COVID COVID-19 Vaccine Progress: Are We Ready for Rollout in Australia?

[bhobba]

This, reported in the local paper, surprised the bejesus out of me. From today's Courier Mail here in Brisbane:

'Holy Spirit Nursing Home residents were given ‘excessive amount’ of COVID vaccine by doctor without required training. The doctor at the centre of the vaccine bungle only took the COVID immunisation training the day after he incorrectly administered the doses to two elderly patients, it can be revealed. He has been referred to the medical regulator, while the contractor which employed him has been warned if there is another incident it will lose the contract. Health Minister Greg Hunt initially told Parliament today that the doctor had completed the training, but later returned to correct the record and say he had not. The Courier-Mail understands that the Australian-trained doctor, who graduated in 2007, completed the training the day after the incident occurred. The government is considering there to be multiple points of failure in this incident, with the company not having checked if the doctor had completed the training before he started his first day.'

It was the Pfizer vaccine. That is aside from the fact should a doctor even need training? As doctors they should independently check correct dose anyway. I have said it before, and will say it again, this pandemic has exposed just how 'shoddy' at least certain parts of out government bureaucracy is. Sigh.

Me - I trust my GP. Unless further evidence comes along I will be getting the Oxford vaccine, first dose - full dose - then second full dose 12 weeks later. The analysis of current data from a Lancet preprint shows first dose - 76% efficacy (22 to 90 days), second dose 84% efficacy if given 12 weeks later or greater. But in anyone that was vaccinated if they got it is was only mild. The data was from an experimental design not set up for checking what was found, so may change as further testing is done. But, if tests show it is OK, will get the Novavax vaccine when it becomes available here in Aus about the second half of this year - it has about 90% efficacy and good protection against new variants (60% efficacy against SA variant).

Thanks
Bill

 

[russ_watters]

That is aside from the fact should a doctor even need training? As doctors they should independently check correct dose anyway.

Doctors are notorious for not RTFM, but in general, yes, they should be trained. Quality medicine is not bred through trust, it comes via verification. You train people so you don't have to trst that they read the manual.

 

[PeroK]

Just to report that I got the AstraZeneca vaccine today. I didn't think they had progressed to the under 60's yet, but perhaps they were struggling to fill all the available slots today: I got a text just before midday inviting me to make an appointment online and got the jab at 15:45. That was a very welcome surprise, I must say.

 

[Ygggdrasil]

The US FDA issued an emergency use authorization for the Johnson and Johnson adenoviral vectored vaccine:

The Food and Drug Administration on Saturday issued an emergency authorization for a Covid-19 vaccine developed by Johnson & Johnson, the third vaccine to be cleared for use in the United States and the first that requires only one dose.

The vaccine, which has not yet been tested in children or adolescents, was cleared for use in adults aged 18 and older.

The addition of J&J’s vaccine to the arsenal could offer a distinct advantage in the effort to vaccinate large swaths of the American public as quickly as possible. The single-shot vaccine doesn’t have the same onerous cold-chain requirements as the two vaccines developed by Moderna and the Pfizer/BioNTech partnership.

https://www.statnews.com/2021/02/27/fda-authorizes-jnj-covid19-vaccine/

Phase 1/2 trial data for the vaccine been published, though I don't think the phase 3 trial data have been published. Phase 3 trial data, however, are available from the EUA application to the FDA which shows 66.5% vaccine efficiency against symptomatic disease: https://www.fda.gov/advisory-commit...-26-2021-meeting-announcement#event-materials

The fact that the vaccine is single dose and requires only refrigeration should make it much easier to distribute the vaccine to harder to vaccinate populations. However, because of production delays, large amounts of the vaccine are not expected to be distributed until April.

 

[berkeman]

The US FDA issued an emergency use authorization for the Johnson and Johnson

I'm really confused about one aspect of the announcements in the popular press and even the announcement at the J&J website:

https://www.jnj.com/johnson-johnson...nterim-analysis-of-its-phase-3-ensemble-trial

85% Effective Overall in Preventing Severe Disease and Demonstrated Complete Protection Against COVID-19 related Hospitalization and Death as of Day 28

So 15% of participants in the study had "severe" COVID-19 symptoms, but were not admitted to a hospital? What am I missing?

 

[berkeman]

(BTW, getting my 2nd Moderna shot Tuesday morning, then I start giving the shots...)

 

[Ygggdrasil]

I'm really confused about one aspect of the announcements in the popular press and even the announcement at the J&J website:

https://www.jnj.com/johnson-johnson...nterim-analysis-of-its-phase-3-ensemble-trialSo 15% of participants in the study had "severe" COVID-19 symptoms, but were not admitted to a hospital? What am I missing?

Here's the data for symptomatic COVID-19:

and the data for severe COVID-19:

 

[berkeman]

Here's the data for symptomatic COVID-19:

Sorry, I'm still not seeing the 15% of severe Pts that refused hospitalization.

 

[Tom.G]

Sorry, I'm still not seeing the 15% of severe Pts that refused hospitalization.

Table 16, top right corner?

Poor labeling in my opinion, 'hospitalization' is not mentioned at all. Perhaps in a subsequent table or buried as a definition in the text of the original report.

 

[bhobba]

So 15% of participants in the study had "severe" COVID-19 symptoms, but were not admitted to a hospital? What am I missing?

But none died - which is one of the key points. Personally I think as a matter of urgency we need to get better data on the Oxford Vaccine. From preliminary data, that could just be a statistical anomaly, we have 76% efficacy (22 to 90 days) on first dose and 84% efficacy on a second dose with all cases that actually got it while vaccinated mild. The JJ vaccine will have its uses, but if the data on the Oxford vaccine holds up it could be used in many cases where the JJ vaccine would have been the preferred choice.

Also of possible importance I did hear a garbelled report on the late news last night that the UK has verified, with the WHO soon to follow, that Ivermectin does have efficacy in Covid prevention and early phase treatment, and will be recommended in that role. If true, when combined with pretty much any of the vaccines, it will hit Covid hard. For those not up on the latest with Ivermectin see:


At the moment it is thought no need to take it when vaccinated - only while waiting for the vaccine or if you are unlucky to get it when vaccinated. But of course this all needs to be tested in properly designed trials.

Thanks
Bill

 

[Ygggdrasil]

Sorry, I'm still not seeing the 15% of severe Pts that refused hospitalization.

An 85% vaccine efficiency against severe disease vs 100% vaccine efficiency against hospitalization does not mean that 15% of severe patients refused hospitalization. Here are the numbers from the phase 3 data submitted to the FDA (https://www.fda.gov/media/146217/download):

Vaccine group (28 days after vaccination): 8 severe/critical cases, 0 requiring medical intervention (out of 19306 total)
Placebo group (28 days after vaccination): 48 severe/critical cases, 7 requiring medical intervention (out of 19178 total)

Note that there were 7 COVID-19 related deaths in the placebo group (not all fall within the category of cases occurring 28 days after vaccination), so the criteria required for hospitalization may be quite high.

Here are the study's definitions:

The case definition for severe/critical COVID-19 was a RT-PCR or molecular test result from samples described above and anyone of the following at any time during the course of observation:

• Clinical signs at rest indicative of severe systemic illness (respiratory rate ≥30 breaths/minute, heart rate ≥125 beats/minute, oxygen saturation (SpO2) ≤93% on room air at sea level, or partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) <300 mmHg)
• Respiratory failure (defined as needing high-flow oxygen, non-invasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation [ECMO])
• Evidence of shock (defined as systolic blood pressure <90 mmHg, diastolic blood pressure <60 mmHg, or requiring vasopressors)
• Significant acute renal, hepatic, or neurologic dysfunction
• Admission to the ICU
• Death

The endpoint of COVID-19 requiring medical intervention is defined as participant requiring hospitalization, ICU admission, mechanical ventilation, and/or ECMO, linked to objective measures such as decreased oxygenation, X-ray or computed tomography (CT) findings, and linked to any molecularly confirmed, COVID-19 with onset at least 14 days and at least 28 days post-vaccination.

I am not a medical doctor, so I can't evaluate the symptoms that define severe/critical COVID-19, but maybe it's possible that conditions outlined in the first bullet point are not severe enough to require hospitalization (the patient gets diagnosed and sent home).

 

[berkeman]

I am not a medical doctor, so I can't evaluate the symptoms that define severe/critical COVID-19, but maybe it's possible that conditions outlined in the first bullet point are not severe enough to require hospitalization (the patient gets diagnosed and sent home).

Interesting, thanks. That must be it -- sure is a confusing point on their own web page!

 

[berkeman]

Hey, does anybody know the dose of the new J&J vaccine? It looks giant from the TV news footage of the J&J vaccines being administered.

Moderna: 0.5cc

https://www.modernatx.com/covid19vaccine-eua/providers/dosing-administration

Pfizer: 0.3cc

https://www.fda.gov/media/144413/download

J&J: ?

https://www.npr.org/sections/corona...ccine-works-where-it-counts-preventing-deaths

https://media.npr.org/assets/img/20...-d799a316eb1f51040a3e670ea8f55fe977c2c481.jpg

 

[Ygggdrasil]

Hey, does anybody know the dose of the new J&J vaccine? It looks giant from the TV news footage of the J&J vaccines being administered.

Ad26.COV2.S (5×10¹⁰ vp) is administered as a single intramuscular injection (0.5 mL dose).

https://www.fda.gov/media/146217/download (page 12)

This is consistent with the picture shown (and the same as the volume of the Moderna shot).

 

[bhobba]

Latest real world results of just one dose of Pfizer or Oxford Vaccine in the UK:


Basically one dose after about 30 days of either vaccine is 80% effective in preventing hospitalizations in older and at risk groups, and that is with the more virulent UK variant. Two doses almost certainly will be better, but is unknown at this stage exactly what it will be.

The South African decision to not give the Oxford vaccine is IMHO mad. They had the vaccine - why not deploy it.

For some reason the data from Scotland was even better with 85% prevention for Pfizer and 94% for Oxford (maybe because they have vaccinated 21% of the entire population not just those most at risk):
https://publichealthscotland.scot/n...-in-risk-of-covid-19-admissions-to-hospitals/

Thanks
Bill

.

 

[Ygggdrasil]

The South African decision to not give the Oxford vaccine is IMHO mad. They had the vaccine - why not deploy it.

Because preliminary studies suggest that the vaccine is not effective against the B.1.351 variant that is the predominant variant in the country:

Safety and efficacy of the ChAdOx1 nCoV-19 (AZD1222) Covid-19 vaccine against the B.1.351 variant in South Africa
https://www.medrxiv.org/content/10.1101/2021.02.10.21251247v1

Abstract:

Background Assessing safety and efficacy of Covid-19 vaccines in different populations is essential, as is investigation of efficacy against emerging SARS-CoV-2 variants of concern including the B.1.351 (501Y.V2) variant first identified in South Africa.
Methods We conducted a randomized multicentre, double blinded controlled trial on safety and efficacy of ChAdOx1-nCoV19 in HIV-uninfected people in South Africa. Participants age 18 to <65 years randomized (1:1) to two doses of vaccine containing 5×1010 viral particles or placebo (0.9%NaCl) 21-35 days apart. Post 2nd-dose serum samples (n=25) were tested by pseudotyped (PSVNA) and live virus (LVNA) neutralization assays against the D614G and B.1.351 variants. Primary endpoints were safety and vaccine efficacy (VE) >14 days following second dose against laboratory confirmed symptomatic Covid-19.
Results 2026 HIV-uninfected adults were enrolled between June 24th and Nov 9th, 2020; 1010 and 1011 received at least one dose of placebo or vaccine, respectively. Median age was 31 years. The B.1.351 variant showed increased resistance to vaccinee sera using the PSVNA and LVNA. In the primary endpoint analysis, 23/717 (3.2%) placebo and 19/750 (2.5%) vaccine recipients developed mild-moderate Covid-19; VE 21.9% (95%Confidence Interval: −49.9; 59.8). Of the primary endpoint cases, 39/42 (92.9%) were the B.1.351 variant; against which VE was 10.4% (95%CI: −76.8; 54.8) analyzed as a secondary objective. The incidence of serious adverse events was balanced between the vaccine and placebo groups.
Conclusions A two-dose regimen of ChAdOx1-nCoV19 did not show protection against mild-moderate Covid-19 due to B.1.351 variant, however, VE against severe Covid-19 is undetermined.

 

[Ygggdrasil]

Also of possible importance I did hear a garbelled report on the late news last night that the UK has verified, with the WHO soon to follow, that Ivermectin does have efficacy in Covid prevention and early phase treatment, and will be recommended in that role. If true, when combined with pretty much any of the vaccines, it will hit Covid hard.

A randomized clinical trial of ivermectin was recently published showing that ivermectin had no effect on speeding recovery from COVID-19:

Early administration of the antiparasitic drug ivermectin didn't significantly shorten time to clinical improvement in 400 adults mildly ill with COVID-19, a clinical trial today in JAMA finds.

Led by researchers from the Centro de Estudios en Infectologia Pediatrica in Cali, Colombia, the single-center, double-blind, randomized trial used random sampling of coronavirus-positive patients to identify inpatients and outpatients with mild COVID-19 within the first 7 days after symptom onset from Jul 15 to Nov 30, 2020.

Median time to symptom resolution was 10 days in the 200 patients randomly assigned to receive ivermectin daily for 5 days, compared with 12 days in 198 patients receiving a placebo (interquartile range for both, 9 to 13 days; hazard ratio, 1.07).

Here's the published, peer-reviewed paper describing the study:

Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19: A Randomized Clinical Trial
https://jamanetwork.com/journals/jama/fullarticle/2777389

Abstract:

Importance Ivermectin is widely prescribed as a potential treatment for COVID-19 despite uncertainty about its clinical benefit.

Objective To determine whether ivermectin is an efficacious treatment for mild COVID-19.

Design, Setting, and Participants Double-blind, randomized trial conducted at a single site in Cali, Colombia. Potential study participants were identified by simple random sampling from the state’s health department electronic database of patients with symptomatic, laboratory-confirmed COVID-19 during the study period. A total of 476 adult patients with mild disease and symptoms for 7 days or fewer (at home or hospitalized) were enrolled between July 15 and November 30, 2020, and followed up through December 21, 2020.

Intervention Patients were randomized to receive ivermectin, 300 μg/kg of body weight per day for 5 days (n = 200) or placebo (n = 200).

Main Outcomes and Measures Primary outcome was time to resolution of symptoms within a 21-day follow-up period. Solicited adverse events and serious adverse events were also collected.

Results Among 400 patients who were randomized in the primary analysis population (median age, 37 years [interquartile range {IQR}, 29-48]; 231 women [58%]), 398 (99.5%) completed the trial. The median time to resolution of symptoms was 10 days (IQR, 9-13) in the ivermectin group compared with 12 days (IQR, 9-13) in the placebo group (hazard ratio for resolution of symptoms, 1.07 [95% CI, 0.87 to 1.32]; P = .53 by log-rank test). By day 21, 82% in the ivermectin group and 79% in the placebo group had resolved symptoms. The most common solicited adverse event was headache, reported by 104 patients (52%) given ivermectin and 111 (56%) who received placebo. The most common serious adverse event was multiorgan failure, occurring in 4 patients (2 in each group).

Conclusion and Relevance Among adults with mild COVID-19, a 5-day course of ivermectin, compared with placebo, did not significantly improve the time to resolution of symptoms. The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand the effects of ivermectin on other clinically relevant outcomes.

 

[Tom.G]

Intervention Patients were randomized to receive ivermectin, 300 μg/kg of body weight per day for 5 days (n = 200) or placebo (n = 200).

The one video I've watched pushing Ivermectin used 7 to 10 times that dose.
The presenter comes across as pushing his favorite Miracle of the Day, but if the data is real it may be worth further investigation.

The first part gives some background on what is currently in use, especially for 'Long Haulers.'
The 'Hard Data' start around the 43:00 mark

Dr. Pierre Kory, Ivermectin, and COVID (Let’s help end the pandemic.)


Cheers,
Tom

 

[bhobba]

The one video I've watched pushing Ivermectin used 7 to 10 times that dose.
The presenter comes across as pushing his favorite Miracle of the Day, but if the data is real it may be worth further investigation.

It's one of those things that polarises people, like HCQ did. Well designed trials are underway, but not yet completed, that will answer the questions one way or the other:
https://www.the-scientist.com/news-...ersial-ivermectin-paper-pre-publication-68505

And 300 μg/kg of body weight for the Ivermectin is actually slightly higher than what the I-Mask+ protocol use which is 200 ug/kg. It usually in practice equates to a 6mg tablet morning and night.

At the moment all we can really say is the NIH changed its recommendation from not recommended except in trials to neutral. But the options are very limited as far as early treatment goes. Telling people to go home and take some paracetamol is not very reassuring. With the neutral recommendation there is little harm in trying it, and I personally have have checked my GP is willing to prescribe the 5 daily dose regime as early as possible if I get it as per the I-Mask+ protocol. I already take all the other stuff of that protocol such as Quercetin. Again 'ironclad' evidence (except for vitamin D) they are of any value is not available. I am not even sure if other things we have now found out, such as being deficient in Vitamin D is a significant risk factor, is just as efficacious. I still think getting a physical that includes checking vitamin D levels, sugar levels etc, based on our current knowledge, is the best course of action while waiting for the vaccine. You can discuss other things like Quercetin, Ivermectin etc with your doctor at the same time.

The good news is, as per a previous post, we now have large scale data from the UK on the Oxford and Pfizer vaccine. Even after just one dose, after about 30 days of either vaccine, it is 80% effective in preventing hospitalizations in older and at risk groups, and that is with the more virulent UK variant. Scotland has vaccinated 21% of its population and is further down the rollout than the UK as a whole. It's data was even better with 85% prevention for Pfizer and 94% for Oxford.
https://publichealthscotland.scot/n...-in-risk-of-covid-19-admissions-to-hospitals/

Strangely the Oxford vaccine, with just one dose, is even more effective at preventing hospitalisations than Pfizer. We eagerly await the data once everyone is vaccinated with two doses. The UK rolled the dice and decided to vaccinate everyone with just one dose before administering the second dose and the gamble seems to have paid off. Pure dumb luck IMHO - sometimes it works in your favor - but I am not a fan.

Thanks
Bill

 

[bhobba]

You can criticize what others are doing - so let's hear your worldwide rollout plan. To which countries would you send the vaccines and why?

I think it depends on public mood. PNG was a former Australian protectorate famed here in Aus for its fuzzy wuzzy angels that saved many lives on the Kokoda Trail in WW2. They are in dire need of Covid help. Knowing how Australians feel about them, despite how cosy they are becoming with China, without hesitation an Australian emergency medical team was sent in, and they will be getting priority access to the Oxford vaccine we are making and being distributed from the 22nd. First is the islands between PNG and Australia (some part of Aus - some part of PNG) - then PNG proper. I guess even with public good will the first consideration is stopping it on islands that can reach Australia first - so we are not entirely altruistic.

Thanks
Bill

 

[bhobba]

Interesting, thanks. That must be it -- sure is a confusing point on their own web page!

As my stats professor said - statistics is like a bikini - it's the bits you don't see you want to know about. Sexist and politically incorrect - but he was still a funny guy.

Thanks
Bill

 

[berkeman]

It looks like some great apes and other zoo animals are starting to receive a vaccine intended just for animals now. Does anybody know what they mean by "intended strictly for non-human use"?

https://www.cnn.com/2021/03/05/us/great-apes-coronavirus-vaccine-san-diego-zoo-trnd/index.html

(CNN) -- Several great apes at the San Diego Zoo have been vaccinated against Covid-19 a few weeks after the zoo's gorillas tested positive for the virus.

Members of the zoo's bonobo and orangutan troops were vaccinated using doses from a supply intended strictly for non-human use, the San Diego Zoo Wildlife Alliance (SDZWA) said in statement to CNN.

 

[Ygggdrasil]

The good news is, as per a previous post, we now have large scale data from the UK on the Oxford and Pfizer vaccine. Even after just one dose, after about 30 days of either vaccine, it is 80% effective in preventing hospitalizations in older and at risk groups, and that is with the more virulent UK variant. Scotland has vaccinated 21% of its population and is further down the rollout than the UK as a whole. It's data was even better with 85% prevention for Pfizer and 94% for Oxford.
https://publichealthscotland.scot/n...-in-risk-of-covid-19-admissions-to-hospitals/

Strangely the Oxford vaccine, with just one dose, is even more effective at preventing hospitalisations than Pfizer. We eagerly await the data once everyone is vaccinated with two doses. The UK rolled the dice and decided to vaccinate everyone with just one dose before administering the second dose and the gamble seems to have paid off. Pure dumb luck IMHO - sometimes it works in your favor - but I am not a fan.

Here's a link to the non-peer reviewed pre-print study cited by the Public Health Scotland site you linked to:

Effectiveness of First Dose of COVID-19 Vaccines Against Hospital Admissions in Scotland: National Prospective Cohort Study of 5.4 Million People
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3789264

Here's the relevant quote from the papers findings:

The first dose of the BNT162b2 vaccine was associated with a vaccine effect of 85% (95% confidence interval [CI] 76 to 91) for COVID-19 related hospitalisation at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 94% (95% CI 73 to 99).

With BNT162b2 referring to the Pfizer-BioNTech vaccine and ChAdOx1 referring to the Oxford-AstraZeneca vaccine.

A few notes:
1) While the point estimate of the vaccine efficiency (VE) for the Oxford vaccine in preventing hospitalizations is higher than the VE of the Pfizer vaccine, the confidence intervals of the estimates overlap considerably, so the study does not provide evidence for a statistically significant difference between the two vaccines.

2) The study is an observational cohort study and not a randomized controlled trial. Because people were not randomized to receive the Ofxford or Pfizer vaccine, there are differences in the populations who received each vaccine (e.g. see the differences in the age distributions for the two vaccines in Fig 2 of the manuscript), which make it difficult to directly compare the observed VE for the two vaccines.

3) The study looked only at hospitalizations at 28-34 days post-vaccination, which is a very short time period after vaccination. More long term data (which is where one might expect to see differences between one dose vs two doses) is needed to assess whether delaying the second dose is ultimately a good idea or not.

 

[bhobba]

The study looked only at hospitalizations at 28-34 days post-vaccination, which is a very short time period after vaccination. More long term data (which is where one might expect to see differences between one dose vs two doses) is needed to assess whether delaying the second dose is ultimately a good idea or not.

Interestingly, when you look at the video I posted, that carefully goes over the UK data (not just Scotland) what they found is in the first 9 days after vaccination the odds of getting Covid rose 48%. I do not think anybody as yet is 100% sure why (again further research is needed) but the hypothesis is people when vaccinated went whoopee - and stopped taking precautions. So people are well advised to keep up the precautions until it has a chance to have maximum effect, which for the Oxford was 75% efficacy at 35 days. So I would wait at least that long before reducing precautions. In fact I would wait until everyone has had the second dose, but that's just me.

Thanks
Bill

 

[Laroxe]

Just a few thoughts.
When we see the headlines about vaccine efficiency the figures don't really say much about an individuals risk, there are lots of variables that effect risk and this means it is virtually impossible to say we get 100% protection. So what we see are risk estimates at a population level, its a statistical measure of relative risk. We can get the relative risk (RR) of infection, the RR of developing serious disease, the RR of dying the RR of being able to transmit the infection etc and for each of these the numbers will be different and they will change over time. The figures usually come from the phase 3 trials where you get thousands of people give half the vaccine and half a placebo then let them loose into the wild, as it were. After some predetermined end point, usually the number of people diagnosed with the disease, at a particular point in time, you can then compare how many people in the vaccine group and how many in the control group became infected. If everything was equal the RR would be expressed as 1 so you start with 1 and subtract any difference seen in the numbers from the vaccine vs the control group. In the moderna trial they had around 30,000 subjects, 15,000 in each group and when 95 people in the 30,000 had developed the infection they found only 5 were in the vaccine group the other 90 were in the control group.

So its 1 - 5/90 which through the magic of statistics is 94.44% efficiency, this figure is most useful in estimating the population level immunity and numbers needed to stop the disease. Remember this is not a fixed number, it will change.

Over time it will be impossible to conduct Placebo controlled trials, we will have to rely more on observational studies.

The discussions about ivermectin seem a bit pointless now, if it does have an effect its a small one, we shouldn't be torturing the data to try and find one. The US are using monoclonal antibodies which do help if given early, these are of course expensive drugs so its difficult to know how widely they will be adopted, I'm not even sure about their use in the uninsured in the US.

There are certainly differences in the mRNA vaccines and the viral vector vaccines both in their adverse events and the timing of the development of immunity but so far they all look very good. The big question that needs answering is how enduring the immunity is.

In the argument between the EU and Astra Zenica over their production problems (shared with Pfizer and Moderna) but in Astra Zenica's case linked with Brexit, EU politicians have inadvertently provided a real world experiment in preventing effective vaccinations programs. Following several politicians attacking the A.Z. vaccine effectiveness there appears to be a general reluctance to accept this vaccine and despite the shortage their are stockpiles being unused. While the ill informed statements have been retracted, so far this has had little impact, it does put the concerns about misinformation on social media into perspective.

 

[Ygggdrasil]

Interestingly, when you look at the video I posted, that carefully goes over the UK data (not just Scotland) what they found is in the first 9 days after vaccination the odds of getting Covid rose 48%. I do not think anybody as yet is 100% sure why (again further research is needed) but the hypothesis is people when vaccinated went whoopee - and stopped taking precautions. So people are well advised to keep up the precautions until it has a chance to have maximum effect, which for the Oxford was 75% efficacy at 35 days. So I would wait at least that long before reducing precautions. In fact I would wait until everyone has had the second dose, but that's just me.

Here's some relevant data from the Scotland paper:
Overall, 7-13 days after the first vaccine dose (either Pfizer or Oxford), they observed a 47% protection COVID-19 from hospitalization (see Table 2). However, there is a difference when the data are split by age group. For ages 65-79, the vaccine efficiency was 62% 7-13 days after the first dose and 67% for those age >80. However, the vaccine efficiency 7-13 days after the first does for those ages 18-64 was -36% (meaning more people were hospitalized for COVID-19 7-13 days after vaccination compared to the general unvaccinated population). The fact that only the younger age groups show a negative vaccine efficiency does support the hypothesis that young people are prematurely stopping precautions after getting vaccinated.

 

[Klystron]

After being too young by one year for the initial public vaccine program in southern Nevada USA, I received the Pfizer vaccine first dose this week at our local veteran's hospital after minimum age reduction from 70 to 65 years old. Second dose scheduled in 21 days.

Online vaccination registration in the three modes I attempted -- local pharmacies, public health centers and veteran affairs (VA) -- required scheduling both injections in order to receive the first. Some local pharmacies indicated available first doses but declined to register me as no second dose was available; perhaps an artefact of the software system as much as supply logistics.

VA scheduling and implementation was efficient and trouble free with walk-ins interleaved with scheduled appointments.

 

[bhobba]

Over time it will be impossible to conduct Placebo controlled trials, we will have to rely more on observational studies.

Yes. Challenge trial studies are however another matter - and the UK has flagged they will definitely be looking into that. Unless of course, and this would IMHO a good outcome, everyone gets the vaccine, so no unvaccinated person can be found to participate, even though challenge trials require a much smaller number of people. This will be more 'ethical' if an effective treatment can be found eg the claims for Ivermectin turn out to be valid.

Thanks
Bill

 

[PeroK]

Interestingly, when you look at the video I posted, that carefully goes over the UK data (not just Scotland) what they found is in the first 9 days after vaccination the odds of getting Covid rose 48%. I do not think anybody as yet is 100% sure why (again further research is needed) but the hypothesis is people when vaccinated went whoopee - and stopped taking precautions.

That's interesting. There are, of course, other possible explanations.

First note that as the number of unvaccinated people significantly outnumbers the number vaccinated in a short period, it doesn't take much to generate a 48% increase - although at first this looks fairly significant.

Let's say Scotland vaccinated 30,000 people one day. You would expect about 4 of those per day to test positive subseqently (going by the national figures). It only takes two extra per day (out of 30,000) to push the numbers up by +50%. That increase can be achieved with relatively few people making whoopee.

It's possible that attending the vaccination centre itself was something of a risk. It was in my mind when I went that it was a risk that had to be taken - although it was relatively quiet when I was there.

It strikes me as the sort of thing that would be very hard to get to the bottom of.

 

[bhobba]

It's possible that attending the vaccination centre itself was something of a risk. It was in my mind when I went that it was a risk that had to be taken - although it was relatively quiet when I was there.

Indeed. That is one reason I will be getting mine from my GP. I will be discussing it with him in the next week or two. But everyone in the practice social distances, wears masks, and there is hand sanitiser everywhere plus after each patient the nurse cleans the consultation room with alcohol (at least it smells like it). It will be interesting to see if the doctor gives the Jab or gets one of the practices nurses to do it. When I was young the doctor gave jabs all the time, but for reasons I do not understand they mostly get the nurse to do it now.

Thanks
Bill