Eleven months after the novel coronavirus was identified, the United Kingdom's Medicines and Healthcare products Regulatory Agency has approved the Pfizer-BioNTech COVID-19 vaccine.  EU countries will have to wait a few more weeks for a similar announcement. The European Medicines Agency will announce its decision on December 29 at the latest, and whether it will also approve a vaccine from the US drugmaker Moderna by January 12. In both cases, phase 3 studies on efficacy and safety continue. Despite the urgency, the vaccines — like others in development by the British-Swedish pharmaceuticals giant AstraZeneca and China's Sinovac and Sinopharm companies — will only be approved if they are found to be safe and effective. 

Because the European Union has purchased large quantities of the millions of doses already produced by the pharmaceutical companies, the bloc is getting ready to distribute vaccines to the member states according to population size as soon as they are approved. However, there will not be enough doses to go around at first as there is simply too much demand. Moreover, it seems that first vaccines will all require a booster shot to provide adequate protection against developing COVID-19. Therefore, distribution will have to be organized efficiently. Politicians and scientists must ensure that distribution is fair and according to needs rather than wealth. 

In a joint paper, the German Ethics Council, the German National Academy of Sciences Leopoldina and the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute public health agency suggested that people who are at higher risk of developing severe cases of COVID-19 because of their age or underlying conditions should be inoculated first. People who work in the health sector and are more likely to be exposed to the disease would also receive the vaccine as soon as possible, as would state employees such as paramedics, firefighters and police officers, teachers and educators. 

It will be an enormous challenge just to vaccinate those groups. Centers will be set up all over Germany, and as many people would be vaccinated as possible in the initial weeks. But the process is expected to last months — and possibly longer. Even if 100,000 people are injected every day, it would be five months before 15 million people could be vaccinated in a country of more than 80 million people — and that's just the first dose. STIKO has projected that the process could continue into 2022. 

A mandatory vaccine?

There are large numbers of people who do not want to be vaccinated. Some are against vaccines as a principle; others are suspicious of a vaccine that has been developed so fast. Some people cannot be vaccinated for health reasons. About half of the respondents to recent polls in Germany expressed some form of reluctance to receive the initial vaccine.

Politicians have assured their constituents that the coronavirus vaccine will not be compulsory in Germany — except perhaps for health sector workers who are likely to come into close contact with high-risk patients. In the future, however, it could well be that the vaccine becomes compulsory for other employees deemed essential. 

Most EU governments are banking on people choosing to be vaccinated. There are many countries where inoculation could be made compulsory as vaccines for hepatitis A and B, the rotavirus, diphtheria, tetanus, yellow fever, and a number of diseases that affect children already are. In the US, the decision about whether to mandate the vaccine would be made at the state level. 

What is more likely than compulsory vaccination is that people might have to provide proof of immunity in order to do certain jobs or engage in other activities. Many people wonder whether they will be allowed to go bars, clubs, restaurants, gyms or concert halls if they have not been vaccinated.

Qantas says yes

The Australian airline Qantas has already announced that it will only allow people who have been vaccinated to fly on its planes. Other airlines and cruise companies could follow suit.

Private companies such as Qantas are generally entitled to make such decisions. However, public companies often cannot. Germany's national rail carrier, Deutsche Bahn will probably not be allowed to bar nonvaccinated people from travel. It might, however, be able to insist that they ride in designated compartments.

For the moment, no general coronavirus vaccination is foreseen in Germany's state schools and kindergartens — unlike the measles inoculation, which became compulsory in March. However, private schools and kindergartens are allowed to require vaccinations.

This article has been adapted from German.

This article has been updated to reflect that the UK has approved the Pfizer-BioNTech vaccine, not that it was approved for emergency use.