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Vaccine process was just quietly changed by the Government on 10:15 - Dec 31 by StokieBlue
I think it's a bit of a gamble to make assumptions on how individual vaccines will work based on data from other vaccines.
In this scenario surely it would be better to:
- Continue using the Pfizer vaccine in the way it was designed, especially given one dose is only at best 52% effective and the absolute most vulnerable people were given Pfizer. Pfizer are saying they don't even know if one dose will work - it simply wasn't tested.
- Use the Oxford vaccine in the way that has been tested, which is one dose and then another one up to 12 weeks later which is now the policy (correctly since the non-public data backs it up). We have more of this vaccine so this should work well.
I don't see the issue with the above, it still maximises the benefits of the vaccine for the quantities we have. The issue is that the most vulnerable people got the Pfizer vaccine first so if we gamble on not giving the second dose and it doesn't work then the most vulnerable people are going to be the ones who have no protection.
Certainly agree we need to be as pragmatic as possible, the NHS needs as much help as it can get but it also needs to be done with the science in mind. Of course I am aware that the JCVI know more than me about the datasets and the vaccine specifics so I guess we need to trust their judgement on this one.
SB
[Post edited 31 Dec 2020 10:18]
Am keeping out of the detail, as
A. I cant change it. B. I dont know it. C. Am happy leaving it to those who do.
I just make the point that they will be running the numbers when making their calls and in doing so, choosing the options they believe give the best overall results.
Have no insights and literally no knowledge of vaccines.
Vaccine process was just quietly changed by the Government on 10:26 - Dec 31 by bluelagos
Am keeping out of the detail, as
A. I cant change it. B. I dont know it. C. Am happy leaving it to those who do.
I just make the point that they will be running the numbers when making their calls and in doing so, choosing the options they believe give the best overall results.
Have no insights and literally no knowledge of vaccines.
Obviously we have to trust that the JCVI have made the right decision as they are the experts.
My only worry is that Pfizer have said they don't know whether one dose works and all the people at the top of the vulnerable list for vaccinations have had Pfizer.
It seems the one cohort that we shouldn't be taking any risks with but I am sure this has been considered.
Overall it's all good news that the Oxford vaccine will stretch further and be used very soon.
SB
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Vaccine process was just quietly changed by the Government on 10:37 - Dec 31 with 1519 views
Vaccine process was just quietly changed by the Government on 10:29 - Dec 31 by StokieBlue
Obviously we have to trust that the JCVI have made the right decision as they are the experts.
My only worry is that Pfizer have said they don't know whether one dose works and all the people at the top of the vulnerable list for vaccinations have had Pfizer.
It seems the one cohort that we shouldn't be taking any risks with but I am sure this has been considered.
Overall it's all good news that the Oxford vaccine will stretch further and be used very soon.
SB
given the severity of the current position i really don't envy the people who are making decisions about things like this.
And so as the loose-bowelled pigeon of time swoops low over the unsuspecting tourist of destiny, and the flatulent skunk of fate wanders into the air-conditioning system of eternity, I notice it's the end of the show
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Vaccine process was just quietly changed by the Government on 10:43 - Dec 31 with 1510 views
Vaccine process was just quietly changed by the Government on 10:29 - Dec 31 by StokieBlue
Obviously we have to trust that the JCVI have made the right decision as they are the experts.
My only worry is that Pfizer have said they don't know whether one dose works and all the people at the top of the vulnerable list for vaccinations have had Pfizer.
It seems the one cohort that we shouldn't be taking any risks with but I am sure this has been considered.
Overall it's all good news that the Oxford vaccine will stretch further and be used very soon.
SB
So it comes down to Pfizer not testing a second dose at 12 weeks. That is an unknown as it stands, clearly.
Reads to me (listening to VT yesterday) they are applying previous learning from other vaccines and assuming those apply to Pfizer's vaccine.
Far from perfect, far from optimal but in decision making (in business) there are lots of ways of making a call based on limited knowledge / estimates. I guess in business every decision is based on probabilities and this decision is far higher stakes too.
But dealing with uncertainty is a reality here. We don't like it, but it is another reality we are having to get used to.
Bit of a ramble, but just trying to explain that those making the calls will be making best estimates based on the limited knowledge they have. We dont have the luxury of testing every which way as we'd like to.
Vaccine process was just quietly changed by the Government on 10:43 - Dec 31 by bluelagos
So it comes down to Pfizer not testing a second dose at 12 weeks. That is an unknown as it stands, clearly.
Reads to me (listening to VT yesterday) they are applying previous learning from other vaccines and assuming those apply to Pfizer's vaccine.
Far from perfect, far from optimal but in decision making (in business) there are lots of ways of making a call based on limited knowledge / estimates. I guess in business every decision is based on probabilities and this decision is far higher stakes too.
But dealing with uncertainty is a reality here. We don't like it, but it is another reality we are having to get used to.
Bit of a ramble, but just trying to explain that those making the calls will be making best estimates based on the limited knowledge they have. We dont have the luxury of testing every which way as we'd like to.
There must be some sort of evidence in the Pfizer data. Even if they don't support it there must be some sort of evidence that it works.
Another thought which has just occurred to me is that if we make a success of this it might give other countries ideas about only using one dose and give them more time to wait for the Oxford vaccine.
No evidence for this but there is the possibility that Pfizer aren't pleased for financial reasons rather than medical reasons as they are making a profit from the vaccine. AstraZeneca aren't making a profit during the pandemic and don't have a problem with the alternative dosing.
Again, it's just an idea and nothing even close to concrete.
Vaccine process was just quietly changed by the Government on 10:43 - Dec 31 by bluelagos
So it comes down to Pfizer not testing a second dose at 12 weeks. That is an unknown as it stands, clearly.
Reads to me (listening to VT yesterday) they are applying previous learning from other vaccines and assuming those apply to Pfizer's vaccine.
Far from perfect, far from optimal but in decision making (in business) there are lots of ways of making a call based on limited knowledge / estimates. I guess in business every decision is based on probabilities and this decision is far higher stakes too.
But dealing with uncertainty is a reality here. We don't like it, but it is another reality we are having to get used to.
Bit of a ramble, but just trying to explain that those making the calls will be making best estimates based on the limited knowledge they have. We dont have the luxury of testing every which way as we'd like to.
There has never been another mRNA vaccine though so comparisons don't have any basis for comparison (ie. dosage effects of mRNA vaccine Vs other vaccines).
As you say, they have made the call based on probability and hopefully it's right.
Like lowhouse said, I don't envy the people having to make the decisions at the moment, it's a horrible call to have to make.
SB
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Vaccine process was just quietly changed by the Government on 11:47 - Dec 31 with 1441 views
Vaccine process was just quietly changed by the Government on 11:00 - Dec 31 by J2BLUE
There must be some sort of evidence in the Pfizer data. Even if they don't support it there must be some sort of evidence that it works.
Another thought which has just occurred to me is that if we make a success of this it might give other countries ideas about only using one dose and give them more time to wait for the Oxford vaccine.
No evidence for this but there is the possibility that Pfizer aren't pleased for financial reasons rather than medical reasons as they are making a profit from the vaccine. AstraZeneca aren't making a profit during the pandemic and don't have a problem with the alternative dosing.
Again, it's just an idea and nothing even close to concrete.
Interesting about the possible profit angle.
However, I wonder if it might be down to UK having used up the entire first batch of Pfizer vaccs (800K was it?) and not having received a second batch - anyone know?
Vaccine process was just quietly changed by the Government on 11:47 - Dec 31 by Ryorry
Interesting about the possible profit angle.
However, I wonder if it might be down to UK having used up the entire first batch of Pfizer vaccs (800K was it?) and not having received a second batch - anyone know?
This morning on BBC news there was one of the expert interviews-don’t know his name-who said it was his understanding that the Pfizer jab would be given following the original schedule in the great majority of cases.
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Vaccine process was just quietly changed by the Government on 17:39 - Dec 31 with 1327 views
Vaccine process was just quietly changed by the Government on 13:01 - Dec 31 by andytown
This morning on BBC news there was one of the expert interviews-don’t know his name-who said it was his understanding that the Pfizer jab would be given following the original schedule in the great majority of cases.
Statement from MHRA about whether dosing the Pfizer vaccine 12 weeks apart is the correct decision
"The decision was made to update the dosage interval recommendations for the Pfizer/BioNTech vaccine following a thorough review of the data by the MHRA's COVID-19 Vaccines Benefit Risk Expert Working Group.
"This expert group concluded that vaccine efficacy will be maintained with dosing intervals longer than 21 days, as specified in the Information for Healthcare Professionals document. This is in line with the Conditional Marketing Authorisation issued to Pfizer/BioNTech by the European Medicines Agency on 21 December.
"This conclusion was based on clinical trial data that showed the vaccine was 90.5% effective against preventing COVID-19 after the first dose once the protection that starts at around 12 days kicks in, and there was no evidence to suggest that the effectiveness of the vaccine is declining towards the end of the 21-day period following the first dose."
Interesting statement there, avoiding directly commenting on the matter at hand and talking about what happens after three weeks rather than what happens after 12 weeks.
Also they said there was no evidence to suggest it was tailing off, rather than saying they had evidence to suggest it wasn't tailing off. It may well suggest that they have no data either way, which would tally with Pfizer's on the record comment, the only difference being the MHRA are dressing it up a little bit using what appears to be an argumentum ad ignorantiam.
Vaccine process was just quietly changed by the Government on 12:45 - Dec 31 by Ryorry
I'm usually an optimist, but this is worrying -
More transmissible - yes Mutations - yes Possibly with antibody resistance - Possibly is the key word. No evidence for this unless i've missed it Semi-immunised - The target was >50% effective. The data suggests the Oxford vaccine is up to 70% effective and stops serious cases.
Vaccine process was just quietly changed by the Government on 17:57 - Dec 31 by J2BLUE
More transmissible - yes Mutations - yes Possibly with antibody resistance - Possibly is the key word. No evidence for this unless i've missed it Semi-immunised - The target was >50% effective. The data suggests the Oxford vaccine is up to 70% effective and stops serious cases.
This really can be spun anyway people want.
I think what he means is that with a more transmissible virus, if you give more people a vaccine that doesn't fully beat back the virus (1 dose) then it gives the virus more chances to develop a random mutation when he vaccine is present which could then render the vaccine much less potent.
Exposure to something is the greatest driver of advantageous mutations.
It's certainly a consideration but in the case of the Oxford vaccine a single dose is only changing the efficacy by 20% so I don't believe it's really a huge concern. It probably won't make any difference at all.
Reducing hospitalisations is the primary concern.
SB
[Post edited 31 Dec 2020 18:06]
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Vaccine process was just quietly changed by the Government on 18:35 - Dec 31 with 1259 views
Vaccine process was just quietly changed by the Government on 18:05 - Dec 31 by StokieBlue
I think what he means is that with a more transmissible virus, if you give more people a vaccine that doesn't fully beat back the virus (1 dose) then it gives the virus more chances to develop a random mutation when he vaccine is present which could then render the vaccine much less potent.
Exposure to something is the greatest driver of advantageous mutations.
It's certainly a consideration but in the case of the Oxford vaccine a single dose is only changing the efficacy by 20% so I don't believe it's really a huge concern. It probably won't make any difference at all.
Reducing hospitalisations is the primary concern.
SB
[Post edited 31 Dec 2020 18:06]
Sorry, I should have added that his tweet is just the OP in a thread which has further contributions from himself (currently working as a virologist); an immunologist, and a physicist amongst others.
Their main concern is that delaying the second dose of the Pfizer vaccine could lead to all strains of the Covid_19 virus becoming resist to that vaccine at least, in the same way that not finishing a course of antibiotics can allow the bugs being targeted to become resistant because they haven't been completely wiped out, just had a half-hearted hit which allows them to survive and adapt.
Edit: agree with you about reducing hospitalisations being the primary concern.
Vaccine process was just quietly changed by the Government on 17:39 - Dec 31 by DublinBlue84
Statement from MHRA about whether dosing the Pfizer vaccine 12 weeks apart is the correct decision
"The decision was made to update the dosage interval recommendations for the Pfizer/BioNTech vaccine following a thorough review of the data by the MHRA's COVID-19 Vaccines Benefit Risk Expert Working Group.
"This expert group concluded that vaccine efficacy will be maintained with dosing intervals longer than 21 days, as specified in the Information for Healthcare Professionals document. This is in line with the Conditional Marketing Authorisation issued to Pfizer/BioNTech by the European Medicines Agency on 21 December.
"This conclusion was based on clinical trial data that showed the vaccine was 90.5% effective against preventing COVID-19 after the first dose once the protection that starts at around 12 days kicks in, and there was no evidence to suggest that the effectiveness of the vaccine is declining towards the end of the 21-day period following the first dose."
Interesting statement there, avoiding directly commenting on the matter at hand and talking about what happens after three weeks rather than what happens after 12 weeks.
Also they said there was no evidence to suggest it was tailing off, rather than saying they had evidence to suggest it wasn't tailing off. It may well suggest that they have no data either way, which would tally with Pfizer's on the record comment, the only difference being the MHRA are dressing it up a little bit using what appears to be an argumentum ad ignorantiam.
[Post edited 31 Dec 2020 17:57]
As you say, interesting statement in your 4th paragraph. They wouldn’t use the appeal to ignorance fallacy surely? Either way it doesn’t tally with what I heard on the news this morning.
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Vaccine process was just quietly changed by the Government on 22:39 - Jan 1 with 1091 views
Vaccine process was just quietly changed by the Government on 18:35 - Dec 31 by Ryorry
Sorry, I should have added that his tweet is just the OP in a thread which has further contributions from himself (currently working as a virologist); an immunologist, and a physicist amongst others.
Their main concern is that delaying the second dose of the Pfizer vaccine could lead to all strains of the Covid_19 virus becoming resist to that vaccine at least, in the same way that not finishing a course of antibiotics can allow the bugs being targeted to become resistant because they haven't been completely wiped out, just had a half-hearted hit which allows them to survive and adapt.
Edit: agree with you about reducing hospitalisations being the primary concern.
[Post edited 31 Dec 2020 18:51]
Looks like we have also agreed to mix and match vaccines if the ‘vaccine of choice’ isn’t available at time of 2nd dose
Do you know which section on the guidelines says that mixing is allowed from now? The only other thing I could find was the fact we are starting a trial in January with regards to mixing the vaccines:
The idea is to promote a "heterologous prime-boost" which basically means that you get the best of both vaccines: Oxford promotes T-Cells more whilst Pfizer promotes antibodies more.
As a trial that seems perfectly sensible, it would be less sensible if it was the immediate plan to do it before the trial is fully completed.
As an aside, I see Fauci isn't keen on the idea of frontloading the vaccine and leaving a longer gap.
SB
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Vaccine process was just quietly changed by the Government on 23:48 - Jan 1 with 1016 views
As usual if we look a little deeper then things aren't what they seem. Here's a video from Dr Campbell who I can't recommend enough. No nonsense, data backed stuff from someone with a comprehensive medical background.
9:40 - talking about the data for one dose and then the second dose for both Pfizer and Oxford-AstraZeneca.
22:30 - talking about two different vaccines being given - one thing I would add is that studies are underway on this and no one will be getting their next dose for at least a couple of months anyway so that instruction will evolve. Obviously there are some who have already had the second dose but they've had it according to Pfizer's recommendations so they don't count.
So yes, technically our strategy will be mixing and maxing (which makes a nice interesting headline) if necessary but this will be clarified later.
Vaccine process was just quietly changed by the Government on 23:46 - Jan 1 by StokieBlue
Do you know which section on the guidelines says that mixing is allowed from now? The only other thing I could find was the fact we are starting a trial in January with regards to mixing the vaccines:
The idea is to promote a "heterologous prime-boost" which basically means that you get the best of both vaccines: Oxford promotes T-Cells more whilst Pfizer promotes antibodies more.
As a trial that seems perfectly sensible, it would be less sensible if it was the immediate plan to do it before the trial is fully completed.
As an aside, I see Fauci isn't keen on the idea of frontloading the vaccine and leaving a longer gap.
Another misleading and scaremongering headline from the NYT.
So only where records don't show which vaccine was used for the first dose, any vaccine may be used for the second. Not if the ‘vaccine of choice’ isn’t available at time of 2nd dose as you have misleadingly stated in your post.
Please stop undermining trust in the vaccines when you either know what you are saying is false or haven’t bothered to read what the JCVI guidance states.
So what’s the best case timescale for coming out of this lockdown? - surely we’re going into a full scale, countrywide lockdown like before. Let’s say 2.5 m first dose by mid Jan, then 2m vaccines per week. 25m people need to be vaccinated to cover high - risk . So that’s everyone first dose by mid to late March. We’re then well into the initial injections having to have their second, this slows down everyone else surely? So Easter at the very earliest, if all goes well?
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