Vaccine Progress, Approval, and Deployment

[brad465]

Which was made totally clear on the news at 13:00 which I assume you did not watch!

It might have been made clear, but the headline is still made to catch the eyes of those who'd like this to continue endlessly, and give them fuel to the fire to their cause.

 

[hwl]

That's incorrect I'm afraid. There is zero evidence that that the SA strain spreads faster or more readily than the Kent Strain. When it was discovered a flustered Hancock said "it could spread faster" but since then Vallance has said there is no evidence for this - and the fact that the Kent strain is so widespread, that it would be extremely unlikely that it was displaced by the SA strain as it isnt more infectious.

So more likely - it co-exists at a much lower level during the summer and onwards after that- similar to Spanish/Italian strain which was dominant last autumn but now at much lower levels than the Kent Strain. With boosters due by autumn this issue is being overhyped massively.

It actually turned out that Vallance hadn't been in one of the briefings and had missed the discussion on some South Africa work (done by close contacts of PHE experts) that was about to be published several days later. With the additional E484K mutation it is fundamentally harder for specific antibodies to stick to that bit of the spike, the practical impact of which is "patients" having high viral loads for longer giving the new strain a transmission advantage. Hence why Hancock is still very worried byt he SA strain.

 

[adc82140]

If this is the case, why is it not running out of control now, like the Kent one did during the November lockdown?

 

[DorkingMain]

That's incorrect I'm afraid. There is zero evidence that that the SA strain spreads faster or more readily than the Kent Strain. When it was discovered a flustered Hancock said "it could spread faster" but since then Vallance has said there is no evidence for this - and the fact that the Kent strain is so widespread, that it would be extremely unlikely that it was displaced by the SA strain as it isnt more infectious.

So more likely - it co-exists at a much lower level during the summer and onwards after that- similar to Spanish/Italian strain which was dominant last autumn but now at much lower levels than the Kent Strain. With boosters due by autumn this issue is being overhyped massively.

Indeed, for these reasons I retain cautious optimism.

The fact we're in lockdown and case numbers are also seeing a huge reduction is also a positive in the respect that: the incidence of the variant will naturally be reduced (and is believed to already be at fairly low numbers anyway), plus lower case numbers mean it is more viable to sequence a greater proportion of tests and gain an understanding of the incidence.

Combination of lockdown reducing case numbers + vaccination still giving some protection + natural summer reduction + isolation through sequencing means it probably won't be a major problem for many more months anyway, by which time the technology could catch up.

If this is the case, why is it not running out of control now, like the Kent one did during the November lockdown?

Transmissibility of the Kent variant came (as I understand it) came from it being able to infect people more easily due to a mutation that allowed it to bond with entry points to the body. This mutation is different, and the problem is antibody response and the inability for antibodies to bond to the spike protein that acts as an antigen for immune response, resulting in the viral load being increased before the body can mount an immune response.

Interesting factor is this presumably means that asymptomatic infection is less likely if the body finds it harder to mount an immune response early.

 

[Nicholas Lewis]

If this is the case, why is it not running out of control now, like the Kent one did during the November lockdown?

All metrics clearly indicate its not with hospitalisations down through 30k and falling at 1200/day for the first four days of Feb so far reported. English data is newer and London is down 20% over the last week, SE at 24% and even NW falling 15%. The discharge to admission rate is running at 2-2.5:1 in L&SE which also indicates time in hospital is reducing which could be an indicator of less poorly people being admitted along with better treatments. Clearly the NHS needs to be given time to drive this down to more manageable levels but the trends are clear to see and the govt can't keep stalling with its roadmap. By all means have a contingency plan if SA variant rears up to stamp down on it but this open ended situation needs some closure so people can see there is way forward even if specific milestones can't yet be dated.

 

[35B]

All metrics clearly indicate its not with hospitalisations down through 30k and falling at 1200/day for the first four days of Feb so far reported. English data is newer and London is down 20% over the last week, SE at 24% and even NW falling 15%. The discharge to admission rate is running at 2-2.5:1 in L&SE which also indicates time in hospital is reducing which could be an indicator of less poorly people being admitted along with better treatments. Clearly the NHS needs to be given time to drive this down to more manageable levels but the trends are clear to see and the govt can't keep stalling with its roadmap. By all means have a contingency plan if SA variant rears up to stamp down on it but this open ended situation needs some closure so people can see there is way forward even if specific milestones can't yet be dated.

I completely agree; we need clarity on what those milestones are so that the government can then help us understand where we are en route to meeting them.

 

[hwl]

Indeed, for these reasons I retain cautious optimism.

The fact we're in lockdown and case numbers are also seeing a huge reduction is also a positive in the respect that: the incidence of the variant will naturally be reduced (and is believed to already be at fairly low numbers anyway), plus lower case numbers mean it is more viable to sequence a greater proportion of tests and gain an understanding of the incidence.

Combination of lockdown reducing case numbers + vaccination still giving some protection + natural summer reduction + isolation through sequencing means it probably won't be a major problem for many more months anyway, by which time the technology could catch up.


Transmissibility of the Kent variant came (as I understand it) came from it being able to infect people more easily due to a mutation that allowed it to bond with entry points to the body. This mutation is different, and the problem is antibody response and the inability for antibodies to bond to the spike protein that acts as an antigen for immune response, resulting in the viral load being increased before the body can mount an immune response.

Interesting factor is this presumably means that asymptomatic infection is less likely if the body finds it harder to mount an immune response early.

With 484K mutations, the Cytokine and T-cell response appears to be similar to older variants but the antibody response far less effective and slower due to poor antibody bonding hence plenty of room for an extended period of very low symptom spreading with high viral load.

If this is the case, why is it not running out of control now, like the Kent one did during the November lockdown?

Dominant new strain share can be low to begin with and there are pretty intensive efforts to suppress transmission in general. September and early October low restriction levels allowed it to initially spread far more easily than it would currently.
This is the latest Belgian thinking (published last Wednesday) on what they are expecting to face with the coming tidal wave of the Kent strain based on the English experience:

 

[philosopher]

With 484K mutations, the Cytokine and T-cell response appears to be similar to older variants but the antibody response far less effective and slower due to poor antibody bonding hence plenty of room for an extended period of very low symptom spreading with high viral load.

It would be interesting to know for those participating in the AstraZeneca trial, what symptoms and the duration of that symptons they actually got when they tested positive the South Africa variant. If they all got mild symptoms like a cough, mild fever or runny nose for only two or three days, then it would be somewhat reassuring as it would suggest the immune system still does at least partly recognise this variant.

 

[Tezza1978]

With 484K mutations, the Cytokine and T-cell response appears to be similar to older variants but the antibody response far less effective and slower due to poor antibody bonding hence plenty of room for an extended period of very low symptom spreading with high viral load.


Dominant new strain share can be low to begin with and there are pretty intensive efforts to suppress transmission in general. September and early October low restriction levels allowed it to initially spread far more easily than it would currently.
This is the latest Belgian thinking (published last Wednesday) on what they are expecting to face with the coming tidal wave of the Kent strain based on the English experience:

View attachment 90196

There's an interesting thread by @sailorrooscout on Twitter relating to why the SA strain won't overtake the Kent strain - this person is a molecular biologist who posts anonymously and worked on the Moderna vaccine and gave twitter the heads up that Moderna jab still worked pretty well against this variant well in advance of it being confirmed on the news

The cases in SA are also dropping like a stone currently even though their lockdown is being poorly observed and there are minimal numbers of reinfections. Points to T-cell immunity being key from previous infections and another indicator that in hard hit areas (London - where 35%+ have antibodies) that things wouldn't go out of control again in autumn even with no new vaccines at all because of a level of population immunity restricting growth. Those Warwick projections with huge spikes in summer if restrictions relaxed (not removed) look even more ludicrous now.

 

[yorkie]

.... it would be somewhat reassuring as it would suggest the immune system still does at least partly recognise this variant.

My understanding is, as @hwl says above, that it doesn't affect the T Cell response, but it causes a delay in the antibody response.

 

[DelayRepay]

For those who understand science I have a question...

The policy at the moment is that the second jab should be the same vaccine type as the first, unless this isn't possible in which case a second jab of any approved vaccine is preferable to none. There has been some discussion about this, especially last week when there was a possibility of the EU blocking exports of the Pfizer vaccine.

Given the news yesterday about the Oxford vaccine being potentially less effective against the SA variant, is it plausible that giving people who've had one dose of Oxford their second dose of Pfizer might actually be beneficial? And is it theoretically possible there would be a net benefit by giving as many people as possible one dose of each, rather than two of the same?

 

[YorkshireBear]

For those who understand science I have a question...

The policy at the moment is that the second jab should be the same vaccine type as the first, unless this isn't possible in which case a second jab of any approved vaccine is preferable to none. There has been some discussion about this, especially last week when there was a possibility of the EU blocking exports of the Pfizer vaccine.

Given the news yesterday about the Oxford vaccine being potentially less effective against the SA variant, is it plausible that giving people who've had one dose of Oxford their second dose of Pfizer might actually be beneficial? And is it theoretically possible there would be a net benefit by giving as many people as possible one dose of each, rather than two of the same?

I read an article that other common vaccines in use in the UK regularly use two different types as standard to offer a higher level of protection. So it is absolutely possible. Just needs testing to determine it is safe.

That's my understanding anyway

 

[notlob.divad]

For those who understand science I have a question...

The policy at the moment is that the second jab should be the same vaccine type as the first, unless this isn't possible in which case a second jab of any approved vaccine is preferable to none. There has been some discussion about this, especially last week when there was a possibility of the EU blocking exports of the Pfizer vaccine.

Given the news yesterday about the Oxford vaccine being potentially less effective against the SA variant, is it plausible that giving people who've had one dose of Oxford their second dose of Pfizer might actually be beneficial? And is it theoretically possible there would be a net benefit by giving as many people as possible one dose of each, rather than two of the same?

There is potentially a massive benefit, particularly surrounding the AZ vaccine. From my understanding the 'technology' AZ uses to deliver the important part of the vaccine is a virus in itself, all be it a harmless one. Whilst the body is generating an immune response to the contents of this package, it also develops an immune response to the package itself. Therefore the more of vaccinations you have based upon the same package, the less effective they will be, because the body starts rejecting the delivery method. That is one reason why the accidental 1/2 dose, full dose, protocol was more effective in the AZ dataset.

So if we are safely able to mix and match vaccines, particularly if the AZ and Sputnik vaccines can work together, it is potentially a way of more specifically targetting the vaccine so that we only become immune to the target of the vaccine not the vaccine itself.

The Pfizer and Moderna vaccines are based on a newer 'technology' MRNA, they may not suffer as much from this package immunity issue. Possibly one reason why they appear to have a bigger impact. Many people may have already had multiple vaccines based upon the AZ technology where it is quite unlikely that people have already had multiple vaccinations based on the MRNA technology.

However as YorkshireBear says above. It is about testing, making sure that mixing these methods is safe and effective in a small sample group of the population, before rolling it out on a wider scale.

 

[DelayRepay]

Thanks. When the debate about possibly mixing vaccines was happening a few weeks ago, it was in the context of potential supply issues and the possibility was presented as a less than ideal situation. It is good to know that it might actually make the vaccines more effective, not less. I hope the research that's going on reaches a positive conclusion. I assume safety concerns are minimal as I believe the current advice is that if the second shot should be the same as the first but if this isn't possible then a second shot of a different vaccine should be used rather than no second shot at all.

 

[notlob.divad]

Thanks. When the debate about possibly mixing vaccines was happening a few weeks ago, it was in the context of potential supply issues and the possibility was presented as a less than ideal situation. It is good to know that it might actually make the vaccines more effective, not less. I hope the research that's going on reaches a positive conclusion. I assume safety concerns are minimal as I believe the current advice is that if the second shot should be the same as the first but if this isn't possible then a second shot of a different vaccine should be used rather than no second shot at all.

I think it is less about making these specific vaccines more effective, but more preventing future vaccines for other diseases being less effective, if you can follow my meaning.

 

[MikeWM]

Covid: Minister rules out vaccine passports in UK

The vaccine minister says people should ask their GP if they need proof of vaccination to go abroad.

www.bbc.co.uk

Good. Hopefully this is one promise they will keep.

I still wonder if they're being cunning and saying this now, waiting for public demand to eg. go abroad, and then they can 'reluctantly' do a u-turn. But preferably there is still some small spark of freedom burning, if currently rather deeply buried, in some Tories.

 

[Domh245]

Good. Hopefully this is one promise they will keep.

I still wonder if they're being cunning and saying this now, waiting for public demand to eg. go abroad, and then they can 'reluctantly' do a u-turn. But preferably there is still some small spark of freedom burning, if currently rather deeply buried, in some Tories.

Vaccine passports for international travel I can understand - we cannot control what other countries demand for entry so it makes sense to have them for that (which is what I expect the ones that were funded late last year will be for). Vaccine passports for daily domestic life absolutely cannot happen though, and whilst they do keep saying the right things ("we won't introduce them") they do keep steadfastly refusing to put into place any legislation that would prevent their use domestically

 

[MikeWM]

Vaccine passports for international travel I can understand - we cannot control what other countries demand for entry so it makes sense to have them for that (which is what I expect the ones that were funded late last year will be for). Vaccine passports for daily domestic life absolutely cannot happen though, and whilst they do keep saying the right things ("we won't introduce them") they do keep steadfastly refusing to put into place any legislation that would prevent their use domestically

I agree that it seems fairly inevitable something will be required for international travel. The problem is preventing whatever that will be, then being demanded domestically. As you suggest, legislation may be the only answer, and I'm not sure they'll do that.

There does - fortunately - seem to be a lot of reluctance by the British to move to a 'papers please' society. I'd hope we were strongly resistant to that, at least.

 

[philosopher]

I have a question. Is there any information anywhere on the split between AstraZeneca and Pifzer vaccines given out in the UK? The UK government dashboard only seems to list the total number of first and second doses, not which vaccine they are.

 

[HSTEd]

I have a question. Is there any information anywhere on the split between AstraZeneca and Pifzer vaccines given out in the UK? The UK government dashboard only seems to list the total number of first and second doses, not which vaccine they are.

We have this data for Scotland

From 08 December 2020 to 31 January 2021, 575,739 individuals received their first dose of COVID-19 vaccination (351,387 Pfizer BioNTech and 224,352 AstraZeneca)

I think the figures will be fairly similar across the board.
The split will be more in Astra Zeneca's favour now, but still something like half the vaccines will be Pfizer.

 

[philosopher]

We have this data for Scotland



I think the figures will be fairly similar across the board.
The split will be more in Astra Zeneca's favour now, but still something like half the vaccines will be Pfizer.

Thanks

 

[packermac]

Good. Hopefully this is one promise they will keep.

I still wonder if they're being cunning and saying this now, waiting for public demand to eg. go abroad, and then they can 'reluctantly' do a u-turn. But preferably there is still some small spark of freedom burning, if currently rather deeply buried, in some Tories.

Not really sure what the issue is.
If I want a Senior Railcard or a Freedom Pass I have to show a passport or a driving licence, neither of which are designed for that purpose. Even my health insurance wanted a copy of either the other week. As my last passport expired 4 years ago not sure what I would do if I also did not have a driving licence, just cease to exist?

 

[MikeWM]

Not really sure what the issue is.

We don't want a 'papers please' society for acts as simple as going to a restaurant or the cinema. We also don't want a *requirement* of vaccination for such things. That's pretty much the perfect example of a 'slippery slope'.

If I want a Senior Railcard or a Freedom Pass I have to show a passport or a driving licence, neither of which are designed for that purpose. Even my health insurance wanted a copy of either the other week. As my last passport expired 4 years ago not sure what I would do if I also did not have a driving licence, just cease to exist?

My mother has neither and has managed so far (including doing fairly scary things like probate of estates), though admittedly I'm not entirely sure how she hasn't had more issues. I've been trying to persuade her to get one or the other for some years, without success.

 

[takno]

We don't want a 'papers please' society for acts as simple as going to a restaurant or the cinema. We also don't want a *requirement* of vaccination for such things. That's pretty much the perfect example of a 'slippery slope'.

My mother has neither and has managed so far (including doing fairly scary things like probate of estates), though admittedly I'm not entirely sure how she hasn't had more issues. I've been trying to persuade her to get one or the other for some years, without success.

My mum has lived most of her life without either, and my dad with only a paper driving licence (he managed to get to 70 and surrender it without ever going to a photocard). They recently got passports because there were just too many things that got inconvenient (although not impossible)

 

[kez19]

We don't want a 'papers please' society for acts as simple as going to a restaurant or the cinema. We also don't want a *requirement* of vaccination for such things. That's pretty much the perfect example of a 'slippery slope'.

the other way they could do it is via an app (some on apple store/google play) if that was the way to go about this (I agree however I don't want to go down this route either), but on the other I have mentioned this before but since I have had my first one and due my second there has been no info on as "proof" I have had it - saying this as from both UK/Scottish Governments.

Yet you would expect governments be more forthcoming regardless, just seems we are in a situation where things are speculated and yet people are turning up a dark alley with no way to go.

 

[MikeWM]

the other way they could do it is via an app (some on apple store/google play) if that was the way to go about this

My suspicion for months was that they would 'repurpose' the NHS contact tracing app to do just this. Eg. see this post from September.

I will be very happy indeed if my suspicions aren't realised!

(I agree however I don't want to go down this route either), but on the other I have mentioned this before but since I have had my first one and due my second there has been no info on as "proof" I have had it - saying this as from both UK/Scottish Governments.

You would suspect if this was planned then they'd have been ready to roll it out when the vaccinations started. So the fact they didn't is a positive sign.

Yet you would expect governments be more forthcoming regardless, just seems we are in a situation where things are speculated and yet people are turning up a dark alley with no way to go.

They have been all over the place, on this as much else. Though even when they are clear, they change their mind a few days later, so I'm not sure it would help much.

 

[kez19]

My suspicion for months was that they would 'repurpose' the NHS contact tracing app to do just this. Eg. see this post from September.

I will be very happy indeed if my suspicions aren't realised!



You would suspect if this was planned then they'd have been ready to roll it out when the vaccinations started. So the fact they didn't is a positive sign.



They have been all over the place, on this as much else. Though even when they are clear, they change their mind a few days later, so I'm not sure it would help much.

I have had my suspicions on the tracing app (its a shortcut to convert them though rename it to vacc app), mind you I don't have it installed anyway lol!

Rolling it out - thats what I had thought too, but on the leaflet I have from Public Health Scotland and as previously mentioned as in England just a date for second dose but other than that nothing on the leaflet to say, the start/process/finish.

The messaging doesn't help either and agree but then thats the governments for you though!

 

[HSTEd]

Overall UK deaths seem to be falling faster than the peak, but hospitalisations seem to be falling slower.

Which I think is some evidence that the vaccinations are starting to have some impact.

 

[NorthOxonian]

Overall UK deaths seem to be falling faster than the peak, but hospitalisations seem to be falling slower.

Which I think is some evidence that the vaccinations are starting to have some impact.

Or it could be evidence that we have better treatments (causing deaths to fall more quickly) but they keep people in hospital longer (so hospitalisations stay higher). I'll cross my fingers that it's a vaccine effect but it could be either.

 

[HSTEd]

Or it could be evidence that we have better treatments (causing deaths to fall more quickly) but they keep people in hospital longer (so hospitalisations stay higher). I'll cross my fingers that it's a vaccine effect but it could be either.

Hospitalisations is new entrants to hospitals, not the number of people in hospitals.