Vaccine Progress, Approval, and Deployment

[Nicholas Lewis]

Great to hear for everyone at home and every day, the closer we hopefully get to normality!



https://www.bbc.co.uk/news/live/world-55605009 , posted at 12pm

With my calculations, assuming that vaccinations centers are doing vaccinations for 12 hours a day, that means every 1 second nearly 5 people are being vaccinated in the UK which is incredible when you consider the logistics of producing and getting people in!

It is excellent and im sure the doomsters will proved wrong about quickly we will get this ramped up and get first jab in.

What we want to know though is when will we see this effort bare down on hospitalisation rates which remain stubbornly high. Hancock says we are at c2m vaccinated now with 3m positive cases so something like 1 in 8 of population or 1 in 10 if you remove under fives should have some level of immunity but transmission rates aren't moderating. Im just interested to know when the experts expect these metrics to start to react?

Am I the only one who thinks it’s real bizarre that some individuals are only trusting the Oxford vaccine. Personally If I was offered the choice I would opt for Pfizer as it’s been authorized by most countries including more “trustworthy” ones and also received WHO approval.

which leads me to believe it could be down to nationalistic nonsense more than genuine safety concerns. Then again there was a uproar because some SNP politicians were refusing to call it the Oxford vaccine which is down right obnoxious behavior on their part as far as I’m concerned.

Oxford vaccine initial batches have come from Holland and Germany but I believe there ramping up production in the UK now.

 

[hwl]

What we want to know though is when will we see this effort bare down on hospitalisation rates which remain stubbornly high. Hancock says we are at c2m vaccinated now with 3m positive cases so something like 1 in 8 of population or 1 in 10 if you remove under fives should have some level of immunity but transmission rates aren't moderating. Im just interested to know when the experts expect these metrics to start to react?.

Unlike previously, they are expecting the death rates to come down first (instead of last) as they are targeting the older age groups for vaccination where the deaths are occurring (average age of death is just over 80), however the average (mean) age of hospitalisation (or ICU admission happens to be the same) is 60-61 (since 1 September) hence it will take longer to have an impact on hospitalisation as most of those admitted aren't in the Boris top 4 groups by mid feb target.
Many people have focused on the average age of those dying and have yet to notice the average age of those being admitted to hospital is 20 years younger.

When it gets to working age groups there are nearly 0.5m per birth year more still alive more than the older age groups targeted so far so if vaccination and take up rates and everything else remains the same then the pace getting through the age groups will slow.

The 12 week mark for those vaccinated first will be 23rd Feb, which will then see the pace of vaccinating those in younger age groups with the first dose slow as the second doses are delivered (Unless manufacture and bottling speed up and they continue to ramp up vaccination centre capacity significantly but then they potentially create another headache 12 weeks on)

 

[matacaster]

In spite of not generally preferring British or British-sounding names, and knowing that the numbers are better for the Pfizer one, I would probably still prefer the Oxford one if offered a choice. It's slightly less innovative, and doesn't need scary-sounding levels of cold. I mean I know they defrost it before they give it to you, but I've still got visions of people in hazmat suits pulling giant needles of experimental gunk out of blocks of dry ice.

As I understand it for people in homes though, they will largely only be offered the Oxford vaccine, just because it's more practical to distribute there.

The Oxford one is significantly cheaper.

 

[hwl]

The Oxford one is significantly cheaper.

And much easier to produce in large volumes

 

[HSTEd]

Well unfortunately in about ten weeks Oxford vaccine administration into new people will have to come to a dead stop for at least several more weeks.

So it's going to be on the Johnson and Johnson vaccine at that point.

 

[hwl]

Well unfortunately in about ten weeks Oxford vaccine administration into new people will have to come to a dead stop for at least several more weeks.

So it's going to be on the Johnson and Johnson vaccine at that point.

And Moderna in April.

 

[6862]

Well unfortunately in about ten weeks Oxford vaccine administration into new people will have to come to a dead stop for at least several more weeks.

So it's going to be on the Johnson and Johnson vaccine at that point.

That assumes that the amount of the vaccine available and the capacity to inject it don't increase. Although I suspect the rates of initial jabs might drop even if they don't completely stop as you suggest.

 

[brad465]

Well unfortunately in about ten weeks Oxford vaccine administration into new people will have to come to a dead stop for at least several more weeks.

So it's going to be on the Johnson and Johnson vaccine at that point.

According to this article in Forbes, Phase 3 data for the J&J vaccine is due later this month and in the US emergency approval could be in February. Given our rate of approving vaccines I suspect if it can be approved we'll be approving no later than when the US do so, but the question is how many doses we'll actually have available once approved (of the 30 million ordered)?

 

[Luke McDonnell]

Do we know so far how effective the vaccine is (with regards to the rollout - not the clinical trials) - I would imagine we would be starting to get data on this quickly given that the prevalence is currently high and we now have over 2m vaccinated so surely we should have accurate data on vaccine effectiveness in the field as opposed to trials? I did read somewhere that there have been no cases so far severe enough to require hospitalisation in anyone who received their first dose 10+ days ago - but I am not sure if this was the trial or the rollout can anyone elaborate. If no one who has received the vaccine so far has been hospitalised with Covid that would be very good news surely that is a question they could ask the scientists at the press conferences? This information should be made public IMO to show the public that the vaccine is doing its job to help encourage uptake

Do we know so far how effective the vaccine is (with regards to the rollout - not the clinical trials) - I would imagine we would be starting to get data on this quickly given that the prevalence is currently high and we now have over 2m vaccinated so surely we should have accurate data on vaccine effectiveness in the field as opposed to trials? I did read somewhere that there have been no cases so far severe enough to require hospitalisation in anyone who received their first dose 10+ days ago - but I am not sure if this was the trial or the rollout can anyone elaborate. If no one who has received the vaccine so far has been hospitalised with Covid that would be very good news surely that is a question they could ask the scientists at the press conferences? This information should be made public IMO to show the public that the vaccine is doing its job to help encourage uptake.

I have also read that pubs and other hospitality may not be permitted to open until the beginning of May that sounds like an awful long time to me - as long as they where closed in the first lockdown why do you think there is a need to keep hospitality shut that long if the vast majority of the vulnerable population are expected to be vaccinated by the middle of February surely if the vaccine was starting to show a large reduction is hospitalisations and deaths the hospitality industry should be lobbying hard to be permitted to open before May especially considering the seasonal effects also. Once the pressure on the NHS goes there should be no justification for keeping such venues closed

 

[hwl]

Do we know so far how effective the vaccine is (with regards to the rollout - not the clinical trials) - I would imagine we would be starting to get data on this quickly given that the prevalence is currently high and we now have over 2m vaccinated so surely we should have accurate data on vaccine effectiveness in the field as opposed to trials? I did read somewhere that there have been no cases so far severe enough to require hospitalisation in anyone who received their first dose 10+ days ago - but I am not sure if this was the trial or the rollout can anyone elaborate. If no one who has received the vaccine so far has been hospitalised with Covid that would be very good news surely that is a question they could ask the scientists at the press conferences? This information should be made public IMO to show the public that the vaccine is doing its job to help encourage uptake.

I have also read that pubs and other hospitality may not be permitted to open until the beginning of May that sounds like an awful long time to me - as long as they where closed in the first lockdown why do you think there is a need to keep hospitality shut that long if the vast majority of the vulnerable population are expected to be vaccinated by the middle of February surely if the vaccine was starting to show a large reduction is hospitalisations and deaths the hospitality industry should be lobbying hard to be permitted to open before May especially considering the seasonal effects also. Once the pressure on the NHS goes there should be no justification for keeping such venues closed

As I have previously mentioned the average age at hospitalisation is 60 (ditto 60 for ICU admission) and the average age of those who die of/with covid is over 80. Hence with targeting the oldest first for vaccination death rates will come down well before hospitalisation rates so the pressure on the NHS will remain for longer than many might expect especially as younger patients spend far longer in ICU.

12+ days post first jab is more sensible as a starting point for useful impact (Oxford and Pfizer) based on trial data.

 

[Nicholas Lewis]

Do we know so far how effective the vaccine is (with regards to the rollout - not the clinical trials) - I would imagine we would be starting to get data on this quickly given that the prevalence is currently high and we now have over 2m vaccinated so surely we should have accurate data on vaccine effectiveness in the field as opposed to trials? I did read somewhere that there have been no cases so far severe enough to require hospitalisation in anyone who received their first dose 10+ days ago - but I am not sure if this was the trial or the rollout can anyone elaborate. If no one who has received the vaccine so far has been hospitalised with Covid that would be very good news surely that is a question they could ask the scientists at the press conferences? This information should be made public IMO to show the public that the vaccine is doing its job to help encourage uptake

Do we know so far how effective the vaccine is (with regards to the rollout - not the clinical trials) - I would imagine we would be starting to get data on this quickly given that the prevalence is currently high and we now have over 2m vaccinated so surely we should have accurate data on vaccine effectiveness in the field as opposed to trials? I did read somewhere that there have been no cases so far severe enough to require hospitalisation in anyone who received their first dose 10+ days ago - but I am not sure if this was the trial or the rollout can anyone elaborate. If no one who has received the vaccine so far has been hospitalised with Covid that would be very good news surely that is a question they could ask the scientists at the press conferences? This information should be made public IMO to show the public that the vaccine is doing its job to help encourage uptake.

I have also read that pubs and other hospitality may not be permitted to open until the beginning of May that sounds like an awful long time to me - as long as they where closed in the first lockdown why do you think there is a need to keep hospitality shut that long if the vast majority of the vulnerable population are expected to be vaccinated by the middle of February surely if the vaccine was starting to show a large reduction is hospitalisations and deaths the hospitality industry should be lobbying hard to be permitted to open before May especially considering the seasonal effects also. Once the pressure on the NHS goes there should be no justification for keeping such venues closed

I believe Hancock is doing a presser tomorrow evening to launch the vaccine daily metrics as well as elaborate further on the rollout perhaps supported by our so called Minster of Vaccinations Nadhim Zahawi who might explain how they are going to ramp up and sustain 300k jabs/day along the whole supply chain.

With 30% of over 80's vaccinated we should by no be seeing both a reduction in hospitalisations as well as the age profile of those being admitted reducing. Its about time this data was produced daily as its erratically updated currently (7th Jan last update) but the over 85 rate is still increasing. The 18-64 rate is also increasing and given this group contains the majority of positive cases its clearly not providing any moderation yet.

 

[HSTEd]

As I have previously mentioned the average age at hospitalisation is 60 (ditto 60 for ICU admission) and the average age of those who die of/with covid is over 80. Hence with targeting the oldest first for vaccination death rates will come down well before hospitalisation rates so the pressure on the NHS will remain for longer than many might expect especially as younger patients spend far longer in ICU.

12+ days post first jab is more sensible as a starting point for useful impact (Oxford and Pfizer) based on trial data.

Is that average mean or median?

 

[The Ham]

I believe Hancock is doing a presser tomorrow evening to launch the vaccine daily metrics as well as elaborate further on the rollout perhaps supported by our so called Minster of Vaccinations Nadhim Zahawi who might explain how they are going to ramp up and sustain 300k jabs/day along the whole supply chain.

With 30% of over 80's vaccinated we should by no be seeing both a reduction in hospitalisations as well as the age profile of those being admitted reducing. Its about time this data was produced daily as its erratically updated currently (7th Jan last update) but the over 85 rate is still increasing. The 18-64 rate is also increasing and given this group contains the majority of positive cases its clearly not providing any moderation yet.

The issue is that even if we've done 1/3 of the over 80's most of those would have been done within the last two weeks and so will have little or no protection from the vaccine.

Also those going into hospital will have been infected 2 weeks before doing so and so even those few 80+ years old who would have been vaccinated at that time would have had little or no protection.

Those dyeing would have been infected at least a month ago when there would have been virtually no vaccinated.

As such we need to wait at least 2 weeks from now before we'd expect to see much of a shift in the numbers going into hospital, quite possibly a month.

Likewise deaths would require at least a month from now, more likely 6 weeks, before we notice a downwards shift in deaths.

We'd likely see the impact from the lockdown over similar timeframes. Therefore we could see both working together to show some reasonable falls.

However one word of warning, with such high case numbers (which show limited falls) it could take longer to slow the numbers down as any interaction is a higher risk (of catching Covid-19) than (say) during November.

 

[Nicholas Lewis]

The issue is that even if we've done 1/3 of the over 80's most of those would have been done within the last two weeks and so will have little or no protection from the vaccine.

Also those going into hospital will have been infected 2 weeks before doing so and so even those few 80+ years old who would have been vaccinated at that time would have had little or no protection.

Those dyeing would have been infected at least a month ago when there would have been virtually no vaccinated.

As such we need to wait at least 2 weeks from now before we'd expect to see much of a shift in the numbers going into hospital, quite possibly a month.

Likewise deaths would require at least a month from now, more likely 6 weeks, before we notice a downwards shift in deaths.

We'd likely see the impact from the lockdown over similar timeframes. Therefore we could see both working together to show some reasonable falls.

However one word of warning, with such high case numbers (which show limited falls) it could take longer to slow the numbers down as any interaction is a higher risk (of catching Covid-19) than (say) during November.

OK I get your view that there will be a lagging impact so I will keep an eye on the >85 hospitalisation rate as that ought to be the best early indicator that things are improving.

Separately I see Guardian are running a piece that says new research shows 1 in 5 people have had Covid

https://www.theguardian.com/world/n...had-coronavirus-in-england-new-modelling-says

It goes on to further suggest 1 in 2 have had it in London - well if they are correct than it hasn't helped very much. Another flawed piece of research that doesn't recognise the reality of the situation.

 

[hwl]

Is that average mean or median?

Mean, median was 62 from memory.

 

[Yew]

OK I get your view that there will be a lagging impact so I will keep an eye on the >85 hospitalisation rate as that ought to be the best early indicator that things are improving.

Separately I see Guardian are running a piece that says new research shows 1 in 5 people have had Covid

https://www.theguardian.com/world/n...had-coronavirus-in-england-new-modelling-says

It goes on to further suggest 1 in 2 have had it in London - well if they are correct than it hasn't helped very much. Another flawed piece of research that doesn't recognise the reality of the situation.

Didn't some studies suggest numbers like that back in the summer?

EDIT:

Yes they did (https://www.manchester.ac.uk/discover/news/over-25-of-the-uk-likely-to-have-had-covid-19-already/)

A team of researchers from The University of Manchester, Salford Royal and Res Consortium, have shown that a significant proportion of people in the UK- over 25% - is likely to have been infected already by the COVID-19 virus.

 

[Nicholas Lewis]

Didn't some studies suggest numbers like that back in the summer?

Indeed and early serology testing gave some credence to it being a far higher number but its not helping to moderate the current wave at all especially on the East side of London which continues to increase. No doubt many factors at play but it suggests that either any immunity acquired has worn off or the new variant isn't being seen by the body as the same as the first one.

Furthermore the great experiment at Liverpool has proved worthless as that city is now vying for the top of the case rate board.

So you can see how the govt is reacting to this with the narrative now shifting to tightening restrictions further before even the tier 3/4 impacts have worked through let alone lockdown 3.0.

 

[takno]

Indeed and early serology testing gave some credence to it being a far higher number but its not helping to moderate the current wave at all especially on the East side of London which continues to increase. No doubt many factors at play but it suggests that either any immunity acquired has worn off or the new variant isn't being seen by the body as the same as the first one.

Furthermore the great experiment at Liverpool has proved worthless as that city is now vying for the top of the case rate board.

So you can see how the govt is reacting to this with the narrative now shifting to tightening restrictions further before even the tier 3/4 impacts have worked through let alone lockdown 3.0.

I suspect that the seeming tail-off in cases in London/East/Southeast in the last week of last year is consistent with those high infection rates. London was noticeably unaffected in September and October, apart from a little disruption related to students. It seems like by mid-November the higher transmissibility of the new strain broke down the network barriers which were keeping infections in equilibrium. At that point it's gone tearing through the 50% of people who had avoided infection before. If it has done that it may already have ripped through enough people to be starting to hit a new equilibrium point, or even to the point of burning out.

Obviously another explanation is that people are liable to reinfection, but the evidence so far on reinfection is patchy. All the signs are also that subsequent reinfections have been less severe, which doesn't really account for the increase in hospital admissions.

A worrying thought for countries which have managed to lock down and avoid infections so far, is what does this variant look like in a community which hasn't built up any significant level of immunity, and where the quarantine protocols may not be enough to keep it from breaking through? Hopefully they will be lucky and the vaccine programmes will be complete before they get to find out.

I'd love to know what modelling is being done of what this kind of thing might look like. I suspect though that any serious efforts are being stymied by the quasi-religious beliefs that herd-immunity is tantamount to murder. Partial herd immunity is going to develop whether it's a good thing or not, and knowing how it's affecting your interventions would be really valuable judging what interventions work and how sudden changes like this strain are likely to pan out.

 

[778]

Well unfortunately in about ten weeks Oxford vaccine administration into new people will have to come to a dead stop for at least several more weeks.

So it's going to be on the Johnson and Johnson vaccine at that point.

Do you think the UK would consider approving any of the Chinese or Russian vaccines (eg sputnik v)? Johnson and Johnson is a single dose vaccine so that should help.

 

[kristiang85]

To me, it's more evidence that PCR testing is massively overstating actual cases (which would create immunity, and that so far seems to be pretty solid in symptomatic cases).

 

[HSTEd]

Do you think the UK would consider approving any of the Chinese or Russian vaccines (eg sputnik v)? Johnson and Johnson is a single dose vaccine so that should help.

Doubtful, there are some major questionmarks over those.

It appears vaccinating over 70s will cut only 25% off intensive care admissions, however note the four priority groups includes other people who are below 70.

Also things rapidly get better after that since getting to over 60s gets us to about half.

Politically problematic but it might be worth going for vaccinating only men for a couple of weeks......

 

[hwl]

I suspect that the seeming tail-off in cases in London/East/Southeast in the last week of last year is consistent with those high infection rates. London was noticeably unaffected in September and October, apart from a little disruption related to students. It seems like by mid-November the higher transmissibility of the new strain broke down the network barriers which were keeping infections in equilibrium. At that point it's gone tearing through the 50% of people who had avoided infection before. If it has done that it may already have ripped through enough people to be starting to hit a new equilibrium point, or even to the point of burning out.

Obviously another explanation is that people are liable to reinfection, but the evidence so far on reinfection is patchy. All the signs are also that subsequent reinfections have been less severe, which doesn't really account for the increase in hospital admissions.

A worrying thought for countries which have managed to lock down and avoid infections so far, is what does this variant look like in a community which hasn't built up any significant level of immunity, and where the quarantine protocols may not be enough to keep it from breaking through? Hopefully they will be lucky and the vaccine programmes will be complete before they get to find out.

I'd love to know what modelling is being done of what this kind of thing might look like. I suspect though that any serious efforts are being stymied by the quasi-religious beliefs that herd-immunity is tantamount to murder. Partial herd immunity is going to develop whether it's a good thing or not, and knowing how it's affecting your interventions would be really valuable judging what interventions work and how sudden changes like this strain are likely to pan out.

Reinfection - The initial NERVTAG and PHE analysis of the new strain show a surprising number of those with the new strain had a positive PCR test with the old strain more than 90day before (when the new didn't exist). A small number but rather larger than one might expect given community case rates (based on ONS sampling work).

The WHO has clarified the definition of Herd immunity (in Autumn 2020) as vaccinated only due to the far stronger average immune reaction to vaccination.

Doubtful, there are some major questionmarks over those.

It appears vaccinating over 70s will cut only 25% off intensive care admissions, however note the four priority groups includes other people who are below 70.

Also things rapidly get better after that since getting to over 60s gets us to about half.

Politically problematic but it might be worth going for vaccinating only men for a couple of weeks......

Also very little on the J&J vaccine out there so confidence might be lower in that let alone the Russian or Chinese?

Many people would love to be a fly on the wall when the ICU stats and what it means are explained to Boris! (It looks like no on has yet)

Half still leaves a big problem, but not having much of the new strain in your local area here is a big advantage.

 

[birchesgreen]

Do you think the UK would consider approving any of the Chinese or Russian vaccines (eg sputnik v)? Johnson and Johnson is a single dose vaccine so that should help.

They are going to look into using Sputnik V with the AstraZeneca one.

 

[Nicholas Lewis]

To me, it's more evidence that PCR testing is massively overstating actual cases (which would create immunity, and that so far seems to be pretty solid in symptomatic cases).

The fact that there is such a difference on positivity rates between pillar 1 & 2 along with the negativity from lab experts about the level of biological control in Lighthouse labs certainly lends credence to Pillar 2 testing being overstated. However, you can't get away from the level of hospitalistions, which is the main metric driving the political response currently but maybe take solace in the fact that the case numbers are overstated so at least this metric won't worsen further.

 

[Yew]

The WHO has clarified the definition of Herd immunity (in Autumn 2020) as vaccinated only due to the far stronger average immune reaction to vaccination.

Which is clearly what it isn't, I think I'll stick to the textbook definitions.

 

[Nicholas Lewis]

2.6m doses have been given to 2.3m people ie 300k have had the second dose.

40% >80yo now have a dose

23% care home residents have a dose

Govt have issued the vaccine delivery plan

It covers

supply – including the development and manufacturing of vaccines, ensuring their safety and effectiveness
prioritisation – insight into the first 2 phases of deployment
places – ensuring simple, fair and convenient access to vaccinations for the public, regardless of where they live
people – mobilising the workforce and providing information on vaccinations to local communities

Also of interest is PHE covid19 vaccine surveillance strategy which will give oversight of vaccine roll out which will involve monitoring of vaccine uptake (coverage), vaccine effectiveness, population impact and vaccine safety

 

[158756]

To me, it's more evidence that PCR testing is massively overstating actual cases (which would create immunity, and that so far seems to be pretty solid in symptomatic cases).

The number of people tested positive so far (~3 million, about 5% of the population) is nowhere near enough to make any significant impact on transmission. Plus in the first wave it is practically certain millions had it but weren't tested, so even if every positive since had been false the official count would still be an underestimate.

I don't think I buy the claim that 50% of London has had it though, given the current rate of spread there. Either it's significantly fewer or immunity doesn't last very long.

 

[HSTEd]

I don't think I buy the claim that 50% of London has had it though, given the current rate of spread there. Either it's significantly fewer or immunity doesn't last very long.

If the no measures R of the new variant really is on the order of 4, 50% of people having it won't dramatically slow it down any more.

It is also true that case numbers in London appear to be bending their curve downwards unlike other areas.

 

[Nicholas Lewis]

It is also true that cases in London are rising more slowly than elsewhere.

That is true now but only after a very significant rise and remember London was placed in Tier 4 nearly three weeks so this ought to have had some impact. Kent areas all accelerated very rapidly but topped out at much lower rate than East side of London so there does appear to be self limiting rate to the new variant but its decay rate looks to have a much longer tail than wave one. Is that just a factor of respiratory virus always thriving in the Northern Hemisphere this time of the year.

The area climbing to the top of the highest case rate leader board now is Liverpool and other local boroughs who were rewarded with being kept in Tier 2 for being the govts test case for mass testing but that has clearly now failed spectacularly and Boris / Hancock have quietly dropped that strategy.

 

[takno]

The WHO has clarified the definition of Herd immunity (in Autumn 2020) as vaccinated only due to the far stronger average immune reaction to vaccination.

The WHO has arbitrarily changed their definition of herd immunity to suit their political agenda. I am not, in so far as I'm aware, obliged to follow suit.