Will people go back to normal after a vaccine?

[hwl]

The effect on hospitalisations should be incremental as more of the most vulnerable get their second jab.

They need to be incrementally moving towards relaxing the most onerous restrictions as this takes place, and supporting the most vulnerable to avoid contact with others whilst they wait. Locking down everyone for as long as possible should not be the default option.

Effectiveness was measured 2 weeks post second jab but was already high at 1 week.

Supplies of the Pfizer jab are quite limited in the near term as the new manufacturing facilities are slightly delayed in coming on line hence with the Pfizer vaccine alone those increments will be very small over the next few months hence the CMO comments. Unfortunately politicians got a bit blindly optimistic about vaccines and the speed of impact. With current Pfizer vaccine availability they can only vaccinate around 20% of their phase 1 priority groups (groups 1-9)

If supplies are initially limited and vaccine logistics are difficult, the best option for case reduction in 4+ months comes from increasing the gap between the minimum three weeks to 4 weeks but they have been very silent on this so far, which suggests they are thinking about it.
The Oxford-AZ vaccine getting approved would be the big game changer in terms of roll out speed and number of vaccinations overall and hence be the driver of restriction reductions.
Given that the government has got burnt by relaxations a few times they will probably want to see the numbers falling first before relaxing and also relax incrementally.

 

[notlob.divad]

Supplies of the Pfizer jab are quite limited in the near term as the new manufacturing facilities are slightly delayed in coming on line hence with the Pfizer vaccine alone those increments will be very small over the next few months hence the CMO comments.

Not just that. If my understanding is correct (an I am happy to be corrected if it is not) the method used for approval in the UK is on a batch basis. That is how the UK has managed to approve it quicker than the European Medicines Aency, who are in the process of approving the lot. If the UK runs out of it's initial batch, it will have to approve another batch for which the appropriate data may not be available. There is already a significant stockpile of the vaccine but it isn't nessesarily from the same batch that the UK has approved for use using the emergancy authorisation.

 

[Darandio]

Not just that. If my understanding is correct (an I am happy to be corrected if it is not) the method used for approval in the UK is on a batch basis. That is how the UK has managed to approve it quicker than the European Medicines Aency, who are in the process of approving the lot. If the UK runs out of it's initial batch, it will have to approve another batch for which the appropriate data may not be available. There is already a significant stockpile of the vaccine but it isn't nessesarily from the same batch that the UK has approved for use using the emergancy authorisation.

Correct, it's batch-specific.

 

[notlob.divad]

Not just that. If my understanding is correct (an I am happy to be corrected if it is not) the method used for approval in the UK is on a batch basis. That is how the UK has managed to approve it quicker than the European Medicines Aency, who are in the process of approving the lot. If the UK runs out of it's initial batch, it will have to approve another batch for which the appropriate data may not be available. There is already a significant stockpile of the vaccine but it isn't nessesarily from the same batch that the UK has approved for use using the emergancy authorisation.

Correct, it's batch-specific.

Thanks for clarifying.

I will just add, that I am not in anyway trying to suggest that the UK will run out of this first batch. That another batch cannot be approved, or that the European Medicines Agency will not approve the whole lot before the need arises. Just that the uncertanty around that adds to HWL's comment.

Supplies of the Pfizer jab are quite limited in the near term

As a result accurate targetting of priority groups is essential for it to be most effective, and even then the impact on wider society and people's return to whatever people want to deem 'normal' is somewhat limited.

 

[LAX54]

But we do have 10,000 containers of PPE and Ventilatiors trying to find a home, so the NHS are well suppiied for the next spike !

 

[hwl]

But we do have 10,000 containers of PPE and Ventilatiors trying to find a home, so the NHS are well suppiied for the next spike !

It was 11,000+ TEU not containers as plenty of 40' included, about 7,000 TEU have now been moved from Felixstowe elsewhere including anywhere they in Suffolk with suitable level surfaces to stack them!

 

[adc82140]

Correct, it's batch-specific.

But only under the emergency protocol. Once full approval comes through (timescale unknown) it'll be for all batches.

 

[yorksrob]

Effectiveness was measured 2 weeks post second jab but was already high at 1 week.

Supplies of the Pfizer jab are quite limited in the near term as the new manufacturing facilities are slightly delayed in coming on line hence with the Pfizer vaccine alone those increments will be very small over the next few months hence the CMO comments. Unfortunately politicians got a bit blindly optimistic about vaccines and the speed of impact. With current Pfizer vaccine availability they can only vaccinate around 20% of their phase 1 priority groups (groups 1-9)

If supplies are initially limited and vaccine logistics are difficult, the best option for case reduction in 4+ months comes from increasing the gap between the minimum three weeks to 4 weeks but they have been very silent on this so far, which suggests they are thinking about it.
The Oxford-AZ vaccine getting approved would be the big game changer in terms of roll out speed and number of vaccinations overall and hence be the driver of restriction reductions.
Given that the government has got burnt by relaxations a few times they will probably want to see the numbers falling first before relaxing and also relax incrementally.

Relaxing restrictions seems to be more about perception than reality. If they decided to come clean about where transmission is occurring, instead trying to persuade everyone that any reduction is down to tier three restrictions (contrary to the evidence) they might find it easier to relax some rules.

 

[Jozhua]

Effectiveness was measured 2 weeks post second jab but was already high at 1 week.

Supplies of the Pfizer jab are quite limited in the near term as the new manufacturing facilities are slightly delayed in coming on line hence with the Pfizer vaccine alone those increments will be very small over the next few months hence the CMO comments. Unfortunately politicians got a bit blindly optimistic about vaccines and the speed of impact. With current Pfizer vaccine availability they can only vaccinate around 20% of their phase 1 priority groups (groups 1-9)

If supplies are initially limited and vaccine logistics are difficult, the best option for case reduction in 4+ months comes from increasing the gap between the minimum three weeks to 4 weeks but they have been very silent on this so far, which suggests they are thinking about it.
The Oxford-AZ vaccine getting approved would be the big game changer in terms of roll out speed and number of vaccinations overall and hence be the driver of restriction reductions.
Given that the government has got burnt by relaxations a few times they will probably want to see the numbers falling first before relaxing and also relax incrementally.

Yeah, I think we're gonna need alternate jabs before mass-vaccination is possible.

The cold chain issues should be able to be sorted out, and no reason that drive-thru/walk thru vaccination can't be set up at the hospitals capable of distributing it. I bet a decent proportion of the population lives within 10 miles of one of the hospitals giving out the vaccines right now. Still, Pfizer will only be able to produce so many, and it needs two doses.

So there's Pfizer, Oxford/AZ and Moderna which have been proven to work, then more should be getting phase three trials results soon?

I think cases should start to come down eventually despite vaccination with herd immunity, so hopefully if vaccination targets the most at risk, the death rate at the very least will be reduced.

 

[hwl]

Relaxing restrictions seems to be more about perception than reality. If they decided to come clean about where transmission is occurring, instead trying to persuade everyone that any reduction is down to tier three restrictions (contrary to the evidence) they might find it easier to relax some rules.

The problem is that it very difficult as we only do forward tracing not backward tracing as part of test and trace. Now if we sorted test and trace...

But Hancock appeared to be very clear in the press conference re East London Kent and Essex! So mass testing at secondary schools to start (which will find even more cases). The reality is that it far easier to work out if cases are spreading in schools than many other locations.
Wales is closing secondary schools early this weekend for Christmas.

The late August - early October experience in several parts of the country suggests that it takes 3 weeks to spread from those age groups to the highest risk ones.

If the Oxford - AZ vaccine is approved soonish a secondary school aged vaccination programme starting around the Easter Holidays when they have done phase 1 vaccinations might well be the quickest way to reduce case numbers and return schools to nearer normal. The potential number of contacts in school / travelling to it is probably far higher than many adults see so it might be the quickest way to get case numbers and transmission rates down.

The US has also just started testing the Moderna vaccine in the 12-18 age groups to they are obviously thinking about schools as key transmission route.

The other problems is that weather / temperature has a big effect on transmission /case rates* so summer, autumn/spring and winter may all have different rates for a certain activity.

*The winter : summer ratio of cases of the 4 common long term human coronaviruses (229E, NL63, OC43, HKU1) where there are decent data sets is around 9:1.

Yeah, I think we're gonna need alternate jabs before mass-vaccination is possible.

The cold chain issues should be able to be sorted out, and no reason that drive-thru/walk thru vaccination can't be set up at the hospitals capable of distributing it. I bet a decent proportion of the population lives within 10 miles of one of the hospitals giving out the vaccines right now. Still, Pfizer will only be able to produce so many, and it needs two doses.

So there's Pfizer, Oxford/AZ and Moderna which have been proven to work, then more should be getting phase three trials results soon?

I think cases should start to come down eventually despite vaccination with herd immunity, so hopefully if vaccination targets the most at risk, the death rate at the very least will be reduced.

The cold chain requirements will still make it far harder to use the Pfizer.
Moderna - we (the UK) won't get any before April.
The others there is a bit of a gap expected till results.
Hence the Oxford / AZ approval is key to getting a large impact in the near future.

 

[yorksrob]

The problem is that it very difficult as we only do forward tracing not backward tracing as part of test and trace. Now if we sorted test and trace...

But Hancock appeared to be very clear in the press conference re East London Kent and Essex! So mass testing at secondary schools to start (which will find even more cases). The reality is that it far easier to work out if cases are spreading in schools than many other locations.
Wales is closing secondary schools early this weekend for Christmas.

The late August - early October experience in several parts of the country suggests that it takes 3 weeks to spread from those age groups to the highest risk ones.

If the Oxford - AZ vaccine is approved soonish a secondary school aged vaccination programme starting around the Easter Holidays when they have done phase 1 vaccinations might well be the quickest way to reduce case numbers and return schools to nearer normal. The potential number of contacts in school / travelling to it is probably far higher than many adults see so it might be the quickest way to get case numbers and transmission rates down.

The US has also just started testing the Moderna vaccine in the 12-18 age groups to they are obviously thinking about schools as key transmission route.

Yes, at least mass testing in hotspot areas actually stands some chance of getting to the route of the problem.

I note that Kent went straight from lockdown to tier three, for all the good it's done.

 

[HSTEd]

The cold chain issues should be able to be sorted out, and no reason that drive-thru/walk thru vaccination can't be set up at the hospitals capable of distributing it. I bet a decent proportion of the population lives within 10 miles of one of the hospitals giving out the vaccines right now. Still, Pfizer will only be able to produce so many, and it needs two doses.

Even if they didn't live close to oneo f the hospitals, it would be cheaper to taxi them all there than to try anything fancy.

I doubt the Astra Zeneca vaccine will be widely used to be honest, they've botched the trial.
I expect it not to be approved until long after the Moderna and Pfizer one have built up a tonne of momentum.

 

[yorksrob]

Even if they didn't live close to oneo f the hospitals, it would be cheaper to taxi them all there than to try anything fancy.

I doubt the Astra Zeneca vaccine will be widely used to be honest, they've botched the trial.
I expect it not to be approved until long after the Moderna and Pfizer one have built up a tonne of momentum.

Depends how quickly the other two can ramp up protection. We need them produced quickly.

 

[hwl]

Yes, at least mass testing in hotspot areas actually stands some chance of getting to the route of the problem.

I note that Kent went straight from lockdown to tier three, for all the good it's done.

The problem is that the lateral flow tests in Liverpool administered by non medical staff only picked up 58% of the the cases so while you take 3 out 5 from circulation the other 2 are still possibly spreading hence they need to do both lateral flow and PCR so doing the later is far more effective. Plenty of PCR capacity currently so should get results back in 36 hours especially if all the swab are taken direct to the lab.

 

[philosopher]

Even if they didn't live close to oneo f the hospitals, it would be cheaper to taxi them all there than to try anything fancy.

I doubt the Astra Zeneca vaccine will be widely used to be honest, they've botched the trial.
I expect it not to be approved until long after the Moderna and Pfizer one have built up a tonne of momentum.

If the Astra Zeneca one is not approved within the next couple of months to allow a mass vaccination of those under 50 in the spring then I reckon the restrictions will continue well into the summer and perhaps autumn.

 

[hwl]

Depends how quickly the other two can ramp up protection. We need them produced quickly.

Not any where near as quickly as the Oxford / AZ one. The Oxford / AZ one is also far easier to produce in large quantities.
Pfizer are having problems ramping up and because we signed up late for Moderna we don't get any till April.

Even if they didn't live close to one of the hospitals, it would be cheaper to taxi them all there than to try anything fancy.

I doubt the Astra Zeneca vaccine will be widely used to be honest, they've botched the trial.
I expect it not to be approved until long after the Moderna and Pfizer one have built up a tonne of momentum.

That Lancet paper was a train wreck but the Pfizer and Moderna results and trial scale eclipsed what everyone else could do in the time so has rebased expectations.

I could see the government doing a revised plan with under 65 on a half then full dose with the Oxford /AZ vaccine.

Worth noting that Moderna tried 4 dose levels in their phase 2 trials and that the lowest was the most effective.

 

[yorksrob]

Not any where near as quickly as the Oxford / AZ one. The Oxford / AZ one is also far easier to produce in large quantities.
Pfizer are having problems ramping up and because we signed up late for Moderna we don't get any till April.

Yes, that's my thought.

Now they've established it's basically safe, it presumably shouldn't take too long to confirm which is the most effective dosage.

 

[hwl]

Yes, that's my thought.

Now they've established it's basically safe, it presumably shouldn't take too long to confirm which is the most effective dosage.

The problem is that getting decent data would take a minimum of 4+ months over winter or even longer in summer. So one alternative is to press the the big green go button on huge scale trial!
AZ have already started a new trial in the US as it is pretty obvious the US will want more data. The US has bet fairly heavily that the Oxford AZ ones is a success too.

 

[yorksrob]

The problem is that getting decent data would take a minimum of 4+ months over winter or even longer in summer. So one alternative is to press the the big green go button on huge scale trial!
AZ have already started a new trial in the US as it is pretty obvious the US will want more data. The US has bet fairly heavily that the Oxford AZ ones is a success too.

Indeed, we've bought it anyway, so we can bank the 60 something percent effectiveness, whatever happens.

 

[Domh245]

I doubt the Astra Zeneca vaccine will be widely used to be honest, they've botched the trial.
I expect it not to be approved until long after the Moderna and Pfizer one have built up a tonne of momentum.

The apparent botching of the trial seems to be a lot less significant than some make it out to be. Even on the figures with the 'botched' it's still more than effective enough to gain approval, and that's before considering that once they realised what had happened they called in regulators quickly to determine how much of an issue it would be - that they continued shows that the regulators aren't overly concerned by it. Not to mention that the trials were carried out at an arguably far higher level than the Pfizer or Moderna vaccines as they actively swabbed to check for infections - the other to date have just relied on people developing symptoms and being tested off the back of it

 

[hwl]

The apparent botching of the trial seems to be a lot less significant than some make it out to be. Even on the figures with the 'botched' it's still more than effective enough to gain approval, and that's before considering that once they realised what had happened they called in regulators quickly to determine how much of an issue it would be - that they continued shows that the regulators aren't overly concerned by it. Not to mention that the trials were carried out at an arguably far higher level than the Pfizer or Moderna vaccines as they actively swabbed to check for infections - the other to date have just relied on people developing symptoms and being tested off the back of it

In many ways the Oxford AZ trial has been far more useful, but the far smaller numbers don't help the error bounds and the 90% effectiveness in the half then full dose was based on a handful of cases (3!) in the vaccinated group so the error bars are large.

As I've said before most of the criticism is coming from specialist pharma finance firms who don't like a new cheap high volume vaccine having been proven to work, in makes investing in other approaches far harder.

 

[HSTEd]

A 60% effective vaccine is essentially useless however.

The political types will never allow a loostening of restrictions when it will still kill a hundred thousand or more people.

Even using only the Pfizer vaccine, the priority 20 million people in the UK that need vaccinating will be done by the end of 2021.
Mass vaccination of the population is not even the plan.

 

[DB]

A 60% effective vaccine is essentially useless however.

The political types will never allow a loostening of restrictions when it will still kill a hundred thousand or more people.

But bear in mind that naturally-occurring herd immunity is now going to be at a level which makes a noticeable difference too.

 

[HSTEd]

But bear in mind that naturally-occurring herd immunity is now going to be at a level which makes a noticeable difference too.

Herd immunity is unclear at the present time.
We are probably well under 20% of people having had it.
And we also have the problem that we don't know who those people are, so we still have to vaccinate them.

And given we have no hard data on how good the vaccine is at preventing transmission, herd immunity may not even be possible here.

 

[Domh245]

In many ways the Oxford AZ trial has been far more useful, but the far smaller numbers don't help the error bounds and the 90% effectiveness in the half then full dose was based on a handful of cases (3!) in the vaccinated group so the error bars are large.

As I've said before most of the criticism is coming from specialist pharma finance firms who don't like a new cheap high volume vaccine having been proven to work, in makes investing in other approaches far harder.

Agreed, although the pfizer vaccine's headline 95% figure is based on 8 people developing covid in their vaccinated group so its not as if the error bars are much smaller there - none of the studies strike me as particularly great, but they're all better than nothing

 

[kristiang85]

And so it begins. Ontario in Canada to issue people with vaccine ID that will enable those vaccinated to live with less restrictions, whilst those without it stay under restrictions.

 

[bramling]

And so it begins. Ontario in Canada to issue people with vaccine ID that will enable those vaccinated to live with less restrictions, whilst those without it stay under restrictions.

Incendiary if it happens here.

 

[trebor79]

Even if they didn't live close to oneo f the hospitals, it would be cheaper to taxi them all there than to try anything fancy.

I doubt the Astra Zeneca vaccine will be widely used to be honest, they've botched the trial.
I expect it not to be approved until long after the Moderna and Pfizer one have built up a tonne of momentum.

We've bought 100m doses and millions of doses have already been manufactured. It's a very low cost vaccine, so even if the efficacy isn't brilliant - it'll get used. I think the efficacy will turn out to be OK.

Agreed, although the pfizer vaccine's headline 95% figure is based on 8 people developing covid in their vaccinated group so its not as if the error bars are much smaller there - none of the studies strike me as particularly great, but they're all better than nothing

Indeed, and Pfizer only looked for symptomatic infection, whereas the AZ trial did weekly PCR tests on all participants, so you'd expect that to find more "infection".

The biggest caveat around the AZ vaccine is use of the Adenovirus, and some suggestion that as well as priming the immune system to fight COVID, it primes the immune system to fight the Adenovirus. It's been posited that's why those who received a half dose initially appeared to have better efficacy, because the immune system didn't react as strongly to the Adenovirus carrier in the second dose, and therefore allowed the RNA package to be delivered more effectively.
This might mean it's of limited use in the future for boosters. But if it's a quick and cheap way out of the current hole we are in whilst production of other technologies is ramped up for annual boosters fo the vulnerable (if in deed they are required), then I'm all for it.

 

[Yew]

We are probably well under 20% of people having had it.

We were above that back in May, even if you only took those with present antibodies, rather than looking at T Cell immunity.

 

[Crossover]

If the Astra Zeneca one is not approved within the next couple of months to allow a mass vaccination of those under 50 in the spring then I reckon the restrictions will continue well into the summer and perhaps autumn.

There will be utter hell on if restrictions continue in any great way much beyond Spring 2021, I would suggest