8 ms·

Looks like they approved the two-dose 62% ~effective~ efficacy regiment. There was a lot of hope for the one-dose given the supply constraints or a retrial fo

Looks like they approved the two-dose 62% ~effective~ efficacy regiment. There was a lot of hope for the one-dose given the supply constraints or a retrial for the more promising half+full dose for greater efficacy. I wonder if people will ask which vaccine they're receiving. 62% is kinda underwhelming when there's two 95% ones (Pfizer/Moderna), a 92% one (Gamaleya), and a 79-86% one (Sinopharm). With the latter two also not needing subzero temps.

jsnell 6y ago
The announcement [0] says they are going to prioritize everyone in risk groups getting their first shot over some people getting two, and as a result might have up to 12 weeks between the two shots. That seems like a reasonable way of dealing with the supply constraints, without entirely throwing out the protocol established via testing. [0] https://www.gov.uk/government/news/oxford-universityastrazeneca-vaccine-authorised-by-uk-medicines-regulator https://www.gov.uk/government/news/oxford-universityastrazen...
- pstrateman 6y ago
  If you're in a high risk group surely you want the more effective vaccine? I doubt you can have both (even if safe, it's not tested at all).
  - MrAlex94 6y ago
    Both vaccines seem to stop hospitalisations completely, which seems to be the most important part. > No hospitalisations or severe disease observed in the vaccinated groups from three weeks after first dose https://www.ox.ac.uk/news/2020-12-08-first-peer-reviewed-results-phase-3-human-trials-oxford-coronavirus-vaccine# https://www.ox.ac.uk/news/2020-12-08-first-peer-reviewed-res...
  - andylynch 6y ago
    Given the choice, yes but anything now is better than something in a few months, time, especially looking at current UK mortality rates. These are now rivalling the first wave, even with treatments learning in the last nine months and NHS fully geared up.
    - lucb1e 6y ago
      > looking at current UK mortality rates. These are now rivalling the first wave Are you sure? This is the data I'm looking at: https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-02-22..latest&country=NLD~DEU~ESP~GBR&region=Europe&deathsMetric=true&interval=smoothed&hideControls=true&perCapita=true&smoothing=7&pickerMetric=total_cases_per_million&pickerSort=desc https://ourworldindata.org/coronavirus-data-explorer?zoomToS... This link goes to "confirmed deaths" per million people, see also the "case fatality rate" setting. The former is about 6.8 now versus 13.8 at the peak in April; the latter is 3% versus 15% at the peak in April. There are half as many deaths and a fifth of the deaths per case. That's not even close to "rivaling it despite being geared up", at least from this data. Is this data wrong?
      - oakesm9 6y ago
        Here’s the official UK data: https://coronavirus.data.gov.uk/details/cases https://coronavirus.data.gov.uk/details/cases https://coronavirus.data.gov.uk/details/deaths https://coronavirus.data.gov.uk/details/deaths Deaths are a bit lower. Cases are higher. Hospitalisations are about the same as the previous peek, but heading further up.
        grey-area 6y ago
        Cases can't really be compared with the first wave because of significantly higher testing (450k per day now vs 60k per day in May, or 20k per day in April at the peak of hospitalisations).
        oakesm9 6y ago
        Yes, that’s true, but neither can deaths as more is known about how to treat severe cases.
        gsnedders 6y ago
        Note that the official data on deaths only includes those confirmed (through a positive test) to have COVID-19; this almost certainly understates the total number of deaths in the first wave due to lack of testing capacity.
  - ggm 6y ago
    Mixing vaccine types is under consideration. An experiment is proposed combining AZ and Sputnik.
  - kenhwang 6y ago
    I'm thinking more the other way around. All the vaccines practically prevent hospitalization/death. But the AZ one is coin flip odds for symptoms, however minor. But even minor symptoms from COVID can have medium term damage (loss of smell/taste/lung capacity) that may not be recoverable. If you're part of the elderly high risk group, long term isn't that much longer anyway. It's the people with most of their life ahead of them that has to pick between the long term damage of COVID vs the unknown potential of long term effects from mRNA/adenovirus.
MrAlex94 6y ago
Seems at least 60% is good enough: > Simulation experiments revealed that to prevent an epidemic (reduce the peak by >99%), the vaccine efficacy has to be at least 60% when vaccination coverage is 100% (reproduction number=2.5–3.5). This vaccine efficacy threshold rises to 70% when coverage drops to 75% and up to 80% when coverage drops to 60% when reproduction number is 2.5, rising to 80% when coverage drops to 75% when the reproduction number is 3.5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361120/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361120/ Also, it prevents hospitalisations completely which is crucial. I asked elsewhere but seems this thread is the busiest: Also, does anyone know - supposedly the Oxford vaccine had swab tests for the virus every week to catch cases even if trial participants weren’t showing symptoms, whereas for the Pfizer/BioNTech vaccine they were only swabbing if someone showed symptoms. Would that not have a large effect on efficacy numbers?
- adrianN 6y ago
  In Germany only 2/3rds of the population want to get vaccinated. So they'd better be vaccinated with a vaccine with very high efficiency.
  - MrAlex94 6y ago
    70% efficacy in that case wouldn’t prevent an epidemic, but since it prevents hospitalisations and severe effects of the disease it’s still worth it.
    - f6v 6y ago
      It’s interesting how the vaccination speed affects epidemic. What’s the effect of vaccinating everyone within a month vs within half a year.
  - krzyk 6y ago
    I wouldn't call 2/3rds as "only", this is quite high. In Poland we have only ~40% that want to be vaccinated (but maybe this a result of Germany having much older population). I'm a bit reluctant to vaccinating until I see some more tests on wider population and we could test for long term complications (e.g. reduced fertility which couldn't be tested earlier) and I'm a person that vaccinated my children (and myself) for all kinds of diseases. So I assume there are more people like me (aside from the usual "anti-vaccination" crowd).
DrBazza 6y ago
I believe there's a journal article being published shortly. In the meantime this article: https://www.bbc.co.uk/news/health-55308216 https://www.bbc.co.uk/news/health-55308216 """Unlike other vaccines being trialled, the Oxford team had been taking weekly swabs from all volunteers to check whether they were infected but showing no symptoms. If the vaccine could prevent silent transmission it could stop them from unwittingly passing on the virus. "That's a big deal. Because that means the virus could be stopped in its tracks," says Pollard. Intriguingly, when the trial results came out, there were indications it may partly suppress transmission of the virus. But more evidence is needed.""" and """Crucially, no-one who got the vaccine was hospitalised or got seriously ill due to Covid. Whereas in the control group there were 10 serious cases and one death.""" Perhaps, regardless of immunity, it reduces symptoms to "not serious", and may reduce transmission, which the other vaccines do not? Which seems like a fair trade for high immunity percentages, and possibly better for the wider community.
- kenhwang 6y ago
  Pfizer has the highest efficacy endpoint (95% at preventing symptomatic infection, which would theoretically also prevent spread and symptoms at higher percentages) with equal efficacy across age groups. Moderna is 95% at preventing symptoms (100% for serious symptoms in their trial but insufficient sample size). They also reported slightly lower efficacy for the elderly. AstraZeneca is 62% for preventing symptoms (unknown for infection and spread). So it's not quite a trade-off of spread prevention vs symptom prevention, because Pfizer claims to do both significantly better. edit: reading the data in more detail, all 3 don't have sufficiently significant data to claim anything other than symptoms. So preventing spread is just PR-hype.
  - _Gyan_ 6y ago
    > Pfizer has the highest efficacy endpoint (95% at preventing infection Cite, please. Pfizer's primary outcome measure was symptomatic infection. Only Oxford/AZ in the UK carried out weekly PCR tests to check for asymptomatic infections.
    - 6y ago
disabled 6y ago
^ This. Although it is better than nothing. However, whatever I am offered, I am taking.
mxcrossb 6y ago
I feel like we’re watching a medical ethics textbook unfold in real time. When the cold judgement of impartial history books come out, it will be interesting to read about. I also am wondering about the mindset of people getting a 60% vaccine. Maybe they will expand access to it to younger front line workers, who know they would have to wait really long for the mRNA version
- beojan 6y ago
  I expect if you are offered the Oxford/AZ vaccine and refuse it, you would not later be offered one of the mRNA vaccines.
- oezi 6y ago
  But aren't 50% vaccines usually deemed effective enough?
  - andygates 6y ago
    Yes. The wacky back-seat epidemiology is new with the many vaccine candidates. Most people won't get an actual choice, they'll be offered what their healthcare provider offers and they can take it or leave it.
    - kenhwang 6y ago
      Well typically there isn't such a large gap in vaccine performance. 62% is about as bad as vaccines get, and in any other circumstance the manufacturer would retrial instead of seek approval. Even the WHO recommends a 70% minimum during pandemic times (with 50%+ being a measure of last resort, which I guess we're at now). On the other hand, 95% is better than the best of the best.
  - mxcrossb 6y ago
    50% is effective enough for a society to squash corona, but a purely self motivated person will surely prefer the 90% version.
jonplackett 6y ago
Most important thing - no-one who was given the vaccine in the trial got seriously ill. Even if that’s all the vaccine can do for me, here’s my arm. Remember the biggest threat is health care systems being overwhelmed. That’s when people will die at much much higher rates because they don’t get respirators/oxygen.
- ptaipale 6y ago
  A bit off topic, but as far as I understand (not a medicla expert), respirators are not as important as they were though to be back in the spring when countries were fighting for equipment deliveries Extra oxygen is critical.
  - jonplackett 6y ago
    Yeah it seems so - but they are still needed and in much more limited supply than oxygen. I listened to an ICU doctor on the radio this morning saying the problem is that ANY kind of illness with covid is problematic because even fairly mild cases often require some medical attention, even if it’s just a doctor to reassure you you’re OK, that’s fine a doctor could be spending doing something more life-saving. Here in the UK with this nee strain, the NHS is running out of resources in hotspot areas so any kind of vaccine will help.
Kneecaps07 6y ago
If it was like my experience, you're told which one it is before you get the vaccine. I was given a 2-page write up on the Pfizer vaccine as I waited to receive the shot.

jsnell 6y ago

The announcement [0] says they are going to prioritize everyone in risk groups getting their first shot over some people getting two, and as a result might have up to 12 weeks between the two shots. That seems like a reasonable way of dealing with the supply constraints, without entirely throwing out the protocol established via testing. [0] https://www.gov.uk/government/news/oxford-universityastrazeneca-vaccine-authorised-by-uk-medicines-regulator https://www.gov.uk/government/news/oxford-universityastrazen...

pstrateman 6y ago
If you're in a high risk group surely you want the more effective vaccine? I doubt you can have both (even if safe, it's not tested at all).
- MrAlex94 6y ago
  Both vaccines seem to stop hospitalisations completely, which seems to be the most important part. > No hospitalisations or severe disease observed in the vaccinated groups from three weeks after first dose https://www.ox.ac.uk/news/2020-12-08-first-peer-reviewed-results-phase-3-human-trials-oxford-coronavirus-vaccine# https://www.ox.ac.uk/news/2020-12-08-first-peer-reviewed-res...
- andylynch 6y ago
  Given the choice, yes but anything now is better than something in a few months, time, especially looking at current UK mortality rates. These are now rivalling the first wave, even with treatments learning in the last nine months and NHS fully geared up.
  - lucb1e 6y ago
    > looking at current UK mortality rates. These are now rivalling the first wave Are you sure? This is the data I'm looking at: https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-02-22..latest&country=NLD~DEU~ESP~GBR&region=Europe&deathsMetric=true&interval=smoothed&hideControls=true&perCapita=true&smoothing=7&pickerMetric=total_cases_per_million&pickerSort=desc https://ourworldindata.org/coronavirus-data-explorer?zoomToS... This link goes to "confirmed deaths" per million people, see also the "case fatality rate" setting. The former is about 6.8 now versus 13.8 at the peak in April; the latter is 3% versus 15% at the peak in April. There are half as many deaths and a fifth of the deaths per case. That's not even close to "rivaling it despite being geared up", at least from this data. Is this data wrong?
    - oakesm9 6y ago
      Here’s the official UK data: https://coronavirus.data.gov.uk/details/cases https://coronavirus.data.gov.uk/details/cases https://coronavirus.data.gov.uk/details/deaths https://coronavirus.data.gov.uk/details/deaths Deaths are a bit lower. Cases are higher. Hospitalisations are about the same as the previous peek, but heading further up.
      - grey-area 6y ago
        Cases can't really be compared with the first wave because of significantly higher testing (450k per day now vs 60k per day in May, or 20k per day in April at the peak of hospitalisations).
        oakesm9 6y ago
        Yes, that’s true, but neither can deaths as more is known about how to treat severe cases.
        gsnedders 6y ago
        Note that the official data on deaths only includes those confirmed (through a positive test) to have COVID-19; this almost certainly understates the total number of deaths in the first wave due to lack of testing capacity.
- ggm 6y ago
  Mixing vaccine types is under consideration. An experiment is proposed combining AZ and Sputnik.
- kenhwang 6y ago
  I'm thinking more the other way around. All the vaccines practically prevent hospitalization/death. But the AZ one is coin flip odds for symptoms, however minor. But even minor symptoms from COVID can have medium term damage (loss of smell/taste/lung capacity) that may not be recoverable. If you're part of the elderly high risk group, long term isn't that much longer anyway. It's the people with most of their life ahead of them that has to pick between the long term damage of COVID vs the unknown potential of long term effects from mRNA/adenovirus.

MrAlex94 6y ago

Seems at least 60% is good enough: > Simulation experiments revealed that to prevent an epidemic (reduce the peak by >99%), the vaccine efficacy has to be at least 60% when vaccination coverage is 100% (reproduction number=2.5–3.5). This vaccine efficacy threshold rises to 70% when coverage drops to 75% and up to 80% when coverage drops to 60% when reproduction number is 2.5, rising to 80% when coverage drops to 75% when the reproduction number is 3.5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361120/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361120/ Also, it prevents hospitalisations completely which is crucial. I asked elsewhere but seems this thread is the busiest: Also, does anyone know - supposedly the Oxford vaccine had swab tests for the virus every week to catch cases even if trial participants weren’t showing symptoms, whereas for the Pfizer/BioNTech vaccine they were only swabbing if someone showed symptoms. Would that not have a large effect on efficacy numbers?

adrianN 6y ago
In Germany only 2/3rds of the population want to get vaccinated. So they'd better be vaccinated with a vaccine with very high efficiency.
- MrAlex94 6y ago
  70% efficacy in that case wouldn’t prevent an epidemic, but since it prevents hospitalisations and severe effects of the disease it’s still worth it.
  - f6v 6y ago
    It’s interesting how the vaccination speed affects epidemic. What’s the effect of vaccinating everyone within a month vs within half a year.
- krzyk 6y ago
  I wouldn't call 2/3rds as "only", this is quite high. In Poland we have only ~40% that want to be vaccinated (but maybe this a result of Germany having much older population). I'm a bit reluctant to vaccinating until I see some more tests on wider population and we could test for long term complications (e.g. reduced fertility which couldn't be tested earlier) and I'm a person that vaccinated my children (and myself) for all kinds of diseases. So I assume there are more people like me (aside from the usual "anti-vaccination" crowd).

DrBazza 6y ago

I believe there's a journal article being published shortly. In the meantime this article: https://www.bbc.co.uk/news/health-55308216 https://www.bbc.co.uk/news/health-55308216 """Unlike other vaccines being trialled, the Oxford team had been taking weekly swabs from all volunteers to check whether they were infected but showing no symptoms. If the vaccine could prevent silent transmission it could stop them from unwittingly passing on the virus. "That's a big deal. Because that means the virus could be stopped in its tracks," says Pollard. Intriguingly, when the trial results came out, there were indications it may partly suppress transmission of the virus. But more evidence is needed.""" and """Crucially, no-one who got the vaccine was hospitalised or got seriously ill due to Covid. Whereas in the control group there were 10 serious cases and one death.""" Perhaps, regardless of immunity, it reduces symptoms to "not serious", and may reduce transmission, which the other vaccines do not? Which seems like a fair trade for high immunity percentages, and possibly better for the wider community.

kenhwang 6y ago
Pfizer has the highest efficacy endpoint (95% at preventing symptomatic infection, which would theoretically also prevent spread and symptoms at higher percentages) with equal efficacy across age groups. Moderna is 95% at preventing symptoms (100% for serious symptoms in their trial but insufficient sample size). They also reported slightly lower efficacy for the elderly. AstraZeneca is 62% for preventing symptoms (unknown for infection and spread). So it's not quite a trade-off of spread prevention vs symptom prevention, because Pfizer claims to do both significantly better. edit: reading the data in more detail, all 3 don't have sufficiently significant data to claim anything other than symptoms. So preventing spread is just PR-hype.
- _Gyan_ 6y ago
  > Pfizer has the highest efficacy endpoint (95% at preventing infection Cite, please. Pfizer's primary outcome measure was symptomatic infection. Only Oxford/AZ in the UK carried out weekly PCR tests to check for asymptomatic infections.
  - 6y ago

disabled 6y ago

^ This. Although it is better than nothing. However, whatever I am offered, I am taking.

mxcrossb 6y ago

I feel like we’re watching a medical ethics textbook unfold in real time. When the cold judgement of impartial history books come out, it will be interesting to read about. I also am wondering about the mindset of people getting a 60% vaccine. Maybe they will expand access to it to younger front line workers, who know they would have to wait really long for the mRNA version

beojan 6y ago
I expect if you are offered the Oxford/AZ vaccine and refuse it, you would not later be offered one of the mRNA vaccines.
oezi 6y ago
But aren't 50% vaccines usually deemed effective enough?
- andygates 6y ago
  Yes. The wacky back-seat epidemiology is new with the many vaccine candidates. Most people won't get an actual choice, they'll be offered what their healthcare provider offers and they can take it or leave it.
  - kenhwang 6y ago
    Well typically there isn't such a large gap in vaccine performance. 62% is about as bad as vaccines get, and in any other circumstance the manufacturer would retrial instead of seek approval. Even the WHO recommends a 70% minimum during pandemic times (with 50%+ being a measure of last resort, which I guess we're at now). On the other hand, 95% is better than the best of the best.
- mxcrossb 6y ago
  50% is effective enough for a society to squash corona, but a purely self motivated person will surely prefer the 90% version.

jonplackett 6y ago

Most important thing - no-one who was given the vaccine in the trial got seriously ill. Even if that’s all the vaccine can do for me, here’s my arm. Remember the biggest threat is health care systems being overwhelmed. That’s when people will die at much much higher rates because they don’t get respirators/oxygen.

ptaipale 6y ago
A bit off topic, but as far as I understand (not a medicla expert), respirators are not as important as they were though to be back in the spring when countries were fighting for equipment deliveries Extra oxygen is critical.
- jonplackett 6y ago
  Yeah it seems so - but they are still needed and in much more limited supply than oxygen. I listened to an ICU doctor on the radio this morning saying the problem is that ANY kind of illness with covid is problematic because even fairly mild cases often require some medical attention, even if it’s just a doctor to reassure you you’re OK, that’s fine a doctor could be spending doing something more life-saving. Here in the UK with this nee strain, the NHS is running out of resources in hotspot areas so any kind of vaccine will help.

Kneecaps07 6y ago

If it was like my experience, you're told which one it is before you get the vaccine. I was given a 2-page write up on the Pfizer vaccine as I waited to receive the shot.