AstraZeneca vaccine – was it really worth it? | Hacker News Reader

AstraZeneca vaccine – was it really worth it?

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59 pointsmellosouls44 comments

People seem to forget that we launched all of these vaccine types simultaneously because we were terrified that NONE would work.

The only reason we can sit here and armchair quarterback the AstraZenca vaccine is because we actually got really lucky and have a plethora of functional vaccines.

Had you told medical researchers 12 months ago that by March 2021 we would have a half-dozen Covid vaccines and we would have multiple ones at 95%+, they would have told you that you were delusional.

The armchair quarterbacks think we have a plethora of functional vaccines. With all the logistics involved, there is little actual choice unless you want countries to remain locked down or watch people keep dying for another 6 months or more. It doesn't matter that Pfizer seems to have won the PR war when we can't afford to wait for factories to be built to manufacture it in sufficient quantity.

We have created a plethora of different functional vaccines, however as you said due to logistics there isn't a plethora of choice for "end users". I could've taken the AZ vaccine, but decided to wait for an available mRNA and it looks like that wont be soon.

We don't get that choice. Our mRNA supply is entirely going to health care workers and the most at risk. And overseas manufacturing capacity is entirely spoken for for longer than anyone wants to wait. So everyone else is getting AstraZeneca, and maybe a switch down the line to something else we can manufacture locally. Choice for the country is AZ, or nothing and starting again in 6+ months. So watching the potential health concerns and trying to weed out the political posturing. The non-justified criticism is going to have a real effect on vaccination numbers and efficacy, and those numbers are already going to suffer due to the justified criticisms.

I think you're overstating it. There's a vast difference between "terrified that NONE would work" and "wanted to maximize the chance of at least one working vaccine."

I don't understand what there was to negotiate about which apparently was done better by the UK than the EU when these vaccines are being sold without profit; so for a fixed price? If there subsequently is a shortage in production you can not accept extra money to provide more to one than the other (then you would make a profit) so I'd say it logically follows that you either go with a first come first serve distribution or a social, per capita, distribution.

PS: I was really hoping the world would have banded together to develop all vaccines publicly; sharing their recipes and allowing the whole world to produce as much vaccine as possible without artificial financial limitations.

So much felt the same about your last point. Unfortunately it looks like every country / bloc is trying to gain advantage by getting to a post covid economic prosperity state first. It is reasonable in real world terms though though because very few countries have the facilities to manufacture vaccines at scale even with open recipes.

How does that make it reasonable to close and effectively keep medicine away from people unless they pay more than cost price? Of course if some countries can not produce it themselves they will buy it from other countries. Having an open recipe just means factories will only be able to compete on price and quality; not on secret recipe.

I don't understand why we allow capitalistic control of medicine at all. The goal should be to maximize health, not profit. And in many ways, directly through subsidizing and indirectly by providing the wealthy infrastructure and schooling etc the public are already paying for medicine research anyhow. Why not go all the way and make it public altogether?

But I guess I'm a bit of an idealist..

I'd love to know how much of AZ's treatment has been legitimate concern versus how much has been political backlash because the EU was humiliated by the UK negotiating the majority of the vaccine access so soon after leaving them.

The real tragedy is that their treatment is certainly a dis-incentive for drug and other companies to ever do anything pro-bono / for the benefit of humanity again. Well done EU!

Yeah, right, it's a huge disincentive indeed. If anyone took the time to read my old posts about Big Pharma he or she would quickly learn that I've been very critical of the pharmaceutical industry for a long time for reasons most of us are all too familiar with. (It will hardly escape anyone who reads my long prolix HN posts in criticism of Purdue Pharma L.P., the Sackler family and the regulators who let the opioid crisis happen that I'm incensed and furious about what happened—especially so given the 150+ years of modern medical experience with these drugs not to mention the presence of both longstanding national and international laws that are in place to control their use.)

Thus you'd expect me to be one of the last to stand up for AstraZeneca, however as I see it the company took an extremely rare approach for a pharmaceutical manufacturer in that it took a philanthropic approach to its vaccine development by foregoing considerable profit and deliberately refraining from price gouging when the world was in a state of crisis. Leaving matters of past bad behavior of the pharmaceutical industry's aside, when those within a section of the industry adopt the moral high ground and act accordingly then they deserve just praise and encouragement, not criticism. Anyone with a modicum of nous ought to be fully cognizant of the fact that with the pandemic raging it's not business as usual and that one ought not to expect everything about the vaccines rollout to run as smoothly as everyone would have liked.

Frankly, I'm appalled at the various politicians, especially those from the EU, who've strongly criticised AstraZeneca over vaccine issues and delays in its delivery. To me, these people are nothing less than nasty hypocritical shits and they deserve to be told so. Moreover, I'm also critical of those such as the British Government for not being more outspoken and thus immediately putting the kibosh on those unjust EU criticisms. AstraZeneca and other pharmaceutical company will not forget this criticism. In the light of what's happened come the next time no AstraZeneca or any other CEO will be so magnanimous. One should not expect it of them given that they are likely to be licked in the face from two sides—their shareholders and ill-informed politicians.

It seems to me that some of the world has gone into brat mode; not only do these criticisers have an overdeveloped sense of entitlement but also they've lost sight of what's really happened over the past fifteen or so months. Back at the beginning of 2020, the pandemic was raging across the world, people were dying on mass, and there was little certainty when a vaccine would be available if at all. Nevertheless, researchers in Oxford and AstraZeneca along with those at Pfizer–BioNTech, Moderna and others responded magnificently and did so in record time. Minor issues aside, this is a truly wonderful achievement and we ought not to lose sight of the fact.

If anyone is to be criticised then it ought to fall on certain politicians (I note however, that some have responded to the crisis very well). I hasten to point out that it was politicians and other influential people who failed to take seriously the many clear warnings from decades-old scientific evidence about forthcoming pandemics. If they had then the world would have been much better prepared for this pandemic (for starters, there would have been sufficient masks to hand for everyone at the beginning of the crisis, and in all likelihood research into coronavirus would, by now, have been much further advanced).

Furthermore, the overly strident criticism over the safety of AstraZeneca's vaccine in the light of a small number of seemingly allergic/overly active antibody reactions is unwarranted as it is way out of proportion to the overall utilitarian benefit that this vaccine will bring to the world. Those who've been critical have in all likelihood caused much more harm than good, as their actions will result in more people refusing to be vaccinated. In the end, far more people are likely to die from not being vaccinated than from any reaction to the vaccine. (It's been long well known that all vaccines—or for that matter, medical procedures of any kind—carry with them some small risk, and with most vaccines made these days it is very small indeed.)

The hypocrisy of hypercritical politicians is even more damning when we consider that only months ago they were urging regulators to approve vaccines post-haste even though only limited trials had been carried out. It's appalling that significant numbers of those charged with the governance of our countries have so little conception about the development to production cycle and problems that are likely to be encountered in manufacturing. It ought to be damned obvious why rushed development and production doesn't always run smoothly or exactly to plan.

I feel very strongly about this because I well remember the polio epidemic when I was a kid—there were kids in my class left with callipers on their legs; with them, they could just barely walk and without them, they couldn’t walk at all. At the time it sent shivers down my back just to think about it. So when Dr Salk's miracle arrived, it was a welcome blessing, especially so for our parents. We accepted with a little fatalism that things weren't perfect and thus there was little complaint from knowledge of fact that early on during the initial phase of production some batches of vaccine suffered quality control problems that caused them to contain active viruses and consequently some kids died tragically from vaccine-induced polio. By my time, we had been informed the QA problem had been fixed and we accepted the fact.

I can vividly recall standing in a long line at school waiting to be vaccinated. By today's standards, this was a risky business as we kids were immunized with a common shared needle that was only changed after a dozen or so kids had been injected. (There was a bidding war and an exchange of coins between us, the highest bidders paying to move to what we guessed would be the best position in the queue come one's turn, that being first after the needle had been changed for new. This wasn't for reasons of health but because a new needle was sharper and thus it hurt less).

There were precious few complaints from us kids about the injection; we were all clearly aware that the alternative was far worse.

The whingeing and bellyaching should stop. It's time those doing so took stock of the fact that the vast majority of people in these pharmaceutical companies as well as those in the medical profession are doing their darnedest to get vaccines out to us as quickly as is possible. If nothing else, the whingers should at least take into account the demoralizing effects their intemperate words have had on hardworking researchers and other workers at Oxford and AstraZeneca. A little humanity would go a long way.

I don't see how you can promise one buyer 'best effort' and then prioritize another buyer. Could AZ deliver nothing to EU and still claim it was their best effort, just because someone else negotiated something 'better' than best effort?

there's 'reasonable effort', 'commercially reasonable effort', 'best effort', etc.

these are all legal terms that are commonly used, but are still a little vague.

my read (and ianal) is that if a company has a hard contractual obligation to fill an order, they need to do that first and then can make a 'best effort' to fill the other orders.

best effort is effectively lower priority than an actual contractual obligation.

> negotiating the majority of the vaccine access so soon after leaving

The UK government tries to make it seem as if the Brexit allowed them to do that but actually all that happened while they were still member of the EU.

It wasn’t directly related to Brexit; as you say, any of the EU member states could have done their own thing and not entered the EU’s vaccine purchasing scheme. But the UK Government’s Brexit mentality would have certainly played into their decision: imagine them entering the EU’s scheme so soon after Brexit - it would have been unconscionable. (And interesting that none of the other major EU countries did go it alone - gotta keep it together.)

Anyway, the real issue here (over which there’s plenty of CYA-ing and blame being thrown at AZ) is the EU did a poor, slow job of a) negotiating vaccine supplies (not just with AZ - but mostly ignoring or deprioritising options from other manufacturers such as Biontech/Pfizer) and b) getting the vaccines approved quickly through the EMA.

As an aside, the EU countries also seem to be doing a fairly poor job of operationalising the vaccination of their citizens. Anecdotally, a friend’s frail father is in a far worse risk group than my mother, yet will be finally vaccinated months later thanks to living in Germany, vs. the UK.

The EU seems to be a bit too good-natured for their own good. They assumed that everyone would play nicely and got double-crossed by the UK and US. I bet they learned a thing and at least regarding AstraZeneca's production inside the EU, they seemed to have taken off the gloves.

> Anecdotally, a friend’s frail father is in a far worse risk group than my mother, yet will be finally vaccinated months later thanks to living in Germany

It's possible to be vaccinated earlier if they are at risk for a severe case of Covid. They might want to consult with their doctor and would need some medical documents to backup the claim. Knowing that it is actually possible might help, so maybe tell them?

to be honest it's less about the EU being good-natured and more about them being bureaucratic. They didn't move fast enough to secure the contract and then distribute the vaccine quickly. That's 100% on them, but now that they're embarrassed they're trying to make the vaccine look like it was a bad thing anyway. That, and threatening to use protectionism to deny AZ the right to fulfil its contracts.

It's very petulant, in the same way if you deny something to a child they could throw a strop and say "well I didn't want it anyway".

> It's possible to be vaccinated earlier if they are at risk for a severe case of Covid. They might want to consult with their doctor and would need some medical documents to backup the claim. Knowing that it is actually possible might help, so maybe tell them?

Thanks, but they (and supportive relatives) are 100% on it. It’s the speed of the roll-out in Germany that’s the issue.

Different federal states have already made use of 75% (Mecklenburg) to 95% (Thuringia) of the doses delivered to them, with most states being in the range of 83-87%. A part of the remaining doses is reserved for second shots and the remaining unused doses really must be because of inefficiences of some sort. Claiming that the speed of roll-out is slow when most federal states have already used more than 6 out of 7 doses that were delivered to them so far is surprising.

https://impfdashboard.de

Fair point: I'm wasn't seeking to differentiate between vaccine supply and operational efficiency. Ultimately, the end user has little insight into where the issue lies - but thanks for the dashboard link that clarifies this.

So let's be more specific: the slow roll-out of vaccination in Germany seems to be related to failures in vaccine procurement and supply at a national and/or EU level. And this is why frail elderly people are still waiting... when less at-risk people in the UK have already been vaccinated.

> They assumed that everyone would play nicely and got double-crossed by the UK and US.

That's a very peculiar perspective about the UK.

A British university and the British government, supported by British public funds, joined with a British/Swedish manufacturer to create and offer a vaccine to the world at cost (having turned their backs on around £15BN of profit - see Pfizer & Moderna projections).

Why would they not expect that the British vaccine plants supply the British needs first?

The UK also got lucky the Oxford jab actually turned out being very effective. If both GSK and Oxford had failed delivering a viable vaccine, the UK would have had to scramble for Pfizer against the US, the EU and the rest of the world.

Let's all remember the UK still hasn't approved either Moderna or J&J, so their success has been basically all thanks to AstraZeneca providing them a constant supply of doses from their UK factories.

They played their cards well, and luck rewarded them. The EU commission played safe by placing (with too much delay) orders on lots and lots of vaccines, but only a handful of them turned out being ready for shipment on December. If Sanofi had something ready months ago, this whole situation would have been very different.

Let me also point out that outside the USA and the UK, both of which are manufacturing countries themselves, and Israel, which accepted to become Pfizer's guinea pig, no other Western country has had a good time at sourcing vaccines. Canada, Australia, even Switzerland (which is filthy rich) all have way less doses available than the EU does, right now.

Also, it's important to remember that the EU scheme allowed less influential nations to actually get hold of vaccines. Without the current scheme Germany and France would most likely have had enough leverage and resources to quickly gobble up the entire available stock of Pfizer and Moderna available for the European market, leaving Eastern and Southern Europe with only the breadcrumbs. The internecine fight that could have ensued would have caused irreparable damage to European integration, throwing the EU countries into deep recession and definitely helped Russia a lot. It's unfortunate the EU commission didn't do a better job, but I think the EU countries knew very well that the Commission has zero experience in this area, and deliberately chose what was simply the less risky long term solution.

The only thing I have learnt from all this is Plague Inc really needs to update its algorithm to take this in to to consideration. Usually once a vaccine is ready it’s game over for my poor virus, but in reality...

So far we can rather assume only the Italian manufacturer botched it. We see not much other evidence.

The British and Swedish batches had not much problems, and the Italians so far 2 major ones. First a changed component which caused the dosis debacle. The whole italian batch was measured to contain the double dosis, so they asked for special permission during the tests to apply only half the dosis. Which turned out to have an 95% effectiveness, compared to 65% with the full dosis.

And then they found 30 million packages hidden in the Italian factory. We don't know if they wanted to sell it non EU countries (most likely), but why? Either for profit, or for less risk, because only the EU requires liability. So if they really had bad batches from Italy, I would try to hide them and sell them elsewhere, without liability.

The third debacle is the German government and the EMA, who continue to act completely irrational. Nobody trusts them anymore, which is counterproductive, with an assumed Factor-V-Leiden risk with women <55 (in 5% of all women in D), but now they cancelled it even for men, and before canceled it for local doctors, which makes even less sense. The local doctors are totally pissed now.

AstraZeneca has completely botched this. There’s no way you get into this much trouble without poor management.

What did they botch? Maybe I am uninformed on this, but from my perspective they did everything right - to the best of their abilities.

HN is teeming with subject matter experts of all kinds, particularly rapid adenovirus-based vaccine development. Best not to question it.

and large container ship rescue specialists too.

It's crazy that you get to hear theoretical physicists casually mention their personal theories too.

HN is quite the zoo!

Saving the world is a thankless task.

You're welcome, bro.

They ran a clinical trial where they accidentally gave a number of patients half a dose. Apparently this was due to lack of validation of an assay by Oxford.

I think the problem is that these "small" issues pop up which just further erodes confidence in the vaccine.

And yet that accident enabled them to discover that an initial "half" dose eas actually more successful than an initial "full" dose.

All of this has been very well scrutinised and documented, far more so than any other vaccine supplier.

It was serendipitous that it happened, but my god, that's not supposed to happen in clinical trials run by companies like AZ.

I suggest that you don't read up on how penicillin was discovered then!

Leaving aside the properties of the vaccine, not keeping promises is a really bad look. Committing to deliver x amount and then delivering .8x without much of an explanation is a sign of bad comms at the very least. And that has not happened once. If you look at how many times AZ has promised to start keeping to the schedule and get their capacity up, the list gets pretty long.

It does not take a management genius to predict, that vaccine deliveries in EU are going to be observed using a microscope and that the moment you flinch, they’ll bite. And AZ flinched.

We’ve all been there. Engineers tell the leadership x is possible, customer demands 2x, leadership bullies engineers into agreeing to deliver on the impossible and in the end it all goes to hell. And that’s a clear leadership failure.

Accepting that they own much of it, I think they don't own all of it. Some of the problem vests completely outside their control.

At root? yes, were I a direct shareholder/invester I'd be seeking management change at the top. So I probably agree with your implied sentiment. But it would be stupid to believe all of the problem vests wither with AZ or with how they reacted to external forces. Some of the blame lies in those (human mediated, political) external forces.

The blood clotting notwithstanding, I listened to the FiveThirtyEight Podcast-19 episode about AstraZeneca's vaccine efforts. It was interesting in recounting the efficacy controversy.

I'm not sure that AstraZeneca is totally persona non grata, but they deserve increased scrutiny with how they determined their efficacy and how selective they were in including certain data. That's one of the core issues with their vaccine.

IIRC, they claimed, early on, an efficacy in the high 70s. The Data and Safety Monitoring Board called them out for selectively including data and mentioning that with the extra data, it would lower their efficacy into the low 70s, and finally, more data was found that could have lowered efficacy to 69%. I think they're settling on a 74% efficacy rating, but still, the haggling over efficacy is concerning.

Whether leadership knew about this or not, they deserve to be scrutinized because they created a culture that would allow for this. Management is always culpable for every institutional failure.

Last I checked, the companies claiming 95% were measuring for COVID symptoms, but AZ was directly testing for infection. Most COVID patients are asymptomatic (especially vaccinated ones), so 74% and 95% suggest similar efficacy for the two groups of vaccines. (And so would a claim of 69% and of 79%)

I honestly don’t understand the controversy. As much as I like 538, their area of expertise is far outside medicine.

Cry me a river. Oxford was going to open-source the vaccine until Bill Gates convinced them to give an exclusive contract to AZ, to lean on their supposed capacity to manage clinical trials and related administrative issues (even though they aren't a vaccine-focused company).

Not a conspiracy theory:

https://www.nytimes.com/2020/11/23/world/bill-gates-vaccine-...

https://khn.org/news/rather-than-give-away-its-covid-vaccine...

That's not a conspiracy theory, that's misinformation. You're misreading it. It's still royalty free.

https://innovation.ox.ac.uk/technologies-available/technolog...

Bill Gates just got them a close partner in AZ to test and distribute it.

E.g Serum Institute is able to make it for free without paying royalties to AZ or Oxford..

The Kaiser piece is pretty clear -- AZ got an exclusive deal.

Here's Bill Gates on his reasoning for pushing the exclusivity deal. Basically he claims to be the authority on which factories/companies are "capable" and which ones are not.

https://youtu.be/Grv1RJkdyqI?t=564

With that in mind, it's sadly ironic that they ended up going with a company that hasn't been able to convince people that their shot is safe and effective.

As I understand it the Serum Institute of India got access through a partnership with AZ, not through a partnership with Oxford directly.

https://www.astrazeneca.com/media-centre/press-releases/2021...

This issue is a little touchy for me because lots of vaccine manufacturers passed over our country (Canada) for manufacturing, because the capacity was "too small for them"

https://nationalpost.com/news/politics/every-covid-vaccine-m...

Despite the fact that we apparently had a facility to manufacture millions of doses by the end of 2020.

https://theconversation.com/the-roots-of-canadas-covid-19-va...

And now we're doing really poorly in the vaccination effort. So yes, I wonder how it could have gone if AZ didn't gatekeep access (and bungle the public relations/comms front).

Interestingly, the company that apparently could have manufactured vaccines in Canada has a recent legal conflict with Bill Gates.

https://globalnews.ca/news/5035009/gates-foundation-sues-can...

Given that Bill Gates had a confirmed influence on the decision of Oxford to license exclusively to AZ, who's to say he didn't push AZ to not manufacture at this facility? It's not a far-fetched thing to imagine, given the "vetting" role he claimed in the YT clip I linked.

We'll probably never know, because this backroom exercise of power is not accountable to the general public, though it has serious implications for all of us.

(edited to lump together several comments)

Not sure why this is so controversial. Man got rich off of strong IP protections & market concentration and is now pushing the same in his "philanthropic" work.

Oh, bullshit. They had a turd on their hands from the very beginning and they knew it. It caused blood-clotting. They forged the efficacy rate by omitting recent data. It was a company with NO experience in making vaccines that took a moon shot and f'd it up and now is relying on the British press to pull them out of their rut. Tough shit.

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