7 ms·

Weirdly, there's only a link to the old paper [0] that initially reported only on severe malaria cases and the complications. I can't find the source of the red

by lopis 3y ago

Weirdly, there's only a link to the old paper [0] that initially reported only on severe malaria cases and the complications. I can't find the source of the reduction in deaths. But regardless, I found "slashing" to be a bit exaggerated when the fatality reduction was 13% in a small pilot program. Very promising, but sensationalistic. I guess when you're up against anti-vax fear mongering, you need to fight fire with fire. [0] https://pubmed.ncbi.nlm.nih.gov/25913272/ https://pubmed.ncbi.nlm.nih.gov/25913272/

chmod600 3y ago
"I guess when you're up against anti-vax fear mongering, you need to fight fire with fire." That's seems like a dubious strategy likely to backfire. I hope you're not serious.
swader999 3y ago
I would expect that approach fuels it.
- bluSCALE4 3y ago
  What would fight it is honesty, not rushing to markets with sensationalism.
  - JumpCrisscross 3y ago
    > What would fight it is honesty To a degree. After a certain point, people have freedom to choose and society natural selection to benefit from.
    - swader999 3y ago
      Society pays a huge cost from premature death.
  - pmarreck 3y ago
    how do you expect to counterargue sensationalistic cherry-picked click-seeking malinformation with plain old boring facts, in a populace that was never taught any critical thinking skill?
    - bluSCALE4 3y ago
      but... but... it's settled science.
mlyle 3y ago
A 13% reduction in all-cause mortality is huge. There are other methodological/reliability concerns, but malaria isn't near 100% of death, even among children.
- CurtisWright 3y ago
  [dead]
- vmilner 3y ago
  I hadn’t grasped the all-cause aspect from a skim read.
- lettergram 3y ago
  That’s not all that huge when there’s such a small number of deaths in the given group over that time. This is part of the reason a lot of drugs later prove to be useless… I also don’t see a citation for the 13% reduction in all cause mortality. To be honest, that’s an insanely weird metric to review for a malaria vaccine. Why not malaria related deaths? Total in 2015 study [1]: > 8922 children and 6537 young infants were included in the modified intention-to-treat analyses. Total deaths: …? Are we talking 8 deaths in the control group and 7 in those injected? This isn’t clear at all to me [1] https://pubmed.ncbi.nlm.nih.gov/25913272/ https://pubmed.ncbi.nlm.nih.gov/25913272/ On page 20 of the 2021 report we see 1443 deaths in comparison group and 1421 in implementing group [2]. With a pretty wide margin of error I might add. Is that what they’re reporting…? [2] https://www.nitag-resource.org/sites/default/files/2022-05/Milligan-Moore-2021-statistical-report-rtss-pilot-evaluation.pdf https://www.nitag-resource.org/sites/default/files/2022-05/M...
  - michaelrpeskin 3y ago
    Actually, all cause is the right metric. Let's say the vaccine stops 100% of malaria but causes severe heart attacks. You'd probably want to know that. I didn't review _this_ study, so I won't comment on the quality of analysis, but what you want to know about a vaccine is "effectivity" does it stop contraction and spread of the illness and "safety" does it not cause any other problems that in aggregate are worse than the illness (all cause mortality is one metric here).
skybrian 3y ago
The significance seems to be that it shows real-world results from a malaria vaccine that’s only moderately effective: > In clinical trial results published in 2015, RTS,S showed 36.3% efficacy against clinical malaria a median of 4 years after toddlers were vaccinated. Some possible side-effects seem to be ruled out: > Giving RTS,S to 5-month-olds to 24-month-olds did not hurt the uptake of other childhood vaccines, which had been a concern. And it didn’t cause a decline in bed net use due to a false sense of security.
eigenket 3y ago
Here is the relevant text from the article > The comparison, covering 46 months, revealed the 13% decline in mortality—excluding accidental deaths—attributed to RTS,S. Thats a 13% decline in all cause morality, excluding accidental deaths. The 13% number isn't just in deaths from malaria, its in deaths including all diseases.
- lopis 3y ago
  From the article, yes. Where's the report?
dgacmu 3y ago
13% of all toddler deaths by any (non-accident) cause. That's very substantial.
- saalweachter 3y ago
  Quick googling says that there are around 3.4 million child (<5 years) deaths in the region; 450k malaria deaths would be about 13% of that.
timr 3y ago
> I guess when you're up against anti-vax fear mongering, you need to fight fire with fire. That's completely unfair, in this case. The vaccine in question was associated with an increase in deaths in some subgroups (vs control), and overall low effectiveness in the phase 3 clinical trials. A 13% decrease in mortality in this study is actually quite good given what was expected, but it is in no way "fear mongering" to question the safety/efficacy balance, even now. For example, you'd likely never administer this vaccine outside of high-risk populations. The fact that the safety signals "went away" in this trial is likely more indicative of the baseline risk of the population than any change in the vaccine itself. Where is this line? Hard to say, but just for the sake of argument: anyone suggesting that we add this to mandatory vaccination schedules in the US would be a total lunatic. Should it be widely used outside of the worst parts of Africa, where malnutrition and preventable childhood illness are rampant? Again, hard to say. Vaccines are not automatically good, and it isn't "anti-vax fear mongering" to question a particular vaccine. We have to test them, and see if the rewards are greater than the risks in the populations where we intend to use them.
- aredox 3y ago
  "The fact that the safety signals "went away" in this trial is likely more indicative of the baseline risk of the population than any change in the vaccine itself" - or just the fact that sometimes, a study can give the wrong signal, the same way it can happen you land a coin three times heads in a row and yet the coin isn't biased...
- rhuru 3y ago
  I think a lot of people simply ignore the basic fact that vaccines aren't safe by nature, they have to be proven to be safe through very very rigorous processes. Anti-vaxxers might come across as a lunatic but their extreme behaviour does not make opposite is true by default.
- asynchronous 3y ago
  An astoundingly level-headed take for HN. We need more science in the science community.
VoodooJuJu 3y ago
> I guess when you're up against anti-vax fear mongering, you need to fight fire with fire. Comment was great until this. Rent-free. Don't start fires and you won't have to fight them.
Slava_Propanei 3y ago
People are opposed to being forced into injections of experimental mRNA. Very few people were ever opposed to the standard-type vaccines we have been using for 100 years. That is why the vast majority of people are happy to vaccinate themselves against polio and tetanus, but only 2% of people were interested in the latest Pfizer booooster experiment. I would suggest against making up imaginary enemies.
- smileysteve 3y ago
  Seems inaccurate where vaccines were correlated to autism in a 2016 GOP debate. (And the doctor on stage said nothing to rebut, and turned out to be anti mRNA as well)
  - kbelder 3y ago
    Don't make it partisan. Remember, for decades prior to covid, antivax had been more predominate on the left. Both parties have plenty of ignorant members.
    - smileysteve 3y ago
      This is a readily citable nationally televised recent singular event with many elected officials on stage, ~3 years before mRNA was rolled out for a major event Decades and smaller advocacy groups are less distinct.
    - acdha 3y ago
      It wasn’t so much a question of skew but visibility: people saw celebrities opposing vaccination a lot more than, say, the Christian homeschoolers who were doing the same things but not holding press conferences back then.
- lost_tourist 3y ago
  The problem with your assessment is that you aren't being injected with experimental mRNA, it is well tested and proven on billions of people. It's fine to not want to be a part of that, but saying it is experimental is misinformation.
Lordarminius 3y ago
> I guess when you're up against anti-vax fear mongering, you need to fight fire with fire. You do know the vax is associated with a myriad of side effects including clots, strokes, reduced fertility and increase in turbo cancers, contains dna contaminants and was not properly tested don't you ?
TimPC 3y ago
The article doesn't say but my understanding is this was a 13% reduction in all-cause mortality as in they measured the number of children who died during the time period and that went down by 13%. Not that 87% of malaria related deaths still occurred. A 13% reduction in all-cause mortality is quite large. To know how effective the vaccine is at stopping malaria related deaths you'd need to know what % of those who were dying were dying to malaria. If it was 14% then the vaccine is performing insanely well if it was 50% more work needs to be done.

by lopis 3y ago

chmod600 3y ago

"I guess when you're up against anti-vax fear mongering, you need to fight fire with fire." That's seems like a dubious strategy likely to backfire. I hope you're not serious.

swader999 3y ago

I would expect that approach fuels it.

bluSCALE4 3y ago
What would fight it is honesty, not rushing to markets with sensationalism.
- JumpCrisscross 3y ago
  > What would fight it is honesty To a degree. After a certain point, people have freedom to choose and society natural selection to benefit from.
  - swader999 3y ago
    Society pays a huge cost from premature death.
- pmarreck 3y ago
  how do you expect to counterargue sensationalistic cherry-picked click-seeking malinformation with plain old boring facts, in a populace that was never taught any critical thinking skill?
  - bluSCALE4 3y ago
    but... but... it's settled science.

mlyle 3y ago

A 13% reduction in all-cause mortality is huge. There are other methodological/reliability concerns, but malaria isn't near 100% of death, even among children.

CurtisWright 3y ago
[dead]
vmilner 3y ago
I hadn’t grasped the all-cause aspect from a skim read.
lettergram 3y ago
That’s not all that huge when there’s such a small number of deaths in the given group over that time. This is part of the reason a lot of drugs later prove to be useless… I also don’t see a citation for the 13% reduction in all cause mortality. To be honest, that’s an insanely weird metric to review for a malaria vaccine. Why not malaria related deaths? Total in 2015 study [1]: > 8922 children and 6537 young infants were included in the modified intention-to-treat analyses. Total deaths: …? Are we talking 8 deaths in the control group and 7 in those injected? This isn’t clear at all to me [1] https://pubmed.ncbi.nlm.nih.gov/25913272/ https://pubmed.ncbi.nlm.nih.gov/25913272/ On page 20 of the 2021 report we see 1443 deaths in comparison group and 1421 in implementing group [2]. With a pretty wide margin of error I might add. Is that what they’re reporting…? [2] https://www.nitag-resource.org/sites/default/files/2022-05/Milligan-Moore-2021-statistical-report-rtss-pilot-evaluation.pdf https://www.nitag-resource.org/sites/default/files/2022-05/M...
- michaelrpeskin 3y ago
  Actually, all cause is the right metric. Let's say the vaccine stops 100% of malaria but causes severe heart attacks. You'd probably want to know that. I didn't review _this_ study, so I won't comment on the quality of analysis, but what you want to know about a vaccine is "effectivity" does it stop contraction and spread of the illness and "safety" does it not cause any other problems that in aggregate are worse than the illness (all cause mortality is one metric here).

skybrian 3y ago

The significance seems to be that it shows real-world results from a malaria vaccine that’s only moderately effective: > In clinical trial results published in 2015, RTS,S showed 36.3% efficacy against clinical malaria a median of 4 years after toddlers were vaccinated. Some possible side-effects seem to be ruled out: > Giving RTS,S to 5-month-olds to 24-month-olds did not hurt the uptake of other childhood vaccines, which had been a concern. And it didn’t cause a decline in bed net use due to a false sense of security.

eigenket 3y ago

Here is the relevant text from the article > The comparison, covering 46 months, revealed the 13% decline in mortality—excluding accidental deaths—attributed to RTS,S. Thats a 13% decline in all cause morality, excluding accidental deaths. The 13% number isn't just in deaths from malaria, its in deaths including all diseases.

lopis 3y ago
From the article, yes. Where's the report?

dgacmu 3y ago

13% of all toddler deaths by any (non-accident) cause. That's very substantial.

saalweachter 3y ago
Quick googling says that there are around 3.4 million child (<5 years) deaths in the region; 450k malaria deaths would be about 13% of that.

timr 3y ago

> I guess when you're up against anti-vax fear mongering, you need to fight fire with fire. That's completely unfair, in this case. The vaccine in question was associated with an increase in deaths in some subgroups (vs control), and overall low effectiveness in the phase 3 clinical trials. A 13% decrease in mortality in this study is actually quite good given what was expected, but it is in no way "fear mongering" to question the safety/efficacy balance, even now. For example, you'd likely never administer this vaccine outside of high-risk populations. The fact that the safety signals "went away" in this trial is likely more indicative of the baseline risk of the population than any change in the vaccine itself. Where is this line? Hard to say, but just for the sake of argument: anyone suggesting that we add this to mandatory vaccination schedules in the US would be a total lunatic. Should it be widely used outside of the worst parts of Africa, where malnutrition and preventable childhood illness are rampant? Again, hard to say. Vaccines are not automatically good, and it isn't "anti-vax fear mongering" to question a particular vaccine. We have to test them, and see if the rewards are greater than the risks in the populations where we intend to use them.

aredox 3y ago
"The fact that the safety signals "went away" in this trial is likely more indicative of the baseline risk of the population than any change in the vaccine itself" - or just the fact that sometimes, a study can give the wrong signal, the same way it can happen you land a coin three times heads in a row and yet the coin isn't biased...
rhuru 3y ago
I think a lot of people simply ignore the basic fact that vaccines aren't safe by nature, they have to be proven to be safe through very very rigorous processes. Anti-vaxxers might come across as a lunatic but their extreme behaviour does not make opposite is true by default.
asynchronous 3y ago
An astoundingly level-headed take for HN. We need more science in the science community.

VoodooJuJu 3y ago

> I guess when you're up against anti-vax fear mongering, you need to fight fire with fire. Comment was great until this. Rent-free. Don't start fires and you won't have to fight them.

Slava_Propanei 3y ago

People are opposed to being forced into injections of experimental mRNA. Very few people were ever opposed to the standard-type vaccines we have been using for 100 years. That is why the vast majority of people are happy to vaccinate themselves against polio and tetanus, but only 2% of people were interested in the latest Pfizer booooster experiment. I would suggest against making up imaginary enemies.

smileysteve 3y ago
Seems inaccurate where vaccines were correlated to autism in a 2016 GOP debate. (And the doctor on stage said nothing to rebut, and turned out to be anti mRNA as well)
- kbelder 3y ago
  Don't make it partisan. Remember, for decades prior to covid, antivax had been more predominate on the left. Both parties have plenty of ignorant members.
  - smileysteve 3y ago
    This is a readily citable nationally televised recent singular event with many elected officials on stage, ~3 years before mRNA was rolled out for a major event Decades and smaller advocacy groups are less distinct.
  - acdha 3y ago
    It wasn’t so much a question of skew but visibility: people saw celebrities opposing vaccination a lot more than, say, the Christian homeschoolers who were doing the same things but not holding press conferences back then.
lost_tourist 3y ago
The problem with your assessment is that you aren't being injected with experimental mRNA, it is well tested and proven on billions of people. It's fine to not want to be a part of that, but saying it is experimental is misinformation.

Lordarminius 3y ago

> I guess when you're up against anti-vax fear mongering, you need to fight fire with fire. You do know the vax is associated with a myriad of side effects including clots, strokes, reduced fertility and increase in turbo cancers, contains dna contaminants and was not properly tested don't you ?

TimPC 3y ago

The article doesn't say but my understanding is this was a 13% reduction in all-cause mortality as in they measured the number of children who died during the time period and that went down by 13%. Not that 87% of malaria related deaths still occurred. A 13% reduction in all-cause mortality is quite large. To know how effective the vaccine is at stopping malaria related deaths you'd need to know what % of those who were dying were dying to malaria. If it was 14% then the vaccine is performing insanely well if it was 50% more work needs to be done.