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Interesting article on vaccine priority lists and current government direction.
It looks like age related, going down in 5 year jumps from 80, with care homes and their workers first and more general "health and social care workers" next highest.
Can I ask the experts, is 90% good for vaccine effectiveness?
And is that 90% likely to be repeatable in the older or more at risk population, do vaccines work well for everyone because we are all basically the same, or are we likely to see significantly less than 90 because the vaccine can't provoke immunity as well in less strong immune systems?
Looking at the other way round, 10% failure in a group like the over 80s is a lot more dangerous for them than it is for the type of person likely to have been in the trial. I'm assuming they are healthy youngsters usually?
I understand that at a population level, eventually, vaccines work by massively reducing the chance of being infected, so I'm not asking about that- more about individuals biology and vaccine response.
And can anyone expand on this bit from the BBC article:
There will also be some people - such as those with a weak immune system - who will not be able to have the vaccine.
https://www.bbc.co.uk/news/explainers-54880084
I met someone late summer who's job was writing drug trial proposals.
She said alot of testing was established drugs being tested to see if they had any effect and any likely vaccine would end up using existing drugs (I don't know the exact term compound? Ingredients?).
She worked for a decent sized phama company.
Seem a plausable first step.
The 90% number is just a wild guess at this point. There is huge uncertainty. It would be useful if achieved in the broader population (and just about anything is better than nothing - flu jab is generally reckoned to be about 60% effective and we haven't had a bad flu year since it's been introduced AIUI). Some vaccinations are (well?) over 95% effective though, which may be necessary to really suppress it long-term depending on take-up.
From reading between the lines, the 90% figure in the publicity was probably derived from a trivial calculation like this:
Two equal-sized groups of people, half got the vaccine, half did not.
86 of the non-vaccinated people got ill (entirely by chance)
8 of the vaccinated people got it.
Assuming that 86 of the vaccinated people would also have got ill if they had not got the injection, we estimate 86-8 = 78 infections were prevented in the latter group. 78/86 = 90%.
The uncertainties on such a calculation are large, it's just a first estimate, and there is no indication of the durability of the immunity.
My prediction is the final answer will be rather lower, for a number of reasons. But it might still be useful, and there will be other vaccines.
Which conspiracy theory will be strongest next year? One of the “anti-vaccine” ones, or one of the “they’re deliberately denying us mass vaccination” ones? Place your bets now…
The one I have heard manages to combine both. They* are prioritising giving the vaccine to old/vulnerable people to kill them off. Proven because someone's 93 year old nan got the flu jab and was dead within the year. It's quite a nasty and insidious one as it can be defended on the basis of concern for others. As with many conspiracy theories the proponents are usually unclear on the question of "Why?".
*They can be any or all of the Government, Bill Gates, George Soros, the Village People, Lizard People etc.
There will also be some people – such as those with a weak immune system – who will not be able to have the vaccine.
Passive protection from antibodies will be available.
From reading between the lines, the 90% figure in the publicity was probably derived from a trivial calculation like this:
Welcome to the world of drug development. Pivotal trial analyses are almost invariably “non-parametric”, ie assumption-free. An exact test for difference of proportions is a chi square test. This is normal and necessarily conservative from a regulatory perspective.
As for 90%, well if is about 9/10 after 28 days. Let’s see what it looks like at six months. Over 50% would be a good outcome. I’m serious; 1 - (9/10)^6 would be at least 43% still protected.
So this vaccine is going to require two carefully spaced doses and take about a month to become effective. It will probably be time limited and require regular booster doses.
It needs to be rolled out to 10s of millions across three countries who can't agree on a common plan by a government that has a less than stellar track record in controlling the pandemic.
Its recipients are a population where a significant proportion are fed up with/don't follow/ don't understand the rules and where most just want to return to pre-Covid normal.
What could possibly go wrong?
Anyone know the CI on the Pfizer 90% number? I'm struggling to track down the paper (anyone got a link?)!
There is a definite correlation between Brexit (sorry but it’s what ive seen), anti mask, pro Trump, anti lock down and anti vaccine.
Hardly a conclusive study but I think others will say they might have observed some of the same?
There's definitely a link, though I'm proud(?) to say my Brexity brother in law was kicking off at an anti-masker on FB the other day. Admittedly, suggesting people refusing to wear a mask without a medical reason should be shot did leave him open to the accusation of being a Nazi. On the other hand, it's a much swifter and more focused application of Darwin's Law, without the risk that the anti-masker will survive Covid but infect and kill my granny. It's worth serious consideration maybe. 🤔
Luckily we already have processes in place for mass seasonal vaccination for flu. The cold chain will be new but providing the government stays out of the way I've got no doubt "big pharma" and the NHS can handle it.
So we're screwed.
There is research that suggests certain people are more prone to conspiracy theories in general so it's not unreasonable that the Venn diagram of Cv19 deniers, antimaskers, brexit loons and antivaxxers would have significant overlap.
Who believes in conspiracy theories?
Also remember that there is no problem for conspiracy theorists believing in several mutually exclusive theories at the same time. E.g. CV19 was created in a lab to kill everyone but CV19 is just the flu and lockdown is a waste of time. The government is incompetent and has messed up the handling of Cv19 but CV19 is a careful designed government plot to systematically murder the elderly.
Go on then I will say it, any conspiracy theorists I know tend to be a bit thick (that is the common denominator)
Thanks @thecaptain and @Tired
So practically, it is likely to improve the survival chances of an elderly relative in their 70s, but it's not a magic wand replacement for careful hygiene, reduced contact and mask wearing.
And for someone immunosuppressed from chemotherapy - not really a proven alternative to shielding yet, but wait and see.
?
And for someone immunosuppressed from chemotherapy – not really a proven alternative to shielding yet, but wait and see.
Indeed. This won't work for mrs_OAB's condition, no point in her having the vaccine, yet she is super high risk.
Is an antibody treatment an alternative for an immunosuppressed person?
Anyone know the CI on the Pfizer 90% number? I’m struggling to track down the paper (anyone got a link?)!
Assuming the split is 8/19477 vs. 86/19477 (38954 evaluable after two doses and 28 days - press release said 38955), then the proportions are 0.0004 vs. 0.0044 = -0.0040 (95% CI 0.0030, 0.0050), odds ratio is 10.793 (95% CI 5.229, 22.279), you are nearly 11x more likely to be infected after 28 days if you did not have the active vaccine.
Press releases prefer P values, so that is P < 0.0001, which means that the probability of achieving a split of 8/86 heads/tails for an unbiased coin flipped 94 times is less than 1/10,000. Rather unlikely that the effect is by chance.
BTW there won't be a paper, the analysis will have been done by a statistician on the Data Monitoring Committee yesterday, and the numbers read off directly and released. The SAS code will have been:
data pfizer;
input Treatment Response Number;
cards;
1 1 86
1 0 19391
2 1 8
2 0 19469
run;proc freq data=pfizer order=data;
weight Number;
tables Treatment*Response / chisq exact relrisk riskdiff;
run;
Luckily we already have processes in place for mass seasonal vaccination for flu. The cold chain will be new but providing the government stays out of the way I’ve got no doubt “big pharma” and the NHS can handle it.
So we’re screwed.
I'm pretty confident, NHS locally at least have been planning for months for it. As Tired has being saying, almost no cost is too expensive so Obvs the Gov, BMJ etc will want to argue a bit about who's going to get the millions of pounds on offer for do their part etc, and I'm sure a few isolated issues will cause some sensationalist headlines in the months to come, but the NHS are in no mood to **** about.
Now... if someone could stick Zuckerberg on a ****ing lead before the bullshit starts to fly, we might just be able to see an end to this whole shit show.
P-Jay - my apologies, it was my poor attempt at humour.
Worth mentioning there are two conceptually distinct ways in which the vaccine protects.
1) Direct effect, say it cuts your personal risk of catching the disease by 90%, this number may not be uniform across groups so could have a greater or lesser effect on deaths depending on whether elderly are better or worse protected. Only applies to people who get the injection of course.
2) Indirect effect due to herd immunity, it may suppress the virus (perhaps in conjunction with some social distancing etc). Even those who don't have the injection are protected by this mechanism but if there are too many of them, it won't happen!
Immunising the elderly, as we do with flu, is just aiming at 1 and not really attempting 2. Though any reduction in at-risk population will help to cut transmission a bit.
P-Jay – my apologies, it was my poor attempt at humour.
Oh I wasn't offended mate, and there's ample scope for the Government to **** it up for the sake of giving their mates a big pile of cash. We may well be screwed ha ha.
If GPs want to be on the front line for it, they certainly should be, but I'd argue they're perhaps not best placed to complete the sorts of numbers needed, even at the furious pace they can work under usually.
I think the plan locally at least is to make use of the current testing facilities, you'll be assigned a time slot, arrive as best as possible as a household, be given the vaccine and then wait under the gaze of a nurse in case of an adverse reaction (this is normal for vaccines). I doubt there will be much of a chance to pre-book your slot, it would cause too much stress and panic as people find sites crash, slots fill up etc, but who the hell is going to say "I can't make it, I'm working that day" or whatever.
Very few people of working age will be getting this vaccine....
Very few people of working age will be getting this vaccine….
Yes, I think a fair bit of perspective has been lost on this vaccine, certainly as far as the initial short term is concerned.
As and when we do get to more large scale vaccination, presumably the fact that it needs two jabs two weeks apart or whatever it is, will mean that some sort of planning/booking/organising will be required.
OK, ordered 40 million doses which since two doses are required for each person that's 20 million. A Pfizer scientist was being interviewed on R4 last night and said that they wouldn't have enough in the short to medium term so the stocks would be distributed pro-rata according to orders. The UK would be likely to get 10 million doses, enough for 5 million.
Here's the UK demographic by age - https://www.statista.com/statistics/281174/uk-population-by-age/ work your way along from the right until you get to five million. There'll be some who won't have it but there's also front line health staff who'll be offered it regardless of age.
I'm 61 so there needs to be about that 40 million doses available before I'd be offered it (assuming the "start with the elderly and move down by five year blocks" scenario).
Im 46 so won't get it at all. Interesting to see that Im expected to fly all around the world every day without it.
Very few people of working age will be getting this vaccine….
THIS one, probably not, certainly not in the first 'wave' especially if there's only enough coming for 5m people. 1m people work in the NHS alone, of which maybe half will be front-line workers, we've got nearly 9m people over 70 too.
That said, assuming it's successful, which seems likely, it won't be the only vaccine. the Oxford vaccine was seemingly a few weeks ahead of this one will likely come soon.
Plus, with almost unlimited demand successful vaccines will have ample opportunity to license production elsewhere. Even with the small margins allowed, it will be something of a gold-rush.
If it worked, as the vaccine is rolled out to the most vulnerable deaths and admissions will fall, which is good for everyone, which will allow restrictions to be slowly lifted and the R rate becomes less of a concern.
It doesn't mean come Christmas we can all go back to licking escalator belts or whatever people do, but barring any **** ups, come Summer, things might seems a lot more normal.
licking escalator belts
LMAO
Tired - thanks for the CI information - interesting stuff!
Pleasure - they may have run Intent To Treat (one dose) on 43,538 subjects (21769/arm). The results barely move.
does it not make economic sense tho to prioritise (after frontline nhs, police, teachers etc) some working people to get the economy cranked back up... even young people so they can carry on their education/lives (and not superspread it to the rest of us!)Very few people of working age will be getting this vaccine….
It might, but they have stated their aim, and it isn't that. Care homes, old age, NHS. then working down to 60+
It might, but they have stated their aim, and it isn’t that. Care homes, old age, NHS. then working down to 60+
Yep..as far as I have read anyone under 50 won't be vaccinated. Basically get the vunerable protected then everyone else is pretty much going to be left to get on with it is the government's plan.
Chap from Oxford was today saying that given we don't know the longer term impact of corona even on healthy folks, this may not be the wisest policy.
does it not make economic sense tho to prioritise (after frontline nhs, police, teachers etc) some working people to get the economy cranked back up… even young people so they can carry on their education/lives (and not superspread it to the rest of us!)
There's probably an argument for that, but Priority 1 is to stop people dying and filling hospitals.
As far as I can see though, they're still aiming to offer it to everyone, we'll just have to wait our turn.
I'd guess by the time they're down to people in their 50s and out of the high risk cat, they'll have a better idea how effective it is medium-term and firm up on the plan. It might just be a case they only offer it free to the over-60s and people with underlying conditions yearly like the flu vax and the rest of us can pay for it if we want, or attempt to eradicate it.
I know people were joking about this earlier in the thread at the time but to have the HEad of the efforts admit this is shocking:
Anyone with an ounce of a brain knew it would happen. Draw your own conclusion.
Sounds suspicious. How could so much money go into a project that could make that big an avoidable mistake? Get that MP that’s supposed to be cracking down on corruption onto it… actually, I’m sure he’s having a good chat to Dido Harding about what went wrong at the highest strategic levels right now…
Immunising the elderly, as we do with flu, is just aiming at 1 and not really attempting 2.
Agreed. We should be looking at teachers, front of house staff in hospitality, public transport passenger facing staff, and shop floor workers. Anyone who’s job it is to deal with loads of people a day. NHS and care staff first though… of course… they not only deal with loads of people a day, but a lot of those people are the most at risk.
Good video from 538
And a 4 day window to bid on £43bn of test contracts. That's insane amounts of money.
Good video from 538
Skimmed it. Just pub politics talk. I’ll wait for the Indy Sage video at the end of the week.
I appreciate pfizer are the competition. But frankly the amounts of profit they are going to make off this vaccine are not acceptable.
it is also going to make it a first world vaccine too.
sadly doesn't surprise me from them either
Is it really only around here that schools are struggling thanks to so many teachers testing positive in the last week or so? Utterly confused to see so little about it anywhere.
One of my teacher friends has hinted (quite strongly) that they're not allowed to talk to the media or post on social media about issues they are having. If they're not allowed to speak about it the story gets supressed.
Her school is currently struggling with 30% of the staff off ill or isolating BTW.
I appreciate pfizer are the competition. But frankly the amounts of profit they are going to make off this vaccine are not acceptable.
it is also going to make it a first world vaccine too.
It's something that doesn't sit well with me either, but I can't see an easy solution. If there's no return on investment for them then it's unlikely we would have a vaccine as quickly as w potentially have.
Surely it makes sense for governments to license the vaccine from Pfizer and start producing it 'locally'. I appreciate it's not going to be cheap to either license or build the infrastructure for production, but when you look at how much the pandemic has cost the economy so far, surely no cost is too much?
Any ideas when will we hear about the Oxford version? I'm assuming the UK government have more of a vested interest in that one, so may be more available. Given I've got asthma I'd like to think I'd qualify for a dose at some point, but I'm not holding my breath.
OK, this is a bit of an emotive subject, but I can’t help but feel that some reticence about having the vaccine is not entirely irrational, given the following statements as reported in the press? Still, long-Covid doesn’t sound fun so I would certainly take it if given the chance.
It uses a completely experimental approach - that involves injecting part of the virus's genetic code - in order to train the immune system.
No vaccine has gone from the drawing board to being proven highly effective in such a short period of time.
I know that AZ and others are going to be selling their vaccine at cost (at least during the pandemic).
Does seem normal for pfizer to profit from most things
Does anyone know how this interacts with various testing?
Will this vaccine or the Oxford one test positive on different SARS-COV19 tests?
Are there any rules or guidelines for hospital admissions if this is the case?
You wouldn’t be shedding virus… no idea about anti-body testing. TiRed is your man.
So, it’s Tuesday… the day where, each week, we get to see the real week on week changes in the data, after a weekend of the media over interpreting the always lower weekend figures… and, again, things aren’t going the right way in England, are they…