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Vaccine Progress, Approval, and Deployment

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The Ham

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Please be careful. Boris might be reading and we don't want to give him any ideas for Tier 5!

Sorry, l'll be more careful in the future.

Although if Boris is reading this there's other ideas for higher level tier restrictions that I can come up with, although there'll be a cost, and if I'm caught breaking them I'll have inserted some minor clause which isn't worth repeating which will allow me to get away with it.
 
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hwl

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Sorry, l'll be more careful in the future.

Although if Boris is reading this there's other ideas for higher level tier restrictions that I can come up with, although there'll be a cost, and if I'm caught breaking them I'll have inserted some minor clause which isn't worth repeating which will allow me to get away with it.
To late, Nicola had already seen it and has been talking about 4 plus...
 

yorksrob

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In that case, I propose a tier 5 where to keep them out of the way of the rest of the population, middle aged single people are encouraged to spend time isolating in pubs and kept in place with a constant supply of ale and snacks.
 

Richard Scott

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To late, Nicola had already seen it and has been talking about 4 plus...
This is now just political games, surely? It's a joke, just not a funny one.
 

kez19

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This is now just political games, surely? It's a joke, just not a funny one.

Can I suggest a change in word here? (nothing personal at you luckily lol), rather saying "political" it maybe quite that its all "mind" games? Thats just a thought that occurred to me (could be both if I am honest but thats another word to throw into the ring)
 

Richard Scott

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Can I suggest a change in word here? (nothing personal at you luckily lol), rather saying "political" it maybe quite that its all "mind" games? Thats just a thought that occurred to me (could be both if I am honest but thats another word to throw into the ring)
Can't deny that's a good suggestion!
 

Class 33

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So the vaccinations started here a few weeks ago now. And already over half a million of the most vulnerable people have been vaccinated. Any realistic estimates as to when this is going to start really impacting on the hospital admissions, patients in hospital, and deaths stats? I'm no expert on this, but I would say surely by late January this should be taking effect? I would hope sooner than that. It just can't come soon enough, because we really need to get those stats down pretty fast otherwise this country is being wrecked by this wreckless government with yet another full national lockdown looming it seems and reports that this time it could last as long as 4 months. A full national lockdown lasting 4 months and the effects it will have on the economy and millions of people, doesn't bare thinking about.
 

brad465

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So the vaccinations started here a few weeks ago now. And already over half a million of the most vulnerable people have been vaccinated. Any realistic estimates as to when this is going to start really impacting on the hospital admissions, patients in hospital, and deaths stats? I'm no expert on this, but I would say surely by late January this should be taking effect? I would hope sooner than that. It just can't come soon enough, because we really need to get those stats down pretty fast otherwise this country is being wrecked by this wreckless government with yet another full national lockdown looming it seems and reports that this time it could last as long as 4 months. A full national lockdown lasting 4 months and the effects it will have on the economy and millions of people, doesn't bare thinking about.
They'll probably need their second dose first, so yes by mid-late January we'd hope for some effect. 500,000 vaccinated is of course significantly higher than any of the measures of deaths with Covid (highest excess death value is around 81,000). I do also think infections could have peaked by the end of January, given how high the rate is currently and the potential for an immunity buffer being established through just the second wave's effects so far.
 

hwl

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"21 shipments" of the vaccine have apparently arrived according to the Graun.

Unclear how many doses are now in the country.

One positive thing is that only 42% of hospital trusts have started vaccinations so vaccination rate might be able to reach 2-3x what it is now without much difficulty.

Which would put us on course for a million doses a week.
Given that only first doses are still being given, the rate will need to at least potentially double for quite along time or else the rate at which first jabs are given will need to decrease to match capacity.

Availability of the Pfizer/BioNTech vaccine is currently good but the quantities available over the next few months may not always be as good as currently, with current supplies coming from stock produced in autumn with around 5M doses available to the UK before end of March (less than originally planned). Hence the Oxford / AZ vaccine is very important.
 

yorksrob

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There was some discussion on the radio this morning that as the Pfizer vaccine is already 90% effective at one dose, we should forego increasing this to 95% by giving the double dose, and instead vaccinate twice as many people at 90%.

It certainly sounded a compelling argument. I did wonder whether there were any potential drawbacks in addition to the 5% loss in effectiveness.
 

brad465

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There was some discussion on the radio this morning that as the Pfizer vaccine is already 90% effective at one dose, we should forego increasing this to 95% by giving the double dose, and instead vaccinate twice as many people at 90%.

It certainly sounded a compelling argument. I did wonder whether there were any potential drawbacks in addition to the 5% loss in effectiveness.
So much so that an "expert" on the field, by the name of Tony Blair, is arguing for this approach:


Ex-PM Tony Blair is urging the government to give as many people as possible an initial dose of a Covid vaccine - rather than preserving stocks so there is enough for second jabs.

The Pfizer-Biontech and Oxford University-Astrazeneca vaccines require two doses to be fully effective.

Mr Blair says his idea would speed up the vaccine programme so the country could come out of lockdown sooner.

In the Independent, he said the roll-out must be "radically accelerated".

The UK has pre-ordered 40 million doses of the Pfizer-BioNTech vaccine and 100 million of the Oxford University Astrazeneca vaccines.

More than 500,000 people in the UK have now been given their first dose of the vaccine.

The two doses of the Pfizer-BioNTech vaccine are administered around 21 days apart.

Speaking to BBC Radio 4's Today programme, Mr Blair said that although "you really need the two doses… the first dose gives you substantial immunity".

He argued there was a "strong case for not holding back the second doses of the vaccine" and instead using those batches to give a greater number of people the first dose.

His proposal was backed up by Professor David Salisbury, the man who was in charge of immunisation at the Department of Health until 2013.

He told Today the numbers are "straightforward".

"You give one dose you get 91% [protection] you give two doses and you get 95% - you are only gaining 4% for giving the second dose," he said.
 

yorksrob

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So much so that an "expert" on the field, by the name of Tony Blair, is arguing for this approach:


They did have someone formerly involved in the national vaccination programme arguing for it as well.

To be fair to Tony Blair, I don't see any other politicians proposing any strategies to remove restrictions at the moment.
 

brad465

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They did have someone formerly involved in the national vaccination programme arguing for it as well.

To be fair to Tony Blair, I don't see any other politicians proposing any strategies to remove restrictions at the moment.
I agree, but I think more voices need to be calling for this fast so doses are not wasted on the same people if one dose definitely is enough.
 

Class 33

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They did have someone formerly involved in the national vaccination programme arguing for it as well.

To be fair to Tony Blair, I don't see any other politicians proposing any strategies to remove restrictions at the moment.

I did see whilst watching some footage of parliament last week that the MP for the Forest of Dean - Mark Harper, is demanding Johnson comes up with an exit strategy out of all these restrictions.
 

yorksrob

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I agree, but I think more voices need to be calling for this fast so doses are not wasted on the same people if one dose definitely is enough.

Indeed. I'd also like to hear pfizers view on whether there would be any potential issues, but I believe that this strategy has been used to make other vaccines go further in the past.

I did see whilst watching some footage of parliament last week that the MP for the Forest of Dean - Mark Harper, is demanding Johnson comes up with an exit strategy out of all these restrictions.

That's a fair point. There is a notable group of Conservative back benchers calling for an exit strategy.
 

bramling

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They did have someone formerly involved in the national vaccination programme arguing for it as well.

To be fair to Tony Blair, I don't see any other politicians proposing any strategies to remove restrictions at the moment.

At least Blair seems to properly recognise the damage this is all doing, and is trying to put an idea on the table that could be genuinely helpful.

Watch this space as he gets humoured by Boris...
 

hwl

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There was some discussion on the radio this morning that as the Pfizer vaccine is already 90% effective at one dose, we should forego increasing this to 95% by giving the double dose, and instead vaccinate twice as many people at 90%.

It certainly sounded a compelling argument. I did wonder whether there were any potential drawbacks in addition to the 5% loss in effectiveness.
Pfizer says the data only shows a single dose of the vaccine is 52% effective. which would struggle to be approved (50% cut off) and would store up huge problems for later due to lower effectiveness.

The second dose increases the effectiveness by 80+% compared to a single dose.

See BMJ coverage here:


Covid-19: Pfizer vaccine efficacy was 52% after first dose and 95% after second dose, paper shows​

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4826 (Published 11 December 2020)Cite this as: BMJ 2020;371:m4826


The Pfizer and BioNTech covid-19 vaccine may provide some early protection, starting 12 days after the first dose, the peer reviewed results of a phase III trial have found.
The study, published in the New England Journal of Medicine,1 found that vaccine efficacy between the first and second doses was 52% (95% credible interval 29.5% to 68.4%), with 39 cases of covid-19 in the vaccine group and 82 cases in the placebo group.
Seven or more days after the second dose, vaccine efficacy then rose to 95% (90.3% to 97.6%), with eight covid-19 cases reported in the vaccine group and 162 cases in the placebo group.
The vaccine has so far been approved in Canada and in the UK, where it is already being rolled out to people over 80 and healthcare workers. In the US the Food and Drug Administration’s independent panel has voted in favour of emergency use authorisation for the vaccine, and the agency is expected to approve it within days.
...

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I agree, but I think more voices need to be calling for this fast so doses are not wasted on the same people if one dose definitely is enough.
It isn't though, which is why there aren't more voices as many potential voices would fact check first.

== Doublepost prevention - post automatically merged: ==

is trying to put an idea on the table that could be genuinely helpful.
As it is contradicted by phase 3 clinical trial data don't expect it to go far. Blair should be apologising for spouting untruths in the national media.
 
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yorksrob

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Pfizer says the data only shows a single dose of the vaccine is 52% effective. which would struggle to be approved (50% cut off) and would store up huge problems for later due to lower effectiveness.

The second dose increases the effectiveness by 80+% compared to a single dose.

See BMJ coverage here:




== Doublepost prevention - post automatically merged: ==


It isn't though, which is why there aren't more voices as many potential voices would fact check first.

== Doublepost prevention - post automatically merged: ==


As it is contradicted by phase 3 clinical trial data don't expect it to go far. Blair should be apologising for spouting untruths in the national media.

Well, that's a shame then.

I wonder if they've tested it at a dose and a half ?

Norman Fowler was asked about the same idea on the programme and was pretty sceptical. He was a fairly competent health minister as I recall.
 
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HSTEd

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Pfizer says the data only shows a single dose of the vaccine is 52% effective. which would struggle to be approved (50% cut off) and would store up huge problems for later due to lower effectiveness.

The second dose increases the effectiveness by 80+% compared to a single dose.

See BMJ coverage here:




== Doublepost prevention - post automatically merged: ==


It isn't though, which is why there aren't more voices as many potential voices would fact check first.

== Doublepost prevention - post automatically merged: ==


As it is contradicted by phase 3 clinical trial data don't expect it to go far. Blair should be apologising for spouting untruths in the national media.

52% is greater than half of 95.
 

Yew

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Pfizer says the data only shows a single dose of the vaccine is 52% effective. which would struggle to be approved (50% cut off) and would store up huge problems for later due to lower effectiveness.

The second dose increases the effectiveness by 80+% compared to a single dose.

See BMJ coverage here:




== Doublepost prevention - post automatically merged: ==


It isn't though, which is why there aren't more voices as many potential voices would fact check first.

== Doublepost prevention - post automatically merged: ==


As it is contradicted by phase 3 clinical trial data don't expect it to go far. Blair should be apologising for spouting untruths in the national media.
2*52 is more than 1*80 though...
 

brad465

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Do we know how many Pfizer doses are still available/on the way soon? I've heard reports that we've got enough till the end of January but after that we have to wait until March for more.
 

Yew

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94.5% is an 81.5% uplift (i.e. 1.815x) from 52%.
True, but I think the absolute number matters here; 200 identical people with 52% protection drops the number of people at risk of hospitalisation by half, whereas 100 with 95% (from a double dose) and 100 (no dose) with 0% drop it by 42%.
 

hwl

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52% is greater than half of 95.
Indeed you only get an extra 0.8 fold benefit not 1.0 from the second dose.

so while there is a potential short term gain you would spectacularly shoot your self in the foot in the medium and longer terms!
 

35B

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True, but I think the absolute number matters here; 200 identical people with 52% protection drops the number of people at risk of hospitalisation by half, whereas 100 with 95% (from a double dose) and 100 (no dose) with 0% drop it by 42%.
And the suggestions seem to be that herd immunity levels sit at 60% or more. This seems a classic case of more haste, less speed.
 

hwl

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True, but I think the absolute number matters here; 200 identical people with 52% protection drops the number of people at risk of hospitalisation by half, whereas 100 with 95% (from a double dose) and 100 (no dose) with 0% drop it by 42%.
1. It is being targeted at those with high risk of hospitalisation so all those people aren't identical

2. There is no clinical trial data for effectiveness in the high risk groups the UK is targeting but from other vaccinations it is known the effectiveness tends to be lower.

== Doublepost prevention - post automatically merged: ==

And the suggestions seem to be that herd immunity levels sit at 60% or more. This seems a classic case of more haste, less speed.
Agree.

It looks like the new strain has moved the goal post on herd immunity into the 70+% range
 
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brad465

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It looks like the new strain has moved the goal post on herd immunity into the 70+% range
It might increase the herd immunity threshold but as it seems to be spreading fast at the moment it might not necessarily be any slower to reach that level. Besides they should really lift everything once the most vulnerable people have been vaccinated, even if herd immunity overall hasn't been reached at that time.
 

hwl

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So the vaccinations started here a few weeks ago now. And already over half a million of the most vulnerable people have been vaccinated. Any realistic estimates as to when this is going to start really impacting on the hospital admissions, patients in hospital, and deaths stats? I'm no expert on this, but I would say surely by late January this should be taking effect? I would hope sooner than that. It just can't come soon enough, because we really need to get those stats down pretty fast otherwise this country is being wrecked by this wreckless government with yet another full national lockdown looming it seems and reports that this time it could last as long as 4 months. A full national lockdown lasting 4 months and the effects it will have on the economy and millions of people, doesn't bare thinking about.
With the Pfizer vaccine 90% effectiveness is achieved 7days post second dose and 95% 7days post second dose. Hence if the second dose is exactly 3 weeks after the first, then there is a 5 week lag till peak effectiveness is achieved after the first dose.

So we should see well over 600k with both doses and peak immunity by the end of Jan along with an even larger number with a just a single dose awaiting the second or awaiting to develop peak immunity in the fortnight after the second dose.

The UK carehome population tends to be just over 400k at any point in time.

Hence end of at the end of Jan we should start to see the impact on hospitalisation. there is a big difference between starting to see an effect on hospitalisation and huge drops which will be end of March.
A huge amount also depends on the Oxford/AZ Vaccine being approved for use as that would have more of an impact than the Pfizer one due to better availability.

The new strain is however a game-changer which will hide the early effectiveness of the vaccination campaign due to higher transmission and case rates.

== Doublepost prevention - post automatically merged: ==

It might increase the herd immunity threshold but as it seems to be spreading fast at the moment it might not necessarily be any slower to reach that level. Besides they should really lift everything once the most vulnerable people have been vaccinated, even if herd immunity overall hasn't been reached at that time.
Immunologists tend to classify immunity by previous infection and vaccination differently as the latter tends to provide far better and longer lasting immunity.
It is worth noting that just over 1% of the new strain covid cases analysed by NERVTAG in last Fridays report had already had an older strain covid infection and positive test result previously which suggests the immunity from developed from having had it is less good than from vaccination. (e.g. You would expect 5% to get infected post 2x Pfizer vaccinations but a fifth of this level got it a second time after 2 random transmissions not just 1 in the time period concerned).

We will have much better data natural immunity after this winter when there have been more people with second cases of covid.
 
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