Vaccine Progress, Approval, and Deployment

[Yew]

I agree with @HSTEd that the EU will block exports. Its in a desperate situation and its not just exports to the UK, its Canada and other countries.

The UK appears to have sufficient stock to get 20 million people both doses on schedule but most of the Astrazenica needs its filler and to be bottled (in Wrexham). Assuming an EU export ban then Pfizer stocks would be mostly used for second doses and Moderna wouldn't arrive to either the EU or US lifted export bans. US rollout should finish during the summer. Without any of new vaccines there will inevitably be a slow down in giving of first doses in second quarter.

Back of fag packet calculations:

UK production of Astrazenica is 2 million doses per week (finished product). 7 million doses of Pfizer have used, imported or should be imported while EU takes a week or so to introduce an export ban. That is a total of 59 million doses available in first half of this year in event of EU export ban. That should be 2 doses for the 20 million high risk people (approximately one in first quarter and one in second quarter) and 19 million first doses. Third quarter Astrazenica doses would need to be mostly dedicated to people who got their first dose in second quarter. UK made Vaneva and Novavax should be used from July, along with J&J (only requires one dose) and Moderna imports. That means the remaining 28 million people should also be fully vaccinated by end of third quarter (but with shorter interval between doses). Production and imports in the third quarter should significantly exceed the first two quarters combined.

I do seriously question the utility of vaccinating everyone, whilst other countries are going without.

 

[35B]

I do seriously question the utility of vaccinating everyone, whilst other countries are going without.

I agree. It's beneficial to this island, but does leave a wee bit of an issue when you look to open to the world - rather the inverse of the issue faced by those places that have taken an elminationist approach to Covid. On the other hand, you have to start somewhere.

 

[ainsworth74]

I do seriously question the utility of vaccinating everyone, whilst other countries are going without.

Is there going to be any political stomach for it? Particularly from this Government with this right wing media? Plus optics could very easily end up being spun to suggest that the Government shafted the young to protect the old and now that the old are protected they're shafting the young again by making it harder/impossible for them to get the same protection?* I think it would be a brave (perhaps even 'courageous' to borrow a phrase) Government who started diverting our vaccine supply to other countries before the majority of the UK population is vaccinated. That being said we do need to (we as in those countries who are going to be able to vaccinate our populations in short order) start to think about how to vaccinate the rest of the world.


*Yes yes they might not need it as much as the overwhelming majority of infections in younger people are either asymptomatic or mild but let's be honest, it isn't going to matter how true that is.

 

[Yew]

Is there going to be any political stomach for it? Particularly from this Government with this right wing media? Plus optics could very easily end up being spun to suggest that the Government shafted the young to protect the old and now that the old are protected they're shafting the young again by making it harder/impossible for them to get the same protection?* I think it would be a brave (perhaps even 'courageous' to borrow a phrase) Government who started diverting our vaccine supply to other countries before the majority of the UK population is vaccinated. That being said we do need to (we as in those countries who are going to be able to vaccinate our populations in short order) start to think about how to vaccinate the rest of the world.

Indeed, the downside of over-egging the risk to young people, I suppose.

*Yes yes they might not need it as much as the overwhelming majority of infections in younger people are either asymptomatic or mild but let's be honest, it isn't going to matter how true that is.

That is the most depressing (but also completely true) statement I think I've seen. It's as if were an entire nation of people who are scared of flying.

 

[kristiang85]

I would happily go without my vaccination if supplies were limited, as I am as low risk as you can get, UNLESS it meant I could not travel or do things I like. This seems likely, sadly (looking at other countries), so I'll be incensed if I have limits placed on my life due to politically-motivated stock issues.

 

[yorksrob]

I do seriously question the utility of vaccinating everyone, whilst other countries are going without.

I agree. It's beneficial to this island, but does leave a wee bit of an issue when you look to open to the world - rather the inverse of the issue faced by those places that have taken an elminationist approach to Covid. On the other hand, you have to start somewhere.

Is there going to be any political stomach for it? Particularly from this Government with this right wing media? Plus optics could very easily end up being spun to suggest that the Government shafted the young to protect the old and now that the old are protected they're shafting the young again by making it harder/impossible for them to get the same protection?* I think it would be a brave (perhaps even 'courageous' to borrow a phrase) Government who started diverting our vaccine supply to other countries before the majority of the UK population is vaccinated. That being said we do need to (we as in those countries who are going to be able to vaccinate our populations in short order) start to think about how to vaccinate the rest of the world.


*Yes yes they might not need it as much as the overwhelming majority of infections in younger people are either asymptomatic or mild but let's be honest, it isn't going to matter how true that is.

From a pure efficacy point of view, vaccinating everyone in the country surely makes it easier to open up, as when unvaccinated residents from abroad enter the country, they're less likely to pass infection onto a vaccinated population.

From a diplomatic point of view, I can see that the Government is going to have to tread carefully. It doesn't behove us to antagonise our neighbours when they are in such a tight spot. From our point of view as I understand it, our vaccine production facilities were designed from the start to partially supply the continent, so we will be walking a tightrope between getting as much of our planned programme done as possible whilst ensuring that as much of Europe's contract is fulfilled as possible.

The plus side is that it looks as though the vulnerable are going to be vaccinated on time. Delays to vaccinations of the wider adult population to assist our neighbers would be so much an easier sell to the population, were we not following an impractical and counterproductive lockdown first strategy !

 

[Bantamzen]

Is there going to be any political stomach for it? Particularly from this Government with this right wing media? Plus optics could very easily end up being spun to suggest that the Government shafted the young to protect the old and now that the old are protected they're shafting the young again by making it harder/impossible for them to get the same protection?* I think it would be a brave (perhaps even 'courageous' to borrow a phrase) Government who started diverting our vaccine supply to other countries before the majority of the UK population is vaccinated. That being said we do need to (we as in those countries who are going to be able to vaccinate our populations in short order) start to think about how to vaccinate the rest of the world.


*Yes yes they might not need it as much as the overwhelming majority of infections in younger people are either asymptomatic or mild but let's be honest, it isn't going to matter how true that is.

Well for the virtue signallers out there, especially on the left this would be quite easy. We vaccinate everyone here and stuff the world, or vaccinate the vulnerable here and in poorer countries around the world. However the right of politics might not be quite so sold on helping foreigners, and sadly this is where the government looks for it's support.

 

[notlob.divad]

I do seriously question the utility of vaccinating everyone, whilst other countries are going without.

In there real world there is none.

However if you are a pseudo-nationalistic government who wants to portray to a dometic audience just how great the country is: now that is has 'independence' and is 'free of the shackles of its neighbours', then you can possibly make quite a lot of headway with such a policy.

 

[yorksrob]

In there real world there is none.

If the Government were taking a measured approach to opening up activity and the economy, it would be easier to release vaccines more equitably.

All the while the Government insists upon onerous restrictions on every day activity until ever greater proportions of the population are vaccinated, they will find it politically difficult to share vaccines more equitably with other countries.

You can paint it in ideological terms as much as you like, but restrictions will lead to vaccine nationalism more than percieved ideology.

 

[ainsworth74]

Personally I'd be quite content, once we've vaccinated our most vulnerable, to see our program slow down to allow us to start vaccinating the most vulnerable of other countries. Once we've got all our vulnerable sorted I'd not be too upset if we reduced our vaccination rate from around 2m to around 1m. Hopefully striking a balance between getting our total population done (which I do think is broadly worthwhile) but starting to save lives overseas as well. But...

However the right of politics might not be quite so sold on helping foreigners, and sadly this is where the government looks for it's support.

However if you are a pseudo-nationalistic government who wants to portray to a dometic audience just how great the country is: now that is has 'independence' and is 'free of the shackles of its neighbours', then you can possibly make quite a lot of headway with such a policy.

...I suspect this, along with the howls of derision I can already hear coming from the Daily Mail, Express, et al, mean I think such an approach of any flavour would be dead on arrival. I suspect we're going to vaccinate everyone over 18 at a breakneck pace whether or not it's the right thing either on a moral or efficacy basis and only once that's done (or nearly done) will we start to turn to other countries.

 

[Domh245]

I suspect we're going to vaccinate everyone over 18 at a breakneck pace whether or not it's the right thing either on a moral or efficacy basis and only once that's done (or nearly done) will we start to turn to other countries.

I think you're right on this, although the one caveat is that case numbers. A 30 year old in the UK with high case levels may be a higher priority for a vaccine than a 60 year old in a country with very low case rates - whilst the risk if they get it is much lower, the chance of them catching it is that much higher that the overall risk is almost even, although given the way IFR and hospitalisation rate grow rapidly with age, case rates would have to be significantly higher I would think

With my lovely shiny tin foil hat on, I wonder if this is why we're seeing stories about case rates not going down as fast as the government testing numbers might suggest

 

[yorksrob]

Personally I'd be quite content, once we've vaccinated our most vulnerable, to see our program slow down to allow us to start vaccinating the most vulnerable of other countries. Once we've got all our vulnerable sorted I'd not be too upset if we reduced our vaccination rate from around 2m to around 1m. Hopefully striking a balance between getting our total population done (which I do think is broadly worthwhile) but starting to save lives overseas as well. But...

I would agree - assuming a more sensible approach to individual risk is pursued in the interim at home.

In terms of the developing world, the best way to get its population vaccinated is to manufacture at cost in the developing world - which to be fair they seem to be doing - to an extent anyway.

 

[Bantamzen]

I think you're right on this, although the one caveat is that case numbers. A 30 year old in the UK with high case levels may be a higher priority for a vaccine than a 60 year old in a country with very low case rates - whilst the risk if they get it is much lower, the chance of them catching it is that much higher that the overall risk is almost even, although given the way IFR and hospitalisation rate grow rapidly with age, case rates would have to be significantly higher I would think

With my lovely shiny tin foil hat on, I wonder if this is why we're seeing stories about case rates not going down as fast as the government testing numbers might suggest

Infection rates currently being published in some parts of the media are not matching the gov.uk figures because they use different data. Within a week or two those too will show a decline in infection rates.

 

[35B]

Is there going to be any political stomach for it? Particularly from this Government with this right wing media? Plus optics could very easily end up being spun to suggest that the Government shafted the young to protect the old and now that the old are protected they're shafting the young again by making it harder/impossible for them to get the same protection?* I think it would be a brave (perhaps even 'courageous' to borrow a phrase) Government who started diverting our vaccine supply to other countries before the majority of the UK population is vaccinated. That being said we do need to (we as in those countries who are going to be able to vaccinate our populations in short order) start to think about how to vaccinate the rest of the world.


*Yes yes they might not need it as much as the overwhelming majority of infections in younger people are either asymptomatic or mild but let's be honest, it isn't going to matter how true that is.

I'd suggest a policy of universal vaccination, like a policy of elimination, will allow normality within a country's borders, because people can act on the assumption that anyone they meet will be Covid free. Unlike an elimination policy, it will also have the benefit that when cases do arise, the need for stringent quarantines to limit spread of Covid will be significantly reduced.

The challenge will be about crossing borders, as different countries have different rates of vaccination, leading to national restrictions on who may enter a country, and on what conditions. As residents of somewhere with universal vaccination, we will be in a relatively privileged position to exercise choice as countries start to open their borders.

I don't see this as a question of "left" or "right", or even nationalism, but of practicality within a country.

 

[Yew]

I think you're right on this, although the one caveat is that case numbers. A 30 year old in the UK with high case levels may be a higher priority for a vaccine than a 60 year old in a country with very low case rates - whilst the risk if they get it is much lower, the chance of them catching it is that much higher that the overall risk is almost even, although given the way IFR and hospitalisation rate grow rapidly with age, case rates would have to be significantly higher I would think

I think you're right on the part I've bolded; and even if the risk per day was higher, I'm not sure the overall risk was, if that makes sense?

 

[notlob.divad]

You can paint it in ideological terms as much as you like, but restrictions will lead to vaccine nationalism more than percieved ideology.

I would portray it slightly differently, onerous restrictions will certainly foster political support for a policy rooted in the underlying ideology.

 

[LAX54]

so, reading between the lines, do I have this right ? The EU have issues with the production of this vaccine, and they are now saying we know we gave you a rough time in leaving the EU, but can you help us out now ?

 

[Domh245]

Infection rates currently being published in some parts of the media are not matching the gov.uk figures because they use different data. Within a week or two those too will show a decline in infection rates.

Presumably you're talking about REACT and the ONS study of infection and prevalence? I was thinking about these as well, and obviously there's a couple of weeks lag to them but there's a fair bit of chatter about how these don't seem to be falling as quickly as the gov cases data was (and similarly lots of surprise about just how quickly the gov data has been falling and claims about weather disrupting people going for tests/people refusing to go if pinged by test & trace etc). Like I said, it's very tin foil hatt-y, and by the time we have to start thinking about this seriously (post group 9) towards March I would hope figures are low given the trends.

 

[Yew]

by the time we have to start thinking about this seriously (post group 9) towards March I would hope figures are low given the trends.

Post group nine, they don't matter.

 

[takno]

so, reading between the lines, do I have this right ? The EU have issues with the production of this vaccine, and they are now saying we know we gave you a rough time in leaving the EU, but can you help us out now ?

The EU has a contract with Astra-Zeneca, which they believe gives a binding commitment to provide a certain level of output, with the output coming from a number of named factories including those in the UK. Astra-Zeneca claims that the commitment is a best-effort commitment. AZ are currently using the entire UK output to meet their contract with the UK government because they believe that this commitment is more binding. The EU believe this is not what was agreed.

If the contract dispute goes the EU's way rather than AZ's, then AZ would have to start providing supplies from the UK, which the UK may decide to prevent. The immediate downside of that is that the EU would probably block supplies for second injections of Pfizer.

More importantly thought, our vaccination efforts are running far ahead of most of the world, and we have pointlessly tied ending lockdown to vaccinating a lot of not-especially-vulnerable people. It will be a very bad look if we start restraining international trade in order to support the rollout to our not-very-vulnerable, whilst condemning European pensioners to "dying on a ventilator, hun".

It's not just the EU, who we urgently need to have some more negotiations with if we are going to avoid destroying our export industries. It's the rest of the world who will see us as basically an international pariah state.

 

[Domh245]

Post group nine, they don't matter.

Largely not, unless the severity*likelihood approach is taken and there are very high case rates. Continuing to vaccinate down past group 9 still will have some benefit though, particularly in terms of allowing hospitals to resume normality and stand down covid wards which I imagine they'd still have to have in place for any younger covid patients that are admitted for isolation purposes

 

[hwl]

Post group nine, they don't matter.

Still just over 25% of ICU admissions and where higher than average rate of transmission occur, if we want to get levels of time off work back to normal levels then we need get 18-50s done too.

 

[Yew]

Still just over 25% of ICU admissions and where higher than average rate of transmission occur, if we want to get levels of time off work back to normal levels then we need get 18-50s done too.

And, it's not necessary, we'll have done millions of vaccinations, and coupled with immunity from infections, there might be a slight 'wave' of cases, but then it will quickly fizzle out and we can get back to normal.

 

[hwl]

And, it's not necessary, we'll have done millions of vaccinations, and coupled with immunity from infections, there might be a slight 'wave' of cases, but then it will quickly fizzle out and we can get back to normal.

Immunity gained from infection is not necessarily the same as that from vaccination (which will vary by vaccine).
Natural immunity from older strain to the combined 501Y+484K variants looks extremely poor as the situation in Manaus illustrates.

 

[notlob.divad]

so, reading between the lines, do I have this right ? The EU have issues with the production of this vaccine, and they are now saying we know we gave you a rough time in leaving the EU, but can you help us out now ?

No not really. The EU's squable is not with the UK persay, (although the Astrazenica's CEO going on record* as saying their UK contract has nationalistic clauses in it, whilst Hancock and Zahawi go on press conferences urging against nationalism probably doesn't help the relationship)

The EUs squable is very clearly with Astrazenica. They clearly think there have been underhand tactics at play: be it
-the listing of UK production facilities as sources of supply without revealing the nation first clauses attached to production at those facilities.
or
-the suspicion (although I haven't seen evidence) that doses from the continental production facilities were distributed to the UK to make up for initial production shortfalls in the UK, simply because the UK had approved emergency usage of the vaccine whereas the EU had concerns over a lack of data which persist to this day.

The EU putting export controls on the Pfizer vaccine will be a last resort effort, but have no doubt they would justify it on the grounds thta when initial exports were allowed they were not aware that potential future movements in the other direction had alreday been undermined. Now that they are aware it is a neccesity for them to reciprocate, they could probably also justify it on the UKs approval to use its AZ supplies on the vulnerable 65+ cohort, meaning that morally their is no risk of the UK not being able to protect life and limb. However doing so would clearly be an escalation from a dispute with one specific company towards a trade war. Hence why it will very much be a last resort.



* https://www.politico.eu/article/astrazeneca-ceo-eu-vaccine-contract-is-not-a-commitment/

Soriot pointed out that the British agreement stipulates that supply coming out of the U.K. would go to the U.K. first. The EU agreement allows use of the U.K. manufacturing sites, “but only later,” Soriot said, once Britain reaches a “sufficient number of vaccinations.”

You can probably portray the EU as being a little naive in perhaps thinking the 'newly independent' UK would not include nationalistic clauses in their contracts. However you also have to call out the rampent hypocrisy of UK ministers in calling out vaccine nationalism, whilst at the same time having it written into their biggest supply contract.

At the end of the day the gerneal public do not know what is written in these contracts and will probably never know of verbal assurances that were made in the meetings surrounding their negotiation on either side of the channel.

 

[Yew]

Immunity gained from infection is not necessarily the same as that from vaccination (which will vary by vaccine).
Natural immunity from older strain to the combined 501Y+484K variants looks extremely poor as the situation in Manaus illustrates.

Which doesn't matter, perhaps vaccination will be longer lasting, but that only matters in the long term, not the short term.

 

[yorksrob]

You can probably portray the EU as being a little naive in perhaps thinking the 'newly independent' UK would not include nationalistic clauses in their contracts. However you also have to call out the rampent hypocrisy of UK ministers in calling out vaccine nationalism, whilst at the same time having it written into their biggest supply contract.

At the end of the day the gerneal public do not know what is written in these contracts and will probably never know of verbal assurances that were made in the meetings surrounding their negotiation on either side of the channel.

And do we believe that EU countries (and come to think of it, any other countries with vaccine production facilities) haven't inserted "nationalistic" clauses in their contracts ? It's notable that Pfizer has also had production problems, yet these don't seem to have attracted so much political attention.

Arguably the whole point of having on-shore production is to have some element of supply chain assurance, and this situation hasn't been been caused by the UK not pulling its weight, these are the continents facilities that aren't up to speed.

Yes, we should assist our neighbours - particularly once our vulnerable have been vaccinated -(which would be assisted by not persisting with a stupid lockdown strategy) however we should resist any narrative that we have taken an unduly nationalistic position. If anything, we should give the assistance and trumpet the fact that we are going above and beyond. Afterall, was Germany being nationalistic last year when it had all of the testing capacity ?

 

[notlob.divad]

Immunity gained from infection is not necessarily the same as that from vaccination (which will vary by vaccine).
Natural immunity from older strain to the combined 501Y+484K variants looks extremely poor as the situation in Manaus illustrates.

I have just been reading the Sabino Buss Carvalho etal article in the lancet. It looks pretty serious for a city that was already believed to have passed the Herd Immunity threshold. I am not surprised governments are taking quick action to try and mitigate the risk of exposure to this strain.

 

[Domh245]

the suspicion (although I haven't seen evidence) that doses from the continental production facilities were distributed to the UK to make up for initial production shortfalls in the UK, simply because the UK had approved emergency usage of the vaccine whereas the EU had concerns over a lack of data which persist to this day.

Whilst this is true, it's a bit of a diversion. At most it was 4m doses of AZ that came across (although even then, I'm not sure that the quote where that number comes from entirely relates to EU produced doses) against a shortfall of something like fifty million.

 

[RomeoCharlie71]

Single dose of the J&J vaccine is shown to be 85% effective in reducing most serious covid symptoms and costs approximately £7 per dose.