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Comment by beagle3 | Hacker News Reader

It should be noted that this is likely nit worse than Pfizer, despite marketing. The 50% for Sinovac is real world data; the 95% for Pfizer comes from company phase 3 data.

Well, last night a reputable Israeli HMO posted it’s real world data for Pfizer, and it’s 50% after 18 days and doesnt seem to get much better (but they don’t have enough data yet to know for sure).

And now, although everyone claims Pfizer says you get 50% after 1st dose and 95# after second, if you read the actual filing, that’s not what it says; efficiency is achieved at day 13 by Pfizer data almost fully; and the reduction in severe disease (the only interesting endpoint) is 75% with confidence interval 0-100%

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"The data, which looked at more than 700,000 fully vaccinated people in Israel, found that only .04 percent of people contracted Covid-19, according to the head of Israel’s Ministry of Health, Dr. Sharon Alroy Preis at a press conference on Thursday.

The type of vaccine Israel has mostly used is the Pfizer/BioNTech vaccine with a small number of doses from Moderna. The two vaccines use the same technology, and in clinical trials were found to be about 95% effective. " https://edition.cnn.com/world/live-news/coronavirus-pandemic... Can you share your datasource claiming that efficacy is only 50%?

https://www.medrxiv.org/content/10.1101/2021.01.27.21250612v...

You’ll have to actually read it, or find a tldr from someone who knows what they are doing.

The same calc that leads to 0.04% above would say overall covid mortality is 0.08% and is intentionally misleading - but no news media so far (in Israel or outside) has done any review. They are all parroting the misleading numbers.

Anything but primary data these days is suspect. (Pfizer’s own primary data, btw, says severe disease is 75% RRR with CI 0-100%. Did you see anyone reporting on that?)

Edit: to add: Israel is an a horrible bind right now. The vaccine is only 50% effective but gov has done very badly in handling the disease and promoted the vaccine as “our way out”, so the gov is attempting to hide that data. Unfortunately for them, Israel is too small and the culture not supportive of hiding this, even if at this point the mass media is cooperating with the government.

Please stop spreading lies. The paper is only about "The effectiveness of the first dose of BNT162 ..."

50% efficacy after the first dose is exactly the number that BioNTech reported in its Phase3 trial. So nothing unusual here. That is why the 2nd booster shot is needed to get to 95%.

No it is not. Have you actually read either Pfizer’s report or this paper? Looked at their data?

The graphs, both in Pfizer’s original report and in this paper, show that past about two weeks, there is almost no change. Please look at the Pfizer graphs and tell me where the great advance is from 50% to 90%

Also, if yo actually read the Pfizer report, you’ll notice the 95% is for mild disease - a totally uninteresting result. For severe disease, it is 75% with a CI spanning the whole 0-100% range.

Well, the solution to this dispute is easy => We just wait another 8 weeks:

(1) If am right, then Covid is gone in Israel by end of March.

(2) If you are right, Covid will be still a huge problem in in Israel.

I won't hold you to this, even though you are guaranteed to lose in this bet even if you are right - because the trial for 5-12 that would allow to vaccinate them is not expected to yield any data until later than that. Even if you are right, it will still be here in that age group.

Also, there's a nature paper from last week that shows incredible correlation between Sun UVB at 34% of equator and the date that a wave starts. Covid will be gone by June, just like last year, thanks entirely to that effect (and possibly arrive again in Sep/Oct, or not). I'm not interested in meterology, but it's possible that even if I'm right, by end of March covid will be very dim in correlation with UVB exposure.

The amount of data actually attributable to cause and effect is incredibly miniscule. I do data science for a living. The headlines are basically all wrong, most discussions are, and quite a bit of the primary data cannot be right.

added: p.s - Did you actually read the papers before calling me a lier (or after?) or just did it based on headlines. I'm not holding it against you either way, just wondering.

Quoting from the link you provided:

"We demonstrated an effectiveness of 51% of BNT162b2 vaccine against SARS-CoV-2 infection 13-24 days after immunization with the first dose. Immunization with the second dose should be continued to attain the anticipated protection."

I.e. if you take only the first dose of the two required then 13 days after taking it you already get an effectiveness of 50%. Therefore they recommend that people take the 2nd dose as prescribed. They don't mention effectiveness one week after the 2nd shot, which is what Israel considers to be immune (i.e. "green passport" status).

The 95% everyone quotes is for mild disease.

For severe disease, Pfizer had 4 in the control group, and 1 in the vaccine group. That’s 75% RRR, with a confidence interval that spans 0-100%.

Look at the graphs here and in Pfizer’s. Immunity seems to taper at 12-18 days and stay there. The 2nd vaccine does not seem to confer more immunity - just expected to last longer time. This article looks at more severe disease than Pfizer’s 95% endloint (though possibly not severe as their “severe disease” endpoint - I don’t remember what definition each uses, but just in Israel the “severe” definition has changed several times)

>Well, last night a reputable Israeli HMO posted it’s real world data for Pfizer, and it’s 50% after 18 days and doesnt seem to get much better

Their initial results are actually very encouraging[0] in this regard.

[0] https://www.ynetnews.com/health_science/article/Hk2URcnku

That is propaganda. The real data is in https://www.medrxiv.org/content/10.1101/2021.01.27.21250612v... and is 50% (not uniformly over age groups, but 50% is a good summary of it all).

The Israeli government failed miserably in dealing with covid. They were successful in getting the vaccines (and thanks to the HMOs and no thanks to the government, deploy them quickly) and selling the hopium that this will solve everything and make up for the failure so far.

So now they are in a very bad place. If they admit the real stats publicly before the vaccine project is done, people will stop getting vaccinated (not because 50% effective is bad - but because they’ve been misled). No one wants that. I suspect that’s why the media (ynetnews - a local USA Today equivalent, included) are all parroting the official statements without review comment or criticism.

The numbers in the ynetnews are not false but they are (likely intentionally) misleading. If you used the same arguments, you’d get an IFR that’s way lower than the flu, for example. They cherry picked a completely meaningless statistic that looks good, and claimed it is the vaccine efficiency. It is not.

Please stop spreading lies. The paper is only about "The effectiveness of the first dose of BNT162 ..."

50% efficacy after the first dose is exactly the number that BioNTech reported in its Phase3 trial. So nothing unusual here. That is why the 2nd booster shot is needed to get to 95%.

See my other reply to the other copy of your comment.

Please prove that you actually read the Pfizer report and not just repeating headlines before calling me a lier.

I might have misread some data, but I see no indication that you are in a position to judge that.

You're mixing up two different datasets. The former deals with first dose effectiveness (which we've always known to be lower - that's why the regiment is two doses), the latter with the full two dose regiment.

Ynet is Yediot, which is either the biggest daily newspaper or the second-biggest depending on how you count, either way it has more influence than Yisrael-Hayom. They do neglect their English site, but this particular content matches their Hebrew publication. It can't be seriously compared to USA Today (which is one of those magazine you mainly get for free, and barely has any dedicated readership).

Please look at the graphs and data, not the headlines.

Nothing magical happens past day 12 from the first vaccine in the Pfizer paper, or day 18 in this paper. Seriously. Look at it.

Yes, ynetnews is ynet/yediot. Their reporting of covid is exactly parroting the government with no criticism whatsoever so far.

I’m not antivax, I’m provad. 50% is pretty damn good for a first attempt. But everything has become so political, I go read primary data - and it is NOT remotely close to what the headlines say.

I'm not referring to the Pfizer research, I'm referring to the Maccabi paper. The data is explicitly for the first dose and not the second. The paper also mentions the effect starts from day 18, not beforehand - maybe you should read it again.

What Maccabi did publish on the second dose, it was in a much more encouraging note. Granted, not a peer reviewed paper, that would be difficult given lack of time.

Claiming Yediot is parroting the government is delusional. I won't belabor about it, since most HN readers deserve better than Israeli politics or the eternal elections.

The main point that beagle3 makes is that the Pfizer study actually shows ~89% efficacy starting 12 days after the first dose, which improves to ~90% immediately after the 2nd dose (day 21) and ~95% 7 days later (day 28).

The Maccabi study was designed with this comparison in mind: they look at efficacy in days 1-12 and 13-24 after the first dose. They are mainly interested in comparing the Pfizer results for days 13-21 (89% efficacy) with real-world data. They show that the real world data is actually showing only ~50% protection in days 13-21, compared to 89% in the Pfizer data for the same period. This is somewhat disheartening.

HOWEVER, the Maccabi paper is not measuring the same thing as the Pfizer study. The Pfizer study only looked at symptomatic infections (Covid19 symptoms + positive PCR for SARS-CoV-2), while the Maccabi paper is also including asymptomatic infections.

Neither study includes sufficient data to accurately compare with the other one - the Pfizer study did not do PCR tests on anyone who didn't show symptoms, so we don't know how many asymptomatic infections they had exra; and the Maccabi study didn't record symptom information, so we don't know what percentage of those infected were symptomatic.

All of these numbers and facts are explicitly mentioned in the Maccabi study, it's not me reading into the data on my own.

You are correct, but this doesn't show a conspiracy like a certain other commenter hints at.

We always knew that the the Pfizer vaccine has a lower chance of preventing transmissions, the original treatment regime was two doses, and we further know that the Pfizer vaccine wasn't originally tested vs B117 and the other mutations and it's quite possible it has lower efficiency vs those.

Still, there's a good chance two doses offer even higher protection, and frankly if all adult population receives only the 'symptomatic' protection the plague will be over as far as Israel is concerned (barring yearly(?) boosters) - hearing there's any protection for asymptomatic infections is heartening.

No, it doesn’t show a conspiracy.

The political rather than medical decision making in Israel is out in the open, there’s no need for conspiracies.

It took @RanBalicer 3 days to acknowledge the abysmal data, and it was not “gee, we might have made a mistake in the model”, it’s always “an unexpected twist in the mutation/behaviour/population”. It is beyond embarrassing. But I digress.

Let’s just agree that the 95% RRR for “reported mild symptoms” is meaningless, and that the 50% number from Maccabi is actually good news, and we should use that number in models and predictions?

I don't have an anti for Balicer, so I don't care if his models are right-or-wrong. It's natural to have mistakes, and changing position after 'only' 3 days is fine enough. I also agree that we heard some good news, but I do think that the 95% RRR is relevant - people who have a strong enough immune reaction to make the disease asymptomatic are people who have been protected. Once enough people have been protected, than hospital burden will go down and Israel could manage this thing.

The 2nd dose data maccabi sent out is pure PR; It's basically "We finished vaccinating yesterday, and almost no one got sick yet!" which, while true, is the most fudgible statistic ever. I'm ignoring it and waiting for the 2nd paper from Maccabi and the 2nd release from the K(alkstein) Institute - whom I trust more than even the Maccabi medarxiv paper (and I do trust them, about a billion times more than government press releases and the incredibly compliant mass media).

Edit: looking at the graph [1] more closely, I understand what you meant - there is no visible change in the slope past day 12 after dose 1 (dose 2 was administered on day 21). So the patient data actually shows that the vaccine achieved its maximum efficacy ~12 days after the 1st dose, not necessarily related to the 2nd dose at all.

Original comment:

I don't know where you're getting this, but the Pfizer paper [0] clearly shows that disease prevalence is much lower after the second dose:

> Among participants with and those without evidence of prior SARS CoV-2 infection, 9 cases of Covid-19 at least 7 days after the second dose were observed among vaccine recipients and 169 among placebo recipients, corresponding to 94.6% vaccine efficacy (95% CI, 89.9 to 97.3).

> Between the first dose and the second dose, 39 cases in the BNT162b2 group and 82 cases in the placebo group were observed, resulting in a vaccine efficacy of 52% (95% CI, 29.5 to 68.4) during this interval and indicating early protection by the vaccine, starting as soon as 12 days after the first dose.

You are right about the severe cases though - they had 1 in the vaccine group and 4 in the placebo group, which is far too little data to draw any meaningful conclusions from (it's also worth noting that the single severe case in the vaccinated group occurred >7 days after the second dose, so there is absolutely no data to draw conclusions on severe disease impact with a single dose).

[0] https://www.nejm.org/doi/full/10.1056/NEJMoa2034577 [1] https://www.nejm.org/na101/home/literatum/publisher/mms/jour...

Indeed that is what I meant. Thanks for trying to understand even if I wasn't perfectly clear in my wording.

Indeed, maximum efficiency is achieved after 12 days in Pfizer data (and similarly in the Israeli data). That's the reason some countries consider giving just one - they suspect it won't be as-long-lasting without the booster, but that's from prior experience, not anything specific for this vaccine.

I'm incredibly frustrated at the amount of people parroting "yes, two weeks after the first vaccine it's 50%, two weeks after the 2nd it's 95%". Yes, that's what Pfizer said, and I think I managed to reproduce their calculation - and if I did, it is intentionally misleading.

It seems a lot of people are religiously believing the headlines without looking at the publicly available data. I thank you for looking at it.

There seems to be a major flaw in comparing the data between the two studies: the Pfizer paper is counting Covid19 cases (symptomatic cases with confirmed PCR for SARS-CoV-2), while the Maccabi paper seems to be counting SARS-CoV-2 infections overall, which would include asymptomatic cases.

They even say so explicitly:

> Second, our case definition was positive SARS-CoV-2 PCR test irrespective to presenting symptoms that defined COVID-19 cases in the RCT. This might explain the discrepancy in results.

So, this new research is not really contradicting the Pfizer paper in any way - they are simply measuring different quantities.

Still, it's nice to know that the vaccine also offers protection from infection, not just the disease.

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