The vaccines | vaxxed boosted unvaxxed? New poll

[jojojo]

Another argument against boosters

Yep, the idea of recommending boosters this early bothers me. If we can find some way of determining who needs a third dose, to get optimum impact from the vaccine - which seems to be the case with organ transplant patients and some others on immune-suppressants, for example - then great. If it's chasing the dream of herd immunity via infection prevention I don't see it.

I think it risks discouraging the unvaxxed and part vaxxed from taking highly effective vaccines, which will make it worse than pointless. Plus, those vaccine doses are needed to save lives in other countries.

If we had a sterilising vaccine, then the calculation might be different, but these vaccines had disease prevention as their goal (and were and are good at it). Maybe a next generation vaccine will offer something more, but that's a different calculation again.

 

[jojojo]

L

Strange thing is it's only in the last few months where people close to me have had the virus and I've known locals who have died from it. In the first year and half or so I saw the figures but didn't really know anyone getting or certainly dying from it. Now all of a sudden have known many who are close friends and family. Would say in the last 7 months or so.

It's strange because although it's still here, we seem to have the vaccine roll out going well and figures are not as bad as they were say a year ago. Certainly locally.

I think that's been a common theme. People have seen the pandemic at different times. My family/friends were hit in the March 2020 wave - 4 people I knew died. In terms of my local area it was the winter 2020 peak that I saw kill a neighbour and hospitalise others before the vax reached their age group. Since the Delta wave started I've seen other family members catch covid (vaxxed 40-something parents/unvaxxed teens) but fortunately with no lasting damage.

It's that local and unpredictable thing that makes it hard for us as individuals to understand what's happening. Which means we have to keep going back to the numbers and the statistical stuff - which can make us forget every number is an individual.

 

[jojojo]

One for people who like graphs...

Vaccine take-up shown as a series of head to head comparisons across Europe. Click the link to go to the app and check them out. Germany don't publish take-up by age so they aren't included in the options.

Basically the more grey you see (particularly in the highest age bands) the bigger the problem the country is likely to hit if cases rise.



Hint: if you want to look at one of the smaller countries like Ireland v a large country, select the scale "different" option.

 

[mav_9me]

Another article showing the benefit of vaccines.

 

[jojojo]

A techie one. But, to quote the author's own TLDR "immune memory looks great and improves over time (even against variants). Boosting existing immunity w/ vaccine significantly increases antibody in the short-term but w/o much effect on already durable memory B/T cells."



Another part of the booster debate and of the, "do you only need a single dose of vaccine if you've already had covid?" approach.

 

[jojojo]

France was behind the UK in vaccine take-up for a long time - even once they had plenty of vaccine doses available. Then one day Macron said you can't go in a cafe if you've not been vaxxed...



Incidentally they also use single dose J&J vaccines and they have a policy of offering single dose mRNA vaccines to people who have previously tested positive for covid. Worth considering for the less enthusiastic and harder to reach groups perhaps?

Also a reminder that unanimity on what vaccine passports mean for travel could prove tricky.

 

[jojojo]

Just a brief diversion into why the vaxxed keep wanting more people vaxxed. I'm going to (over) simplify the actual maths modelling dramatically but hopefully it will still make sense.
Disclaimer: Anyone who knows the epidemiology should exit now as you'll find my attempt to simplify it infuriating

First: let's assume that an infected person (on average) can spread it to two people. It could be more depending on your work and your social life, it could be less of you work from home, live alone, are cautious when you go out etc. But averages are just that, averages.

Second: let's assume the current worst case results reported on vaccine effectiveness. These suggest it could be around 50% effective at stopping you getting infected (to a level where you test positive on a PCR).

In unvaxxed land:
1 infects 2 (after about 10 days)
2 infects 4 (after about 20 days)
4 infects 8 (after about 30 days)
"R rate = 2" - actually if everyone was behaving completely like the old normal R would be closer to 6, and the cases stemming from that first person would be in their hundreds. But in the UK at least we're not really back to behaving as we did.

In vaxxed land:
1 infects 1(after about 10 days)
1 infects 1 (after about 20 days)
1 infects 1 (after about 30 days)
"R rate = 1" - actually it is probably better than this because the evidence is building that the infected but vaxxed are less likely to be infectious.

Stir the vaxxed and unvaxxed together and the maths gets complicated, and you have to make a lot of allowances for how much mixing happens between different groups of people. What's currently happening in the UK is that the R rate nationally is just above R=1 - cases are growing slowly by about 10% per week.

Some events (with mostly unvaxxed attendees and lots of close proximity like overnight tent parties, squashed on the shuttle bus, sharing supplies) are tripping big surges. Others (like mostly vaxxed football crowds) currently aren't.

The maths for the UK is currently "just about getting away with it" in terms of hospitalisations etc, but can easily turn nasty as people start to mix more for work or leisure. Basically the more people who are vaxxed the safer everyone becomes. The odds of meeting someone infectious will reduce, which means the fewer of the vulnerable (vaxxed or not) will catch it, and there will be less illness around and fewer deaths.

 

[McGrathsipan]

Of the 30 covid patients in my hospital, 2 are vaccinated, one is fine barely on any O2. Other guy is intubated, sicker but I think that's due to bacterial pneumonia.

Is the pneumonia connected to Covid?

Sorry I am clueless

 

[Solius]

Is the pneumonia connected to Covid?

Sorry I am clueless

Yep.

 

[Solius]

Surely some of the 309 'When it's approved for my age group' posters have had theirs now. Change your votes, people.

 

[horsechoker]

Who are the ten years plus voters?

 

[Solius]

Who are the ten years plus voters?

The Venn diagram has them in the same circle as people who think Bruno wasn't fouled.

 

[Kasper]

Surely some of the 309 'When it's approved for my age group' posters have had theirs now. Change your votes, people.

I think less than 10% of people who voted regulary check this thread so I doubt this poll is reflective of the current vaccination quota on the caf, even with the adapted thread title. Re-doing the whole poll would probably give a more accurate picture.

 

[mav_9me]

Is the pneumonia connected to Covid?

Sorry I am clueless

Yep.

No. Completely different. I cannot say for sure but it's my opinion that the bacterial pneumonia is the bigger issue rather than covid19.

 

[WI_Red]

No. Completely different. I cannot say for sure but it's my opinion that the bacterial pneumonia is the bigger issue rather than covid19.

Seeing as how we have an effective vaccine for COVID I would agree. I spent a decade studying Streptococcus pneumoniae and we were concerned about seroswitching back then. The pneumoccal vaccines are serotype specific and we were seeing continued infections, especially in children, but they were just different serotypes.

 

[Cheimoon]

in case it's not been mentioned yet, here's a quote from today's Nature Briefing:

Vaccines don’t affect fertility
There is no evidence that COVID-19 vaccines affect any aspect of reproduction or sexual functioning. Four experts in reproductive and sexual biology look at the facts about vaccines and pregnancy, menstruation and sperm and erectile function.

This abstract refers to the following article with further details and references: https://www.scientificamerican.com/...igns-of-harming-fertility-or-sexual-function/. Its title and subtitle are this:

COVID Vaccines Show No Signs of Harming Fertility or Sexual Function
The novel coronavirus, in contrast, can disrupt both things in unvaccinated men and women

In case anyone still woried about this aspect.

 

[WI_Red]

in case it's not been mentioned yet, here's a quote from today's Nature Briefing:

This abstract refers to the following article with further details and references: https://www.scientificamerican.com/...igns-of-harming-fertility-or-sexual-function/. Its title and subtitle are this:

In case anyone still woried about this aspect.

They should check marriage next

 

[Cheimoon]

They should check marriage next

Although I suspect you actually know couples that were affected by this, and then it rather turns into something like

 

[Stookie]

I’ve been working on ICU this week and we have 11 patients all of whom have COVID. The youngest 19 the eldest 70. The common denominator is that none have had the vaccine. 4 of them on end of life care. We have seen a huge rise in pregnant women with COVID as well- 3 of which are on ICU, 2 after delivery and 1 is going into theatre tomorrow. All on ICU for COVID reasons. It seems this disease is affecting the younger much more severe than when it first reared it’s head.

 

[Pogue Mahone]

I’ve been working on ICU this week and we have 11 patients all of whom have COVID. The youngest 19 the eldest 70. The common denominator is that none have had the vaccine. 4 of them on end of life care. We have seen a huge rise in pregnant women with COVID as well- 3 of which are on ICU, 2 after delivery and 1 is going into theatre tomorrow. All on ICU for COVID reasons. It seems this disease is affecting the younger much more severe than when it first reared it’s head.

Worth bearing in mind that this isn’t because the virus is suddenly much more dangerous to young people. It’s because the older generations are much better protected with vaccines. Without vaccines you’d have at least 10 elderly admissions for each one of those youngsters.

It’s actually horrific to think what the hospitals would look like if society had opened up as much as it has without the incredible number of vaccines rolled out. Which highlights the insanity of those calling for everything to be opened up before any vaccines were available.

 

[Sparky Rhiwabon]

Aren’t we getting close to the point where it’s as good as it’s going to be with regards to number of people vaccinated and, therefore, the Covid situation in general? Surely, soon, everyone who wants to be vaccinated will have been. In fact, as time goes on less people will probably renew them as it’s no longer a “novelty“.

 

[Pogue Mahone]

@jojojo

Or anyone else who is deep into all this stuff. Is it just me or is all this “waning immunity” stuff not taking into account something really obvious?

Meanwhile, data from the UK-based Zoe Covid Study app, where users can log whether they have been vaccinated, Covid test results and symptoms, has suggested protection against infection after two shots of the Pfizer/BioNTech jab decreased from 88% at one month to 74% at five to six months, while protection against infection after two Oxford/AstraZeneca jabs fell from 77% to 67% at four to five months.

Surely the proportion of cases due to Delta has increased massively between the first one or two months after vaccination and five to six months? It’s not like the vaccines have been out all that long. So most people hitting six months post jab are getting infected at a time when they’re catching Delta. While most of the earlier, much higher, efficacy stats were generated when alpha was the only show in town.

So couldn’t all these concerns about waning immunity be entirely down to vaccines being a bit less effective against delta than alpha? A trend that boosters might not reverse?

 

[Revan]

Not in Germany.

Not true. You can easily take Jensen in Germany, and in consultation with a doctor, the Astrazeneca vaccine.

 

[jojojo]

@jojojo

Or anyone else who is deep into all this stuff. Is it just me or is all this “waning immunity” stuff not taking into account something really obvious?



Surely the proportion of cases due to Delta has increased massively between the first one or two months after vaccination and five to six months? It’s not like the vaccines have been out all that long. So most people hitting six months post jab are getting infected at a time when they’re catching Delta. While all the earlier, much higher, efficacy stats were generated when alpha was the only show in town.

So couldn’t all these concerns about waning immunity be entirely down to vaccines being a bit less effective against delta than alpha? A trend that boosters might not reverse?

Multiple effects at work I think. Pfizer is less effective against Delta than Alpha, and it was less effective against Alpha than against the Spring 2020 version (that the phase 3 data came from). The lab studies, the PHE surveillance etc all agree on those losses, but they're relatively small and protection against severe illness remains high.

It's also getting harder to obtain genuine matched control groups for doing effectiveness calculations. The higher the percentage vaccinated, the smaller the comparison group gets. Meanwhile, as more people catch covid, the number of actual immune-naive people is reduced, but we don't know by how much. Now throw in the fact that many of the unvaxxed will also be people who don't want to get tested and the confounding factors just keep rising.

Which brings us to Israel and the additional problem of moving the goalposts. The vaccine trials reported on symptomatic infection, with testing done in response to symptoms and efficacy reported against symptomatic infection. They weren't chasing data on asymptomatic infection. Once we talk about infection/transmission prevention we're asking the vaccines a different question.

Because of how good the vaccines are, people started expecting them to stop infections and it looks like while we're still flooded with the first flush of vaccine induced antibodies they do pretty well at it. Israel's data suggests that once those heavy antibody levels fall so does that inhibition on infection.

We also know that Delta has shorter delays from infection to symptom onset. Maybe the immune memory cells come in to antibody producing action too slowly to stop the infection before it gets a strong enough hold to test positive on PCR and show up as symptoms?

If we're chasing having high levels of covid neutralising antibodies all the time we will need boosters - but I must admit I'm not convinced that's a good or (for most of the population) necessary road to go down.

 

[WI_Red]

@jojojo

Or anyone else who is deep into all this stuff. Is it just me or is all this “waning immunity” stuff not taking into account something really obvious?



Surely the proportion of cases due to Delta has increased massively between the first one or two months after vaccination and five to six months? It’s not like the vaccines have been out all that long. So most people hitting six months post jab are getting infected at a time when they’re catching Delta. While most of the earlier, much higher, efficacy stats were generated when alpha was the only show in town.

So couldn’t all these concerns about waning immunity be entirely down to vaccines being a bit less effective against delta than alpha? A trend that boosters might not reverse?

I'm with you, sort of. I am not convinced the boosters are necessary. While antibodies are great and all what matters is memory cells. Our bodies don't keep high titers of antibodies floating around for everything we have ever encountered, that would just be stupid and is simply not how our immune systems work. As long as we are forming a long lasting, and robust, memory response to COVID we are fine. It is this response that, while it will most likely not prevent infection, will reduce the likelihood for severe symptoms and hospitalization. This is why the whole "OMG! I had the vaccine and I still got (asymptomatic) COVID! The vaccines don't work!" is so maddening. That is not how these things are supposed to work! Ugh. My (previous) profession is so bad a messaging and the general public is so bad a listening.

 

[WI_Red]

Multiple effects at work I think. Pfizer is less effective against Delta than Alpha, and it was less effective against Alpha than against the Spring 2020 version (that the phase 3 data came from). The lab studies, the PHE surveillance etc all agree on those losses, but they're relatively small and protection against severe illness remains high.

It's also getting harder to obtain genuine matched control groups for doing effectiveness calculations. The higher the percentage vaccinated, the smaller the comparison group gets. Meanwhile, as more people catch covid, the number of actual immune-naive people is reduced, but we don't know by how much. Now throw in the fact that many of the unvaxxed will also be people who don't want to get tested and the confounding factors just keep rising.

Which brings us to Israel and the additional problem of moving the goalposts. The vaccine trials reported on symptomatic infection, with testing done in response to symptoms and efficacy reported against symptomatic infection. They weren't chasing data on asymptomatic infection. Once we talk about infection/transmission prevention we're asking the vaccines a different question.

Because of how good the vaccines are, people started expecting them to stop infections and it looks like while we're still flooded with the first flush of vaccine induced antibodies they do pretty well at it. Israel's data suggests that once those heavy antibody levels fall so does that inhibition on infection.

We also know that Delta has shorter delays from infection to symptom onset. Maybe the immune memory cells come in to antibody producing action too slowly to stop the infection before it gets a strong enough hold to test positive on PCR and show up as symptoms?

If we're chasing having high levels of covid neutralising antibodies all the time we will need boosters - but I must admit I'm not convinced that's a good or (for most of the population) necessary road to go down.

From a pure science perspective the difference in Pfizer/Moderna is fascinating. They are using the same protein sequence for their vaccine, with the only differences being in the leading and trailing portions of the mRNA strand and the carrier nanoparticles. There is so much to learn from this to optimize the next generation of mRNA vaccines!

 

[mav_9me]

@jojojo

Or anyone else who is deep into all this stuff. Is it just me or is all this “waning immunity” stuff not taking into account something really obvious?



Surely the proportion of cases due to Delta has increased massively between the first one or two months after vaccination and five to six months? It’s not like the vaccines have been out all that long. So most people hitting six months post jab are getting infected at a time when they’re catching Delta. While most of the earlier, much higher, efficacy stats were generated when alpha was the only show in town.

So couldn’t all these concerns about waning immunity be entirely down to vaccines being a bit less effective against delta than alpha? A trend that boosters might not reverse?

I actually don't see the waning immunity. Lower levels of antibodies are not a problem as @WI_Red pointed out.

Protection against hospitalizations and deaths continues to be excellent. This is where it might be a touch lower with delta but still very very good.

 

[mav_9me]

From a pure science perspective the difference in Pfizer/Moderna is fascinating. They are using the same protein sequence for their vaccine, with the only differences being in the leading and trailing portions of the mRNA strand and the carrier nanoparticles. There is so much to learn from this to optimize the next generation of mRNA vaccines!

I don't know much about biontech but I'm impressed with Moderna. Obviously I think mRNA technology is revolutionary for medicine. Question is which of these two companies is better? If one is better to begin with.

Ps. I need to read more regarding the differences in their technologies, and implications for future.

 

[mav_9me]

As I am writing these posts someone just sent me this.

https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1.full.pdf

Argues in favor of Moderna over Pfizer and notes decreased efficacy in July likely due to higher delta. Interesting. Don't have time to read the whole article. But will look out for discussion on this.

 

[jojojo]

This Twitter thread brings a lot of the current booster debate/data together:

 

[Wolverine]

https://www.timesofisrael.com/covid-booster-shots-raise-protection-against-severe-illness-to-97-tv/

After 16 days, a third coronavirus vaccine dose boosts protection against severe illness from the virus to 97 percent, according to Health Ministry figures cited by Channel 12 news on Wednesday night.

The network also said that 16 days after the booster shot is administered, protection against infection jumps to 95%. According to the report, while the level of antibodies is considerably higher within seven days of the shot, they appear to reach their peak after 16 days.

More than 1.7 million Israelis have received a booster dose since the shots first became available on August 1. As of Tuesday, the third doses are available to all Israelis over the age of 30. More than 70% of those over the age of 70 have already received a third dose of the vaccine.

In about a month or so I think we'll have more clearer evidence regarding booster shots possibly

 

[Pogue Mahone]

https://www.timesofisrael.com/covid-booster-shots-raise-protection-against-severe-illness-to-97-tv/



In about a month or so I think we'll have more clearer evidence regarding booster shots possibly

Wow. Didn’t realise they were boosting everyone over 30. If that efficacy vs infection persists they could get close to herd immunity.

 

[Pexbo]

Obviously I’m no expert but it seems to be to be a zero sum game and with a finite production capacity it would make morse sense both ethically and strategically to focus on getting the rest of the world vaccinated to some degree than finessing a few extra percentage of efficacy for the richer, developed nations.

 

[11101]

As I am writing these posts someone just sent me this.

https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v1.full.pdf

Argues in favor of Moderna over Pfizer and notes decreased efficacy in July likely due to higher delta. Interesting. Don't have time to read the whole article. But will look out for discussion on this.

There are a couple of these studies coming out which suggest similar, though the difference is small. Could be due to the larger dose given in Moderna?

As a company, Moderna do nothing else but mRNA and this is their first and only product. This quote from their last earnings kind of sums them up:

Total revenue was $4.4 billion for the three months ended June 30, 2021, compared to $67 million for the same period in 2020.

They've gone from a small, loss making research house to a multi billion dollar company overnight. You'd imagine they're pretty good at mRNA but at the same time they don't have anywhere near Pfizer's expertise in scaling up production.

 

[jojojo]

Wow. Didn’t realise they were boosting everyone over 30. If that efficacy vs infection persists they could get close to herd immunity.

They'd need to vaccinate a lot more people though, not just boost the currently vaxxed. They've vaccinated around 65% of the population. More significantly on the severe disease front they've vaccinated around 90% of their over 70s. That's not enough to protect their hospitals.

I understand the desire to offer the best protection possible to those willing to be protected. But I worry it will come at the cost of more vaccine hoarding by the rich countries and it's not a great way to encourage the hesitant unvaxxed to get jabbed, which would save more lives and have a bigger impact on infection growth.

We'll know more from both Israel and the UK over the next few weeks. Which hopefully Ireland and other countries can benefit from in making their own plans.

 

[Pogue Mahone]

They'd need to vaccinate a lot more people though, not just boost the currently vaxxed. They've vaccinated around 65% of the population. More significantly on the severe disease front they've vaccinated around 90% of their over 70s. That's not enough to protect their hospitals.

I understand the desire to offer the best protection possible to those willing to be protected. But I worry it will come at the cost of more vaccine hoarding by the rich countries and it's not a great way to encourage the hesitant unvaxxed to get jabbed, which would save more lives and have a bigger impact on infection growth.

We'll know more from both Israel and the UK over the next few weeks. Which hopefully Ireland and other countries can benefit from in making their own plans.

It’s a different approach. If you can get extremely high protection vs infection in everyone vaccinated that can suppress disease to a level that protects everyone else. Which they achieved pre-delta and are presumably hoping they can do again. An approach that these early booster effectiveness results would seem to endorse.

I agree re both your points about vaccine hoarding and undermining the confidence in vaccines. But I’m sure they would argue that this approach is still easier/quicker than changing the minds of the most sceptical and/or trying to help vaccinate the whole world.

 

[jojojo]

It’s a different approach. If you can get extremely high protection vs infection in everyone vaccinated that can suppress disease to a level that protects everyone else. Which they achieved pre-delta and are presumably hoping they can do again. An approach that these early booster effectiveness results would seem to endorse.

I agree re both your points about vaccine hoarding and undermining the confidence in vaccines. But I’m sure they would argue that this approach is still easier/quicker than changing the minds of the most sceptical and/or trying to help vaccinate the whole world.

It depends on how much inter-community mixing occurs. Vaccination patterns are uneven in Israel with some orthodox communities having lower take-up but also not mingling much with the wider society. Case rates have been higher in higher income, more mobile groups in Israel - so I guess you might get a kind of mini herd created of whole groups of people.

Hospitalisation rates are high, but from what few raw statistics have been revealed (a lot of the Israel's reporting seems to be in the form of a couple of PowerPoint slides per week) overall they're only where you'd expect them to be in a country with "only" 90% of over 70s vaxxed.

There's a lot of work going on trying to see how the UK and Israel data map onto each other. Is it just that they are a month or so ahead on the waning immunity front? Or are they really just seeing different behavioural factors or chasing different outcomes. Unfortunately the answer is probably - all the above and more.

Which may mean there's no clear answer to the, do you offer boosters (if so, to who?) and does that mean that vaccine passports etc are even more of a lottery (are we now talking about 6/9/12 monthly top-ups etc).

Things that might do more harm than good when it comes to core messages about social cohesion, encouraging vaccination etc.

 

[djembatheking]

Obviously I’m no expert but it seems to be to be a zero sum game and with a finite production capacity it would make morse sense both ethically and strategically to focus on getting the rest of the world vaccinated to some degree than finessing a few extra percentage of efficacy for the richer, developed nations.

My thoughts exactly, it seems totally wrong that while we are back to living a fairly normal life that we are thinking about boosters while there are many less fortunate countries still not seen a vaccine and probably still not had Delta yet.

 

[WI_Red]

Anti-vaxx sister in law just tested positive. She’s an ER nurse and was mandated to get vaccinated. Got her first Moderna dose a few days before her positive test. I would say whatever but my little niece also just tested positive, a week after having strep throat. Two more nieces that are also not vaccinated and I can’t imagine they are not infected by now. Sent them all to school yesterday (before nieces positive test) too the insane witch. Husband is a Trumper and she “lets him decide” these types of things. Fuming right now.

 

[AllGoodNamesRGone]

Anti-vaxx sister in law just tested positive. She’s an ER nurse and was mandated to get vaccinated. Got her first Moderna dose a few days before her positive test. I would say whatever but my little niece also just tested positive, a week after having strep throat. Two more nieces that are also not vaccinated and I can’t imagine they are not infected by now. Sent them all to school yesterday (before nieces positive test) too the insane witch. Husband is a Trumper and she “lets him decide” these types of things. Fuming right now.

An ER nurse that is anti vaxx? That should be grounds to be struck off. Such a dangerous thing in such a profession.