Vaccine Progress, Approval, and Deployment

[Typhoon]

My uncle who is 84 had his appointment cancelled last week as they’d ran out of vaccines. He’s not in a care home so that suggests a wider issue. It obviously doesn’t disprove your theory though and one could be forgiven for thinking a little cynically at this stage....

I know a 90 year, a carer, who was sent a letter, phoned up, they had run out, don't know when they will get more. Next town, mass vaccination at a drive through, hundreds done on Saturday. High numbers towards the target but possibly leaving some of the more vulnerable behind to be picked up later. I suspect the policy is to contact too many or make too many appointments to ensure all the vaccines are used. Fine for the global policy, but worrying for those who have been unable to get the jab now.

My 100-year old father in law is cared for in a residential home not far away. They have managed to keep the virus out of the home despite a couple of positive tests amongst the staff. They have just had their second promised date for vaccination cancelled, reportedly because the local GP service has failed to get the promised delivery. The staff are really worried that the variant virus will get there first, after all their efforts.

While I am writing this, they have the Chair of the National Care Homes Association on the local news - she described the roll out as 'patchy' so I suspect that care home is not unique. Indeed 'patchy' appears to apply more general roll out, a 100 year old has not been invited to have the jab while much younger neighbours have had both jabs. They are registered with different surgeries. In another case, a woman tried to get an appointment and was offered one in Epsom, Stevenage or, I think, Wimbledon. She lives in north-west Kent. The MP for Tunbridge Wells was on, local GPs are not offering the jab, residents are offered an alternative - over 20 miles away, and not directly accessible by public transport. Just no consistency and that is in one county.

In 'More or Less' (Radio 4), they pointed out that the 15 million by mid-February promise by our Prime Minister has been revised by Nadhim Zahawi (the Vaccines Minister), it is 15 million vaccines will have been offered (and it was suggested that this might mean invitations shoved into letterbox at 23:00 on 14th Feb, I am sure that was in jest, no-one would do such a thing). Its just a numbers game, reach the target at all costs.

 

[Domh245]

it is 15 million vaccines will have been offered (and it was suggested that this might mean invitations shoved into letterbox at 23:00 on 14th Feb, I am sure that was in jest, no-one would do such a thing).

The reason behind using "offered" rather than "given" as the target is because inevitably some will refuse it, although it does give them the wriggle room for 'letterbox-shoving' if things really go wrong. Thankfully things do seem to be on track to get 15 million arms done by mid February.

 

[Bayum]

Could you provide some evidence to back up your assertion please?

What evidence specifically are you after?

 

[Xenophon PCDGS]

Is there any truth in what I was told by someone whilst waiting to be inoculated early this week about Pfizer cutting down on their Covid-19 vaccine shipments to certain Eastern European countries?

 

[Typhoon]

Is there any truth in what I was told by someone whilst waiting to be inoculated early this week about Pfizer cutting down on their Covid-19 vaccine shipments to certain Eastern European countries?

I thought I had heard something similar. I found:

Several EU countries are receiving significantly fewer doses of the Pfizer coronavirus vaccine than expected, after the US firm slowed shipments.

Six nations called the situation "unacceptable" and warned it "decreases the credibility of the vaccination process".

Sweden, Denmark, Finland, Lithuania, Latvia and Estonia urged the EU to apply pressure on Pfizer-BioNTech.

Pfizer said the reduced deliveries were a temporary issue.

In a statement on Friday, the drugmaker said shipments were being affected by changes to its manufacturing processes designed to boost production.

"Although this will temporarily impact shipments in late January to early February, it will provide a significant increase in doses available for patients in late February and March," Pfizer said.

https://www.bbc.co.uk/news/world-europe-55666399

 

[Yew]

What evidence specifically are you after?

That " Vaccination is the only viable way to reduce the severity of the disease and stopping the mass hospitalisation leading to the situation we see currently."

 

[DustyBin]

Absolutely not. When will people get it into their heads that this is not just about the vulnerable picking up the virus? That’s only part of the manoeuvre. The NHS is in dire straits right now and the virus is having a big impact on those under the age of 65 - the NHS has said that above a quarter of hospital admissions are those under 65. If we just continue to shield the vulnerable, as we have been, we will always end up in this situation. Vaccine is needed to reduce disease severity in all age groups so that the NHS can cope with future demand.

Here’s a (surprisingly) balanced article from the BBC, complete with statistics, which rather disproves your assertion:

Are Covid patients getting younger?

What does the data show about the age groups being affected by the virus in the second wave?

www.bbc.co.uk

Since the end of the second lockdown in England, the numbers of people being admitted to hospital with Covid have been rising quickly on a daily basis.
Some healthcare staff say they are seeing younger patients, so what does the data show?

Are different age groups being affected now?​

There are more people of all ages in hospital with Covid now than in the first wave last spring - that includes the young and old.
Infections have been highest in teenagers, students and people in their 20s and 30s in recent months. A small percentage of people from these age groups inevitably end up in hospital needing treatment.
But the overall pattern of those at risk of becoming seriously ill or dying has not changed significantly.
The older someone is, the greater their risk from Covid-19 - particularly over the age of 65.
For people under 40 who are infected, their risk of death is 0.1%. This rises to more than 5% for people over 80, according to Imperial College London research on the first wave.

 

[Bayum]

Here’s a (surprisingly) balanced article from the BBC, complete with statistics, which rather disproves your assertion:

Are Covid patients getting younger?

What does the data show about the age groups being affected by the virus in the second wave?

www.bbc.co.uk

Even though the graph clearly shows that a quarter of under 55’s make up the admissions?

A quarter of coronavirus admissions to hospital are people under the age of 55, the head of NHS England has said. (11th January)

The BBC article you’ve quoted used the 18-64 age bracket:
In the last few weeks, for example, adults aged 18-64 have accounted for 40% of daily Covid admissions to hospitals, data from Public Health England shows.

That " Vaccination is the only viable way to reduce the severity of the disease and stopping the mass hospitalisation leading to the situation we see currently."

The data from numerous COVID vaccine studies shows that disease severity is significantly reduced compared those who have not been vaccinated. I’m not finding specific studies because it’s fairly easy to check yourself with it being so current. We’ve had recent studies showing that previous infection gives you a 5 month ‘grace period’ from getting severe disease. Unfortunately, there have been numerous cases of people being hospitalised with severe disease the second time they have had the infection.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30783-0/fulltext

This second article explains the concern around the immune response causing SARS: https://www.sciencemag.org/news/202...-twice-suggesting-immunity-wanes-quickly-some

 

[DustyBin]

Even though the graph clearly shows that a quarter of under 55’s make up the admissions?

A quarter of coronavirus admissions to hospital are people under the age of 55, the head of NHS England has said. (11th January)

The BBC article you’ve quoted used the 18-64 age bracket:
In the last few weeks, for example, adults aged 18-64 have accounted for 40% of daily Covid admissions to hospitals, data from Public Health England shows.

I think you’ve missed the point (I may not have made it clear). The point is that proportionally there is little if any change, which contradicts the claim that the virus if affecting more young(er) people. My original argument was that if we take the over 75’s and other vulnerable groups out of the equation (via vaccination) the NHS will be able to cope, which would appear to be the case.

 

[Nicholas Lewis]

I think you’ve missed the point (I may not have made it clear). The point is that proportionally there is little if any change, which contradicts the claim that the virus if affecting more young(er) people. My original argument was that if we take the over 75’s and other vulnerable groups out of the equation (via vaccination) the NHS will be able to cope, which would appear to be the case.

Absolutely that was the whole rationale behind lockdown 3 is it buys time whilst we get to cohorts 1-4 over 70 year olds(health workers are included to protect them) vaccinated we potentially remove 88% of those suffering mortality The whole premise being once you have vaccinated this group you will significantly reduce hospitalisations and the NHS will have the capacity to manage the case rate associated with relaxed restrictions. However, yesterdays briefing looked like it was rolling back on that and BoJo wants to go further before he changes anything maybe he's now a fully paid convert to SAGE.

 

[brad465]

Absolutely that was the whole rationale behind lockdown 3 is it buys time whilst we get to cohorts 1-4 over 70 year olds(health workers are included to protect them) vaccinated we potentially remove 88% of those suffering mortality The whole premise being once you have vaccinated this group you will significantly reduce hospitalisations and the NHS will have the capacity to manage the case rate associated with relaxed restrictions. However, yesterdays briefing looked like it was rolling back on that and BoJo wants to go further before he changes anything maybe he's now a fully paid convert to SAGE.

How long Johnson will get away with that though remains to be seen, given there's a budget in early March to reveal the staggering cost of what we've done the last year, and Steve Baker now appears to be sowing the seeds for a leadership challenge.

 

[yorksrob]

I would hope that at the very least, "stay at home" would be ditched in mid February.

 

[The Ham]

That " Vaccination is the only viable way to reduce the severity of the disease and stopping the mass hospitalisation leading to the situation we see currently."

Before it's possible to answer that fully, what are we comparing it to (i.e. what other measures do you think that we could do to achieve the same result)?

Whilst there's possible options (such as lockdowns or seeing what happens if the NHS gets overwhelmed) I'm not sure that there's many which people would be overly keen on.

Absolutely that was the whole rationale behind lockdown 3 is it buys time whilst we get to cohorts 1-4 over 70 year olds(health workers are included to protect them) vaccinated we potentially remove 88% of those suffering mortality The whole premise being once you have vaccinated this group you will significantly reduce hospitalisations and the NHS will have the capacity to manage the case rate associated with relaxed restrictions. However, yesterdays briefing looked like it was rolling back on that and BoJo wants to go further before he changes anything maybe he's now a fully paid convert to SAGE.

You may not actually reduce hospital admissions all that much unless you are doing things to limit the overall number of cases.

As whilst the proportion of cases would go down, of the overall cases go up it might not be any better.

 

[HSTEd]

I would expect a deescalation to Tier 4 in late February, more for morale purposes than anything.

As whilst the proportion of cases would go down, of the overall cases go up it might not be any better.

If we had an infinite supply of people to be infected, this might be true.
But the virus is burning through people fast enough that it's going to run out of people to infect pretty quickly if it goes fast enough to overwhelm the NHS with Cohorts 1-4 vaccinated

 

[Solent&Wessex]

I would expect a deescalation to Tier 4 in late February, more for morale purposes than anything.

De-escalation?

Apart from schools re-opening what does that achieve? Tier 4 was lockdown in all but name anyway. Incidentally for all intents and purposes so was Tier 3, apart from a few more shops being allowed to open.

 

[HSTEd]

De-escalation?

Apart from schools re-opening what does that achieve? Tier 4 was lockdown in all but name anyway.

For morale purposes, it shows things going in the right direction.
A few weeks later as hospitalisation figures continue to fall we will deescalate to Tier 3 and Tier 2, stepwise by region.

 

[yorksrob]

Yes, tier 4 would be no good.

For morale purposes, it shows things going in the right direction.
A few weeks later as hospitalisation figures continue to fall we will deescalate to Tier 3 and Tier 2, stepwise by region.

Tier 4 is stay at home. It would be being fobbed off with no material change.

 

[Mag_seven]

Tier 4 (with a few minor adjustments) is actually what we are in now.

 

[chris11256]

Exactly, tier 4 is essentially lock down with a different name. Tier 3 is similar except retail and restaurants can be open. Rather than thinking about what can open and trying to adapt the tiers, in my mind we should be asking how soon after late March/April can we completely ditch social distancing.

From what has been seen on the vaccine roll out plan before the Scottish Government pulled it, it looks like a case of the Government deliberately under promising on the vaccine roll out with the reality being a lot better than they're saying publicly(in terms of vaccine roll out).

COVID-19: Every UK adult could be vaccinated by mid-July - if these figures are anything to go by | UK News | Sky News
It may seem hard to believe, but based on these figures, and the increasingly positive noises coming out of Westminster, the UK government vaccination programme is on track to under-promise and over-deliver.

 

[yorkie]

I think you’ve missed the point (I may not have made it clear). The point is that proportionally there is little if any change, which contradicts the claim that the virus if affecting more young(er) people. My original argument was that if we take the over 75’s and other vulnerable groups out of the equation (via vaccination) the NHS will be able to cope, which would appear to be the case.

You made an excellent point.

I would expect a deescalation to Tier 4 in late February, more for morale purposes than anything.

We are in T4 nationally now; I think you mean T3 (i.e. gyms etc an open but pubs etc can't) in which case I agree; I predict this from 22 February so that the lockdown can end "on time" while still imposing heavy restrictions.

 

[Crossover]

Well, I was somewhat haeartened to drive into one of our local towns today to find a bustle of activity at a Covid vaccination centre (almost opposite a near deserted testing station)

Tier 3 is similar except retail and restaurants can be open.

Retail, yes - restauants, no, as I recall (except takeaway)

 

[Solent&Wessex]

Exactly, tier 4 is essentially lock down with a different name. Tier 3 is similar except retail and restaurants can be open. Rather than thinking about what can open and trying to adapt the tiers, in my mind we should be asking how soon after late March/April can we completely ditch social distancing.

Well, I was somewhat haeartened to drive into one of our local towns today to find a bustle of activity at a Covid vaccination centre (almost opposite a near deserted testing station)


Retail, yes - restauants, no, as I recall (except takeaway)

Tier 3 was cafes pubs and restaurants closed except for takeaway.

Tier 2 they were allowed to open but could only serve alcohol as part of a meal and you were only allowed to visit with your own household.

To be of any use and for the sake of many people's sanity restrictions need to allow for household mixing, even if in a limited sense, both privately and in hospitality as soon as possible.

It's fine having shops open again but this ban on meeting other households, friends and family has gone on too long now, especially in parts of the North and East Midlands where it has been illegal to meet anyone you don't live with in an indoor setting for over 6 months in many cases, and sometimes for the best part of a year.

 

[DerekC]

Tier 3 was cafes pubs and restaurants closed except for takeaway.

Tier 2 they were allowed to open but could only serve alcohol as part of a meal and you were only allowed to visit with your own household.

To be of any use and for the sake of many people's sanity restrictions need to allow for household mixing, even if in a limited sense, both privately and in hospitality as soon as possible.

It's fine having shops open again but this ban on meeting other households, friends and family has gone on too long now, especially in parts of the North and East Midlands where it has been illegal to meet anyone you don't live with in an indoor setting for over 6 months in many cases, and sometimes for the best part of a year.

I think the problem is that household mixing is exactly where the most transmission takes place and is the most difficult to control. Social distancing is pretty meaningless when you get a family or close friends indoors. Our brains just aren't wired that way.

 

[hwl]

Absolutely not. When will people get it into their heads that this is not just about the vulnerable picking up the virus? That’s only part of the manoeuvre. The NHS is in dire straits right now and the virus is having a big impact on those under the age of 65 - the NHS has said that above a quarter of hospital admissions are those under 65. If we just continue to shield the vulnerable, as we have been, we will always end up in this situation. Vaccine is needed to reduce disease severity in all age groups so that the NHS can cope with future demand.

Agreed, It is worth looking at the latest update of the ICU stats from Friday (since ICU is the main crunch point for NHS functionality):

https://www.icnarc.org/DataServices/Attachments/Download/4cd9c693-6657-eb11-912d-00505601089b

Mean age of ICU admission: 60.0
Median age of ICU admission: 61
Just 25% of ICU admissions with covid are over 70 (which roughly correlates with the priority groups 1-4 that the government want to invite* for vaccination before mid Feb, *Note that government changed from actually vaccinate to invite recently as their target definition so look out for lots of vaccination invitation 100miles away at short notice that are declined the day before the deadline! Similar to the swap kits in the post to meet the target)
25% of ICU admissions with covid are under 52 only some of which will not be be in priority group 1-9

Only 10.1% of ICU admission with covid had significant other medical issues and only 22.4% with any prior medical issues.

While vaccination groups 1-4 might target groups where 85-90% of deaths occur it only covers a quarter on age as regards ICU admission hence ICU will be having problems for a while, hence ICU admissions will still be dominated by case rates rather than vaccination rates for quite a while.

Boris, Whitty and Vallance can all see this given their comments on Friday so why can't others? (unless they are blind to data they don't like?).

The 12 week mark post first vaccinations is 23rd Feb at which point the first vaccination rate will comparatively slow as the do second jabs as well (if they haven't already)

 

[6862]

Agreed, It is worth looking at the latest update of the ICU stats from Friday (since ICU is the main crunch point for NHS functionality):

https://www.icnarc.org/DataServices/Attachments/Download/4cd9c693-6657-eb11-912d-00505601089b

Mean age of ICU admission: 60.0
Median age of ICU admission: 61
Just 25% of ICU admissions with covid are over 70 (which roughly correlates with the priority groups 1-4 that the government want to invite* for vaccination before mid Feb, *Note that government changed from actually vaccinate to invite recently as their target definition so look out for lots of vaccination invitation 100miles away at short notice that are declined the day before the deadline! Similar to the swap kits in the post to meet the target)
25% of ICU admissions with covid are under 52 only some of which will not be be in priority group 1-9

Only 10.1% of ICU admission with covid had significant other medical issues and only 22.4% with any prior medical issues.

While vaccination groups 1-4 might target groups where 85-90% of deaths occur it only covers a quarter on age as regards ICU admission hence ICU will be having problems for a while, hence ICU admissions will still be dominated by case rates rather than vaccination rates for quite a while.

Boris, Whitty and Vallance can all see this given their comments on Friday so why can't others? (unless they are blind to data they don't like?).

The 12 week mark post first vaccinations is 23rd Feb at which point the first vaccination rate will comparatively slow as the do second jabs as well (if they haven't already)

You make some valid points, but I would argue that a 25% reduction in ICU admissions should make quite a difference, combined with the additional effect on transmission of increased immunity in the population. Of course it won't solve the problem entirely, but given that hospital ICUs are generally fairly full in an average winter, perhaps it will just transform February onwards into something like a normal flu season. However I'm sure they'll find some way to make the data look as bad as possible come mid February so they can avoid easing restrictions.

 

[yorkie]

Presumably being obese does not count as having a pre-existing condition?


Edit: Can I also ask that we try to keep reasonably on the topic of the vaccine? I know it's all linked; the vaccine is of course going to result in a reduction in people developing severe symptoms and in turn that will result in easing of restrictions but there is no point having this as a separate thread if we are duplicating discussion elsewhere.

 

[yorksrob]

Agreed, It is worth looking at the latest update of the ICU stats from Friday (since ICU is the main crunch point for NHS functionality):

https://www.icnarc.org/DataServices/Attachments/Download/4cd9c693-6657-eb11-912d-00505601089b

Mean age of ICU admission: 60.0
Median age of ICU admission: 61
Just 25% of ICU admissions with covid are over 70 (which roughly correlates with the priority groups 1-4 that the government want to invite* for vaccination before mid Feb, *Note that government changed from actually vaccinate to invite recently as their target definition so look out for lots of vaccination invitation 100miles away at short notice that are declined the day before the deadline! Similar to the swap kits in the post to meet the target)
25% of ICU admissions with covid are under 52 only some of which will not be be in priority group 1-9

Only 10.1% of ICU admission with covid had significant other medical issues and only 22.4% with any prior medical issues.

While vaccination groups 1-4 might target groups where 85-90% of deaths occur it only covers a quarter on age as regards ICU admission hence ICU will be having problems for a while, hence ICU admissions will still be dominated by case rates rather than vaccination rates for quite a while.

Boris, Whitty and Vallance can all see this given their comments on Friday so why can't others? (unless they are blind to data they don't like?).

The 12 week mark post first vaccinations is 23rd Feb at which point the first vaccination rate will comparatively slow as the do second jabs as well (if they haven't already)

I'm not staying in lockdown for months on end.

They need to be finding ways for people to get out once the vulnerable have been vaccinated. This could be similar to tier 3, but having everyone locked down for months on end isn't a plan.

 

[DustyBin]

Agreed, It is worth looking at the latest update of the ICU stats from Friday (since ICU is the main crunch point for NHS functionality):

https://www.icnarc.org/DataServices/Attachments/Download/4cd9c693-6657-eb11-912d-00505601089b

Mean age of ICU admission: 60.0
Median age of ICU admission: 61
Just 25% of ICU admissions with covid are over 70 (which roughly correlates with the priority groups 1-4 that the government want to invite* for vaccination before mid Feb, *Note that government changed from actually vaccinate to invite recently as their target definition so look out for lots of vaccination invitation 100miles away at short notice that are declined the day before the deadline! Similar to the swap kits in the post to meet the target)
25% of ICU admissions with covid are under 52 only some of which will not be be in priority group 1-9

Only 10.1% of ICU admission with covid had significant other medical issues and only 22.4% with any prior medical issues.

While vaccination groups 1-4 might target groups where 85-90% of deaths occur it only covers a quarter on age as regards ICU admission hence ICU will be having problems for a while, hence ICU admissions will still be dominated by case rates rather than vaccination rates for quite a while.

Boris, Whitty and Vallance can all see this given their comments on Friday so why can't others? (unless they are blind to data they don't like?).

The 12 week mark post first vaccinations is 23rd Feb at which point the first vaccination rate will comparatively slow as the do second jabs as well (if they haven't already)

Again, 25% is a lot in terms of ICU admissions, remove them and the NHS should be able to cope. However, ‘vulnerable’ shouldn’t (and isn’t) based purely on age. We know who the vulnerable people are in the younger age groups so they need to be prioritised as well.

It’s not clear what they define as prior medical issues (unless I’m missing something?). We know things like obesity increase the likelihood of becoming ill, I don’t know if this is counted as a medical issue though? (Edit: @yorkie beat me to it).

I’d also like to know if there has been a shift in policy regarding hospital admissions (and ICU admissions in particular). It looks as though the same age group continues to contribute disproportionately to the number of deaths, but they aren’t dying in hospital? Am I interpreting the data correctly?

Finally, and this is a genuine question, why has the mean and median age of admission increased by a year since September?

 

[Domh245]

You make some valid points, but I would argue that a 25% reduction in ICU admissions should make quite a difference, combined with the additional effect on transmission of increased immunity in the population. Of course it won't solve the problem entirely, but given that hospital ICUs are generally fairly full in an average winter, perhaps it will just transform February onwards into something like a normal flu season. However I'm sure they'll find some way to make the data look as bad as possible come mid February so they can avoid easing restrictions.

The 25% reduction will make a difference, but when ICUs are running at double their usual occupancy in places (L&SE particularly) it's still a major issue. Between lower case rates and increasing herd immunity effects (although vaccinating the elderly probably won't have much impact on that of itself I would have thought) there should be some cause for optimism, but I don't think we'll start rapidly dropping restrictions in mid February.

 

[hwl]

Presumably being obese does not count as having a pre-existing condition?

They take a look at obesity in detail separately:

From 1st September to till about a week ago

BMI group	Proportion of Covid patients admitted to ICU	Age− and sex−matched general population	Covid difference (delta)
<18.5	0.7%	0.7%	0.0%
18.5 - 25	20.0%	26.2%	-6.2%
25 - 30	31.8%	41.4%	-9.6%
30 - 40	36.3%	28.7%	+7.6%
>40	11.9%	2.9%	+8.0%

Less significant than the first wave and summer.