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The vaccine

The home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
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This is the home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
AleisterCrowley
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Re: The vaccine

#423833

Postby AleisterCrowley » June 30th, 2021, 8:27 pm

Lootman wrote:Agreed, I think that the AZN vaccine is perfect for developing countries and/or places that lack either the funds to buy the more expensive vaccines or else lack the cold chain technology to deliver it.

And none of them deliver 100% protection. It is good to have a choice and I was merely stating what my choice would be, and why.


Not just 'developing countries' - much easier to roll out to village halls/sports arenas/whatever.
I had the AZN vaccine in a 'function room' up in Pangbourne - and I was more comfortable with the more robust vaccine in that case.
If I'd been vaccinated at a major hospital I'd probably have preferred the Pfizer - not that anyone has the choice.

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Re: The vaccine

#423837

Postby Lanark » June 30th, 2021, 8:42 pm

Lootman wrote:
Lanark wrote:
Lootman wrote:Odd in a way coming right on the tails of Pfizer and Moderna stating that the immunity granted by their vaccines may last "several years".

Maybe this is all back down to the Astra Zeneca product being second rate? But at least it is cheap and the NHS loves cheap.

The Astra Zeneca vaccine is in no way second rate, what are you basing that claim on?

The original test data had the AZN efficacy at averaging in the 70% range whereas PZE and MRNA were over 90%. There were more negative side-effects from AZN than its competitors. It has failed the US FDA criteria and has not been approved there, whilst various European nations have stopped using AZN, at least for certain demographics.

It may be way better than nothing, and the price is right, but most people would choose another if they were given a choice.

One dosing regimen (n=2,741) showed vaccine efficacy of 90% when AZD1222 was given as a half dose, followed by a full dose at least one month apart, and another dosing regimen (n=8,895) showed 62% efficacy when given as two full doses at least one month apart. The combined analysis from both dosing regimens (n=11,636) resulted in an average efficacy of 70%. Nov 2020

Real world data from PHE, published as a pre-print, demonstrated two doses of COVID-19 Vaccine AstraZeneca are 92% effective against hospitalisation due to the Delta variant and showed no deaths among those vaccinated. The vaccine also showed a high level of effectiveness against the Alpha variant (B.1.1.7; formerly the ‘Kent’ variant) with an 86% reduction of hospitalisations and no deaths reported. June 2021

If you dig out the results for Pfizer or any other vaccine you will find percentages for different trials conducted on different populations in different conditions/times. So NONE of them are directly comparable.

Choosing a vaccine is not like buying a car where you can narrow down minor differences to make the best decision. Any vaccine which has greater than 60% effectiveness is a first class vaccine.

We don't know what new variants may be around the corner and a vaccine which is 10% better at fighting the delta variant may turn out to be 10% worse at the epsilon variant (or whatever name comes next)

murraypaul
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Re: The vaccine

#423839

Postby murraypaul » June 30th, 2021, 9:12 pm

Lanark wrote:
Lootman wrote:Maybe this is all back down to the Astra Zeneca product being second rate? But at least it is cheap and the NHS loves cheap.

The Astra Zeneca vaccine is in no way second rate, what are you basing that claim on?


I think it is fair to say that the trials and results so far show that AZ does seem to perform worse than Pfizer.
But it isn't fair to say the UK/NHS loved AZ because it was cheap, we/they loved it because it was available.
If we had sat and waited for Pfizer doses we would have the same low levels of vaccinations that most of the EU do.

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Re: The vaccine

#423854

Postby Lanark » June 30th, 2021, 11:32 pm

murraypaul wrote:I think it is fair to say that the trials and results so far show that AZ does seem to perform worse than Pfizer.


I disagree, they may have percentage rates that are slightly lower, but those numbers are not comparable because the studies are not the same.
If we were talking about a 20% difference, that might be notable, but 5% is within the error tolerance.

In several of the covid studies just adding or removing a single case would make a huge difference to the numbers.

I'm not saying that AZ is better than Pfizer, I'm saying we don't know.

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Re: The vaccine

#423880

Postby Mike4 » July 1st, 2021, 8:18 am

murraypaul wrote:I think it is fair to say that the trials and results so far show that AZ does seem to perform worse than Pfizer.



I think if there was a way to compare the sheer number of infections prevented in the community by the AZ and by the Pfizer, the AZ would prove to have been more beneficial to society as a whole by a country mile. Mainly because it was available to more people more quickly due to it not requiring specialist storage and transport.

Lootman
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Re: The vaccine

#423885

Postby Lootman » July 1st, 2021, 9:04 am

Mike4 wrote:
murraypaul wrote:I think it is fair to say that the trials and results so far show that AZ does seem to perform worse than Pfizer.

I think if there was a way to compare the sheer number of infections prevented in the community by the AZ and by the Pfizer, the AZ would prove to have been more beneficial to society as a whole by a country mile. Mainly because it was available to more people more quickly due to it not requiring specialist storage and transport.

But that was not the question here, which was more about how they compare on a shot-by-shot basis.

So sure, yes, for the millions living in the poorest parts of Africa and Asia, AZN may be more useful. But the question is for people in the West, who have a choice or at least should have one. And I maintain that based on the data most reasonable people would want the jab with the better numbers (and as it turns out, the fewest side-effects). The newest data also shows that the Pfizer and Moderna vaccines are longer-lasting and more effective against variants.

So there is a place for the AZN vaccine. It's just not in my arm IF I can get one of the others instead. Of course in practice the only way to have a choice is to figure out which vaccination centre is offering which vaccine before you go.

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Re: The vaccine

#423915

Postby murraypaul » July 1st, 2021, 10:54 am

Lootman wrote:But the question is for people in the West, who have a choice or at least should have one.

And now there are enough doses available, they do.
All under 40s in the UK are offered an alternative to AZ, and effectively all over 40s who want a vaccine will already have had one, so in practice everyone has a choice.

So there is a place for the AZN vaccine. It's just not in my arm IF I can get one of the others instead.

If I'd been offered a choice, I would have chosen Pfizer. But it meant waiting, I'd have taken the AZ straight away rather than Pfizer later.
Any vaccine is far far better than no vaccine, and the differences between them are small.

We are arguing about what sort of sides we want with our steak.

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Re: The vaccine

#424210

Postby Julian » July 2nd, 2021, 12:14 pm

There's not enough data yet to draw too many high confidence conclusions re double dosing but the table on page 9 of the latest PHE vaccine efficacy report does seem to be heading in the direction of showing the Pfizer vaccine to be at least 10% more effective than the AZ vaccine across the board (https://assets.publishing.service.gov.u ... eek_26.pdf).

As an AZ recipient I don't like typing that and as mentioned more data might adjust or even reverse some or all of the comparisons seen in table 3. I have heard some expert opinion speculating that the AZ vaccine takes longer to reach full efficacy than the Pfizer vaccine. That has been seen to be the case after the first dose in previous PHE reports with the AZ vaccine continuing to gain efficacy after day 35 whereas the Pfizer vaccine's efficacy had plateaued by then; there is a school of expert though that the same slower efficacy growth might be true for the second dose too. We need more time to collect more data before we can be sure.

My personal emotional reaction (as in my instinct because as mentioned there is not enough data to do a fully informed comparison) is that when I got my first vaccine it was shortly after the UK extended the dosing interval and there was some clinical trial data hinting that AZ efficacy actually benefited from an extended dosing interval whereas there was no data for what it would do to Pfizer efficacy so I walked to the clinic hoping that it would be an AZ vaccine that I would get. If I had my time again, having seen all the PHE observational reports, I would have preferred the Pfizer vaccine. In 6 months time it will probably be academic though since as a healthy over 60 I suspect I will get offered a booster in maybe October or early November and if they go for mixing vaccine types for the booster, which I hope they do if the data supports it and so for it seems to, I will probably end up with a Pfizer or Moderna jab and get to >90% protection against hospitalisation and death thereafter.

- Julian

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Re: The vaccine

#424215

Postby Mike4 » July 2nd, 2021, 12:24 pm

Julian wrote:<snip> I will probably end up with a Pfizer or Moderna jab and get to >90% protection against hospitalisation and death thereafter.

- Julian


I do find the way the trials lump these two outcomes together perplexing, given hospitalisation and death are totally different outcomes, and neither is necessarily dependent on the other.

Hospitalisation is a serious outcome but far preferable to death, so should be recorded separately in my opinion.

Also, presumably one has to both be hospitalised AND die to be recorded in that category. Where are people who die without being admitted to hospital recorded, I find myself wondering, and how many people are hospitalised and recover?

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Re: The vaccine

#424218

Postby Julian » July 2nd, 2021, 12:34 pm

Mike4 wrote:
Julian wrote:<snip> I will probably end up with a Pfizer or Moderna jab and get to >90% protection against hospitalisation and death thereafter.

- Julian


I do find the way the trials lump these two outcomes together perplexing, given hospitalisation and death are totally different outcomes, and neither is necessarily dependent on the other.

Hospitalisation is a serious outcome but far preferable to death, so should be recorded separately in my opinion.

Also, presumably one has to both be hospitalised AND die to be recorded in that category. Where are people who die without being admitted to hospital recorded, I find myself wondering, and how many people are hospitalised and recover?

They don't lump them together. All trials split out those 2 categories. So do the observational studies since in both cases they are quite easy to collect whereas determining whether a symptomatic case is mild, moderate or severe for instance requires a precise definition of the number and/or severity of symptoms that determines what category to place an infection in.

I should probably have said "get to >90% protection against both hospitalisation and against death thereafter". If I hope to meet the tentative Pfizer 2 dose efficacy as reported (with medium confidence) in that PHE report it would actually be a lower confidence bound of 90% against hospitalisation and 95% against death so the categories are reported on separately.

- Julian

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Re: The vaccine

#424220

Postby XFool » July 2nd, 2021, 12:36 pm

Mike4 wrote:
Julian wrote:<snip> I will probably end up with a Pfizer or Moderna jab and get to >90% protection against hospitalisation and death thereafter.

- Julian

I do find the way the trials lump these two outcomes together perplexing, given hospitalisation and death are totally different outcomes, and neither is necessarily dependent on the other.

Surely that isn't true? Anyone sick enough to end up dying from COVID-19 will already be in hospital. At least, this will be true in developed countries such as the UK.

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Re: The vaccine

#424221

Postby Mike4 » July 2nd, 2021, 12:42 pm

XFool wrote:
Mike4 wrote:
Julian wrote:<snip> I will probably end up with a Pfizer or Moderna jab and get to >90% protection against hospitalisation and death thereafter.

- Julian

I do find the way the trials lump these two outcomes together perplexing, given hospitalisation and death are totally different outcomes, and neither is necessarily dependent on the other.

Surely that isn't true? Anyone sick enough to end up dying from COVID-19 will already be in hospital. At least, this will be true in developed countries such as the UK.


So why do they specify hospitalisation and death? Surely counting the deaths wherever they happen would be better, even though most (but not all) happen in hospital. Why do they only count deaths occurring in hospital? People die of Covid hypoxia without even realising they are that ill, AIUI.

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Re: The vaccine

#424224

Postby servodude » July 2nd, 2021, 12:58 pm

Mike4 wrote:
XFool wrote:
Mike4 wrote:I do find the way the trials lump these two outcomes together perplexing, given hospitalisation and death are totally different outcomes, and neither is necessarily dependent on the other.

Surely that isn't true? Anyone sick enough to end up dying from COVID-19 will already be in hospital. At least, this will be true in developed countries such as the UK.


So why do they specify hospitalisation and death? Surely counting the deaths wherever they happen would be better, even though most (but not all) happen in hospital. Why do they only count deaths occurring in hospital? People die of Covid hypoxia without even realising they are that ill, AIUI.


It was originally because no-one died in the studies (in the vax group from a covid thing)
- very very few became seriously ill so they extrapolated the claim
It is a bit of a conflation but I can get what they mean


-sd

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Re: The vaccine

#424225

Postby XFool » July 2nd, 2021, 1:01 pm

Mike4 wrote:
XFool wrote:
Mike4 wrote:I do find the way the trials lump these two outcomes together perplexing, given hospitalisation and death are totally different outcomes, and neither is necessarily dependent on the other.

Surely that isn't true? Anyone sick enough to end up dying from COVID-19 will already be in hospital. At least, this will be true in developed countries such as the UK.

So why do they specify hospitalisation and death? Surely counting the deaths wherever they happen would be better, even though most (but not all) happen in hospital. Why do they only count deaths occurring in hospital? People die of Covid hypoxia without even realising they are that ill, AIUI.

I do not know but suspect the number who die outside hospital is small compare to those who do die in hospital. Then again, how do you know they are not counted? Does 'hospitalisation AND death' mean 'hospitalisation AND hospitalisation + death' or simply 'deaths + hospitalisation AND hospital deaths'?

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Re: The vaccine

#424226

Postby Mike4 » July 2nd, 2021, 1:10 pm

servodude wrote:
Mike4 wrote:
XFool wrote:Surely that isn't true? Anyone sick enough to end up dying from COVID-19 will already be in hospital. At least, this will be true in developed countries such as the UK.


So why do they specify hospitalisation and death? Surely counting the deaths wherever they happen would be better, even though most (but not all) happen in hospital. Why do they only count deaths occurring in hospital? People die of Covid hypoxia without even realising they are that ill, AIUI.


It was originally because no-one died in the studies (in the vax group from a covid thing)
- very very few became seriously ill so they extrapolated the claim
It is a bit of a conflation but I can get what they mean


-sd


Ah I see, thanks.

So when no-one dies in the vax group, all the results come back as 100% effective which isn't actually very helpful... So they added in hospitalisation to bump up the figures, yes?

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Re: The vaccine

#424227

Postby onthemove » July 2nd, 2021, 1:11 pm

Mike4 wrote:
XFool wrote:
Mike4 wrote:I do find the way the trials lump these two outcomes together perplexing, given hospitalisation and death are totally different outcomes, and neither is necessarily dependent on the other.

Surely that isn't true? Anyone sick enough to end up dying from COVID-19 will already be in hospital. At least, this will be true in developed countries such as the UK.


So why do they specify hospitalisation and death? Surely counting the deaths wherever they happen would be better, even though most (but not all) happen in hospital. Why do they only count deaths occurring in hospital? People die of Covid hypoxia without even realising they are that ill, AIUI.


I don't believe they are considering only deaths in hospital.

"hopsitalisation and death" is talking about an aggregation of categories - one category being 'hospitalisation', and the other category being 'death' - so the overall aggregated category includes hospitalisations and it includes deaths, but it doesn't mean literally only deaths in hospital

If you were to take it literally as a logical "and", it wouldn't then include people who were hospitalised but didn't die. Which would not be consistent with the context in which the researchers used the term.

Surely it is obvious from the contexts that they aren't literally meaning "only those who have died and who were in hospital"... why would they exclude deaths outside hospital, and why would the exclude hospitalisations that didn't involve death. It would make no sense.

So the obvious interpretation for the majority of people is that they are talking about an aggregation of hospitalisations, and of deaths, into a single group.

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Re: The vaccine

#424232

Postby XFool » July 2nd, 2021, 1:19 pm

XFool wrote:Does 'hospitalisation AND death' mean 'hospitalisation AND hospitalisation + death' or simply 'deaths + hospitalisation AND hospital deaths'?

I think that should have been written as:

Does 'hospitalisation AND death' mean 'hospitalisation + hospitalisation AND death' or simply 'hospitalisation + hospital deaths + non hospital deaths'?

Perhaps better expressed in plain English, as in post above. ;)

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Re: The vaccine

#424306

Postby tjh290633 » July 2nd, 2021, 10:18 pm

Are we not back to discussing "Death within 28 days of a positive test", Death with Covid mentioned on the death certificate, Death where Covid is mentioned but is not the cause of death, and probably Death from respiratory disease?

Why do the daily figures not include Hospitalisations? I would have thought that was a better yardstick than deaths.

TJH

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Re: The vaccine

#424321

Postby Julian » July 2nd, 2021, 11:25 pm

tjh290633 wrote:Are we not back to discussing "Death within 28 days of a positive test", Death with Covid mentioned on the death certificate, Death where Covid is mentioned but is not the cause of death, and probably Death from respiratory disease?

Why do the daily figures not include Hospitalisations? I would have thought that was a better yardstick than deaths.

TJH

They do give hospitalisation data. Look in the “healthcare” section where it has tables for daily admissions, current total in hospital and current total on mechanical ventilation - https://coronavirus.data.gov.uk/details/healthcare.

There is a purely administrative issue with reporting these numbers however which means that the daily figures can be be updated erratically and sometimes “stall” for up to a week before another day’s worth of data comes in as opposed to the cases, deaths and vaccination numbers which, baring some exceptional issue, are updated every day like clockwork at about 4:00pm to reflect the previous day. For instance right now the latest healthcare data figures are for June 28th. The admin issue is that all the various health trusts submit their figures individually, probably having to chase their individual hospitals to get them which might be why often they report a number of days after the day in question. That means that the overall picture comes in to the government in dribs and drabs and they don’t put up a day’s data until everyone has reported their numbers for that day so for instance the reason why we don’t have any data for 29 June yet is almost certainly because there will be one or more trusts who have still not submitted their figures for that day so the national totals for that day are not yet available.

Re the definition of deaths, if we”rep talking about clinical trial data then each death is individually investigated by the clinical trial team and a full medical diagnosis is used for the cause(s) of death, certainly no COVID-19 death would be excluded from a clinical trial death count simply because the unlucky volunteer had first tested positive more than 28 days before death. With the observational studies I have been linking to the mortality data is taken from the NHS and ONS mortality which I believe by that time is using death certificate data so again not subject to invalid exclusions from this 28 day thing.

- Julian

- Julian

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Re: The vaccine

#424443

Postby Julian » July 3rd, 2021, 2:16 pm

On the subject of vaccines and the "is Pfizer better than AZ?" debate here's one very encouraging bit of news that slipped under the radar a bit...

Early clinical data from studies of the NVX-CoV2373 vaccine (Novavax), a recombinant nanoparticle vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that contains the full-length spike glycoprotein of the prototype strain plus Matrix-M adjuvant, showed that the vaccine was safe and associated with a robust immune response in healthy adult participants.
...
A total of 15,187 participants underwent randomization, and 14,039 were included in the per-protocol efficacy population. Of the participants, 27.9% were 65 years of age or older, and 44.6% had coexisting illnesses. Infections were reported in 10 participants in the vaccine group and in 96 in the placebo group, with a symptom onset of at least 7 days after the second injection, for a vaccine efficacy of 89.7% (95% confidence interval [CI], 80.2 to 94.6). No hospitalizations or deaths were reported among the 10 cases in the vaccine group. Five cases of severe infection were reported, all of which were in the placebo group. A post hoc analysis showed an efficacy of 86.3% (95% CI, 71.3 to 93.5) against the B.1.1.7 (or alpha) variant and 96.4% (95% CI, 73.8 to 99.5) against non-B.1.1.7 variants. Reactogenicity was generally mild and transient. The incidence of serious adverse events was low and similar in the two groups.


[ Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2107659 ]

This was a fairly recent UK trial so at the time the Alpha variant was dominant which, while not having the same level of escape as for instance the Beta (first seen in South Africa) variant, has still been shown to have a modest impact on the efficacy of the AZ and Pfizer vaccines (and others) re symptomatic illness and other efficacy numbers so the fact that the Novavax vaccine showed 86.3% efficacy against Alpha and 96.4% against non-alpha (against symptomatic illness) puts it right up there with the Pfizer and Moderna vaccines at least on the basis of the phase 3 trials since those mRNA trials were much earlier with less exposure to some of the more challenging new variants. The icing on the cake is also that the Novavax vaccine is going to be manufactured locally in the UK with 60m doses on order [ Source: https://www.nepic.co.uk/blog/memberpost ... illingham/ ]. It's also stored at regular fridge temperatures.

Not yet approved but the trial data looks good so hopefully approval will come soon and give the UK, and ultimately by donation some of the rest of the world, another really good vaccine. All reasons to be cheerful I think.

- Julian


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