Oxford vaccine

[Thehairyqueenofscots]

Been told at work we will be getting this at next round of vaccinations. It always seems to be high regarded on here so I'm quite pleased about this. Would you have a preference or not bothered?

That’s why it’s only 20% most vulnerable that is being hovered

Other countries might have different (and less risky) demographics, but they are not devoid of the vulnerable, and need their HCPs just as much as everyone else does

Re private roll out it’s envisaged this will commence once countries have completed their priority vaccinations which for U.K. is anticipated (although probably unrealistic) to be Spring. This is all just what I’ve researched not my opinion by the way. It’s easily searchable. As I said I’d imagine by Mid Summer it’ll be possible to buy vaccine privately in U.K.

To be honest, all that I need from a vaccine is that I don’t die and preferably am not hospitalised. I don’t mind getting slightly ill briefly. The Oxford one ticks those boxes. Also the mRNA vaccines are a brand new sort of vaccine so, although I would take either sort if that is all there is, I would feel safer with the Oxford vaccine which uses a tried and tested method.

Re private vaccines, it is true that money talks. Once it is approved in a few countries I expect money will find a way to get it to those who can pay.

I don't think she's misreading it.
www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932661-1

Table 2: Efficacy against SARS-CoV-2 more than 14 days after a second dose of ChAdOx1 nCoV-19 vaccine in the primary efficacy population

Any NAAT-positive swab vaccine efficacy 55.7%

The legend also states ¶Other non-primary symptomatic
COVID-19 disease includes cases who have symptoms other than the five main symptoms that are required for inclusion in the primary analysis (eg, a participant who has
diarrhoea and malaise but no fever, cough, shortness of breath, anosmia, or ageusia).
which suggests that the primary analysis (70% or 62.7% efficay) was based on the 5 main symptoms.

The primary outcome was virologically
confirmed, symptomatic COVID-19, defined as a NAAT positive swab combined with at least one qualifying
symptom (fever ≥37·8°C, cough, shortness of breath, or
anosmia or ageusia).
There were 131 cases of symptomatic COVID-19 in
LD/SD or SD/SD recipients who were eligible for
inclusion in the primary efficacy analysis more than
14 days after the second dose of vaccine (table 2). There
were 30 (0·5%) cases among 5807 participants in the
vaccine arm and 101 (1·7%) cases among 5829 participants in the control group, resulting in vaccine
efficacy of 70·4% (95·8% CI 54·8–80·6; table 2; figure).
In participants who received two standard-dose vaccines,
vaccine efficacy was 62·1% (95% CI 41·0–75·7), whereas
in those who received a low dose as their first dose of
vaccine, efficacy was higher at 90·0% (67·4–97·0;
pinteraction=0·010; table 2; appendix 1 pp 12–13).

If I get given the Oxford vaccine as a vulnerable person will I then be able to pay for the 92% effective one when it becomes available? Will it still work and be safe after I’ve had the oxford one?

@JS87

The primary outcome was virologically confirmed, symptomatic COVID-19, defined as a NAAT positive swab combined with at least one qualifying symptom (fever ≥37·8°C, cough, shortness of breath, or anosmia or ageusia). There were 131 cases of symptomatic COVID-19 in LD/SD or SD/SD recipients who were eligible for inclusion in the primary efficacy analysis more than 14 days after the second dose of vaccine (table 2). There were 30 (0·5%) cases among 5807 participants in the vaccine arm and 101 (1·7%) cases among 5829 participants in the control group, resulting in vaccine efficacy of 70·4% (95·8% CI 54·8–80·6; table 2; figure). In participants who received two standard-dose vaccines, vaccine efficacy was 62·1% (95% CI 41·0–75·7), whereas in those who received a low dose as their first dose of vaccine, efficacy was higher at 90·0% (67·4–97·0; pinteraction=0·010; table 2; appendix 1 pp 12–13).

Thank you, yes. The headline numbers of 62 and 90% explicitly don’t include asymptomatic cases. This is clear in the document and from expert analysis. The primary endpoint of the trial was symptomatic infection.

That it shows some efficacy against asymptomatic transmission in the LD/SD subset is heartening but it needs to be validated by a larger more statistically compelling trial that includes over 55s.

If I get given the Oxford vaccine as a vulnerable person will I then be able to pay for the 92% effective one when it becomes available? Will it still work and be safe after I’ve had the oxford one?

The highest quality answer to this is... maybe. These are not known facts currently. But it looks like the Oxford vaccine would stop you getting very ill in any case so that might be all you need.

@JS87

I don't think she's misreading it. www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932661-1

Table 2: Efficacy against SARS-CoV-2 more than 14 days after a second dose of ChAdOx1 nCoV-19 vaccine in the primary efficacy population

Any NAAT-positive swab vaccine efficacy 55.7%

The legend also states ¶Other non-primary symptomatic
COVID-19 disease includes cases who have symptoms other than the five main symptoms that are required for inclusion in the primary analysis (eg, a participant who has
diarrhoea and malaise but no fever, cough, shortness of breath, anosmia, or ageusia).
which suggests that the primary analysis (70% or 62.7% efficay) was based on the 5 main symptoms.

Well we can add poor data presentation to their list of problems then. Even if they're only counting people with those five symptoms as symptomatic, you can't compare it to a study that was only testing on those symptoms. There's a difference between the sort of symptoms that would trigger a test and the sort of symptoms you would notice after a test coming back positive

In my opinion Oxford is another example of the total ineptitude our Government has shown in response to this whole Pandemic. They basically just backed a (cheaper) horse based on Oxford name without looking into the detail of it. Many scientists expressed concerns over how effective an adenovirus vaccine would be if you read up. Why we aren’t more up in arms about it I guess is because the penny hasn’t dropped with people yet. The fact they’re having to repeat part of the trial and are running new trials to try and improve efficacy with an mRNA one speaks volumes. Scandalous really.

At the start of the pandemic, and even a month or so age, we were hoping for a vaccine with 50-60% efficacy. No one expected over 90%. That the mRNA vaccine would be so efficacious had not been predicted. We will have enough of the Pfizer and Moderna vaccines to cover high risk people and the Oxford vaccine will cover the rest of us. To call this a scandal is absurd.

@cathyandclare

Yes, yes and yes again.

I don't think Oxford will be rolled out any time soon. BBC reporting they are now recruiting to retrial it in combination with the Sputnik V Russian vaccine.

I disagree. Read up on the review of Oxford. They had 3 cases of Transverse Myelitis (one in control arm) one linked to MS and one linked to vaccine. The mRNA as far as I’ve read have had zero adverse events (bar the two allergy ones which I don’t understand how they were allowed to occur as apparently the vaccine was contraindicated for those with serious allergies)

Why should we in U.K. be landed with an inferior vaccine? It is totally scandalous how the trial was carried out/reported given so much was riding on this and the issue of vaccine hesitancy. Why should we not be allowed to be up in arms over sloppy trials? Peoples lives and our economy ride on this.

@Oaktree55

Why should we in U.K. be landed with an inferior vaccine

I think you're jumping to conclusions (and at the moment I'm not planning on having either)

Why not wait for the Pfizer vaccine (and others) mass roll-out to be able to ascertain more precisely what the adverse events might be?

I’m comparing the trials. The Oxford trial was sub standard (Pfizer included more with comorbidities/older age etc and doesn’t require repeating/further trials) to quote re Oxford......

The limitations include that less than 4% of participants were older than 70 years of age, no participants older than 55 years of age received the mixed-dose regimen, and those with comorbidities were a minority, with results for that subgroup not yet available. The heterogeneity in vaccine dosage was fortuitous in uncovering a potentially highly efficacious formulation but was unplanned, and needs further evaluation in older adults and to confirm the unexpected results.

Yes and wait for the peer-reviewed papers

IT shouldnt be about inferior or superior or about which one is best. It should be about whether it is safe effective and good enough.

One type of vaccine isnt going to be good enough Pfizer on its own isnt cost effective or transportable enough to be good enough even though its effiacy is good.

The question do we have enough patience to see it through to its natural conclusion and I dont think we do.

Because Oaktree you are right lives and the economy does ride on this so it becomes a question of it is good enough. For you clearly it is not. For me the jury is still out on this we will have to see what the regulators say

You’re missing the point. Vaccines are useless without uptake. Once the papers /social media get hold of how inferior Oxford is in terms of efficacy then not enough people will take it and trust me when it’s 62% not 95% the numbers needing to take it will be far higher.

The imperial vaccine is an mRNA vaccine is it not? There are many criticisms we can level at this government but given that mRNA technology is so new I don't think spreading bets over a number of technologies is "scandalous". There was no guarantee an mRNA vaccine would work at all.

We will not get people to adhere to SD measures for much longer, we need to be realistic and not allow the perfect to be the enemy of the good.

If Whitty and co are right in thinking vaccinating the vulnerable with the Pfizer vaccine will cut healthcare and mortality burden by 99% then it is a stretch to understand why a 62% efficacy for everyone else would make any difference.

With the greatest respect I think you are missing the point with inferiority and efficacy and I get that vaccine uptake is a thing which is why it becomes a matter of good enough not the best.

www.nytimes.com/2020/12/08/briefing/vaccine-don-gable-your-tuesday-briefing.html

Shows that actually a lower efficacy with lower community spread is better than high efficacy and high spread.

The vulnerable and the elderly should of course be prioritised to get the best - they are the ones for the most part suffer the most.

For the rest of us it is Russian Roulette as to whether we get it badly or not - long covid or the complications that can lead to death. For us it is about not just protecting ourselves from that risk but ensuring that community spread is kept low enough that those who have the higher efficacy vaccines are protected as much as possible.

For us -- working like the flu virus (around 50-60% efficacy) is sufficient to protect not just ourselves but those who need it.

If the media do go down the line you thing they should in terms of inferiority that would be incredibly foolhardy, dangerous and potentially more fatalaties

By all means question whether the trial has been handled properly and whether it is a safe vaccine. As i said the jury is still out on this and I would hope that the MHRA is wise enough to ensure it properly takes it time to ensure that is the case. Alongside the data being peer reviewed.

But it all of that holds its 50-60% efficacy, is safe doesnt have side effects believe me that should be GOOD ENOUGH

The Pfizer vaccine is so incredibly fragile and difficult to handle. I wonder if the efficacy will be the same anyway in real life clinical mass vaccination situations? I don’t think the efficacy for either is that well established given the tiny numbers who actually caught covid in the trials.
I’m not sure I’m keen about having Sputnik myself!

My biggest concern with the Oxford trial data so far is the relatively low number of participants. Only roughly 5500 in each of the vaccinated and placebo arms and a mess of different dose combinations, time between doses, and different placebo solutions.

The main thing we want to prevent is severe illness — there were only two severe cases in placebo arm (and another 8 hospitalised with mild/moderate illness). So whilst it’s likely the vaccine prevents severe illness the numbers are not as compelling as Pfizer and Moderna on this point (yet).

Personally I don’t care about getting mild symptomatic covid, I just don’t want to get it severely, this is the data I care about and I look forward to the results of the US AstraZeneca/Oxford trial which will hopefully provide more reassurance on this point as it’s a 30,000+ participant trial.

After today’s news on the GSK vaccine, that it failed to maintain a strong response in over 50s, I’m also curious to see a demographic breakdown of the 68 participants in the vaccine arm of the Oxford trial that still got Covid (symptomatic and asymptomatic).