Adverse events of special interest (AESI) such as Bell’s palsy and narcolepsy often present to primary care settings rather than hospitals and COVID-19 vaccine pharmacovigilance using hospital data only will miss these cases. Primary care databases are a key source of data for pharmacoepidemiology and vaccine pharmacovigilance internationally because they provide individual level information on demographics combined with laboratory test results, and diagnostic codes (

The simultaneous development of so many vaccines for COVID-19 and their anticipated deployment in both high- and low-middle- income countries to meet the global need is unprecedented. If a true rare safety issue with one of these COVID-19 vaccine candidates exists, it is likely to only be detected post-introduction, when millions of people (including at risk subpopulations) will have been vaccinated.