Vaccine Progress, Approval, and Deployment

[7 Ingleborough]

You have to train up the people administering the vaccine as well as get the doses in position. At present they are concentrating on getting the approved vaccines to the less mobile and the most vulnerable while over 30,000 staff (The initial tranche) are being trained up to man the the mass vaccination centres. Those of us who have passed the vaccination course, (yes it is possible to fail) will be working in teams of six with a more qualified overseer as the 7th. The Pfizer vaccine as is well reported has some issues around storage at low temperatures so will likely be used in, or very close to hospitals where the storage facilities are located. The 'Oxford' vaccine, which will hopefully be approved for use very soon, will be the one used more commonly at the high capacity vaccination centres. Both require two doses between 21 and 28 days apart, and the immunity response should peak 5-7 days later.
The injection is into the Deltoid muscle, about an inch below the shoulder. after each jab the patient will be directed to a rest area for 15 minutes to check that there is no immediate allergic reaction.
The logistics behind all this are immense, and fortunately, this time round, after the PPE fiasco, the Military are in charge of distribution, and setting up the mass vaccination centres. Many members of all our armed services will have no Christmas this year, but speaking to the ones I met in Bristol, they have a job with a vital purpose, and the pride in the job shows.
It is a race, vaccinations now have to outpace the infection rate, and that will be hard given the 4-5 weeks it takes for the immune response. Classes of people taken off the vaccination list also now include breast feeding mothers. No risk has been identified, but safety first.

 

[Yew]

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.

True, but if we can get decent levels of protection for the most vulnerable, we don't have to worry about community transmission as much.

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: 23 Dec 2020 ==

1. I agree, but I'd suggest that since we're using different priority 'bands' we can treat those as a relatively homogenous group, my thoughts were to protect the extremely vulnerable more quickly, rather than for example, starting to vaccinate down the tiers more quickly.

Immunologists tend to classify immunity by previous infection and vaccination differently as the latter tends to provide far better and longer lasting immunity.

For getting things back on the road in the short term, it doesnt matter about long-term immunity.

 

[hwl]

For getting things back on the road in the short term, it doesnt matter about long-term immunity.

The danger is that by focusing entirely on the short term with a single dose approach the UK would give itself huge problems in the medium and long terms compared to other countries who hold their nerve and go for maximum effectiveness in vaccinated individuals so they stand a better chance of getting back to something near normal where as the UK would still be left with the NHS struggle to cope and some restrictions removed.

 

[Yew]

The danger is that by focusing entirely on the short term with a single dose approach the UK would give itself huge problems in the medium and long terms compared to other countries who hold their nerve and go for maximum effectiveness in vaccinated individuals so they stand a better chance of getting back to something near normal where as the UK would still be left with the NHS struggle to cope and some restrictions removed.

Getting things back up and running can easily pay for people to be re-vaccinated with a double dose six months down the line if needed.

EDIT: I think the best way of putting it is "whilst supply is limited", we should try to maximise coverage, especialy as some sources suggest a 90% effectiveness after one dose. If we have to re-dose in the future, once supply is better, then I think that the costs make it worth it.

 

[hwl]

Getting things back up and running can easily pay for people to be re-vaccinated with a double dose six months down the line if needed.

The immune system doesn't necessarily work like that though*, it is worth noting that the anticipated long term booster strategy the manufacturers envisage is a single dose. If the optimum initial double dose isn't achieved then the maximum immunity levels may never be achieved. It isn't just about money but science too.

*The Moderna and Oxford/AZ trial results hint that it doesn't in the covid case.

If the gap between doses of the Oxford vaccines is over 8 weeks it looks like 2 full doses would be needed not the half then full doses. With the Oxford vaccine the personnel doing it are the main restriction and we will still be vaccinating in the autumn making kicking the 6 months down the road option difficult too.

There may well be one opportunity to do it right, but never under estimate british politicians' ability to snatch a screwup from the jaws of victory.

 

[MattA7]

Is there any evidence that the vaccine is effective against South African covid. Which has allegedly reached the UK.

 

[Yew]

Is there any evidence that the vaccine is effective against South African covid. Which has allegedly reached the UK.

It's not been tested for specifically, but there is no evidence of vaccinated people contracting this new mythical strain that happened to appear at the same time that Matt dedided he wanted to lock down a load of people.

Given that we've seen cross-immunity from other coronaviruses it'd be highly unlikely that any strain will have a significant impact on vaccine effectiveness.

 

[DB]

It's not been tested for specifically, but there is no evidence of vaccinated people contracting this new mythical strain that happened to appear at the same time that Matt dedided he wanted to lock down a load of people.

Given that we've seen cross-immunity from other coronaviruses it'd be highly unlikely that any strain will have a significant impact on vaccine effectiveness.

And out of all the mutations which have appeared so far, it's remarkably convenient that two which are apparently a cause for concern should appear right at the time when they need something new to scare people with!

 

[Yew]

And out of all the mutations which have appeared so far, it's remarkably convenient that two which are apparently a cause for concern should appear right at the time when they need something new to scare people with!

Exactly, if only the virus could have been this accomodating throughout the rest of the year...

 

[kristiang85]

As long as the spike proteins don't change, which will take a lot of mutation, then the vaccine should be fine. Coronaviruses are usually very stable as they mutate.

Hancock obviously doesn't go for the optimistic route when explaining to the population though.

 

[Richard Scott]

Hancock obviously doesn't go for the optimistic route when explaining to the population though.

Or show any knowledge about the subject, the ignorance of our politicians is unbelievable.

 

[hwl]

EDIT: I think the best way of putting it is "whilst supply is limited", we should try to maximise coverage, especially as some sources suggest a 90% effectiveness after one dose. If we have to re-dose in the future, once supply is better, then I think that the costs make it worth it.

The problem is we have no data on a different dosing strategy e.g double dose later after single dose soon or differences in effectiveness that result. It isn't about cost. If a better overall solution 3 weeks later on average is far better in the medium /long term than a suboptimal one very slightly sooner?

Given the probable approval of the Oxford /AZ vaccine soon (with extra data set submitted on half /full dose) so the supply limited issue may well soon evaporate.

The high single dose effectiveness quoted in places is relatively short term and goes back down again.

 

[yorksrob]

Here's a question. Now that we know a reasonable amount about the virus and its spikey bits, could we genetically engineer a version that wasn't deadly, but was more transmissable ?

I realise that we have vaccines, but they rely on sticking needles in people. Why not let the virus do the work ?

 

[Domh245]

Why not let the virus do the work ?

There's speed if nothing else - in two weeks, and at a very sedate pace we've managed to (half) vaccinate 500,000 people, whilst in three hundred days the virus has infected around 2,500,000 (lower bound). Short of instructing everyone to go around licking doorknobs and coughing at each other (neither of which is ideal in the best of cases, let alone likely to happen after a year of sanitise everything, don't go within 1/2 a mile of anyone, etc) you'd struggle to match the rate of spread compared to a well organised vaccination program

There's also no guarantee that the less deadly variant you've engineered wouldn't naturally mutate to something more deadly unless you deactivate it, but then it wouldn't spread naturally and you're back at just having a vaccine

 

[yorksrob]

There's speed if nothing else - in two weeks, and at a very sedate pace we've managed to (half) vaccinate 500,000 people, whilst in three hundred days the virus has infected around 2,500,000 (lower bound). Short of instructing everyone to go around licking doorknobs and coughing at each other (neither of which is ideal in the best of cases, let alone likely to happen after a year of sanitise everything, don't go within 1/2 a mile of anyone, etc) you'd struggle to match the rate of spread compared to a well organised vaccination program

There's also no guarantee that the less deadly variant you've engineered wouldn't naturally mutate to something more deadly unless you deactivate it, but then it wouldn't spread naturally and you're back at just having a vaccine

Nature eh !

 

[Richard Scott]

There's speed if nothing else - in two weeks, and at a very sedate pace we've managed to (half) vaccinate 500,000 people, whilst in three hundred days the virus has infected around 2,500,000 (lower bound). Short of instructing everyone to go around licking doorknobs and coughing at each other (neither of which is ideal in the best of cases, let alone likely to happen after a year of sanitise everything, don't go within 1/2 a mile of anyone, etc) you'd struggle to match the rate of spread compared to a well organised vaccination program

There's also no guarantee that the less deadly variant you've engineered wouldn't naturally mutate to something more deadly unless you deactivate it, but then it wouldn't spread naturally and you're back at just having a vaccine

In recent weeks think nature has got close to 500,000 cases as well so it's not too far behind?

 

[Domh245]

In recent weeks think nature has got close to 500,000 cases as well so it's not too far behind?

A fair point - over the same time span (8/12-22/12) there were 372,357 cases announced, so perhaps the speed advantage isn't quite as great as I might have thought. It's still far preferable to get jabbed than rely on a genetically engineered virus doing the rounds

 

[Reliablebeam]

Some of you may find this tweet interesting

Nick Davies on Twitter: "We project the potential impact of the spread of this new variant throughout England and look at possible control policies. Achieving 2 million vaccinations/week could substantially reduce the burden. 200,000 vaccinations/week does not have much impact. NOT PEER REVIEWED 5/9 https://t.co/G9uFm8pfXu" / Twitter

Many of the authors are on various SAGE related committees so no doubt some of this modelling will influence government thinking!

Basically models the effect of different interventions, combined with a January 'lockdown', this includes different rates of vaccination and possible one month school closure. Basically if they can get 2 million vaccinations a week that really does damp down the mythical 'R' quite quickly. Assuming you place a lot of faith in these models of course....*

*The confidence intervals look reasonable for London and the South East of England, much more uncertainty in the Midlands, North and East of England..

 

[yorksrob]

Some of you may find this tweet interesting

Nick Davies on Twitter: "We project the potential impact of the spread of this new variant throughout England and look at possible control policies. Achieving 2 million vaccinations/week could substantially reduce the burden. 200,000 vaccinations/week does not have much impact. NOT PEER REVIEWED 5/9 https://t.co/G9uFm8pfXu" / Twitter

Many of the authors are on various SAGE related committees so no doubt some of this modelling will influence government thinking!

Basically models the effect of different interventions, combined with a January 'lockdown', this includes different rates of vaccination and possible one month school closure. Basically if they can get 2 million vaccinations a week that really does damp down the mythical 'R' quite quickly. Assuming you place a lot of faith in these models of course....*

*The confidence intervals look reasonable for London and the South East of England, much more uncertainty in the Midlands, North and East of England..

Can they do 2 million vaccinations a week ?

If so I'm all for it. It sounds a lot, but we probably produce more than 2 million loaves of bread a week.

If we need 2million vaccinations a week+lockdown+school closures, then it's a bit much.

 

[chris11256]

After a skim read I think the modelling assumes staying in tier 4 with all education physically closed until the end of January.

Basically once the Oxford vaccine arrives the government really does need to rapidly speed up the pace. The modelling shows vaccinating 2 million a week would have a significant impact on ‘R’ keeping it below one from late January/February onwards.

is worth a read.

 

[Richard Scott]

A fair point - over the same time span (8/12-22/12) there were 372,357 cases announced, so perhaps the speed advantage isn't quite as great as I might have thought. It's still far preferable to get jabbed than rely on a genetically engineered virus doing the rounds

Probably, was just pointing it out!!!

 

[hwl]

Some of you may find this tweet interesting

Nick Davies on Twitter: "We project the potential impact of the spread of this new variant throughout England and look at possible control policies. Achieving 2 million vaccinations/week could substantially reduce the burden. 200,000 vaccinations/week does not have much impact. NOT PEER REVIEWED 5/9 https://t.co/G9uFm8pfXu" / Twitter

Many of the authors are on various SAGE related committees so no doubt some of this modelling will influence government thinking!

Basically models the effect of different interventions, combined with a January 'lockdown', this includes different rates of vaccination and possible one month school closure. Basically if they can get 2 million vaccinations a week that really does damp down the mythical 'R' quite quickly. Assuming you place a lot of faith in these models of course....*

*The confidence intervals look reasonable for London and the South East of England, much more uncertainty in the Midlands, North and East of England..

The government plan with the Oxford / AZ Vaccine approved is 2million per week hence why they looked at 2M / week.

 

[yorksrob]

They need to get on with it then.

 

[Reliablebeam]

The government plan with the Oxford / AZ Vaccine approved is 2million per week hence why they looked at 2M / week.

I thought that might be the case. The modelling looks like a cabinet/ civil service scenario. If they stand by this, and the AZ vaccine gets deployed on schedule then hopefully Adam Kucharski and Edmunds will allow us our civil liberties back!

 

[brad465]

They need to get on with it then.

I recall reading elsewhere on this forum that others believe it's ready for approval but are waiting for a specific day to announce it for political reasons.

 

[DB]

I recall reading elsewhere on this forum that others believe it's ready for approval but are waiting for a specific day to announce it for political reasons.

31st would no doubt suit Johnson - keep the Brexit shambles off the front pages on 1st Jan.

 

[brad465]

31st would no doubt suit Johnson - keep the Brexit shambles off the front pages on 1st Jan.

If as is being speculated a deal being reached will be announced today, a good day to approve the vaccine would be the day the ERG and others who don't like the contents discover what's in it.

 

[HSTEd]

If they can actually do two million a week, another lockdown looks fairy pointless

 

[Class 317]

As 2 doses are required for both vaccines (assuming Oxford one approved in the next couple of weeks) and also assuming all 12 million over 65's take the vaccine then it's 12 week's minimum to vaccinate those considered as at highest risk. Adding a week for immunity to take effect and sometime for ramping up vaccinations I can't realistically see many restrictions going before end of March.

However once the over 65's are done hospital admissions should drop significantly and lead to a progressive easing of restrictions.

All depends how quickly it can be ramped up but end of January seems unrealistic.

 

[HSTEd]

However once the over 65's are done hospital admissions should drop significantly and lead to a progressive easing of restrictions.

All depends how quickly it can be ramped up but end of January seems unrealistic.

By the time the over 65s are done deaths will be down over 90%

Indeed 35-40% of the deaths are amongst the 1.2 million people over 80.