Yes my comment about Germany was over the top but in my defence there appears to be an undercurrent on this board almost willing the U.K. to fail again simply so they can beat the government over the head with something else. The roll out of successful vaccines is too important for that.
The vaccines | vaxxed boosted unvaxxed? New poll
- Thread starter Badunk
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From an ethical standpoint where are we with this?
It seems the two schools of thought are either:
A) The UK: we don't know it doesn't work, so we might as well assume it does and inject.
B) Germany: we don't know that it works, so we want to wait for more information.
As far as I'm aware, nobody is doubting the safety of the vaccine in any age group (except from possibly very, very old people). In an ideal situation, I feel both regulatory bodies would want better data, but in what is demonstrably an emergency situation what is the justification for waiting to see? If it ultimately turns out that the protection it offers in 65+ patients is not great, then what's stopping from then immunising again with a vaccine that has been more successful? And if it does turn out that the AZ vaccine is pretty good in 65+ patients aren't we all better off for having vaccinated them now?
At the very least they could use it for healthcare workers, who are also a big priority. I don't think there exists a scenario where a goverment would just leave a working vaccine on the table.
In that case you have wasted time, logistics and vaccine doeses that could have been used to actually protect (younger) people, e.g. healthcare workers. One could argue that desperate times warrant certain risks, but bottom line to me looks like the UK is taking a gamble, while the EU plays it safe(r).
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At this point, even if it is only even 40% effective in over 65s, surely that added level of immunity to reduce severe disease is worth it?
Also, is it known/common for a vaccine to work within a certain age group, and then fall off a cliff for another age group?
What @do.ob said. Plus the ethics would be very different if this was the only vaccine so elderly people had the choice between this vaccine or no vaccine. Thankfully we’re not in that scenario so can choose to use the range of vaccines in a way that we are most confident will get the best outcome. The rollout in the UK so far has been one size fits all but the more prudent/scientific approach might be different vaccines for different age groups. Likewise the dosing regime. The time interval between jabs should be tailored to the best available evidence from each vaccine.
Obviously you’d want predictable supplies for an evidence driven approach like this. Which is one of the reasons why AZ’s dramatic reduction has thrown them into a tizzy.
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Better than nothing but not better than an alternative vaccine which has demonstrated better efficacy in the same cohort.
And I know I seem to be shitting on the UK government a lot in this thread. To be fair they’ve done very well at securing so much supplies and injecting so many people already. So if the gamble they’re taking (by assuming all vaccines are equivalent) pays off then they’ve played an absolute blinder.
But to some extent we are, aren't we? I don't think either the UK or the EU have enough Pfizer/Moderna stock to be able to roll that out at maximum pace to the most vulnerable groups.
I guess you could make the argument that you need to get maximum value out of each shot in those circumstances, but when the mortality rate amongst over 65s is so many orders of magnitude higher than <65 I guess I'm wondering if the gamble is worthwhile. If you're not injecting them with AZ, then in some cases you'll be waiting on more supply of Pfizer/Moderna anyway, right?
Not necessarily. As I said, the UK is rolling out the Pfizer and AZ vaccine simultaneously. With no preference based on age. They could have chosen to restrict the Pfizer vaccine for older people and AZ to younger people while still vaccinating the same numbers.
The EU is different in that nobody has been given AZ yet. They might be able to choose to give it only to U65s when available. That will depend on supplies at the time. I honestly don’t know how the numbers stack up. If they’re desperately short they could maybe push out the max age for AZ jabs to 70 or 75. They will (hopefully) have options. If not then yeah, they have tough decisions ahead.
I think we're talking slightly at cross purposes though, aren't we?
I fully understand that logic and that argument, and in many respects think it makes more sense than our approach. If you can be that granular with the logistics, and I guess the Pfizer temp reqs might make that hard, it sounds sensible.
But, if, the limiting factor is, as we're told it is, the manufacture of the vaccines themselves then it stands to reason you're going to use up the most of the one you are using the most of which, given the demographics of the priority groups getting vaccinated, would be Pfizer if it was reserved for 65+ – assuming a 50/50 split, I think in reality we may have more AZ but I don't know where I heard that.
At that point surely you're left with a choice which is sub-optimal of either rolling AZ out to groups we don't have much data for or leaving 65+ unvaccinated whilst vaccinating younger people at which point, does the reality of the pot luck approach really look substantially different? If you're over 65 your chances of getting AZ or Pfizer just become a question of when you get your letter, rather than what they happen to have on the day when you turn up.
Either way, it seems stupid to use Pfizer on people <65 when the date from AZ is more robust there, and maybe I'm too caught up in the hypothetical of running out of Pfizer when we don't really know what our limits are.
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I don’t think we’re talking at cross purposes. I don’t even think we’re disagreeing! It’s just that neither of us know if the short of hard choices you describe need to be made. I’m possibly being a bit optimistic. Who knows?!?
Oh, I don't think we are either; I think my posts on this forum probably leave it clear I'm not looking for excuses for the UK's approach at any rate! I'm just interested in how two groups of people, both of whom know far more than me, can come to these different conclusions and what the ramifications are.
I think this has been asked before, so apologies, but is there any risk that if AZ doesn't work in elderly people it could make a Pfizer vaccine less effective?
Good question and the answer is nobody knows. My guess would be that it’s unlikely. In theory any vaccine can act as a booster for any other vaccine. Their are studies underway to confirm this. Medicine can surprise you sometimes. Stuff which seems obvious can turn out very different when you study it. Which is why the most sensible approach is to not make any treatment decision until you have hard evidence to support it. But that doesn’t mean that a common sense prediction won’t come true most of the time.
Interesting article on vaccine development and the elderly
https://theconversation.com/why-vac...elderly-and-what-it-means-for-covid-19-141971
https://theconversation.com/why-vac...elderly-and-what-it-means-for-covid-19-141971
https://www.google.co.uk/amp/s/amp.ft.com/content/1978fc50-99f0-4aab-88cb-15dd1ba14c95
Another one on the way. Johnson and Johnson next week too hopefully.
Another one on the way. Johnson and Johnson next week too hopefully.
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Crucially:
Preliminary analysis indicates that the UK variant strain that was increasingly prevalent was detected in over 50% of the PCR-confirmed symptomatic cases (32 UK variant, 24 non-variant, 6 unknown). Based on PCR performed on strains from 56 of the 62 cases, efficacy by strain was calculated to be 95.6% against the original COVID-19 strain and 85.6% against the UK variant strain [post hoc].
https://ir.novavax.com/news-release...-vaccine-demonstrates-893-efficacy-uk-phase-3
Also some early data on the SA strain, where in a Phase 2B trial (half dose dose 1 + full dose dose 2) it looks like it's got an efficacy of 50% + against the SA strain.
60% in a smaller South African trial too the cases of which were the South African variant. Not sure that’s completely awful news - it at least shows it still had some impact.
27% of subjects over 65. That’s more like it.
Good news! Hopefully by the backend of this year we’ll have enough between the vaccines & effective treatments to bring this fecking virus under significant control.
It’s kind of awful news in that they allude to the fact that a 1/3 of the South African subjects had previous Covid infection but it didn’t protect them against the new strain. They’ve also been a bit sneaky claiming 60% efficacy. That’s only true if you exclude all HIV positive subjects, which wasn’t planned in the protocol. Otherwise the efficacy is <50% (95% CI 6% to 72%)
This variant sounds like a real cnut. Way more bothersome than the UK variant. Glad to hear they’re already working on a specific tweak to the vaccine.
The SA data is also significant because they have a large number of seropositive patients (evidence of prior infection with covid in initial blood test) - and first analysis suggests the vaccine is more protective against the new SA strain than past infection with the original covid variant. Early results of course based on small numbers (not enough in themselves to be statistically solid) but significant.
Unsurprisingly Novavax say they're in the process of tweaking the vaccine for the new variants now,
Were you in the Novavax trial or J&J? Can’t remember. Sounds like you chose a good one, if so!
Just want to say thanks to @711 and @Pogue Mahone for the helpful and kind comments. It's made me feel a bit more hopeful. It's very difficult to see healthy people casually turning down the vaccine when people in my position want it but have real concerns!
To be fair, Novavax always said the SA HIV+ group would be reported separately.
Novavax trial.
No idea what I actually got though, and won't find out until the NHS offer me an appointment for a real vaccine. Anyone know what efficacy saline solution + placebo effect has?
Ah. I didn’t realise. The results are more reliable so. Good news.
Do they need evidence of your appointment to unblind? Or could you massage the truth a wee bit?!Novavax trial.
No idea what I actually got though, and won't find out until the NHS offer me an appointment for a real vaccine. Anyone know what efficacy saline solution + placebo effect has?
How long is the approval loop for a tweaked vaccine? Does it all start from scratch again?
No worries. It must be an anxious time for you. Obviously go with whatever your own doc advises but my instinct, if I was you, would be to risk it. If only using a lightning never strikes twice sort of logic. You had an incredibly rare side effect when your immune system was triggered by a specific antigen. This is a completely different antigen so you would be extremely unlucky to go through the same experience again.
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Not at all. It’s massively abbreviated. Can be done in a few weeks. Which is why they can cover multiple new influenza strains every year.
Yeah I did read about the reinfection rates. It does seem worrying - definitely likely they’ll be a third booster this autumn. The key stat is hospitalisations I guess - was anyone symptomatic hospitalised after having the vaccine - no in this case but only one was in the placebo so too small a sample. The J&J data is going to be fascinating as it has been rumoured it’s very good - that trial was in SA I believe so it will contain SA variant cases.
Same as AZ if you're over 65.Anyone know what efficacy saline solution + placebo effect has?
Great, sounds like they should be all be doing it then (AZ, Moderna and Pfizer). Though I think Moderna and Pfizer seem confident that their original vaccines are still effective agains the SA strain.
Haven't heard anything about the AZ vaccine on this front
Just read there will be data next week from AZ apparently. Trial taking place in South Africa.
Yeah, good to see the only severe case was in the placebo group. I must look up their definition of moderate and severe. Possible that moderate cases included hospitalised patients. They don’t give any information on breakdown of moderate cases. Will keep an eye out for that when preprint comes out.
Good news. Another vaccine with easy storage requirements. Well done on taking part.
and if you're 64?Same as AZ if you're over 65.
The over 75s and NHS staff are apparently just being unblinded if they call up now (on an "it's probably true"), others are/were being cross-checked apparently. So, a certain amount of plausibility assessment seems to be evolving.
Rumours abound now on where the UK trial goes next. Suggestions that all UK subjects may be unblinded after their 3 month follow-up session or offered another round of jabs (placebo if you had the vaccine or vice versa). I guess a new anti-mutations formulation might even appear in the story (for the placebo arm?) Broadly speaking, I'm hearing the Novavax trial team want to keep it running - and are asking everyone to keep showing up for appointments, blinded or not, vaccinated group or placebo, even if they get a different company's vaccine at some point.
Very good news on Novavax, although the decreased efficacy against the SA strain is worrying.
I could see the vaccines being made multivalent and continuosly updated to increase efficacy against new variants for the next 5-10 years. Then eventually as disease burden around the world falls the rate at which new variants crop up will decrease and vaccines might not have to be updated as often.
I could see the vaccines being made multivalent and continuosly updated to increase efficacy against new variants for the next 5-10 years. Then eventually as disease burden around the world falls the rate at which new variants crop up will decrease and vaccines might not have to be updated as often.
The figures I saw were 95% original virus, 85% UK strain and 60% South African strain. Novavax are already talking of tweaking the vaccine specifically for the SA variant.
And how is efficacy assessed? Does that mean that 40% got no advantage at all e.g. no decreased symptoms?
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It’ll be nice to get the readout of the Oxford vaccine from the US trial. The results published till now have been such a shitshow.
Is the SA variant a bit of a one off or is it something that is likely to happen more?