England's Covid Inquiry published its fourth report, a 274-page assessment of the United Kingdom's Covid vaccination programme that called for urgent reforms to address vaccine hesitancy, misinformation, and support for people harmed by the jabs. The report described the rollout as the largest immunisation programme in UK history, one that saved hundreds of thousands of lives.

Approximately 130 million Covid vaccine doses were administered in the UK within one year, and more than nine in 10 people aged over 12 were immunised against Covid. The development and rollout of vaccines occurred within months, a process that normally takes years of research and clinical trials. The inquiry said the safety and regulation of Covid vaccines were not compromised, and that the programme showcased many of the best attributes of the UK's health and scientific systems.

To boost uptake, the NHS and government partnered with local community leaders, and pop-up clinics were run in community centres and faith settings. However, high levels of distrust in authority existed in certain communities, including ethnic minority groups and people living in deprived areas. Misinformation that spread online about vaccines during the pandemic damaged uptake of the Covid jab and has subsequently affected confidence in other childhood vaccines. The inquiry concluded that more must be done to rebuild trust in all vaccines.

In June 2021, the government announced that care workers in England had to be vaccinated to work in care homes, and within months ministers said they would extend the requirement to all health and care staff. The government later scrapped the broader mandate before it was introduced and revoked the care home requirement after evidence showed the vaccine's ability to stop infections was limited, with its major benefit being the protection of vaccinated individuals against serious illness. The inquiry suggested that vaccine mandates likely contributed to alienation and increased hesitancy.

UK researchers identified that the steroid dexamethasone was effective at reducing an immune system overreaction in Covid patients that led to fatal lung damage. The drug started being used in UK hospitals in June 2020 within hours of trial results being confirmed. By March 2021, dexamethasone is estimated to have saved 22,000 lives in the UK and one million lives worldwide.

While long-term health problems caused by Covid vaccines were rare, a small group of people experienced serious injury or death. More than 20,000 people have made Covid-related claims to the Vaccine Damage Payment Scheme, with about 1% resulting in one-off tax-free awards of £120,000. That payout has been capped at £120,000 since 2007, and the current system requires claimants to demonstrate at least 60% disability to receive payment. The report called for urgent reform of the scheme, stating it is not sufficiently supportive and that the payout needs to rise at least in line with inflation, with new levels based on the degree of injury suffered.