Oxford University breakthrough on global COVID-19 vaccine
ox.ac.uk
ox.ac.uk
That’s much more accessible to developing / low GDP countries as opposed the cumbersome and expensive storage requirements of the other two.
-80C is really close to dry-ice temperatures. So I wonder if its actually -80C or if the researchers were just saying "Dry Ice".
Realistically, every major population can be reached in 24 hours by modern transport, and the Pfizer 5000-dose transport package keeps the temperature for 5 days.
Of course we now have reason to believe that vaccines that don't need dry ice will be approved, so logistics will direct the easier to ship ones to remote places.
Most of the producers have had their entire capacity bought out in prep for distribution of the vaccine.
Eventually you are right. If the Pfizer vaccine is to be used in remote places the people getting the vaccine will need to schedule it in advance (and probably pay for it) to ensure that once it arrives it is used.
You might want to update the comment to avoid confusion.
Additionally, lots of countries have already preordered all the major candidates, so in those cases its already spent money.
It isn't a new thing for what it's worth. Going back to earlier this year it has been looked at, but we don't really have a clear picture on what will shake out.
We need the vaccine to remove the virus from circulation, not just keep us safe from it as individuals.
This vaccine is cheap, 90% efficient and easy to get people vaccinated. The other ones are expensive, 95% efficient and difficult to get people vaccinated.
The Oxford is best only if you either live in a very remote place, or are a very poor place. If you rely on the oxford vaccine it will be a little longer to get herd immunity, but overall your costs will be cheaper.
But I must reemphasize, the above is only about logistics. Because most people live in cities, all vaccines will be distributed in big cities just to get the numbers they need. What ever vaccine you are offered first is the one to take. You personally are unlikely to be offered a choice other than take it or leave it.
Regretfully, it would be not the first example of major economies using the current reality as an excuse/cover to conveniently push political policies/agendas that would otherwise have been impossible to implement (at least not without violating laws/treaties and maybe even basic human rights). I have no intention to fear monger, but I believe way too many are too naive about some of the things that are currently happening. That is, mostly people within those major economies, for people in less fortunate countries already learned the hard way how double-faced those major economies turned out.
How all this will eventually turn out ... anyone's guess is as good as mine. I guess we will all learn, when the immediate emergency of the current situation is over. I would prefer to be/remain optimistic, but thus far there appear to be more reasons for caution and skepticism (at best).
I've read this 3 times and can't figure out what you're trying to say.
Are you saying that rich countries are going to intentionally choose more expensive vaccines, with the intention of suppressing the lower classes?
That's so rediculous. In rich countries (other than the usa) the gov pays for these things not the citizens. Even then, the expensive vaccine is only $40, that's within the means of most poor people.
Not to mention that would screw over the rich people who want to benefit from (vaccine induced) heard immunity.
> .. the gov pays for these things not the citizens .. You do know that the only money governments have, is the money they got from its citizens, right? That is, aside from what they may have earned (though plundered or extorted might be more fitting) from other nations.
> .. the expensive vaccine is only $40, that's within the means of most poor people .. You may want to reevaluate your knowledge about the rest of the world. That is, outside the USA and some the more affluent parts of Europe. Also, that vaccine probably won't cost "just" $40 equally for everyone.
However, believe whatever you want. Time will no doubt teach us all a lessen. Personally, I hope it will teach me that I was wrong with my skepticism.
> Time will no doubt teach us all a lessen.
I doubt it. You need to actually have a position that can be shown to be true or false with the passage of time before you can learn something from the passage of time. You have a bizare, logically disconnected, rant that does not make any predictions. I don't think any course of events would prove you right (or wrong).
> You may want to reevaluate your knowledge about the rest of the world
In context, we were discussing afluent countries, canada europe, etc.
> Also, that vaccine probably won't cost "just" $40 equally for everyone.
They will cost $0 directly. As you say there will be indirect costs based on taxes. However that will be true regardless of if you get the vaccine and be scaled based on your income, so im not sure how you think that applies to your argument sbout class divide.
The price difference will likely remain substantial, but in case anyone is unaware, the difference is currently greater due to AstraZeneca pledging to the sell the vaccine at cost "during the pandemic", while Pfizer and Moderna have indicated that they fully intend to profit. [1]
Once AstraZeneca deem the pandemic to be over, the price will likely rise.
It was reported a few months ago that internal AstraZeneca documents showed them projecting the "Pandemic Period" to end on 1 July 2021. [2]
[1] https://www.nytimes.com/2020/07/21/health/covid-19-vaccine-c...
[2] https://thehill.com/policy/healthcare/520202-astrazenecas-no...
Also, all 3 have made various noises about not making a profit etc, it's quite hard to sort out the marketing from what will actually happen at this point. Oxford/Astra have committed to supplying at least 100M doses to low-income countries for under $3 though.
Edit: just found a source here confirming what you said: https://www.bbc.com/news/health-55040635
India's Serum Institute has already partnered to mass produce this vaccine. https://www.ndtv.com/world-news/oxford-says-covid-19-vaccine...
The fact that we have three highly effective vaccines in such a short period is amazing and between them we might stand a chance of making and distributing them at the scale necessary to get things under some kind of control by August.
Pandemrix, a flu vaccine, caused a notable uptick in narcolepsy in Sweden, Finland and likely the UK. This was not (and could not) be seen in smaller trial populations.
It is not a given that any of the covid vaccines is safe enough. Historically, two cases of rushed vaccines (cutter polio and Gullah barre) were worse than the disease - and these were for diseases worse than covid. Those were 50-60 years ago. Pandemrix was 10-20. I’m not sure we’re that much better on safety now to rush vaccines.
https://www.who.int/vaccine_safety/committee/topics/influenz...
“Even at this stage, it does not appear that narcolepsy following vaccination against pandemic influenza is a general worldwide phenomenon, as no excess of narcolepsy has been reported from several other European states where Pandemrix was used, or from Canada where a pandemic vaccine similar to pandemrix was used. This complicates interpretation of the findings in Finland and Sweden. It seems likely that some as yet unidentified additional factor was operating in Sweden and Finland. The findings from the VAESCO project and further investigations in Finland and Sweden, may help clarify the determinants of any increased risk of narcolepsy, which currently appears to be restricted to the months following vaccination and by age group and country.”
What’s certainly true that for some effects to be observable, millions have to be vaccinated first.
2013:
https://www.reuters.com/article/us-narcolepsy-vaccine-pandem...
“In total, the GSK shot was given to more than 30 million people in 47 countries during the 2009-2010 H1N1 swine flu pandemic.”
“Independent teams of scientists have published peer-reviewed studies from Sweden, Finland and Ireland showing the risk of developing narcolepsy after the 2009-2010 immunization campaign was between seven and 13 times higher for children who had Pandemrix than for their unvaccinated peers.”
“Europe’s drugs regulator has ruled Pandemrix should no longer be used in people aged under 20.”
So if you give the entire US population a vaccine like that, less than twenty thousand of them develop narcolepsy. As a reminder a quarter million of them already died from COVID-19 and more are dying every day - not to mention the tens of thousands whose cause of death isn't listed as COVID-19 but would not be dead if not for an ongoing pandemic.
Cutter screwed up. No amount of prior safety testing can fix that. Their Polio vaccine had Polio virus in it (to be clear: The traditional Oral Polio Vaccine is supposed to have a "live" virus in it, but the injected vaccine Cutter were selling is not). Obviously nobody is going to test "What happens if we inject children with the Polio virus" because the answer is "Some of them get Polio. Duh" and so no test could have prevented Cutter from screwing up.
I have no idea what you meant by "Gullah barre" the Google results I get are all about Guillain-Barré syndrome, which I mentioned above. Guillain-Barré is not a vaccine, it's a weird auto-immune disorder, and arguably even where it's listed as very rare side effect of a vaccine, that's misleading because it's also a side effect from getting viral infection, so if you avoid vaccination but do get the virus you may get GBS as a result anyway. The human immune system is pretty inscrutable.
I assume the concern is that an unknown unknown means it could cause/trigger/amplify some other disease/condition that may be comparable/worse than the problem it solves.
Cause/effect and morals are hard. Add to the mix a general statistical innumeracy, and some general suspicion about authorities, and it makes it really hard for the general populace to actually weigh the two different options.
I don't think we should dismiss these concerns as just stuff for nutjobs. I've seen otherwise reasonable people having trouble making up their minds about that.
And yes, the mechanism is likely that Pandemrix activated a predisposition. But it was not activated in statistically equivalent kids who did not get Pandemrix.
Why is it so hard to acknowledge that not all vaccines are perfect, and that there’s a risk involved? I am not avtivax. I am pro vaccination. I am anti religious “a vaccine can never be bad” thinking which seem to be prevalent among otherwise rational scientific people.
This is just patently untrue.
The Cutter Incidence gave patients Polio due to an improperly activated virus. While this is bad, it could not be worse than the disease itself - since it is the disease itself, no worse, no less.
Regarding risk of Gullain-Barre syndrome due to vaccination, Wikipedia has this to say: "In fact, natural influenza infection is a stronger risk factor for the development of GBS than is influenza vaccination and getting the vaccination does reduce the risk of GBS overall by lowering the risk of catching influenza." So here I also find it hard to believe the vaccine would be worse than the disease,
I'm also sceptical of the claim that Polio or the 1976 Swine Flu would unambiguously be worse than Covid19. 70% of Polio case have no symptoms, and less than 0.5% cause permanent injury, according to Wikipedia. The 1976 Swine Flu outbreak seems to have caused a few hundred cases and only one death.
On the other, a cursory search says the current record for fastest developed vaccine was mumps at 4 years. So this is a vaccine setting new milestones, and there is a risk that not all of them will be positive. I'd rather be a little late to be vaccinated than a little early, especially being in a lower risk demographic.
At the 1-year mark, everything looked perfect. At the towo years mark (original endpoint) the conclusion was that while it was safe, it offered statistically insignificant protection.
Properly designed tests need those 2 years, at the very least. The “SAFE” confidence axis was compromised. Whether or nit it is justified is what we’re discussing here.
Cutter was, most definitely, much worse than the disease if you look at it from a population perspective.
The 1976 Guilian barre was at least comparable to the flu it was supposed to stop, if not worse. According to https://en.m.wikipedia.org/wiki/1976_swine_flu_outbreak, the disease caused one death and 13 hospitalizations, and an uptick of Giullan barre reports - a disease that more often than not requires hospitalization and sometimes death. I can assure you it caused more than 13 hospitalizations, and - having known two GBS people who made a full recovery - a very long and painful months long process. So, at 50,000,000 immunized - a 1 in 1,000,000 would still be worse than the flu.
I am not anti vax even if HN constantly seems to interpret my comments as such.
I am vaccinated, so are my kids. But whenever I mention that immunizations have risks, I’m treated like a heretic.
Everyone is assuming something like cutter cannot happen again. This is a religious assumption, not a scientific one.
This is a more reasonable assessment, but it is still patently false. According to Wikipedia, 0.04% vaccinations resulted in paralysis in the Cutter Incident, compared to 0.1-0.5% of wild type polio. So the vaccine was 2-10x safer than wild polio. Without vaccinations, virtually all children were infected with polio virus early in life [1], so being administered the defective vaccine was still a lot better than taking a chance with the real disease.
Of course, you are correct regarding the 1976 flu outbreak. If you administer something to a large segment of the healthy population, even a small risk of side-effects will add upp to a large number of cases. If the disease itself turns out to be very rare, as was the case with the flu outbreak, the vaccine itself could cause more damage than the disease even if the disease is much worse.
However, this is clearly not applicable Covid-19, which we already know is spreading very fast and will need to infect a large number of the population before herd immunity is achieved. The situations are simply not comparable at all – even the vaccine from the 1976 flu outbreak would be less risky than the odds of being infected with a serious case of Covid 19 (of which the long term effects are also unknown, to be clear).
> But whenever I mention that immunizations have risks, I’m treated like a heretic.
Mainstream media, healthcare professionals and social media are all worried about the risks of a rushed vaccine. I literally see articles and hear conversations about this several times a month. Nobody is denying that large scale vaccinations have risks.
I'm not criticizing you because I'm against being cautious of vaccination risks. The criticism is that you are spreading false facts and misleading analysis that grossly mischaracterise what the risks of vaccinations really are, both presently and historically.
"Some vaccines can have rare but serious side effects" is a perfectly alright statement. But "Historically, two cases of rushed vaccines (cutter polio and Gullah barre) were worse than the disease - and these were for diseases worse than covid" is just not. Some of it is false and the comparison to Covid19 is misleading.
From https://en.wikipedia.org/wiki/Polio_vaccine#1950%E2%80%93195... : "The Cutter vaccine had been used in vaccinating 200,000 children in the western and midwestern United States.[76] Later investigations showed that the Cutter vaccine had caused 40,000 cases of polio, killing 10.[76]". So, 20% incidence; mentions 250 "paralytic illness", so 0.125% paralysis (no idea where you took the 0.04% - it does not appear in the Wikipedia text).
From https://en.wikipedia.org/wiki/Polio#Paralytic_polio : "In children, nonparalytic meningitis is the most likely consequence of CNS involvement, and paralysis occurs in only one in 1000 cases." ; So, for children, the incidence of paralysis is 0.1%
Who got the cutter vaccine? Mostly children. See e.g. from https://www.washingtonpost.com/history/2020/04/14/cutter-pol... "By April 30, within forty-eight hours of the recall,” Offit wrote. “Cutter’s vaccine had paralyzed or killed twenty-five children: fourteen in California, seven in Idaho, two in Washington, one in Illinois, and one in Colorado."
So, I just tried to check your numbers, and I couldn't; Could you post references?
But I also wanted to check my memory, and Wikpedia seems to agree with me, Go on, please do check my quotes.
still patently false. pfft. Perhaps false under some assumptions, definitely not "patently false".
You would also have to include further transmissions caused by wild polio if you would like to make such a comparison.
> still patently false. pfft. Perhaps false under some assumptions, definitely not "patently false".
Even with your own calculation, which is inflated by also including transmission within the community for the vaccine but not for wild polio, the vaccine was very much comparable to wild polio (0.125% versus approx. 0.1%). Without vaccination, polio would usually infect virtually all children. So even with your own inflated assumptions it's false that the vaccine was worse than polio.
So under which assumptions would it not be false?
Take them with wikipedia, not me. I will note, that Wikipedia talks about both Cutter and Wyeth having problems, so it is possible the numbers are a sum of wyeth+cutter which would be compatible with your numbers being cutter only, but in the context of safety vs. polio wouldn't matter.
> You would also have to include further transmissions caused by wild polio if you would like to make such a comparison.
All wild polio numbers include those numbers by default - there actually is no way to get them otherwise, I guess you are saying "you should probably debase by more than 200,000 because of secondary infections". I don't know how to do that, exactly, but it will likely still be similar.
> Even with your own calculation, which is inflated by also including transmission within the community for the vaccine but not for wild polio, the vaccine was very much comparable to wild polio (0.125% versus approx. 0.1%).
With this calculation, the vaccine was 25% worse than the wild type. No error bars, but, that's easily worse, even much worse.
> So under which assumptions would it not be false?
How kind of you to drop "patently". If you didn't mean "patently" false earlier, why did you use that word? twice?
From[0]: "Patently: in a way that is so obvious that no one could disagree.". It's nice of you to finally bring sources, but even these sources don't make it "patently" false, given that they disagree with the sources I gave (which, I concede, reference more than just the safety of the Cutter incident which I originally mentioned, but which are definitely the subject matter under discussion)
[0] https://www.macmillandictionary.com/dictionary/british/paten...
Wikipedia is not wrong, but you are using their numbers wrong. Your source is talking about the total number paralysis cases that occurred as a result of the vaccine ("250 cases of paralytic illness had occurred"). This includes secondary infections. If you follow the sources listed on Wikipedia page you reference, you will find two sources: my source [1], and [2] (via [3]), both which declare around 60 cases of paralysis in vaccinated persons, and then a larger number (in the order of 200) of total cases. The numbers you reference are referring to only the Cutter polio vaccine, by the way.
And you cannot use the total number of cases in the comparison that you did.
> All wild polio numbers include those numbers by default - there actually is no way to get them otherwise, I guess you are saying "you should probably debase by more than 200,000 because of secondary infections". I don't know how to do that, exactly, but it will likely still be similar.
If by debase you mean divide, then yes: you would need to divide by more than 200,000.
Your number is {how likely am I to get paralysed by the vaccine polio + how likely am I to cause further paralysis via secondary infection chain}, and you are comparing it to simply {how likely am I to get paralysed by the wild polio}. The first number is inflated a lot by the addition of secondary infections.
The numbers are not at all likely to be similar. As you can see in my (and your) sources, secondary infections accounted for more than double the number of paralysis cases, and therefore there it is likely a lot more people got sick via the secondary infections than the number people who was vaccinated. This causes the big discrepancy between our numbers.
Wild polio causes secondary infections as well, but this is not included in the number you are using for comparison, since it only includes the individual risk.
> With this calculation, the vaccine was 25% worse than the wild type. No error bars, but, that's easily worse, even much worse.
But the lack of error bars means that the calculation is meaningless.
You are assuming that "one in 1000 cases" means exactly one case per 1000 cases, and translate this to 0.100% with three decimals of accuracy.
It is clear from context that "one in 1000" is a rounded number for convenience, and they could very well have runded up from 0.8 or down from 1.4. You simply cannot conclude that the vaccine was 25% worse from your data. But we can conclude that they were in some way similar under your false assumptions, as they both would round to 1.
If you want to conclude anything else except "they are both around 0.1%", you would have to find a source that specifies at least 1 decimal of accuracy in the number incidents per 1000 cases.
Of course, this does not really matter, since you would still be comparing the wrong numbers.
Your argument here is "It's ambiguous and inconclusive when using clearly wrong assumptions that inflate the difference". Taking that argument into consideration, I'm still willing to confidently call it patently false.
Although I agree that I should not have said "Even with your own inflated assumptions it's false that the vaccine was worse than polio." What I meant was "Even your own inflated assumptions does not support that the vaccine was worse than polio", but I clearly worded it badly.
> How kind of you to drop "patently". If you didn't mean "patently" false earlier, why did you use that word? twice?
I meant it when I used it, and my question had a purpose. If you cannot give any reasonable assumptions where it wouldn't be false (which you haven't been able to do), then it would be patently false to me. The reason it does not seem patently false to you is because you have several misunderstandings in your reasoning and your reading of the sources. But I'm not really interested in discussing this terminology further.
> given that they disagree with the sources I gave
They don't. As I said, you are simply misreading your sources.
But seriously, even if you would manage to find some source which would refute my sources and back up your original claims, I have a bigger point to make now:
During this discussion, you have made numerous mistakes in many posts, beyond my criticism of your faulty reasoning:
(1) Mathematical mistakes
(2) Misreadings of the sources
(3) Inability to clear up ambiguities by looking at the referenced source or secondary sources
Even if by some happenstance you would happen to be right (even a broken clock, etc), you clearly are not confident enough doing this kind of analysis to be lecturing people about the specifics of vaccination risks. You are just as likely to mislead yourself and others as you are to educate.
Of course, this probably won't stop you, since you are not likely to respect my opinion. But hopefully it will still be in the back of your mind next time you approach this topic.
[1] https://www.nejm.org/doi/full/10.1056/NEJMp048180 [2] https://www.cabdirect.org/cabdirect/abstract/19642705083 [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928990
And I may agree with your analysis - on phone now, can’t really do the reading.
However, we have two sources you claim are only for the cutter incident, whee one quotes 200,000 doses and another 120,000; as you note, the 1/1000 might well be 0.8 or 1.3 in 1000; it may be false but it is definitely bot “patently false”.
On the same note, it’s the internet, and for all you know I am a dog, but I have saved a family members from years of agony and wrong treatments due to wrong diagnosis after being told “it is patently obvious” that my analysis was wrong. And I have apology letters from department heads at two of the world’s highest ranked hospitals after it turned out I was right and they were wrong.
And you know what? I’m quite sure I probably had a few mathematical errors along the way back then as well. But what they thought was two orders of magnitude more probable evidence towards one direction, turned out to be higher probability in the other (by less than an order of magnitude) and turned out to be what the thought was improbable beyond consideration. (And, I found a few mathematical errors in a three peer reviewed papers they were relying on)
I take issue with people who claim “patently obvious” about things which have about factor of 2 or so (if I take your numbers) without error bars (120000-200000 is a large difference) and without supplying sources, which you didn’t bother until I did.
(And I may not have time to delve into this further - this is merely of historical interest to me, not life and death like that other event).
Also, you may notice this sub thread is basically the only one that actually discusses numbers, others use arbitrary determinations like “most people’s living memory” to discard concerns. Despite advocating vaccines myself, I have a problem with religious zealotry around vaccines, which is what most pro-vaccine people practice - I have a child who could not get vaccines for medical reasons for many years, and I have to explain that, no, vaccines are not perfectly safe on an individual basis, and have not historically been perfectly safe on a population basis (Swedish Pandemrix), even though on a net population basis they are a net positive.
I thank you again for your thoughtful discussion.
Sure, having Guillain-Barre is scary, but it is something that you can make a full recovery from.
It is never an excuse NOT to get a vaccine, unless you actually know that you got Guillain-Barre Syndrome from a vaccine. That is a discussion between that particular patient and their neuromuscular neurologist. In that case, you do not get the flu vaccine any longer because it can cause you to experience Guillain-Barre Syndrome again.
But, this really is an isolated situation that can be categorized as very rare and the general public should always get their vaccines.
If you catch the flu, it can absolutely trigger Guillain-Barre Syndrome, and would be far more likely to trigger Guillain-Barre Syndrome than the flu vaccine itself. If you get the flu and had the flu vaccination, it typically makes the flu illness less worse, making you less likely to get something like Guillain-Barre Syndrome.
There are lots of infectious agents that can trigger Guillain-Barre Syndrome, so it is wise to get your vaccines to prevent them as much as possible. They prevent serious infections, at minimum, which would help prevent Guillain-Barre Syndrome.
I also have the long term variant of Guillain-Barre Syndrome, known as Chronic Inflammatory Demyelinating Polyneuropathy, which is in pharmaceutical remission due to me taking subcutaneous immunoglobulin twice a week for 3 hours each time.
What I am saying is that while all of this sounds rare and devastating, it’s treatable. Not only that, you’re more likely to get Guillain-Barre Syndrome from a bad case of the flu than from a flu shot.
"The increased risk of narcolepsy due to vaccination was 1 in 18400 or 0.005%."[1] Considering the fatality and long term disability rate of Covid, and the way testing and safety protocols are done for vaccines, I don't really see how there could be an unknown and unseen risk that would outweigh the risk of contracting Covid.
It might be, but it’s not open and shut.
Additionally, it's not as if the average vaccine has a 0.005% chance of giving you narcolepsy. That figure was for the one vaccine in one country which appears to be the only example in most people's living memory of a vaccine possibly causing long-term side effects (it's not even proven the vaccine was the cause). There have been tens of billions of vaccines given during this time period and this is the only example where there may have been long term side effects.
> There have been tens of billions of vaccines given during this time period and this is the only example where there may have been long term side effects.
No, there are other examples, the other two I just mentioned are from memory, I suspect if I go research I will find more (I don't have the time). You know what else is common to those other two cases? They were rushed (pandemrix wasn't AFAIK).
SARS-Cov-2 vaccines were all rushed, and the safety protocols used to confidently ascertain those billions of vaccines were NOT followed - The standard is to wait 2-4 years to see that there's no ADE or other issues.
I am pro-vaccination. I don't understand why it is hard to acknowledge and discuss the risk profile of vaccines - they re not risk free. Excuse me if I don't automatically think a rushed vaccine is perfectly safe.
That Polio vaccine wasn't a side effect of the vaccine though, it was an issue with people accidently getting injected with a live virus. Since no live virus is even remotely involved in any COVID19 vaccines it has zero relevance here. Even if they were, we have 60+ years of history with no similar incidents since then.
> I suspect if I go research I will find more
You really won't. I've been reading about this extensively during this period and those are the only examples where there may have been long term effects that anyone can point to.
I qualified my original comment with "in most people's living memory" and didn't include the '76 swine flu vaccine because, frankly, I don't think pointing to an issue that happened 44 years ago in a field that has seen pretty significant technological advancement in knowledge, methods, and manufacturing processes really makes sense.
> why it is hard to acknowledge and discuss the risk profile of vaccines
My issue is not that there's isn't some theoretical risk, it's that it just isn't put in context of how minute it is. In all likelihood your risk of facing long term effects from a car accident happening on your way to get vaccinated are higher than anything that could happen from the vaccine. And both those risks are, of course, many orders of magnitude less than your chance of suffering long-term effects from catching COVID19.
Your omnipotent knowledge is inspiring. We have absolutely zero years of experience with RNA based vaccines. We had incidents with vaccines, not of the same kind. Ergo, there's a non zero probability we will have incidents in the future, by any reasonable inference.
> I qualified my original comment with "in most people's living memory" and didn't include the '76 swine flu vaccine because, frankly, I don't think pointing to an issue that happened 44 years ago in a field that has seen pretty significant technological advancement in knowledge, methods, and manufacturing processes really makes sense.
That's really painting a target where your arrow landed. Most people's living memory does not include e.g. the 1918 pandemic or the bubonic plague, or atomic bombs, or thousands of other things we're proactively defending against and of which we have better understanding but are still an issue. If "living memory" is your criterion ... well, I wouldn't describe it as anything but completely arbitrary.
Within living memory you have totally understandable and preventable things like Fukushima, the nestle mother milk fiasco in Africa, and others. We had enough understanding to stop all of them, and yet they happened. Every single SARS-COV-2 vaccine manufacturer has gotten government immunity from future claims, which aligns their incentive differently compared to vaccines they have produced in the past. They have become too big/important to sue - much like e.g. the fukushima reactor operator. Given this distinctly different incentive structure, rushed schedule, novel RNA delivery system - your belief that the past is a good predictor of the future is unscientific (at the very least, unbayesian without a ton of nontrivial priors you don't bother stating).
> And both those risks are, of course, many orders of magnitude less than your chance of suffering long-term effects from catching COVID19.
Ah, about that. Do you have any actual data about that? Because the best summary of "long covid" evidence I found was written by an MD, is summarized here[0], and can further be summarized by the word "lacking". I spent a lot of time looking for actual data about long covid (not anecdotes), and this summary is better than what I was able to find myself (but I do urge you to read it - do introduce it to your "living memory").
[0] https://sebastianrushworth.com/2020/11/17/what-is-long-covid...
Apparently the pfizer and Moderna vaccines will keep for 30 days at refrigerator temps after thawing out. You can ship in dry ice and then I can't imagine the vaccine sitting around in any doctors office or pharmacy for longer than 30 days.
Honestly I feel like this vaccine is going to leave the mRNA-based vaccines trailing in its wake in terms of global government adoption.
However for developing world the prices becomes the issue, so you are probably right, this vaccine is cheaper and thus more available.
[1]: https://www.nationalgeographic.com/science/2020/11/moderna-e...
The other two current candidates are mRNA vaccines, an approach which hasn't been used in humans before -- looks like the harbinger of a revolution but we have no past experience.
This O/AZ uses the actual spike protein embedded in a simian virus (that does not affect humans and has its own DNA removed). It's possible to generate antibodies to the vehicle (virus) which is why a simian virus is used (humans won't already have encountered it) but also means your own immune system could target the vaccine itself. Loewe speculates that this is why the higher dose was less effective.
On the other hand we still have no idea how well these vaccines will work. First, we have (as I discussed) two different approaches in the three current candidates, one of which is fairly new and one which is completely novel. We have had only limited time to see how well they work and have only limited experience in broad efficacy, duration of effect, and, crucially, how long they last (it takes a long time to learn if you'll need a 10 year booster!). We don't know how fast the virus mutates away from the vaccine's target (though we do currently think we have a good idea). And we simply haven't tried enough people to get a good handle on side effects.
One of the difficulties in solving these is that new approaches contain unknown unknown. Look at CRISPR-CAS: got a (deserved) Nobel this year yet may already have been discovered to be ineffective or worse in the real world. That takes time to learn.
Now it's not that the people doing the work are idiots -- they know all these problems better than I do. But I am appalled that this is treated by the press as a distinction between, say, a pair of beta implementations of something, one in Python and one in Ruby.
Going back to systems issues: when we don't know these factors we take a calculated risk (really an estimated risk). The social aspects of vaccination (close to ubiquitous use, the risk of any side effects increasing the anti-vaxx rate for other immunizations, which itself could become a public health disaster etc) mean these factors are upmost in public health officials, not whether they have adequate refrigeration.
Vaccines are particularly difficult for reasons like these above -- there's a reason why they have their own special laws and government-assumed liability insurance. I haven't worked on vaccines, so take this as you will, but I have worked in anti-invectives, have designed preclinical and clinical protocols (including first-in-human) which were submitted and approved by the FDA, run clinical trials, have presented to the FDA and defended protocol design, so I have some idea what's involved and how to read the presented endpoints and findings.
Sorry I’m a total noob in this area.
I answer your question in a parallel comment; click "parent" on your comment and look at my response to jeromegv
> Currently, OWS is working with 11 drug manufacturing companies to produce 800 million doses of six different COVID-19 vaccines, five of which are in Phase III clinical trials. By prepurchasing and premanufacturing these vaccines prior to approval, the vaccine distribution plan can be activated and supplies delivered within 24 hours of any of the vaccines receiving FDA approval.
https://college.acaai.org/updates-on-covid-19-vaccine-distri...
https://investors.biontech.de/news-releases/news-release-det...
But you are right, today we don't have all of that information.
This does not mean that by not picking your nose you can prevent covid
We would need more data to show that conclusively
Simiarly, we need more data to show that these vaccines are effective and don't have negative long-term effects
Maybe "you" need more data for whatever concept you have in your head of how this should work. However, within the scientific community involved with developing and approving these vaccines, the data we have is sufficient (pending review of course).
Moderna and Pfizer submitted for approval shortly after they released their initial Phase 3 results. Approval is expected to be expedited, but will not be instant (I've read a few weeks, assuming no problems). Oxford/AstraZeneca will likely follow the same course now that their results are available (they were waiting for enough people in their trials to become infected, same as the other Phase 3 trials).
It is widely expected that large scale distribution of these vaccines will begin in late December.
https://www.bloomberg.com/news/articles/2020-11-13/india-to-...
1/5th the price, and no need for freezers. This vaccine is huge. I pray for more like this.
That makes no sense since there are no tested regimes with 70% effectiveness. The reporting should say there is a vaccine regime with 90% effectiveness, and add a footnote that another regime that will not be used had a far lower rate of effectiveness.
Thee's another regime that we can all just forget about because it uses the same vaccine but with a different method of delivery that will be discarded in favor of the method proven far more effective. Averaging the two makes no sense.
Pfizer and Moderna vaccines are not vectored.
I think its possible that this is just noise. The difference between '60%' and '90%' might just be a handful of cases.
They show that it works though, thats the main thing.
edit: e.g. of those 130 cases lets assume half were in each regimen experiment. So 65 cases in the 'two full doses experiment' if they got 60% efficiacy then that means about 26 people with the vaccine got covid vs 39 with placebo. In the 'half dose then full dose' experiment if they got 90% efficacy then that means about 7 people with the vaccine got covid vs 58 with placebo. So the difference between 60% and 90% is 19 people. They show that the vaccine works but there is lots of uncertainty between the two dosing regimens.
Edit: why the downvotes?
This is I think why the mRNA vaccines are doing better. They don't use a virus as a vector, they use a less convoluted vector of a more basic mRNA instruction set. They're also in a way more "scalable" in that a future disease or a mutation of Covid with a new spike protein could have a new vaccine made quickly by tweaking the mRNA sequence.
When the government announced they were shutting down PHE, in an attempt to copy the RKI (forgetting that PHE is far more than disease control, of course), the RKI wrote a letter to all senior management at PHE. This was quite a confused letter - the RKI didn’t understand why the UK gov were making this decision, when the RKI modelled their processes on PHE. I’ve read the letter.
Add to this, daily squabbles between cabinet office and other branches of government. If there was good news, you’d hear back immediately and you’d be blocked from sharing it. Bad news, cabinet would stall sometimes for weeks.
But ultimately all the guidance was irrelevant because the UK government are not interested in listening to it. When an adviser egregiously broke the rules, a story which dominated the headlines for weeks, they changed the rules. You see it now - the UK isn’t even on the downslope of wave 2, but apparently in 2 weeks we’ll have fans at football games and business as usual.
People are going to look back at this pandemic with amazement at the work the world scientists did to create a vaccine in record time, but with shame and embarrassment at the loss of life in countries that are considered world powers due to politics, ignorance, and stubbornness.
This isn’t safe to argue at all. In fact, it’s completely wrong. We know that the poor UK response is almost exclusively due to politicking and government corruption. The scientific advisory panel of the government (SAGE) hasn’t always been right in their assessment but they very quickly produced rigorous working models and solid recommendations, most of which have mirrored (and continue to mirror) the international consensus. Furthermore, public research in the UK has, sometimes against the active opposition of the government, done stellar work to ramp up testing and genetic sequencing.
For instance, several institutes (incl. the Crick Institute in London and the University of Cambridge) had extensive testing capabilities set up in record time, but their offers to official channels were ignored for weeks, if not months (the Crick in particular simply ignored this and already provided testing internally and externally, at a time when basically no country had widespread testing yet).
Likewise, a collaboration of different institutes quickly set up genome sequencing pipelines for COVID-19 samples, and as far as I know the Sanger Institute is sequencing more COVID-19 samples than any other individual entity in the world: https://www.sanger.ac.uk/about/who-we-are/sanger-institute/t...
That's not logical at all. It's a reasonable argument that poor general response to COVID is an indicator that you aren't currently doing a good job of governance, but that's a whole different kettle of fish.
Is that also true of the Pfizer and Moderna trials? Are the various trials measuring 'effectiveness' in the same way? Is there a standard for 'effectiveness' in these Covid-19 trials?
It will take some digging and real effort to compare the risks and benefits of the various vaccines coming to market.
And it's pretty easy to compare the vaccines. It will mostly come down to price, ease of manufacture and ease of distribution i.e. temperature. Given that for the 3 viruses all have no risks associated with their use.
“There were 10 severe cases of COVID-19 observed in the trial, with nine of the cases occurring in the placebo group and one in the BNT162b2 vaccinated group.” (1) “170 confirmed cases of COVID-19 were evaluated, with 162 observed in the placebo group versus 8 in the vaccine group.”
1) https://www.pfizer.com/news/press-release/press-release-deta...
I think the commenter wanted to know whether anyone who received the vaccine was hospitalized for anything covid related, not for anything vaccine related.
a) A virus that is known to cause severe disease in a significant proportion of people, including months-long serious health effects, hospitalisation and death.
b) A virus chosen because it doesn't causing any ill-effects in humans, modified to take on some non-harmful aspects of virus a) and found to not cause any significant harm in tens of thousands of people over several months.
Which is more likely to cause long-term side effects?
The Pfizer press release states: "There were 10 severe cases of COVID-19 observed in the trial, with nine of the cases occurring in the placebo group and one in the BNT162b2 vaccinated group."
So, zero severe cases for Oxford, and one for Pfizer. Interesting.
Should also point out the Pfizer trial may have had 43,000 participants, and the Oxford one 24,000, so they are different size trials. Also, it's super easy to miss important details when comparing outcomes like this, to do this properly really requires a project or in-depth investigation, not my 15-minutes research effort. :)
Pfizer release: https://www.pfizer.com/news/press-release/press-release-deta...
Seriously, do you think this is a huge difference in quality of measurements?
Maybe its chance that none of those 39 got really sick. I'm not sure what the age breakdown of trial participants was- were the people in the oxford trial younger? Did the distribution match the distribution from the mRNA trials? I have no idea.
But you're less correct about saying "smple size is probably too small" (in general, people really really really need to stop dismissing things based on sample sizes until they actually go through a Power calculation!). Your question about demographic breakdown is entirely valid.
Hospitalization rate for covid is about 228.7 hospitalizations per 100,000 population [0]. Or, more easily interpretted, about 10-20% of cases turning to hospitalization. Taking the more conservative (10%) rate, we'd need 31 samples for a 95% CI and 5% margin of error. Thus, the interpetation is that is it unlikely that the _lack of seeing any hospitalizations in the vaccine+covid-positive group is by chance_.
Hope that helps!
[0] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidvi...
I think there was a bit of an implication in the parent post that it would eliminate hospitalizations (instead of just reduce), i still think that is unrealistic.
Just as a reminder, that vaccine had more than 40k people in each group, with 170 cases of COVID-19 being observed, 162 in the placebo group, 8 in the vaccine group.
As you can see, the sample sizes get quite small, so I’m not sure how much, if anything, this tells you regarding severe cases. There could have been just as well no severe case in the treatment group, just by luck. What would that tell us?
I didn’t find any info regarding severe cases and the Moderna vaccine but I maybe I missed it. Those press releases are hard to read.
My source is Pfizer’s press release: https://www.pfizer.com/news/press-release/press-release-deta...
https://clinicaltrials.gov/ct2/show/NCT04368728
Everybody in all arms (groups) gets a jab, twice, but what exactly what is in the needle varies. The study paperwork doesn't say which placebo was used in this trial (the participants would definitely have been told), sometimes vaccine studies use a vaccine for something else that you didn't need but is presumably harmless (e.g. think of vaccines you take when going somewhere a bit dubious on holiday). Other times they just use saline. Some other groups got higher doses of vaccine.
Anyway, since everybody got stabbed, nobody (as much as possible not even the people giving you a jab) know what's in the needle - everybody gets assessed for side effects. One of the very revealing things about all these studies is how many side effects you get for injecting people with saline. Sore arm makes some sense at least, somebody stuck a tiny needle in your arm - but you'll get headaches, dizziness, flu symptoms even. The mind is powerful.
Yes, its true that there were no "severe" cases in the other vaccine trials as well.
> This statement seems a big deal: "There were no hospitalised or severe cases in anyone who received the vaccine"
It may be. When considering disease severity, we are no longer looking at a pool of people who have been given the vaccine (which is in the tens of thousands for all of these), we are looking at a pool of people who got sick. That means the sample size is reduced to approximately 90-100 for placebo wing of each vaccine, and 30 for ChadOx vaccine arm, and about 5 for Moderna/Pfizer vaccine arms each. That's fairly small.
Seems like the estimated rate of severe cases is around 10-20%. Assuming its 10% (which would mean its harder to identify an actual reduction in disease severity rate from the placebo group), then in the case of Pfizer/Moderna, there would be a greater than 50% chance of seeing no severe cases in a group of 5 infected, vaccinated patients, even if there was no effect on the severity of the disease. The greatest benefit to the vaccine is that they seem to prevent infections substantially, but that also means it will take months before enough infections occur to get some kind of statistical significance on if severity is also affected.
But with this vaccine, 30 cases with no infections is definitely in the realm of statistical significance. I don't have the exact numbers from the trial, but if it indeed is 0/30 vs around 10/100 between the vaccine/placebo wings, it definitely meets the typical thresholds of statistical significance.
It's important to note that, at least according to my understanding, the Pfizer/Moderna trials are measuring symptomatic cases, not doing actual tests on their trial participants. This means that it could well mean that the reason the vaccines appear to be so effective is because they truly are reducing the severity of the disease to the point of being asymptomatic. We just aren't able to see it yet due to the way the data is being collected.
[1]: https://www.theguardian.com/world/2020/nov/23/coronavirus-sc...
It is the classic "make a baby in 9 months with 9 women" dilemma. There is no way around conducting a trial and waiting long enough until you see what happens to the participants.
A little time could maybe be shaved off by speeding up production. The mRNA vaccines have an advantage here, you can basically use an RNA printer to churn out whatever RNA sequence you need.
Unfortunately, rules in fields like medicine and aviation are written with blood. Someone gets too greedy or too comfortable and you have large numbers of people death or incapacitated.
We already have large numbers of charlatans preying on the hopes of desperate people, must be very careful not to lower the barrier too much or these might jump too. Even worse, people might be targeted by slick psychopaths and coerced into extremely dangerous things, destroying communities when anything goes wrong.
Hopefully though, some mountains might have been moved and some things might have gotten faster from now on.
There are people out there that won't hesitate to kill any number of people for the hard cash or fame, some did it before and that's how the rules were born. I am sure that some of rules could be revisited thanks to the new tech but portraying it as "rules kill people" is intellectually dishonest or naive.
Look what happened with Boeing 737-MAX. Some businessmen, scientists and engineers will cut corners to get their job "done" and every now and then it will be catastrophic.
It’s just that using the vaccine is an active choice so you run into trouble with ethics.
https://www.statnews.com/2020/06/23/challenge-trials-live-co...
Our current testing protocol requires letting the virus rampage through the population before the trials will achieve statistical significance, which is surely more unethical than deliberately exposing a small number of people.
Suppose we replace Covid with "car crashes" and vaccine with "seatbelts". This is a good analogy because crashes are rare and we can't cure trauma (like on Star Trek). It would be absurd to deliberately cause car crashes in order to study the effect of seatbelts. For the experimental group, there will still be some minor injuries. For the control group, many will die.
Phase III trials for each of these new vaccines end long after the efficacy is determined. Estimated primary completion dates are in June 2021 (BioNTech/Pfizer) and November 2021 (Moderna).
Even after the drug is accepted, monitoring for safety continues.
If exposing a few people on purpose is a moral wrong, then surely allowing millions of them to contract it by accident so that a few people in your RCT can become infected by chance is a moral abomination.
FWIW, ethicists were split, but mostly on board with HCTs. It was mostly the government that was opposed.
Essentially, no one signing up for the trial would have been properly able to give consent, because no one knew the real consequences.
Limiting factor is safety and testing for safety.
They started trials with two people, one gets vaccine one gets placebo. They look for side effects then add more and more people while constantly observing those vaccinated for side effects.
Vaccines are not inherently safe, they are safe because they have gone trough huge amount of volunteer testing. If there are unwanted side-effects, vaccine is withdrawn. Since vaccines work with the immune system, you must look for autoimmune reactions, neurological symptoms etc. Some of them can emerge weeks or months later. With new mRNA vaccines there are even more unknowns.
Emergency authorization they seek means taking calculated risk. With covid-19 epidemic taking that risk is acceptable.
I cannot think of a valid utilitarian argument allowing willing people from getting a vaccine.
First, vaccines have an extremely high success rate, 33% of vaccines make it through all trials to approval. 50% after phase 1 is complete.
The worst vaccine side effect ever is widely considered to be the swine flu vaccine from 60 years ago, where 1 in 100,000 got GBS (a bad disease).
If we knew with 100% confidence that this vaccine was tied for the worst, then if you are over 65 it would be about 1,000x better for you to take this "bad vaccine" versus not.
Each successive trial lost us a lot of time, and very little confidence gain.
The reality is we had many groups all independently find a vaccine that worked in Q12020. It's only the government ban on their use that allowed the pandemic to proceed like it has.
Right now in the US, the FDA has said it is not even planning to MEET on the Pfizer candidate's approval for 3 weeks. Just insane. Then, the CDC says it needs 24-48 hours after FDA approval to authorize it's release. Why can't the meet right now? Why can't the CDC pre approve release? Or be in the meeting and give simultaneous approval? Or be on a phone alert to give approval within 1 hour?
The most likely answer is that in a nationally declared pandemic, any vaccine produced by someone who has gotten a vaccine approved in the last 10 years can sell and distribute (cash only no insurance) vaccines without approval. Require them to collect data on its usage and efficacy. Wait until normal process to require people to be vaccinated.
I think you should check your math. Because covid-19 infection fatality rate is "relatively low", only 10 times seasonal influenza (3X for people in their 30's 15X for people in their 70s) the limit where utility turns negative is quite low.
One purpose of approval is to move responsibility from drug companies to the government. They can just pay small fee for National Vaccine Injury Compensation Program or something similar. If you allow volunteers but they have to pay the insurance from free markets, vaccines become too expensive. Drug companies are not willing to give them.
Biopharma leaders unite to stand with science http://www.news.sanofi.us/2020-09-08-Biopharma-leaders-unite...
>The worst vaccine side effect ever is widely considered to be the swine flu vaccine from 60 years ago, where 1 in 100,000 got GBS (a bad disease).
During the 2009 A(H1N1) influenza pandemic Finnish health system used vaccine called Pandemrix, It was almost exactly the same as Focetria used elsewhere in the Europe but it was manufactured using slightly different method. It caused Narcolepsy for 200 kids in Finland and 100 in Sweden before withdrawn.
First, regarding "worst case side effects", I am willing to accept your premise that elevated rates of narcolepsy was in the 2009 A(H1N1) vaccine was worse, and do some math based on that.
Looking solely at deaths (let alone potential long term health risks of contracting covid). The IFR for those over 75 is about 4.6% now https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v....
If you assume that people had a 10% chance of contracting the disease, you can say that those over 75 would have approximately a 0.46% chance of dying (4.6 in 1,000 dead) if they don't get the vaccine.
If they do get a vaccine, that turns out to be as bad as Pandemrix (I believe your example of the worst case side effects), then you would expect 1 in 18400 to get narcolepsy. (source: https://en.wikipedia.org/wiki/Pandemrix).
So if you are a regulator looking at the elderly population, and you assume this is tied for Pandemrix, then for every 18,400 people you would assume 1 case of narcolepsy if you give the vaccine, and 84.64 dead. (85x by volume).
I don't know your opinion of "how much worse is death versus narcolepsy?". If you believe death is 10x worse than narcolepsy, then by severity and volume, taking a vaccine with the worst side effects ever would seem about 850x better than not taking it (in elderly populations). Earlier in the pandemic, when IFRs were over 2x as bad, this was well over 1,000x better.
If you are getting different math, please let me know, because even using Pendemrix, I cannot seem to justify banning vaccines on utilitarian grounds.
Now I do agree that moving responsibility from drug companies to the government is fine, but I think that can be addressed directly if that is a concern. If the argument is "without government assuming responsibility they would be too expensive", I don't think we have any proof of that, not enough for a ban.
This is awesome for more than just vaccinations. Traditionally the groups allocating govt funding to science and industries are very risk averse and this could be one more example where taking risks can payoff.
Note that approvals of these were late 2019 and the summer of this year. So still very new from an "approved on humans" point of view (although not _as_ new as mRNA-based vaccines). The techniques have both been in development for years and years of course, including determining their safety profiles.
> One dosing regimen (n=2,741) showed vaccine efficacy of 90% when AZD1222 was given as a half dose, followed by a full dose at least one month apart, and another dosing regimen (n=8,895) showed 62% efficacy when given as two full doses at least one month apart. The combined analysis from both dosing regimens (n=11,636) resulted in an average efficacy of 70%. All results were statistically significant (p<=0.0001).
Also:
> and no hospitalisations or severe cases of the disease were reported in participants receiving the vaccine.
https://www.astrazeneca.com/media-centre/press-releases/2020...
quote from the link here, but for those who don’t want to click through (this article is fascinating though), it is told in the context of a joke which i will post below the link.
https://www.theatlantic.com/health/archive/2020/08/covid-19-...
There’s a joke about immunology, which Jessica Metcalf of Princeton recently told me. An immunologist and a cardiologist are kidnapped. The kidnappers threaten to shoot one of them, but promise to spare whoever has made the greater contribution to humanity. The cardiologist says, “Well, I’ve identified drugs that have saved the lives of millions of people.” Impressed, the kidnappers turn to the immunologist. “What have you done?” they ask. The immunologist says, “The thing is, the immune system is very complicated…” And the cardiologist says, “Just shoot me now.”
I hope not, but sadly it is a real possibility that needs further study.
What about this news?
Moderna: £45, Pfizer: £20, Oxford: £3,
The Oxford one is also easier to store and transport.
Many countries e.g. Australia are licensing the formula so this is an important aspect.
> But we also hope to have, as we always do in life cycle management, a new lyophilized formulated vaccine by -- within maybe a year after initial delivery such as fourth quarter 2021 and the lyophilized formulation could be stored in refrigerator.
[1] https://s21.q4cdn.com/317678438/files/PFE-USQ_Transcript_202...
Yes it has, most recently in 2009. From Wikipedia:
“ Well known outbreaks of H1N1 strains in humans include the 2009 swine flu pandemic, as well as the Spanish flu.”
The “Spanish flu” is the name of the 1918 outbreak of H1N1. There was also a major H1N1 outbreak in 2009.
> Phase 3 interim analysis including 131 Covid-19 cases indicates that the vaccine is [on average] 70.4% effective when combining data from two dosing regimens ... In the two different dose regimens vaccine efficacy was 90% in one and 62% in the other
And to be clear, it's not just one dose vs two:
> tests on two different dose regimens showing that the vaccine was 90% effective if administered at a half dose and then at a full dose, or 62% effective if administered in two full doses.
So "Oxford vaccine is up to 90% effective", perhaps?
I'm not a microbiologist, but this is not how vaccines work. The vaccines are going to put "something strange" in your body that "resembles" the virus, but it's not the virus (it's either a deactivated version of it, or some proteins which identify it...) and then is YOUR immune system the one which "attacks" this pseudo-virus. In this way, your immune system is learning how to defend to "this kind" of strange agents.
In a future if your immune system sees the virus, will defend you.
If you get the two kinds at the same time, maybe the two doses are too much for your immune system to handle it properly and the side effects may affect you (e.g. you can get fever because your immune system is under too heavy load).
In any case, getting the vaccination can (maybe) actually increase your risk of a severe Covid sickness, when you are exposed to real covid virus at the same time.
https://onlinelibrary.wiley.com/doi/10.1111/ijcp.13795
And I have no data for it and I can imagine it being hard to get reliable data about it, but autoimmune sickness is on the rise. I am not sure a quickly hacked together vaccine can rule that possibility out.
There are definitely benefits to vaccine diversity. The Oxford ChAdOx1 virus involves putting a modified chimp adenovirus into people. People don't have immunity to chimp adenovirus, so it infects them and delivers the spike protein, which elicits immunity. But that might also elicit immunity to the chimp adenovirus! If that happens, then a later does of the vaccine - say, for a new strain of SARS-CoV-2 in a year or two - might not be as effective, because immunity to the chimp adenovirus will stop the vaccine delivering the spike. In that case, having a different way to deliver a vaccine will be a life-saver.
By comparison, the Moderna is making a RNA vaccine, and BioNTech an epitope vaccine (the actual protein).
The ‘invasive’ effect is decreasing in that order. Oxford’s ChAdOx1 infects your cells to create RNA, then protein, then T-cell recognition/apoptosis, then epitopes trigger B-cell antibody production. Moderna RNA skips the infection part. BioNTech epitopes go right to B-cells.
But, they also have deceasing stability and manufacturing scalability in that order.
I think BioNTech's vaccine is also an mRNA vaccine.
> Our vaccine consists of a short segment of genetic material, called messenger RNA, that provides instructions for a human cell to make a harmless version of a target protein, or immunogen, which activates the body’s immune response against the SARS-CoV-2 virus
Also, the issue will not be which vaccine is chosen, but above a certain percentage of effectiveness who can even supply enough of their vaccine to meet demand?
1. Are there any vaccine ( of any Disease ) that are 100% effective? Or do we operate ( as I would assume ) something like 5 Nines effective rate and call it 100%?
2. Across all type of Vaccine, what are the average or median effective rate? i.e Should we expect Vaccine to be 90%+ effective in the first place? Or is that a wrong expectation to make?
3. What happens in the case of 10% ineffective, do they take a third dose?
Sometimes, vaccines are only 30% or 40% effective, leading to terrible flu seasons.
I don't really know the mean/median/mode, but 90% is really high for a vaccine.
> 3. What happens in the case of 10% ineffective, do they take a third dose?
How do you know if someone is one of those 10%?
I would assume everyone have the vaccine and they still get caught COVID afterwards?
Or do I misunderstood what effective means?
Your immune system naturally becomes immune after it fights off an infection. But because of the risk of long-term effects and/or death when you're infected with COVID19, people want a safer solution that provides immunity.
A vaccine provides immunity, but at a lesser rate than the actual virus. But 90% (or even 70%) effectiveness is a good thing: it means 90% to 70% people do NOT spread the virus anymore.
You'd think that means 90% or 70% fewer deaths, but that's mistaken. That 70% is compounded over-and-over every generation. If everyone else is vaccinated: you infect 70% fewer people. Those people infect 70% fewer people, and those people infect 70% fewer people.
After 3 generations, a 70% vaccine would wipe out 97.3% of possible infections. And a "generation" in COVID19 terms is roughly 1-week.
---------
So yes, even a 70% vaccine (if everyone took it) is a very, very, very good thing. But the two vaccine trials that finished first were 90% effective, so I think people will prefer the higher-efficacy (at least, if they have access to Dry Ice / -80C storage).
A vaccine that is 90% effective against one strain may only be 40% effective against the collective.
Simple single stranded viruses like Covid19 are vastly more stable. A good vaccine as long as we force everyone to take it will wipe out covid19.
https://en.wikipedia.org/wiki/Influenza_vaccine#Effectivenes...
The best effectiveness of a flu vaccine in the US since 2004 was 60%.
A vaccinated individual will also have milder symptoms.
Together with how rare adverse reactions are to the vaccination, the smallpox vaccine is really a wonder.
Higher R0 means you need a greater percentage vaccinated population to achieve herd immunity
If everyone got vaccinated with 90% effectivity (or even 70%), it would be enough. However, availability won't be sufficient to get to 100% within a year, and compliance seems to be somewhere around 50-70% at most given polls. (There are a huge number of people even in this forum who are antisocial - "I won't get vaccinated until I have seen super-long-term effects, and screw the people who I superspread the disease to".)
Covid is not nearly as contagious, so to prevent outbreaks it doesn't have to be nearly as good at the same vaccination grade.
For an individual, however, 70% would not feel very reassuring, which is why we need a lot of people getting vaccinated.
Edit: fixed some autocorrect issues. I feel I should add: measles is not at fun, even if you don't have any complications. You become very sick. Serious complications are _a lot_ more common than adverse reactions to the vaccine. Don't rely on other people being vaccinated unless you have a compromised immune system in any way.
Agreed, but keep in mind that no one in the Oxford trial who got the vaccine got a serious case of COVID or needed to go to the hospital. So it's only 70%-90% effective (depending on dose) at keeping you from getting infected, but so far 100% effective at reducing severity and keeping you from dying or going to the hospital. So that's a huge positive to keep in mind and yet another reason to get vaccinated.
My guess is the lighter dose is really slightly less effective, but the same size is so small that statistical issues make it seem better than it really is.
Good:
+ likely 90% effective if we use optimal dosing
+ no significant side effective. Looks better than Pfizer or Moderna.
+ already pre-produced at huge scale, 3 Bln doses in 2021
+ easy to store and administer, just regular fridge required
+ several times cheaper than mRNA
+ more traditional vaccine than novel mRNA, less tail risk in production and scaling up the process
Not good:
- two doses, efficient one month after first injection
- likely public will be confused about efficiency due to dosing regime
I'm thinking it's going to accidentally happen to some people, at least if there are facilities that offer more than one vaccine.
1. You may end up just getting very short and weak immunity, making this approach ineffective.
2. You may get a combination of immunity which can have different efficiency.
3. For some vaccines of same type this works, but is rarely recommended.
4. Mixing partly mRNA and Adenovirus vaccines doesn't to be winning strategy. It is rather more likely to give another vaccine if after two doses you didn't get immunity.
A caveat here is that different vaccines might use different versions or modifications of the spike protein, in which case it's possible they wouldn't boost each other. This feels unlikely, though, because i think that would also reduce their effectiveness against the real virus.
The other major benefit is that these vaccines can be developed more quickly, which is worthwhile in its own right.
I don't know the economics here, but I would assume that cost advantages are much more likely to appear for small-scale products here than what we have now, producing a billion doses in large factories.
I don't know that the manufacturing costs are less (for Pfizer, Moderna), but I think it's a fair assumption that the bulk of the difference is AstraZeneca (currently) providing it at cost.
I agree about the confusion, though. I worry that people will avoid this vaccine, in the hopes of receiving the Moderna/Biontech one instead.
That would be a real shame, because the results here are extremely positive. The media’s reporting of this is concerning.
There's no reason to expect that the 39 would have a similar age distribution to the population because it's not a random sample.
Every positive announcement raises my spirits slightly.
On the other hand, it is generally thought that vaccines can trigger immune reactions that are often much stronger and longer lasting than just being infected, so you would expect there to be a benefit to getting vaccinated even if you already had it. But only time will tell for sure. No one really knows how long immunity of either type will last - we just have to wait and find out!
Interestingly the opposite is true for influenza: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870374/
A vaccine is meant to stimulate adaptive immunity which culminates in formation of memory cells - highly selected T and B lymphocytes which are very specific to the infectious agent. This process typically takes a couple days [1] and is rather involved. Once you have the memory cells, however, the next time you get in contact with the virus your memory cells will jump-start the immune response much more quickly, before the virus gets a chance to replicate.
In a regular infection the same mechanisms of adaptive immunity are activated, but on top of that you already have the complications from the virus itself (cell death in lung epithelium, accumulation of excess fluid, hypoxia, cytokine storm etc). A vaccine dose won't necessarily speed it up, there are plenty of virus particles already stimulating the immune system - it's just picking up the slack a bit too late.
There are other factors to consider but that's the general idea.
[1] https://www.researchgate.net/figure/Kinetics-of-CD8-T-cell-d...
Does anyone know if there's data for this and the other vaccines, whether any of those that still end up infected under the trials have had any of the secondary symptoms such as missing sense of smell, reduced cognitive function, reduced bio-motor functions, cardiac damage and so on? Not dying from a lung infection is obviously the most important, but some of the other organ damage that corona-virus can cause is pretty scary too, and I'd like to know whether the vaccines seem to prevent this too.
Once the oxford vaccine is deployed I suspect they will then have to create a new vector if they need to create another batch in the future as your body might have developed immunity to the vector virus itself making future doses ineffective.
A vaccine is something that primes the immune system, so that when the real virus enters the body it is attacked and destroyed quickly. This means that the virus can never start multiplying in the body and shedding to other people.
I don't believe there is any modern vaccine that doesn't reduce or eliminate asymptomatic spreading of the disease.
However, I believe that it is different between bacteria and viruses.
From my understanding of the whooping cough studies, they found that some vaccinated baboons who were subsequently infected still had high levels of pertussis bacteria after five weeks. These bacteria couldn't cause widespread infections in the host, but had seemingly found pockets where they were safe from the immune system.
A virus, however, can't find a "safe pocket" away from the immune system in which to survive and multiply. It needs to use the body's own cells and machinery to do so, and (outside of the blood-brain barriers) there aren't cells hidden from the immune system.
Also, "There were no hospitalised or severe cases in anyone who received the vaccine".
Can we infer anything from that statement? They seem to be suggesting that the infection might be less serious in the vaccinated population...
Why the downvotes? I'm answering the question that is being asked. The study is talking about the side-effects of receiving the vaccine.
> "Also, "There were no hospitalised or severe cases in anyone who received the vaccine".
Can we infer anything from that statement? They seem to be suggesting that the infection might be less serious in the vaccinated population... "
70% is still a great effectiveness rate, specially for a cheaper and easier to distribute vaccine.
With the second jab those antibodies immediately neutralize the adenovirus so it can't infect enough cells and make enough of the COVID antigens so the protection is not that strong.
The Russian vaccine avoids it by using two different strains of adenovirus for the two jabs
That would complicate manufacturing, logistics and distribution somewhat right?
"They're lying to you, they claimed it's 90% effective but actually it's 70%".
Source?
I know it's CNN (what I could find with 5 mins of Googlefu) and they don't explicitly mention the falsified data part. But the Gamaleya Institute is well known in Russia for falsifying data both as a propaganda machine, as well as to obtain further funding from the federal government. I can't find another source I read earlier concerning a past instance of fraud perpetrated by the institute (it was in German).
Btw .. I think public health needs to start educating people on how these things work in order to get high coverage. I am alarmed at the number of highly educated people I know who seem suspicious. This fear is just borne by a lack of understanding and can be corrected IMHO.
This vaccine isn't mRNA though.
I don't know how many existing vaccines fall into either category here, i.e. whether there are many vaccines that prevent disease but do not even reduce the ability to spread. Would be interesting to know.
[0]: https://www.nytimes.com/2020/11/17/health/coronavirus-immuni...
for SARS-COV-2 you need around 70% immunity in the population to achieve herd immunity
This is the required immunity of the population, but not the effectiveness of the vaccine. Inside the population there are groups that you cannot put the vaccine (smallest babies, immunosuppressed people, etc).
The business-as-usual replication rate of covid appears to be somewhere around 4-6, meaning that if we have universal vaccination with something like 80% efficacy, the number of active cases will exponentially decay with no other measures taken (social distancing, masks, lockdowns, quarantines etc).
People infected by SARS-Cov2 seem to infect two to six other people [0]. Reduce this number by 90% and we are well below one infection per infected, so it is not sustained. This assumes that everyone would be vaccinated.
Currently we are doing something similar: each measure like wearing a mask, social distancing, meeting fewer people, ventilating rooms, finding infected people before they can infect someone else ("contact tracing") contributes to reducing the number of follow-up infections a bit. (This is why "but masks do not really work" is an ill-informed argument. They do not have to because they are meant to be used together with other measures to achieve reduction in spread)
A vaccine will protect us passively instead of requiring us to actively following these measures and will therefore be a lot more convenient.
In case of need, the Swiss cheese model:
https://mobile.twitter.com/sketchplanator/status/13127289416...
Covid is apparently around 3, and if you can vaccinate 90% of the population then an effectiveness of 75% would be the minimum you could get away with.
Probably 20% of people are responsible for 80% of infections. (People who work in shops or public places, people in large extended families, people who socialize a lot).
If you can identify and vaccinate those people it will be much more that 20% effective. (It might be hard to identify those but it's probably easy to identify people at low risk of spreading it and infer)
Keep in mind, that controlling covid is a giant win. We don't need to eradicate it, just get things under control.
Based on what we've seen there is no grey area. Either you fully control it which then ends up basically eradicating it e.g. Australia/NZ or you don't and then you end up like EU/US and going in and out of infection waves.
Right now if every activity would be fully available (concerts, conferences, airlines, etc.) every healthcare system across the world would probably be overwhelmed within 2 months, max.
Once we reduce the rates to a trickle, things are probably good enough.
I'm not saying that we shouldn't try to eradicate it, but as with everything, unfortunately, things are frequently taken to a point where they're "good enough" and no further.
The point of a vaccine is that you can't scale it back for populist appeasement; once you have broad immunity you keep broad immunity for long enough that you end up eradicating the virus almost involuntarily. In comparison, a lockdown is much more vulnerable to feel-good measures reducing the effectiveness.
Anything that reduces the R rate sufficiently will mean fewer outbreaks and reduce the strain on the hospital system.
From:
https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#:~:te....
In other words, its May 2020 and you have the option to ban vaccines or allow vaccines for the elderly, what do you pick?
We know the following about vaccines generally: -Vaccines have an extremely high success rate, 33% of vaccines make it through all trials to approval. 50% after phase 1 is complete. -The worst vaccine side effect ever is widely considered to be the swine flu vaccine from 60 years ago, where 1 in 100,000 got GBS, or Pandemrix, where 1 in 18400 got narcolepsy. (1)(2) -Vaccine candidates have 85% chance of making it from phase III to approved (phase III is supposed to be the efficacy check), in other words we expect about a 15% chance that the vaccine is not effective, most of the tests are about safety.
We know the following about COVID: -Unknown long term side effects, reasonably likely to be worse than the worst vaccines ever, but unknown. -The IFR for those over 75 is about 4.6% now(1). Earlier in the pandemic it was about 11.6%(2). -If you assume that people have a 10% chance of contracting the disease, you can say that those over 75 would have approximately a 0.46% chance of dying (4.6 in 1,000 dead) if they don't get the vaccine. This seems to be a conservative estimate.
So if you have to decide whether to ban a vaccine or not in May 2020, and you assume with 100% confidence that this vaccine was tied for the "worst side effects ever", for example it turns out to be as bad as Pandemrix, then you would expect 1 in 18400 to get something like narcolepsy if you give them the vaccine.
Using the IFR and 10% number above, you assume that not giving the vaccine would leave 84.64 dead for the same population. (85x by volume).
I don't know your opinion of "how much worse is death versus narcolepsy?". If you believe death is 10x worse than narcolepsy, then by severity and volume, taking a vaccine with the worst side effects ever would seem about 850x better than not taking it (in elderly populations). Earlier in the pandemic, when IFRs were over 2x as bad, this was well over 1,000x better.
I mean, the numbers so dramatically favor vaccination that I don't get it at all. Why is this not approved already? Why does it take the FDA 3 weeks to even discuss the matter of approval when this made sense to approve in May? Why did all governments opt to ban the vaccines versus allow them?
Sources: (1) https://en.wikipedia.org/wiki/Pandemrix (2) https://www.cdc.gov/vaccinesafety/concerns/concerns-history.... (3) https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v... (4) https://www.nature.com/articles/d41586-020-02483-2
I read recently that in some European country (was it Germany?) the willingness to vaccinate against COVID-19 went down from 80% to 60%. With these numbers policy makers will have a hard time convincing the broad population that they can rely on a due process and be safe. In the meantime there is a proliferation of false information and fake news, while in the past there was not much media coverage of significant side effects from a rushed swine flu vaccine [1].
[1] https://www.vox.com/2015/7/27/9047819/H1N1-pandemic-narcolep...
Medicine is a bit different though and every country probably has institutes checking the vaccines independently. A lot of eyes are on this probably. No company wants to be the company that botched the corona vaccine.
It depends what's more effective, as these groups are all different: do you jab first those who can most easily spread it, those who would most easily get it, those who would most severely be impacted if they got it, or do you jab those who are most diligent, enthusiastic and first in the queue?
I'd even wager that most healthy adults around the world will not be getting the vaccine (but that might be a negative story to run with) but that's at less odds than just healthy, enthusiastic, low risk people getting the jab first.
So, like nil then? I still can’t find anything beyond dramatized anecdotes to suggest any special danger beyond what is commensurate with the symptoms.
By the time the vaccine is available for my kids, hundreds of millions of people will have already been vaccinated, and there will be very extensive safety data. Part of the requirements for emergency use authorization is extensive monitoring of safety, so if there's any problem with one particular vaccine, it will be known by then.
But for the deadly virus you interpret the lack sufficient evidence on children as no risk, for the vaccine as as a sign of risk. How do you justify that inconsistency?
Not the person you're replying to, but looking at similar viruses, there's basically never been a flu-like virus that has no short-term symptoms but serious long-term symptoms, however there have been rushed vaccines that had serious long-term symptoms.
I think getting people vaccinated is going to be a huge challenge.
I think whilst we all want to be safe, ultimately in a year or so, most of the population won't be getting this shot on a regular basis.
>> Citation needed <<
https://www.wral.com/coronavirus/are-nc-s-coronavirus-case-n...
https://www.portugalresident.com/judges-in-portugal-highligh...
(NYT) https://www.nytimes.com/2020/08/29/health/coronavirus-testin...
There's probably a name for the phenomenon. If not, let me propose "The duality of Hans"
This is not without risk.
There are a lot of unknowns with this brand new vaccine, yet many of us have personal examples of people in our lives shrugging off a bout of Covid with ease. It's not a completely irrational choice to wait for a few years before taking this vaccine.
If you're a front line worker, like a doctor or nurse in a hospital, your chances of getting real COVID with real damage are very high. The long term effects of that are known to be bad. So any long terms effects of the vaccine are more than likely to be way way less dangerous. Also vaccine is, so far, not lethal which makes it a way better option.
Eventually we, the general population, will learn more about these potential side effects of the vaccines and start to gain access to said vaccines. Until then let's not go all anti-vaxxer and pretend we think vaccines give you autism.
I agree with most of what you said, but equating rational skepticism with anti-vaxxer paranoia is a bit of a dick move.
Any drug should be approached with great caution, and we should be willing to see its faults even when we're primed to strongly wish for relief from the grip of Covid lockdowns.