Can anyone sum up what’s going on with vaccines for me?

[Cornettoninja]

I don’t understand why this has emerged as the next problem.

So the government are saying that there are problems with supply; this makes no sense to me regarding the AZ one. It’s been reported for months that this has been in manufacturing throughout trials with the understanding it would all be binned off it didn’t work. The Pfizer one... I’m not sure about the supply issues with this one if I’m honest. I’ve read reports from both companies this morning that there is no issue their end with supply.

Secondly how is it possible that despite months of vaccines being ‘imminent’ (to be clear I’m using that term loosely) now there are issues with staffing a vaccine programme? Health settings have had protocols in place for months at the behest of the government so they could be ready to go.

Lastly, what the hell is this sudden redesigning of dosing regimes about? Pfizer have publicly distanced themselves from the UK’s plan to extend time between doses. Do it properly or not at all!

I would be incredibly pleased to hear that this isn’t just the latest balls up of our incompetent government thinking they know better than experts and gambling with our best chance out of this absolute nightmare. Unfortunately I suspect that is the case given their track record throughout that leaves the majority of the country saying WTF.

cathyandclare that line is indeed 'pretty binary' but since it measures cumulative incidence it doesn't actually state what & when on the line. It does states that there is an effect after day 11, but it doesn't state that e.g. day 17 was greater than day 16.

Many of us find that having the actual facts helps them to cope with a situation because then they can understand better and cope with the risks
Others want to believe anything that apparently comes from authority that makes them feel better/hopeful/safe/whatever because they cannot bear the anxiety of feeling at risk
Generally MN is made up of those two apparently opposing voices who cannot understand each other

Superbly put, Haffiana. The only point I'd add as someone who appreciates facts is that, between the self interest of both governments and commercial concerns, it's not always easy to identify what's fact and what isn't

It shows that the immunity kicks in after 11 days, so that the increase is not day by day but sudden. 17 is not materially greater than 16. The placebo curve is cumulative too, so the comparison is fair.

@Puzzledandpissedoff

Many of us find that having the actual facts helps them to cope with a situation because then they can understand better and cope with the risks Others want to believe anything that apparently comes from authority that makes them feel better/hopeful/safe/whatever because they cannot bear the anxiety of feeling at risk Generally MN is made up of those two apparently opposing voices who cannot understand each other

Superbly put, Haffiana. The only point I'd add as someone who appreciates facts is that, between the self interest of both governments and commercial concerns, it's not always easy to identify what's fact and what isn't

It's not about having the facts vs believing authority. It's interpretation of the facts. I like to have the facts, read the medical journals widely and follow the stats. I have a health cynicism for the government. Having followed all this, I believe that the spaced dose strategy is reasonable in the situation we're now in. Others agree. It's insulting and inaccurate to say that those who disagree with you don't understand the 'actual facts'.

It's all about interpretation. I would suggest that a number of the people that oppose your view are medically, scientifically qualified.

It's insulting and inaccurate to say that those who disagree with you don't understand the 'actual facts'

I agree with this - also that much is about interpretation - which is why I try to avoid saying that someone with a different view "doesn't understand"

What I do maintain, and have from the start, is that it can be very diificult to identify where the facts actually lie because of the many self interests (including the financial ones) involved

Very true

It shows that the immunity kicks in after 11 days, so that the increase is not day by day but sudden. 17 is not materially greater than 16. The placebo curve is cumulative too, so the comparison is fair.

OK, look I am talking about the error in stating that efficacy builds day on day. We don't know that. The data doesn't state that it builds day on day. What you said MAY be correct, but it is an interpretation that is quite different from correctly saying that by day 20 the vaccine shows a greater efficacy than day 1 or day 11.

In scientific terms one statement is not accurate, and one is. One has not actually been measured, and one has. It matters.

@Haffiana

It shows that the immunity kicks in after 11 days, so that the increase is not day by day but sudden. 17 is not materially greater than 16. The placebo curve is cumulative too, so the comparison is fair.

OK, look I am talking about the error in stating that efficacy builds day on day. We don't know that. The data doesn't state that it builds day on day. What you said MAY be correct, but it is an interpretation that is quite different from correctly saying that by day 20 the vaccine shows a greater efficacy than day 1 or day 11.

In scientific terms one statement is not accurate, and one is. One has not actually been measured, and one has. It matters.

I see that in the pp you said that the efficacy 'changes' rather than 'builds' day by day.

Absolutely fair enough. It was the 'day by day' bit that I was questioning, as it suggests something more gradual than the curve suggests.

I probably didn't explain myself clearly.

@LemonTT of course, i didn’t mean to suggest it was that % effective immediately after administering. It takes time to mount an immune response after all. Still don’t believe we should be meddling outside of the manufacturer’s recommendations.

I think regarding Pfizer's vaccine, it is almos a gamble. I do want to read about the reasoning behind that. I have not found anything yet.

I do pray that they are right. I really hope it works. And that immunity and transmission are closely related. So once vaccinated, people acts as blockers for the virus.
Time will tell.
Regarding supply, they keep saying that they are distributing doses as fast as they are available. It should not be that difficult either. I have seen mass vaccination before in my life, and seriously, they could not be simpler. Pfizer needs the freezers, which will need some extra logistics.

So have we agreed then that the CMO et al are working on no data for people NOT vaccinated twice? They have no data on that as it was not trialed.

There is no suggestion to vaccinate once. The only change is the gap.

@ObliviouslyIgnorant regarding the pfizer vaccine, they must have arrived to the conclusion that two doses are needed, at 21 days intervals somehow. Presumably they had data saying that one dose is not enough. And then optimised the time between doses. And they arrived to the optimal, two doses, 21 days appart and you gain reliable immunity around two weeks after your last dose.
If they had data suggesting longee interval is ok, or only one dose, they would support the decission? That is what is worrying me. That Pfizer is not agreeable with this.

@cathyandclare

There is no suggestion to vaccinate once. The only change is the gap.

Is there any data yet on when immunity from the first dose starts to decline? It was my understanding that the flu vaccine loses efficacy pretty quickly.

I believe India have bought more of the AZ one than the U.K. currently have so a lot of stuff already manufactured has been sent there.

No, it's not been studied but the booster is being suggested in 4-12 weeks. It would be unusual to disappear in that time.

A Twitter thread talking about immunity and dose gapping in vaccination (someone else on here shared this) :

threadreaderapp.com/thread/1344949258483621888.html

@JacobReesMogadishu

I believe India have bought more of the AZ one than the U.K. currently have so a lot of stuff already manufactured has been sent there.

India are major vaccine manufacturers, so they have manufactured the vaccine under licence at the Serum Institute. We're really playing catch up with vaccine manufacturing.

@MushMonster

I think regarding Pfizer's vaccine, it is almos a gamble. I do want to read about the reasoning behind that. I have not found anything yet.

I do pray that they are right. I really hope it works. And that immunity and transmission are closely related. So once vaccinated, people acts as blockers for the virus.
Time will tell.
Regarding supply, they keep saying that they are distributing doses as fast as they are available. It should not be that difficult either. I have seen mass vaccination before in my life, and seriously, they could not be simpler. Pfizer needs the freezers, which will need some extra logistics.

The JCVI's reasoning is at app.box.com/s/uwwn2dv4o2d0ena726gf4403f3p2acnu This includes their reasoning and the evidence it is based on.

Pfizer is significantly more complex than the flu jab. Three reasons:

1. People understandably have many more questions than with the flu jab, which is very much roll up your sleeve and go. These take time and relevant expertise to answer.
2. The risk of anaphylaxis means additional medical support needs to be immediately available.
3. The practicalities of defrosting, diluting, drawing up, and maintaining the cold chain are actually quite complex.

Oh that makes sense that India can manufacture their own.

I think the biggest sticking point is going to be lack of vaccination slots due to lack of vaccinators/not enough sites/buildings rather than the actual medication.

They’re saying in 3 weeks time they’ll be manufacturing 2million doses a week. I’d be amazed if we actually vaccinate 2million people a week. Even if we did that’s going to be around six months to do everyone?

And that’s not even thinking about 2nd doses!

MushMonster - your assumptions are incorrrect. The Pfizer/BioNTech vaccine was only ever tested with two doses 21 days apart - even in Phase I. There was no time to do the optimisation you speak of. They don’t have data saying that 21 days is optimal, nor that one dose is insufficient.

They simply haven’t tested any alternative to 21 days. They know that there is high protection from 11 days after dose 1, and that this increases modestly after the second dose. They do not know about long-term protection as there is no data on this as enough time has not elapsed.

At the time of setting up the trials, it was not known how effective it would be, so they had to do an approach which got results quickly. Testing the optimal gap, or what happens with a longer gap would have delayed the test results.

According to the vaccine calculator im due sometime between January and July 2022.........i find that soooo depressing, suppose on the upside theyll have sorted out the dosage by then.

@Eyewhisker

MushMonster - your assumptions are incorrrect. The Pfizer/BioNTech vaccine was only ever tested with two doses 21 days apart - even in Phase I. There was no time to do the optimisation you speak of. They don’t have data saying that 21 days is optimal, nor that one dose is insufficient.

They simply haven’t tested any alternative to 21 days. They know that there is high protection from 11 days after dose 1, and that this increases modestly after the second dose. They do not know about long-term protection as there is no data on this as enough time has not elapsed.

At the time of setting up the trials, it was not known how effective it would be, so they had to do an approach which got results quickly. Testing the optimal gap, or what happens with a longer gap would have delayed the test results.

That was the shittiest clinical trial in history then!

There is no suggestion to vaccinate once. The only change is the gap

And given that there's already squabbling over supply vs delivery issues, what happens if there are insufficient doses available to give the second jab?
Will it turn into "you don't actually need a second one at all", with no research available to back this up but a couple of tame commentators brought on to reassure us all?

No-one here has mentioned that those having just received the Pfizer vaccine first dose (either 80-plus people or those working in front line health care) are now going to have a much lower % of immunity for the first 3 months, going forward (52% was mentioned by PPs), rather than what they were expecting to have, i.e. 95%, a week after their second dose.

These are either very vulnerable people, or very important health workers who really need max protection in order to help the sick or very frail. Now they will not have that increased protection for another 3 months. I find that disturbing.

I know we want to protect as many people as we can, but will we actually be achieving that for the oldest/most frail amongst us?