Comment by Exmoor | Hacker News Reader

Comment by Exmoor | Hacker News Reader

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I disagree with your general conclusion that the vaccine should not be approved as-is. The efficacy results are certainly disappointing compared to the near-miraculous results with the two mRNA vaccines, but 60%+ efficacy is still enough to save many, many lives and bring the world back to normalcy. Remember, the 60% number doesn't mean 60% see improvement, it means of the people who would've gotten COVID without the vaccine, 60% didn't get it at all and 40% got it with significantly less negative effects. In all likelihood it will also greatly reduce the ability to spread the virus.

They have already begun testing the half-full dose as another trial, so if that works better than full-full we may see the approval modified down the line.

> we already have Pfizer and Moderna

Unfortunately production constraints are going to mean that it will take a long time for those two vaccines to be produced in enough quantity to vaccinate most of the rich world. The cost for them and temperature requirements mean that they'd be impractical for most countries even in a few years.

> 60% didn't get it at all and 40% got it with significantly less negative effects

We don't know that. As with the Pfizer and Moderna trials, the endpoint was incidence of disease, and only people with disease symptoms were tested. 60% fewer people experienced symptoms in the treatment group than the control group, but some of those may well still have "gotten it." There were very likely asymptomatic infected people in both groups, and we have no idea how many there were, or how the numbers different between groups. For all we know, just as many people in the treatment group were infected as in the control group, they were capable of spreading infection the whole time, and all the vaccine did was suppress their symptoms. (Again: possibly true of any of the vaccine candidates.)

When the broadest studies indicate that symptomatic cases are ~25x more likely to transmit the virus to people in their household[0] I would say that converting a lot of symptomatic cases to asymptomatic cases is likely pretty consequential.

[0]https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

Are you sure Oxford and AstraZeneca did not test for asymptomatic participants? My understanding is they tested a proportion weekly.

Edit: Nature mentions they did: https://www.nature.com/articles/d41586-020-03504-w

My understanding is that they did test a subset of participants, but that the 62% figure doesn't figure in the asymptomatic cases. They've made it very confusing though, much like how they've explained the half-full dose results.

Relevant section: The Oxford–AstraZeneca team is the only one of the three leading vaccine developers that monitored for asymptomatic infections, by collecting weekly swabs from some participants to determine whether they had the coronavirus but did not become ill.

> I disagree with your general conclusion that the vaccine should not be approved as-is.

Which dosing regime should be recommended in this case?

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