The vaccines | vaxxed boosted unvaxxed? New poll

[Wibble]

What would happen if the COVID death rate was double (like smallpox). What if it was like the plague, or Ebola? How would the speed to vaccine differ (I know Ebola is a virus) How would the global response differ? Just a hypothetical.

The (or one of) nightmare scenario isn't Ebola as it is hard to catch and very fatal restricting the spread. A highly infectious novel virus that has a long incubation period, can freely infect other people for a long time before symptoms reveal themselves, but also with even more severe symptoms than SARS-CoV-2 including death, could be truly devastating. The odds of that are small but sadly nowhere near zero.

What this should have taught us is that we simply aren't prepared for a pandemic. Massive funds and planning need to be put into pandemic response planning once we start getting back to normal if not sooner.

 

[Jippy]

Quick question. How hard is it to combine different vaccines into a single jab, eg MMR or tetanus/diptheria/polio? Presuming they'll look to combine the Covid and flu jabs down the line?

Also, presumably some can't be combined? Maybe due to how your immune system reacts or the dose size needed?

 

[Wibble]

I am likely in total fantasy land but I wonder if mRNA vaccines (or another vaccine technology) could be developed that is almost modular and could thus shorten the production and manufacture time for a vaccine. Find a new novel pandemic capable virus, quickly shut borders, slot the viral DNA into the base module, do end to end Phase 1-3 trials in 2/3 months while simultaneously manufacturing on the assumption of success and possibly get back to normal in 6 months.

Pie in the sky I know as countries are too selfish to cooperate even in the very unlikely event that something as complex as vaccine development could be reduced to a glorified lego set.

 

[Wibble]

Quick question. How hard is it to combine different vaccines into a single jab, eg MMR or tetanus/diptheria/polio? Presuming they'll look to combine the Covid and flu jabs down the line?

Also, presumably some can't be combined? Maybe due to how your immune system reacts or the dose size needed?

Many vaccines are combines without a reduction in efficacy but I assume there are limitations and challenges. If we got a much greater uptake of influenza vaccination that would be a huge win. Australia was suffering 400 fewer deaths per month in winter due to covid measures and a huge increase in demand for flu shots.

@Pogue Mahone @Tony Babangida

 

[Tony Babangida]

I am likely in total fantasy land but I wonder if mRNA vaccines (or another vaccine technology) could be developed that is almost modular and could thus shorten the production and manufacture time for a vaccine. Find a new novel pandemic capable virus, quickly shut borders, slot the viral DNA into the base module, do end to end Phase 1-3 trials in 2/3 months while simultaneously manufacturing on the assumption of success and possibly get back to normal in 6 months.

Pie in the sky I know as countries are too selfish to cooperate even in the very unlikely event that something as complex as vaccine development could be reduced to a glorified lego set.

Definitely not fantasy land, although 6 months is very fast! These vaccine “platforms” already exist (not just for mRNA) with the purpose of accelerating vaccine development. That’s part of the reason these vaccines were so fast, but it is dependent on knowing what will make a good immunogen (spike in this case). You can’t know this unless you have previously done some basic science on the virus or virus family. Luckily SARS-1 and MERS scared us enough to do this work for coronaviruses.

mRNA vaccines are really exciting if they work. The speed they can be made is exciting but also I posted something a while ago about the potential for their use in personalised cancer treatment.

 

[Tony Babangida]

Quick question. How hard is it to combine different vaccines into a single jab, eg MMR or tetanus/diptheria/polio? Presuming they'll look to combine the Covid and flu jabs down the line?

Also, presumably some can't be combined? Maybe due to how your immune system reacts or the dose size needed?

That is a great question. I don’t know the answer, but you should write to TWiV and I guarantee your letter will get read out and answered at some point! https://www.microbe.tv/twiv/

 

[Wibble]

Definitely not fantasy land, although 6 months is very fast! These vaccine “platforms” already exist (not just for mRNA) with the purpose of accelerating vaccine development. That’s part of the reason these vaccines were so fast, but it is dependent on knowing what will make a good immunogen (spike in this case). You can’t know this unless you have previously done some basic science on the virus or virus family. Luckily SARS-1 and MERS scared us enough to do this work for coronaviruses.

mRNA vaccines are really exciting if they work. The speed they can be made is exciting but also I posted something a while ago about the potential for their use in personalised cancer treatment.

Thanks and very interesting. And of course my timeframe was plucked out of thin air.

 

[Wibble]

That is a great question. I don’t know the answer, but you should write to TWiV and I guarantee your letter will get read out and answered at some point! https://www.microbe.tv/twiv/

Do it @Jippy

 

[Brwned]

You can be almost certain that the risk of getting an unidentified long term serious side effect is much less than the risk of getting a comprably bad or worse serious side effect of catch covid.

If everyone had the same risk from covid and all side effects were considered equal then that might be the case. The thing is, we know both are not true.

Right now, kids may not get vaccinated. They aren't going to be getting this vaccine in the UK, in any case. The government have also already signalled that they might not push to vaccinate all adults. If the vaccine is effective enough at limiting transmission just by vaccinating the high priority groups, then they might just leave it there. That's because the risk profile from getting covid is incredibly different.

The evidence we have now is that if you are young you are more likely to end up in hospital with covid. How likely is it? For a white 18-49 year old, the US hospitalisation rate is 43 per 100,000. As those 30-49 are 3x more likely to get hospitalised, the hospitalisation rate for white 18--29 year olds is probably below 20 per 100,000. The hospitalisation rate for flu is 58 per 100,000 for 18-49 year olds. A lot of those don't get vaccinated for the flu, they accept the personal risks as they are.

For children the differences are more clear. Kids aged 0-4 are more than twice as likely as those 18-49 to end up hospitalised with the flu, at a rate of 129 per 100,000, but with covid they are at least 4x less likely, with a hospitalisation rate more than 10x lower than for the flu. Which is why they might not vaccinated at all for covid, but many do get vaccinated for fly. And so the same logic applies to different age groups. If we are not going for total vaccination, which some countries have already signalled and it remains a debated subject, then there is a point where some experts think the risk/reward is not so clear. There might well be a cut-off point.

Then you need to assess the impact of those effects. I don't want to end up hospitalised with flu or covid so I get the flu jab routinely, but for most people with that risk profile, it's not the end of the world. It depends on what happens in the hospital and what happens after. If they're just monitored with some relatively minor breathing issues and a fever then that is something many people would have no problem with. If that's put up side by side with "unknown long-term effects of fast-tracked vaccine" then many people would choose the former.

The best proxy we have for severity of cases is the ICU rate, and the CDC estimated that 0.5% of 18-29 year olds with covid end up in ICU. So it could be that your chance of ending up in ICU is less than 3 in 100,000 for covid. Or of the 9m people in that age group in the UK, 270 of them will end up in ICU. Many people would assess that as a very low risk that they are comfortable with, while many people don't feel comfortable assessing the long-term risk of the vaccine. If the worst concern about getting the vaccine was a short trip to the hospital then you wouldn't see the same level of hesitancy. It's worries about life-long complications that animates much of that discussion.

There is a risk that this vaccine will have unexpected outcomes due to it being created with a new technology, due to it having more stringent and challenging distribution protocols with an immense logistical burden, and due to it being tested over a much shorter period of time. You know the risk is small, but you do not know precisely how small, and that precision matters because the covid risk to young people is also very small. I am comfortable trusting my doctor to make that judgment based on my own risk profile, and in the interests of wider societal protection. That isn't the only legitimate position to take. It would be silly for a 25 year old to be equally as motivated as a 55 year old to get the vaccination because the risks of covid are wildly different, while the risks of the vaccine are probably the same. The risk/reward profile is different, no matter how much you want to blur the lines.

You can keep describing things as black and white but you shouldn't be surprised that other people can see these things have at least a tint of grey.

The problem I have with people worrying about the long-term effects of the vaccine is not that they believe there is a possibility they exist. I think that too. It's the comparison between the long-term risk of the vaccine and the long-term risk of covid that doesn't quite add up. They're both non-zero. We already know a lot of doctors are very concerned about what people will be living with post-covid, but we don't know how bad it will be, how long it will last, or how many people it effects. We just know it exists. Why are people assuming that risk is lower than the risk of long-term side effects of the vaccine?

 

[Wibble]

If everyone had the same risk from covid and all side effects were considered equal then that might be the case. The thing is, we know both are not true.

Right now, kids may not get vaccinated. They aren't going to be getting this vaccine in the UK, in any case. The government have also already signalled that they might not push to vaccinate all adults. If the vaccine is effective enough at limiting transmission just by vaccinating the high priority groups, then they might just leave it there. That's because the risk profile from getting covid is incredibly different.

The evidence we have now is that if you are young you are more likely to end up in hospital with covid. How likely is it? For a white 18-49 year old, the US hospitalisation rate is 43 per 100,000. As those 30-49 are 3x more likely to get hospitalised, the hospitalisation rate for white 18--29 year olds is probably below 20 per 100,000. The hospitalisation rate for flu is 58 per 100,000 for 18-49 year olds. A lot of those don't get vaccinated for the flu, they accept the personal risks as they are.

For children the differences are more clear. Kids aged 0-4 are more than twice as likely as those 18-49 to end up hospitalised with the flu, at a rate of 129 per 100,000, but with covid they are at least 4x less likely, with a hospitalisation rate more than 10x lower than for the flu. Which is why they might not vaccinated at all for covid, but many do get vaccinated for fly. And so the same logic applies to different age groups. If we are not going for total vaccination, which some countries have already signalled and it remains a debated subject, then there is a point where some experts think the risk/reward is not so clear. There might well be a cut-off point.

The risk of adverse covid effects for the population is already much higher than the phase 3 trials figures for a vaccine and long term side effects will virtually certainly be incredibly rare - far far rarer than adverse effects for even young people with covid. In any case we need a society wide response not a cherry picking response by age/race. Getting to HIT or as close as possible as soon as possible is how we head back towards normal and start to repair the economy.

Then you need to assess the impact of those effects. I don't want to end up hospitalised with flu or covid so I get the flu jab routinely, but for most people with that risk profile, it's not the end of the world. It depends on what happens in the hospital and what happens after. If they're just monitored with some relatively minor breathing issues and a fever then that is something many people would have no problem with. If that's put up side by side with "unknown long-term effects of fast-tracked vaccine" then many people would choose the former.

That doesn't work because the consequences of getting flu are so much less serious than getting covid. The flu vaccine is also the one that most often (but still incredibly rarely) has side effects revealed by long term post approval assesment and it also gets reconstituted all the time without going through trials again, yet we all happily take it.

The best proxy we have for severity of cases is the ICU rate, and the CDC estimated that 0.5% of 18-29 year olds with covid end up in ICU. So it could be that your chance of ending up in ICU is less than 3 in 100,000 for covid. Or of the 9m people in that age group in the UK, 270 of them will end up in ICU. Many people would assess that as a very low risk that they are comfortable with, while many people don't feel comfortable assessing the long-term risk of the vaccine. If the worst concern about getting the vaccine was a short trip to the hospital then you wouldn't see the same level of hesitancy. It's worries about life-long complications that animates much of that discussion.

Hesitancy has been largely bred by incompetent government and terrible messaging. Any concern about a serious long term side effect of the vaccine should have been address as far far less of a risk than us not getting society vaccinated. Vaccinations shouldn't be an individual decision as it effects everyone but that is a different if associated discussion.

There is a risk that this vaccine will have unexpected outcomes due to it being created with a new technology, due to it having more stringent and challenging distribution protocols with an immense logistical burden, and due to it being tested over a much shorter period of time. You know the risk is small, but you do not know precisely how small, and that precision matters because the covid risk to young people is also very small. I am comfortable trusting my doctor to make that judgment based on my own risk profile, and in the interests of wider societal protection. That isn't the only legitimate position to take. It would be silly for a 25 year old to be equally as motivated as a 55 year old to get the vaccination because the risks of covid are wildly different, while the risks of the vaccine are probably the same. The risk/reward profile is different, no matter how much you want to blur the lines.

But we aren't talking about a few individuals with health issues not taking a vaccine or a particular vaccine, in the case of an mRNA vaccine if they have autoimmune issues. We are talking about individuals wanting others to take the risk for them under the (mistaken) impression they are reducing their individual risk. We really are in this together in this sense and mass vaccination is the main (but not sole) measure that will get us out.

You can keep describing things as black and white but you shouldn't be surprised that other people can see these things have at least a tint of grey.

Not black and white but we need a consistent informed message that incompetents like BoJo et al. have totally failed to deliver. That message should be that to get back to normal we need to mass vaccinate, the comparative risks should be clearly communicated and the whole operation should be phrased as our civic duty - part of the social contract. Probably then time to evoke the wartime spirit thing. Instead we have a vacuum where uncertainty rules. I wonder if this is why such discussions are seemingly much rarer elsewhere. Here in Australia only about 5% say they won't voluntarily take a vaccine and that when we have zero cases of community transmission at the moment. I hear Taiwan who have had 200 days free from covid also has widespread acceptance of covid vaccination.

The problem I have with people worrying about the long-term effects of the vaccine is not that they believe there is a possibility they exist. I think that too. It's the comparison between the long-term risk of the vaccine and the long-term risk of covid that doesn't quite add up. They're both non-zero. We already know a lot of doctors are very concerned about what people will be living with post-covid, but we don't know how bad it will be, how long it will last, or how many people it effects. We just know it exists.

We know that long covid is already a very serious and real danger and very serious symptoms and even death are to some degree quantified and only going to become a larger problem if we let the virus run. To get away from that a vaccine (in fact vaccines) that so far have no serious side effects or deaths, that will seemingly soon pass phase 3 trials, must be widely administered as the world can't afford for this shit show to continue. And that of course leads to the fact we are ignoring the indirect health benefits to mental and physical health (and the economy) that getting back to normal will allow.

Why are people assuming that risk is lower than the risk of long-term side effects of the vaccine?

Because it is almost by definition. And if it isn't we will know very quickly. If something is revealed by long term post Phase 3 monitoring it almost certainly won't be because it took a long time to manifest but rather that it occurs within 2 months of vaccine administration but is so rare that to become apparent it needs absolutely huge data sets.

The bottom line really is that we must mass vaccine ASAP across the whole population/world or all this continues.

 

[Brwned]

Wibble you're still talking in absolutes, and many of those absolutes are only true in the context you want to portray them, not in all scenarios.

Here's two examples:

That doesn't work because the consequences of getting flu are so much less serious than getting covid. The flu vaccine is also the one that most often (but still incredibly rarely) has side effects revealed by long term post approval assesment and it also gets reconstituted all the time without going through trials again, yet we all happily take it.

We don't. Maybe people like you all happily take it, all the time, but most of the population don't. On average around a third of 18-49 year olds get the flu vaccine every year. These are the very same people that are hesitant about taking the vaccine now. When it is purely an individual risk assessment, the flu is more dangerous to many of them, and they accept that risk. And for a lot of the same reasons. The question is whether they will take what they perceive to be an unnecessary individual risk if it can be demonstrated to them that it has broad societal benefits. I think they will. I don't think people taking your approach will help, because you're talking down to them, telling them they're wrong, and refusing to even listen to what they're saying. That will make some of them stop listening to what mass vaccination advocates are saying, in return.

The bottom line really is that we must mass vaccine ASAP across the whole population/world or all this continues.

That's one strategy. It is not yet the scientific consensus because unlike you, they're willing to accept they do not know the impact this vaccine will have on the chain of transmission, and therefore do not know the incremental value of improving coverage among groups that are at low risk of covid. If we get slightly above flu vaccination rates it may be enough to get things back to normal. It is entirely possible that we don't vaccinate kids at all. It is somewhat possible that healthy 18-29 year olds are given the option of the vaccine for a price, or other less aggressive vaccination strategies are employed, because it is not deemed essential. Those questions are still being debated now and can't be authoritatively answered without more data.

 

[Wibble]

Wibble you're still talking in absolutes, and many of those absolutes are only true in the context you want to portray them, not in all scenarios.

Here's two examples:



We don't. Maybe people like you all happily take it, all the time, but most of the population don't. On average around a third of 18-49 year olds don't get the flu vaccine every year. These are the very same people that are hesitant about taking the vaccine now. When it is purely an individual risk assessment, the flu is more dangerous to many of them, and they accept that risk. And for a lot of the same reasons. The question is whether they will take what they perceive to be an unnecessary individual risk if it can be demonstrated to them that it has broad societal benefits. I think they will. I don't think people taking your approach will help, because you're talking down to them, telling them they're wrong, and refusing to even listen to what they're saying. That will make some of them stop listening to what mass vaccination advocates are saying, in return.

I'd like to think trying to persuade them to take it would work but with the donkeys we elect to rule us who can't get an accurate message straight for 2 minutes and the fact that the benefits of vaccines have been well publicised for a hell of a long time I somehow doubt it. To me making all vaccines strongly encouraged by legislation is the way to go. No different from making seatbelt wearing compulsory as long as you don't hold people down and stick needles in them.

A nice start may be those who are fully vaccinated get a bump in social payments or if you do down the stick route then unvaccinate kids aren't allowed to enrol in school or daycare without vaccination or have to pay a NHS/Medicare levy at tax time. You already need vaccinations to travel to some places and lots of places demand vaccinations before enrolling you in e.g. most US Universities. And I'd do it for everything including annual flu shots, covid, genital warts/cervical cancer. etc etc.

That's one strategy. It is not yet the scientific consensus because unlike you, they're willing to accept they do not know the impact this vaccine will have on the chain of transmission, and therefore do not know the incremental value of improving coverage among groups that are at low risk of covid. If we get slightly above flu vaccination rates it may be enough to get things back to normal. It is entirely possible that we don't vaccinate kids at all. It is somewhat possible that healthy 18-29 year olds are given the option of the vaccine for a price, or other less aggressive vaccination strategies are employed, because it is not deemed essential. Those questions are still being debated now and can't be authoritatively answered without more data.

It is the scientific advice at this end of the world. Australia is aiming for 95% although I doubt they will get there but 85% will hopefully be enough to reach HIT. Kids under 9 might be an exception but I'd be all for vaccinating everyone - 100% if possible (I know ....).

All kids can still carry and spread covid so I suspect they will end up being vaccinated in many countries - probably last.

It will be interesting to see how we pull out of this as we could end up with a pacific/Asia block who eradicate or at least get close to HIT with very low numbers and form a travel bubble, with the US and Europe vaguely controlled. That could really change world politics if travel barriers remain in the medium or long term.

 

[jojojo]

Quick question. How hard is it to combine different vaccines into a single jab, eg MMR or tetanus/diptheria/polio? Presuming they'll look to combine the Covid and flu jabs down the line?

Also, presumably some can't be combined? Maybe due to how your immune system reacts or the dose size needed?

The Phase 3 trial for Novavax includes a category for participants getting the flu and covid jab in the same session (but not in the same jab). That would avoid the current, wait for a month after the flu jab, recommendation if it works.

The normal flu jab advice is that you should stay near medical support for at least 15 minutes afterwards and it's the same with the first covid jabs (looking for anaphylactic shock I guess). I would think it will be a while (if ever) before we see them combined, and I doubt they'd combine it with one of these jabs that need super low temperature storage etc. But being able to give them in the same session would obviously be a big logistical advantage of they can do it.

 

[Tibs]

Any ideas asto when the scientific data will be released?

 

[Brwned]

That leads me to believe they are desperate to get it out to the public but why? It kills roughly 0.1% of people which is far less than many diseases we have no cures for. We take radical actions to avoid the spread of this disease with a death rate far lower than any previous pandemic. What am I missing? The pieces aren't adding up.

It's the rate it spreads multiplied by the danger it poses to each individual that determines the seriousness of the threat. Infectivity and virulence are the two key measures. There is no comparable virus in the last century that spreads as quickly and easily and that causes such serious consequences.

But you don't need to think about it in such abstract terms, or try and make sense of small percentages. Just look at the reality across Europe.

A week ago, half of French intensive care beds were occupied. Now, 70 percent are occupied, with more than 3,500 coronavirus patients. When President Emmanuel Macron announced a second national lockdown last week — something he and other European leaders had sought mightily to avoid — he warned that “at this stage, we know that whatever we do, nearly 9,000 patients will be in intensive care by mid-November, which is almost the entirety of French capacities.”]

“In summer, at the end of June, beginning of July, we had 300 new infections on most days,” Merkel said at the end of September. “And now we have on most days 2,400 infections. And that means that in July, August, September, in three months, the infection rate has doubled three times.”

If the cases kept increasing at the same rate, she warned, they would be up to 19,200 a day by the end of December, a number that at the time seemed fantastical and chilling. In the end, it took only a month: Germany reported a record 19,059 cases Saturday, a 173 percent rise over the past two weeks.

The full impact of those record infections will be felt in intensive care wards in two weeks, Merkel said Monday, as Germany began its new lockdown.

The numbers are leading “with increasing speed to an acute emergency situation in our hospitals,” she said at a news conference. “We can’t allow this rapid spread of the virus to continue to overwhelm our health system."

There were 2,061 coronavirus cases being treated in German intensive care beds Sunday, a doubling from 10 days earlier and a more than fivefold increase since Oct. 1. While the country still has more than 20,000 available ICU beds, including a new emergency reserve, it will max them out by early December at the current pace, according to a simulator created by researchers at the University of Saarland.

“We are alarmed,” said Joachim Odenbach, a spokesman for the German Hospital Association. There is a shortage of 4,700 intensive care staff members, he said.

In Britain, coronavirus-related hospital admissions have doubled in two weeks, and top public health advisers have warned that hospitals could be overwhelmed within six weeks, forcing a reluctant Prime Minister Boris Johnson to announce a lockdown Saturday.

Without a lockdown, “doctors and nurses could be forced to choose which patients to treat, who would live and who would die,” Johnson told the House of Commons on Monday. “The virus is doubling faster than we can conceivably add capacity. Even if we double capacity, the gain would be consumed in a single doubling of the virus.”

In Belgium and the Netherlands, staffing shortages are leading nursing homes and hospitals to ask doctors and nurses to keep working if they have tested positive for the virus but are asymptomatic, because so many other medical workers are sick or quarantining.

“Employees who are infected with the coronavirus and have no or very mild complaints are allowed to continue working at Argos Care Group in an intensive-care corona department if they wish,” wrote one Dutch nursing home chain Thursday. Some Dutch hospitals are full enough that the country has started transferring a handful of patients by helicopter to Germany. Coronavirus patients in Dutch intensive care beds have doubled in three weeks.

“We will support by taking patients into our ICU capacities as long as we can,” German Health Minister Jens Spahn said Friday, declaring that his country was also preparing to take in Belgian and Czech patients.

The situation in Central Europe is especially dire. The medical systems of Poland, the Czech Republic and some of their neighbors have fewer resources than do the richer countries to the west, and leaders did not use the relative calm of the spring and summer to build capacity for the fall. Polish hospital cases have doubled in two weeks, and authorities are just now building a 1,200-bed field hospital in the National Stadium in Warsaw.

Czech authorities are frightened — a sharp change from the spring, when the country was among the least touched in Europe. Prime Minister Andrej Babis predicted that the health system would collapse between Nov. 7 and 11 if he did not impose the lockdown he announced Oct. 21. The Texas and Nebraska National Guards are flying people in to bolster Czech medical staffs. Hospitals around the country are seeking volunteers.

I can understand how you might have thought in the summer that what happened in the first wave was just a lack of preparedness, when things seemed fine on the ground and they were just predictions of what might come if we don't stick to the plan. But we're living in it right now. Belgium's hospitals are almost overwhelmed, they're currently staffed with infected workers, and they are flying people across borders just to cope. Car crash victims are being turned away by all local hospitals because they do not have the beds or the doctors. The national guard is being flown into central Europe. Emergency hospitals are being built out of sports stadiums in Russia and taking in patients from other overwhelmed local hospitals. All this while we're still living in bizarre social distancing bubbles, with intermittent nationwide quarantines. How can you think any of this is normal?

Elements of hospital capacity can be elastic, especially for patients who do not need the most intensive care but simply need someone to keep an eye on them. Nurses can be spread more thinly. Doctors can do fewer rounds. Patients can be discharged earlier. But intensive care units need heavy staffing, and access to them can be a matter of life and death for those who are ailing.

Managing the coronavirus has proved particularly difficult because patients often need long hospital stays and because doctors and nurses need to take so many time-consuming precautions that they can see fewer patients any given hour, said Marc Noppen, chief executive of University Hospital Brussels.

His hospital is not yet at capacity, but it could be within weeks, he said. Hospital leaders have been reviewing an ethics charter they drew up in the spring “in case you have to make a choice, in case you have only one ventilator left and two patients. Who gets it?” Noppen said. “We have to hope for the best and prepare for the worst.”

The risks were already visible midsummer, Noppen said: On July 22, a day when Belgium reported 145 new cases, he circulated a model that predicted that the country’s hospitals could be saturated around Nov. 6 if on the same trajectory.

On Saturday, the country reported 23,921 new cases, a record. And, as predicted in July, hospitals could be saturated by Nov. 6.

 

[jojojo]

Any ideas asto when the scientific data will be released?

Before the end of the month according to Pfizer. More data collection to do and then the analysis phase, followed (they expect) by a formal request for an emergency use approval in the US.

The provisional stuff released at the weekend is from the review team, rather than the actual research team. Apparently it was the review stage needed to get permission for the researchers to actually see the unblinded data on the covid cases. Up until that review they weren't allowed to know who was/wasn't in the placebo group.

 

[11101]

So far the risk of a serious known side effect of a vaccine is zero. Even if it were 1 in 43000 that compares to 1 in 5 people who catch covid who have serious symptoms that require medical intervention and up to 15% need ICU treatment of some sort and 5% require ventilation. The vast majority of these 15-20% then suffer serious long term, possibly permanent, symptoms. So not taking the vaccine is at least 8600 times riskier than not taking it.

Even if you decide you only want to consider young people the 50-85 age groups are only 4 to 13% more likely to be hospitalised, so even if that is an average of 10% then young people are still more than 800 times more at risk of a serious health outcome from catching covid than taking the virus.

If a very rare serious side effect is revealed by post approval monitoring that is highly unlikely to significantly move the huge gap in comparative risk.

That's just not a true statement. The risk is currently less than 1 in 43,500. You could insert a confidence interval to give you an estimated figure, but it's not zero, there is no such thing. (A fairly standard upper limit for a zero incidence would be 3/n, which would give an estimated maximum risk of 3/43500)

If you are assessing the risk of vaccine vs no vaccine to a population of 1 million people, you have to consider the probability of them being exposed to the virus/vaccine AND what happens when they are. It is not just the probability of what happens when they have it. If everybody is getting vaccinated the probability of being exposed to the vaccine is 1, but the probability of being exposed to the virus it is a lot lower. That is what skews the figures away from what you have posted.

If we could vaccinate the whole world today, in one day, for younger people the total risk of the virus is lower than the current understood risk of the vaccine. For older people, it is not. We can't vaccinate everybody in one go, so we start with those where the risk balance is in favour and the numbers will change for the others as we move down the list.

If we got to a million doses and found out the risk of death is 1 in 43501, you can guarantee the whole population will not be given this.

 

[Jippy]

The Phase 3 trial for Novavax includes a category for participants getting the flu and covid jab in the same session (but not in the same jab). That would avoid the current, wait for a month after the flu jab, recommendation if it works.

The normal flu jab advice is that you should stay near medical support for at least 15 minutes afterwards and it's the same with the first covid jabs (looking for anaphylactic shock I guess). I would think it will be a while (if ever) before we see them combined, and I doubt they'd combine it with one of these jabs that need super low temperature storage etc. But being able to give them in the same session would obviously be a big logistical advantage of they can do it.

Thanks Jo. I hadn't seen the month apart guidance. They certainly weren't following the 15 minute resting period protocol on the flu jab at the clinic I went to last month- it was like a conveyor belt there.
Makes sense about the low temperature issue, I wasn't sure how unusual that is and whether there is a likelihood they find an easier to handle vaccine.

That is a great question. I don’t know the answer, but you should write to TWiV and I guarantee your letter will get read out and answered at some point! https://www.microbe.tv/twiv/

Heh, I'll try and slide a subtle Caf reference into my questions, cheers!

 

[Bestietom]

Looks like good news today but it's unlikely that the general public will be getting vaccinated on a large scale for a while yet. The elderly and those on the front line are likely to be at the head of the queue.

My question is, if and when it becomes available to you, are you going to take it?

Yes, I will.

 

[Bestietom]

The Phase 3 trial for Novavax includes a category for participants getting the flu and covid jab in the same session (but not in the same jab). That would avoid the current, wait for a month after the flu jab, recommendation if it works.

The normal flu jab advice is that you should stay near medical support for at least 15 minutes afterwards and it's the same with the first covid jabs (looking for anaphylactic shock I guess). I would think it will be a while (if ever) before we see them combined, and I doubt they'd combine it with one of these jabs that need super low temperature storage etc. But being able to give them in the same session would obviously be a big logistical advantage of they can do it.

Isn't the covid jab in two 6 monthly phases.

 

[Kaos]

I'm a little concerned with the reluctance of so many people to take it. I can respect the apprehensions for being early adopters, but the success on it does bank on compliant vaccinations to build up a working herd immunity. And from what I've seen of the data, there isn't too much to be concerned about yet. Granted the data is still young and you could argue for there being a lack of long-term testing, but I trust the global collaboration of scientists enough to vaccinate myself tomorrow.

I'm not a fan of the government making it mandatory (that will go down a treat), but perhaps people can incentivised to take it, e.g allowing them access to sporting/music events and exempt from social distancing obligations.

 

[hungrywing]

Isn't the covid jab in two 6 monthly phases.

Pfizer one is twenty-one days.

Jojojo was talking about people happening to want to get a flu shot around the same time.

 

[Classical Mechanic]

According to this the Pfizer vaccine comes with a lot of not insignificant issues.

https://www.telegraph.co.uk/news/20...ts-logistics-could-still-see-oxfords-vaccine/

 

[Bestietom]

Pfizer one is twenty-one days.

Jojojo was talking about people happening to want to get a flu shot around the same time.

Ok. Right.

 

[jojojo]

They certainly weren't following the 15 minute resting period protocol on the flu jab at the clinic I went to last month- it was like a conveyor belt there.

I don't think it's viewed as a rest period, more a "be aware" thing to caution you against just driving off - I spent mine shopping in the supermarket next door. Maybe they don't bother with the warning if you had the same jab without a reaction last year? For the covid vaccine they'll probably advise it for everyone.

 

[RoyH1]

I'm overwhelmed by the number of countries/companies that are developing their own vaccine. I suppose that the more 'varieties' the merrier, but I'm really hoping that it doesn't become a jungle to work out which vaccines are being more effective/have least side effects.

 

[Pogue Mahone]

According to this the Pfizer vaccine comes with a lot of not insignificant issues.

https://www.telegraph.co.uk/news/20...ts-logistics-could-still-see-oxfords-vaccine/

There’s a whiff of Torygraph nationalism off that piece. Tub-thumping for the British candidate. The issues they raise are fair but bird in the hand and all that.

Best case scenario is both vaccines getting approved. The more options the better.

 

[Dante]

I'm a little concerned with the reluctance of so many people to take it. I can respect the apprehensions for being early adopters, but the success on it does bank on compliant vaccinations to build up a working herd immunity. And from what I've seen of the data, there isn't too much to be concerned about yet. Granted the data is still young and you could argue for there being a lack of long-term testing, but I trust the global collaboration of scientists enough to vaccinate myself tomorrow.

I'm not a fan of the government making it mandatory (that will go down a treat), but perhaps people can incentivised to take it, e.g allowing them access to sporting/music events and exempt from social distancing obligations.

I'd definitely be up for it if they promised that.

Though it'd be funny for the first 6 months or so when it's only old people getting the jab. Gigs and nightclubs be full of geriatrics getting crunk.

 

[Bestietom]

I'd definitely be up for it if they promised that.

Though it'd be funny for the first 6 months or so when it's only old people getting the jab. Gigs and nightclubs be full of geriatrics getting crunk.

Wouldn't think so, most are gone past this now. You still young then.

 

[Compton22]

According to this the Pfizer vaccine comes with a lot of not insignificant issues.

https://www.telegraph.co.uk/news/20...ts-logistics-could-still-see-oxfords-vaccine/

I don't think the issues are something that developed countries can't handle. The problem is with less developed countries which do not have the sophisticated technologies in abundance. That is why it is good that other vaccines are at or near the same stage of development and the Pfizer results bode well for them.

 

[Jippy]

I don't think it's viewed as a rest period, more a "be aware" thing to caution you against just driving off - I spent mine shopping in the supermarket next door. Maybe they don't bother with the warning if you had the same jab without a reaction last year? For the covid vaccine they'll probably advise it for everyone.

Ah, ok. I spent mine walking with the wife to the restaurant we were going to. It was my second one, but her first and it was absolutely fine. I guess it's the 'don't operate heavy machinery' type advice.

 

[Fluctuation0161]

But they’re all profit motivated. Likewise the motivation to make sure it’s safe. If this thing turns out to be inadequately tested and harmful because they “fudged” something then Pfizer will face the biggest class action in history.

Would they? What happened to this consultation? I'm unsure what the outcome was of not allowing liability and allowing unlicensed products.

https://www.gov.uk/government/consu...s-to-support-the-rollout-of-covid-19-vaccines

 

[Pogue Mahone]

Would they? What happened to this consultation? I'm unsure what the outcome was of not allowing liability and allowing unlicensed products.

https://www.gov.uk/government/consu...s-to-support-the-rollout-of-covid-19-vaccines

It was a discussion that needed to be had.

At present, drug companies can supply drugs that are not yet licensed for compassionate use in a specific patient after a written request from the doctor looking after them (typically a cancer treatment with good evidence it works and when the patient has run out of licensed alternatives) Whenever a drug is prescribed that doesn’t have a license the doctor (and to a lesser extent the company) are quite exposed, legally, so compassionate supply requires complex paperwork and a lot of back and forth for each and every patient.

Trying to use this same process when vaccinating millions and millions of people with an unlicensed medicine will create a logistical nightmare. So makes sense that they should take a look at these regulations and try to find a workaround. There’s nothing in there which would absolve pharma companies of liability if they behave in a fradulent or otherwise illegal manner.

The hysteria about this on social media was typically knee jerk and over the top. Anyone who actually takes the time to read that link you shared would have a much better understanding of why this is necessary. I wonder how many people who share that link even bother?

 

[jojojo]

The Van-Tam segment of the press conference this morning talked a bit about the ways in which the covid
vaccine development has differed from normal timelines. It's that combination of overlapping phases and the sheer size of some trial groups (which had a much bigger and faster ramp up than normal) that makes it so fast.

As an example of a Phase2/3 overlap, I believe the Astra Zeneca trial Phase 3 trial started in the usual manner with an under 65, no major pre-existing conditions group. Meanwhile they entered Phase 2 trials with over 65s and people with certain pre-conditions and people on some other medications - that's where their provisional "we are seeing a similar immune response and fewer adverse reactions" observations came from. They were looking for additional over 70s volunteers last month, so they may now be in Phase 3 with that group as well.

In normal circumstances it's not uncommon for drug companies to wait until (close to) the end of the Under 65 Phase3 trial before widening the test group, in case the main Phase 3 trial shows adverse reactions or minimal efficacy. Certainly ideas like manufacturing production stock while still in Phase 2 just wouldn't make commercial sense. In fact in most circumstances companies won't commit to manufacturing sufficient even for a widescale Phase 3 trial until Phase 2 trials are complete and reviewed, and the market for the product reassessed. They certainly wouldn't go to large scale manufacture until Phase 3 was complete and signed off.

The graphic from the Van-Tam press conference:

 

[Wibble]

⁴
That's just not a true statement. The risk is currently less than 1 in 43,500. You could insert a confidence interval to give you an estimated figure, but it's not zero.,

The current risk is exactly zero as we have no serious adverse side effects which means that the the 95% confidence interval includes the null value.

If we get a confirmed side effect then the risk may change of course but currently it is zero.

 

[Fluctuation0161]

It was a discussion that needed to be had.

At present, drug companies can supply drugs that are not yet licensed for compassionate use in a specific patient after a written request from the doctor looking after them (typically a cancer treatment with good evidence it works and when the patient has run out of licensed alternatives) Whenever a drug is prescribed that doesn’t have a license the doctor (and to a lesser extent the company) are quite exposed, legally, so compassionate supply requires complex paperwork and a lot of back and forth for each and every patient.

Trying to use this same process when vaccinating millions and millions of people will create a logistical nightmare. So makes sense that they should take a look at these regulations and try to find a workaround.

The hysteria about this on social media was typically knee jerk and over the top. Anyone who actually takes the time to read that link you shared would have a much better understanding of why this is necessary. I wonder how many people who share that link even bother?

As you described, the sense of scale between this project and individual cancer cases is very different.

Having read the various documents on the government link when they came out in October (?), it seems I'm much less comfortable with broad use of unlicensed medication with no liability, unless in very specific individual cases, than you are.

Maybe the government were just exploring the options with this consultation. Which is why I asked what the outcome was?

Allowing vaccine manufacturers to have zero liability on an unlicensed product, which will be administered to millions of people, sets a dangerous precedent in my opinion. I hope that will not be the case and they have full confidence in whatever product finally rolls out.

 

[Pogue Mahone]

As you described, the sense of scale between this project and individual cancer cases is very different.

Having read the various documents on the government link when they came out in October (?), it seems I'm much less comfortable with broad use of unlicensed medication with no liability, unless in very specific individual cases, than you are.

Maybe the government were just exploring the options with this consultation. Which is why I asked what the outcome was?

Allowing vaccine manufacturers to have zero liability on an unlicensed product, which will be administered to millions of people, sets a dangerous precedent in my opinion. I hope that will not be the case and they have full confidence in whatever product finally rolls out.

That bit in bold is a complete fiction. A lie being spread on social media. Which you would know if you read the links you share. I’ll save you some time. Here’s the relevant bit:

The UK government therefore proposes to clarify the legislation by putting the pharmaceutical company responsible for placing unlicensed products on the market on the same footing as manufacturers of unlicensed products – and the same footing as marketing authorisation holders of products which the licensing authority recommends are used otherwise than in accordance with their authorisation. This will help to give companies willing to co-operate in the sort of mass vaccination programme under consideration for COVID-19, or mass distribution of treatments in other situations, some assurance that they will not be exposed inappropriately to civil liability.

The point being that they should be exposed to the exact same liability that they would with any other licensed medicine. The proposal is that they wouldn’t be exposed to the additional risk that comes with the distribution of unlicensed medicines, when the government wants to implement a nationwide roll out of a vaccine before the licensing process is completed.

 

[rcoobc]

The current risk is exactly zero as we have no serious adverse side effects which means that the the 95% confidence interval includes the null value.

If we get a confirmed side effect then the risk may change of course but currently it is zero.

Eh?

 

[zing]

Question on logistics.. what is a realistic number of people who the UK could vaccinate per month with no constraints on supply?

 

[jojojo]

A piece of background on the UK.

https://www.bbc.co.uk/news/health-54902909
The current priority list known as "phase one" is:

• People living and working in care homes
• Then those over 80, then over 75, over 70, over 65 and over 60
• Then adults, but not children, with a health condition that puts them at greater risk
• Then people aged over 55 and finally those over 50

However, the priority list is subject to change with close attention being paid to how the vaccines work in older age groups, who often have a weak response to immunisation.

What they then do in terms of younger people will depend on what they find out about the vaccine - not just its efficacy at protecting against the covid disease symptoms, also the answer to the question of whether it stops you contracting (and subsequently spreading) the virus. If it stops people spreading it then mass immunisation (for herd immunity and also for potential exemptions from travel quarantine etc) become part of the equation. Meanwhile, they'll stick to priorities based on how dangerous the virus is to various age groups and to people with certain pre-conditions.

In other words, they're doing the same questioning and risk analysis that a lot of younger posters in this thread are doing. Which is exactly what I'd expect them to do.