Vaccine Progress, Approval, and Deployment

[Bayum]

So what's the suggestion - that everyone over (say) 50 has to fill in a Government form to assess their quality of life - presumably with medical information plus all sorts of personal information about family support, happiness etc, it's all fed into a computer and out of it comes the vaccine priority list? And of course Serco would be given lots of money to run the system. I can just imagine the cockup that would be made of that - and the bad feeling created. At least age priority is simple to understand, hard to get wrong and makes sense to people.

Whenever I’ve done them (disabled and sufferer of juvenile arthritis) they’re usually completed in outpatient clinics, at least in my experience. They usually ask pretty simple questions - do you feel as if you are able to enjoy life as much s you used to? Can you do the things you would like to do? On a scale of x to y, where would you place your health right now types of questions. I’d imagine there might be some form of data collection to see which age groups have the best QALY and which groups do not.

 

[Dent]

We were talking about the WHOs (new) definition of herd immunity on the other thread which is now locked, and also why some people may be reluctant to have the vaccine. It’s better discussed in this thread anyway I think. I’ve just seen this in our favourite newspaper which is interesting:

Previous coronavirus infection reduces reinfection risk by 83%

Data from Public Health England (PHE) comes from more than 20,000 healthcare workers at more than 100 sites across Britain to see how likely reinfection was.

www.dailymail.co.uk

How is the existence of the immune system "news"? This has been known about for centuries.

 

[Bantamzen]

How is the existence of the immune system "news"? This has been known about for centuries.

Indeed. I wonder when the world will also relearn that immunity is not just down to antibodies, and that even when they have stopped being produced after an infection that there are still cells that can restart production if a re-infection is detected? Although thinking about it perhaps the last part is best kept out of the news, the news that people can be re-infected will give lockivists ammunition and make them believe this equals being ill and spreading the virus automatically.

 

[Philip]

Indeed. I wonder when the world will also relearn that immunity is not just down to antibodies, and that even when they have stopped being produced after an infection that there are still cells that can restart production if a re-infection is detected? Although thinking about it perhaps the last part is best kept out of the news, the news that people can be re-infected will give lockivists ammunition and make them believe this equals being ill and spreading the virus automatically.

What makes you think people actually want lockdown to continue longer than necessary? It is negatively impacting on the vast majority of people in one way or another.

 

[Yew]

So what's the suggestion - that everyone over (say) 50 has to fill in a Government form to assess their quality of life - presumably with medical information plus all sorts of personal information about family support, happiness etc, it's all fed into a computer and out of it comes the vaccine priority list? And of course Serco would be given lots of money to run the system. I can just imagine the cockup that would be made of that - and the bad feeling created. At least age priority is simple to understand, hard to get wrong and makes sense to people.

More on a demographic basis, How many qualys would we save by vaccinating 100 60 year olds, vs vaccinating 100 90 year olds. I'm sure you can see that vaccinating someone with months left to live may not be the wisest course, if there is an option to vaccinate someone else in a demographic that, on average could save many years.

They're quite easily calculated just by using estimates for age and expected life, you don't even need to bring quality into it particularly (although I remain of the view that being put in a care home should constitute a negative QALY score).

I wouldn't quite go negative, and we must remember that many people can live relatively well in care homes, and just need a little extra help to keep them relatively independent; but it does feel like there are some people that we're keeping alive for the sake, and have a lot go pain and very little dignity in their life.

How is the existence of the immune system "news"? This has been known about for centuries.

Remember, that we need conclusive evidence for everything, apart from masks and lockdowns.

 

[Bantamzen]

What makes you think people actually want lockdown to continue longer than necessary? It is negatively impacting on the vast majority of people in one way or another.

What makes me think it? Oh I don't know, social media, people commenting on news stories, SAGE saying they want longer, harder lockdowns....

 

[hwl]

Great. Just watch the legions begin to argue that we should just let infection run rife through communities or pass the jab because they’ve had COVID already...

There were some arguing that reinfection didn't really occur. 1 in 6 being vulnerable to re-infection at <= 5 months busts that myth...

The 83% is again a blended number, the reality was:
" A previous infection, provides 94% protection against symptomatic reinfection, and 75% protection against asymptomatic reinfection."

 

[Bantamzen]

There were some arguing that reinfection didn't really occur. 1 in 6 being vulnerable re-infection at <= 5 months busts that myth...

Re-infection doesn't mean no immunity. The body won't produce antibodies forever when they are not currently needed, but cells become infected again the immune system will likely have genetic memory to restart production as well as tackle infected cells.

 

[roversfan2001]

What makes you think people actually want lockdown to continue longer than necessary? It is negatively impacting on the vast majority of people in one way or another.

There are a decent number of people who are quite enjoying being paid 80% of their wage to sit at home and watch TV. They're in for quite a shock when furlough ends and they're jobless. I'm sure their opinion on lockdowns will change then.

 

[chris11256]

There are a decent number of people who are quite enjoying being paid 80% of their wage to sit at home and watch TV. They're in for quite a shock when furlough ends and they're jobless. I'm sure their opinion on lockdowns will change then.

Exactly, I know several people in this position. They're thrilled that they're being paid to sit at home doing nothing and want this to continue for as long as possible regardless of vaccine rollout.

 

[takno]

There were some arguing that reinfection didn't really occur. 1 in 6 being vulnerable re-infection at <= 5 months busts that myth...

PCR tests are a real game-changer when it comes to detecting reinfection. They are so sensitive they can detect a completely harmless reinfection in the hours it takes for the immune system to wake up and deal with it. And when certain groups of people take such a lot of them it becomes wonderfully inevitable.

The trouble is that we are taking data from PCR tests and comparing them to diseases from the past where we only had less sensitive tests or just diagnosis based on symptoms. If we did regular mass PCR tests for other diseases that people have vaccine or exposure-based resistance to like chicken pox or measles, what would the figures look like for them?

 

[Horizon22]

I noticed that the rail minister explicitly mentioned using the railways to travel to vaccination centres:

UK rail services to be reduced to 72% of pre-pandemic levels

Timetable cuts to be announced Thursday are less than 50% reduction in services that was expected

www.theguardian.com

Rail minister Chris Heaton-Harris said: “It is critical that our railways continue to deliver reliable services for key workers and people who cannot reasonably work from home, and that they respond quickly to changes in demand.

“The new reduced timetable delivers that, as well as reducing the financial burden on the taxpayer. Levels of services will vary by operator and changes will come into effect steadily over the next few weeks. Passengers who are using the railways, including those who need to travel to vaccination centres, should check their route before they travel, and aim to do so outside of peak times wherever possible

 

[NorthOxonian]

More on a demographic basis, How many qualys would we save by vaccinating 100 60 year olds, vs vaccinating 100 90 year olds. I'm sure you can see that vaccinating someone with months left to live may not be the wisest course, if there is an option to vaccinate someone else in a demographic that, on average could save many years

The problem is that 90 year olds are much more likely to die if they do get the virus. Therefore even though the vaccine wouldn't give them as many years, the vaccine is much more likely to save their life.

To use some (very approximate figures):

A 90 year old has about a 10% chance of dying if they get the virus, and would be expected to live for 5 more years on average. A 60 year old has a 0.5% chance of dying but would probably live for more like 25 years.

Therefore giving the vaccine to a typical 90 year old would be expected to save 6 months of life (10% of 5), whereas giving the vaccine to a typical 60 year would would save something like 1.5 months of life (0.5% of 25).

Those figures are all approximate but I don't think any of them are off by very much. Any errors certainly wouldn't be enough to make vaccinating an average 60 year old save more years of life than an average 90 year old.

 

[Yew]

The problem is that 90 year olds are much more likely to die if they do get the virus. Therefore even though the vaccine wouldn't give them as many years, the vaccine is much more likely to save their life.

To use some (very approximate figures):

A 90 year old has about a 10% chance of dying if they get the virus, and would be expected to live for 5 more years on average. A 60 year old has a 0.5% chance of dying but would probably live for more like 25 years.

Therefore giving the vaccine to a typical 90 year old would be expected to save 6 months of life (10% of 5), whereas giving the vaccine to a typical 60 year would would save something like 1.5 months of life (0.5% of 25).

Those figures are all approximate but I don't think any of them are off by very much. Any errors certainly wouldn't be enough to make vaccinating an average 60 year old save more years of life than an average 90 year old.

Indeed, but if we account for quality adjustment, and any differences in the actual numbers (is a 90 yo really expected to live to 95, and a 60 yo expected to live until 85?), and I think it could be a lot closer, or potentially suggest a different order of vaccination.

 

[NorthOxonian]

Indeed, but if we account for quality adjustment, and any differences in the actual numbers (is a 90 yo really expected to live to 95, and a 60 yo expected to live until 85?), and I think it could be a lot closer, or potentially suggest a different order of vaccination.

Those figures were just guesses - I've had a look at the life tables and a 90 year old would be expected to live 4.1 or 4.7 years (depending on whether they're a man or a woman), and a 60 year old would be expected to live 22.8 or 25.4 years. Using the real figures has little effect on the calculation.

You're possibly right about quality and that's harder to quantify, but the gap in terms of actual years is so large that I wouldn't expect it to be completely cancelled out.

 

[hwl]

How is the existence of the immune system "news"? This has been known about for centuries.

A fair number seemed to believe that re-infection was very very unlikely because the immune systems was so good. This shows that isn't the case.

Past Covid-19 infection may provide 'months of immunity'

But researchers warn there is still a risk of catching and passing the virus on to others again.

www.bbc.co.uk

Prof Susan Hopkins, who led the study, said the results were encouraging, suggesting immunity lasted longer than some people feared, but protection was by no means absolute.
It was particularly concerning some of those reinfected had high levels of the virus - even without symptoms - and were at risk of passing it on to others, she said.
"This means even if you believe you already had the disease and are protected, you can be reassured it is highly unlikely you will develop severe infections but there is still a risk that you could acquire an infection and transmit to others," she added.

It will be interesting to see what the numbers look like over longer time periods especially vs vaccines.

 

[Bantamzen]

A fair number seemed to believe that re-infection was very very unlikely because the immune systems was so good. This shows that isn't the case.

Past Covid-19 infection may provide 'months of immunity'

But researchers warn there is still a risk of catching and passing the virus on to others again.

www.bbc.co.uk

It will be interesting to see what the numbers look like over longer time periods especially vs vaccines.

"By no means absolute"? Whoever said anything was absolute? I'm seriously getting sick of this desire to go to zero risk living coming out of some quarters of the scientific community. Any degree of post-infection and/or post-vaccine immunity reduces the risk of people re-infected passing it on, and for those that do the risk of being people being hospitalised is also reduced among the most vulnerable with application of the vaccine. For the rest the risk is mainly around feeling grotty for a few days, maybe a couple of weeks.

If Prof Hopkins wants zero risk, she may as well advocate sealing us into our homes.

 

[hwl]

"By no means absolute"? Whoever said anything was absolute? I'm seriously getting sick of this desire to go to zero risk living coming out of some quarters of the scientific community. Any degree of post-infection and/or post-vaccine immunity reduces the risk of people re-infected passing it on, and for those that do the risk of being people being hospitalised is also reduced among the most vulnerable with application of the vaccine. For the rest the risk is mainly around feeling grotty for a few days, maybe a couple of weeks.

If Prof Hopkins wants zero risk, she may as well advocate sealing us into our homes.

Plenty of people were assuming it was absolute (or very close to) and trying to deny the possibility of reinfection. If you look at her comments and the full press release - I don't think she is worried about zero risk, just people believing and behaving like they they are zero risk when they aren't especially when so few have had it or been vaccinated.

 

[Bantamzen]

Plenty of people were assuming it was absolute (or very close to) and trying to deny the possibility of reinfection. If you look at her comments and the full press release - I don't think she is worried about zero risk, just people believing and behaving like they they are zero risk when they aren't especially when so few have had it or been vaccinated.

Same difference surely? She's worried about people trying to live their lives normally, so she tries to scare people into following a zero-risk model. I hope she never finds herself in a position where she needs to leave the comfort of her Zoom meetings.

 

[Yew]

It will be interesting to see what the numbers look like over longer time periods especially vs vaccines.

Probably lower in the long run, but if it's good enough to get us back to normal more quickly, and we can worry about it later in the year; I'll take it.

 

[HSTEd]

It will be interesting to see what the numbers look like over longer time periods especially vs vaccines.

In this situation a year of immunity is pretty much as good as infinite immunity.
By the time the immunity wears off this will be over.

 

[takno]

Plenty of people were assuming it was absolute (or very close to) and trying to deny the possibility of reinfection. If you look at her comments and the full press release - I don't think she is worried about zero risk, just people believing and behaving like they they are zero risk when they aren't especially when so few have had it or been vaccinated.

I don't think many people were. It's always been clear that protection against coronaviruses isn't usually particularly long term - what is required for a Swedish-style strategy is a level of immunity which will greatly slow the rate of infection, and hopefully make subsequent recurrences less severe (and ideally a king who can keep his nose out of government). This study demonstrates that the average length of protection from being able to get a detectable and transmissible dose is likely to be significantly over 6 months, and that there appears to be lasting immunity which has so far prevented recurrences from being serious, which is what people were hoping for.

Taking sides and misrepresenting other peoples' positions isn't useful.

 

[brad465]

This report has come out showing the variation in vaccination rates across the country. However I think the way it's been reported (as if it's a race/competition) is extremely divisive which we've had far too much off on a whole host of issues over the years:

Covid-19: North-east England leads race to vaccinate over-80s

More than 45% of this priority group has now been vaccinated, compared with about 30% in London.

www.bbc.co.uk

Nearly 46% of over-80s in England's North East and Yorkshire region have been given their first dose of a Covid vaccine - more than any other area, official figures show.
This compares with about 30% of over-80s in both London and the East of England who have received a first jab.
London Mayor Sadiq Khan claims the capital is not getting its fair share of vaccine doses.
In total, more than 2.2 million people in England have had one vaccine dose.
About 400,000 second doses have also been given, despite guidance from the UK's chief medical officers and vaccine advisers, the JCVI, that giving a first dose to as many people as possible was a public health priority.

The NHS England figures cover Covid-19 vaccinations given to people at hospital hubs and GP practices between 8 December 2020 and 10 January 2021.
Among the over-80s alone, most first doses - 204,140 - were administered in north-east England and Yorkshire, while the lowest number (92,398) were given to this age group in London.
Overall, more than one-third of people aged 80 and over in England have received at least one dose.

 

[Ediswan]

This report has come out showing the variation in vaccination rates across the country. However I think the way it's been reported (as if it's a race/competition) is extremely divisive which we've had far too much off on a whole host of issues over the years:

Covid-19: North-east England leads race to vaccinate over-80s

More than 45% of this priority group has now been vaccinated, compared with about 30% in London.

www.bbc.co.uk

Blame the House of Commons Liason Committee. One of them asked Boris for regional figures, 'in the interest of transparency'.

 

[Darandio]

And so it starts, a firm planning to rewrite all staff contracts to make them get the vaccine. He does claim the employees are approving of the policy but also states no new employees will be hired unless they have had it. Now i'm not a lawyer but that sounds on dodgy legal ground to me.

Pimlico Plumbers to make workers get vaccinations

Founder Charlie Mullins says it is a "no-brainer" that workers should get immunised.

www.bbc.co.uk

A large London plumbing firm plans to rewrite all of its workers' contracts to require them to be vaccinated against coronavirus.
Pimlico Plumbers chairman Charlie Mullins said it was "a no-brainer" that workers should get the jab.
If they do not want to comply with the policy, it will be decided on a case-by-case basis whether they are kept on, he said.
Employment lawyers said the plan carried risks for the business.
The NHS is seeking to vaccinate 15 million people from priority groups by mid-February as part of efforts to try to control the spread of Covid-19.
But Mr Mullins said he was prepared to pay for private immunisations for people at the firm, which would be done on the company's time.
Doctors have warned that key hospital services in England are in crisis, with reports of hospitals cancelling urgent operations after a surge in Covid patients in recent weeks.

Pimlico Plumbers plans to change its contracts for new joiners to require immunisation. It will rewrite its contracts with existing workers and employees as soon as is practical, depending on vaccine availability.
The firm has about 350 plumbers working as contractors and about 120 employees.
Mr Mullins said the firm was "not putting anyone under any pressure" to have the jab.
However, new starters who were not immunised would not be taken on, he said.
Mr Mullins said employees approved of the policy.
"It's a no-brainer," he said. "I've talked to people who have said: 'I will queue up all night to get the vaccine.'
"I think it will be the norm in five or six months. To go into a bar or cinema, or go on a plane, you have to have a vaccine," he added.
Mr Mullins said he had set aside £800,000 to pay for private vaccinations, but was expecting costs in the region of £100,000.
"Whatever it costs, I will pay," he said. "I would pay £1m tomorrow to safeguard our staff.
"If people don't want the vaccine, let them sit at home and not have a normal life," he added.

 

[DerekC]

More on a demographic basis, How many qualys would we save by vaccinating 100 60 year olds, vs vaccinating 100 90 year olds. I'm sure you can see that vaccinating someone with months left to live may not be the wisest course, if there is an option to vaccinate someone else in a demographic that, on average could save many years.

I wouldn't quite go negative, and we must remember that many people can live relatively well in care homes, and just need a little extra help to keep them relatively independent; but it does feel like there are some people that we're keeping alive for the sake, and have a lot go pain and very little dignity in their life.


Remember, that we need conclusive evidence for everything, apart from masks and lockdowns.

Indeed, but if we account for quality adjustment, and any differences in the actual numbers (is a 90 yo really expected to live to 95, and a 60 yo expected to live until 85?), and I think it could be a lot closer, or potentially suggest a different order of vaccination.

Those figures were just guesses - I've had a look at the life tables and a 90 year old would be expected to live 4.1 or 4.7 years (depending on whether they're a man or a woman), and a 60 year old would be expected to live 22.8 or 25.4 years. Using the real figures has little effect on the calculation.

You're possibly right about quality and that's harder to quantify, but the gap in terms of actual years is so large that I wouldn't expect it to be completely cancelled out.

This strikes me as a delightfully academic argument which ignores the question of how you assess 15 million people in a couple of weeks.

 

[Domh245]

"Mr Mullins said the firm was "not putting anyone under any pressure" to have the jab."
..
"If they do not want to comply with the policy, it will be decided on a case-by-case basis whether they are kept on, he said."

It'd be funny if it wasn't so depressingly predictable (or threat to our freedoms)

This strikes me as a delightfully academic argument which ignores the question of how you assess 15 million people in a couple of weeks.

You don't have to assess individuals, just work on population averages. It is also a rather academic point as the government has set out it's plan and won't change it now (and as per the maths done upthread, a QALY approach would have kicked out more or less the same answer)

 

[takno]

And so it starts, a firm planning to rewrite all staff contracts to make them get the vaccine. He does claim the employees are approving of the policy but also states no new employees will be hired unless they have had it. Now i'm not a lawyer but that sounds on dodgy legal ground to me.

Pimlico Plumbers to make workers get vaccinations

Founder Charlie Mullins says it is a "no-brainer" that workers should get immunised.

www.bbc.co.uk

The BBC do love to him and his firm a lot of free publicity. I wouldn't particularly take any notice of what he's got to say on anything - it'll probably never come to anything

 

[philosopher]

The BBC do love to him and his firm a lot of free publicity. I wouldn't particularly take any notice of what he's got to say on anything - it'll probably never come to anything

If an employee or potential employee can’t get vaccinated because of an allergy or a needle phobia would that not be disability discrimation?

 

[brad465]

The BBC do love to him and his firm a lot of free publicity. I wouldn't particularly take any notice of what he's got to say on anything - it'll probably never come to anything

Presumably it could also be very easily challenged in courts