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?

@bloodpressureboiling

ultimately leads to herd immunity

But if it doesn't stop transmission it will not lead to herd immunity

@trulydelicious
But if it doesn't stop transmission it will not lead to herd immunity

We don't completely know yet, as trials are still ongoing. Other vaccines do though. Other vaccines that employ similar mechanisms. We should assume that the majority of COVID vaccines will lead to a degree of immunity that will ultimately reduce cases and spread.

Regardless of herd immunity, I strongly believe, especially as a health care professional who is in the lucky position of having already received my first dose of Pfizer, and will be vaccinating others next month, that it is my social responsibility to promote this vaccine and encourage it's uptake.

Even without trials, if we really do manage a million vaccinations a week we will be able to see the R rate go down over time if vaccination does make you less infectious. I just really hope we can get to that number. It seems no one is publishing the weekly number currently.

They are obviously going to use the more efficacious half dose then full dose regime for the roll out and that was 90% effective so the results with the other regime aren't really relevant.

There are technical reasons to do with immune response to the vector virus why the half dose full dose regime is better. Sputnik uses a different adenovirus vector for each dose to avoid this which is clever and that explains why it would make sense to combine those.

Oxford is well known technology vs the newer mRNA vaccines so if you are worried about safety then you'll do well to have the Oxford one

Quite frankly I'll have any bloody vaccine that I am offered. Even if it was 60% it's much better than nothing and with the correct dosing regime it will be 90% anyway

Oaktree you are speaking with the benefit of hindsight

It is good that vaccines with different mechanisms of action were trialled. At the outset no-one knew if mRNA would be effective or adenovirus vector or both or neither.

What if the mRNA vaccines had failed? Would you still say the U.K. was stupid to try a different approach. I am glad the whole world didn't back one horse and now we have options.

If there was a case of transverse myelitis in the control arm doesn't that kinda prove it's not vaccine related? Certainly there can be no statistical difference between 1 case in control and 2 in vaccine amongst thousands of people vaccinated.

This is not a case of U.K. incompetence. It was perfectly reasonable to try the approach we did and it has worked to a degree that people would be overjoyed by if there were no other options. It just so happens there are other options as well and that is really good news.

The world scientific community has come together to provide a number of effective vaccines against Covid and that should be celebrated rather than stupid infighting about which is the absolute best.

It's your choice if you want to wait for the very best one and pay privately but a slightly less efficacious one would actually be fine for most less vulnerable people. Even if it doesn't prevent infection entirely it prevents death and hospital admission and that is good enough for me.

@DougRossIsTheBoss

They are obviously going to use the more efficacious half dose then full dose regime for the roll out and that was 90% effective so the results with the other regime aren't really relevant.

There are technical reasons to do with immune response to the vector virus why the half dose full dose regime is better. Sputnik uses a different adenovirus vector for each dose to avoid this which is clever and that explains why it would make sense to combine those.

Oxford is well known technology vs the newer mRNA vaccines so if you are worried about safety then you'll do well to have the Oxford one

Quite frankly I'll have any bloody vaccine that I am offered. Even if it was 60% it's much better than nothing and with the correct dosing regime it will be 90% anyway

No, they simply don’t have the data to approve the LD/SD. I’d be totally gobsmacked if the MHRA approved that before more trials were concluded. The numbers are too small and all participants in that arm were under 55 and the time between doses was all over the place. They even acknowledge in their Lancet article that the result of that arm could be down to statistical noise.

If there was a case of transverse myelitis in the control arm doesn't that kinda prove it's not vaccine related?

No because the control "placebo" was the meningitis vaccine. So at best you could claim it was "only" 2-3 times worse than this. That's the issue with using real vaccines in the placebo. The potential to discount the compounding of accepted adverse side effects.

But the meningitis vaccine is licensed and presumably it wouldn't be if transverse myelitis is a risk with it.

Also the difference between 2 and 1 cannot be statistically significant. It is clearly as likely to be due to chance.

I can see why the MHRA are in a bit of a bad position then. They'll have to licence the less good dose regime and wait for more data on the better regime. That does seem a shame as it's obviously not going to be worse or less safe and in all likelihood it would be better to have the LD/SD regime.
I'd like to be offered that choice.

I did feel suspicious of why a regime that was essentially an accident turned out better but I had the science explained to me by a virologist and now I understand:

The immune system produces antibodies to both the Covid spike protein (desirable) and the vector virus (not desirable). With the full dose regime the 2nd dose may be less effective because the antibodies to the vector clear it too efficiently from the body before antibodies to the Spike are produced. With the half dose first this doesn't happen so much.

Apparently the Russians used different vectors for each dose of Sputnik to avoid this. Clever Russians. As it's a similar approach a collaboration isn't stupid idea at all.

We need to find out whether it's safe to have an mRNA vaccine and a vector one because that will be happening in reality so the fact they are trialling this is a good thing and not suspicious in any way.

Regarding social responsibility, even if a vaccine can’t offer herd immunity as such and ‘only’ lessens the effect of the virus there is still a social responsibility to lessen your personal burden on the health service.

Our aim is for the health services to cope with the number of sick presenting to them, a vaccine that reduces the disease to something much milder that reduces the likelihood of needing medical support. It isn’t just about those who die.

My local hospital has 60+ covid inpatients and 8 in ICU. That’s a lot for one virus. Those numbers could be slashed with a vaccine that could ensure that a lot of people will only experience a very mild illness.

Even licensed vaccines have side effects and risks. Not every person has the same risk profile. An acceptable background risk profile for someone with no contraindications is different from an acceptable profile for someone with underlying risk.

This is what is conveniently forgotten in discussions about community versus individual risk.

This is why I find it extremely concerning that so little regard appears to have been given to the allergy risk with the Pfizer roll out and that concerns about adverse events in the trials are being minimised.

Regarding social responsibility, even if a vaccine can’t offer herd immunity as such and ‘only’ lessens the effect of the virus there is still a social responsibility to lessen your personal burden on the health service.......Those numbers could be slashed with a vaccine that could ensure that a lot of people will only experience a very mild illness.

Agreed. However it is already the case that the majority of people (up to 90% per Whitty and co) will only experience a very mild illness. Makes sense to target the vaccine at those for whom this is not the case both for them and for society as a whole. The Govt vaccine programme seems to be doing a decent job of this so far.

Roll out to the "low risk" proportion of the population is a different calculation.

Regarding social responsibility, even if a vaccine can’t offer herd immunity as such and ‘only’ lessens the effect of the virus there is still a social responsibility to lessen your personal burden on the health service.

Agreed

The problem with mixing and matching to improve efficacy will arise if the vaccine has to be repeated annually like the flu rather than one regimen like most childhood vaccines. They could end up running out of combinations or playing constant catch up.

Again this would be more of an issue in the younger low risk section of the population than in the current roll out cohort. Worst outcome would be having a vaccine when you were young and healthy and then finding having done so means the booster doesn't work when you are old and at risk.

@Dinnafashyersel I agree to a point but I feel that the numbers of people seeking medical help for ‘moderate ‘ cases are being overlooked because of the urgency around the numbers becoming seriously ill and dying.

There are a lot of people with mild/moderate illness putting pressure on the NHS. You don’t have to look far on here to find accounts of people who have become breathless enough to call an ambulance (completely reasonable) to find that their oxygen saturation is fine when checked by a paramedic. Of the inpatients I mentioned earlier, a high proportion of them are going to be absolutely fine and/or only hospitalised for a night or two to support/sort out basic issues. These are all small, short needs that build into huge numbers which contribute to the buckling resources available.

My DP was taken by ambulance to hospital in March (before lockdown) in hypertensive crisis. He was in for a matter of hours with follow up appointments after because he stabilised with intervention very quickly. Who knows if that was due to covid or would have happened anyway (no testing unless admitted at that point) but that’s the kind of thing that had been strongly linked to a covid infection along with clots and strokes.

If these kinds of presentations can be avoided it adds to the strength of our position.

Per Whitty and Vallance the current roll out will cut healthcare burden as well as death by 99%. Time will tell whether they are correct and we should be able to tell quite quickly if the programme proceeds as planned.

Vaccination below the current threshold is a somewhat academic discussion atm as there is rationed availability.

Initially they were quoting 20% of those infected would need a hospital visit. Is that still the case?

Another aspect to consider re: health service burden is affecting me as we speak

I have got COVID right now acquired at work and so have 10 of my colleagues. This means our team cannot work so our patients cannot get a service.
As we are a community crisis team this will inevitably mean more admissions to hospital and burden on beds.

Being able to vaccinate front line health care staff will avoid this from occurring and mean we can keep working.

If we had been vaccinated even with a 60% effective vaccine then less of us would have caught it and we would have been able to carry on providing our essential service.

I am low risk and I don't feel very ill so far so I hope not to burden the NHS by requiring care

But I can't work and won't be able to for 2 weeks which is a loss of skilled labour that the NHS can ill afford so it's a burden in a different way.

With the whole team out at the same time plus others self isolating due to contact you can see how badly the NHS will be affected if our situation is replicated across the country.

DougRossIsTheBoss I hope you and the team all get well soon.

The same is true of other key workers eg in social care and by extrapolation to society as a whole.

The burden of lost productivity through illness and isolation will be lessened by a vaccine even if it's not a perfect one so any vaccine has to be better than none at all.

If they had longer to work on it I'm sure they could make it more efficacious eg with different dose regimes, different vectors or a mixed approach. But this is urgent right now. No-one wants to wait to get it perfect. If it's safe and it works a bit then it's better than nothing whilst we continue to do further research to optimise things.

Thanks one glass
I am fairly sure I'll be OK but I have older more vulnerable and ethnic minority colleagues who I am scared for

And the guilt if any of us have passed it on to patients will be horrific. We all wore PPE and abided by guidelines and as far as we know so far it's not the case but I am very very scared it could happen and how would we live with that.

Patients were begging us to visit face to face and not happy with telephone or video calls (plus it wasn't possible in many cases). I am going over in my head all my visits thinking 'did I really really need to do that? Should I have tried harder to get them to do video'
I just really hope our PPE works

You did the very best you could based on what was available to you. Try to ignore that voice in your head.

With all the current tier 3/4 until we are vaccinated restrictions has anyone changed their mind?

For me as soon as the Oxford one is cleared I will be waiting to get it - it seems really the only way out for the UK

@BungleandGeorge

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!

Agree with this. Many, many vaccines have demonstrated apparently efficacy in trials, but have turned out to have no real-world benefit. The same may turn out to be true of all the Covid vaccines, but the mRNA vaccines have got to be more of a gamble because of their novel technology.

The gamble could go either way, of course- they might turn out to be far superior. Personally, assuming I can only have one of the vaccines (one type, I mean, not one dose) for the foreseeable future, I'm going to opt for the Oxford one if I can, as the more tried and tested technology. But we are all guessing which one turns out to be the best in real-world settings.