Exactly. I don't think an I.M injection is that hard to train for either . In India we always had to do 24-48 hr shifts but laws in the UK prevent that which is absolutely right in general circumstances but right now they should get everyone involved & just get this thing done whatever way possible
The vaccines | vaxxed boosted unvaxxed? New poll
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Exactly. I don't think an I.M injection is that hard to train for either . In India we always had to do 24-48 hr shifts but laws in the UK prevent that which is absolutely right in general circumstances but right now they should get everyone involved & just get this thing done whatever way possible
I think they've updated the rules to allow other HCWs to train. Groups like St Johns Ambulance have been asked to identify what training is needed if they or the first aiders they've trained are involved as well.
I suspect the first real rule/procedure change will be in division of labour though. With the injector not having responsibility for the paperwork the pre-vaccine health/suitability checks or the post vaccine monitoring. I assume the bigger sites (sports halls?) will have someone loading the (multidose) vials into the syringes as well. More like production lines really for the patients who can handle the travel
Leaving the GPs/local nurses to concentrate on patients who can't/won't go to the centres, home visits, carehomes etc.
This is a key part of their decision:
They are saying the first dose works “at least in the short term” and the second dose is “likely to be important for longer term” because they do not know the conclusive answer to either. It is optimised after dose 2, but they can’t say to what degree it is optimised, and they can only speculate in the ways it is optimised.
The first dose works until at least day 21. Afterwards they believe it still works to a satisfactory level but they don’t know, because the data doesn’t exist. They think the second dose is important for longer term protection, but how much longer term? They don’t know. It could be two months, two weeks, two years. They also don’t know whether delaying the second jab for Pfizer will actually decrease the overall length of immunity offered by it, because it’s not something anyone has any data on. It isn’t an unknown question, the complete trial specifications are publicly available and Pfizer have reiterated the point.
All you can do is compare Pfizer’s vaccine to AZ and other current ones now, and assume they respond similarly in dosing schedule variations. But we know they don’t respond similarly. After day 14 of dose 1 Pfizer’s kicks in almost fully, until dose 2. AZ’s still gets progressively better at that point, it doesn’t get anywhere close to its peak protection level even a month after dose 1, and it still improves a fortnight after dose 2. So it’s just the reality that the comparison between the two is very limited. Better scientists can make better decisions with less data but their decisions are still inherently limited by the data.
They are using very careful language and revealing very little information because there is very little information to reveal. Their lack of transparency on that is very dangerous for public trust, IMO. They should be much clearer about the uncertainties now because if they’re clarified in 2 months’ time after an unexpectedly high number of vaccinated people get COVID, things will spiral. They are exposing individuals to more risk in the interest of serving the wider population quicker. They need to tackle that head on. Choosing to only highlight the positives and glossing over the negatives is wrong in a situation this serious.
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This nonsense won't just affect the UK, a developed, internationally-visible* country playing around with schedules gives cover to everybody else.
*Indian Oxford/AZ approval is supposed to follow UK approval, obviously developments in the west are being looked at.
*Indian Oxford/AZ approval is supposed to follow UK approval, obviously developments in the west are being looked at.
I don't understand those numbers. Does the 80% "after dose 1" include the time after dose 2 as well? Because the between doses numbers don't look promising in the slightest.
I also saw the equivalent Moderna data on twitter - worth noting that the sample size for it is ~10% of the sample for the actual 2-dose trial.
Hopefully they'll at least do a bit of PR damage limitation and announce that for the Pfizer single dose they'll be doing bloodtests on a couple of hundred of the already vaccinated group, tracking antibody levels at 4/6 weeks or something. Just something to make it sound more like science and less like panic, and something that will actually contribute to the dataset.
On AZ, there is already some evidence to suggest that the longer delay between doses does no harm and may even do some good. So that one seems like a straightforwardly good decision to me - a reflection both of the emergency and the science.
we're usually on the opposite side of big pharma love here, but how will it benefit pzifer's bottom-line when the vaccine has been pre-ordered; in fact, wouldn't giving more people a pfizer 1st dose make it incubent upon the govt to also get them the pfizer 2nd dose?
Yeah the 80% is inclusive of the second dose, so it’s essentially drawing a distinction between the 95% efficacy x days after dose 2, and the slightly lower overall efficacy after vaccination begins. Some people get symptoms in between dose 1 and 2 essentially.
Then in between doses number is a bit incomprehensible too. I think it includes the 7 days before day 14 where almost no protection is offered, and 7 days after 14 where almost full protection is offered. That’s what gives you the almost 50% efficacy. In reality the “protection starts after day 14” description is the most useful one.
Agreed!
Just booked myself in for first vaccine dose on Tuesday morning. Probably the first time in my life I'm excited about getting an injection.
Seen so much anger from certain doctors, immunologists etc - people who I've otherwise found to be very calming and reliable Twitter follows throughout the pandemic - really criticising the Oxford vaccine heavily.
Are there any decent articles that can explain in relative layman's terms what the issues are? Nothing conspiracy based or overly technical?
From the small bit of research I've done, they seem largely to be focusing on the error in dosing, the press releases that have been put out and the lack of immunosupressed and elderly trial participants. Are these the three main things?
I've seen people go as far as saying that Oxford's clinical trials are a goldmine for anti-vaxxers... so I want to find out the actual facts.
Only taking notice because it's from people I've found sound minded and intelligent...people who have been praising the Moderna and Pfizer vaccines - and before the trial data was released, were hugely optimistic for the Oxford vaccine too.
Are there any decent articles that can explain in relative layman's terms what the issues are? Nothing conspiracy based or overly technical?
From the small bit of research I've done, they seem largely to be focusing on the error in dosing, the press releases that have been put out and the lack of immunosupressed and elderly trial participants. Are these the three main things?
I've seen people go as far as saying that Oxford's clinical trials are a goldmine for anti-vaxxers... so I want to find out the actual facts.
Only taking notice because it's from people I've found sound minded and intelligent...people who have been praising the Moderna and Pfizer vaccines - and before the trial data was released, were hugely optimistic for the Oxford vaccine too.
To me, their biggest cock up seems to be they got caught up in a competition with Pfizer/Moderna. As soon as those two announced 90% efficacy, the AZ vaccine was suddenly under huge pressure to meet that bench mark when they should've just ignored that.
They shouldn't ever have made the half dose/full dose results public until they had a full set of trial results for them - it all of a sudden started questioning their development process and scientific practice. They should've just said the vaccine was 62% effective - which was enough to get it validated, and highlighted the fact that they can produce far more of it and it can be stored a lot more easily.
Then whenever they got enough results to validate/approve other dosing regimes, that's when they should've ever released those results.
Yeah, has been obvious for a while. And in general I don’t understand how the production can be such a bottle neck. Built a new factory, pour couple of billions into it. Who cares what it costs, do it. It is meaningless amounts in all of this. Everything is done too slow without any foresight. Coming up with the vaccine was the hard part, everything else should have been relatively easy.
The issue with getting new manufacturing sites online isn’t just about money. There’s a lot of QA stuff that takes time to complete and can’t be fast-tracked. A lot of it was done at risk (i.e. before they knew the vaccine worked) anyway but there’s only so much risk a publicly traded company can expose its shareholders to.
Are there any monoclonal antibody treatments available to the masses in Europe at the moment ? I just read that a treatment called Bamlanivimab (by Eli Lily) is apparently now available by application here in the US.
For Australia to make the mRNA vaccines it was apparently a 12 month project including training etc. Not sure if they went ahead or if we are going to import the Phizer vaccine as needed/available. We can and are making the Oxford vaccine.
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Found this tweet linked to one of those. It’s a good point and worries me. A lot.
Yep. I don't like what they're doing. It feels like we're moving away from the worthwhile risk (some protection + less chance of serious disease) delay that was initially proposed for AZ. AZ itself being a vaccine that may even benefit from the delay.
As the boundaries get stretched further into the untested territory, the possibility of making a real mistake goes up.
I'm still very concerned that we may have "manufactured" the current worrying virus mutation in a hospital patient - by prescribing multiple antibody treatments. I know that's a tough thing to prove, but it did sound horribly plausible.
Agreed. The virus will obviously mutate around the vaccines at some point, but this has every chance of making it happen in months rather than years.
Viruses are made to evolve.
For example, one variant is linked to mink farms, and interactions humans/animals can make virus mutate.
https://www.who.int/csr/don/03-december-2020-mink-associated-sars-cov2-denmark/en/
Plausible and very worrying. To me the real cock-up isn’t so much going heavy on the monoclonals but how the feck that strain jumped from hospital to the community? It’s not as though the diagnosis wasn’t known when the mutation happened. Would have to be a really fundamental failure of correct PPE use for that to happen.
I think people need to actually wake up to the reality the UK is facing. If the transmission of this new variant is increased by the 50% they’re saying the level of lockdown required to suppress the virus just isn’t achievable. We have to vaccinate as many people as quickly as possible to at least give some short-term protection. That’s it. Good practice, informed consent and whatever other wonderful things we should be doing go out the window. We don’t have 140m doses waiting around ready to be injected into people. The supply lines aren’t certain. The NHS is genuinely facing collapse over the next month and I think people are so numb to the numbers they just aren’t getting it. All 4 CMOs have taken the decision because it is the only chance we have to get through the next 12 weeks. It’s not based on good science, it’s based on pragmatism, realism and necessity. There are no easy solutions here - so it’d be nice if the people so angry on twitter and speculating on worst case scenarios such as what if it mutates to avoid the vaccine could offer some solutions instead of completely undermining the vaccine effort.
I’m willing to compromise on them just being angry in private tbhYour solution is to ask "angry people on twitter" to offer some solutions
Shouldn’t the first step be a complete lockdown, all over the UK? Schools, offices, non-essential retail, everything shut. Exercise only 2km from your house. The same as March, all over again. Stricter, if possible. We know that tier 4 in November didn’t stop the new variant spreading but that was a distinctly half-arsed effort at a lockdown.
I’m so confused by the tiers and regional variations in the Uk I don’t know what’s going on in terms of lockdown right now. But weren’t there still fans at some PL games this week?
To me it seems crazy to be potentially risking the success of our only way out of this hell in the long-term because of hesitancy in going into a full lock-down. Which is even more criminal considering they made the same mistake with the first wave.
Something else that seems insane to me is the bureaucracy around training up someone to stick a needle in someone’s arm.
It’s in exactly these kind of situations where senior decision makers under immense pressure, with no good options and without good evidence to justify any of them, make terrible mistakes. I would prefer we try and change absolutely everything else before changing the vaccination plan for Pfizer. Go back to living like hermits, close everything, focus on the first few rounds of vaccination then start to play the balancing act with much of the at risk population vaccinated and a good chunk of transmission reduced.
There are legitimate fears that arise from making decisions in those conditions which aren’t guided by good science. It is not at all a worst case scenario to suggest two simple practical eventualities will almost inevitably result from this.
More people will now only get one dose, either through distribution complications and administrative problems, or because they now think we never really needed that second dose anyway. It’s not all guided by good science so why should I bother taking those side effects again, I’ve got the vaccine, I’m good. There was always a risk of a minority doing that before and now that will be a bigger minority. We’ll be able to compare to other countries that followed a different schedule and I’d be very surprised if the UK doesn’t have a higher level of second dose skippers. It will also make vaccine hesitant people now vaccine sceptical, because if it isn’t guided by good science, it’s back to trusting senior decision makers who got us in this mess, or who have tried to control us all this time. This will persuade more people to take that hardline stance.
Maybe those are necessary trade offs but the fact they’re not talking about the trade offs leaves the possibility open that we’ve made a mistake.
A million people vaccinated in just over 3 weeks. Is that a good pace and could we actually get to the 2 million a week target?
Close schools for 3 months? I’m fine with that. I have no kids. I don’t think society is going to go with that though and rules are useless if people don’t obey them. What did the R number get to under that level of lockdown? Is it even enough to suppress it with the new strain?
Why are people talking about no data for how long immunity lasts after one dose when there’s no data for how long it lasts after two either? It might be gone after 4 months for all we know. We have no idea how long it lasts after two doses. We don’t even know if it works with the new variant. Everything is an educated guess at this point. Surely this “risk” of the virus mutating is the same when immunity starts to wane after the second dose? That risk is always there? According to the immunisers at work (who are perplexed by the level of attention they now get
) dosing regimes being changed from the manufacturers guidance is not unusual. The pace and how much the situation changes is unprecedented - that’s the unusual bit.Completely agree about the staff needed to stick needles in arms though. The fact the NHS are having to provide qualified nurses at this time to do it is insane. In my naive little world I thought we could have trained a staff pool nationally for this over the last 4 months and have them ready - after all we kinda knew we’d be vaccinating people...Oxford can be done by HCSWs though which is a help.
Close schools for 3 months? I’m fine with that. I have no kids. I don’t think society is going to go with that though and rules are useless if people don’t obey them. What did the R number get to under that level of lockdown? Is it even enough to suppress it with the new strain?
Why are people talking about no data for how long immunity lasts after one dose when there’s no data for how long it lasts after two either? It might be gone after 4 months for all we know. We have no idea how long it lasts after two doses. We don’t even know if it works with the new variant. Everything is an educated guess at this point. Surely this “risk” of the virus mutating is the same when immunity starts to wane after the second dose? That risk is always there? According to the immunisers at work (who are perplexed by the level of attention they now get
Completely agree about the staff needed to stick needles in arms though. The fact the NHS are having to provide qualified nurses at this time to do it is insane. In my naive little world I thought we could have trained a staff pool nationally for this over the last 4 months and have them ready - after all we kinda knew we’d be vaccinating people...Oxford can be done by HCSWs though which is a help.
There is a big difference between no data, and some data. We do have some evidence that the current vaccines provide protection at least 3 months after the second injection, nearly 4 months after the first. We don't have any evidence that Pfizer provides protection after 3 weeks of the first dose. So yes they are making some educated guesses on what happens outside the limits of their data, but the importance of these guesses and the level of confidence you can apply to them are wildly different.
These companies will continue to monitor how long protection lasts, and they'll monitor it under the conditions the vaccine was administered in. If the UK decides to follow their own approach then any of the future findings about length of immunity might not correlate very well. Maybe Pfizer finds out it only gives immunity for 9 months, and with our adjusted dosing schedule, it only gives immunity for 6 months, and it blindsides us with another wave as vaccinated people start living freely again. And as Moderna pointed out in their journal 3 days ago, we don't have any "identified correlate of protection", so there is no quick and easy way to regularly assess immunity levels en masse. It's still the timely lab testing among samples of people.
Is UK about to undo all the good work done by Pfizer and with a change of dose scheduling potentially contribute towards a mutation in virus that will make the vaccine ineffective?
Surely this will impact the effectiveness of the vaccines? Is it even ethical? Considering that this is completely untested approach.
Britain Opts for Mix-and-Match Vaccinations, Confounding Experts
If a second dose of one vaccine isn’t available, another may be substituted, according to new U.K. guidelines.
https://www.nytimes.com/2021/01/01/health/coronavirus-vaccines-britain.html
Britain Opts for Mix-and-Match Vaccinations, Confounding Experts
If a second dose of one vaccine isn’t available, another may be substituted, according to new U.K. guidelines.
https://www.nytimes.com/2021/01/01/health/coronavirus-vaccines-britain.html
Maybe it will. Maybe it won’t. We don’t know. All we can go on is an educated guess. I’m assuming they’ve looked at the level of immune response from the Pfizer vaccine and the Oxford one from Phase 2/3 and determined that if the latter lasts 12 weeks then there’s nothing to suggest the former won’t either. Also the fact one dose was 52% after 10 days and second was 96% after 7 (you’ve got to think the effects of the first dose had an impact in that... ) My understanding was both vaccines after one dose provided a bigger antibody level than someone with severe covid - I could be wrong on that as this was way back in august which feels like a lifetime ago now! The reason we don’t know is like you’ve said - the data isn’t there because they didn’t test for it. All the initial green book said was you can’t give the second dose under 19 days.
Also your assertion in your previous post that they haven’t factored in the trade offs is just wrong. Of course they’ve thought about the negatives when making the decision. Everything to do with COVID is about taking the least worst option. Nobody WANTS to take this course but looking at the bigger picture of a new highly contagious variant, a less compliant public, hospital admissions already through the roof and an already jaded/depleted NHS workforce they’ve decided prioritising first dose over second is the course to take. What people aren’t getting is they’ve been holding back distribution of the Pfizer vaccine because they couldn’t guarantee the second dose would be available. This 40m doses you hear in the news is bollocks. The supply isn’t there. After April hopefully it will be. If the evidence from other countries is our immunity is likely to wane based on this dosing regime then we’ll just start over again with the supply and infrastructure in place and hopefully COVID not quite so rampant. This is all about getting through the next 12 weeks. The CMOs will have access to data we don’t and will be looking at the bigger picture - I’m choosing to trust them and being closer on the ground to this than most on here I seriously think it’s a no-brainier giving what we know now. It may be the start of a chain of events that result in a new vaccine resistant variant that completely screws up the world but I’m going to choose to not think about that for now.
I honestly think stating now that the schools are shut/online only for January is just facing reality. In a lot of the country, classes (bubbles!) have been sent home for days at a time, over and over again - and that's before the new mutation, current rates/100k etc kicked off.Close schools for 3 months? I’m fine with that. I have no kids. I don’t think society is going to go with that though and rules are useless if people don’t obey them. What did the R number get to under that level of lockdown? Is it even enough to suppress it with the new strain?
Why are people talking about no data for how long immunity lasts after one dose when there’s no data for how long it lasts after two either? It might be gone after 4 months for all we know. We have no idea how long it lasts after two doses. We don’t even know if it works with the new variant. Everything is an educated guess at this point. Surely this “risk” of the virus mutating is the same when immunity starts to wane after the second dose? That risk is always there? According to the immunisers at work (who are perplexed by the level of attention they now get
Completely agree about the staff needed to stick needles in arms though. The fact the NHS are having to provide qualified nurses at this time to do it is insane. In my naive little world I thought we could have trained a staff pool nationally for this over the last 4 months and have them ready - after all we kinda knew we’d be vaccinating people...Oxford can be done by HCSWs though which is a help.
The test kit strategy proposed for schools isn't plausible. There just aren't that many hours in the day, or spaces in the hall to do it. Nor are kids going to safely/correctly do the throat/nose swabs that are supposed to be self administered. As soon as you talk about outside resources, you'd be talking about taking the very people who we'd want as vaccine centre staff.
If we had saliva tests on paper strips - sure, maybe we'd be in with a chance.
Better to actually plan and announce a closure. If they don't want to say for how long then they could talk about a two week rolling review, but try and give schools and parents a bit of notice. To get to within a couple of days of opening, and still have government revising lists of who should/can be shut on Monday just undermines public confidence. In doing so, I think it undermines compliance in other measures as well.
I do get the pressure that the planners are under - the whole system is between a rock and a hard place. But equally I'm not going to be critical of people who do want to think about that vaccine resistant variant issue now. Because I'm hoping we can actually get out of this misery in Q3/Q4 rather than seeing it all kick off again next winter.
On a different note, Israel has now given first jabs to over 1m people, about 12% of the population, and are currently dispensing about 125k/Pfizer vaccines per day.
https://www.bbc.co.uk/news/world-55514243
Anybody know how logistically their rollout is being done? Mass vaccination centres, minimal paperwork? Or something else?
https://www.bbc.co.uk/news/world-55514243
Anybody know how logistically their rollout is being done? Mass vaccination centres, minimal paperwork? Or something else?
I’m willing to compromise on them just being angry in private tbh
I understand your anger and frustration, which are feelings widely shared
I think maybe they have the army involved. There’s probably a degree of pre-existing organization there which is helping facilitate progress.
Here’s some good data on vaccine rollout for us all to get competitive about. Dunno what the hell they’re doing in Israel but I’m deeply jealous of them anyway.