Vaccine Progress, Approval, and Deployment

[yorkie]

If teaching is anything like my workplace then most covid related absences are caused by someone being told to self isolate as a result of being a close contact rather than testing positive themselves. Vaccination won't currently solve this issue.

This is true, though anything that gets transmission down will reduce the impact of such absences.

Some countries are focussing on key workers (and in the case of a country like Australia they are focusing on prioritising staff who may contact with people who have arrived from abroad, which makes total sense) on the basis that the vaccines will primarily be used to reduce transmission, initially. I think that may be the best approach for countries with very low levels of the virus.

I think the UK could have done a hybrid of key workers + by health condition + by age but it would have been very complex and given how endemic the virus already was at the start of the programme, I think the best decision has been taken for us, while other countries adopting a very different approach may well be doing what is best for them.

In the papers today...80% (Eighty percent) of the AZ vaccine in Mainland Europe is unused ! seems they do not trust the AZ vaccine, yet all that fuss they made about the UK not letting them have their fair share !

Yes you couldn't make this stuff up if you tried! It's insane.

Macron and others are to blame for this.

 

[Cdd89]

What exactly has been published on the medium or long-term potential risks? Zero, since that haven't been in existence for long enough yet.

In addition to the points that have been made about weighing up the risk of death or hospitalisation from Covid against the vaccine, I’d make this point:

If you are concerned there may be long-term effects from the vaccines that only present themselves after a period of remission, then the same concern should apply to contracting Covid.

How do you judge the unknowable long-term risks of the vaccine as being sufficiently worse than the unknowable long-term risks of Covid, to be worth accepting the known death/hospitalisation risks of Covid by not being vaccinated?

To be clear I firmly believe that vaccination should be voluntary and nobody should be in any way pressured to do so.

 

[MikeWM]

What puzzles me is your view about vaccine safety over time. I wasn't aware of the Swine Flu vaccine related narcolepsy, but some quick googling suggests that incidents arose in a narrow group of the population within a short window of vaccination. That fits with my understanding of how vaccination works to provoke an immune response, and that where vaccination has side effects, they occur relatively quickly.

Yes, for traditional vaccines that is generally the case. But that may not apply to the new mRNA-style vaccines. Equally the risk from ADE - that future exposure to this virus (or other common coronaviruses?) could cause a potentially dangerous overreaction by the immune system - will be hard to assess for a while, as currently we're still in the pandemic and people are getting seriously ill from the virus anyway. Part of the reason previous coronavirus vaccines were abandoned was due to cases of ADE being observed in animal testing, so I don't think that this is a trivially dismissed concern.

If I contrast that with medicines, where side effects may be due to either the dose when it is taken or to a build up of dosage over time, I'm much more relaxed about vaccine on a risk basis.

To me this is the other way around, and another reason to be somewhat cautious. If you have a nasty side-effect from a medicine, in most cases it goes away when you stop taking the medicine. (I have personal experience of this!) You don't have that option with a vaccination.

I also regard my vaccination as being both a private good (it helps protect me) and a public good by helping protect others. Therefore, my taking the vaccine once the offer reaches me, if only because it reduces the severity of disease (and therefore my production of virus), helps protect others. While I accept it's less transmissible, that transmissibility is far from zero, as we've seen in the last year.

I agree, but my responsibilities to society only go so far. If I have a reasonable belief of an element of personal risk, that may outweigh my responsibility to society. I don't think that has any simple answers really, it needs to be up to the individual to assess that balance.

 

[35B]

I wouldn't object if eg. she was patron of a charity that supported blood donation. I would very much have an issue with her implying those who do not do so are being selfish - part of the role is that she is meant to be above politics. (Part of the reason Charles may prove to be rather problematic, once we get to that point).

All the quotes I've seen of what the Queen said were about encouraging people to be altruistic, and to put the benefit of others above their own difficulties with the vaccine. I can't read that as calling people who don't take the vaccine selfish, though I'm sure that cap will fit a number of heads.

Making a comment like that doesn't to me compromise her neutrality on political matters - it is her supporting a national initiative and being encouraging of it.

 

[jfollows]

Who is eligible for the flu vaccine? It's never occurred to me to try and have it. I had flu at school and possibly once since.

It's been by age, >60 I believe, plus younger people with specific conditions. However the age limit was decreased in 2020 to >50, I believe. I was eligible for it but chose not to take it until last year.

EDIT: https://www.gov.uk/government/publications/flu-vaccines-for-the-current-season implies that it used to be for those aged 65 or greater, but was extended to include 50 or greater in 2020

 

[35B]

It's been by age, >60 I believe, plus younger people with specific conditions. However the age limit was decreased in 2020 to >50, I believe. I was eligible for it but chose not to take it until last year.

EDIT: https://www.gov.uk/government/publications/flu-vaccines-for-the-current-season implies that it used to be for those aged 65 or greater, but was extended to include 50 or greater in 2020

It is also available privately to all. Many employers fund employees to take it; I took that option for the first time in 2020.

 

[Yew]

I think the UK could have done a hybrid of key workers + by health condition + by age but it would have been very complex and given how endemic the virus already was at the start of the programme, I think the best decision has been taken for us, while other countries adopting a very different approach may well be doing what is best for them.

Indeed, I'd thoroughly support trying to go and actively ask them to come forward first, but I don't think I'd go as far as stopping others from having the vaccine until they are done, as it sounds like a logistical nightmare to get that information in a manner that's accurate.

 

[MikeWM]

In addition to the points that have been made about weighing up the risk of death or hospitalisation from Covid against the vaccine, I’d make this point:

If you are concerned there may be long-term effects from the vaccines that only present themselves after a period of remission, then the same concern should apply to contracting Covid.

How do you judge the unknowable long-term risks of the vaccine as being sufficiently worse than the unknowable long-term risks of Covid, to be worth accepting the known death/hospitalisation risks of Covid by not being vaccinated?

I don't believe we have enough data to make a fair judgement at this point, and with that data we do have I don't think one side massively outweighs the other in my particular case, so I therefore choose to do nothing, and let fate decide.

That's probably my solution to the 'trolley problem' too. Probably not a popular answer, but here we are.

 

[35B]

Indeed, I'd thoroughly support trying to go and actively ask them to come forward first, but I don't think I'd go as far as stopping others from having the vaccine until they are done, as it sounds like a logistical nightmare to get that information in a manner that's accurate.

I saw a very interesting Twitter thread from Robert Colville (a think tanker), suggesting that the successes and failures of government policy can be linked to where there were already good databases. So furlough went well, because PAYE has a very good database, but the equivalent schemes for the self employed, which don't have a similarly robust database, didn't.

On that basis, an really simple age + medical condition view works well, because GPs have that information readily to hand in their records. Add jobs, or some other risk factor to that, and you make sorting the list of recipients much harder. Especially when you consider that we don't have a robust way to identify an individual across all government systems. So the "35B" with NI Number AA 12 34 56 C may be really hard to match with the "35B" with NHS number 123456789, as there's nothing to link those records. And without that, you then have a real challenge working back to see whether I am a teacher (or even employed by an education authority), or in the police, or whatever.

 

[DorkingMain]

I saw a very interesting Twitter thread from Robert Colville (a think tanker), suggesting that the successes and failures of government policy can be linked to where there were already good databases. So furlough went well, because PAYE has a very good database, but the equivalent schemes for the self employed, which don't have a similarly robust database, didn't.

On that basis, an really simple age + medical condition view works well, because GPs have that information readily to hand in their records. Add jobs, or some other risk factor to that, and you make sorting the list of recipients much harder. Especially when you consider that we don't have a robust way to identify an individual across all government systems. So the "35B" with NI Number AA 12 34 56 C may be really hard to match with the "35B" with NHS number 123456789, as there's nothing to link those records. And without that, you then have a real challenge working back to see whether I am a teacher (or even employed by an education authority), or in the police, or whatever.

Yep. This is the main reason why it makes sense to just roll out the vaccine on age past the priority groups.

Plus the difference will be a matter of a couple of months for most people, given the prediction is now that everyone will get a first dose by end of May to July

I'll happily take the vaccine, even if I am relatively young and healthy - if it helps bring an end to this stupid mess then I am all for it.

 

[Ediswan]

On that basis, an really simple age + medical condition view works well, because GPs have that information readily to hand in their records. Add jobs, or some other risk factor to that, and you make sorting the list of recipients much harder.

Plus, if some jobs or some other risk factors were added, there would immediately be lobbying for additional jobs and risk factors to be added, rinse, repeat.

 

[Yew]

On that basis, an really simple age + medical condition view works well, because GPs have that information readily to hand in their records. Add jobs, or some other risk factor to that, and you make sorting the list of recipients much harder. Especially when you consider that we don't have a robust way to identify an individual across all government systems. So the "35B" with NI Number AA 12 34 56 C may be really hard to match with the "35B" with NHS number 123456789, as there's nothing to link those records. And without that, you then have a real challenge working back to see whether I am a teacher (or even employed by an education authority), or in the police, or whatever.

That is a very astute observation, we should try and resolve this somewhat, as the ability to easily resolve an individual across multiple government systems has some distinct advantages.

 

[35B]

That is a very astute observation, we should try and resolve this somewhat, as the ability to easily resolve an individual across multiple government systems has some distinct advantages.

I take no credit for the observation.

Your suggestion, which I support, would rapidly take us into the deep waters ID of the card debate... As Sweden is often mentioned on these threads, all I will observe is that the best part of 20 years ago, some Swedish colleagues became aware of the limitations of NI Numbers, particularly their uselessness for ID purposes, and compared the lack of a common identity in the UK very unfavourably to that in Sweden. Not from a government perspective, but because of how easy the Swedish ID system made proving their identity when they needed to prove it. A glance at discussion of vaccine passports will suggest the terms of debate that might arise.

 

[Bald Rick]

I don't believe we have enough data to make a fair judgement at this point

Genuine question - do you have the same principles in other elements of your life, aside from medicine?

 

[ainsworth74]

But apparently only 4% of people regularly do give blood (source : here). Do you have 'very little time' for all the other healthy people who choose not to?

(For what it is worth, I would like to do so, but I'm not allowed to as I had transfusions in hospital 15+ years ago - which seems a bit silly, but that's the rules).

Hmm perhaps I could have expressed myself better (this will teach me for writing quickly rather than taking my time) but in general terms if those who don't donate blood (and were able to do so, I quite obviously wouldn't hold it against someone who can't such as your good self!) held a view similar to what has been expressed on this thread around not being made to feel 'welcome' by society therefore effectively sticking two fingers up at it in return then yes I would have little time for them.

It would have been more accurate to express myself as having little time for such views rather than such people however and for that mistake I apologise.

I wouldn't object if eg. she was patron of a charity that supported blood donation. I would very much have an issue with her implying those who do not do so are being selfish - part of the role is that she is meant to be above politics. (Part of the reason Charles may prove to be rather problematic, once we get to that point).

Personally I didn't take her comments that way as it seemed she was asking people to be altruistic and think of others than explicitly saying that those who don't are selfish. And I find it somewhat sad that we might be approaching the point where a being seen to be in favour of taking a vaccine, something that will help people, is seen as overly political. But I do certainly agree with you on Charles, can we not just skip him and go to William instead?

Good, I would hope most would agree on that.

I would go even further and say I would hope all would agree on that

 

[MikeWM]

Genuine question - do you have the same principles in other elements of your life, aside from medicine?

Not quite sure what you're asking, sorry. If you're asking do I apply a higher standard of caution about having medical products injected into my body over, say, what brand of TV to buy or where to go on holiday this year, then yes I do. I'd think it rather odd not to, in fact.

It would have been more accurate to express myself as having little time for such views rather than such people however and for that mistake I apologise.

That's fair enough, thanks!

Personally I didn't take her comments that way as it seemed she was asking people to be altruistic and think of others than explicitly saying that those who don't are selfish. And I find it somewhat sad that we might be approaching the point where a being seen to be in favour of taking a vaccine, something that will help people, is seen as overly political.

I agree, but then I don't believe anything about a pandemic ought to be political, which it seems is a very minority view nowadays (but fairly standard 50 or 60 years ago).

But I do certainly agree with you on Charles, can we not just skip him and go to William instead?

I'm really not sure about monarchy in general, but if the alternative is President Tony Blair or similar, that's one definite positive in its favour

I would go even further and say I would hope all would agree on that

I'd *hope*, but I suspect I'd be disappointed.

 

[Bald Rick]

Not quite sure what you're asking, sorry. If you're asking do I apply a higher standard of caution about having medical products injected into my body over, say, what brand of TV to buy or where to go on holiday this year, then yes I do. I'd think it rather odd not to, in fact.

No, I mean would you, say, refuse to get on an Airbus A350 to go on that holiday, as a new design of aircraft using new construction techniques (largely composites), and a new engine design. Carbon composite aircraft haven’t been around long enough to know what effect long term use will have on their structural integrity. The detailed science says it will be fine (as does the detailed science behind the Covid vaccines), but until they have been in service for a long time, you can’t be sure.

 

[VauxhallandI]

No, I mean would you, say, refuse to get on an Airbus A350 to go on that holiday, as a new design of aircraft using new construction techniques (largely composites), and a new engine design. Carbon composite aircraft haven’t been around long enough to know what effect long term use will have on their structural integrity. The detailed science says it will be fine (as does the detailed science behind the Covid vaccines), but until they have been in service for a long time, you can’t be sure.

737 MAX

 

[Yew]

No, I mean would you, say, refuse to get on an Airbus A350 to go on that holiday, as a new design of aircraft using new construction techniques (largely composites), and a new engine design. Carbon composite aircraft haven’t been around long enough to know what effect long term use will have on their structural integrity. The detailed science says it will be fine (as does the detailed science behind the Covid vaccines), but until they have been in service for a long time, you can’t be sure.

Pressurised Aircraft and aircraft with Jet engines had existed for a while when the DeHaviland Comet was developed.

 

[Bald Rick]

Pressurised Aircraft and aircraft with Jet engines had existed for a while when the DeHaviland Comet was developed.

Exactly.

 

[MikeWM]

No, I mean would you, say, refuse to get on an Airbus A350 to go on that holiday, as a new design of aircraft using new construction techniques (largely composites), and a new engine design. Carbon composite aircraft haven’t been around long enough to know what effect long term use will have on their structural integrity. The detailed science says it will be fine (as does the detailed science behind the Covid vaccines), but until they have been in service for a long time, you can’t be sure.

I doubt I would have any issue - we understand machines, aerodynamics and materials science a lot better than we understand human biology. They're a lot simpler, for one.

If a plane falls to pieces in mid-air, we put a vast amount of effort into discovering why and then make very sure we never make the same mistake again. In part, this is incentivised by the fact the aeroplane manufacturer has legal responsibility to make sure their planes don't fall to pieces in mid-air, so when something does go badly wrong, they certainly don't want it to ever happen again.

But has it been properly explained, for example, why the swine flu vaccine caused narcolepsy in a small minority of people? The only explanation I can find is one paper published years later that suggests a 'plausible' mechanism. How can you avoid the same or similar mistakes if you don't know what went wrong last time? And the situation is hardly helped by the vaccine designers/manufacturers being legally indemnified against any issues caused by their products, which doesn't exactly incentivise them to investigate too closely.

 

[Richard Scott]

I doubt I would have any issue - we understand machines, aerodynamics and materials science a lot better than we understand human biology. They're a lot simpler, for one.

If a plane falls to pieces in mid-air, we put a vast amount of effort into discovering why and then make very sure we never make the same mistake again. In part, this is incentivised by the fact the aeroplane manufacturer has legal responsibility to make sure their planes don't fall to pieces in mid-air, so when something does go badly wrong, they certainly don't want it to ever happen again.

But has it been properly explained, for example, why the swine flu vaccine caused narcolepsy in a small minority of people? The only explanation I can find is one paper published years later that suggests a 'plausible' mechanism. How can you avoid the same or similar mistakes if you don't know what went wrong last time? And the situation is hardly helped by the vaccine designers/manufacturers being legally indemnified against any issues caused by their products, which doesn't exactly incentivise them to investigate too closely.

Not sure about the others but thought the Astra Zeneca vaccine was a modification of one that had already been developed and extensively tested or am I incorrect there?

 

[MikeWM]

Not sure about the others but thought the Astra Zeneca vaccine was a modification of one that had already been developed and extensively tested or am I incorrect there?

I thought it was a small modification of one they already had quite far along in development and had started trials, but not been rolled out for general use. I'm not 100% sure though, I'd have to check.

 

[Domh245]

I thought it was a small modification of one they already had quite far along in development and had started trials, but not been rolled out for general use. I'm not 100% sure though, I'd have to check.

That's the situation as I understand it - ChAdOx-1 (the adenovirus vector that contains the Covid spike proteins used to generate the immune response) had previously been got as far as Phase IIa studies when being used as a Malaria vaccine (checking to "demonstrate clinical efficacy or biological activity"), but not the wider Phase III trials

 

[LAX54]

It is also available privately to all. Many employers fund employees to take it; I took that option for the first time in 2020.

Its been offered to all Net Rail empoyees for a few years now, not sure what the uptake is, although fairly high where I worked.

In addition to the points that have been made about weighing up the risk of death or hospitalisation from Covid against the vaccine, I’d make this point:

If you are concerned there may be long-term effects from the vaccines that only present themselves after a period of remission, then the same concern should apply to contracting Covid.

How do you judge the unknowable long-term risks of the vaccine as being sufficiently worse than the unknowable long-term risks of Covid, to be worth accepting the known death/hospitalisation risks of Covid by not being vaccinated?

To be clear I firmly believe that vaccination should be voluntary and nobody should be in any way pressured to do so.

So are the ant-vaccination people saying it's not been tested long enough, as other vaccines have, and thus we should stay locked down until the results over 2 or 3 years are back and checked ? of course by which time, there will be no life to go back to ! There will ALWAYS be risks to a vaccine, to anything! LIFE is a risk, if you took the view I am not going out until it safe, then you would never leave the house, you'd never eat pre-packed food, go to work in case someone had the flu etc ..
There are some of course that due to their medical conditions, cannot have this or any other vaccine.

 

[VauxhallandI]

Its been offered to all Net Rail empoyees for a few years now, not sure what the uptake is, although fairly high where I worked.


So are the ant-vaccination people saying it's not been tested long enough, as other vaccines have, and thus we should stay locked down until the results over 2 or 3 years are back and checked ? of course by which time, there will be no life to go back to ! There will ALWAYS be risks to a vaccine, to anything! LIFE is a risk, if you took the view I am not going out until it safe, then you would never leave the house, you'd never eat pre-packed food, go to work in case someone had the flu etc ..
There are some of course that due to their medical conditions, cannot have this or any other vaccine.

I think the anti-vax are saying never to take it?

 

[nlogax]

I think the anti-vax are saying never to take it?

Who cares what they're saying? They need to be ignored, noting that we should be absolutely clear on the difference between anti-vaxxers and those with reasonable concerns.

 

[yorkie]

I think the anti-vax are saying never to take it?

Yes anti-vax people are generally against vaccinations full stop. Some people may be vaccine hesitant which is a bit different and a bit more understandable.

On the subject of Sars-CoV-2 vaccine safety (and a lot more information about these vaccines), this video is worth a watch:

Professor Shane Crotty, PhD answers a series of COVID 19 vaccine questions including what are the chances of long-term side effects?

How safe is RNA vaccine (i.e. Pfizer / BioNTech and Moderna Vaccines) technology? How long does mRNA from a vaccine stay in our cells? What else goes in vaccines? How long does immunity last? Why are T-Cells so important? Why does Pfizer's vaccine need to stay SO cold?

Shane Crotty, PhD is a Professor at the La Jolla Institute for Immunology, Center for Infectious Disease and Vaccine Research, Crotty Lab. Professor Crotty also has an academic appointment with the University of California San Diago.

See his full bio here: https://www.lji.org/labs/crotty/#over...
Professor Crotty on Twitter: https://twitter.com/profshanecrotty
Interviewer: Kyle Allred, Physician Assistant, Producer and Co-Founder of MedCram.com

See our new interview with Prof. Crotty on how virus mutations (UK variant and S. African variant) may be impacting COVID-19 transmission and vaccine efficacy.

Research referenced in this video from Prof. Crotty and his team was published Jan. 6, 2021, in the prestigious Journal Science: https://science.sciencemag.org/conten... New York Times article highlighting Prof. Shane Crotty's research: https://www.nytimes.com/2020/11/17/he...
00:00 Introducing Prof. Shane Crotty's Research
0:35 How long does COVID-19 "immune memory" last?
0:57 The three primary aspects of immune memory: antibodies, killer T cells, and helper T cells
2:25 The anatomy (protein makeup) of SARS-CoV-2
3:02 Why is spike protein the primary target?
5:17 Could a mutation allow SARS-CoV-2 to infect without spike protein?
7:02 Utilizing lipid nanoparticles to deliver mRNA and the role of RNA normally
9:52 What human cells does an RNA vaccine go into?
10:36 How long does mRNA from a vaccine stay in human cells?
11:44 What else goes in vaccines besides mRNA and lipid nanoparticles? Any preservatives or adjuvants?
12:30 Why are adjuvants used in many vaccines?
14:08 Protein production from mRNA
15:00 Why utilize the "extra" step of mRNA to code for protein antigens?
17:28 Are mRNA vaccines the future of vaccine development?
19:18 Any chance for mRNA to enter our cells' nucleus?
20:55 The immune response to a coronavirus vaccine
23:17 Expected symptoms from immune response to a vaccine vs. vaccine side effects
25:50 Should people who've had COVID-19 get vaccinated?
27:27 Immunity from COVID vaccine vs. a natural infection
28:30 Why does the Pfizer vaccine need to be stored so cold?
29:04 What would you say to a family member who is nervous about a rushed vaccine and RNA technology?
32:37 What about the possibility of long term side effects from RNA vaccines?
33:30 What's next for Shane Crotty's research team? (This video was recorded on December 16, 2020).

Most of the people who I argue with over vaccine efficacy tend to be pro-lockdown / "zero Covid" and falsely claim that "new variants" could render the vaccines "completely useless" which is absolutely false and demonstrates a complete lack of understanding regarding how the immune response to this virus works (I also knew next to nothing until about a year ago, but then I didn't go round making false claims!). Such people seem to be enjoying their doom-mongering and the current authoritarian regime and do not want this era to end, nor do they want to listen to podcast interviews to find out accurate information, preferring instead to be mislead by hysterical media headlines!

 

[HSTEd]

If we were going to have serious side effects from the vaccines, we would be buried in reports of them by now.

Tens or even hundreds of millions of doses have already been expended, some many weeks ago.

 

[MikeWM]

So are the ant-vaccination people saying it's not been tested long enough, as other vaccines have, and thus we should stay locked down until the results over 2 or 3 years are back and checked ?

Not in my experience.

Those I've seen who would prefer not to have the vaccine - like myself - are of the opinion that it is entirely unnecessary to vaccinate *everyone*, a fairly logical extension to the argument that lockdowns, masks, social distancing, etc. were also a very bad idea. A natural extension of the idea of the Great Barrington declaration - protect those at risk, while everyone else should just get on with it.

If we were going to have serious side effects from the vaccines, we would be buried in reports of them by now.

Tens or even hundreds of millions of doses have already been expended, some many weeks ago.

You can see the reported adverse reactions (via the yellow card system) here, up to Feb 14

https://www.gov.uk/government/publi...irus-vaccine-summary-of-yellow-card-reporting

As of 14 February 2021, for the UK

• 26,823 Yellow Cards have been reported for the Pfizer/BioNTech
• 31,427 have been reported for the Oxford University/AstraZeneca vaccine
• 177 have been reported where the brand of the vaccine was not specified

For both vaccines the overall reporting rate is around 3 to 5 Yellow Cards per 1,000 doses administered.

There's lots more information to be found there, if you're interested.