Global Vaccination Programs

A vaccine is a biological preparation that trains the immune system to recognize and respond to a specific pathogen without causing disease. Vaccines work by presenting the immune system with antigens derived from a weakened, killed, or engineered version of a virus or bacterium, prompting the body to generate antibodies and memory cells that can later mount a rapid defense against the real infection. The cumulative effect across a population is a dramatic reduction in the incidence, severity, and onward transmission of vaccine-preventable diseases, and in many cases the near-elimination of infections that were once leading causes of childhood death.

Global vaccination programs are the coordinated systems through which governments, international agencies, manufacturers, health workers, and communities deliver vaccines at scale. These systems include laboratory research and clinical trials, regulatory approval, manufacturing and quality control, procurement, international shipping, cold chain storage, national immunization schedules, community outreach, and routine surveillance. The World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Gavi the Vaccine Alliance, and national immunization programs are the primary institutional actors, supported by a network of manufacturers, research universities, and non-governmental organizations.

According to published estimates from the World Health Organization and UNICEF, childhood immunization prevents several million deaths every year across the world, and the broader expansion of vaccination since the second half of the twentieth century is credited with saving tens of millions of lives. Smallpox has been eradicated from nature, polio is close to elimination, and measles, diphtheria, tetanus, pertussis, and many other diseases have been driven to historically low levels in most countries. Progress remains uneven, however, and a significant number of children are still born each year into communities where routine immunization is absent, disrupted, or refused.

This article surveys the history of vaccination, the science behind how vaccines work, the Expanded Programme on Immunization and the contemporary global schedule, the major vaccine-preventable diseases, the institutional architecture of global vaccination, the experience of COVID-19 and the COVAX Facility, and the contemporary challenges of reaching zero-dose children, strengthening manufacturing, and rebuilding trust in the face of organized vaccine hesitancy.

Practices that resemble vaccination predate the word itself by many centuries. The oldest documented technique is variolation, in which material from the pustules of a person with a mild case of smallpox was deliberately introduced, usually by scratching it into the skin or blowing dried scabs into the nose, in the hope of producing a survivable infection that conferred lifelong immunity. Variolation is well attested in China by the tenth century, spread across South and Central Asia, and was introduced into the Ottoman Empire by the seventeenth century. Lady Mary Wortley Montagu, the wife of the British ambassador in Constantinople, famously had her own children variolated in 1718 and helped publicize the practice in the United Kingdom. Variolation carried a real risk of severe smallpox and death, but in an era when natural smallpox killed roughly one in three of those infected, the trade-off was widely accepted.

The transition from variolation to true vaccination is conventionally dated to 1796, when the English country physician Edward Jenner inoculated an eight-year-old boy named James Phipps with material taken from a cowpox lesion on the hand of a milkmaid named Sarah Nelmes. Jenner had observed that milkmaids who contracted cowpox, a mild disease of cattle, seemed protected from smallpox, and he reasoned that a deliberate cowpox inoculation might offer the same protection without the dangers of variolation. When Phipps was later exposed to smallpox and remained well, Jenner published his findings in 1798. The Latin word for cow, vacca, gave the new procedure its name: vaccination. The practice spread quickly across Europe and the Americas, aided by the Spanish Balmis Expedition of 1803 to 1806, which carried live cowpox material across the Spanish empire using orphaned boys as arm-to-arm carriers.

The next decisive leap came in the late nineteenth century, as Louis Pasteur and his colleagues developed the germ theory of disease and began systematically attenuating pathogens in the laboratory. Pasteur introduced a veterinary vaccine against chicken cholera in 1879 and against anthrax in 1881, and in July 1885 he used a rabies vaccine to treat a nine-year-old boy named Joseph Meister, who had been badly bitten by a rabid dog. Meister survived, and rabies post-exposure prophylaxis rapidly entered clinical practice. Over the following decades, scientists produced vaccines against typhoid fever (1896), cholera (1896), plague (1897), tuberculosis (the Bacille Calmette-Guerin or BCG vaccine, 1921), diphtheria toxoid (1923), tetanus toxoid (1924), pertussis whole-cell vaccine (1926), and yellow fever (1937).

The middle of the twentieth century was the age of the great childhood vaccines. An inactivated poliovirus vaccine developed by Jonas Salk was licensed in the United States in 1955, followed by an oral live-attenuated poliovirus vaccine developed by Albert Sabin, first licensed in the early 1960s. The measles vaccine, derived from the Edmonston strain, was licensed in 1963. The mumps vaccine followed in 1967, and a rubella vaccine in 1969; these three were combined into the MMR vaccine in 1971. Hepatitis B plasma-derived vaccines appeared in the early 1980s, rapidly superseded by recombinant hepatitis B vaccines produced in yeast, the first true genetically engineered vaccines in widespread human use. Haemophilus influenzae type b (Hib) conjugate vaccines, pneumococcal conjugate vaccines, rotavirus vaccines, and human papillomavirus (HPV) vaccines followed over the next two decades. Each of these advances reshaped the epidemiology of a disease that had previously caused major childhood mortality or lifelong disability.

Vaccines exploit the adaptive immune system, the branch of immunity that generates pathogen-specific responses and long-term memory. When a vaccine introduces an antigen into the body, specialized white blood cells called antigen-presenting cells carry fragments of the antigen to lymph nodes, where they activate B cells and T cells bearing matching receptors. Activated B cells proliferate and mature into plasma cells that secrete antibodies capable of neutralizing the pathogen or marking it for destruction. A fraction of the responding B and T cells become long-lived memory cells, which can be reactivated rapidly if the same pathogen is encountered years later. The overall effect is that subsequent exposure to the real pathogen provokes a faster and stronger response than would otherwise occur, often preventing disease entirely.

Several platforms are used to deliver antigens. Live attenuated vaccines contain a weakened version of a virus or bacterium that can replicate briefly in the body without causing illness; the measles, mumps, rubella, varicella, yellow fever, rotavirus, BCG, and oral polio vaccines all use this approach. Inactivated or killed vaccines use pathogens that have been chemically or physically inactivated, as in the Salk inactivated polio vaccine, most seasonal influenza vaccines, and inactivated hepatitis A vaccines. Subunit, recombinant, and conjugate vaccines use purified fragments of the pathogen, such as the hepatitis B surface antigen, the polysaccharide capsule of Haemophilus influenzae type b linked to a carrier protein, the HPV virus-like particle, or the recombinant spike protein used in some COVID-19 vaccines. Toxoid vaccines, such as those for diphtheria and tetanus, use chemically inactivated bacterial toxins.

Two newer platforms came to global prominence during the COVID-19 pandemic. Messenger RNA (mRNA) vaccines deliver a short strand of synthetic messenger RNA, encapsulated in lipid nanoparticles, that instructs cells in the body to transiently produce a specific viral protein. The immune system then reacts to that protein as it would to a viral infection. Viral vector vaccines use a harmless virus, such as a modified adenovirus, to carry the genetic instructions for a target antigen into cells. Both platforms build on decades of prior research in oncology, HIV vaccine development, and gene therapy, and both can in principle be adapted rapidly to new pathogens.

Community or herd immunity is the population-level consequence of widespread vaccination. When a sufficient fraction of a population is immune, the pathogen has too few susceptible hosts to sustain chains of transmission, and outbreaks fade out even among the unvaccinated. The threshold varies by disease and depends on the basic reproduction number; highly transmissible diseases such as measles require roughly 95 percent coverage for elimination, while less transmissible diseases may require lower thresholds. Community immunity is particularly important for infants too young to be vaccinated, for the immunocompromised, and for those in whom vaccines are less effective.

The Expanded Programme on Immunization (EPI) was launched in May 1974 by resolution of the Twenty-seventh World Health Assembly, the governing body of the World Health Organization. The program was conceived in the shadow of the successful smallpox eradication campaign, then entering its final phase, and was intended to extend the benefits of routine childhood vaccination from wealthy countries to the entire world. At the time of its launch, fewer than five percent of children in low-income countries received a full course of basic childhood vaccines.

The original EPI schedule targeted six diseases with six traditional antigens: tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, and measles, delivered through BCG, the diphtheria-tetanus-pertussis (DTP) combination vaccine, oral poliovirus vaccine, and measles vaccine. National immunization programs in member states were built around this core schedule, supported by WHO technical guidance, UNICEF procurement and cold chain equipment, and bilateral donors. By the end of the 1980s, the program had reached approximately 80 percent global coverage for a third dose of DTP and for measles vaccination, a remarkable achievement over only 15 years.

Over the following decades, the EPI expanded well beyond its original six antigens. Hepatitis B vaccine was added in most countries in the 1990s and 2000s. Haemophilus influenzae type b conjugate vaccine became routine across much of the world in the 2000s, often as part of a pentavalent vaccine combining DTP, hepatitis B, and Hib. Pneumococcal conjugate vaccine and rotavirus vaccine were introduced in low- and middle-income countries from the late 2000s onward, supported heavily by Gavi. Human papillomavirus (HPV) vaccine for adolescent girls, rubella vaccine, second dose of measles, and in selected settings meningococcal, yellow fever, typhoid, and cholera vaccines have all become part of expanded national schedules. The WHO and UNICEF jointly publish annual estimates of national coverage for each recommended antigen.

Global coverage trends over the half-century since 1974 tell a story of impressive but uneven progress. After the rapid gains of the 1980s, coverage plateaued in the 1990s, climbed again during the 2000s under the influence of Gavi, and reached historic highs in the late 2010s. The COVID-19 pandemic disrupted routine services, and DTP3 coverage fell for the first time in a generation in 2020 and 2021 before beginning to recover. Restoring the gains of the pre-pandemic period, while closing the persistent gap in low-income and conflict-affected countries, is now the central challenge of the contemporary EPI agenda.

Vaccination programs have transformed the epidemiology of a wide range of infectious diseases. Smallpox, once among the most feared killers in human history, was declared eradicated by the World Health Assembly in May 1980 after a WHO-led global campaign that combined routine vaccination, ring vaccination of contacts, and meticulous surveillance. Smallpox remains the only human disease ever to have been eradicated, and its elimination is the foundational success of international immunization.

Poliomyelitis, which as recently as the mid-1950s paralyzed hundreds of thousands of children each year, has been driven to the brink of eradication by the Global Polio Eradication Initiative launched in 1988. Wild poliovirus type 2 was declared eradicated in 2015 and type 3 in 2019, leaving only type 1 in limited circulation. Measles, an extremely transmissible viral illness that still causes severe childhood mortality in under-vaccinated populations, has been driven to low levels in most of the world but continues to cause periodic outbreaks when coverage falls. Rubella elimination has been achieved across large portions of the world and is intimately linked with measles control through combined MMR and MR vaccines.

Diphtheria, tetanus, and pertussis, the three diseases targeted by the DTP combination vaccine, have been reduced by orders of magnitude in countries with sustained programs. Maternal and neonatal tetanus, once a leading cause of newborn death, has been eliminated as a public health problem in most countries through maternal immunization during pregnancy. Hepatitis B vaccination has driven childhood hepatitis B infection and the associated lifetime risks of cirrhosis and liver cancer to historically low levels; hepatitis B birth-dose coverage is among the most important metrics of health system performance.

Haemophilus influenzae type b (Hib), once a major cause of childhood bacterial meningitis and pneumonia, has nearly disappeared in countries that use Hib conjugate vaccines. Pneumococcal conjugate vaccines have substantially reduced severe childhood pneumonia and meningitis and are now in routine use in the majority of countries. Rotavirus vaccines have cut severe diarrheal disease and infant hospitalizations, with particularly large benefits in low-income countries where rotavirus was a leading cause of under-five mortality. Human papillomavirus vaccines are now preventing the infections responsible for most cervical cancers and a significant share of anal, oropharyngeal, and penile cancers, offering the prospect of cervical cancer elimination as a public health problem within the twenty-first century.

Other diseases on national and regional schedules include meningococcal disease (especially in the African meningitis belt, where the MenAfriVac conjugate vaccine dramatically reduced meningitis epidemics after 2010), yellow fever, typhoid fever, cholera, seasonal and pandemic influenza, Japanese encephalitis, rabies post-exposure prophylaxis, and increasingly respiratory syncytial virus (RSV). The list of vaccine-preventable diseases continues to grow as new candidates advance through clinical development, including vaccines for malaria, tuberculosis (new generation), and group B streptococcus.

Beyond routine immunization, a set of specialized global initiatives coordinates the world's efforts against individual high-burden diseases. The Global Polio Eradication Initiative (GPEI), founded in 1988, is a partnership led by WHO, Rotary International, the United States Centers for Disease Control and Prevention, UNICEF, the Bill and Melinda Gates Foundation, and Gavi. It has reduced wild polio cases by more than 99 percent since its founding and continues to pursue eradication through mass oral polio vaccine campaigns, surveillance, and response to vaccine-derived poliovirus outbreaks. The Measles and Rubella Partnership, co-led by the American Red Cross, the CDC Foundation, the United Nations Foundation, UNICEF, and WHO, supports national measles and rubella elimination efforts and funds supplementary immunization activities.

The Stop TB Partnership coordinates the global response to tuberculosis, including research into new tuberculosis vaccines to replace or supplement BCG, which offers limited protection against adult pulmonary disease. The Global Fund to Fight AIDS, Tuberculosis and Malaria, founded in 2002, is the world's largest multilateral financier of HIV, tuberculosis, and malaria programs; while not a vaccine agency in the narrow sense, it finances the health systems through which vaccination is delivered, as well as malaria vaccine introduction in the countries where it is recommended. The United Nations system as a whole supports these initiatives through WHO, UNICEF, the UN Population Fund, and the World Bank.

Regional initiatives complement these global bodies. The Pan American Health Organization's Revolving Fund has for decades pooled the vaccine purchases of countries in the Americas to achieve lower prices and reliable supply. The African Vaccine Acquisition Trust (AVAT), established during the COVID-19 pandemic, aggregates African demand for vaccines. National regulatory agencies, such as the United States Food and Drug Administration, the European Medicines Agency, India's Central Drugs Standard Control Organization, and World Health Organization prequalification, together form the scientific backbone for vaccine licensing and international procurement.

Gavi, the Vaccine Alliance, was launched at the World Economic Forum in Davos in January 2000, with a founding grant from the Bill and Melinda Gates Foundation and participation from the World Health Organization, UNICEF, the World Bank, donor governments, developing country governments, vaccine manufacturers, and civil society organizations. It is headquartered in Geneva, Switzerland, and operates as a public-private partnership whose central mission is to expand access to new and underused vaccines in the world's lowest-income countries.

Gavi's financing model is distinctive. It uses long-term, predictable donor commitments to negotiate bulk purchases of vaccines from manufacturers, lowering per-dose prices and signaling durable demand that in turn encourages investment in expanded manufacturing capacity. The International Finance Facility for Immunisation (IFFIm), established in 2006, raises funds on the capital markets against future donor commitments and channels them to Gavi programs. The Advance Market Commitment (AMC) for pneumococcal conjugate vaccines, launched in 2009, guaranteed a market at a fixed price for manufacturers that could supply a product meeting specified criteria, and is widely credited with accelerating access to PCV in developing countries.

Eligibility for Gavi support is determined primarily by gross national income per capita. Low-income countries receive the largest share of Gavi support; countries that grow wealthier pass through a phase of co-financing and eventually transition out of Gavi eligibility as their economies develop. This model has been successful at supporting graduation for many middle-income countries but has also raised concerns about a coverage cliff for fragile states and middle-income countries that lose access to concessional prices before their domestic financing fully replaces external support.

Since its founding, Gavi has supported the vaccination of more than one billion children and has played a central role in accelerating the introduction of pneumococcal, rotavirus, HPV, measles-rubella, and malaria vaccines in low-income countries. It has also invested heavily in health system strengthening, cold chain equipment, electronic immunization registries, and targeted programs to reach zero-dose children. Gavi was a co-lead of the COVAX Facility during the COVID-19 pandemic.

The COVID-19 pandemic produced the most rapid vaccine development program in history. The SARS-CoV-2 genome was published on January 11, 2020; the first human trial of a candidate vaccine began on March 16, 2020; and the Pfizer-BioNTech mRNA vaccine BNT162b2 received emergency authorization in the United Kingdom on December 2, 2020, with Moderna's mRNA-1273 following later that month. Over the course of 2021, viral vector vaccines (AstraZeneca-Oxford, Janssen, and Sputnik V), inactivated vaccines from Sinovac and Sinopharm, and protein subunit vaccines from Novavax and others entered use across the world. By the end of 2022, more than 13 billion doses had been administered globally.

The COVAX Facility was created in April 2020 to ensure that low- and middle-income countries would not be excluded from access to COVID-19 vaccines. Co-led by WHO, Gavi, and the Coalition for Epidemic Preparedness Innovations (CEPI), COVAX functioned as a pooled procurement and risk-sharing mechanism. The COVAX Advance Market Commitment (AMC) provided financing for 92 lower-income economies to receive vaccines on a no-cost or highly subsidized basis, while self-financing participants paid for their own doses through the same mechanism. By the end of its operational mandate, COVAX had delivered approximately 1.99 billion doses to 146 participating economies.

COVAX faced substantial challenges. Wealthy countries signed large bilateral agreements with manufacturers, constraining the supply available to COVAX in early 2021. Export restrictions on vaccines produced in India during the second wave of COVID-19 further squeezed COVAX supply. The initial inequity of the global rollout, with high-income countries achieving high coverage many months before much of Africa, South Asia, and Latin America, provoked a broader debate about pharmaceutical access, intellectual property, and pandemic preparedness. Nevertheless, COVAX demonstrated the feasibility of rapidly assembling a global vaccine distribution platform in the midst of a crisis and provided the organizational template for future pandemic response.

One concrete legacy of the pandemic is the effort to decentralize vaccine manufacturing. The WHO-supported mRNA Technology Transfer Hub, established at Afrigen Biologics in Cape Town, South Africa in 2021, aims to build regional mRNA manufacturing capacity across Africa and other low- and middle-income regions. Partner manufacturers in South Africa, Egypt, Kenya, Senegal, Nigeria, Brazil, Argentina, India, Indonesia, and other countries are acquiring mRNA technology and know-how to produce vaccines for future pandemic threats as well as for endemic diseases.

Despite the scale of global immunization, substantial gaps persist. WHO and UNICEF estimate that approximately 14 million children are born each year who receive no routine vaccinations at all, the so-called zero-dose children. These children are concentrated in a small number of countries facing conflict, fragility, displacement, or severe poverty, including the Democratic Republic of the Congo, Ethiopia, Nigeria, Pakistan, India, the Philippines, and Indonesia, though clusters of zero-dose children also exist in urban slums, remote rural communities, and marginalized minority populations within otherwise high-coverage countries. The Immunization Agenda 2030, endorsed by the World Health Assembly in 2020, sets a target of halving the number of zero-dose children by 2030.

The COVID-19 pandemic caused the largest sustained backsliding in routine immunization coverage in three decades. Lockdowns, health worker diversion to pandemic response, supply-chain disruption, and parental avoidance of health facilities combined to cut DTP3 and measles first-dose coverage in 2020 and 2021. Although partial recovery is under way, the number of children missing essential vaccines has not yet returned to pre-pandemic levels in all regions. Strengthening primary health care, integrating immunization with other maternal and child health services, and improving the microplanning that identifies missed communities are the central strategies for recovery. Effective immunization is also closely tied to nutrition and food security, since undernutrition impairs vaccine response and increases the severity of vaccine-preventable diseases.

Vaccine hesitancy, defined by WHO as delay in acceptance or refusal of vaccination despite availability of services, has become a major challenge in both high- and low-coverage settings. The drivers are varied and context-specific, and include concerns about vaccine safety and efficacy, mistrust of government or pharmaceutical manufacturers, the amplification of misinformation through social media, religious and ideological opposition, and the erosion of experiential memory of the diseases themselves as they become rarer. Politically mobilized anti-vaccine movements gained significant ground during and after the COVID-19 pandemic, contributing to measles and pertussis outbreaks in several high-income countries and to slower uptake of HPV and routine childhood vaccines in some regions.

Cold chain logistics remain a technical challenge, particularly for vaccines that require strict temperature control. Most traditional vaccines must be kept between two and eight degrees Celsius from manufacture to point of use; the two leading mRNA COVID-19 vaccines initially required ultra-cold temperatures as low as minus 70 degrees Celsius, creating new logistical problems in settings with unreliable electricity. Investments in solar-powered refrigeration, controlled temperature chain vaccines such as heat-stable oral polio and tetanus-diphtheria formulations, and thermostable single-dose prefilled delivery devices are gradually easing the last-mile burden, but reaching nomadic, remote, and conflict-affected populations remains difficult.

Vaccine manufacturing capacity is heavily concentrated. The Serum Institute of India in Pune is the world's largest producer of vaccine doses by volume and supplies many of the core EPI vaccines, including measles, rubella, DTP, pentavalent, pneumococcal, HPV, and oral polio vaccines. Biological E Limited in Hyderabad, Bharat Biotech, and Panacea Biotec, also in India, add significant capacity. Multinational pharmaceutical firms Pfizer, Moderna, Merck, Sanofi, GSK, Johnson & Johnson, and AstraZeneca lead in innovation and high-income-market supply. Chinese firms Sinovac Biotech and Sinopharm (through the China National Biotec Group) produce influenza, hepatitis, BCG, JE, and COVID-19 vaccines at scale. Brazil's Instituto Butantan and Bio-Manguinhos, Indonesia's Bio Farma, Senegal's Institut Pasteur de Dakar, and the new African mRNA hub centered in Cape Town represent the emerging push to broaden the geographic base of vaccine production. The COVID-19 experience made the geopolitical fragility of this concentration unmistakable and has shaped investment priorities since.

Looking ahead, the pipeline of new vaccines includes mRNA products against seasonal influenza, RSV, cytomegalovirus, and future pandemic threats; the RTS,S and R21 malaria vaccines now being introduced in sub-Saharan African countries; next-generation tuberculosis vaccines; and candidate vaccines against group B streptococcus, Salmonella Typhi conjugate vaccines for typhoid elimination, universal coronavirus vaccines, and HIV. A full discussion of the history of deadly outbreaks that motivated these programs is available in the companion article on major pandemics in history. For its part, the World Health Organization continues to coordinate the institutional frameworks that make global immunization possible.

Detailed citations, data references, and institutional sources for all CountryReports content are listed on the Sources page. The following international agencies, government public-health bodies, research institutes, and peer-reviewed journals are the primary authorities we rely on for content on global vaccination programs. Each link points to the institution's homepage or relevant subsite.

International Agencies and Alliances

• World Health Organization — Immunization, Vaccines and Biologicals — WHO position papers, the Immunization Agenda 2030, SAGE recommendations, and annual WHO/UNICEF Estimates of National Immunization Coverage (WUENIC).
• UNICEF — Immunization — Global vaccine procurement, cold chain support, and country programmes delivered through the world's largest vaccine buyer for children.
• Gavi, the Vaccine Alliance — Strategy documents, country investment cases, and performance data on Gavi-supported vaccines in low- and lower-middle-income countries.
• Global Polio Eradication Initiative — Weekly surveillance updates on wild and vaccine-derived poliovirus cases and progress toward eradication.
• Coalition for Epidemic Preparedness Innovations (CEPI) — Pandemic preparedness investments, the 100 Days Mission, and co-leadership of the COVAX Facility.
• The Global Fund to Fight AIDS, Tuberculosis and Malaria — Financing and programme data for diseases linked to the broader immunization agenda, including malaria vaccine introduction.
• Stop TB Partnership — Coordination of global tuberculosis policy and advocacy for new TB vaccine development.
• Measles and Rubella Partnership — Joint programme of the American Red Cross, CDC Foundation, UN Foundation, UNICEF, and WHO for measles and rubella elimination.

Government Public-Health Agencies

• United States Centers for Disease Control and Prevention — Vaccines & Immunizations — ACIP recommendations, the U.S. immunization schedule, and surveillance of vaccine-preventable diseases.
• European Centre for Disease Prevention and Control — Immunisation and Vaccines — EU/EEA immunization policy, surveillance, and vaccine-preventable disease reports.
• United States Food and Drug Administration — Vaccines — Regulatory reviews and approval records for vaccines licensed in the United States.

Research Institutes and Non-Governmental Organizations

• International Vaccine Institute (IVI) — Seoul-based research institute focused on vaccines for cholera, typhoid, and other diseases of developing countries.
• PATH — Global health organization with longstanding work in vaccine development, market-shaping, and immunization system innovation.
• Our World in Data — Vaccination — Long-run coverage, child mortality, and disease-burden charts based on WHO, UNICEF, and IHME data.
• Institute for Health Metrics and Evaluation — Global Burden of Disease — Independent estimates of deaths and disability averted by vaccination across the world.

Peer-Reviewed Journals

• The New England Journal of Medicine — Pivotal trial reports including the Phase 3 results for the BNT162b2 and mRNA-1273 COVID-19 vaccines.

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