of these antibodies to catch any virus particles entering the body and immediately disarm them.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhat type of immunity do the Covid-19 vaccines provide?\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\"In a nutshell we don't know, because they’re too new,\" says Neal.\u003C\u002Fp\u003E\n\u003Cp\u003ESo far, the available Covid-19 vaccines have not been judged primarily on their ability to prevent transmission – though this is now being evaluated as a secondary endpoint for many of them. Instead, their efficacy was assessed by whether they could prevent symptoms from developing. \"This means that we set our targets kind of pragmatically,\" says Danny Altmann, professor of immunology at Imperial College London.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-2"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p095xd8z"],"imageAlignment":"centre","imageAltText":"People queueing at a vaccination centre in Israel (Credit: Getty Images)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EScientists already know that the antibodies people develop after natural infections with Covid-19 don't always prevent them from being reinfected. One study of British healthcare workers found that people who \u003Ca href=\"https:\u002F\u002Fwww.medrxiv.org\u002Fcontent\u002F10.1101\u002F2021.01.13.21249642v1\"\u003Ehad antibodies already\u003C\u002Fa\u003E when the study began – presumably from a first infection – had a 17% chance of catching it a second time. Around 66% of these cases were asymptomatic, but it's thought that you \u003Ca href=\"https:\u002F\u002Fwww.bmj.com\u002Fcontent\u002F371\u002Fbmj.m4851\"\u003Edon't need to have symptoms\u003C\u002Fa\u003E to be at risk of passing the virus on to others. \u003C\u002Fp\u003E\n\u003Cp\u003E\"For a virus like this, I almost think that's asking too much of a vaccine,\" says Altmann. \"It's really, really hard to do.\"\u003C\u002Fp\u003E\n\u003Cp\u003EHappily, this isn't quite the end of the story.\u003C\u002Fp\u003E\n\u003Cp\u003EThere are some early hints that certain vaccines might be able to reduce transmission, even if they can’t eliminate it entirely. One way it might do this is by reducing the number of viral particles in people’s bodies. \"It is quite likely that if the vaccines are making people less ill, they are producing less virus, and therefore will be less infectious, but that's just a theory,\" says Neal.  \u003C\u002Fp\u003E\n\u003Cp\u003ESterilising immunity is also notoriously tricky to prove.\u003C\u002Fp\u003E\n\u003Cp\u003ESince most clinical trials didn't check whether the vaccines were preventing transmission, scientists are currently looking to see whether they are having an impact on infection rates in places where they have already been widely distributed. In the UK, you might expect that outbreaks in care homes – where vaccination efforts are being prioritised – would become less frequent, if the vaccines were having an effect.\u003C\u002Fp\u003E\n\u003Cp\u003EBut this is problematic. \"There are two factors,\" says Neal. \"We've got lockdowns and a vaccine. So, it's actually quite difficult to separate them out. Is it the vaccine? Is it the lockdown, or more likely a combination of both?\"\u003C\u002Fp\u003E\n\u003Cp\u003EHere's what we know so far about the current vaccines' ability to halt transmission. (But first – to avoid confusion, information about their ability to prevent symptoms or protect people from disease has not been included.)         \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EOxford-AstraZeneca\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EBack in July last year, a \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41586-020-2608-y\"\u003Estudy testing the efficacy\u003C\u002Fa\u003E of this vaccine in rhesus macaques – which have similar lung physiology to humans – provided some promising results. It found that while the monkeys were protected from serious illness, it did not prevent them from becoming infected with Covid-19 in the first place. Vaccinated monkeys were as likely to become infected as the unvaccinated ones, though they did have fewer viral particles in their lungs than the unvaccinated group.\u003C\u002Fp\u003E\n\u003Cp\u003EThe authors noted that their results suggested that the vaccine might not prevent the transmission of the virus, \"\u003Cem\u003Ehowever, it could significantly reduce illness\"\u003C\u002Fem\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EFast-forward to the \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(20)32661-1\u002Ffulltext\"\u003Ephase III trials\u003C\u002Fa\u003E in humans, and the picture becomes a little more complicated. Unusually, the Oxford-AstraZeneca vaccine didn't just involve injecting the participants with two doses of either the new vaccine or a placebo – in this case, the meningitis vaccine – and then following up to see if they had developed any symptoms several weeks later. This trial also involved the additional step of asking them to complete a nose and throat swab each week, to test for asymptomatic infections.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p095xcvr"],"imageAlignment":"centre","imageAltText":"Neisseria meningitidis cells under a microscope (Credit: Alamy)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAccording to these results, published in January 2021, the vaccine was 59% effective at preventing infections in those who received a half dose, followed by a standard dose – a group that also happened to be \u003Ca href=\"https:\u002F\u002Fwww.bloomberg.com\u002Fnews\u002Farticles\u002F2020-11-24\u002Fastra-vaccine-s-90-efficacy-in-covid-came-in-younger-population\"\u003Eyounger than the average\u003C\u002Fa\u003E for the study overall. However, among those who received two full doses, that figure dropped to just 4%. The research did not look at whether the vaccine had any impact on the number of viral particles in the patients' lungs.\u003C\u002Fp\u003E\n\u003Cp\u003EThe authors explained that while the reduction in the number of infections – and therefore the potential for transmission – in the half-dose group was promising, further data was needed to confirm the findings.\u003C\u002Fp\u003E\n\u003Cp\u003EThe latest development is a new paper \u003Ca href=\"https:\u002F\u002Fpapers.ssrn.com\u002Fsol3\u002Fpapers.cfm?abstract_id=3777268\"\u003Epublished in pre-print\u003C\u002Fa\u003E on 1 February, which revealed the results of a further month of studying the trial participants. The researchers found that the vaccine cut the number of cases with detectable virus by 67% after a single standard dose, and wrote that this shows \"\u003Cem\u003Ethe potential for a substantial reduction in transmission\"\u003C\u002Fem\u003E.   \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EPfizer-BioNTech\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThere isn't yet any conclusive evidence that the Pfizer-BioNTech vaccine can prevent people from being infected with the coronavirus – and therefore halt its spread. But there are some early signs that it might.\u003C\u002Fp\u003E\n\u003Cp\u003EIn early January, the chief executive of Pfizer, Albert Bourla, said animal studies found that it provided \u003Ca href=\"https:\u002F\u002Fwww.thejournal.ie\u002Fpfizer-ceo-5323949-Jan2021\u002F\"\u003Esignificant protection\u003C\u002Fa\u003E from transferring the virus, though this hasn’t been proven in humans.\u003C\u002Fp\u003E\n\u003Cp\u003EThen a \u003Ca href=\"https:\u002F\u002Fwww.shebaonline.org\u002Fpfizer-biontech-vaccine-is-highly-effective\u002F\"\u003Esmall Israeli survey\u003C\u002Fa\u003E found that, out of 102 medical staff who had received two doses of the vaccine, only two had developed \"low\" amounts of antibodies. The other 98% had more antibodies than people who had been infected with Covid-19. The results were released via a press release, which quotes the head of the study speculating that these powerful immune responses were likely to prevent people from becoming carriers or spreading the disease.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, there are a number of reasons to be cautious about interpreting these results, such as the small sample size and the fact that the research was not published in a peer-reviewed journal.\u003C\u002Fp\u003E\n\u003Cp\u003EMore recently, the Israeli Ministry of Health (MoH) looked at the health records of a million people in the country, and found that – a week after being fully vaccinated – just \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2021\u002Fjan\u002F31\u002Fisrael-covid-vaccination-data-offers-hope-exit-pandemic\"\u003E317 people out of 715,425\u003C\u002Fa\u003E tested positive for the coronavirus.\u003C\u002Fp\u003E\n\u003Cp\u003EAgain, this was not a clinical trial – there was no unvaccinated control group, and the effect could be down to something else, such as the \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Farticle\u002Fhealth-coronavirus-israel\u002Fupdate-1-israel-imposing-third-national-covid-19-lockdown-idUSL1N2J40HC\"\u003Eimpact of a lockdown imposed in December\u003C\u002Fa\u003E. But the infection rate was considerably lower than elsewhere (0.04%, while it's estimated that 1.87% of people in England had the virus in the week ending 23 January).\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-6"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p095xdj8"],"imageAlignment":"centre","imageAltText":"Lab technicians manufacturing the Oxford\u002F Astra Zeneca vaccine (Credit: Getty Images)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EA study by the nation’s domestic healthcare provider – Maccabi Healthcare Services – found similarly encouraging results. Out of 163,000 people given a full course of the vaccine, just 31 were infected, compared to 6,500 infections in an equivalent group of unvaccinated people.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EModerna\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThough the Moderna trial did not look specifically at whether the vaccine can prevent transmission, participants were checked for Covid-19 infection before they received their first and second doses – meaning it was possible to compare the rates of infection in these groups. In all, 14 people tested positive after having one shot, verses 38 who had received a placebo.\u003C\u002Fp\u003E\n\u003Cp\u003EThis suggests that the vaccine \u003Ca href=\"https:\u002F\u002Fwww.fda.gov\u002Fmedia\u002F144453\u002Fdownload\"\u003Emight be able to prevent two-thirds of asymptomatic cases\u003C\u002Fa\u003E after one shot. However, there were limitations to this provisional research – the number of people who tested positive was small, so the estimate may not be entirely accurate. It was published in a briefing submitted to the FDA, and has not yet been peer-reviewed.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ENovavax\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThe vaccine hasn't yet been approved for use anywhere in the world – and like the others, it has not yet been comprehensively shown to prevent infections or transmission in humans.\u003C\u002Fp\u003E\n\u003Cp\u003EBut back in November, some early results \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2020\u002F11\u002Fwill-small-long-shot-us-company-end-producing-best-coronavirus-vaccine\"\u003Egot scientists excited\u003C\u002Fa\u003E.  \u003C\u002Fp\u003E\n\u003Cp\u003EThe company revealed that it prevented the virus spreading entirely during \u003Ca href=\"https:\u002F\u002Fwww.biorxiv.org\u002Fcontent\u002F10.1101\u002F2020.08.18.256578v1\"\u003Estudies in rhesus macaques\u003C\u002Fa\u003E, when they were given a high enough dose. These results put it in an exclusive club of vaccines that are able to prevent asymptomatic transmission completely in other primates – seen as a promising sign, because they have \u003Ca href=\"https:\u002F\u002Fwww.jimmunol.org\u002Fcontent\u002Fjimmunol\u002F192\u002F6\u002F2821.full.pdf\"\u003Esimilar respiratory physiology to humans\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003ENow scientists are waiting to find out if the vaccine can achieve sterilising immunity in vaccinated humans, too.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EIncomplete herd immunity \u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EUnfortunately, the ability of the vaccines to prevent transmission won't just have an effect on how long social distancing rules need to be followed – it will also have an impact on herd immunity.\u003C\u002Fp\u003E\n\u003Cp\u003E“If the vaccines don't completely stop transmission, it will increase the amount of people we need to vaccinate to truly cross the herd immunity thresholds and drive down cases to somewhere near zero,\" says Michael Head, a senior research fellow in global health at the University of Southampton. He explains that it's not yet clear what the herd immunity threshold is, because it hasn't been reached either through natural infection or through vaccination.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p095xdcs"],"imageAlignment":"centre","imageAltText":"A woman being vaccinated in a care home in Scotland (Credit: Russell Cheyne\u002F Reuters)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EHerd immunity is the indirect protection from an infectious disease that populations acquire when enough people are immune. The threshold needed to achieve it depends on many different factors, such as the reproduction number of the virus, or \"R\" – the number of further people infected by each carrier – which itself varies widely. Some factors that affect the latter include where in the world you live, \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fnews\u002Fdatablog\u002F2021\u002Fjan\u002F25\u002Fnew-coronavirus-variants-may-spread-more-easily-so-what-does-this-mean-for-the-fight-against-covid\"\u003Ethe variant involved\u003C\u002Fa\u003E, and the conditions on the ground, such as lockdowns.\u003C\u002Fp\u003E\n\u003Cp\u003EThis means that, even when scientists do know more, there will be no set threshold for herd immunity that works everywhere – but it's possible to estimate roughly what it might be.\u003C\u002Fp\u003E\n\u003Cp\u003EFor example, one calculation suggests that for a vaccine that totally eliminates transmission, \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(20)32318-7\u002Ffulltext\"\u003E60-72% of the population would need to have it\u003C\u002Fa\u003E, it order to accomplish complete herd immunity. But if the vaccine’s effectiveness were 80%, between 75 and 90% of people need to have it.\u003C\u002Fp\u003E\n\u003Cp\u003EThis is potentially higher than the vaccination ambitions of many countries. The UK is aiming to immunise every adult by September, which equates to around 51m out 67.5m people – 75% of the population in total. That's assuming that every adult in the country is willing to be vaccinated, and healthy enough to be eligible.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, most scientists aren't expecting to eliminate the virus entirely. For the moment, the goal is to reduce its transmission as much as possible. \"Even if you vaccinate, you've still got a fairly large number of susceptible people there,” says Head. \"So, we will still see outbreaks happen. I think they would be fairly localised, but they would still cause concern and cause a burden of disease\".   \u003C\u002Fp\u003E\n\u003Cp\u003ESome scientists argue that the emphasis on preventing transmission is \u003Ca href=\"https:\u002F\u002Fwww.politico.eu\u002Farticle\u002Fcan-vaccines-stop-the-spread-of-coronavirus\u002F\"\u003Ea red herring\u003C\u002Fa\u003E, because once enough people have been vaccinated, it doesn't matter if they are still able to spread the virus – everyone will have immunity.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, it may prove crucial for those who are unable to be vaccinated, for example because they are pregnant, too young, or too unwell.\u003C\u002Fp\u003E\n\u003Cp\u003EUntil we have an answer, perhaps we should all keep in mind the story of the 11-year-old boy with mumps – and act as though we haven't been vaccinated, even if we have. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EZaria Gorvett is a senior journalist for BBC Future and tweets @ZariaGorvett\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EThis story was updated on 24\u002F2\u002F2021. An earlier version incorrectly stated that 17% of healthcare workers in a Biritsh study caught the virus for a second time. In fact, they had a 17% chance of being reinfected.   \u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cem\u003E\u003Cstrong\u003EFacebook\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cem\u003E\u003Cstrong\u003ETwitter\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003C\u002Fem\u003E\u003Cstrong\u003E\u003Cem\u003E \u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cem\u003E\u003Cstrong\u003EInstagram\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cem\u003E\u003Cstrong\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called \"The Essential List\". A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19-10"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-02-03T11:49:55.289Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"Can you still transmit Covid-19 after vaccination?","headlineShort":"Can vaccinated people spread Covid-19?","image":["p095xcsb"],"imageAlignment":"centre","imageAltText":"Voters in a socially distanced queue in Caracas (Credit: Getty Images)","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"There's no evidence that any of the current Covid-19 vaccines can completely stop people from being infected – and this has implications for our prospects of achieving herd immunity.","summaryShort":"None of the current vaccines can completely stop people from being infected","tag":["tag\u002Fcovid-19"],"textToSpeech":false,"creationDateTime":"2021-02-03T13:38:55.74789Z","entity":"article","guid":"410efdfd-1c1e-4947-b7cf-e6ec6f3f0b95","id":"future\u002Farticle\u002F20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19","modifiedDateTime":"2021-11-19T20:27:03.076838Z","project":"future","slug":"20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19","cacheLastUpdated":1642293446383},"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose","_id":"6183c2b745ceed08fb2735b3","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"Pretend it didn't happen – expert advice on how to behave after receiving a single dose of any of the Covid-19 vaccines.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\u003Cem\u003EAs we head towards the end of another extraordinary year, BBC Future is taking a look back at some of our favourite stories for our “Best of 2021” collection. \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumns\u002Fbest-of-bbc-future\"\u003EDiscover more of our picks here\u003C\u002Fa\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThe cases are already beginning to emerge.\u003C\u002Fp\u003E\n\u003Cp\u003EWhen 85-year-old Colin Horseman was admitted to Doncaster Royal Infirmary in late December, it was for a suspected kidney infection. But not long afterwards he caught Covid-19 – at the time, roughly \u003Ca href=\"https:\u002F\u002Fwww.hsj.co.uk\u002Fpatient-safety\u002Fcovid-infections-caught-in-hospital-rise-by-a-third-in-one-week\u002F7029211.article\"\u003Eone in four people in hospital\u003C\u002Fa\u003E with the virus had acquired it there. He developed severe symptoms and was eventually put on a ventilator. A few days later, he died.\u003C\u002Fp\u003E\n\u003Cp\u003EAt first glance, Horseman's situation may seem fairly typical, though no less tragic for it. After all, at least 84,767 people have now succumbed to the disease in the UK alone at the time of writing. But, as his son recently explained in a \u003Ca href=\"https:\u002F\u002Fwww.doncasterfreepress.co.uk\u002Fnews\u002Fpeople\u002Fstay-safe-warning-doncaster-granddad-dies-covid-nearly-two-weeks-after-being-vaccinated-3090110\"\u003Elocal newspaper\u003C\u002Fa\u003E, less than three weeks earlier he had been among the first people in the world to receive the initial dose of a Covid-19 vaccine – the Pfizer-BioNTech version. He was due to receive the second dose two days prior to his death.\u003C\u002Fp\u003E\n\u003Cp\u003EIn fact, most vaccines require booster doses to work.\u003C\u002Fp\u003E\n\u003Cp\u003ETake the MMR – measles, mumps and rubella – vaccine, which is given to babies around the world to prevent these deadly childhood infections. Around 40% of people who have received just one dose are \u003Ca href=\"https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS0264410X01004352\"\u003Enot protected from all three viruses\u003C\u002Fa\u003E, compared to 4% of those who have had their second. People in the former group are four times more likely to catch measles than those in the latter – and there have been \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F17609829\u002F\"\u003Eoutbreaks\u003C\u002Fa\u003E in places where a high proportion of people have not completed the full MMR vaccination schedule.  \u003C\u002Fp\u003E\n\u003Cp\u003E\"The reason that people are so keen on boosters and consider them so vital is that they kind of send you into this whole other kind of fine-tuning mode of your immune response,\" says Danny Altmann, professor of immunology at Imperial College London.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EHow booster vaccines work\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EWhen the immune system first encounters a vaccine, it activates two important types of white blood cell. First up are the plasma B cells, which primarily focus on making antibodies. Unfortunately, this cell type is short-lived, so although your body might be swimming in antibodies within just a few weeks, without the second shot this is often \u003Ca href=\"https:\u002F\u002Fwww.who.int\u002Fimmunization\u002Fdocuments\u002FElsevier_Vaccine_immunology.pdf\"\u003Efollowed by a rapid decline\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EThen there are the T cells, each of which is specifically tailored to identify a particular pathogen and kill it. Some of these, memory T cells, are able to linger in the body for decades until they stumble upon their target – meaning immunity from vaccines or infections can \u003Ca href=\"https:\u002F\u002Fwww.historyofvaccines.org\u002Fcontent\u002Farticles\u002Ftop-20-questions-about-vaccination\"\u003Esometimes last a lifetime\u003C\u002Fa\u003E. But crucially, you usually won't have many of this cell type until the second meeting. \u003C\u002Fp\u003E\n\u003Cp\u003EThe booster dose is a way of re-exposing the body to the antigens – the molecules on pathogens that trigger the immune system – to initiate part two of the response. \"You've kicked in all this fancy stuff,\" says Altmann. \"So, once you've had your boost you'll have a higher frequency of memory T cells and ditto to some extent for the size of the pool of memory B cells you'll have. They'll also be making higher quality antibodies.\"\u003C\u002Fp\u003E\n\u003Cp\u003EOn second exposure to the same vaccine or pathogen, the B cells that remain from before are able to rapidly divide and create a menacing throng of descendants, leading to a second spike in the amount of antibodies circulating.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09416t4"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThe second dose also initiates the process of \"B cell maturation\", which involves selecting the immature ones with the best receptors for binding to a particular pathogen. This happens while they're still in the bone marrow – where white blood cells are made – and afterwards they travel to the spleen to finish developing. This means B cells are not only more numerous afterwards, but the antibodies they produce are better targeted.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also be interested in\u003C\u002Fem\u003E\u003Cem\u003E:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19\" target=\"_blank\"\u003EHere's why vaccination beats infection \u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months\" target=\"_blank\"\u003EThe quest to make a global vaccine in 12 months \u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210127-covid-19-variants-how-mutations-are-changing-the-pandemic\" target=\"_blank\"\u003E\u003Cstrong\u003EWhat we know about the new Covid-19 variants\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20210119-covid-19-variants-how-the-virus-will-mutate-in-the-future\" target=\"_blank\"\u003E\u003Cstrong\u003EHow Covid-19 might evolve in the future\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EMemory T cells, meanwhile, also proliferate rapidly. They're already \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200716-the-people-with-hidden-protection-from-covid-19\"\u003Ethought to have played a critical role\u003C\u002Fa\u003E during the current pandemic, protecting some people from developing severe Covid-19. Though the virus may have only been circulating globally since around \u003Ca href=\"https:\u002F\u002Fwww.weforum.org\u002Fagenda\u002F2020\u002F05\u002Fcoronavirus-spread-around-world-2019-study\u002F\"\u003EDecember 2019\u003C\u002Fa\u003E, there's some evidence they may have \"seen\" other coronaviruses before, such as those that cause the common cold – allowing them to recognise Covid-19.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ESo how effective is a single dose of each of the Covid-19 vaccines?\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EAt a time when the answer is more urgent than ever – especially as the British government has decided to delay the second dose of all currently approved Covid-19 vaccines from 3-4 weeks to 12, and Russia is trialling a single-dose regimen of its Sputnik V vaccine named \"Sputnik-Light\" – it's also surprisingly complicated. Here's what we know so far. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EPfizer-BioNTech\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EAccording to Pfizer data \u003Ca href=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMoa2034577?query=RP\"\u003Epublished in December 2020\u003C\u002Fa\u003E, the Pfizer-BioNTech vaccine is roughly 52% effective after the first dose. Out of 36,523 participants in the phase three trial – the final stage of testing where people either received two full doses, 21 days apart, or a placebo – who had no evidence of existing infection, 82 people in the placebo group and 39 in the vaccine group developed Covid-19 symptoms.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Preclinical trials would have shown that they didn't think there was enough immunity after one shot. So they've gone for both – Deborah Dunn-Walters","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EHowever, this early protection comes with some important caveats. First, the protection doesn't kick in until at least day 12 – until then, there was no difference between the two groups. Secondly, one dose is still significantly less protective than two. The latter is 95% effective at preventing the disease after a week.\u003C\u002Fp\u003E\n\u003Cp\u003EBut there is also another figure that has been circulating on the internet, and anecdotally, being fed to patients by certain doctors – the suggestion that the first dose is around 90% effective. And this is where it gets a little more complicated.\u003C\u002Fp\u003E\n\u003Cp\u003EThe second estimate comes from the UK's Vaccine Committee, the JCVI, who decided to \u003Ca href=\"https:\u002F\u002Fapp.box.com\u002Fs\u002Fuwwn2dv4o2d0ena726gf4403f3p2acnu\"\u003Ecalculate the efficacy\u003C\u002Fa\u003E of the vaccine differently. Instead of using all the data on the number of infections, including from days when the first dose hadn't yet started to work, they only looked at days 15-21. Using this method, the efficacy of the vaccine jumps up to 89%, because it's not being diluted by the relatively high number of infections before the vaccine begins to have an effect. Taking things even further and only looking at the first seven days after the second dose (days 21-28) – because the second dose might not have kicked in yet by then – it's 92%.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, these calculations are controversial.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09414wg"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\"People are very keen on at the moment on that graph in the Pfizer paper in the New England Journal of Medicine where they show that there must be some kind of de facto benefit as early as something like day 14,\" says Altmann. \"It's the one where the curve for the placebo group and the vaccine group completely diverge, and cases start taking off in the placebo group. But obviously that's not measuring an immune response directly – it's using quite a crude measure of how many people have been infected.\" Altmann explains that he wouldn't advise anyone to consider themself safe 14 days after their first dose of the vaccine. \"The graph is just a way of saying 'something is happening',\" he says.\u003C\u002Fp\u003E\n\u003Cp\u003EIn a more recent development, an Israeli academic who coordinated the country’s Covid-19 response – Professor Nachman Ash – has claimed that a single dose of the vaccine is not as effective as Pfizer originally estimated. However, the comments have been \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fhealth-55734257\" target=\"_blank\"\u003Ewidely criticised\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cbr \u002F\u003EThere are a number of reasons that it is inappropriate to compare the research, which was conducted by the health organisation Clalit, with the Pfizer study. For one, the Israeli study found that a single dose of the vaccine reduced the number of people testing positive for the virus, i.e. being infected, by 33%, while the Pfizer paper suggested that it would prevent 52% from developing symptoms – they looked at two different things.\u003C\u002Fp\u003E\n\u003Cp\u003EIn addition, the data from Clalit has not been made available, or peer-reviewed. It also involved examining the impact of the vaccine just two weeks after people had received it – considered too early to see an immune response – rather than three, as in the Pfizer study. Finally, the research was not a clinical trial, but rather an observational study, which means the results should be viewed with caution.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EOxford-AstraZeneca\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EFor the Oxford-AstraZeneca vaccine, things are a bit different. In a paper published in January, the authors explain that the vaccine offers protection of \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flancet\u002Farticle\u002FPIIS0140-6736(20)32661-1\u002Ffulltext\"\u003E64.1% after at least one standard dose\u003C\u002Fa\u003E. This compares to 70.4% if you've had two full doses, or – oddly – 90% in people who have had one half dose followed by one full dose.\u003C\u002Fp\u003E\n\u003Cp\u003EA month later, AstraZeneca revealed the results of a first analysis of their phase III trial data in a \u003Ca href=\"https:\u002F\u002Fwww.astrazeneca.com\u002Fmedia-centre\u002Fpress-releases\u002F2021\u002Fcovid-19-vaccine-astrazeneca-confirms-protection-against-severe-disease-hospitalisation-and-death-in-the-primary-analysis-of-phase-iii-trials.html\" target=\"_blank\"\u003Epress release\u003C\u002Fa\u003E. Starting from 22 days after the first dose, the vaccine provided 70% protection against mild or moderate illness and 100% against severe disease, hospitalisation and death.\u003C\u002Fp\u003E\n\u003Cp\u003EBecause the phase three trial included two gaps between the first and the second dose – including one of six weeks and a longer one of 12 weeks – it's possible to say with more certainty that the first dose can continue to provide some protection for at least a few months before the booster shot.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EModerna\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EAccording to a document the company submitted to the FDA, the Moderna vaccine can provide 80.2% protection after one dose, \u003Ca href=\"https:\u002F\u002Fwww.fda.gov\u002Fmedia\u002F144434\u002Fdownload\"\u003Ecompared to 95.6% after the second\u003C\u002Fa\u003E (in people aged 18 to 65 – it's 86.4% in those over 65). As with the Pfizer vaccine, all participants in the phase three trial received two doses of the vaccine or a placebo within a single set time period – in this case, 28 days – so it's not yet known whether the immunity from a single vaccine would continue, or drop off after this stage.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ESinovac\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThe CoronaVac vaccine was developed by Sinovac, a biopharmaceutical company based in Beijing, China. This version is unusual as it has been trialled independently in several countries – all of which have produced different results.\u003C\u002Fp\u003E\n\u003Cp\u003EAccording to \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Farticle\u002Fus-health-coronavirus-turkey-china\u002Fturkey-says-chinas-sinovac-covid-vaccine-91-25-effective-in-late-trials-idUSKBN28Y1R1\"\u003Eresearchers in Turkey\u003C\u002Fa\u003E, the vaccine is 91.25% protective, while scientists in Indonesia have said that it’s \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Farticle\u002Fus-health-coronavirus-indonesia\u002Findonesia-approves-chinas-sinovac-vaccine-as-infections-surge-idUSKBN29G0RP\"\u003E65.3% effective\u003C\u002Fa\u003E, and the Butantan Institute in São Paulo, Brazil recently announced that the vaccine prevents \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2021\u002F01\u002Fthird-time-s-charm-brazil-scales-back-efficacy-claims-covid-19-vaccine-china\" target=\"_blank\"\u003E50.4% of people\u003C\u002Fa\u003E from developing symptoms. At the moment, no one has released data on the efficacy of a single dose – these figures only apply to two doses, spaced 14 days apart.\u003C\u002Fp\u003E\n\u003Cp\u003EThe results have been viewed with \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fworld-latin-america-55642648\"\u003Esome scepticism\u003C\u002Fa\u003E, because they were published via press releases, instead of – as would normally be the case – in a peer-reviewed journal. Without access to more information about the trial methods and the data that was collected, it’s harder for scientists to make their own assessments of the results' validity. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ESinopharm\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIn all, there are five Chinese vaccines at various stages of development.\u003C\u002Fp\u003E\n\u003Cp\u003EAnother is \"BBIBP-CorV\", by the state-owned company Sinopharm, based in Shanghai. Officials in the country recently announced that this version is 79% effective after two doses – though by then, it had already been distributed to \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fworld-asia-china-55212787\" target=\"_blank\"\u003Enearly a million\u003C\u002Fa\u003E people. This estimate has not been verified by the international community, because the underlying data and methods for its trial have not been made publicly available. It's not yet clear how protective it might be after a single dose.\u003C\u002Fp\u003E\n\u003Cp\u003EOutside China, the vaccine is currently being tested all over the world, and has \u003Ca href=\"https:\u002F\u002Fcovid19.trackvaccines.org\u002Fvaccines\u002F5\u002F\" target=\"_blank\"\u003Ebeen approved\u003C\u002Fa\u003E in Bahrain, Egypt, Jordan, the Seychelles, and the United Arab Emirates. The UAE recently became the first to rate its efficacy, claiming via a press release that it is \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2020\u002F12\u002Fgreat-efficacy-claimed-another-covid-19-vaccine-one-china\" target=\"_blank\"\u003E86% effective\u003C\u002Fa\u003E.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-6"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09417kl"],"imageAlignment":"centre","imageAltText":"Coronavirus particles attacking human cells under the microscope (Credit: Getty Images)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\u003Cstrong\u003ESputnik V\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThe Sputnik V vaccine is named after the world's first artificial satellite, the iconic Soviet-era \"Sputnik 1\", which was launched into low Earth orbit in October 1957 – it burned up three months later when its batteries died. Its namesake was developed by the Gamaleya Research Institute of Epidemiology and Microbiology in Moscow, Russia.\u003C\u002Fp\u003E\n\u003Cp\u003EAs with the others, this vaccine is administered as two doses, and is apparently \u003Ca href=\"https:\u002F\u002Fsputnikvaccine.com\u002Fnewsroom\u002Fpressreleases\u002Fthe-sputnik-v-vaccine-s-efficacy-is-confirmed-at-91-4-based-on-data-analysis-of-the-final-control-po\u002F#:~:text=The%20efficacy%20of%20the%20Sputnik,after%20administering%20the%20first%20dose.\"\u003E91.4% effective\u003C\u002Fa\u003E after both – there is currently no publicly available information on the efficacy of just one dose.\u003C\u002Fp\u003E\n\u003Cp\u003EAgain, these results haven’t been published in a peer-reviewed journal and therefore may not be reliable. Despite a rapid rise in the number of Covid-19 cases in the country, the vaccine’s safety and efficacy has been viewed with suspicion by many Russians, according to a \u003Ca href=\"https:\u002F\u002Fwww.washingtonpost.com\u002Fworld\u002Feurope\u002Frusisia-vaccine-sputnik-interest\u002F2020\u002F12\u002F10\u002F005917fa-3702-11eb-9699-00d311f13d2d_story.html\"\u003Ereport in the Washington Post\u003C\u002Fa\u003E. In the first week it was rolled out in December, clinic waiting rooms were reportedly half-empty.\u003C\u002Fp\u003E\n\u003Cp\u003EMore recently, the Russian government announced that it was \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Farticle\u002Fhealth-coronavirus-russia-vaccine\u002Frussia-to-try-out-sputnik-light-covid-vaccine-to-make-it-go-further-idUSL1N2JM0NY\"\u003Edeveloping a new version, \"Sputnik-Light\"\u003C\u002Fa\u003E, as a temporary solution to shortages of the original. The vaccine would be delivered as a single dose, though it's not yet clear how protective it would be.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ECan you change your behaviour after receiving a single dose?\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\"I would behave exactly as if I hadn't had the vaccine yet,\" says Altmann. \"I wouldn't drop my guard at all or do anything differently.\"\u003C\u002Fp\u003E\n\u003Cp\u003EDeborah Dunn-Walters, professor of immunology at the University of Surrey, is just as unequivocal about how people should behave. \"There's a couple of reasons for that,\" she says. \"One is, you're not going to be fully protected. And another is there is no evidence as yet that having had the vaccine will stop you getting the virus and passing it on.\"\u003C\u002Fp\u003E\n\u003Cp\u003EDunn-Walters explains that the efficacy of the vaccines were largely assessed by looking at whether they prevented people from developing symptoms – not if they stopped them being infected with the virus. \"And we do know that it's possible to have asymptomatic infection,\" she says. There is not yet any evidence that one dose – or even two – of the existing vaccines will stop people from giving the virus to others.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003ECan you skip the second vaccine dose?\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\"Preclinical trials would have shown that they didn't think there was enough immunity after one shot. So they've gone for both,\" says Dunn-Walters. Similarly, during phase three trials, there were more antibodies and T cells in the blood after two doses than there were after one. \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09415jq"],"imageAlignment":"centre","imageAltText":"Two children walk past wall art in Kolkata, India (Credit: Getty Images)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAs the chief executive of Pfizer, Albert Bourla, explained in December that it would be a \"big mistake\" to skip the second dose, because it almost doubles the amount of protection you get. \u003C\u002Fp\u003E\n\u003Cp\u003EPfizer and BioNTech themselves have already \u003Ca href=\"https:\u002F\u002Fwww.bmj.com\u002Fcontent\u002F372\u002Fbmj.n18#:~:text=The%20trials%20of%20the%20Oxford,overall%20participant%20numbers%20were%20small.\"\u003Eurged caution\u003C\u002Fa\u003E on the grounds that their data ends at day 21, and \"there is no data to demonstrate that protection after the first dose is sustained after 21 days\". It's possible that the protection people seem to have will suddenly drop off after that point – in fact, this wouldn't be surprising based on the way the immune system usually works.\u003C\u002Fp\u003E\n\u003Cp\u003EReliably estimating how long the protection from a single dose might last is further complicated by the fact that all the currently approved Covid-19 vaccines are using brand-new technology.\u003C\u002Fp\u003E\n\u003Cp\u003EThe Oxford-AstraZeneca and Sputnik-V vaccines both involve modified versions of adenoviruses – a group that can break into many different cell types and cause a range of illnesses, such as respiratory infections. While the Oxford version uses an adenovirus from chimpanzees, the Russian one includes a mixture of two human types.\u003C\u002Fp\u003E\n\u003Cp\u003EThe virus was altered for the vaccines so that it's safe and can't make more copies of itself inside cells. It is able to teach the body to recognise the coronavirus by encoding the instructions to make a feature found on its surface, the spike protein. \u003C\u002Fp\u003E\n\u003Cp\u003EThough adenoviruses have been used in \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC4507798\u002F#:~:text=Adenovirus%20vectors%20are%20the%20most%20commonly%20employed%20vector%20for%20cancer%20gene%20therapy.&text=Adenovirus%20vectors%20can%20be%20replication,vaccines%2C%20and%20for%20cancer%20therapy.\"\u003Ecancer vaccines and gene therapy\u003C\u002Fa\u003E for years, they had only ever been used once before to prevent a viral infection – an \u003Ca href=\"https:\u002F\u002Fwww.biopharma-reporter.com\u002FArticle\u002F2020\u002F07\u002F06\u002FJanssen-Ebola-vaccine-gets-European-approval#:~:text=Johnson%20%26%20Johnson%20has%20now%20received,vaccine%20regimen%20in%20African%20countries.\" target=\"_blank\"\u003EEbola vaccine\u003C\u002Fa\u003E using this method was approved for use in European Union countries in July 2020.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-10"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p09417x6"],"imageAlignment":"centre","imageAltText":"A scientist works on a Covid-19 vaccine in the lab (Credit: Getty Images)","imageOrientation":"landscape","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThe Moderna and Pfizer-BioNTech versions, on the other hand, are arguably even more \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fscience\u002F2020\u002Fnov\u002F21\u002Fcovid-vaccine-technology-pioneer-i-never-doubted-it-would-work\"\u003Epioneering\u003C\u002Fa\u003E. Both contain countless miniscule fragments of mRNA, which – as with the adenovirus-based vaccine – encode the spike protein from the surface of Covid-19. They are the only mRNA vaccines to have ever been approved for use in humans.\u003C\u002Fp\u003E\n\u003Cp\u003EWithout other mRNA vaccines to compare them to, the world is in uncharted territory. As Ronald Corley, professor of microbiology at Boston University, recently \u003Ca href=\"https:\u002F\u002Fwww.bu.edu\u002Farticles\u002F2020\u002Fwith-two-covid-19-vaccines-on-the-way-we-are-in-new-territory\u002F\"\u003Eexplained in an interview with the university news magazine\u003C\u002Fa\u003E, there are many unknowns, such as whether they will work just as well in people from different ethnicities, and how long immunity will last.\u003C\u002Fp\u003E\n\u003Cp\u003EThe Sinovac and Sinopharm versions contain inactivated coronavirus particles instead. This method is less unusual – the concept of using dead pathogens in vaccines has been around since the \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC4151719\u002F#:~:text=In%20the%2020th%20century%2C%20chemical,inactivated%20polio%20vaccine%20(46).\"\u003Elate 19th century\u003C\u002Fa\u003E. However, it’s no less clear how long the immunity will last, since no vaccines made from a member of this virus family \u003Ca href=\"https:\u002F\u002Ftheconversation.com\u002Fcoronavirus-vaccine-reasons-to-be-optimistic-137209\"\u003Ehad ever been approved\u003C\u002Fa\u003E before the pandemic. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EImmunity takes time to develop\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EFinally, Dunn-Walters is keen to point out that immunity takes time to develop – so regardless of whether a single dose of any of the Covid-19 vaccines can provide protection eventually, for the first couple of weeks you will have no more than you started with.\u003C\u002Fp\u003E\n\u003Cp\u003E\"There's a part of the immune system which we call innate immunity, which responds immediately,\" says Dunn-Walters. This encompasses physical barriers to infection, like your skin, as well as certain types of white blood cell and chemical signals. But she explains that this generally can't prevent disease on its own – and isn't affected by vaccines. \"So you need adaptive immunity as well. But the issue with adaptive immunity is that, as its name says, it's adaptive – it adapts to individual challenges by pathogens.\"\u003C\u002Fp\u003E\n\u003Cp\u003EFor vaccines to have any effect, they must encourage the body to make more immune cells – some of which in turn produce antibodies. \"And this takes time,\" says Dunn-Walters.\u003C\u002Fp\u003E\n\u003Cp\u003ESo while the global roll-out of the new vaccines may be exciting, it looks like most of us will have to wait a while longer before normal life can resume. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EThis story was updated on 18\u002F1\u002F2021. An earlier version incorrectly stated that an Ebola vaccine using adenoviruses had been approved for use in the US. Separately, it said that the CoronaVac vaccine was tested by the UAE. The Ebola vaccine has been approved for use in the European Union and the UAE tested a different vaccine, made by the company Sinovac. The article was also updated on 21\u002F04\u002F21 with new information about the efficacy of one dose of the Oxford-AstraZeneca vaccine. \u003Cbr \u002F\u003E\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called \"The Essential List\". A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose-12"}],"collection":["future\u002Fcolumn\u002Fbest-of-bbc-future","future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2021-01-15T01:00:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"How effective is a single vaccine dose against Covid-19?","headlineShort":"How effective is a single vaccine dose?","image":["p09413dd"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"Pretend it didn't happen – expert advice on how to behave after receiving a single dose of any of the Covid-19 vaccines.","summaryShort":"Pretend it didn't happen – expert advice on how to behave after one dose","tag":["tag\u002Fcovid-19"],"textToSpeech":false,"creationDateTime":"2021-01-15T01:00:48.469527Z","entity":"article","guid":"2900dd79-41a9-400b-b1ba-d79b5ac5ef2c","id":"future\u002Farticle\u002F20210114-covid-19-how-effective-is-a-single-vaccine-dose","modifiedDateTime":"2021-12-21T11:13:43.318948Z","project":"future","slug":"20210114-covid-19-how-effective-is-a-single-vaccine-dose","cacheLastUpdated":1642293446385},"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19","_id":"6183c1fd45ceed35a24a79d4","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"From the surprisingly treacherous path to herd immunity to the potentially superior protection offered by vaccines, there are many reasons to avoid Covid-19.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAll throughout history, people have gone to extraordinary lengths to avoid infections.\u003C\u002Fp\u003E\n\u003Cp\u003EIn the Middle Ages, it was common to douse oneself in “\u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Farticles\u002F10.3389\u002Ffpls.2020.571042\u002Ffull#B9\"\u003Efour thieves vinegar\u003C\u002Fa\u003E” – a concoction of herbs brewed in cider vinegar – before leaving the house, as a way of staving off the plague. Legend has it that a group of \u003Ca href=\"https:\u002F\u002Fwww.farmersalmanac.com\u002Ffour-thieves-vinegar-35968\"\u003Egrave robbers\u003C\u002Fa\u003E invented it to keep them safe. Eventually they were arrested, but the authorities agreed to let them go in exchange for their secret recipe.\u003C\u002Fp\u003E\n\u003Cp\u003EIn 16th-Century Sardinia, things were a bit more sophisticated. The doctor Quinto Tiberio Angelerio devised an ingenious method of social distancing, in which “any person going out from home must \u003Ca href=\"https:\u002F\u002Fwww.frontiersin.org\u002Farticles\u002F10.3389\u002Ffpls.2020.571042\u002Ffull#f1\"\u003Ecarry a cane six spans long\u003C\u002Fa\u003E [the distance measured by a human hand], and as long as the cane is, one must not approach other people”. In his spookily prescient manual on the sanitary measures to be taken during an outbreak in the city of Alghero, he also recommended only \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3810900\u002F\"\u003Eone person per household venture out to do the shopping\u003C\u002Fa\u003E, and urged his readers to be careful when shaking hands.\u003C\u002Fp\u003E\n\u003Cp\u003EIn 1793, the US government simply \u003Ca href=\"https:\u002F\u002Fwww.history.com\u002Fthis-day-in-history\u002Fyellow-fever-breaks-out-in-philadelphia\"\u003Eevacuated entire sections of Philadelphia\u003C\u002Fa\u003E – the then-capital – to protect residents from a yellow fever outbreak. An estimated \u003Ca href=\"https:\u002F\u002Fwww.history.com\u002Fnews\u002Fyellow-fever-outbreak-philadelphia\"\u003E20,000 people left the city\u003C\u002Fa\u003E over the course of a month, which amounted to half its population at the time.\u003C\u002Fp\u003E\n\u003Cp\u003EOther precautions adopted by our ancestors include \u003Ca href=\"https:\u002F\u002Fwww.livescience.com\u002Fissac-newton-plague-toad-vomit-auction.html\"\u003Etoad-vomit lozenges\u003C\u002Fa\u003E, developed by none other than the celebrated physicist Sir Isaac Newton during the Black Death, and an alarmingly recent dental practise: in the 1940s, women would \u003Ca href=\"https:\u002F\u002Fwww.bristolpost.co.uk\u002Fnews\u002Fhistory\u002Fbrace-yourself-painful-terrifying-history-25906\"\u003Eroutinely have all their teeth removed\u003C\u002Fa\u003E, just in case they ever went septic. The preventative was so popular, it was often paid for as part of a wedding gift, or for their 18th birthday. (Happy birthday, you now need dentures!)\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201027-what-is-added-to-vaccines\"\u003EThe strange ingredients in vaccines\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate\"\u003EWhy the elderly are harder to vaccinate\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct\"\u003EHow Covid-19 is changing the flu\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EEven centuries before we knew about microorganisms, antibodies or vaccination, people had a pretty good idea that being infected was something to avoid at all costs. \u003C\u002Fp\u003E\n\u003Cp\u003EIn 2020, cracks began to appear in this previously universal thinking. Early in the Covid-19 pandemic, it was reported some people were considering the – deeply risky and highly dubious – strategy of \u003Ca href=\"https:\u002F\u002Fwww.huffingtonpost.co.uk\u002Fentry\u002Fcoronavirus-infection-immunity-passports_uk_5e89df7cc5b6cbaf282ae5ff?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAJuqW1GC5yNMErMIFtCiJxpATaEeHT_CZ9mR18pWO1gjzMQj2_dcUuzqk02QVQyDyOz2Vg5hT2-UJgZK3kV4VOSN6ETpK8S0ydmw1Td_6SK73pz47QdPK2ClUN4fkB6V8h7oTHi3nrVaU0LvYpIWltd94mRNMtkUKb3ieggsQuvG\"\u003Ecatching Covid-19 on purpose\u003C\u002Fa\u003E, as a way to fast-track their route back to normal life. The terms “immunity passport” and “herd immunity” became part of the mainstream lexicon, and low antibody counts in the population were \u003Ca href=\"https:\u002F\u002Fwww.telegraph.co.uk\u002Fnews\u002F2020\u002F07\u002F25\u002Fnumber-people-coronavirus-antibodies-third-lower-thought-figures\u002F\"\u003Eframed as a “blow”\u003C\u002Fa\u003E rather than a success.\u003C\u002Fp\u003E\n\u003Cp\u003ENow a group of scientists has signed a controversial statement – the \u003Ca href=\"https:\u002F\u002Fgbdeclaration.org\u002F\"\u003EGreat Barrington Declaration\u003C\u002Fa\u003E – which criticises the imposition of lockdowns, and instead calls for what they call “focused protection”. It claims that the most compassionate approach to the pandemic would be to “allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk”. It has attracted \u003Ca href=\"https:\u002F\u002Fwww.bmj.com\u002Fcontent\u002F371\u002Fbmj.m3908\"\u003Ethousands of signatures\u003C\u002Fa\u003E since \u003Ca href=\"https:\u002F\u002Fwww.aier.org\u002Farticle\u002Freaching-immunity-a-private-summit-of-epidemiologists-against-lockdowns-video\u002F\"\u003Eit was unveiled\u003C\u002Fa\u003E, but many of their claims have been \u003Ca href=\"https:\u002F\u002Fwww.sciencemediacentre.org\u002Fexpert-reaction-to-barrington-declaration-an-open-letter-arguing-against-lockdown-policies-and-for-focused-protection\u002F\"\u003Equestioned by others in the scientific community\u003C\u002Fa\u003E.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08z2g3q"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIn some places, however, infections have even become an implicit part of the national strategy. \u003C\u002Fp\u003E\n\u003Cp\u003EIn Sweden, the Folkhälsomyndigheten (FHM), or public health agency, has taken what is arguably one of \u003Ca href=\"https:\u002F\u002Fmarkets.businessinsider.com\u002Fnews\u002Fstocks\u002Fsweden-coronavirus-economy-relaxed-lockdown-stronger-rest-of-europe-2020-7-1029415101\"\u003Ethe most relaxed\u003C\u002Fa\u003E approaches in Europe. The country is currently \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2020\u002Fnov\u002F16\u002Fsweden-limits-public-gatherings-to-eight-people-amid-covid-surge\"\u003Eentering its first lockdown\u003C\u002Fa\u003E, but for most of the last year, it has remained a rare bastion of normality. The state epidemiologist Anders Tegnell has actively \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2020\u002F10\u002Fit-s-been-so-so-surreal-critics-sweden-s-lax-pandemic-policies-face-fierce-backlash\"\u003Ediscouraged the public from wearing masks\u003C\u002Fa\u003E, and while much of the rest of Europe has been housebound, the Nordic nation has been mingling freely in bars, gyms, shops and restaurants. Back in July, the FHM \u003Ca href=\"https:\u002F\u002Fwww.dn.se\u002Fnyheter\u002Fsverige\u002Ffhm-stockholm-kan-ha-40-procents-immunitet\u002F\"\u003Eclaimed\u003C\u002Fa\u003E that the rate of immunity in the capital, Stockholm, could be as high as 40%, and was already pushing back the virus.\u003C\u002Fp\u003E\n\u003Cp\u003EThis may all soon be behind us. It looks increasingly like there are at least two \u003Ca href=\"https:\u002F\u002Fwww.nytimes.com\u002F2020\u002F11\u002F17\u002Fhealth\u002Fcoronavirus-vaccine-operation-warp-speed.html\"\u003Eviable vaccines\u003C\u002Fa\u003E on the horizon, and the German immunologist behind one of them – the Pfizer-BioNTech version – recently predicted that the \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fhealth-54949799\"\u003Epandemic will be over by next winter\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EBut for now, the pandemic continues. Covid-19 cases are rising rapidly in the \u003Ca href=\"https:\u002F\u002Fedition.cnn.com\u002F2020\u002F11\u002F18\u002Fhealth\u002Fus-coronavirus-wednesday\u002Findex.html\"\u003EUS\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.france24.com\u002Fen\u002Feurope\u002F20201115-who-dashboard-documents-record-daily-covid-19-cases\"\u003EFrance\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fuk.reuters.com\u002Farticle\u002Fhealth-coronavirus-belgium\u002Fbrussels-edges-towards-lockdown-as-belgian-covid-19-cases-hit-record-high-idINKBN2790LQ\"\u003EBelgium\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2020\u002Fnov\u002F13\u002Fglobal-report-germany-may-extend-lockdown-as-covid-cases-in-italy-soar\"\u003EGermany\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.ft.com\u002Fcontent\u002Fd132e1ad-ebc5-3bce-b160-66668ae4391b\"\u003EItaly\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fuk.reuters.com\u002Farticle\u002Fhealth-coronavirus-russia-hospital\u002Fmoscow-turns-ice-rink-into-hospital-as-russias-covid-19-cases-hit-record-idUSL8N2I226D\"\u003ERussia\u003C\u002Fa\u003E, the \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fuk-54908680\"\u003EUK\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fworld-asia-india-54912871\"\u003EIndia\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fuk.reuters.com\u002Farticle\u002Fus-health-coronavirus-mexico\u002Fmexicos-coronavirus-cases-rise-to-almost-800000-idUKKBN26T019\"\u003EMexico\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.ft.com\u002Fcontent\u002F67fc5152-d500-4b9e-ad5c-79e1bf2b68e2\"\u003ESweden\u003C\u002Fa\u003E, and \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002Flive\u002F2020\u002Fnov\u002F11\u002Fcoronavirus-live-news-governments-scramble-to-secure-vaccine-doses-as-us-infections-top-100000-for-seventh-day-in-a-row\"\u003EGreece\u003C\u002Fa\u003E. Russia has \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Farticle\u002Fus-health-coronavirus-russia-hospital-idUSKBN27W14E\"\u003Eturned an ice rink into a hospital\u003C\u002Fa\u003E, the Indonesian capital, Jakarta, is \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fcities\u002F2019\u002Fnov\u002F01\u002Fin-jakartas-cemeteries-theyre-stacking-the-dead-six-deep\"\u003Erunning out of graves\u003C\u002Fa\u003E, and Spain has declared a \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2020\u002Foct\u002F25\u002Fglobal-report-spain-declares-covid-state-of-emergency-as-italians-urged-to-stay-home\"\u003Estate of national emergency\u003C\u002Fa\u003E. The situation in America has been described as the “\u003Ca href=\"https:\u002F\u002Fedition.cnn.com\u002F2020\u002F11\u002F18\u002Fhealth\u002Fus-coronavirus-wednesday\u002Findex.html\"\u003Elast big surge\u003C\u002Fa\u003E”.\u003C\u002Fp\u003E\n\u003Cp\u003EAs we’re still faced with the uneasy dichotomy of lockdowns verses mass infection, here’s a rundown of the reasons experts are so enamoured with the first option – and why you really don’t want to catch any kind of pathogen on purpose.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EVaccines can be more protective\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIn February 2009, a brand new flu virus \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2009\u002F07\u002Fyet-another-new-patient-zero-swine-flu-pandemic\"\u003Eemerged from a pig farm in eastern Mexico\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003ETo begin with, infected pigs began to cough or ”bark”, producing a harsh, reverberating noise like the honking of geese. Over the coming days, victims could be found suffering from sticky noses and red eyes, breathing with their mouths wide open and \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC2764467\u002F\"\u003Efeeling generally reluctant to get up\u003C\u002Fa\u003E. Some developed a temperature and experienced sneezing fits, while others had no symptoms whatsoever.\u003C\u002Fp\u003E\n\u003Cp\u003EOne day, it’s thought to have hopped from a sickly pig to a human in a nearby mountain village – possibly a \u003Ca href=\"https:\u002F\u002Fedition.cnn.com\u002F2009\u002FHEALTH\u002F04\u002F29\u002Fswine.flu.patient.zero\u002Findex.html#:~:text=LA%20GLORIA%2C%20Mexico%20(CNN),documented%20case%20of%20swine%20flu.\"\u003Esix-year old boy\u003C\u002Fa\u003E, possibly a \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2009\u002F07\u002Fyet-another-new-patient-zero-swine-flu-pandemic\"\u003Ebaby girl\u003C\u002Fa\u003E. From there, it quickly swept around the globe. By May, \u003Ca href=\"https:\u002F\u002Fwww.sciencedaily.com\u002Freleases\u002F2009\u002F05\u002F090503190223.htm\"\u003Eat least 18 countries\u003C\u002Fa\u003E had been affected. As of July, it had been found in 168, and there were \u003Ca href=\"https:\u002F\u002Fwww.who.int\u002Fcsr\u002Fdon\u002F2009_08_04\u002Fen\u002F\"\u003Ecases on every continent\u003C\u002Fa\u003E. This was a pandemic.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Sometimes our immune systems are able to side-step their usual blunder","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBut while the world’s attention was focused on tracking the spread of this mysterious virus, something extraordinary was happening – people infected by it were acquiring a kind of universal protection to other types of the flu.\u003C\u002Fp\u003E\n\u003Cp\u003ELeft to their own devices, our immune systems tend to hone in the “head” of a virus particle, making antibodies that can identify this part. But this is a mistake. The flu is a famously slippery beast, and the head evolves rapidly – meaning that this generally only provides protection against the specific strain that you have been exposed to. All other flu viruses remain unrecognisable. This is why we can catch the flu again and again, and why it’s necessary for the more vulnerable to have flu vaccines annually. \u003C\u002Fp\u003E\n\u003Cp\u003EThis time it was different. It just so happens that, when exposed to swine flu, sometimes our immune systems are able to side-step their usual blunder – and focus their attention on the much-more-stable “stalk” of the virus instead, which is shared between lots of different types.\u003C\u002Fp\u003E\n\u003Cp\u003E“When we analysed the antibody responses that some of the infected people had made,” says Ahmed Rafi, the Director of the Emory Vaccine Center, Georgia, “we found that that many of the antibodies that were generated were very broadly cross reactive.” This meant they weren’t just effective against the H1N1 strain they were made for – but to \u003Ca href=\"https:\u002F\u002Frupress.org\u002Fjem\u002Farticle\u002F208\u002F1\u002F181\u002F40767\u002FBroadly-cross-reactive-antibodies-dominate-the\"\u003Emany other flu viruses as well\u003C\u002Fa\u003E.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08z2bw3"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThe result was radical. The ability to recognise the stalk is thought to have been so potently useful, some scientists think it explains another event that coincided with the pandemic. Every other kind of influenza A that had existed up until that point in humans – the only type that causes pandemics, as well as \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fnrmicro.2017.118.pdf?origin=ppub\"\u003Emost cases of seasonal flu\u003C\u002Fa\u003E – abruptly disappeared. It looks as if, by training the body to recognise many other flu viruses, H1N1 made its closest relatives extinct.\u003C\u002Fp\u003E\n\u003Cp\u003EBut if this leaves you thinking that catching swine flu sounds like a good deal, you might want to reconsider. Like the strain behind the 1918 pandemic, the virus has the \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flanonc\u002Farticle\u002FPIIS0140-6736(10)61195-6\u002Ffulltext\"\u003Eunusual habit of killing young people\u003C\u002Fa\u003E. It’s also been linked to the development of autoimmune conditions, including \u003Ca href=\"https:\u002F\u002Fwww.sciencedaily.com\u002Freleases\u002F2017\u002F09\u002F170913193138.htm#:~:text=People%20inherit%20a%20genetic%20susceptibility,of%20autoimmune%20disorders%20including%20narcolepsy.\"\u003Etype 1 diabetes\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F26668381\u002F#:~:text=An%20increased%20incidence%20in%20the,far%20mainly%20focused%20on%20autoimmunity.\"\u003Enarcolepsy\u003C\u002Fa\u003E. And though the fatality rate has turned out to be low overall, this \u003Ca href=\"https:\u002F\u002Fonlinelibrary.wiley.com\u002Fdoi\u002Fpdf\u002F10.1111\u002Firv.12074\"\u003Etook years to establish\u003C\u002Fa\u003E.  \u003C\u002Fp\u003E\n\u003Cp\u003EInstead, insights from the swine flu pandemic are being channelled into developing what could become the first universal flu vaccines. “That paper was very influential in the strategy that is now being used by many research groups,” says Rafi. Until his discovery, \u003Ca href=\"https:\u002F\u002Fwww.pnas.org\u002Fcontent\u002F109\u002F23\u002F9047\u002F\"\u003Eno one knew if they were even possible\u003C\u002Fa\u003E. But in 2018, nearly a decade after the swine flu pandemic, such a vaccine finally \u003Ca href=\"https:\u002F\u002Fwww.the-scientist.com\u002Fnews-opinion\u002Ffirst-universal-flu-vaccine-to-enter-phase-3-trial-65073\"\u003Emade it to Phase III clinical trials\u003C\u002Fa\u003E – large-scale tests in humans that help to assess the safety and effectiveness of medical interventions.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"The technology that you use for vaccination can swing the profile of the of the immune response a little bit – Beate Kampmann","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThis is the first big advantage of modern vaccines. “Not all natural infections cause long-lasting immunity,” says Beate Kampmann, who is a professor of infection and immunity at the London School of Hygiene and Tropical Medicine and director of its vaccine centre. “This is a big deal in the context of Covid-19, because the coronaviruses generally don't. So, if you think about the vaccine, if you want long-lasting immunity, you have to do better than nature.”\u003C\u002Fp\u003E\n\u003Cp\u003ETo achieve this, scientists can draw on more than a century of knowledge and expertise in making vaccines. Some contain specific proteins painstakingly selected for their ability to generate enduring immunity – like those found in swine flu. They often include added ingredients – from shark liver oil to aluminium – that contribute to their effectiveness. (\u003Cem\u003ERead more about \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201027-what-is-added-to-vaccines\"\u003Ethe strange ingredients added to vaccines\u003C\u002Fa\u003E.)\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThen there’s the way they’re taken – vaccines can be injected into \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fvaccines\u002Fhcp\u002Fadmin\u002Fadminister-vaccines.html\"\u003Emuscle or below the skin\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fflu\u002Fprevent\u002Fjet-injector.htm\"\u003Eblasted at the skin\u003C\u002Fa\u003E in a jet of fluid, introduced via \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC2904604\u002F\"\u003Emicroneedles\u003C\u002Fa\u003E, ingested on a \u003Ca href=\"https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fabs\u002Fpii\u002F0025556494000463\"\u003Esugar cube\u003C\u002Fa\u003E, or \u003Ca href=\"https:\u002F\u002Fwww.nihr.ac.uk\u002Fnews\u002Fnew-study-to-trial-inhaled-covid-19-vaccines\u002F25646\"\u003Einhaled\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E“The technology that you use for vaccination can swing the profile of the immune response a little bit,” says Kampmann. She gives the example of the BCG. The tuberculosis vaccine is injected into the skin, rather than the muscle – and this helps it to interact more closely with a person’s T cells, whose main job is to attack infected cells, rather than produce antibodies. It just so happens this is the optimal strategy for this pathogen.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08z2cfs"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E“So, the vaccine reaches a different sort of distribution. It's almost like there’s a street map of the immune system, and if you take a vaccine one way rather than another you’re taking the M1 rather than the M25,” says Kampmann.\u003C\u002Fp\u003E\n\u003Cp\u003EThere are already a number of vaccines which can be more protective than natural infections, including the zoster, Hib, HPV, and tetanus vaccines.\u003C\u002Fp\u003E\n\u003Cp\u003EPeople who receive the live zoster virus in vaccine form are around \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fbooks\u002FNBK47446\u002F\"\u003E20 times\u003C\u002Fa\u003E less likely to develop shingles in adulthood than people who catch chickenpox – which is caused by the same virus – in childhood. The Hib vaccine – which protects against the \u003Cem\u003EHaemophilus Influenzae\u003C\u002Fem\u003E type b bacterium, is \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC2870866\u002F\"\u003Eparticularly effective in children\u003C\u002Fa\u003E, in whom natural infections lead to a negligible immune response. People who have been infected with tetanus do not have any natural immunity and \u003Ca href=\"https:\u002F\u002Fwww.who.int\u002Fnews-room\u002Ffact-sheets\u002Fdetail\u002Ftetanus\"\u003Ecan be infected again\u003C\u002Fa\u003E; \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fvaccines\u002Fpubs\u002Fpinkbook\u002Ftetanus.html\"\u003Ealmost 100%\u003C\u002Fa\u003E of vaccinated individuals are protected.   \u003C\u002Fp\u003E\n\u003Cp\u003EAnd while natural infections with HPV generate a \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fvaccines\u002Fpubs\u002Fsurv-manual\u002Fchpt05-hpv.html\"\u003Eminimal immune response\u003C\u002Fa\u003E – some people don’t produce any detectable antibodies – the vaccine can \u003Ca href=\"https:\u002F\u002Facademic.oup.com\u002Fjid\u002Farticle-abstract\u002F221\u002F11\u002F1884\u002F5698719?redirectedFrom=fulltext\"\u003Eprotect people for up to nine years\u003C\u002Fa\u003E. This ingenious technology is made from the protein that normally coats the virus, which \u003Ca href=\"https:\u002F\u002Fvirologyj.biomedcentral.com\u002Farticles\u002F10.1186\u002F1743-422X-9-52\"\u003Eself-assembles\u003C\u002Fa\u003E into particles that resemble it – known as virus-like particles – as it’s being manufactured. The protein is more concentrated in the vaccine than the virus, which is thought to help increase the potency of the immune response.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"It’s not yet clear how the immunity generated by natural infections with Covid-19 compares to that produced by the vaccines currently in clinical trials","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIn other cases, vaccination would clearly be preferable to natural infection because once you’re infected, the pathogen never goes away. Famous examples include HSV-2, which causes genital herpes, and HIV. There aren’t yet any licensed vaccines that can prevent either, but a candidate for the former has already \u003Ca href=\"https:\u002F\u002Fjournals.plos.org\u002Fplospathogens\u002Farticle?id=10.1371\u002Fjournal.ppat.1008795\"\u003Eshown promising results in animal studies\u003C\u002Fa\u003E, while a potential option for the latter has \u003Ca href=\"https:\u002F\u002Fwww.aidsmap.com\u002Fnews\u002Fmar-2020\u002Fhiv-vaccine-generates-broadly-neutralising-antibodies-passes-first-safety-and-proof\"\u003Epassed the first safety test in humans\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EAll this means that becoming infected with Covid-19 may not have the same payoff as receiving the vaccine.\u003C\u002Fp\u003E\n\u003Cp\u003EIn October, \u003Ca href=\"https:\u002F\u002Fwww.imperial.ac.uk\u002Fnews\u002F207333\u002Fcoronavirus-antibody-prevalence-falling-england-react\u002F\"\u003Eresearchers from Imperial College London\u003C\u002Fa\u003E estimated that the number of people in the UK with antibodies to the virus is likely to have \u003Ca href=\"https:\u002F\u002Fwww.imperial.ac.uk\u002Fnews\u002F207333\u002Fcoronavirus-antibody-prevalence-falling-england-react\u002F\"\u003Efallen between June and October\u003C\u002Fa\u003E. The findings made international headlines and caused widespread alarm, with many concerned that this suggests it’s possible to be \u003Ca href=\"https:\u002F\u002Fwww.thetimes.co.uk\u002Farticle\u002Fquarter-of-early-patients-have-lost-coronavirus-antibody-defences-wwcfn7pwf\"\u003Ereinfected with Covid-19\u003C\u002Fa\u003E regularly – and that this would inevitably mean vaccines wouldn’t provide lasting protection either.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, as a number of experts pointed out, this is \u003Ca href=\"https:\u002F\u002Fwww.sciencemediacentre.org\u002Fexpert-reaction-to-a-preprint-from-the-react-2-study-looking-at-prevalence-of-antibody-positivity-to-sars-cov-2\u002F\"\u003Enot necessarily the case\u003C\u002Fa\u003E. For example, the study \u003Ca href=\"https:\u002F\u002Ftheconversation.com\u002Fa-new-study-suggests-coronavirus-antibodies-fade-over-time-but-how-concerned-should-we-be-148957\"\u003Edidn’t look at T-cell immunity\u003C\u002Fa\u003E – a kind of lasting protection thought to \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200716-the-people-with-hidden-protection-from-covid-19\"\u003Eplay an important role\u003C\u002Fa\u003E in the severity of Covid-19 infections. But crucially, vaccines are very different to natural infections.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-12"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08z2d59"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-13"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIt’s not yet clear how the immunity generated by infection with Covid-19 compares to that produced by the vaccines currently in clinical trials – including those made by Pfizer\u002FBioNTech and Moderna, which have released preliminary results demonstrating \u003Ca href=\"https:\u002F\u002Fwww.pfizer.com\u002Fnews\u002Fpress-release\u002Fpress-release-detail\u002Fpfizer-and-biontech-announce-vaccine-candidate-against\"\u003Eabove 90%\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Finvestors.modernatx.com\u002Fnews-releases\u002Fnews-release-details\u002Fmodernas-covid-19-vaccine-candidate-meets-its-primary-efficacy\"\u003E94.5%\u003C\u002Fa\u003E effectiveness respectively. However, early results from trials in animals suggest that some vaccine candidates lead to \u003Ca href=\"https:\u002F\u002Fwww.fiercebiotech.com\u002Fresearch\u002Fpfizer-biontech-report-strong-immune-response-animals-to-covid-19-mrna-vaccine-candidate\"\u003Ehigher antibody levels\u003C\u002Fa\u003E than are found in the blood of recovered patents. This suggests they might be more protective than natural infections.\u003C\u002Fp\u003E\n\u003Cp\u003EAnother crucial advantage of vaccines is that they provide the opportunity to generate immunity in large numbers of people all at once. \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EHerd immunity usually happens via vaccines\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EEarly in the Covid-19 pandemic, Italy was one of the \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2020\u002Fmar\u002F01\u002Fcoronavirus-deaths-iran-rise-global-outbreak-worsens\"\u003Ehardest-hit countries on the planet\u003C\u002Fa\u003E. And within it, Bergamo – a northern province encompassing 1.1 million people and  covering 2,755 sq km (1,064 sq miles) – was the epicentre of the outbreak.\u003C\u002Fp\u003E\n\u003Cp\u003EThough Bergamo is usually renowned for its \u003Ca href=\"https:\u002F\u002Fwww.italyheaven.co.uk\u002Flombardy\u002Fbergamo-mountains.html\"\u003Ealpine vistas\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fitaliantravel.it\u002Fwine-regions-around-bergamo\u002F\"\u003Evineyards\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Fwww.nytimes.com\u002F2010\u002F12\u002F19\u002Ftravel\u002F19bergamo-overnighter.html#:~:text=For%20nearly%20400%20years%2C%20starting,narrow%20and%20winding%20cobblestone%20streets.\"\u003Emedieval history\u003C\u002Fa\u003E, suddenly this was a place where ambulance sirens wailed all through the day and night, doctors were faced with heart-breaking \u003Ca href=\"https:\u002F\u002Fwww.reuters.com\u002Farticle\u002Fus-health-coronavirus-italy-ethics-speci-idUSKBN2133KG\"\u003Emoral dilemmas\u003C\u002Fa\u003E about who to prioritise for intensive care beds, and many older patients reportedly \u003Ca href=\"https:\u002F\u002Fwww.nytimes.com\u002F2020\u002F03\u002F16\u002Fworld\u002Feurope\u002Fitaly-coronavirus-funerals.html\"\u003Edied alone\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EIn one tragic case, a 74-year-old priest was gifted a ventilator by his adoring congregation. It might have saved his life – but instead he \u003Ca href=\"https:\u002F\u002Fwww.cbsnews.com\u002Fnews\u002Fitalian-priest-coronavirus-ventilator-don-giuseppe-berardelli\u002F\"\u003Edonated it to someone younger\u003C\u002Fa\u003E, and died shortly afterwards.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-14"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Contrary to popular belief, there is no reliable threshold at which herd immunity can be reached","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-15"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAs of September, scientists have estimated that around 38.5% of people in Bergamo had antibodies against Covid-19, suggesting that \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Febiom\u002Farticle\u002FPIIS2352-3964(20)30445-X\u002Ffulltext\"\u003Earound 420,000 people\u003C\u002Fa\u003E in the province have been infected. There are only a handful of other places where such a high proportion of people are thought to have contracted the virus, including the Brazilian city of Manaus, where roughly \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02948-4\"\u003E66% of people\u003C\u002Fa\u003E have antibodies.\u003C\u002Fp\u003E\n\u003Cp\u003EIn both Bergamo and Manaus, the number of Covid-19 cases has tailed off dramatically, possibly as a result of herd immunity curtailing the virus’ spread. But there are several reasons that this is ordinarily achieved with vaccines – and why it’s unusual to discuss the concept in the context of natural infections.\u003C\u002Fp\u003E\n\u003Cp\u003EHerd immunity is a kind of disease resistance that occurs within a population, as a result of the \u003Ca href=\"https:\u002F\u002Fwww.who.int\u002Fnews-room\u002Fq-a-detail\u002Fherd-immunity-lockdowns-and-covid-19\"\u003Ebuild-up of immunity in individuals\u003C\u002Fa\u003E. It doesn’t make viruses disappear completely, but limits their spread as long as they are contagious – it doesn’t work for infections that are caught in other ways. If few people are susceptible to a certain pathogen, there won’t be much of it in circulation.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-16"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08z2f55"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-17"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EContrary to popular belief, there is \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02948-4\"\u003Eno reliable threshold at which herd immunity can be reached\u003C\u002Fa\u003E, such as the commonly-cited 66% of people for Covid-19. Instead, the point at which it materialises depends the reproduction (R) number, which represents the number of people that the average person infects. Where the R number is high, the number of people that need to be immune before herd immunity kicks in is high also. This is the case for measles, where each person infects around 15 others and around \u003Ca href=\"https:\u002F\u002Fwww.ovg.ox.ac.uk\u002Fnews\u002Fherd-immunity-how-does-it-work\"\u003E90-95% of the population\u003C\u002Fa\u003E needs to be protected at all times.\u003C\u002Fp\u003E\n\u003Cp\u003EIn reality, this means that there is unlikely to be a single, reliable threshold at which herd immunity is reached for Covid-19. The R number varies around the world, and depends on our behaviour and the level of immunity in the population. It’s also not usually evenly distributed across a population – for example, it might be \u003Ca href=\"https:\u002F\u002Fwww.centreforcities.org\u002Fblog\u002Fhave-uk-cities-been-hotbeds-of-covid-19-pandemic\u002F\"\u003Ehigher in cities\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flanres\u002Farticle\u002FPIIS2213-2600(20)30461-6\u002Ffulltext\"\u003Ecertain demographics\u003C\u002Fa\u003E.  \u003C\u002Fp\u003E\n\u003Cp\u003EAs a result, estimates for the number of people that need to be immune to the virus to end the pandemic have ranged from 85% in Bahrain to 5.66% in Kuwait, \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02948-4\"\u003Eaccording to an article published by the journal Nature\u003C\u002Fa\u003E.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-18"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"It’s possible that that people who have been infected with Covid-19 once will still be able to catch it and spread it again","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-19"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThis is one reason relying on the population building up herd immunity naturally is \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02948-4\"\u003Eusually not recommended\u003C\u002Fa\u003E. Due to its dynamic nature, it can be hard to spot and quick to slip away. It can also be totally impractical; if 85% of people need to be infected to achieve it, you’re reaching the point where it’s not protecting many people who haven’t already had the virus – and shielding the most vulnerable members of society might be impractical.\u003C\u002Fp\u003E\n\u003Cp\u003ESecondly, it’s possible that people who have been infected with Covid-19 once will \u003Ca href=\"https:\u002F\u002Fwww.thelancet.com\u002Fjournals\u002Flaninf\u002Farticle\u002FPIIS1473-3099(20)30766-0\u002Ffulltext\"\u003Estill be able to catch it and spread it again\u003C\u002Fa\u003E, even if they don’t develop symptoms the second time – as is the case for some seasonal cold viruses. If this kind of immunity doesn’t halt onward transmission, herd immunity may never materialise.\u003C\u002Fp\u003E\n\u003Cp\u003EThirdly, herd immunity can come at a steep price. In Bergamo alone, there have been 3,100 deaths, while in Manaus around \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02725-3\"\u003Eone in every 500-800 people\u003C\u002Fa\u003E has been killed by the disease. Catching any pathogen is a gamble – especially one that’s new to humankind. Sometimes, the cost of an infection doesn’t show up for months or years afterwards; HPV can take years to lead to cervical cancer, while HSV-1 has recently been \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3546524\u002F\"\u003Elinked to Alzheimer’s disease\u003C\u002Fa\u003E. \u003C\u002Fp\u003E\n\u003Cp\u003EA \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fcoronavirus\u002F2019-ncov\u002Flong-term-effects.html\"\u003Ewide range of longer-term health problems\u003C\u002Fa\u003E are now believed to be caused by Covid-19 in those who have been infected – something that has now become known as “\u003Ca href=\"https:\u002F\u002Fwww.england.nhs.uk\u002F2020\u002F11\u002Fnhs-launches-40-long-covid-clinics-to-tackle-persistent-symptoms\u002F\"\u003Elong-Covid\u003C\u002Fa\u003E”.\u003C\u002Fp\u003E\n\u003Cp\u003ENo one knows how enduring long Covid will be. The syndrome of fatigue, breathlessness, brain fog and joint pain, among other things, occurs in \u003Ca href=\"https:\u002F\u002Fcovid.joinzoe.com\u002Fpost\u002Flong-covid#:~:text=The%20latest%20analysis%20of%20data,lasting%20more%20than%208%20weeks.\"\u003Eone in 20 people\u003C\u002Fa\u003E who have recovered from Covid-19. There are already signs that the consequences of the pandemic might be with us for years to come.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-20"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08z286k"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-21"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EPreliminary data from one study suggests that \u003Ca href=\"https:\u002F\u002Fwww.medrxiv.org\u002Fcontent\u002F10.1101\u002F2020.10.14.20212555v1.full.pdf\"\u003Ealmost 70% of people with long Covid\u003C\u002Fa\u003E have impairments in one or more organs four months after they first developed symptoms of infection. This includes damage to the heart, lungs, liver, kidneys, spleen and pancreas.\u003C\u002Fp\u003E\n\u003Cp\u003EA follow-up study of patients who were \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41413-020-0084-5\"\u003Ehospitalised with another coronavirus infection, Sars, 15 years previously\u003C\u002Fa\u003E recently found that, while their lungs tended to recover substantially within the first year after infection, there was very little change after that.\u003C\u002Fp\u003E\n\u003Cp\u003EMeanwhile a large-scale analysis of the evidence found that the survivors of Mers and Sars often found it hard to exercise and this \u003Ca href=\"https:\u002F\u002Fwww.medrxiv.org\u002Fcontent\u002F10.1101\u002F2020.04.16.20067975v1.full.pdf\"\u003Edid not improve much beyond six months afterwards\u003C\u002Fa\u003E. There was also a “considerable prevalence” of lingering psychological disorders. The authors speculated this may have implications for the long-term prospects of those who have been infected with Covid-19.\u003C\u002Fp\u003E\n\u003Cp\u003EIf this is true, it may well be preferable to \u003Ca href=\"https:\u002F\u002Fwww.medrxiv.org\u002Fcontent\u002F10.1101\u002F2020.10.14.20212555v1.full.pdf\"\u003Eminimise the number of infections\u003C\u002Fa\u003E. Looking at humanity’s long history of desperate, even nauseating strategies for avoiding infection, you might say it’s the least we can do.\u003C\u002Fp\u003E\n\u003Cp\u003EStaying home, keeping your distance, wearing a mask, and washing your hands should be easy – certainly better than toad vomit-flavoured lozenges or the prospect of tooth pulling.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19-22"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-11-23T11:46:18Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"Why you really don’t want to catch Covid-19","headlineShort":"Here’s why vaccination beats infection","image":["p08z2drw"],"imageAlignment":"centre","imageAltText":"","isSyndicated":false,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"From the surprisingly treacherous path to herd immunity to the potentially superior protection offered by vaccines, there are many reasons to avoid Covid-19.","summaryShort":"Vaccines can provide stronger and longer-lasting protection than infections","tag":["tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2020-11-23T01:00:28.546835Z","entity":"article","guid":"03d40a44-4a37-4477-9b38-80f52b712088","id":"future\u002Farticle\u002F20201120-why-you-really-dont-want-to-catch-covid-19","modifiedDateTime":"2021-09-01T17:32:31.391753Z","project":"future","slug":"20201120-why-you-really-dont-want-to-catch-covid-19","cacheLastUpdated":1642293446387},"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives","_id":"6183c24345ceed4eb930e4f8","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"Numerous vaccines are made using the cells, which were taken from a foetus in the 1960s. But their use has also created a moral dilemma.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumn\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIn 1612, the streets of Paris were alive with a tantalising rumour – that a man had achieved immortality.\u003C\u002Fp\u003E\n\u003Cp\u003EHis name was Nicholas Flamel, and though he had been born in France nearly 300 years earlier, he was credited with \u003Ca href=\"https:\u002F\u002Fwww.cambridge.org\u002Fcore\u002Fbooks\u002Falchemy-reader\u002Fnicolas-flamel-13301417-from-his-exposition-of-the-hieroglyphical-figures\u002FE15E13E31069BEBAE999AC0628375B2A\"\u003Eauthoring a book about alchemy\u003C\u002Fa\u003E, published that year. In it, he claimed to have successfully made the philosopher's stone, a mythical object which allows its owner to turn base metals to gold and produce the elixir of life. \u003C\u002Fp\u003E\n\u003Cp\u003EAs the legend of Flamel’s immortality spread, people began to report seeing him out and about. Even Isaac Newton, widely regarded as one of the most brilliant minds who ever lived, believed the tales. He took the book extremely seriously, and devoted a large part of his professional career to studying its contents.\u003C\u002Fp\u003E\n\u003Cp\u003EAlas, it wasn’t true. The real Flamel was no alchemist – he had worked as a scribe, and died in 1418 at the respectable age of 88. The book had been written by someone else. \u003C\u002Fp\u003E\n\u003Cp\u003EThe quest for immortality took another blow in 1961, this time in a modern laboratory in Philadelphia.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201027-what-is-added-to-vaccines\"\u003E\u003Cstrong\u003EThe strange ingredients in vaccines\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate\"\u003E\u003Cstrong\u003EWhy the elderly are harder to vaccinate\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months\"\u003E\u003Cstrong\u003EWhy a global vaccine is such a challenge\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EFor decades, scientists had thought that the roughly 37.2 trillion cells that make up our bodies would keep dividing – and thus replenishing themselves – forever, if only they were given the chance. \u003C\u002Fp\u003E\n\u003Cp\u003EThen a young American scientist, Leonard Hayflick, made a discovery which shocked the world. It turns out ordinary human cells can only divide between 40 and 60 times before they undergo a violent, pre-determined death. This strict cut-off is known as the “\u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002F35036093\"\u003EHayflick limit\u003C\u002Fa\u003E”, and it has two important consequences.\u003C\u002Fp\u003E\n\u003Cp\u003EFirstly, our current lifespans might not just be constrained by the way we live our lives – our diets, and so on. Instead, it’s possible that there are built-in limits to how old it’s possible to get. In fact, if you multiply the number of cells in the human body by the average time it takes for cells to reach the Hayflick limit, you end up with 120 years. The oldest person who has ever lived, \u003Ca href=\"https:\u002F\u002Fwww.guinnessworldrecords.com\u002Fnews\u002F2020\u002F5\u002Fworlds-oldest-man-bob-weighton-dies-aged-112#:~:text=The%20oldest%20person%20ever%20to,days%20on%2012%20June%202013..\"\u003EJeanne Calment\u003C\u002Fa\u003E, made it to 122 years and 164 days – uncannily close.\u003C\u002Fp\u003E\n\u003Cp\u003ESecondly, it’s difficult to find cells that scientists can grow in the laboratory – an essential step in the production of many drugs and vaccines. Because cells are mortal individually, if you grow them in a petri dish, sooner or later they will stop dividing and die.\u003C\u002Fp\u003E\n\u003Cp\u003EThis is the story of the cells that helped to overcome this obstacle, and their controversial origins at a clinic in Sweden. Why are they so special? And how can we justify continuing to use them given the way they were obtained?\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA hidden crisis\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EBefore Hayflick’s discovery, scientists had got around the division limit by continually replenishing their cell supplies with fresh ones from new animals, or using cancerous cells – since cancer doesn’t play by the same rules as healthy tissue, and will keep growing indefinitely. But scientists were urgently in need of another way.\u003C\u002Fp\u003E\n\u003Cp\u003EIn the 1960s, the polio vaccine used in the United States had been hit by calamity.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08x8ndp"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ESome vaccines are made by growing viral particles in cells, and then killing or weakening them so that they can’t cause disease. These inactivated particles become the active ingredient – the part that teaches the immune system what to look out for. \u003C\u002Fp\u003E\n\u003Cp\u003EFor decades, the polio vaccine had been made in cells taken from monkey kidneys, some of which – it was later discovered – were infected with a virus, simian virus 40 (SV40). Though today vaccines are extensively filtered, and don’t contain any material from the cells they’re grown in, between 1955 and 1963, it’s been estimated that up to 30 million people were infected in the United States alone.\u003C\u002Fp\u003E\n\u003Cp\u003EThe contamination is thought to have occurred because the cells were usually grown fresh from monkeys – as opposed to from a stock of laboratory cells – and SV40 is a common infection in the most widely used species, the rhesus macaque.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Over the ensuing years, frozen vials of the cells were flown to hundreds of laboratories across the world","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EWhether the introduction of the virus had any medical consequences is \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC6669359\u002F\"\u003Estill under question\u003C\u002Fa\u003E – as is the possibility that it is now spreading to people who were never vaccinated. In the laboratory, the virus has been shown to be carcinogenic, and a possible link between the virus and several types of cancer, from \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC452549\u002F#:~:text=The%20polyomavirus%20simian%20virus%2040,and%20represents%20an%20emerging%20pathogen.\"\u003Ebrain cancer to lymphoma\u003C\u002Fa\u003E, has been investigated, but there isn’t yet definitive evidence either way.\u003C\u002Fp\u003E\n\u003Cp\u003ENevertheless, it suddenly became necessary to find an alternative supply of cells.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EAn anonymous woman \u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThen in 1962, Hayflick made another discovery. “Without it, you and I might not even be alive,” says Stuart Jay Olshansky, an expert in biodemography and gerontology at the University of Illinois, Chicago.\u003C\u002Fp\u003E\n\u003Cp\u003EIt began when a nameless woman who was three months pregnant had a legal abortion in Sweden. As the author Meredith Wadman wrote in her book, The Vaccine Race: Science, Politics and the Human Costs of Defeating Disease, the foetus wasn’t incinerated, buried or thrown away – instead it was wrapped in sterile green cloth and \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Fnews\u002Fmedical-research-cell-division-1.13273\"\u003Esent to the Karolinska Institute in northwest Stockholm\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EAt the time, Hayflick was sourcing the cells he used for his research from this institution. In his laboratory at the Wistar Institute in Philadelphia, he managed to incubate some of the tissue in several glass bottles at 37C (98F). He added an enzyme to break down the protein that bound the cells together, as well as \"growth medium\", a solution which contained the nutrients they needed to divide. After a few days, he was \u003Ca title=\"https:\u002F\u002Fwww.researchgate.net\u002Fprofile\u002FLeonard_Hayflick\u002Fpublication\u002F282116974_The_serial_cultivation_of_human_diploid_cell_strains\u002Flinks\u002F5a57c68ea6fdccf0ad1a375c\u002FThe-serial-cultivation-of-human-diploid-cell-strains.pdf\" href=\"https:\u002F\u002Fwww.researchgate.net\u002Fprofile\u002FLeonard_Hayflick\u002Fpublication\u002F282116974_The_serial_cultivation_of_human_diploid_cell_strains\u002Flinks\u002F5a57c68ea6fdccf0ad1a375c\u002FThe-serial-cultivation-of-human-diploid-cell-strains.pdf\"\u003Eleft with a continuous sheet of cells\u003C\u002Fa\u003E. \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08x8qk1"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EOne of these cells eventually turned into the cell line “WI-38”, which stands for Wistar Institute foetus 38.\u003C\u002Fp\u003E\n\u003Cp\u003EOver the ensuing years, frozen vials of the cells were flown to hundreds of laboratories across the world, WI-38 is now one of the oldest and most widely available cell lines on the planet. As Hayflick has noted previously – although perhaps rather insensitively – as early as 1984, WI-38 had become “the first cultured normal human cell population to ever reach voting age”. Today the cells are routinely used to make vaccines against polio, measles, mumps, rubella, varicella zoster (chicken pox), herpes zoster, adenovirus, rabies and Hepatitis A.\u003C\u002Fp\u003E\n\u003Cp\u003EWhy are the cells so special? And how can we justify continuing to use them?\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EAn unlimited supply of cells\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003ESoon after Hayflick discovered that cells are mortal, he realised that if you siphon some off each time they divide and freeze them, a single source can theoretically provide an almost unlimited supply – around \u003Ca href=\"https:\u002F\u002Fwww.researchgate.net\u002Fprofile\u002FLeonard_Hayflick\u002Fpublication\u002F282116974_The_serial_cultivation_of_human_diploid_cell_strains\u002Flinks\u002F5a57c68ea6fdccf0ad1a375c\u002FThe-serial-cultivation-of-human-diploid-cell-strains.pdf\"\u003E10,000,000,000,000,000,000,000\u003C\u002Fa\u003E (10 sextillion) in total.\u003C\u002Fp\u003E\n\u003Cp\u003EAnd though WI-38 cells are mortal, because the cells had divided relatively few times when they were collected, they can be grown for longer before they reach the Hayflick limit. Most WI-38 cells have \u003Ca href=\"https:\u002F\u002Fwww.lgcstandards-atcc.org\u002Fproducts\u002Fall\u002Fccl-75.aspx?geo_country=gb\"\u003E50 divisions left\u003C\u002Fa\u003E, which each take 24 hours to complete, so they can be grown continuously for 50 days before you need to start again.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Though there are hundreds of cell lines available in the United States, WI-38 makes up the majority of the cells used","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAnother reason WI-38 has become so ubiquitous is that a quirk of the American legal system at the time of its discovery: it wasn’t possible to patent living things. This \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F9467730\u002F\"\u003Emeans their use was never restricted\u003C\u002Fa\u003E, and scientists around the world were able to share them freely with colleagues.\u003C\u002Fp\u003E\n\u003Cp\u003EThough there are hundreds of cell lines available in the United States, WI-38 makes up the majority of the cells used, together with just one other.\u003C\u002Fp\u003E\n\u003Cp\u003E“MRC-5” cells, named after the initials of the Medical Research Council where they were collected, were obtained from the lungs of another three-month-old foetus. This time the abortion happened in England in 1966 for “psychiatric reasons”.\u003C\u002Fp\u003E\n\u003Cp\u003EWI-38 was fundamental for the development of vaccines against polio, measles, mumps, rubella, varicella zoster (chicken pox), herpes zoster, adenovirus, rabies and Hepatitis A, as well as in the production of many early vaccines. Today it's still used to make the rubella vaccine – part of Merck's measles, mumps and rubella (\u003Ca href=\"https:\u002F\u002Fwww.merck.com\u002Fproduct\u002Fusa\u002Fpi_circulars\u002Fm\u002Fmmr_ii\u002Fmmr_ii_pi.pdf\"\u003EMMR\u003C\u002Fa\u003E) jab – and Teva's adenovirus vaccine for the US military.\u003C\u002Fp\u003E\n\u003Cp\u003EFinally, foetuses are thought to be the “cleanest” possible source of cells, since they are less likely to have picked up any viruses from the outside world which might contaminate vaccines or confound the results of experiments.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08x8kk4"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBack in 2017, Hayflick asked Olshansky to quantify exactly how many lives the cells had spared until that point. By comparing the global prevalence of certain infectious diseases in the 1960s, when the cell line was discovered, with the prevalence of  infectious diseases then, he calculated that vaccines made with WI-38 may have \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC5689800\u002F\"\u003Eprevented around 4.5 billion infections\u003C\u002Fa\u003E. In total, the cells are likely to have spared 10.3 million lives.\u003C\u002Fp\u003E\n\u003Cp\u003E“Not everybody dies from these diseases. But if you survive, you might survive disabled,” says Olshansky. “My wife and I, we have a very close friend of ours who is suffering from the consequences of a polio exposure as a child today.”\u003C\u002Fp\u003E\n\u003Cp\u003EThough there hasn’t been a single case of polio in the United States since 1979, a significant number of people are still thought to be living with the after-effects. This includes potentially hundreds of thousands with “\u003Ca href=\"https:\u002F\u002Fwww.ninds.nih.gov\u002FDisorders\u002FPatient-Caregiver-Education\u002FFact-Sheets\u002FPost-Polio-Syndrome-Fact-Sheet#:~:text=Post%2Dpolio%20syndrome%20(PPS),affected%20by%20the%20polio%20infection.\"\u003Epost-polio syndrome\u003C\u002Fa\u003E”, in which muscles slowly weaken and shrink. One man, \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fsociety\u002F2020\u002Fmay\u002F26\u002Flast-iron-lung-paul-alexander-polio-coronavirus\"\u003E74-year-old Paul Alexander\u003C\u002Fa\u003E, is still trapped in an iron lung. He was paralysed by the virus in 1952 at the age of six.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"You have to think, well what about the ethical consequences of not using the cell line? - Stuart Jay Olshansky","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThere has been some controversy surrounding the origins of the cell line, however.\u003C\u002Fp\u003E\n\u003Cp\u003EApart from the fact that some people \u003Ca href=\"https:\u002F\u002Fwww.deseret.com\u002Findepth\u002F2020\u002F5\u002F19\u002F21254937\u002Fcovid-19-coronavirus-vaccine-pro-life-abortion-fetal-cells-catholic-religion-ethics\"\u003Efeel uncomfortable\u003C\u002Fa\u003E about its links to abortion, the woman whose foetus the cells came from, who Wadman has named “Mrs X”, \u003Ca href=\"https:\u002F\u002Fwww.nybooks.com\u002Farticles\u002F2019\u002F06\u002F27\u002Fvalue-of-cell\u002F\"\u003Edid not consent to its use\u003C\u002Fa\u003E. In fact, she didn’t even know about it until years later, when she was contacted by someone from the Karolinska Institute who was hoping for a more detailed medical history. \u003C\u002Fp\u003E\n\u003Cp\u003EThe incident is unlikely to happen again today, because human tissue is regulated in the United States. Any material collected is subject to the Common Rule – a set of ethical standards introduced in 1981, which researchers must comply with in order to receive federal funding. Chief among them is the requirement for informed consent.\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, the rule doesn’t apply retrospectively, and there are many examples of tissue which was effectively stolen and continues to be used to this day.  \u003C\u002Fp\u003E\n\u003Cp\u003EThe issue was first brought to the public attention by the 2010 book, The Immortal Life of Henrietta Lacks, about an African-American woman of the same name who unknowingly had cells taken from a cervical tumour and turned into the popular cell line HeLa in 1951. So far, the cells have contributed to over 70,000 studies, and led to the discovery that the majority of cervical cancers are caused by the HPV virus. However, while Lacks' descendents are generally proud of what her cells have achieved, some have been critical that others have profited from them, when her own family has not. (\u003Cem\u003ELearn more about \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Freel\u002Fvideo\u002Fp08wr9gf\u002Fhow-one-woman-s-immortal-cells-changed-the-world\" target=\"_blank\"\u003Ethe immortal cells of Henrietta Lacks\u003C\u002Fa\u003E.\u003C\u002Fem\u003E)\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-12"},{"bodyHtml":{"assets":[]},"cardType":"Video","iFrameType":"","videoImageAlign":"centre","videoUrn":["p08wr9gf"],"id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-13"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\u003Cstrong\u003EGenetic insight\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EThese ethical transgressions have become even more problematic with the advent of \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3737160\u002F\"\u003Eaffordable genetic sequencing\u003C\u002Fa\u003E. Human cell lines contain human DNA – and WI-38 will share 50% of its DNA with the foetus’ mother. In this light, the cell line is considered by some as potentially representing a \u003Ca title=\"https:\u002F\u002Fwww.g3journal.org\u002Fcontent\u002F3\u002F8\u002Fvii.short\" href=\"https:\u002F\u002Fwww.g3journal.org\u002Fcontent\u002F3\u002F8\u002Fvii.short\"\u003Eprivacy risk\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EA person’s genetic sequence can provide insights into their familial risk of disease, ancestry, intelligence, and potential lifespan. In fact, even in cases where informed consent is obtained, there is still some debate about the ethics of using human tissue – because genetic material is familial by nature, and this decision could potentially affect many other relatives other than the one who provided it.\u003C\u002Fp\u003E\n\u003Cp\u003EOne way to deal with these concerns is to involve the family in decisions about when and how their genetic information is used. For the HeLa cell line, there have been some efforts to achieve this. Back in 2013, the National Institutes of Health \u003Ca href=\"https:\u002F\u002Fwww.nih.gov\u002Fnews-events\u002Fnews-releases\u002Fnih-lacks-family-reach-understanding-share-genomic-data-hela-cells\"\u003Ecame to an understanding\u003C\u002Fa\u003E with Lacks’ relatives, and set up a  panel with three family members to review requests to access the full genome. By then, a German team had already published the full sequence on the internet.  \u003C\u002Fp\u003E\n\u003Cp\u003EDespite these concerns, the benefits of using the cells are widely thought to vastly outweigh them, and many religious organisations which are otherwise anti-abortion have publicly announced their support for the use of vaccines manufactured this way when no other alternatives exist, including the \u003Ca href=\"https:\u002F\u002Fwww.immunize.org\u002Ftalking-about-vaccines\u002Fvaticandocument.htm\"\u003ECatholic Church, \u003C\u002Fa\u003Ealthough it did express a need for alternative sources of vaccines. \u003C\u002Fp\u003E\n\u003Cp\u003EThe connection between the chilling origins of many cell lines and the benefits they provide is perhaps most striking in the development of the rubella vaccine. Though it’s produced in WI-38 cells to this day, its early development relied heavily on cells taken from several different aborted foetuses – many of which had been aborted \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F5794813\u002F\"\u003Efor the very reason that their mother was infected with the virus\u003C\u002Fa\u003E.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-14"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08x8pv9"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-15"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ERubella can cause a number of serious consequences during pregnancy, such as stillbirth and miscarriage. If a woman is infected early on, she has a \u003Ca href=\"https:\u002F\u002Fwww.who.int\u002Fnews-room\u002Ffact-sheets\u002Fdetail\u002Frubella#:~:text=When%20a%20woman%20is%20infected,for%20a%20year%20or%20more.\"\u003E90% chance of passing the virus to her unborn child\u003C\u002Fa\u003E, where it can lead to “congenital rubella syndrome” and a constellation of health problems, from brain damage to hearing loss.\u003C\u002Fp\u003E\n\u003Cp\u003E“You have to think, well what about the ethical consequences of \u003Cem\u003Enot\u003C\u002Fem\u003E using the cell line?” says Olshansky. “Just keep in mind that they are a critical link in the chain, in the development of viral vaccines.” \u003C\u002Fp\u003E\n\u003Cp\u003EFour centuries on from the publication of Flamel’s book, and his fans might be disappointed to hear that no one has made it to 300, let alone discovered the secret to living forever. But though the Hayflick limit currently seems like a formidable barrier for people, it’s no longer such a problem for scientists. Ironically, their efforts to overcome it in cells have arguably helped to keep more of us alive than research into immortality ever has.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EThis article has been amended to clarify that WI-38 is one of the oldest cell lines in use, rather than the oldest, and which vaccines it is used to produce today.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives-16"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-11-04T09:30:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"The controversial cells that saved 10 million lives","headlineShort":"The cells that saved 10 million lives","image":["p08x8k96"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":["p08x8pv9"],"relatedStories":null,"relatedTag":null,"summaryLong":"Numerous vaccines are made using the cells, which were taken from a foetus in the 1960s. But their use has also created a moral dilemma.","summaryShort":"They are used to create vaccines but their origins pose a moral dilemma","tag":["tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2020-11-04T10:14:26.947814Z","entity":"article","guid":"88aa8cdd-440d-4798-a134-3ebac3646cde","id":"future\u002Farticle\u002F20201103-the-controversial-cells-that-saved-10-million-lives","modifiedDateTime":"2021-11-17T17:22:47.365953Z","project":"future","slug":"20201103-the-controversial-cells-that-saved-10-million-lives","cacheLastUpdated":1642293446388},"future\u002Farticle\u002F20201027-what-is-added-to-vaccines":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20201027-what-is-added-to-vaccines","_id":"6183c1f245ceed22272c92b4","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"Scientists add some bizarre things to vaccines, such as aluminium and extracts from shark livers. Many vaccines simply don’t work without them – but no one knows why.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumns\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIn 1925, Gaston Ramon embarked upon an experiment that even he described as… “\u003Ca href=\"https:\u002F\u002Fbooks.google.co.uk\u002Fbooks\u002Fabout\u002FTopics_in_Vaccine_Adjuvant_Research.html?id=9pWauBxDu38C&redir_esc=y\"\u003Einteresting\u003C\u002Fa\u003E”.\u003C\u002Fp\u003E\n\u003Cp\u003EA few years earlier, the French veterinarian had been trying out a new diphtheria vaccine on horses, when he made an accidental discovery: some animals reacted by developing nasty abscesses at the injection site, and these ones also tended to develop stronger immune responses. This got him thinking – what else could he add to the vaccine, to encourage this to happen?\u003C\u002Fp\u003E\n\u003Cp\u003EOver the next year, Ramon tested a bizarre smorgasbord of ingredients, seemingly based on what he happened to have in his kitchen cupboards. Together with the diphtheria vaccine, his unfortunate patients were injected with tapioca, starch, agar, lecithin – an emulsion of oil, commonly found in chocolate – and even breadcrumbs.\u003C\u002Fp\u003E\n\u003Cp\u003EThe experiments were a success. Animals which had been given vaccines that included Ramon’s concoctions produced significantly more antibodies than those which didn’t, suggesting that they would be better protected against diphtheria.\u003C\u002Fp\u003E\n\u003Cp\u003EAnd thus the field of “adjuvants” was born. Named after the Latin word “\u003Cem\u003Eadjuvare”\u003C\u002Fem\u003E, meaning “to help” or “aid”, these are substances which can be added to vaccines to make them more effective. They’re widely used to this day – and they’re no less weird than they were to begin with.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate\"\u003E\u003Cstrong\u003EWhy older people are harder to vaccinate\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct\"\u003E\u003Cstrong\u003EHow Covid-19 is changing the flu\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months\"\u003E\u003Cstrong\u003EWhy a vaccine is so hard to make\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EThe most commonly used adjuvant on the planet is aluminium. The chemical is found in \u003Ca href=\"https:\u002F\u002Fwww.immunology.org\u002Falum-1926#:~:text=Today%2C%20alum%20%E2%80%93%20potassium%20aluminium%20sulphate,phosphate%20and%20mixed%20aluminium%20salts.\"\u003Ethe majority of vaccines\u003C\u002Fa\u003E, including the diphtheria, tetanus, and whooping cough (DTP) vaccine, as well as those that protect against hepatitis A, hepatitis B, HPV, Japanese encephalitis, meningitis B, anthrax, pneumococcus, and \u003Cem\u003EHaemophilus influenzae\u003C\u002Fem\u003E type b.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EOther popular adjuvants include squalene, an oily substance made from shark livers, and extracts from the bark of the quillaja tree, which has traditionally been used by the Andean Mapuche people to make soap as its bark can be powdered and mixed with water to form a lather. The newest additions – which haven’t yet been licensed – are perhaps the strangest of all, such as the \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F29580106\u002F\"\u003Edisembodied tails of bacteria\u003C\u002Fa\u003E and “\u003Ca href=\"https:\u002F\u002Fveterinaryresearch.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs13567-017-0442-5\"\u003Ebacterial ghosts\u003C\u002Fa\u003E”, made from their empty skins.  \u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIt’s been estimated that vaccines save \u003Ca href=\"https:\u002F\u002Fourworldindata.org\u002Fvaccination\"\u003Etwo to three million lives per year\u003C\u002Fa\u003E, as well as preventing lifelong disabilities. No one has quantified exactly what proportion of these triumphs are down to adjuvants. But by encouraging the body to respond to vaccines more vigorously, they can make them more effective and protect people for longer than they otherwise would. In some demographics, such as the elderly, certain vaccines simply wouldn’t work without them.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08wkfyh"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E“Without an adjuvant, antibodies will generally disappear, maybe after a few weeks or months. But with adjuvants they might last for a few years.” says Bingbing Sun, a chemical engineer at Dalian University of Technology, in the Chinese city of Dalian. He gives the example of certain types of \u003Ca href=\"https:\u002F\u002Fwww.mdpi.com\u002F2076-393X\u002F8\u002F1\u002F139\u002Fpdf\"\u003Ehepatitis B\u003C\u002Fa\u003E vaccine. “If they don't include adjuvants, antibody production will be very, super low. They don't really have the ability to induce antibody production,” he says.\u003C\u002Fp\u003E\n\u003Cp\u003EFor over a century, why these apparently random ingredients are so essential to vaccines has remained a total mystery. Now scientists are racing to unravel their secrets.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA mistaken scandal\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EFirst up, though the concept of additives in vaccines might sound alarming, they’re included in microscopic quantities. There is as little as \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41541-018-0089-x#:~:text=The%20amount%20of%20aluminum%20adjuvant,and%20about%204.5%20mg%20AP.&text=Licensed%20human%20vaccines%20typically%20contain,%2B86%20(Table%201).\"\u003E0.2mg of aluminium in a typical vaccine dose\u003C\u002Fa\u003E, which is equivalent to less than the weight of a \u003Ca href=\"https:\u002F\u002Fwww.bluebulbprojects.com\u002Fmeasureofthings\u002Fresults.php?amt=0.20&comp=weight&unit=mgs&searchTerm=\"\u003Esingle poppy seed\u003C\u002Fa\u003E. The weight of evidence is that adjuvants do not lead to serious side-effects.\u003C\u002Fp\u003E\n\u003Cp\u003EIn fact, safety is the reason adjuvants were popularised in the first place.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"The scandal spurred scientists to look for new ways to make vaccines","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBack in the 1970s, a paediatric neurologist gave a speech at the Royal Society of Medicine which caused controversy that lasted a decade. John Wilson claimed that 36 children had acquired brain damage – and erroneously blamed it on the vaccine for pertussis.\u003C\u002Fp\u003E\n\u003Cp\u003EThe story was picked up by journalists, and before long it was a full scandal – complete with prime-time specials and front page headlines. Over the coming years, the rates of pertussis vaccination \u003Ca href=\"https:\u002F\u002Fwww.bmj.com\u002Fcontent\u002Fbmj\u002F282\u002F6276\u002F1563.full.pdf\"\u003Eplummeted by more than half in the UK\u003C\u002Fa\u003E, while in some countries it stopped altogether.\u003C\u002Fp\u003E\n\u003Cp\u003EAlthough some initial studies appeared to indicate there was a link, their validity has been questioned and a number of large scale studies have subsequently failed to find \u003Ca href=\"https:\u002F\u002Fbooks.google.co.uk\u002Fbooks?id=XISzQXUhaQoC&pg=PA230&lpg=PA230&dq=The+availability+of+new+tools+has+shed+light+on+the+issue+of+pertussis+vaccine+and+brain+damage.+In+a+landmark+study,+de+novo+mutations+in+the+gene+encoding+a+neuronal+sodium+channel+protein+were+found+in+11+of+14+patients+who+allegedly+had+suffered+vaccine+encephalopathy.+These+individuals+were+born+with+a+molecular+defect+that+would+cause+seizures+and+regression,+vaccines+or+no+vaccines.+Despite+this+finding,+and+despite+the+fact+that+acellular+pertussis+vaccines+have+replaced+whole-cell+vaccines,+encephalopathy+remains+an+injury+that+can+be+compensated+through+the+Vaccine+Injury+Table+under+the+VICP.&source=bl&ots=tOT9msNQTo&sig=ACfU3U2C96rQcbjlIR9j9Xt4T8RTwIqk_Q&hl=en&sa=X&ved=2ahUKEwjFgo2y7dzsAhWGfMAKHUFTDTwQ6AEwAHoECAEQAg#v=onepage&q=The%20availability%20of%20new%20tools%20has%20shed%20light%20on%20the%20issue%20of%20pertussis%20vaccine%20and%20brain%20damage.%20In%20a%20landmark%20study%2C%20de%20novo%20mutations%20in%20the%20gene%20encoding%20a%20neuronal%20sodium%20channel%20protein%20were%20found%20in%2011%20of%2014%20patients%20who%20allegedly%20had%20suffered%20vaccine%20encephalopathy.%20These%20individuals%20were%20born%20with%20a%20molecular%20defect%20that%20would%20cause%20seizures%20and%20regression%2C%20vaccines%20or%20no%20vaccines.%20Despite%20this%20finding%2C%20and%20despite%20the%20fact%20that%20acellular%20pertussis%20vaccines%20have%20replaced%20whole-cell%20vaccines%2C%20encephalopathy%20remains%20an%20injury%20that%20can%20be%20compensated%20through%20the%20Vaccine%20Injury%20Table%20under%20the%20VICP.&f=false\" target=\"_blank\"\u003Esufficient evidence to support it\u003C\u002Fa\u003E. But the vaccine did produce \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fmmwr\u002Fpreview\u002Fmmwrhtml\u002F00048610.htm#:~:text=Whole%2Dcell%20DTP%20vaccines%20are,)%20(5%2C6).\"\u003Esome mild immediate side-effects\u003C\u002Fa\u003E, such as a fever, and this was easy to confuse with something more sinister. More serious side effects were considered to be extremely rare.\u003C\u002Fp\u003E\n\u003Cp\u003EWhat the pertussis scandal did achieve, however, was to spur scientists to look for new ways to make vaccines.\u003C\u002Fp\u003E\n\u003Cp\u003EPreviously, most vaccines had been made using live microorganisms, which had been weakened in some way to make them less infectious or harmful – while still helping the body to recognise them – or killed and included whole. The latter was the case for the pertussis vaccine, which was administered along with tetanus and diphtheria (DTwP).\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08wkh49"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThese vaccines were sometimes accompanied by temporary symptoms because they mimicked natural infections. And just like natural infections, they were highly effective at generating immunity – often giving rise to potent responses which would last decades. Many vaccines containing live microorganisms also provided a kind of accidental bonus protection against unrelated infections, which continues to benefit people to this day (\u003Cem\u003ERead more about \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200915-the-mystery-of-why-some-vaccines-are-doubly-beneficial\"\u003E\u003Cem\u003Ethe mystery of why some vaccines are doubly beneficial\u003C\u002Fem\u003E\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\n\u003Cp\u003EThe new system was different. After the pertussis scare, scientists started to favour just including certain parts of microorganisms, such as the toxins they produce or fragments from their outer surfaces. These new vaccines were just as safe and much more comfortable to receive. But there was a catch.\u003C\u002Fp\u003E\n\u003Cp\u003EMaking vaccines this way means they are less “immunogenic” – the protection they provide isn’t as robust and it doesn’t last as long. To overcome this, \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC4494348\u002F\"\u003Escientists turned to adjuvants\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe aluminium paradox\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EAluminium is not only the most common adjuvant, but one of the oldest.\u003C\u002Fp\u003E\n\u003Cp\u003EShortly after Ramon discovered that his horses responded better to vaccines with added culinary ingredients, the British immunologist Alexander Glenny made another accidental finding. In 1926, his team was trying to purify the toxin produced by the diphtheria bacteria, to make it dissolve less rapidly in the body. The hope was that this would mean it lingered for longer at the injection site, and produced a stronger immune response.\u003C\u002Fp\u003E\n\u003Cp\u003ETo achieve this, Glenny tried using aluminium salts which, legend has it, just so happened to be the first thing he saw in his chemical shelf – who knows, perhaps it was alphabetised. But when he vaccinated guinea pigs with his freshly-prepared diphtheria toxin, something unexpected happened. Those which had been injected with the toxin plus aluminium salts developed much stronger immunity than those which were only injected with the toxin, and not because it was more pure. They were responding to the aluminium itself.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Genny himself believed that aluminium salts help by binding to the vaccine’s main ingredient, the part resembling the pathogen","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ETo this day, the aluminium in vaccines is always in the form of salts. These include aluminium hydroxide (commonly used as an antacid to relieve indigestion and heartburn), aluminium phosphate (often used in \u003Ca href=\"https:\u002F\u002Fwww.sciencedirect.com\u002Ftopics\u002Fmaterials-science\u002Faluminum-phosphate\"\u003Edental cement\u003C\u002Fa\u003E) and potassium aluminium sulphate, which is sometimes found in baking powder.\u003C\u002Fp\u003E\n\u003Cp\u003EGenny himself believed that aluminium salts help by binding to the vaccine’s main ingredient, the part resembling the pathogen, presenting it to the immune system more slowly. This might give the immune system longer to respond, and therefore lead to stronger immunity.\u003C\u002Fp\u003E\n\u003Cp\u003EBut this idea has gone out of fashion – and the truth has proven to be a lot more complicated.\u003C\u002Fp\u003E\n\u003Cp\u003EOne theory is that \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3147301\u002F\"\u003Ethe toxicity of aluminium salts\u003C\u002Fa\u003E is, paradoxically, the reason they work. They lead distressed cells to release uric acid, which activates an immune reaction normally associated with damage. Immune cells flock to the site, and start producing antibodies – and voila, the vaccine has worked.\u003C\u002Fp\u003E\n\u003Cp\u003EAnother idea is that a receptor called “Nalp3” is \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fnature06939\"\u003Elikely to play a central role\u003C\u002Fa\u003E. For a 2008 study led by Richard Flavell from Yale University, Connecticut, mice which had been genetically engineered without it were injected with a vaccine containing aluminium. Their immune response was almost non-existent. However, when they tried a vaccine using a different adjuvant – one containing an emulsion of mineral oil – the animals produced antibodies as usual.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08wkcpx"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThis suggests that in ordinary mice (and humans), the aluminium in vaccines works by activating the Nalp3 receptor, which acts as a kind of danger switch alerting the rest of the immune system. Once the immune cavalry has arrived, they help to generate a stronger response and the vaccine has more of an impact.\u003C\u002Fp\u003E\n\u003Cp\u003EIn fact, though there are many different types of adjuvant, and many different potential mechanisms, this seems to be at the core of how they work – they attract the attention of the immune system, and this leads to a stronger memory of the pathogen the vaccine resembles.  \u003C\u002Fp\u003E\n\u003Cp\u003ETake squalene, an oil made from shark livers and a key ingredient in the adjuvant “MF59”. It’s already added to vaccines for the seasonal flu and is currently being investigated for use in vaccines against Covid-19. (This has caused some controversy, after reports that, if such a vaccine were mass produced so that the entire global population could receive a dose, around 250,000 endangered sharks would need to be slaughtered – however \u003Ca href=\"https:\u002F\u002Fwww.nytimes.com\u002F2020\u002F10\u002F13\u002Fscience\u002Fsharks-vaccines-covid-squalene.html\"\u003Ethis estimate is up for debate\u003C\u002Fa\u003E.)\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Scientists are starting to wonder whether they can come up with something better than those accidental adjuvants","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EOne way MF59 is thought to work is by \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F22682289\u002F\"\u003Etriggering the release of chemokines\u003C\u002Fa\u003E – signalling chemicals – by nearby cells, which then encourage other cells to produce yet more chemokines. Eventually, this cascade attracts immune cells, which ingest the vaccine – including recognisable parts of the pathogen it protects against – and transport the lot to the lymph nodes, which filter pathogens out of the body and help to identify infections.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe next generation\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E“In the vaccine industry, people are very conservative,” says Sun. “So whenever they try to find an adjuvant for a new type of vaccine, most of the ones under investigation are the traditional ones, which we know are safe and effective.”\u003C\u002Fp\u003E\n\u003Cp\u003EHowever, scientists are starting to wonder whether they can come up with something better than those accidental adjuvants from the 1920s and 1950s, discovered before the structure of DNA was known, or man had set foot on the Moon, when computers either didn’t exist or were the size of a house.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-12"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08wkj73"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-13"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThis is particularly important, because of a tragic irony: people who are the most vulnerable to infections also tend to have the weakest responses to vaccines. For example, one flu vaccine was 58% effective at \u003Ca href=\"https:\u002F\u002Facademic.oup.com\u002Fjid\u002Farticle\u002F216\u002F4\u002F405\u002F4036225\"\u003Epreventing hospitalisation in “frail” people\u003C\u002Fa\u003E over the age of 65, but 77.6% effective in those who were not.\u003C\u002Fp\u003E\n\u003Cp\u003EThere are already fears that this could be the case for \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2020\u002Fjun\u002F23\u002Fcovid-19-vaccine-may-not-work-for-at-risk-older-people-say-scientists\"\u003Evaccines against Covid-19\u003C\u002Fa\u003E, which is hundreds of times more likely to kill a person over the age of 80 \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02483-2\"\u003Ethan those under the age of 50\u003C\u002Fa\u003E. (\u003Cem\u003ELearn more about \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate\" target=\"_blank\"\u003Ewhy older people are harder to vaccinate\u003C\u002Fa\u003E.\u003C\u002Fem\u003E)\u003C\u002Fp\u003E\n\u003Cp\u003EAs the global population of septuagenarians, octogenarians, nonagenarians and centenarians creeps up, these problems are only set to get worse. Enter the next generation of adjuvants, which promise to make modern vaccines even more effective.\u003C\u002Fp\u003E\n\u003Cp\u003EOne candidate is the protein flagellin. It’s found in bacteria such as \u003Cem\u003ESalmonella\u003C\u002Fem\u003E, which use it in their tails, or flagella, to propel themselves around. Sometimes it’s made by \u003Ca href=\"https:\u002F\u002Fwww.scielo.br\u002Fscielo.php?script=sci_arttext&pid=S0104-66322011000400003\"\u003Edetaching the tails from bacteria\u003C\u002Fa\u003E – though more recently it’s become common to grow it in genetically modified cells.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-14"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"The development of adjuvants is tedious work – Bingbing Sun","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-15"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EFlagellin isn’t yet licensed for use in any human vaccine, but it’s shown \u003Ca href=\"https:\u002F\u002Fwww.tandfonline.com\u002Fdoi\u002Fabs\u002F10.1080\u002F14760584.2018.1457443\"\u003Epromising results in trials\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EDuring a natural infection with bacteria, the protein binds to receptors on the surface of immune cells. This acts like a danger signal and encourages them to tell other immune cells to flock to the site – leading to a protective response. In theory, this is also what happens when it’s included in vaccines. As with other adjuvants, it gets the attention of the immune system, so that the vaccine can do its job.\u003C\u002Fp\u003E\n\u003Cp\u003ESo-called bacterial ghosts are another possibility, composed of the empty skins of bacteria. These are made by splitting open bacterial cells, such as those belonging to \u003Cem\u003EE. coli\u003C\u002Fem\u003E, so that you are left with the cell membrane and nothing else. Like squalene-based adjuvants, they lead to the production of chemical signals, which call for help from immune cells and \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3037582\u002F#:~:text=The%20Bacterial%20Ghost%20(BG)%20platform,derived%20from%20Gram%2Dnegative%20bacteria.\"\u003Emaximise the chances of them finding the vaccine\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E“The development of adjuvants is tedious work,” says Sun. “I mean, you have to make sure of the safety as well as the efficacy – and this takes time. For a traditional vaccine, it usually takes about 10-12 years for us to licence the vaccine.”\u003C\u002Fp\u003E\n\u003Cp\u003EWho knows, nearly a century after Gaston Ramon experimented with breadcrumbs, the world of adjuvants might be about to get a modern makeover – and the next generation looks set to be just as bizarre as they were to begin with.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EThe paragraph about adjuvants and possible side effects has been amended for clarification. Additional detail about the link between the pertussis vaccine and encephalopathy has also been added for clarity and to correct a statement that the vaccine had been administered for decades without incident.\u003Cbr \u002F\u003E\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines-16"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-10-28T01:00:00Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"The surprising ingredients found in vaccines","headlineShort":"The surprising ingredients in vaccines","image":["p08wkgv4"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":["p08wkcpx"],"relatedStories":null,"relatedTag":null,"summaryLong":"Scientists add some bizarre things to vaccines, such as aluminium and extracts from shark livers. Many vaccines simply don’t work without them – but no one knows why.","summaryShort":"From aluminium to the disembodied tails of bacteria","tag":["tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2020-10-28T01:30:59.919873Z","entity":"article","guid":"32e623a9-56f2-41a7-a673-883fdc8d8f34","id":"future\u002Farticle\u002F20201027-what-is-added-to-vaccines","modifiedDateTime":"2021-09-01T17:31:07.577571Z","project":"future","slug":"20201027-what-is-added-to-vaccines","cacheLastUpdated":1642293446391},"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate","_id":"6183c1f245ceed2a23317fa1","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002F20150417-william-park"],"bodyIntro":"The strategy for rolling out a Covid-19 vaccine might be undermined by older people’s immune systems.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumns\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003EIn a hypothetical alternative universe where we already have a vaccine against Covid-19, world leaders will have a choice about how to deliver it to the population. The most vulnerable people, along with the nurses, doctors and care workers who look after them, are likely to be protected first.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIf only it were that straightforward. The most vulnerable age group, the elderly, are particularly tricky to vaccinate.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“We have very few vaccines designed for older populations,” says Shayan Sharif, a professor of vaccinology at the University of Guelph, Canada. “More often than not in the last century, most vaccines have targeted childhood diseases.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EShingles is one exception, usually given to patients in their 70s, and there are one or two other vaccines for diseases like meningitis or human papillomavirus developed for young adults. But otherwise immunology is skewed in favour of children.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“We have a tremendous amount of knowledge about childhood diseases,” says Sharif. “When it comes to young adults, middle age and old age, we don’t have a lot of experience.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976\"\u003EThe warp-speed vaccine plan that failed\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200928-how-the-first-vaccine-was-born\"\u003EHow the first vaccine was born\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months\"\u003EWhy a vaccine is so hard to make\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ETo understand why older people are harder to vaccinate, we have to look at the differences in their immune system. \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC7333612\u002F\"\u003EMany infectious diseases are more severe in older adults than younger adults\u003C\u002Fa\u003E. \u003Ca href=\"https:\u002F\u002Fonlinelibrary.wiley.com\u002Fdoi\u002Ffull\u002F10.1002\u002Frmv.2144\"\u003EOlder people have more risk factors – a lifetime of exposure to carcinogens or other infectious diseases will increase the risk of future disease from new infections\u003C\u002Fa\u003E. But they also undergo something called immunosenescence – ageing of the immune system.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EJust like many other parts of the body, our immune system shows signs of our ageing. Some of the immune cells lose their function. The immune system is a very complex network of cell types that interact with each other. If something, somewhere within the system is not working, it interrupts the delicate balance of the immune response.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EHow does the aging immune system work?\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWhen you are infected by a pathogen, the first layer of the immune system, the innate immune response, starts attacking the pathogen at the site of infection. For respiratory diseases, that could be the lungs, trachea or nose. White blood cells, or macrophages, attack the pathogen, swallowing it up before destroying it.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAs those macrophages break apart the pathogen inside themselves, they present bits and pieces of it to another type of immune cell known as T cells. These serve as the “memory” of the immune system. T cells cannot see the pathogen by themselves and need certain macrophages, called antigen presenting cells, to show them the pathogen. That activates the next layer, the adaptive immune system.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08v4h4s"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThere are several types of T cells. Killer T cells, or cytotoxins, attack our own bodies’ cells in order to eliminate those already infected by the pathogen, reducing its proliferation. Helper T cells provide assistance to B cells, another part of the adaptive immune system.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EB cells can see the pathogen on their own but for optimum function they need helper T cells. B cells produce antibodies. But to produce the most effective antibodies, they need this complex interaction with T cells.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe goal of a vaccination is to stimulate our immune systems \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fni.2588.pdf?origin=ppub\"\u003Eto produce effective antibodies\u003C\u002Fa\u003E before we are exposed to the pathogen. Much has been made in the news of antibody tests as a way of proving who has had Covid-19. However, not all antibodies work, not everyone who has been infected with Sars-Cov-2 – the virus that causes Covid-19 – has antibodies and some antibodies have a limited lifespan. (\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200421-will-we-ever-be-immune-to-covid-19\"\u003E\u003Cem\u003ERead more about whether we can be immune to Covid-19.\u003C\u002Fem\u003E\u003C\u002Fa\u003E)\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe issue for vaccinologists is that the delicate balance between all of these cells in elderly people becomes disrupted. So, what happens in an older person’s immune system?\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“Basically all of those cell types are impaired in their function,” says Birgit Weinberger, from the University of Innsbruck, who studies immunosenescence and vaccinations of the elderly. “They produce a different set of cytokines [proteins that aid communication between immune cells]. I think the important issue one has to keep in mind is that none of those cell types act on their own.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"You have to keep in mind how all those different parts of the immune system come together in concert – Birgit Weinberger","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E\u003Cspan\u003EIf antigen presentation by the macrophages is impaired in old age this \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC5778733\u002F\"\u003Ecould lead to a decrease in T cell activation\u003C\u002Fa\u003E, less help for the B cells and a lower antibody response\u003C\u002Fspan\u003E. But it might be because of issues with the very first innate response.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“You have to keep in mind how all those different parts of the immune system come together in concert,” says Weinberger.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWe also have a finite number of B cells and T cells in our adaptive immune system, says Sharif, and we lose some of them over time. That can create problems in later life.  “When we encounter a new pathogen our ability to respond becomes a lot more limited.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Ca href=\"https:\u002F\u002Ftheconversation.com\u002Fwhy-vaccines-are-less-effective-in-the-elderly-and-what-it-means-for-covid-19-141971\"\u003EImmunosenescence does not affect all people equally\u003C\u002Fa\u003E. As with other body parts, some people age better than others either by looking after themselves or being lucky enough to have the right genetic make-up. But it’s not all bad news. Some parts of our immune system improve with age, too.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“There are some cells in our immune system that become more vigorous as we age,” says Sharif. “If we have been exposed to a wide variety of pathogens, we have an immune memory to them so we don’t need to have an armoury of cells to respond to novel antigens.” But Sars-CoV-2 is one virus we have never been exposed to, so we do not have that memory.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08v4jj5"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThis is the balance struck by our immune system: older people have a better immune memory for things they have already been exposed to, \u003Ca href=\"https:\u002F\u002Fwww.karger.com\u002FArticle\u002FAbstract\u002F504485\"\u003Ebut have a more limited repertoire to respond to novel diseases\u003C\u002Fa\u003E. Ordinarily, this might be fine. But as humans come into contact with more pathogens that jump species (what’s called zoonotic disease) more frequently, our ability to handle novel disease might be more important.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EWhat does this mean for vaccines?\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWhen vaccines undergo in-human clinical trials, at stage one they are tested for safety (usually on only a few individuals), at stage two they are tested for efficacy (whether they produce the response that you intended) and stage three for effectiveness (if they do produce the right response, do they actually work at protecting against disease).\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EVaccines have to compromise. \u003Ca href=\"https:\u002F\u002Fimmunityageing.biomedcentral.com\u002Farticles\u002F10.1186\u002Fs12979-019-0154-y\"\u003EWhile they might work well on one group of people, they might work less well on others\u003C\u002Fa\u003E. Currently there are a multitude of clinical trials for Covid-19 vaccines, many of which might make it all the way through development to approval. For Weinberger and Sharif, this is a good thing. Having a suite of vaccines that you can rely on means we can pick and choose the right one for the right scenario. One might work better for old people than others.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"While all vaccines approved will need to show t they protect against disease, not all vaccines will prevent transmission","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ENo vaccine is going to be perfect. “There is not one vaccine that can provide 100% efficacy, not one, nada,” says Sharif.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWhile all vaccines approved will need to show they protect against disease, not all vaccines will prevent transmission. \u003Ca href=\"https:\u002F\u002Fwww.hindawi.com\u002Fjournals\u002Fjar\u002F2019\u002F9287121\u002F\"\u003EMost vaccines work by preventing the pathogen from causing disease, but they do not necessarily eliminate it from the body\u003C\u002Fa\u003E, meaning a vaccinated person might still shed viral particles, and so potentially infect others around them.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThis has an important implication for how we choose to vaccinate the population. For those having to decide who gets the vaccines, \u003Ca href=\"https:\u002F\u002Flink.springer.com\u002Fchapter\u002F10.1007\u002F978-3-030-05159-4_7\"\u003Ethe emphasis should be on the vulnerable\u003C\u002Fa\u003E. But if we vaccinate nurses, doctors and care workers without first vaccinating their patients, while those key workers might be protected, they might still pass on the pathogen to other vulnerable people.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“A vaccine could disrupt transmission, but it is unlikely we will find a vaccine that will completely stop transmission of the virus,” says Sharif. “Influenza vaccines are actually a good example: they do not do much to reduce transmission, but they reduce disease.”\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08v4jyj"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EWeinberger says that a strategy for vaccination is like a complex puzzle of social, medical, political and economic factors. But what should be clear is that while mortality is so much higher in some groups, they should be prioritised. Others need to get used to living with the virus.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EHow age affects the spread of the virus is still largely a mystery. Weinberger raises concerns about some of the early research that suggested children were less contagious. Those studies, she says, were not optimal for coming to that conclusion, because they were conducted when children in Europe were off school. Might those children now pick up the virus at school and spread it to grandparents when they come to collect them?\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Sometimes we put on our blindfold and we say vaccines are the only saviour but that is not the case – Shayan Sharif","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBetter understanding the spread of the virus will reveal the \u003Ca href=\"https:\u002F\u002Flink.springer.com\u002Farticle\u002F10.1186\u002Fs12979-019-0164-9\"\u003Ebest strategies for vaccinating the population\u003C\u002Fa\u003E. “We are doing a very good job to speed up the process [of developing a vaccine], but for some decisions we need the knowledge first,” says Weinberger.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ESince we first started treating people for Covid-19, the medical knowledge about therapy drugs has significantly moved forward even if it has rarely been covered in the news – something Sharif finds puzzling. Fewer people may be aware of the progress with immunotherapeutics could be because they are a bit less glamorous, he says. We can all picture a vaccine, we should all be able to remember having one. But if you were asked to picture an immunotherapy, could you summon an image? \u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“Sometimes we put on our blindfold and we say vaccines are the only saviour, but that is not the case,” says Sharif. “Vaccines can take 14 to 28 days and require multiple injections and exposures. Immunotherapeutics can work in minutes and hours.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\"The most immediate hope for older people suffering with Covid-19 might be when we find a drug that \u003Ca href=\"https:\u002F\u002Ftheconversation.com\u002Ffast-covid-19-vaccine-timelines-are-unrealistic-and-put-the-integrity-of-scientists-at-risk-139824\"\u003Ereduces hospital time from weeks to days\u003C\u002Fa\u003E, says Sharif, or even one that negates the need for intensive care at all. \u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EHundreds of drugs are currently being researched as potential treatments for Covid-19. At the moment, one of the most promising drugs is Dexamethasone, \u003Ca title=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMoa2021436\" href=\"https:\u002F\u002Fwww.nejm.org\u002Fdoi\u002Ffull\u002F10.1056\u002FNEJMoa2021436\" target=\"_blank\"\u003Ea steroid proven to reduce the mortality rate of patients receiving oxygen\u003C\u002Fa\u003E which has been approved for use in the UK and Japan and was \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fhealth-54418464\" target=\"_blank\"\u003Egiven to President Trump when he was hospitalised with the disease earlier this month\u003C\u002Fa\u003E. \u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAt the moment, there are five drugs \u003Ca href=\"https:\u002F\u002Fwww.fda.gov\u002Fdrugs\u002Fcoronavirus-covid-19-drugs\u002Fcoronavirus-treatment-acceleration-program-ctap\"\u003Eauthorised for \"emergency use\"\u003C\u002Fa\u003E, including Dexamethasone, in the US by the FDA. Of these, none have yet received FDA approval following a clinical trial so are used only in very specific cases. But the benefit of searching for a treatment among known drugs is that they have already received approval, and are proven to be safe in other contexts. Their approval following a successful clinical trial should therefore be relatively speedy – much quicker than the amount of approval a new vaccine requires.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EOlder people hospitalised with Covid-19 might benefit from this treatment research before seeing a vaccine. So, while vaccines might be a little way off, there are other reasons to be positive.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate-12"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-10-14T11:34:08Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"Why older people are harder to vaccinate","headlineShort":"Why the elderly are harder to vaccinate","image":["p08v4q9b"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"The strategy for rolling out a Covid-19 vaccine might be undermined by older people’s immune systems.","summaryShort":"An older immune system sometimes struggles","tag":["tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2020-10-14T00:30:14.745614Z","entity":"article","guid":"364a9d02-0617-45f1-98d9-80a5af284684","id":"future\u002Farticle\u002F20201013-why-older-people-are-harder-to-vaccinate","modifiedDateTime":"2021-09-01T17:30:27.206711Z","project":"future","slug":"20201013-why-older-people-are-harder-to-vaccinate","cacheLastUpdated":1642293446392},"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct","_id":"6183c1ea45ceed2b9a570d1a","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Fzaria-gorvett"],"bodyIntro":"Humanity hasn’t always lived with the flu. Could this era of social distancing hasten its demise?","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIt was the first time the \u003Cem\u003ESapanawa\u003C\u002Fem\u003E tribe had ever made contact.\u003C\u002Fp\u003E\n\u003Cp\u003EThe meeting occurred in the remote Serra do Divisor National Park – a vast area of the Amazon basin in the far west of Brazil. From the sky, it looks like a uniform stretch of unbroken forest; concealed beneath are waterfalls, rivers, dormant volcanos and human villages. This is a place where giant armadillos, tapirs and jaguars roam the landscape, and uncontacted peoples live largely as they have done for some 32,000 years. \u003C\u002Fp\u003E\n\u003Cp\u003EBut for one isolated tribe, everything changed in 2014. Several members of the \u003Cem\u003ESapanawa\u003C\u002Fem\u003E strayed out of their time warp after \u003Ca href=\"https:\u002F\u002Fwww.survivalinternational.org\u002Fnews\u002F10394\"\u003Efleeing violent attacks from logging gangs\u003C\u002Fa\u003E across the border in Peru. They raided the village of another remote tribe, who had settled down and made contact with modern civilisation decades ago. Afterwards, they spent three weeks in the company of FUNAI, a government body that protects indigenous people from the outside world.\u003C\u002Fp\u003E\n\u003Cp\u003EIndigenous Amazonians are anomalies in almost every way – they speak ancient, little-known languages, some of which \u003Ca href=\"https:\u002F\u002Fwww.sciencedaily.com\u002Freleases\u002F2012\u002F02\u002F120221104037.htm\"\u003Elack words for numbers\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Fwww.sapiens.org\u002Flanguage\u002Fcolor-perception\u002F\"\u003Eeven colours\u003C\u002Fa\u003E. Their societies are \u003Ca href=\"https:\u002F\u002Fwww.journals.uchicago.edu\u002Fdoi\u002Fabs\u002F10.3998\u002Fjar.0521004.0067.203?journalCode=jar\"\u003Eoften egalitarian\u003C\u002Fa\u003E. And they are also among the only communities on Earth not to suffer from the diseases which plague the rest of humanity. Some uncontacted peoples – though not all – have never experienced the misery of having a cold or the flu, or other more life-threatening illnesses such as measles.\u003C\u002Fp\u003E\n\u003Cp\u003EFor the \u003Cem\u003ESapanawa\u003C\u002Fem\u003E, this fragile disease-free state ended remarkably quickly after their first contact. Within days, many became gravely unwell; they had \u003Ca href=\"https:\u002F\u002Fwww.sciencemag.org\u002Fnews\u002F2014\u002F07\u002Fmembers-previously-uncontacted-tribe-infected-flu\"\u003Ecaught a respiratory infection\u003C\u002Fa\u003E, probably influenza. When tribes are first exposed to the flu, the fatality rate is usually extremely high. But on this occasion, there was a happy ending. The raiders received medical treatment and no one died, so after a brief period of quarantine, they returned home to their people. As far as anyone knows, this was the end of that flu epidemic.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200915-the-mystery-of-why-some-vaccines-are-doubly-beneficial\"\u003EWhy some vaccines are doubly beneficial\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200928-how-the-first-vaccine-was-born\"\u003EHow the first vaccine was born\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976\"\u003EThe warp-speed vaccine plan that failed\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003EThe presence of flu-free societies raises an important question: could the rest of the world ever be rid of this virus? As it happens, the world is making some tantalising first steps towards this goal.\u003C\u002Fp\u003E\n\u003Cp\u003EBack in January 2020, at the end of the Australian summer, the country had \u003Ca href=\"https:\u002F\u002Fwww.newscientist.com\u002Farticle\u002F2242113-australia-sees-huge-decrease-in-flu-cases-due-to-coronavirus-measures\u002F\"\u003E6,962 cases of the flu\u003C\u002Fa\u003E confirmed via a laboratory test. At this time, Covid-19 was still known only as “the novel coronavirus” and mostly confined to China. Ordinarily, you would have expected to see more and more cases of the flu as the days became shorter and winter descended.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08tr5dp"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EInstead, something unexpected happened. By April there were just 229 cases of the flu – down from 18,705 at the same time the previous year. Covid-19 had already ripped across the world, collectively infecting more than a million people, including the \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fworld\u002F2020\u002Fapr\u002F05\u002Ftimeline-boris-johnson-and-coronavirus\"\u003EBritish prime minister\u003C\u002Fa\u003E, and spreading to \u003Ca href=\"https:\u002F\u002Fwww.aljazeera.com\u002Fnews\u002F2020\u002F04\u002F10\u002Fcovid-19-in-charts-and-maps\u002F\"\u003Eevery continent except Antarctica\u003C\u002Fa\u003E. Lockdowns had been imposed, hand-washing had been popularised and mask-wearing had become commonplace – though the latter was still much more widely practiced in Asia than elsewhere.\u003C\u002Fp\u003E\n\u003Cp\u003EBy August, it was clear that Australia’s flu season had been the mildest on record. In all, there were \u003Ca href=\"https:\u002F\u002Fwww.healthline.com\u002Fhealth-news\u002Faustralia-mild-flu-season-what-means-for-the-united-states\"\u003Efewer than a 10th of the infections seen in 2019\u003C\u002Fa\u003E – and the vast majority of these occurred before the pandemic hit. This is all against a backdrop of more testing than had ever been conducted before.\u003C\u002Fp\u003E\n\u003Cp\u003EThe same pattern also occurred elsewhere. The co-head of South Africa’s National Institute of Communicable Diseases (NICD) recently told CBS News that the country “\u003Ca href=\"https:\u002F\u002Fwww.cbsnews.com\u002Fnews\u002Fcoronavirus-south-africa-thanks-to-anti-covid-measures-expert-says-country-didnt-have-a-flu-season\u002F\"\u003Ejust didn't have a flu season this year\u003C\u002Fa\u003E”, while in New Zealand, doctors didn’t detect a single flu case during their annual screening drive, though last year 57% of the \u003Ca href=\"https:\u002F\u002Fwww.theguardian.com\u002Fsociety\u002F2020\u002Fsep\u002F17\u002Ffalling-flu-rates-in-southern-hemisphere-offers-hope-as-winter-approaches-coronavirus\"\u003Eswabs they took were positive\u003C\u002Fa\u003E.  \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Many experts suspect that the trend is down to physical distancing and improvements to hygiene in the wake of the pandemic","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ENow winter is over in the Southern Hemisphere and beginning in the North. And though it’s still early in the season, already things look radically different to how they ordinarily would.\u003C\u002Fp\u003E\n\u003Cp\u003EAs of September, the World Health Organization (WHO) reported the missing flu cases were a global phenomenon, with significantly \u003Ca href=\"https:\u002F\u002Fwww.who.int\u002Finfluenza\u002Fsurveillance_monitoring\u002Fupdates\u002Flatest_update_GIP_surveillance\u002Fen\u002F\"\u003Elower levels\u003C\u002Fa\u003E than would be expected, from tropical Africa to the Caribbean. For the week beginning 7 September, the flu tracker FluMart recorded just 12 lab-confirmed cases of the flu \u003Ca href=\"https:\u002F\u002Fapps.who.int\u002Fflumart\u002FDefault?ReportNo=2\"\u003Eon the entire planet\u003C\u002Fa\u003E.   \u003C\u002Fp\u003E\n\u003Cp\u003E“What we’re seeing in Australia, New Zealand, South America, Hong Kong, are really, really attenuated seasons of not just the flu, but also respiratory syncytial virus (RSV),” says Sarah Cobey, an epidemiologist at the University of Chicago. \u003C\u002Fp\u003E\n\u003Cp\u003EOf course, there are many possible reasons that cases might be down this year. People could be afraid to seek medical treatment, and in some places, there it’s possible that fewer tests were conducted as resources were diverted elsewhere. But many experts suspect that the trend is down to physical distancing and improvements to hygiene in the wake of the pandemic.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08tr9ty"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E“We don't really understand it, but it may have to and may have to do with a little bit of changes in terms of how we interact with each other,” says Peter Palese, a microbiologist and expert in RNA viruses at Icahn School of Medicine at Mount Sinai, New York. “There is a possibility this might also continue in the future.”\u003C\u002Fp\u003E\n\u003Cp\u003EThis raises a number of questions. How is this new scarcity of flu affecting the virus? Is it even theoretically possible that it could permanently disappear? And have any other viruses been affected?\u003C\u002Fp\u003E\n\u003Cp\u003EHumanity hasn’t always lived with the flu. It’s thought that we caught it from the first domesticated birds \u003Ca href=\"https:\u002F\u002Fwww.history.com\u002Ftopics\u002Fpre-history\u002Fneolithic-revolution\"\u003Earound 10,000 years ago\u003C\u002Fa\u003E, when people started to move away from hunter-gathering and switched to farming. For millennia, it was confined to the Old World, before eventually spreading to the Americas with the \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC1071659\u002F\"\u003Efirst European colonisers\u003C\u002Fa\u003E, who also brought with them a smorgasbord of additional diseases, including smallpox, measles, bubonic plague, malaria, leprosy, chickenpox, mumps, typhus, cholera, diphtheria and yellow fever.\u003C\u002Fp\u003E\n\u003Cp\u003ENone of these pathogens were permanently eliminated until 8 May 1980, when the World Health Assembly officially declared the world free of smallpox. The only other human pathogen that’s ever been pushed to extinction is Sars. The first effort relied on vaccination – and the second on contact-tracing. Unfortunately, neither approach is currently applicable to the flu.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Even if we could eliminate the virus entirely from the developed world, since we lack long-term immunity all it would take is a single case for it to come right back","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E“The big problem with influenza is that it changes,” says Palese. The virus is always evolving, so our immune systems are never able to recognise the virus for long after we’ve cleared an infection – and as everyone knows, this means we can be infected again and again; by one estimate, the flu affects up to \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F12686093\u002F\"\u003E10% of the global population\u003C\u002Fa\u003E every year.\u003C\u002Fp\u003E\n\u003Cp\u003EWhich brings us to the bad news. On its own, social distancing is extremely unlikely to push the flu to extinction. “We have to really think here worldwide,” says Palese. “And even if all of the UK, the US and China wear masks, that doesn't mean that the rest of the world does it. And from what we have seen on television, not everyone in the US wears a mask.” Despite the low number of cases recorded this year, he explains that there will still be pockets of society where the virus is spreading as normal.\u003C\u002Fp\u003E\n\u003Cp\u003EEven if we could eliminate the virus entirely from the developed world, since we lack long-term immunity all it would take is a single case for it to come right back. “Humans are distributed in such a way that flu viruses can do that – they just keep hopping around different populations without going extinct,” says Cobey.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08tr7cs"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EHowever, this might not always be the case.\u003C\u002Fp\u003E\n\u003Cp\u003EBecause of the pace at which the flu evolves, current vaccines typically only protect people for around \u003Ca href=\"https:\u002F\u002Fwww.health.com\u002Fcondition\u002Fcold-flu-sinus\u002Fhow-long-does-the-flu-shot-last\"\u003Esix months\u003C\u002Fa\u003E. To achieve these impressive feats of evasion, the virus relies mostly on “antigenic drift”, where a gradual build-up of mutations that affect the head of a viral particle – the part that’s usually recognised by the immune system – eventually change it enough so that it can no longer be identified as a threat.\u003C\u002Fp\u003E\n\u003Cp\u003EThis change typically occurs while it’s overwintering, so that it can hop back across to the opposite end of the globe once the season is over. (People who live near the equator are \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC4847850\u002F#pone.0153003.ref001\"\u003Ealso infected at regular intervals\u003C\u002Fa\u003E, though these can occur year-round, rather than seasonally). At the moment, new vaccines must be developed every year, to match the viruses that are expected to circulate next; the composition of the Northern Hemisphere vaccine is \u003Ca href=\"https:\u002F\u002Fwww.scientificamerican.com\u002Farticle\u002Fhow-are-seasonal-flu-vaccines-made\u002F\"\u003Edecided in February\u003C\u002Fa\u003E, while the makeup of the Southern Hemisphere vaccine is chosen in September.\u003C\u002Fp\u003E\n\u003Cp\u003EEnter the “universal flu vaccine” – a vaccine that you would only need once, and could protect you against all types of the flu, year after year. With such a tool, it would be possible to enact a mass vaccination programme and consign the flu to history. Right now, scientists across the globe are racing to achieve this goal – and after decades of research, we’re inching closer.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"The challenge of a universal vaccine is to nudge the immune system in the right direction","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBack in the 1980s, Palese and colleagues discovered that unlike the fickle “head” of the virus, the “stalk” is remarkably consistent – so antibodies that matched the stalk of one strain could also \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F6189287\u002F\"\u003Ebind to – and therefore identify – others\u003C\u002Fa\u003E. The body can produce these \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fs41591-019-0463-x\"\u003Eantibodies naturally\u003C\u002Fa\u003E, but the head is larger and more striking, so the immune system tends to focus on identifying it and the stalk gets overlooked.\u003C\u002Fp\u003E\n\u003Cp\u003EThe challenge of a universal vaccine is to nudge the immune system in the right direction.\u003C\u002Fp\u003E\n\u003Cp\u003EThis is exactly what the not-so-catchily titled “H1ssF_3928” has been designed to do. In animal trials, the vaccine has already shown that it can provide immunity to H5N1 – also known as “bird flu” – though it was made from the stalk of H1N1, or swine flu. Now it’s in the \u003Ca href=\"https:\u002F\u002Fwww.nih.gov\u002Fnews-events\u002Fnews-releases\u002Fnih-begins-first-human-trial-universal-influenza-vaccine-candidate\"\u003Efirst stage of human trials\u003C\u002Fa\u003E, in which people will be vaccinated and then monitored to see what kind of antibodies they produce. H1ssF_3928 is just one of many potential universal vaccines currently in development which, if they’re successful, could be rolled out worldwide.\u003C\u002Fp\u003E\n\u003Cp\u003EBut even here, there’s a catch.\u003C\u002Fp\u003E\n\u003Cp\u003EThe issue is that there isn’t just one flu virus – today the flu is a many-headed beast, with four main strains which circulate every year; two belong to the group influenza A, which is also found in other animals, while two belong to the group influenza B, which is only found in humans and seals. Occasionally, non-human flu A viruses will take the leap to infecting us, and cause a pandemic – such as the \u003Ca href=\"https:\u002F\u002Facademic.oup.com\u002Faje\u002Farticle\u002F187\u002F12\u002F2498\u002F5059949\"\u003E1918\u003C\u002Fa\u003E and \u003Ca href=\"https:\u002F\u002Fvirologyj.biomedcentral.com\u002Farticles\u002F10.1186\u002F1743-422X-6-207#:~:text=The%20swine%2Dorigin%20influenza%20A,North%20America%20around%201999%2D2000.\"\u003E2009\u003C\u002Fa\u003E strains, both of which may have come from pigs.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-12"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08tr5zr"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-13"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E“A universal flu vaccine will only eradicate flu B, not flu A,” says Palese, who explains that even if you were to hunt down all of the flu A currently circulating in humans, new strains could still cross over from the reservoir in wild and domesticated animals. “So in terms of influenza A, we would have to constantly vaccinate the entire population, which is basically impossible. And if we don't do that, then animal strains, as I said, those in reindeer, those in chickens, those in pigs, those in horses, they can jump into humans.”\u003C\u002Fp\u003E\n\u003Cp\u003EPalese gives the example of smallpox, which had the ideal features for elimination – the virus evolved slowly, and it had no animal hosts. Even with these advantages, it took nearly 200 years of vaccination to push it to extinction.\u003C\u002Fp\u003E\n\u003Cp\u003EBut though the flu is unlikely to disappear completely any time soon, the current pandemic might be affecting the virus in other ways. Here there are two possible scenarios – one of which is a lot more desirable than the other.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","pullQuote":"If there’s less virus around, fewer mutations happen – Peter Palese","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-14"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08ttv9k"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-15"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EFirst up, the virus might be evolving more slowly than usual. This matters, because it means the strains we see next year wouldn’t be too dissimilar to the ones that circulated last year, and infections might be relatively mild. “I was talking about that with a colleague of mine recently,” says Cobey. “What's hard about influenza is that it's always evolving into something new that we've never ever seen before. And so it's actually very hard to say, ‘if things were a little bit different, it would evolve like this’, because it's kind of so unpredictable to begin with. But this could be really good – it’s exciting,” says Cobey.       \u003C\u002Fp\u003E\n\u003Cp\u003E“It's really simple,” says Palese. “If there’s less virus around, fewer mutations happen.” He explains that if you have 10,000 infected people, statistically speaking you would expect 10 mutations to emerge. So if you had just a thousand, you would expect a 10th of that number.  \u003C\u002Fp\u003E\n\u003Cp\u003ETheoretically, anything that affects the amount of virus circulating should affect its evolution – even the flu vaccines that are currently available. “If Bill Gates [the billionaire philanthropist and co-founder of Microsoft, who has helped to fund the eradication of polio] would pay for it, and then 95% of people would agree to have it, then I think that kind of immune protection would then result in a different Darwinian selection,” he says. “But on the other hand, only around 5% of the world population gets vaccinated,” says Palese.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-16"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"If there’s less virus around, fewer mutations happen – Peter Palese","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-17"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EHowever, there is another possibility.\u003C\u002Fp\u003E\n\u003Cp\u003EIn reality, we don’t know for sure if social distancing has led to fewer flu infections worldwide – or just the number recorded. If it hasn’t, the rate of its evolution might be largely unchanged. This would mean that next year – when social distancing may have been largely abandoned – parts of the world that currently have fewer flu cases could be hit hard.\u003C\u002Fp\u003E\n\u003Cp\u003E“If there's no transmission of other respiratory pathogens, that means people are not getting immunity to them,” says Cobey. “One thing I really am worried about is what will happen to these other pathogens once there’s a [Covid-19] vaccine.”\u003C\u002Fp\u003E\n\u003Cp\u003ECobey suggests that, instead of focusing our efforts entirely on developing a vaccine, it would be helpful to take the opportunity to invest in the types of prevention and treatment that can also work against other respiratory pathogens, such as improvements in hygiene and access to ventilators. “So that maybe when we have that vaccine, we don't have to go back to exactly how things were before,” she says.\u003C\u002Fp\u003E\n\u003Cp\u003EPalese, on the other hand, is keen to stress the importance of getting vaccinated against the flu. “Even if it is not completely protective, it is certainly resulting in a more mellow disease – and it’s a very safe vaccine,” he says.\u003C\u002Fp\u003E\n\u003Cp\u003ECrucially, scientists don’t yet know what happens when people are infected with Covid-19 and the flu at the same time. “We really don't know. I am very worried that it might increase the severity of the disease,\" says Palese.\u003Ca href=\"#_msocom_1\"\u003E\u003Cbr \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","pullQuote":"If there’s less virus around, fewer mutations happen – Peter Palese","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct-18"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-10-12T12:03:20Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"How Covid-19 is changing the flu","headlineShort":"How Covid-19 is changing the flu","image":["p08trc3c"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"Humanity hasn’t always lived with the flu. Could this era of social distancing hasten its demise?","summaryShort":"What would it take to banish the flu forever?","tag":["tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2020-10-12T00:30:51.216291Z","entity":"article","guid":"a365279f-b32d-41be-abbc-272d753efdce","id":"future\u002Farticle\u002F20201009-could-social-distancing-make-the-flu-extinct","modifiedDateTime":"2021-09-01T17:30:11.957511Z","project":"future","slug":"20201009-could-social-distancing-make-the-flu-extinct","cacheLastUpdated":1642293446392},"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months","_id":"6183c1f545ceed30b10c12e6","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002F20141212-peter-ray-allison"],"bodyIntro":"The global quest to find a vaccine for Covid-19 has so far tended to focus on the clinical research, but manufacture and distribution also need to be considered.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EVaccines by themselves do not save lives, but rather the immunisation process does. This highlights a challenge the world is facing right now. The process used to create a vaccine in a laboratory is different to the one used for bulk manufacturing by the pharmaceutical industry in order to immunise people.\u003C\u002Fp\u003E\n\u003Cp\u003EWe already manufacture billions of doses of vaccines every year, from the annual influenza jab to the combined measles, mumps and rubella (MMR) immunisation. The 2009 \u003Ca href=\"https:\u002F\u002Fwww.bbc.co.uk\u002Fnews\u002Fhealth-21194090\"\u003Eswine flu pandemic\u003C\u002Fa\u003E, which saw the death of hundreds of thousands of people, lead to approximately three billion doses of flu vaccines being produced and delivered within six months.\u003C\u002Fp\u003E\n\u003Cp\u003EDeveloping a new vaccine is a lengthy process. The 2014 to 2016 Ebola outbreak in West Africa resulted in the death of more than 11,000 people. Scientists with the Public Health Agency of Canada had been working on the rVSV-ZEBOV vaccine since 2003 and it was only during the Ebola outbreak that the vaccine’s clinical trials were actually conducted. It was successfully concluded in November 2016 and was approved three years later following a further trial study with 15,000 people.\u003C\u002Fp\u003E\n\u003Cp\u003ECreating and manufacturing an entirely new vaccine on a national or global scale, whilst maintaining production of all the other vaccines, becomes a Herculean endeavour, experts say. “We're making a vaccine for a virus that we've never made a vaccine for, that's not approved, using platforms that haven't been used extensively in the clinic with patients,” explains Angela Rasmussen, a virologist at Columbia University’s \u003Ca href=\"https:\u002F\u002Fwww.publichealth.columbia.edu\u002Fresearch\u002Fcenter-infection-and-immunity\"\u003ECenter for Infection and Immunity\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003EConventionally, vaccine research can take 10 years from initial development through to mass distribution. However, for Covid-19, there is a global effort to reduce that to only 18 months, whilst maintaining the same safety standards.\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976\"\u003EThe warp-speed vaccine plan that failed\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200918-why-some-deadly-viruses-vanish-and-go-extinct\"\u003EThe deadly viruses that vanished\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200928-how-the-first-vaccine-was-born\"\u003EHow the first vaccine was born\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003ECentral to this is the parallel development process that the pharmaceutical industry is using during the crisis. Vaccine research is usually performed in a sequence of successive steps. Typically, there would be a laboratory development stage, followed by animal testing, and then several stages of clinical trials. Once these stages have been successfully completed, the vaccine would be submitted for approval, prior to developing a manufacturing process. \u003C\u002Fp\u003E\n\u003Cp\u003EFor Covid-19 vaccines, several stages of development are being carried out in parallel.  This is necessary due to the urgent need for the vaccine, but it has the drawback that one stage of the process does not inform the next in the usual way. For example, results from animal trials would normally inform the choice of appropriate dose level for the start of human trials.  The present situation is that data from several various stages are being analysed concurrently.\u003C\u002Fp\u003E\n\u003Cp\u003E“We're actually seeing preclinical data in non-human primates for vaccines that are already in phase three clinical trials,” explains Margaret Liu, chair of the board of the \u003Ca href=\"https:\u002F\u002Fisv-online.org\u002F\"\u003EInternational Society for Vaccines\u003C\u002Fa\u003E.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08tdw58"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAs part of the parallel development process, manufacturing facilities are already being built around the world, ahead of any vaccine being approved. This carries a significant financial risk, as there is a chance that certain vaccines may not be approved. It is only through enormous financial investment, such as $10bn (£7.85bn) for \u003Ca href=\"https:\u002F\u002Fwww.hhs.gov\u002Fabout\u002Fnews\u002F2020\u002F06\u002F16\u002Ffact-sheet-explaining-operation-warp-speed.html\"\u003EOperation Warp Speed\u003C\u002Fa\u003E, a US government initiative, that these facilities can be built in advance.\u003C\u002Fp\u003E\n\u003Cp\u003ETo bulk manufacture a vaccine, it is not a simple case of scaling up the process used in a laboratory.  This is because it is analogous to baking a cake: if a recipe worked well for a small cake, tripling the ingredients may result in a cake that is burnt at the edges yet soggy in the middle. Similar issues are found in bulk vaccine manufacturing. “Processes that work well at a small scale in a test tube or petri dish often don’t behave in a predictable way in larger quantities,” explains Bryan Deane, director of new medicines and data policy at the \u003Ca href=\"https:\u002F\u002Fwww.abpi.org.uk\u002F\"\u003EAssociation of the British Pharmaceutical Industry\u003C\u002Fa\u003E.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Many of the vaccines being developed require two doses in order to be effective","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EA gradual up-scaling of the manufacturing process is therefore required. The vaccine will be manufactured in increasingly larger batches, with each batch checked to ensure efficacy is maintained. “There's quite a lot of trial and error to achieve the best yield,” says Deane. “It takes time to work through those challenges of scale-up, until you get to a point where you're getting a decent return on each batch that you put through.”\u003C\u002Fp\u003E\n\u003Cp\u003EThis problem is compounded by the fact that not all vaccine technologies, especially those that are showing the most promising results in clinical trials against Covid-19, have been used at such a large scale before. “Everyone is going to share the challenge of the large quantities that they're trying to do,” explains Liu. “No vaccines have been utilised at this pace and scale for roll-out and the most advanced types of vaccine candidates have never been approved as vaccines at all.”\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08tdwhh"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIn addition to this, many of the vaccines being developed require two doses in order to be effective, essentially doubling the number of vaccine doses required globally to nearly 16 billion. Only having a single shot of a vaccine, which requires multiple doses to be effective, can lead to problems. \u003C\u002Fp\u003E\n\u003Cp\u003E“If people have low levels of antibody, but they think they've been immunised, one of the biggest risks is that then they will stop the social distancing and wearing masks,” says Liu. “Then they'll get infected more easily, which in turn would make them capable of spreading the virus to others.”\u003C\u002Fp\u003E\n\u003Cp\u003ESome vaccines also require special devices to be used. There are some DNA-based vaccines in development that require an electroporation device for each dose. Electroporation has previously been used to deliver a cancer drug into tumours. It uses a device the size of an electric toothbrush to generate a small electrical current that opens holes in the membrane of a cell, allowing a drug or vaccine to enter. Although the device can be used multiple times, it is nonetheless an additional manufacturing challenge in order to ensure there are a sufficient number of these. Medical staff would also need to have the appropriate training in how these devices are used.\u003C\u002Fp\u003E\n\u003Cp\u003EAnd the supply of another piece of vaccine paraphernalia may also be an issue. Vaccines are generally supplied inside small glass vials. While it may seem surprising that glass is a limited resource, the glass used in vaccine vials is of a special type called borosilicate. It is highly resistant to temperature change and has low chemical reactivity, thereby minimising potential contamination from the vial. Given the colossal demand Covid-19 is generating for additional vials, this may constrain the number of vaccines that are initially available.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Just having the vaccines is one thing, but keeping them safe and secure is another","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EMulti-dosage vaccine vials might mitigate this problem, but could also lead to wasted doses if not all of the vaccine is used by the end of the day. When demand is at a premium, this sort of wastage must be avoided.\u003C\u002Fp\u003E\n\u003Cp\u003EOf course, just having the vaccines is one thing, but keeping them safe and secure is another. Most vaccines need to be refrigerated, but some being developed for Covid-19 need to be stored in temperatures as low as -70°C (-94F) or -80°C (-112F). These kind of temperatures are commonly found in research laboratories, but many medical centres do not have such facilities.\u003C\u002Fp\u003E\n\u003Cp\u003EIn order to solve this cold storage problem, distribution companies such as UPS and DHL are building colossal \u003Ca href=\"https:\u002F\u002Fwww.lloydsloadinglist.com\u002Ffreight-directory\u002Fnews\u002FUPS-to-build-two-giant-freezer-farms-for-COVID-19-vaccine\u002F77117.htm#.X2sUvot7ncc\"\u003Efreezer farms around the world\u003C\u002Fa\u003E, capable of storing millions of vaccines at -80°C (-112F), in order to have the appropriate facilities in place for when the vaccine is distributed.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08tdsqr"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E“People have developed vaccine vial monitors, to make sure that the whole time there's a recording of the temperature,” says Liu. “You don't want something thawed and then refreeze it. You have to know what happens every second of the way during the transportation.”\u003C\u002Fp\u003E\n\u003Cp\u003EThere is also what is known as the Last Mile Problem. Distribution to major cities is fairly easy, due to them having transport hubs. However, getting it to smaller towns and remote villages, especially in developing countries, will be much more difficult.\u003C\u002Fp\u003E\n\u003Cp\u003EBy spring 2021 we could well see a gradual release of a vaccine for Covid-19 for priority cases, leading up to mass-distribution by the summer. In anticipation of this, steps are already being taken to ensure the manufacturing – and distribution – infrastructure is in place to meet the global demand.\u003C\u002Fp\u003E\n\u003Cp\u003EThis challenge may seem colossal, but what has already been achieved, through collaboration and working together like never before, demonstrates that it is not insurmountable.\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months-10"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-10-06T14:18:05Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"The quest to make a global vaccine in 12 months","headlineShort":"Why a vaccine is so hard to make","image":["p08tdtbt"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":["p08tdsqr"],"relatedStories":null,"relatedTag":null,"summaryLong":"The global quest to find a vaccine for Covid-19 has so far tended to focus on the clinical research, but manufacture and distribution also need to be considered.","summaryShort":"Producing a vaccine for the entire world will be a huge challenge","tag":["tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2020-10-06T00:30:01.066078Z","entity":"article","guid":"1bd46b28-1fd1-4e9e-ae19-0006b5eddd74","id":"future\u002Farticle\u002F20201005-the-quest-to-make-a-global-vaccine-in-12-months","modifiedDateTime":"2021-09-01T17:29:45.65428Z","project":"future","slug":"20201005-the-quest-to-make-a-global-vaccine-in-12-months","cacheLastUpdated":1642293446393},"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born","_id":"6183c1f145ceed30246b3713","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Frichard-hollingham"],"bodyIntro":"Smallpox used to kill millions. But a chance discovery led to the first vaccine, and a transformation in human health.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ESmallpox was a terrible disease.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“Your body would ache, you’d have high fever, a sore throat, headaches and difficulty breathing,” says epidemiologist René Najera, editor of the \u003Ca href=\"https:\u002F\u002Fwww.historyofvaccines.org\u002F\"\u003EHistory of Vaccines website\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EBut that wasn’t the worst of it.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“On top of that, you’d get a horrible disfiguring rash over your entire body – pustules filled with pus on your scalp, feet, throat, even lungs – and over the course of a couple of days, they would dry out and start falling off,” says Najera.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWith the rise in global trade and the spread of empires, smallpox ravaged communities around the world. Around a third of adults infected with smallpox would be expected to die, and eight out of 10 infants. In the early 18th Century, the disease is calculated to have killed some 400,000 people every year in Europe alone.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EPorts were particularly vulnerable. The 1721 smallpox outbreak in the US city of Boston \u003Ca href=\"https:\u002F\u002Flink.springer.com\u002Farticle\u002F10.1007\u002Fs00268-020-05670-4\"\u003Ewiped out 8% of the population\u003C\u002Fa\u003E. But even if you lived, the disease had lasting effects, leaving some of the survivors blind and all of them with nasty scars.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“When the scabs fell off, they’d leave you pockmarked and disfigured – some people committed suicide rather than live with the scarring,” Najera says.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou might also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976\"\u003E\u003Cstrong\u003EThe warp-speed vaccine plan that failed\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200918-why-some-deadly-viruses-vanish-and-go-extinct\"\u003E\u003Cstrong\u003EThe deadly viruses that vanished\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200915-the-mystery-of-why-some-vaccines-are-doubly-beneficial\"\u003E\u003Cstrong\u003EThe unintended benefits of vaccination\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ETreatments ranged from the useless to the bizarre (and also useless). They included placing people in hot rooms, or sometimes cold rooms, abstaining from eating melons, wrapping patients in red cloth and – according to one 17th-Century medic giving “12 bottles of small beer” to the patient every 24 hours. The intoxication might have at least dulled the pain.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThere was, however, one genuine cure. Known as inoculation, or variolation, it involved taking the pus from someone suffering with smallpox and scratching it into the skin of a healthy individual. Another technique involved blowing smallpox scabs up the nose.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EFirst practiced in Africa and Asia before being eventually brought to Europe in the 18th Century, and North America \u003Ca href=\"https:\u002F\u002Fwww.historyofvaccines.org\u002Fcontent\u002Fblog\u002Fonesimus-smallpox-boston-cotton-mather\"\u003Eby an enslaved man named Onesimus\u003C\u002Fa\u003E, inoculation usually resulted in a mild case of the disease. But not always. Some people contracted full-on smallpox and all those inoculated became carriers of the disease, inadvertently passing it on to people they met. A better solution was needed.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"infographic","imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08ssb79"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EBy the 1700s, it was relatively well known in rural England that a group of people seemed to be immune to smallpox. Milkmaids instead contracted a relatively mild cattle disease called cowpox, which left little scarring.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EDuring a smallpox epidemic in the west of England in 1774, farmer Benjamin Jesty decided to try something. He \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC1200696\u002F\"\u003Escratched some pus from cowpox lesions\u003C\u002Fa\u003E on the udders of a cow into the skin of his wife and sons. None of them contracted smallpox.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIt wasn’t, however, until many years later that anyone knew of Jesty’s work. The man credited with inventing vaccination, and more importantly, popularising it, made similar observations and came to similar conclusions.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EEdward Jenner was a country doctor working in the small town of Berkeley in Gloucestershire. He had trained in London under one of the foremost surgeons of the day. Jenner’s interest in curing smallpox is thought to be influenced by his childhood experience of smallpox inoculation.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-2"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"In 1796, after gathering some circumstantial evidence from farmers and milkmaids, Jenner decided to try an experiment","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EIt’s said that Jenner was psychologically scarred by that experience, some of his motivation was just how horrific he'd found it,” says Owen Gower, manager of \u003Ca href=\"https:\u002F\u002Fjennermuseum.com\u002F\"\u003EDr Jenner’s House Museum\u003C\u002Fa\u003E. “He was thinking, ‘I want to find an alternative, something that's safer, that's less terrifying’.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIn 1796, after gathering some circumstantial evidence from farmers and milkmaids, Jenner decided to try an experiment. A potentially fatal experiment. On a child.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EHe took some pus from cowpox lesions on the hands of a young milkmaid, Sarah Nelms, and scratched it into the skin of eight-year old James Phipps. After a few days of mild illness, James recovered sufficiently for Jenner to inoculate the boy with matter from a smallpox blister. James did not develop smallpox, nor did any of the people he came into close contact with.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAlthough the experiment worked, by today’s standards it was ethically problematic.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08ss8m2"],"imageAlignment":"centre","imageOrientation":"portrait","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003E“It really wasn't a clinical trial and the choice of who they vaccinated really makes you uncomfortable,” says Sheila Cruickshank, professor of immunology at the University of Manchester.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ENor did Jenner know the science underlying the discovery. There was no understanding that smallpox was caused by the variola virus, and the functioning of the body’s immune system was still a mystery at the time.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“A lot of what they were doing was relying on creating immunity, creating antibodies, creating memory, and they had no concept of that,” says Cruickshank. “It's mind blowing, slightly scary as well.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-6"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Jenner didn't seek to make any money from his vaccine, he wasn't interested in patenting it – Owen Gower","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ENevertheless, Jenner realised that his smallpox vaccine – the name derived from the Latin for cowpox, \u003Cem\u003Evaccinia\u003C\u002Fem\u003E – had the potential to transform medicine and save lives. But he also knew he would only halt the disease if he could vaccinate as many people as possible.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“Jenner didn't seek to make any money from his vaccine, he wasn't interested in patenting it,” says Gower. “He just wanted people to know about it and he wanted to share it.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EHe converted a rustic summerhouse in his garden into his Temple of Vaccinia and invited local people to be vaccinated after church on Sunday.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“He wrote to other physicians offering them samples of the vaccine material and encouraging them to do it themselves so that people were vaccinated by their own local trusted health professional,” Gower says. “It's a theme that we see now in terms of vaccine advocacy and ensuring acceptance of a vaccine is the right message delivered by the right person.”\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08ssgmn"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAfter Jenner published his findings, news of the discovery spread across Europe. And then, thanks to the support of the King of Spain, around the world.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EKing Charles IV had \u003Ca href=\"https:\u002F\u002Facademic.oup.com\u002Fcid\u002Farticle\u002F41\u002F9\u002F1285\u002F278013\"\u003Elost several members of his own family to smallpox\u003C\u002Fa\u003E, while others – including his daughter Maria Luisa – were left scarred after surviving the disease. When he heard of Jenner’s vaccine, he commissioned a physician to lead a global expedition to deliver it to the furthest reaches of the Spanish Empire. Although to be fair, most of these areas of the world were places European colonists had introduced smallpox to in the first place.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIn 1803, the ship sailed for South America. On board were 22 orphans to act as vaccine carriers.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“There is no way of mass-producing vaccine, so they give it to a child,” explains Najera. “The child will develop the lesion, then they take it from their child a couple of days later, give it to the next child and so on and so forth down the line.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe children were cared for on the journey by the orphanage director, Isabel de Zendala y Gomez, who also brought along her own son to contribute to the mission.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"Jenner did all this without knowing what he was dealing with - René Najera","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EDividing forces, the expedition travelled through the Caribbean, South and Central America and eventually crossed the Pacific to reach the Philippines. Within 20 years of its discovery, Jenner’s vaccine was already saving millions of lives. Soon, smallpox vaccination was common practice around the world. It was completely eradicated in 1979.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“Personally, it gives me hope for the Covid-19 vaccine,” says Najera. “Now we have 200 years of knowledge of viruses and the immune system but Jenner did all this without knowing what he was dealing with.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“Jenner’s up there as one of my top scientific heroes,” says Gower. “His determination and innovation changed the world and saved countless millions of lives and continues to save lives.”\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003ERichard Hollingham is a science and space journalist, feature writer for BBC Future and the author of \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.penguin.co.uk\u002Fbooks\u002F108\u002F1080856\u002Fblood-and-guts\u002F9781785940248.html\"\u003E\u003Cem\u003EBlood and Guts, A History of Surgery\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E--\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003EFacebook\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003ETwitter\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or\u003Cstrong\u003E \u003C\u002Fstrong\u003E\u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003EInstagram\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from BBC Future, Culture, Worklife, and Travel, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born-12"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-09-29T16:25:30Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"The chilling experiment which created the first vaccine","headlineShort":"How the first vaccine was born","image":["p08ss7d5"],"imageAlignment":"centre","imageAltText":"","isSyndicated":false,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":["tag\u002Fvaccine"],"summaryLong":"Smallpox used to kill millions. But a chance discovery led to the first vaccine, and a transformation in human health.","summaryShort":"A chance discovery which saved millions","tag":null,"textToSpeech":false,"creationDateTime":"2020-09-29T00:30:45.259861Z","entity":"article","guid":"7132f99b-fa42-4922-923f-c6282c3a6b34","id":"future\u002Farticle\u002F20200928-how-the-first-vaccine-was-born","modifiedDateTime":"2021-09-01T17:29:22.894757Z","project":"future","slug":"20200928-how-the-first-vaccine-was-born","cacheLastUpdated":1642293446394},"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976":{"urn":"urn:pubpipe:wwverticals:article:future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976","_id":"6183c2b445ceed04095afea4","ambientVideo":"","articleType":"story","assetVideo":null,"author":["future\u002Fauthor\u002Frichard-fisher"],"bodyIntro":"With a pandemic looming, the US president announced a warp-speed effort to vaccinate every man, woman and child in the country. As Richard Fisher discovers, the mistakes that followed hold lessons for today.","businessUnit":"worldwide","cards":[{"bodyHtml":{"assets":[],"html":"\u003Cp class=\"series-top-banner\" style=\"position: relative; display: block; width: 97%; margin-left: 0;\"\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumns\u002Fimmune-response\"\u003E \u003Cimg src=\"https:\u002F\u002Fychef.files.bbci.co.uk\u002F832x70\u002Fp08r2hgb.jpg\" border=\"0\" alt=\"Vaccine season banner (Credit: Getty Images\u002FBBC)\" width=\"100%\" \u002F\u003E \u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EPascal Imperato was waiting in line for his vaccine shot. So were the cameras.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIt was around 10:30 in the morning on 12 October 1976, and Imperato was at the Chelsea Health Clinic, an Art Deco building in the lower west side of Manhattan. The clinic was one of around 60 locations dotted around New York, preparing to vaccinate almost everyone in the city.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThat year, fears of a swine flu pandemic had loomed large, so President Gerald Ford had ordered an unprecedented mass vaccination of everyone in the United States. As Imperato rolled up his sleeve, it was the first day of the effort in New York.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EImperato was deputy health commissioner and the chair of the task force charged with rolling out the programme in the city, so had volunteered to be photographed for the newspapers as he got his shot. The mayor of New York City, when asked, had refused, so Imperato had stepped up. Turnout was strong across the city that morning.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EBut what was meant to be a ceremonial opening and positive public relations effort would turn sour. That week, the papers had begun reporting troubling news from vaccine clinics in Pittsburgh: three apparently unexplained deaths due to heart attacks.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“I remember that day. I remember it vividly,” recalls Imperato. “I saw those headlines on the subway. And I said, ‘Good God. All hell is breaking loose here.’”\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-0"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08rvzd0"],"imageAlignment":"centre","imageOrientation":"portrait","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-1"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThe headlines would get worse. Two days later, the New York Post tabloid wrote of “The Scene at the Pennsylvania Death Clinic”, featuring emotional but almost certainly embellished tales: “One of the old people, 75-year old Julia Bucci, had winced at the hypodermic needle in her arm, had taken a few feeble steps, then dropped dead on the floor of the health station. Right in front of their eyes.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe stories, it would turn out, were false and misleading. But it was just one of many problems that plagued the “swine flu affair of 1976”, when a US president decided to rush a vaccine to the entire American population based on ill-founded science and political imprudence. Lawsuits, side-effects and negative media coverage followed, and the events dented confidence in public health for years to come. What happened might even have laid the foundations for the mistaken anti-vax views and distrust in public health that would spread decades later.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAs the world rushes to roll out a vaccine to billions of people today, what might we learn from the ill-fated events of 1976? \u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EYou may also like:\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cul\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200721-coronavirus-vaccine-trial-what-its-like-to-participate\"\u003E‘What I learnt in the Oxford vaccine trial’\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200915-the-mystery-of-why-some-vaccines-are-doubly-beneficial\"\u003EThe unintended benefits of vaccination\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003Cli\u003E\u003Cstrong\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Fcolumns\u002Fimmune-response\"\u003EBBC Future’s Immune Response vaccine series\u003C\u002Fa\u003E\u003C\u002Fstrong\u003E\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIt began at a US Army training base in New Jersey. In February 1976, several soldiers at Fort Dix fell ill with a previously unrecognised swine flu. None had been in contact with pigs, so human transmission was assumed. Testing revealed that the virus had spread to more than 200 recruits.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe pandemics of 1957 and 1968 were still fresh in the memory, and fears soon escalated of another \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20200302-coronavirus-what-can-we-learn-from-the-spanish-flu\"\u003E1918-like influenza pandemic\u003C\u002Fa\u003E, which had killed tens of millions. Further investigation found that people under 50 years old had no antibodies to this new strain.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EUrgent decisions were needed. Public health officials realised it might be possible to get a vaccine to the public by the end of the year if they acted fast. The pharmaceutical industry had just finished manufacturing vaccines for the normal flu seasons. They also had an animal advantage: roosters. Back then, influenza vaccine was produced in fertilised hen’s eggs. That season’s roosters were due for slaughter, so a slow decision would add a delay of several months to vaccine manufacture.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIn March, President Ford announced a $137m (£67.5m in 1976) effort to produce a vaccine by the autumn. “Its goal was to immunise every man, woman and child in the US, and thus was the largest and most ambitious immunisation program ever undertaken in the United States,” wrote Imperato in a 2015 \u003Ca href=\"https:\u002F\u002Flink.springer.com\u002Farticle\u002F10.1007\u002Fs10900-015-0020-6\"\u003Epaper reflecting on the events\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWith hindsight, it’s easy to see that the fears of the time were unfounded. The swine flu strain spotted at Fort Dix was not dangerous, and there would be no pandemic. Later, researchers discovered that benign swine flu strains had been circulating in the US population long before this one was identified at the military base. And scientists who feared another Spanish flu did not know that \u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Fnews\u002Fstudy-revives-bird-origin-for-1918-flu-pandemic-1.14723\"\u003Ethe 1918 influenza was avian\u003C\u002Fa\u003E, not swine. Researchers at the time also suffered from a form of \u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Farticle\u002F20160605-the-trouble-with-big-data-its-called-the-recency-bias#:~:text=To%20understand%20why%20this%20matters,will%20closely%20resemble%20recent%20experience.\"\u003Erecency bias\u003C\u002Fa\u003E: based on experience from the 1950s and 60s, they assumed major influenza pandemics happened on an 11-year cycle, when they are actually more irregular.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-2"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08rvzq9"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-3"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ESo, as has happened throughout the Covid-19 pandemic of 2020, the scientists could only give the best advice they could based on incomplete knowledge. Many public health officials were sceptical and uncertain too, including Imperato in New York. “I think all of us were in agreement that yes, it's probably unlikely but we can't be absolutely sure,” he recalls.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EFord did convene a high-profile meeting of scientists to decide if there should be a vaccination programme, but “this was interpreted to be a political event rather than a scientific process”, \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Farticles\u002FPMC3291400\u002F\"\u003Eaccording to David Sencer\u003C\u002Fa\u003E,\u003Cspan\u003E \u003C\u002Fspan\u003Ethe then-director of the CDC (the Center for Disease Control, \u003Ca href=\"https:\u002F\u002Fwww.cdc.gov\u002Fmmwr\u002Fpreview\u002Fmmwrhtml\u002F00017924.htm#:~:text=On%20October%2027%2C%201992%2C%20CDC's,disease%2C%20injury%2C%20and%20disability.\"\u003Eas it was known before\u003C\u002Fa\u003E a renaming in the 1990s).\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EStill, that’s not to say that scientists were neutral in their uncertainties. As former president of the Institute of Medicine Harvey Fineberg concluded in \u003Ca href=\"https:\u002F\u002Facademic.oup.com\u002Fjid\u002Farticle\u002F197\u002FSupplement_1\u002FS14\u002F841620#14565158\"\u003Ea lacerating review of the events in 2008\u003C\u002Fa\u003E, plenty of senior scientists supported the vaccine with pre-existing agendas. Some researchers saw the chance to improve the credentials of their institution or field on the national stage, he wrote, while others held a “conviction that prevention of disease by vaccination was an achievable perfection of the human condition”. \u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAs the US summer arrived, no outbreak had emerged nationally or internationally, but efforts continued nonetheless. Four pharmaceutical companies had begun production, and testing was underway in clinical trials. But in June, there was a problem that would have far-reaching effects for years afterwards.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIt began when the industry manufacturers announced that they had been refused liability insurance, effectively downing tools. They asked Congress to indemnify them, but were turned down.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-4"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08rvzv0"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-5"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EFor weeks, this hampered the plans of local public health officials like Imperato, but crucially, also dented public confidence. “While the manufacturers' ultimatum reflected the trend of increased litigiousness in American society, its unintended, unmistakable subliminal message blared ‘There's something wrong with this vaccine,’” writes Sencer. “This public misperception, warranted or not, ensured that every coincidental health event that occurred in the wake of the swine flu shot would be scrutinised and attributed to the vaccine.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EIn July, the Ford administration agreed to bear the cost of defending lawsuits and asked Congress to pass legislation. The programme was back on track, but it was too late to reverse the damage to public perception.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EThe October crisis\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EBy mid-October, as Imperato was queuing with the photographers for his shot in New York City, the whole enterprise was already well on the way to another crisis, even if leaders did not acknowledge it.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E“The president himself was vaccinated on television on 14 October, further heightening perceptions that this was a politicised event,” writes Sencer.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-6"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"infographic","image":["p08rvzt3"],"imageAlignment":"centre","imageOrientation":"landscape","pullQuoteImageAlignment":"centre","videoImageAlign":"centre","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-7"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EThe deaths in Pittsburgh would be the start. While there was no causal evidence linking these deaths to the vaccine, they triggered many people to come forward claiming evidence of ill health, falsely blaming the inoculation. Nine states shut down their programmes.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWith such a high-profile roll-out, closely attached to the White House, many journalists unused to covering science reported only what they saw and heard from the public, without interrogating whether it was linked. Tabloid journalists gave few column inches to epidemiological nuance. What they should have looked for was “\u003Ca href=\"https:\u002F\u002Fwww.nature.com\u002Farticles\u002Fd41586-020-02497-w?utm_source=Nature+Briefing&utm_campaign=91ddd34d75-briefing-dy-20200902&utm_medium=email&utm_term=0_c9dfd39373-91ddd34d75-43399913\"\u003Eexcess mortality\u003C\u002Fa\u003E” – deaths that would not have happened otherwise – but the daily emerging tales of unexplained heart attacks, distraught nurses, and political failure won more attention.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe events became known in Imperato’s team as “the October crisis”. Take-up of the vaccine in the following days plummeted as public confidence waned. “Some of those headlines were really terrible. I remember, one of them was ‘death toll mounting’,” he recalls. “What they were really doing was monitoring the normal pattern of deaths in a population of older people that would have occurred anyway.” Blaming the vaccine, he says, was akin to concluding that a man killed by a falling tree limb died because of his red socks.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-8"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08rvzwy"],"imageAlignment":"centre","imageOrientation":"portrait","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-9"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EImperato grew frustrated with the CDC during this period, who he believes should have stepped in faster to reassure people and present the evidence. “The CDC remained silent. We were not happy about that,” he recalls. “We were very angry with them.” Echoing the speculation around the CDC today, he wonders whether they were muted for political reasons, but does not know. (Sencer, the CDC chief at the time, could probably say, but he died in 2011. In 2006, he did write, however, that the CDC believed that local and state public health departments were best placed to communicate with the media and public.)\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cstrong\u003EA problem of nerves\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAs the months continued – still with no outbreak – new problems arose. And this time, they were real side-effects. Millions of vaccinations meant dozens of cases of Guillain-Barre syndrome, a rare problem where the body’s immune system attacks the nerves. It leads to weakness and tingling in the extremities, and in some cases can be severe, leading to other complications and paralysis. The syndrome was less understood in the 1970s. Research has since found that the chances of developing the condition after vaccination are extremely small, but the scale of the 1976 roll-out meant that a handful of people were bound to be affected.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAs \u003Ca href=\"https:\u002F\u002Fwww.who.int\u002Fbulletin\u002Fvolumes\u002F87\u002F6\u002F09-040609\u002Fen\u002F\"\u003ESencer once pointed out\u003C\u002Fa\u003E in an interview with the World Health Organization, if a pandemic \u003Cem\u003Ehad\u003C\u002Fem\u003E happened in 1976, then these rare cases would have been “a blip on the screen” amid a much deeper, wider problem. It’s no secret that vaccines can have side-effects, but their protective effects against deadly diseases significantly outweigh these risks for the vast majority of people. As Helen Branswell of Stat News pointed out recently, mild side-effects \u003Ca href=\"https:\u002F\u002Fwww.statnews.com\u002F2020\u002F07\u002F27\u002Fcovid-19-vaccines-may-cause-mild-side-effects-experts-say-stressing-need-for-education-not-alarm\u002F\"\u003Eshould be anticipated as new vaccines emerge for Covid-19\u003C\u002Fa\u003E and it’s no cause for alarm. Also, you are more likely to get Guillain-Barre syndrome from an \u003Ca href=\"https:\u002F\u002Fwww.nhs.uk\u002Fconditions\u002Fguillain-barre-syndrome\u002Fcauses\u002F#:~:text=In%20the%20past%2C%20vaccinations%20(particularly,a%20vaccination%20are%20extremely%20small.\"\u003Einfection such as the flu than the flu vaccine\u003C\u002Fa\u003E. The rate of extra cases associated with the 2009 swine flu vaccine was two in a million.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EStill, the Guillain-Barre problem in 1976 did, sadly, cause illness and suffering among an unlucky group of people – perhaps as many as hundreds – who we can now conclude did not need to go through what they did.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-10"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"The swine flu affair, the New York Times concluded, had been a “sorry debacle” and “fiasco” marked by political expediency and unwarranted confidence","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-11"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EAfter months of negative media coverage, the Guillain-Barre reports brought an overdue end to the swine flu affair. Ford’s programme was suspended in December 1976 with only some 20% of the US population vaccinated. And since the US government had offered liability coverage to the pharmaceutical manufacturers that summer, \u003Ca href=\"https:\u002F\u002Fwww.jstor.org\u002Fstable\u002F29758667#metadata_info_tab_contents\"\u003Ehundreds of compensation claims\u003C\u002Fa\u003E from Guillain-Barre claimants followed for years afterward.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe swine flu affair, \u003Ca href=\"https:\u002F\u002Fwww.nytimes.com\u002F1976\u002F12\u002F21\u002Farchives\u002Fswine-flu-fiasco.html\"\u003Ethe New York Times concluded\u003C\u002Fa\u003E after the programme was suspended, had been a “sorry debacle” and “fiasco” marked by political expediency and unwarranted confidence. “The danger now is that the whole idea of preventive medicine may be discredited,” the editorial warned.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EWhile it would be a stretch to suggest that it led directly to the anti-vax movement decades later, the botched decisions of 1976 would remain in the American memory, and would have done little to boost confidence in vaccines and public health advice for years afterwards.\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-12"},{"bodyHtml":{"assets":[]},"cardType":"Image","iFrameType":"","image":["p08rvzzq"],"imageAlignment":"centre","imageOrientation":"landscape","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-13"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003ESo, as our politicians stand at their podiums making claims and promises about vaccines during the Covid-19 pandemic, what else might be learnt from the swine flu affair of 1976?\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EFor Fineberg, “the fundamental strategic blunder” was announcing a mass vaccination programme so early. It was premature, and locked politicians into a very visible commitment. So, when presidents and prime ministers make bold promises to the public – like \u003Ca href=\"https:\u002F\u002Fwww.hhs.gov\u002Fabout\u002Fnews\u002F2020\u002F06\u002F16\u002Ffact-sheet-explaining-operation-warp-speed.html#:~:text=Operation%20Warp%20Speed%20(OWS)%20aims,(collectively%20known%20as%20countermeasures).\"\u003EOperation Warp Speed,\u003C\u002Fa\u003E the current US effort to roll out 300 million doses to the US public by January 2021 – it makes a scientific process into a political pledge.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAs 1976 showed, such a commitment can make leaders less willing to adapt to new evidence – or changes in risk. Sencer writes that Ford and other leaders were continually briefed that a pandemic remained “possible”, but not how “probable”, even as the likelihood declined with time. There was also arguably a language gap: to a scientist, possible can mean a one in a million chance; to a politician, it necessitates action.\u003C\u002Fp\u003E\n\u003Cp\u003EIn the post-mortems of 1976, it is also striking to read of the pitfalls of politicians presenting scientific information to the public. When Ford was the face for the vaccine initiative, Sencer writes, it did not foster trust. “Scientific information coming from a non-scientific political figure is likely to encourage scepticism, not enthusiasm,” he writes. How quickly these errors of judgment have been forgotten during the Covid-19 pandemic, as politicians shoulder out experts when the cameras point their way. \u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-14"},{"bodyHtml":{"assets":[]},"cardType":"PullQuote","iFrameType":"","pullQuote":"When politicians talk of “the science” as a complete body of knowledge, a manual for what to do, it neglects the uncertainty of evidence and ignores that science is a human endeavour.","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-15"},{"bodyHtml":{"assets":[],"html":"\u003Cp\u003EScientists, however, are human too. Today, it’s easy to see gaps in the scientific evidence of 1976, such as the belief that the virus mirrored the 1918 outbreak or that a pandemic was due. But the scientists of the time could not, so faced with uncertainty, they made conclusions influenced by belief, instinct or fear. The same must almost certainly be true today. The science of viruses in 2020 may be far more sophisticated, but the science of Sars-Cov-2, the virus that causes the disease Covid-19, remains incomplete. According to Fineberg, the swine flu affair was characterised by “overconfidence in theory spun from meagre evidence”. There was also a kind of “hero” effect at play, says Fineberg, where the fear of disaster led to an immovable zeal. \u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003ESo, when politicians in the present day talk of “the science” as if it is a complete body of knowledge, a manual for what to do, it neglects the uncertainty of evidence and ignores that science is a human endeavour.\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EAs for Imperato, remembering the day he was vaccinated for the cameras and the surrounding chaos gives him some concerns about what’s ahead in 2020. “I really see the beginnings of the same patterns of commentary about the Covid-19 vaccines and the trials,” he says. There’s no reason, he believes, why a mass vaccination effort could not be rolled out quickly, but he worries about the media context it will happen within. “There are so many talking heads, on television and on social media, commenting on every aspect of this pandemic,” he says. “Their credentials are not matched to what they're commenting on. I refer to them as trespassers.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003EThe swine flu affair of 1976 holds many lessons for today, says Imperato, and there’s wisdom in the aphorism that those who ignore the lessons of history are doomed to repeat it. Still, throughout his career he has remained a strong advocate for the life-saving properties of vaccines. “You know, all that happened while I was getting my shot, it didn't dissuade me. I still went ahead with it.”\u003C\u002Fp\u003E\n\u003Cp\u003E \u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E*Richard Fisher is a senior journalist for BBC Future, and tweets \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002Frifish\"\u003E\u003Cem\u003E@rifish\u003C\u002Fem\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003E--\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EAs an award-winning science site, BBC Future is committed to bringing you evidence-based analysis and myth-busting stories around the new coronavirus. You can read more of our \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002Ftags\u002Fcovid-19\"\u003E\u003Cstrong\u003E\u003Cem\u003ECovid-19 coverage here\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EJoin one million Future fans by liking us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.facebook.com\u002FBBCFuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EFacebook\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, or follow us on \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Ftwitter.com\u002FBBC_Future\"\u003E\u003Cstrong\u003E\u003Cem\u003ETwitter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E or \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.instagram.com\u002Fbbcfuture_official\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EInstagram\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E.\u003C\u002Fem\u003E\u003C\u002Fp\u003E\n\u003Cp\u003E\u003Cem\u003EIf you liked this story, \u003C\u002Fem\u003E\u003Ca href=\"http:\u002F\u002Fpages.emails.bbc.com\u002Fsubscribe\u002F?ocid=fut.bbc.email.we.email-signup\"\u003E\u003Cstrong\u003E\u003Cem\u003Esign up for the weekly bbc.com features newsletter\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, called “The Essential List”. A handpicked selection of stories from \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ffuture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EBBC Future\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fculture\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003ECulture\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Fworklife\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003EWorklife\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, and \u003C\u002Fem\u003E\u003Ca href=\"https:\u002F\u002Fwww.bbc.com\u002Ftravel\u002F\"\u003E\u003Cstrong\u003E\u003Cem\u003ETravel\u003C\u002Fem\u003E\u003C\u002Fstrong\u003E\u003C\u002Fa\u003E\u003Cem\u003E, delivered to your inbox every Friday.\u003C\u002Fem\u003E\u003C\u002Fp\u003E"},"cardType":"Body","iFrameType":"","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976-16"}],"collection":["future\u002Fcolumn\u002Fimmune-response"],"disableAdverts":false,"displayDate":"2020-09-22T00:00:42Z","embeddedCustomHtml":"","embeddedInfographicUrl":"","embeddedType":"infographic","headlineLong":"The fiasco of the 1976 ‘swine flu affair’","headlineShort":"The warp-speed vaccine plan that failed","image":["p08rw02w"],"imageAlignment":"centre","imageAltText":"","isSyndicated":true,"latitude":"","longitude":"","mpsVideo":"","option":[{"Content":{"Description":"Apple News Publish: Select to publish, remove to unpublish. (Do not just delete or unpublish the story)","Name":"publish-applenews-system-1"},"Metadata":{"CreationDateTime":"2016-02-05T14:32:31.186819Z","Entity":"option","Guid":"13f4bc85-ae27-4a34-9397-0e6ad3619619","Id":"option\u002Fpublish-applenews-system-1","ModifiedDateTime":"2021-08-25T12:48:44.837297Z","Project":"","Slug":"publish-applenews-system-1"},"Urn":"urn:pubpipe:wwverticals:option:option\u002Fpublish-applenews-system-1","_id":"6183c2c945ceed0d2f73335b"}],"partner":null,"primaryVertical":"future","promoAlignment":"centre","promoAltText":"","promoImage":null,"relatedStories":null,"relatedTag":null,"summaryLong":"With a pandemic looming, the US president announced a warp-speed effort to vaccinate every man, woman and child in the country. The mistakes that followed hold lessons for today.","summaryShort":"What the fiasco of the 1976 ‘swine flu affair’ can teach us about today","tag":["tag\u002Fvaccine"],"textToSpeech":false,"creationDateTime":"2020-09-21T23:00:47.332924Z","entity":"article","guid":"8d29dc88-c122-4a28-a671-5364f69fea29","id":"future\u002Farticle\u002F20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976","modifiedDateTime":"2021-09-01T17:28:47.892146Z","project":"future","slug":"20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976","cacheLastUpdated":1642293446395}},"tags":{"tag\u002Fvaccine":{"urn":"urn:pubpipe:wwverticals:tag:tag\u002Fvaccine","_id":"6183c30245ceed14d238f62f","assetImage":null,"description":"The BBC's latest stories on 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