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Vaccine Progress, Approval, and Deployment

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Richard Scott

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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.
What's the scientific proof for this? Why is someone's natural immunity having had the virus any less likely to prevent reinfection? Sounds like changing it just for their own narrative, not for a scientific reason. This virus has caused some very bad science to occur. Some of these so called experts should be ashamed.
 
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DustyBin

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

That would stop people saying they only want the Oxford vaccine!

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.

This is quite clearly the case. If you look at the ‘before and after’ definitions it’s obvious.
 

hwl

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What's the scientific proof for this? Why is someone's natural immunity having had the virus any less likely to prevent reinfection? Sounds like changing it just for their own narrative, not for a scientific reason. This virus has caused some very bad science to occur. Some of these so called experts should be ashamed.
Plenty of science - The nature and quality of immunity acquired from infection and vaccination are very different with the vaccinated response being stronger and longer lasting but quite how much the difference is varies by virus/bacteria and the vaccine. See plenty of work from 1920s onwards e.g. TB and BCG vaccine.

This has been well known for a long long while to immunologists, but there has been a recent problem with lots of non-immunologists not understanding the difference hence the urgent need to clarify.

The difference in immune response between the two will affect things like ability to reduce transmission or infection rates if vaccinated -vs- re-infection rates with infection acquire immunity.

(This may also answer certain questions about sustained high case rates in London etc. but we will need to wait a while for more data first)

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.
Their previous definition was very poor / sloppy and while a bit better the new one should in my view have gone further and highlight the differences between naturally acquired and vaccinated immunity with differences in effectiveness at reducing transmission (and more) for most viruses/bacteria between the two hence different effects on R values etc.
 
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Richard Scott

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Plenty of science - The nature and quality of immunity acquired from infection and vaccination are very different with the vaccinated response being stronger and longer lasting but quite how much the difference is varies by virus/bacteria and the vaccine. See plenty of work from 1920s onwards e.g. TB and BCG vaccine.

This has been well known for a long long while to immunologists, but there has been a recent problem with lots of non-immunologists not understanding the difference hence the urgent need to clarify.

The difference in immune response between the two will affect things like ability to reduce transmission or infection rates if vaccinated -vs- re-infection rates with infection acquire immunity.

(This may also answer certain questions about sustained high case rates in London etc. but we will need to wait a while for more data first)


Their previous definition was very poor / sloppy and while a bit better the new one should in my view have gone further and highlight the differences between naturally acquired and vaccinated immunity with differences in effectiveness at reducing transmission (and more) for most viruses/bacteria between the two hence different effects on R values etc.
Thank you for that, very helpful.
 

hwl

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Thank you for that, very helpful.
Given the rest of that part of the website is targeted at those with low end GCSE level biology or equivalent, I suspect they dumbed the definition down to that level which has come back to hurt them badly.
(I'm often involved producing various tiers of simplified advice or learnings for different audiences hence I tend to notice levels of simplification more than most in such circumstances)
 

takno

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Plenty of science - The nature and quality of immunity acquired from infection and vaccination are very different with the vaccinated response being stronger and longer lasting but quite how much the difference is varies by virus/bacteria and the vaccine. See plenty of work from 1920s onwards e.g. TB and BCG vaccine.

This has been well known for a long long while to immunologists, but there has been a recent problem with lots of non-immunologists not understanding the difference hence the urgent need to clarify.

The difference in immune response between the two will affect things like ability to reduce transmission or infection rates if vaccinated -vs- re-infection rates with infection acquire immunity.

(This may also answer certain questions about sustained high case rates in London etc. but we will need to wait a while for more data first)


Their previous definition was very poor / sloppy and while a bit better the new one should in my view have gone further and highlight the differences between naturally acquired and vaccinated immunity with differences in effectiveness at reducing transmission (and more) for most viruses/bacteria between the two hence different effects on R values etc.
I don't think people were widely failing to understand that there are different levels of immunity, or that vaccinations are (hopefully) at the much better end of the immunity spectrum. Changing the definition to a definitive assertion that no meaningful population-level protection can be gained from catching the disease at all is simply unhelpful, and curiously in line with a clearly political agenda that certain portions of the WHO leadership seem desperate to promote.

If you believe that the page has just been simplified for the benefit of people with relevant knowledge or experience, then quoting it at me in relation to the original point I was making is disingenuous at best.
 

duncanp

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Story in the Telegraph this morning saying that, according to Nicola Sturgeon "Healthy Competition Between Scotland and England Can Speed Up Vaccine Roll Out"

Does this woman never give up on playing politics with COVID-19, and using it to further the only cause which means anything to her?

No doubt if Scotland is progressing better than England in its' vaccination program, it is all credit to the SNP government, and is Scotland is faring worse than England it is all nasty old Westminster's fault.


Nicola Sturgeon has said "healthy competition" between Scotland and England could speed up the Covid vaccine roll-out as she warned lockdown is "very unlikely" to end this month.

The First Minister said the two countries striving to be the first to vaccinate their adult population may not be a "bad thing as it makes us all run faster."

She insisted that Scotland was not already falling behind despite official figures showing England has vaccinated a higher proportion of its population, and seven mass vaccination centres opening this week south of the Border.

But her denial came as an email to GPs in the Edinburgh area warned similar centres may not open in Scotland until Feb 15 thanks to a possible delay in the creation of a national booking system.

Family doctors were warned to expect a "couple more weeks of frustration" as supplies of the Pfizer and Oxford vaccines were not expected to become reliable until Jan 25.

The SNP government said the email, sent on Jan 8 by the Edinburgh Health and Social Care Partnership, included "inaccuracies" and insisted a national scheduling system would be ready this month.

But it also emerged that the SNP government is yet to ask for support from the British Armed Forces' Vaccine Quick Reaction Force, which is already helping to prepare seven NHS England regions for "surge support" to the roll-out.


Ms Sturgeon said 330,000 doses had been delivered to Scotland so far, but the UK Government insisted the true figure was 560,000 - a total she appeared to agree with the previous day.

The Scottish Government said a further 170,975 doses were "available but not yet delivered." However, officials did not explain what this meant, or whether they were in Scotland.

The Scottish Tories said the SNP government was on course to fall short of its target to vaccinate 560,000 by the end of this month by around 130,000 unless the roll-out accelerates.

A further 12,565 Scots have received their first dose, it was announced yesterday, taking the total to 175,942. In England the total rose by 140,441 to nearly 2.5 million.

The row broke out as Ms Sturgeon warned that the wholesale lifting of lockdown at the end of the month was "very unlikely" and no restrictions at all may be eased.

The First Minister is expected to unveil proposals on Wednesday to shut down more sectors of the economy in the hope of stemming the new, more transmissible Covid strain. Construction, manufacturing, takeaway food and 'click and collect' retail services could all be axed or curtailed.

Jeane Freeman, her Health Secretary, will also publish the Scottish Government's latest vaccination plan. However, a series of her previous targets and deadlines have already been radically scaled back.

She had hoped to vaccinate a million Scots by the end of this month but this has been scaled by to 560,000, including the over-80s. The over-70s are to be given their first dose by mid-February.

However, Ms Sturgeon denied that the UK Government publishing a 47-page vaccine delivery plan, opening mass vaccination centres and allowing GPs to prioritise vaccinations over routine care meant England was better prepared than Scotland.

Speaking at her daily Covid briefing, she said "the nature of our geography" and the different structure of the Scottish NHS meant there would be less emphasis on large, centralised vaccination centres.

Ms Sturgeon said some, including the media, viewed the roll-out as a "competition" between the home nations.

"And maybe a bit of healthy competition around this is not a bad thing as it makes us all run faster," she continued.

"But no government wants anything other right now than to go as fast as it possibly can."

She said there was an "apparent difference" in the early days, with England slightly ahead, because Scotland focused more on vaccinating care home residents and this took longer than community-based vaccination.

A UK Government source said: "It's absolutely not a competition and, as the First Minister herself explained, there are differences in geography and demography that render comparisons meaningless.

"The important thing is the UK Government delivers as much of the vaccine as possible and the Scottish Government has an operation in place that is capable of delivering that vaccine when it arrives."

The email to Edinburgh's GPs said mass and local clinics were due to start on Feb 1 "but there may be delay in the delivery of the national booking system, which might knock this back to Feb 15."

It also confirmed that the Edinburgh International Conference Centre (EICC) will be the main venue in the capital for mass vaccinations, with a deal also being worked on to use the Royal Highland Centre and Queen Margaret University in Musselburgh.

Jamie Stone, the Liberal Democrat MP for Caithness, Sutherland and Easter Ross, yesterday pressed Ben Wallace in the Commons to remind the SNP government that the Vaccine Quick Reaction Force was available to help.

The Defence Secretary replied: "At the moment, we haven't received a request for the use of some of these quick reaction vaccine teams but they are for the taking if they are asked for. I am very happy to support and sign off any request like that."

A Scottish Government spokesman said: "The vaccination programme is functioning well across Scotland – and it is entirely incorrect to claim otherwise. The Army is already supporting planning activity at a national and local level across Scotland, and we will continue to look at how the Armed Forces can help the rollout of vaccines.

"The Health Secretary recently approved additional support from the army for rolling out the vaccine. The national scheduling system, built on NSS Service Now, will be ready this month and we anticipate no delay to appointments during the roll-out."
 

Bantamzen

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Story in the Telegraph this morning saying that, according to Nicola Sturgeon "Healthy Competition Between Scotland and England Can Speed Up Vaccine Roll Out"

Does this woman never give up on playing politics with COVID-19, and using it to further the only cause which means anything to her?

No doubt if Scotland is progressing better than England in its' vaccination program, it is all credit to the SNP government, and is Scotland is faring worse than England it is all nasty old Westminster's fault.

I think this says it all. covid has been politically weaponised. No wonder no-one wants to think about relaxing any restrictions, the game is afoot.
 

kez19

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I think this says it all. covid has been politically weaponised. No wonder no-one wants to think about relaxing any restrictions, the game is afoot.


I never realised vaccinating people was a competition during this whole saga I thought she was slagging England off for everything else and that Scotland was good no matter, sure it was my imagination!
 

Bantamzen

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I never realised vaccinating people was a competition during this whole saga I thought she was slagging England off for everything else and that Scotland was good no matter, sure it was my imagination!
It absolutely shouldn't be, but like the war of restriction attrition it has become this. We are no longer following the science, we are feeding political egos. And history reminds us why this never ends well.
 

Philip

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Does anyone think vaccinating the extremely vulnerable of all age groups should be much higher up the list than is currently? I believe the over 80s and over 70s are currently above them in priority and I'm not sure I agree with it.
 

Bantamzen

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Does anyone think vaccinating the extremely vulnerable of all age groups should be much higher up the list than is currently? I believe the over 80s and over 70s are currently above them in priority and I'm not sure I agree with it.
No, the data shows that the risk of hospitalisation or even death is much greater in the most elderly than those further down. Vaccinating those most at risk first makes the most sense whilst more stocks of the vaccine become available.
 

duncanp

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Does anyone think vaccinating the extremely vulnerable of all age groups should be much higher up the list than is currently? I believe the over 80s and over 70s are currently above them in priority and I'm not sure I agree with it.

There seems to be a lot of people saying that this group or that group should be higher up the vaccine priority list.

Examples I have seen over the past few says are the police, customs officials at ports, teachers and young people with learning disabilities.

I don't doubt for one minute that each of these groups has a good case for getting vaccinated as soon as possible.

But the point is that if one group is moved higher up the vaccine priority list, then that means that someone else, who maybe would benefit just as much from a vaccine, has to move lower down the priority list and wait longer.

I think that vaccinating those who account for most hospitalisations and deaths first is the best strategy, as it most likely to reduce the burden on the NHS sooner rather than later. This in turn will lead to an earlier lifting of restrictions, which is something that we all want. (Apart from SAGE, Karen from Facebook and the Mumsnet brigade, that is)
 

kez19

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It absolutely shouldn't be, but like the war of restriction attrition it has become this. We are no longer following the science, we are feeding political egos. And history reminds us why this never ends well.

They all come down with a bang, get the popcorn ready!
 

Domh245

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No, the data shows that the risk of hospitalisation or even death is much greater in the most elderly than those further down. Vaccinating those most at risk first makes the most sense whilst more stocks of the vaccine become available.

If we are aiming to reduce pressure on the healthcare system than dodging deaths, then there is an argument for targeting the vaccine more at the younger age range of the phase 1 groups than the most elderly to start with, as it's the younger elderly who tend to be 'clogging' up the healthcare system (ICUs in particular). That isn't to say we should have started with 70 year olds and worked our way down, but simply working from oldest to youngest (and doing the 18-65 CEV with the 70 year olds) won't have necessarily been the best way to reduce the pressure on the healthcare system.
 

Mag_seven

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Does anyone think vaccinating the extremely vulnerable of all age groups should be much higher up the list than is currently? I believe the over 80s and over 70s are currently above them in priority and I'm not sure I agree with it.

No - the priority list has been decided by the The Joint Committee on Vaccination and Immunisation (JCVI). They know what they are talking about and we should stick to what they have decreed as the priority order. We cannot start chopping and changing again like we have done with so many other things during this pandemic.
 

Yew

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No, the data shows that the risk of hospitalisation or even death is much greater in the most elderly than those further down. Vaccinating those most at risk first makes the most sense whilst more stocks of the vaccine become available.
I would be interested to see what order things came out in if we prioritised by number of QALY's saved overall, rather than deaths, and if it would be any different.
 

ainsworth74

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I would be interested to see what order things came out in if we prioritised by number of QALY's saved overall, rather than deaths, and if it would be any different.

Apologies but what is a "QALY"?
 

Bertie the bus

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I would be interested to see what order things came out in if we prioritised by number of QALY's saved overall, rather than deaths, and if it would be any different.
You seem to be suggesting the order of vaccination should driven by individual circumstances. How would that aid a mass vaccination programme if we analysed each individual’s specific need? It would also create moral and ethical issues. Say for example, the risk of death of a 70 year old (who are in group 4) is the same as that as somebody who is morbidly obese (who are in group 6), why is the life of somebody who can do nothing about their condition – age – less important than somebody who can and has ignored decades of medical advice and takes no responsibility for their own health?
 

Yew

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Apologies but what is a "QALY"?
Quality Adjusted Life-Year

You seem to be suggesting the order of vaccination should driven by individual circumstances. How would that aid a mass vaccination programme if we analysed each individual’s specific need? It would also create moral and ethical issues. Say for example, the risk of death of a 70 year old (who are in group 4) is the same as that as somebody who is morbidly obese (who are in group 6), why is the life of somebody who can do nothing about their condition – age – less important than somebody who can and has ignored decades of medical advice and takes no responsibility for their own health?
I was thinking more on a demographic basis, would vaccinating the same number of 70 year olds save more QALY's on average than giving the same number of 90 year olds. I don't know how the numbers work out, but for a while I've been of the belief that we should be minimising the loss of QALYS, rather than deaths.
 

Horizon22

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I never realised vaccinating people was a competition during this whole saga I thought she was slagging England off for everything else and that Scotland was good no matter, sure it was my imagination!

It isn't but seeing as numbers are publicly available, some will naturally start saying "oh look we're ahead of X". The Tories put out a tweet recently about this which wasn't well received:


Does anyone think vaccinating the extremely vulnerable of all age groups should be much higher up the list than is currently? I believe the over 80s and over 70s are currently above them in priority and I'm not sure I agree with it.

Possibly, but changing the order would once again be another logistical change at the last minute, something we'd all rather the government did less of. It's better they stick to their guns on the original 8 categories and orders.
 

kez19

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It isn't but seeing as numbers are publicly available, some will naturally start saying "oh look we're ahead of X". The Tories put out a tweet recently about this which wasn't well received:



Yet at the start of it all, all I heard Sturgeon blab on about was our numbers are better than England, the situation in England is worse than in Scotland etc - it helps no one and if it was meant to be a so called 4 nation approach then all parties involved have gone the wrong way about it all.

If we are meant to be having adult conversations about this then maybe its time the whole lot grew up and actually dealt with the situation other than slag each other off and pass the buck, but I forgot these are politicians we speak of - they live more in la la land than the reality that you or I face.
 

HSTEd

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I would be interested to see what order things came out in if we prioritised by number of QALY's saved overall, rather than deaths, and if it would be any different.

I would actually be really interested what a vaccination order optimised for reduced ICU bed-day consumption would look like.

Probably a lot of 50-70 ear olds at the top of the queue.

ALso not entirely convinced prioritising healthcare staff is a good option - unless they instructed vaccinated staff to ignore all symptoms I can't see it materially changing the NHS's personnel position.
 

Domh245

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ALso not entirely convinced prioritising healthcare staff is a good option - unless they instructed vaccinated staff to ignore all symptoms I can't see it materially changing the NHS's personnel position.

I think that similarly to the extended dose interval (now being investigated and rolled out in other countries across the world) it's an educated gamble on it cutting transmission. It may not improve the staff situation in allowing them to skip isolation (a can of worms that I don't think they'll roll back on until official cases drop or we reach a high %age of people vaccinated because if it's alright for NHS staff to do it, then it's alright for the vaccinated pensioners to do it but the young still have to isolate because they're not likely to die enough) but it should cut down the intra-hospital transmission and further help reduce case load amongst the vulnerable
 

island

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Apologies but what is a "QALY"?
Quality-Adjusted Life Year. In principle a way of measuring how many years of life an intervention saves, but if the years are lived with a disability or some other drawback, each year counts as some fraction of a year instead. For example, if someone is bedridden for a year, that might only count as the same “value” as 0.3 years of perfect quality life.
 

ainsworth74

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Quality Adjusted Life-Year

Quality-Adjusted Life Year. In principle a way of measuring how many years of life an intervention saves, but if the years are lived with a disability or some other drawback, each year counts as some fraction of a year instead. For example, if someone is bedridden for a year, that might only count as the same “value” as 0.3 years of perfect quality life.

Thank you both :)
 

DustyBin

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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:


People previously infected with the coronavirus have more protection against reinfection five months later than people getting the Oxford vaccine, and the same level of immunity that is provided by the Pfizer jab, a Public Health England (PHE) study has found.


Data from PHE's SIREN study, which follows more than 20,000 healthcare workers at more than 100 sites across Britain, looked at how many members of NHS staff in the study group caught the virus more than once.

A total of 6,614 workers were found to have had the virus in early 2020, either through antibody testing, PCR swabs or clinical evaluation based on symptoms.

Just 44 people from this group later tested positive for the coronavirus as a result of reinfection.

PHE scientists say this means previous infection confers 83 per cent protection against reinfection, and also reduces the likelihood of developing symptoms and severe disease.
 

DerekC

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Quality Adjusted Life-Year


I was thinking more on a demographic basis, would vaccinating the same number of 70 year olds save more QALY's on average than giving the same number of 90 year olds. I don't know how the numbers work out, but for a while I've been of the belief that we should be minimising the loss of QALYS, rather than deaths.

Quality-Adjusted Life Year. In principle a way of measuring how many years of life an intervention saves, but if the years are lived with a disability or some other drawback, each year counts as some fraction of a year instead. For example, if someone is bedridden for a year, that might only count as the same “value” as 0.3 years of perfect quality life.
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.
 

Bayum

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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:

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...
 

Domh245

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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.

'Quality' in the QALY sense isn't the same as quality in most other senses. From NICE's definition:

It is often measured in terms of the person’s ability to carry out the activities of daily life, and freedom from pain and mental disturbance.

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). You essentially see if vaccinating 70 year olds first instead of 90 year olds will result in more years of life being saved - vaccinating a 70 year old who then goes on to live another 12 years is preferable to vaccinating a 90 year old who might only get 5 for example. If you really wanted to go in depth, you can even start looking at the impact of overwhelmed healthcare on the whole population QALY, which could change whether you give vaccines to people who just die if they catch covid or to those who sit in hospital for 3 weeks if they get it
 
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