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Comment by mellosouls | Hacker News Reader

This seems like another overreaction that will be interpreted - rightly or wrongly - in the UK in political (Brexit) terms rather than medical or scientific (although they are clearly an important consideration).

It's difficult to see how Denmark isn't failing its population with this decision.

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It is about picking a safer and possibly better alternative costing a few weeks delay.

In Denmark, at least among the people I talk to, there isn't much confidence in AZ. The feeling is that Moderna or Pfizer are safer with higher protection (also against mutations).

So the common feeling here is really that the government would fail the population by using AZ instead of the (possibly better) alternatives.

Also, like it or not, the anti-vax pro-corona[0] movement is relatively large here, so using a vaccine that has possible fatal side-effects may give momentum to that movement, even if using it could save lives from a utilitarian point of view.

[0] One of their slogans is literally "Corona, yes please! The virus isn't dangerous." https://www.ooc.one/

Isn't this rather because AstraZeneca is sold at cost whereas other jabs are for profit? Then Google history of corruption of companies like Pfizer. I sound cynical, but I don't believe one bit that politicians are doing something out of their good will.

It seems like a far stretch to call this political?

If they're confident that they can source enough doses of another vaccine that has better efficacy and is not linked to serious side effects (even if very rare) then it makes sense for them to go with that one and drop AZ.

But if the alternative is no vaccine or AZ then it is indeed vastly better to continue using AZ.

Denmark's population is also less than 6 million so they don't need a massive supply compared to larger countries.

I'm currently living in Denmark. They are performing 200k PCR tests per day, that's literally 1/30th of the population every day.

If they could source the vaccines, they have the infrastructure to vaccinate the population in a month.

Of course, Denmark is part of Europe and therefore bears equal parts responsibility for the EU vaccination program joke.

The sad part is that AstraZeneca chose to sell the vaccine at cost, making no profit. This amount of negative publicity with no good reason will make them (and others) think twice about such a gesture.

Like half of the bad publicity for AZ is their own fault. The blood clotting issue is not, but the bad studies and the poor communication totally are.

Getting a warning letter from an US agency for publishing outdated data in a press release is quite a feat.

"The company says the agreed cut-off point for data was 17 February, by which time there had been 141 cases and efficacy was 79%. Within 48 hours, AstraZeneca had added more recent data. On a total of 190 cases, there was 76% efficacy (and as always 100% against severe illness and death). It’s not much of a difference." [0]

[0]: https://www.theguardian.com/business/2021/mar/26/how-the-ast...

That baffled me. They got a huge amount of stick for measuring up to the pre-determined cutoff point, which as I understand it is the correct way to do a scientific study if you want your results to actually be valid...

From what gathered, AZ said they had final data, but hadn’t actually finished the analysis, but preliminary numbers looked similar to interim so they just used those.

This.

The reason it is risky to measure data after a predetermined stop point is that it lets human bias play a role in making conclusions.

It is very subtle, but this human behavior has been a contributor to the replication crisis:

https://en.m.wikipedia.org/wiki/Replication_crisis

"It's not much of a difference" is a terrible excuse. This isn't about the percentage points they were off, this is about how such a thing looks in the public.

When you get a warning from a gov agency that you shared outdated data that just looks terrible. Just don't do anything in a press release that could even remotely look like you're trying to cheat with your data. It's a terrible idea in a situation like this.

Is this supposed to be some mitigation? A pharma company has a responsibility to publish accurate and up to date data. Full stop.

You say they chose, but wasn't this a condition that came from Oxford in negotiations?

"Citing the attack from Macron and unfounded accusations over safety and efficacy, Bell [0] said the company could re-think its philanthropic stance. “There’s a point at which AstraZeneca could just say, ‘you’ve got to be joking, we’re going to stop [charging cost price] now because we’re not getting any credit for what we’re doing.’ The share price has gone down, not up. We’re making more vaccines than everybody else. This is a safe and effective vaccine, but nobody seems to care,” he said this week."

[0]: Sir John Bell, the Oxford University professor who helped drive the vaccine’s development

> “This is a safe and effective vaccine”

> Sir John Bell, the Oxford University professor who helped drive the vaccine’s development

Since academics traffic in reputation, this is an example of a conflict of interest I think.

The vaccine's safety and efficacy is not based on one person's opinion, it's an established fact.

Yeah, $20 a shot vs $3 a shot buys a lot of influence.

Still, it’s good that someone stepped up the the plate, otherwise most people on earth would remain unvaccinated.

What would also help is if the UK and the US would export vaccine to other countries, like the rest of the world does. Sharing is caring?

EDIT: https://www.statista.com/chart/24555/vaccine-doses-produced-...

The UK mostly doesn't export its vaccines, because it makes much more sense for them to just set up other factories manufacturing them in other countries. Which is what AZ has done.

Looking at exported vaccine doses is a blunt measure

The lipids used in Pfizer's come from UK, Moderna exported vaccines from EU are actually brewed in Switzerland and finished in Spain for export

Well...not really. The UK manufacturing capacity is tiny from a global perspective. The EU tried to scapegoat the UK for their failure to run an efficient procurement, but that was just irrational politicking. The U.S. obviously has more manufacturing capacity, but like the UK it basically has no chance of dealing with the pandemic without mass vaccination, so exports are a political non starter.

What was really required was a globally coordinated response to the design, test, manufacture, and distribution of COVID-19 vaccine candidates, through the WHO/CEPI with the backing of the security council members. Unfortunately with the major countries locked in various levels of sub-explosive warfare with each other (and our international institutions gravely weakened*) we've ended up with a scramble powered by commerce and nationalism.

Edit: *through malice and incompetence

> so exports are a political non-starter

...in the US and the UK. In the end it's also a reflection of what is important to a nation. Should the strong help the weak? Is it every man for themselves? Thank you for making my point.

I think pointing to "international organizations" to do something, when you could have done something yourself, is a weak argument.

> in the US and the UK. In the end it's also a reflection of what is important to a nation. Should the strong help the weak? Is it every man for themselves? Thank you for making my point.

The UK has no ban on vaccine exports. It is more accurately the case that nobody has ordered vaccines from the UK except for the UK itself, because the UK had absolutely zero vaccine manufacturing facilities.

And of course it is factually false in any case: https://www.dw.com/en/australia-receives-astrazeneca-vaccine...

The EU (after encouraging other countries to invest in facilities in the EU) changed its mind and interdicted vaccines going to Australia. So they got some manufactured from the UK instead. But somehow it is the UK that is the bad guy!

The strong should protect the weak; they still have to put their own oxygen mask on first though.

Protecting your citizens is the first duty of government. There is a political failure here, but the domestic mass vaccination programs aren’t part of it.

Why on earth would the US export when it's supply-constrained itself? Of course, the US can and will export once it has sufficient supply. But countries exist in large part to look after the self-interest of their own population. It would rightly be a complete political non-starter for the US to start shipping vaccines elsewhere while it still needed more doses domestically.

Don't you think Europe is supply-constrained? What about India/Russia/China?

If these countries didn't export, Israel wouldn't have any vaccine, Australia wouldn't have any vaccine, Canada wouldn't have any vaccine, New Zealand wouldn't have any vaccine. And let's not even talk about the rest of the world.

But yeah, it's inconvenient. I get it. Greed is good! Let them starve.

Wouldn’t the greedy thing be to export all the vaccines you produce for maximum profit?

Everyone is supply constrained. Actually, the US is probably the country that is the least supply constrained.

Yet the EU and even India/China/Russia are exporting vaccines. This speaks a lot.

How is that sad? Do you think the CEO and shareholders approved that deal because their hearts are so good and pure, to help humanity? No, it was to become a vaccine manuf. in a time of pandemic, to make big bucks (since at cost sales end in August this year).

Oxford scientists came up with the vaccine and the deal to manufacture it with a partner. It looked like a great deal until it turned out that AZ is completely incompetent.

How is AZ incompetent? On other aspects than PR, that is. Their vaccine is working, it is sufficiently effective by anyones standard. That mRNA vaccines turned out to be better is great, but it was not sure a year ago.

They failed to deliver and respect the contract with the EU. This and what their CEO said about the differences in contracts between UK and EU (timing and best efforts - while the differences did not justify the different treatment). They cared so little about PR that some science communicators (like Burioni in Italy) stopped to defend the AZ vaccine because of the total lack of statements and communications from AZ, even if they have a positive opinion about the vaccine itself.

Well, my interpretation is that AZ did, in fact, not violate the EU contract. The contract states "best effort", not penalties and even redemnifies AZ from delivery delays in case these delays are caused by additional orders from the EU. And guess what the EU did, IMHO mainly to media and public pressure, earlier this year.

Given the bad press AZ got, reverting to a "no comment" strategy is not such a bad idea. Anything they say will be used against them anyway.

"Best effort" has a specific meaning in a contract, which is different from everyday use; this is why AZ could still be found in violation of the contract. This does not change the fact they have been unable to deliver by a huge margin and informed the UE with a short notice.

A company that just avoid commenting on issues your product could have or misinformation regarding it does not seem a company that cares about that. Hard for me that they had a good PR strategy.

I wrote drafts and analyzed procurement contracts for smaller volumes and less critical parts before. Of course with legal support. And all these contracts included initial delivery schedules (as an annex), delivery SLAs and penalties. And they were all considerably longer than the AZ contractthat was published. Fun fact, they didn't sacrifice 5 pages to talk about the order form.

The AZ contract has none of that. Ultimately, it would need a court to decide that. Once the point of discusing contract terms, the relation ship between supplier and customer is already ruined.

Good :) So you know what the contract and "best effort" mean and the kind of forces driving both parties. "customer is already ruined": that is why they would probably EU will not go to a court but it just ordered 50 M vaccines from Pfizer, while rumours of the EU not renewing the contract with AZ are getting stronger (some EU/EEA countries have plans to move forward without it).

I just see a bad behaviour and PR from AZ. That and having a CEO that says that UK got it first because of the "best effort" clause when both UK and EU contracts have does not seem very professional to me IMHO. I am not sure why that happened.

I think incompetent is harsh, but they had a bad data submission and also a dosing error. Neither is a good look. Neither ended up being a big problem but they could’ve been.

Yeah, that was an issue. I cannot tell how much of an issue, because I have zero experience with medical trials. As do most people, I assume, getting upset about that. Regardless, AZ got approval in the UK and from EMA in the EU. And these entities job is clinical trial assessment.

Unless I am going to refuse any and all drugs and medical treatment, I will have to trust e.g. EMA that the stuff I take when being sick is safe and working as intended.

A good heuristic for how big/rare of a problem would be to try to find another instance of NIAID publicly scolding a company seeking approval. Doesn't happen.

I’ve got a little bit of FDA experience, but of course no COVID-19 EUA experience. Based on what we submitted to the FDA and the comments we received, I would personally think it most likely there were many issues with AZ’s materials, at least as far as their attempts to seek approval from the FDA went.

^ This is misinformation.

AZ is a profit driven pharma manufacturing company. Oxford University developed the vaccine.

When Oxford licenced the vaccine to AZ -- it was at the institence of Bill Gates a major donor to Oxford and shareholder of AZ. The licence allows AZ to make a profit -- after the pandemic.

Before a certain 'letter to Oxford' from Gates, Oxford was planning on giving away the vaccine to anyone who wanted to manufacture it.

So I find it particularly disgusting that people are falling over themselves to associate AZ with altruism when the company isn't really even holding up it's bargain.

Rumours are that AZ is constantly trying to make a profit by shipping the vaccine produced in Europe outside Europe. It can make a profit this way because it only has to sell 'at cost' but the cost varies depending on the facility that produced it giving rise to a profit incentive.

> The licence allows AZ to make a profit -- after the pandemic.

After could be as early as 1st July 2021.

https://www.reuters.com/article/health-coronavirus-astrazene...

The quotes in this article contradict what you're saying:

https://www.theguardian.com/business/2021/mar/26/how-the-ast...

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