I noted this report from Politico this morning (and as ever, I do suggest subscribing, not least because it is free and very good):
Health Secretary Sajid Javid [has said that] the U.K. has secured 114 million more doses to arrive over the next two years, made up of 60 million Moderna jabs and 54 million Pfizer/BioNTech doses. The government had already closed deals for 100 million extra jabs from Pfizer, Novavax and Sanofi.
What I immediately noticed is that AstraZeneca is not on that list. Actually, as they also note, it only now seems to feature on the list of vaccines being donated to developing countries. As they say:
Government officials stressed last night that Britain will donate 100 million doses to countries in need by mid-2022. Plans are currently in place to redistribute 50 million AstraZeneca jabs and 20 million Janssen doses.
So, whilst the UK has enough doses now for everyone to be jabbed six times (unless you're in Scotland when it is jagged six times) we are only slowly getting up to speed with developing country rollouts, but at far too slow a pace to protect us and with a vaccine now dropped in the UK.
Three questions then.
Why has AZ been dropped for use in the UK?
What were the equivalent death rates for those with AZ and Pfizer the first time round? The answer is known, without a doubt, but has never been published. Why not?
And, if AZ is apparently no good for us any more, why is it being given away?
To fuel my concern I note this Tweet from the highly respected Prof Ravi Gupta yesterday:
60% effectiveness is, as I understand it, the minimum threshold required for a vaccine to be considered as such. AZ crept in, but is that really good enough for us to be giving it away now when there may be better products available?
I am worried that an international vaccine programme based on a product we will no longer buy is really not good enough and will rebound badly for everyone.
What is necessary is that the truth about this vaccine's effectiveness in the UK be told. Then an informed decision can be made and proper judgement be formed. I really don't think that is too much to ask for now.
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Mushroom principle rules OK. Throughout the pandemic embarrassing data is buried.
When was the last time we heard about Test and Trace, or the infamous app? How many people are dying quietly at home and not being included in coronavirus data?
The little people just need to shut up and continue to vote to maintain the current system.
All very good questions, but there are many more.
I’m afraid there’s simply too much opacity accompanying everyone of these vaccines. Moderna have released very little, Pfizer have been better – publishing at least partial results in the New England Journal of Medicine – but even then their papers expose some troubling issues that need to be clarified (and conspicuously weren’t by the FDA). The biggest one (IMHO) is the fact that in both the adult and child trials the effect size (the reduction in CV19 cases between the vax & pacebo group) was exceeded by the number of participants rejected disproportionately between the two groups. In the child trials this was 47 vax kids rejected to 3 placebo kids. Why were these children rejected? Why has this not been published.
NakedCapitalism have covered this at some length – they’re definitely not anti-vaxxers, but note the lack of time & resources given to this by the FDA and the very troubling wording of the consent forms for all the trials. Participants could be remove for going to the Emergency Room. And then there’s the clear evidence of malpractice revealed by a whistleblower in the BMJ – not followed up by the FDA.
Pfizer & the FDA were taken to court to release their raw data and exchanges – with the judge allowing them to release it 500 pages per month (which will take them 55 years by some accounts). The first batch has just been published in the last day or so. It has already transpired that they somehow managed to miss out 9 deaths from their 6 month adult follow-up – 6 in the vax group 3 in the placebo. No explanation has been given for this.
Scepticism of big pharma used to be the default position on the left (we all used to read Ben Goldacre didn’t we) – where has that gone now?
jFWIW I had the AZ vaccine back in March and recently caught Covid from my 8 year old son – neither of us had anything other than mild symptoms – we isolated, but were not restricted to bed. I won’t be getting my kids jabbed until there is very much ore transparency.
Then that is grossly irresponsible of you, IMO, both for their sake and for society’s at large.
Have you not heard of long Covid?
Of course I’ve heard of long-covid and am not disputing it is serious for those suffering from it. However, prior to 2020 I would not have exposed my children to an experimental drug, using novel technologies, to prevent such a condition – at the rates at which it is currently reported (69K sufferers on a rather loose definition perhaps) without those drugs going through the ENTIRE set of regulatory proceedures (Stages 1-4 at least) – with ALL of those results properly, and openly, reported. I’ve not changed my stance in the CV19 era.
I’ve not seen any published data showing that the vaccinations will offer any kind of lasting protection against long covid for my 6 & 8 year old boys.
I’ve not seen any estimates of how long the protections may last from the jabs in children – will they require boosters as often as adults? What might be the long term effects of these?
My 8 year old made a full recovery and will now benefit from naturally aquired immunity which, at least until 2020, was commonly, and uncontroversially, thought to be much more robust than that developed from flu vaccinations – this short 2017 paper discussing the issue of ‘Original Antigenic Sin’ (OAS) states this boldly:
“”Hoskins et al concluded at that time that prior infection is more effective than vaccination in preventing subsequent infection, an observation that remains undisputed. ”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853211/
The possibility of OAS is important as it could be that priming an immune response to one virus may make people more susceptible to others – with flu viruses & vaccines particularly prone to this. Pfizer & Moderna’s reports are nowhere near sufficient to rule this out.
Again the effect size in Pfizer’s child study (the difference in CV19 cases between vax & placebo group) was smaller than the difference in the numbers excluded between those two groups during the trial – and they only followed up the kids for 2 months FFS. This is unacceptable and until there are concrete answers as to why so many more vaxxed kids were rejected than unvaxxed the results should be disregarded.
My position has not been changed by your argument
Fair enough Richard. I’m just concerned that the process itself is not being scrutinised in the kind of detail that really it warrants. It’s in no small part due to following you (for 15 years now I thikn) and the likes of NakedCapitalism, Prem et al. that I’m aware of hte issues of regulatory capture, revolving doors, lack of transparency etc. etc.
I’d suggest that the influence of the pharma giants over the entire scientific & regulatory process is at least as complete and pernicious as is that of thee Big Four over auditing, tax and accounting. They must be treated with the utmost scepticism. Their failure to prodouce timely and complete data here is a scandal – and the fact that this may result in irrevocable harm to my kids makes me even more wary of it.
Let’s agree to amicably differ
The figure that has always worried me the most is the death rate, which only includes those dying within 28 days of a positive test. Why? Obviously, this restriction hides (is designed to hide) the true effects of Covid. Is there a scientific basis for this of which I am unaware?
Well in this world I suspect ‘brown envelopes’ and in the words of Harry Rednapp ‘bungs’. So very appealing. Also off topic but after Hastings the RNLI need a shout.
I too share your concerns and at the root of this will be money I promise you.
Interesting that you pick up on this Richard, as I’ve been wondering the same having heard from various friends who’d had the AZ vaccine initially, and therefore expecting it for the booster, that they’d been given Moderna as a booster. Then on Saturday me and my wife had our boosters and the same happened with my wife, only this time she had Pfizer instead and AZ (I’d had the Pfizer vaccine from the outset). Interesting also because I hadn’t picked up that it was now accepted practice in England to mix the vaccines. It was being touted as a possibility back in the Spring but I’d obviously missed news that it’d been approved.
But anyway, I assume you’re proposition about why this is happening is correct – certainly given the research from India. And with large numbers of experts also saying that even the most effective vaccines will not be as effective against Omicron, due to the range and level of it’s mutations, and the evidence from SA this morning that Omicron appears to be fueling an exponential growth in infections (8561 daily cases compared to 1275 and week earlier) I assume that the effectiveness of the AZ vaccine will be even lower. So, it would seem to be not very good news at all for anyone vaccinated with AZ who hasn’t had a booster. Perhaps that’s at least partly behind the desperate rush to get everyone to have a booster by the end of January.
I suspect you are right
Of corruption scandals swimming around Boris Johnsons government this is the least suspicious. Alternatives to AZ are expected to be more effective against Omicron. This is particularly true for people previously double jabbed with AZ who will get overlapping but different benefits from a different vaccine.
AZ is still a more practical option for poor nations that don’t have effective freezer distribution systems. Also AZ is also likely to be cheaper, which means limited aid that rich country voters are willing to support will protect more people.
BBC News highlighted that AZ vaccine has already saved over 1 million lives worldwide. We should not let the perfect be the enemy of a huge Global good.
But data would still be good, don’t you think?
Maybe it’s because AZ have not put in a bid to buy the Vaccine Manufacturing Innovation Centre.
https://inews.co.uk/news/health/uk-vaccine-manufacturing-centre-which-has-received-more-than-200m-government-funding-put-up-for-sale-1325458
https://www.ft.com/content/2986f544-b3b6-4fa5-9dff-fea9132be466
The R – rate of infection rate, is not mentioned now and this is important for tracking the progress of infection. The government is obviously wanting people to be kept in the dark about this when the rate goes up. R going up means votes for them going down obviously.
Anything to avoid Plan B seems to be their concern, however many deaths are involved let alone long covid.
I opted in to the ONS covid 19 infection survey from the inception of it to the most recent where they now ask for blood samples. Both of my jabs where astra zenica. After my first Jab I had a blood sample done which came back negative for antibodies. When I went for my second Jab, I discussed this with the man doing the second jab who commented that there’s a lot of people having astra zeneca ending up with negative antibodies. My next blood sample after second jab also came up negative. My booster is due next week, not surprisingly it’s Pfizer.
I’ve also heard of people being vaccinated with AZ, being tested and no antibodies being present. Not rumours – peopel telling me that it has happened to friends and family.
That’s why you need to be vaccinated AND be still careful.
Certainly the UK seem to have decided on mRNA vaccines for boosters. It may simply be logistical, they are using these for the teenagers and with the Pfizer vaccine being shipped in large batches wit a short shelf-life after thawing it does make things easier. But there are very few head-to-head trials, and those that exist have been small; for obvious reasons manufacturer-run trials concentrate on their own products. Comparison from real life data is difficult since populations aren’t matched, for example in the UK the majority of Pfizer doses have been given to younger fitter individuals. In addition there will be no data when what you want to know is how they manage against a newly emerged variant (and even testing variants against the antibodies raised by vaccines, which can be done in a few weeks, only gives an approximation of how effective they are against actual infection/severe disease/death).
If boosters are to become annual it would make sense to adapt them to include changes seen in variants, and both the mRNA vaccines and adenovirus vaccines (AZ and J&J) are easily adaptable. There are theoretical reasons why it could be better to have a booster different from the primary vaccinations, though not guaranteed.
Paulhenry – I recall that early in the pandemic a longer time interval was used. However I think the daily figure is derived simply be taking the NHS numbers of people dying and looking to see if that corresponds to a previous positive test, something that is easily done automatically. The interval was reduced to 28 days after complaints that it included people who had recovered from Covid but then died in a road accident (or for another unrelated reason). I believe that the records are revised retrospectively as death certificate data feeds through the system, so that older data will genuinely represent cases where Covid was identified as the cause or a significant contributory factor.
Another question worth asking is why UK Gov cancelled an order for 100m doses of Valneva vaccine, made in Livingston, which is now undergoing a rolling review from European Medicines Agency
https://www.reuters.com/business/healthcare-pharmaceuticals/eu-regulator-begins-rolling-review-valneva-covid-19-vaccine-2021-12-02/
I agree. The careless and inept way the government announced the cancellation of the Valneva contract was simply ridiculous, regardless of the rights or wrongs of the decision. I’ve always thought that having an inactivated virus vaccine would be useful for those worried about the ‘newness’ of mRNA and adenovirus vaccines. Though perhaps less effective than the other vaccine technologies, there would be wider immune response, not just targetted at the spike protein, and this might well make it suitable for a booster as well. You’d also think that it would be seen as a less ‘risky’ choice to give to children who have been receiving inactivated vaccines for decades.
I’d expect that the Valneva vaccines which have been produced already in Scotland will find their way into arms soon and save lots of lives.
As for the AZ vaccine, it is a very good vaccine (especially the case against the original virus and even Alpha), but it just happens to be the fact that the mRNA vaccines appear to be more effective. AZ was less effective (yet pretty decent), against Delta and Lambda (the one in South America), but not very effective at reducing the risk of infections against Beta and most likely Omicron. AZ have been running trials of a vaccine modified to target Beta because of that particular weakness for some months. However, the biggest issue is obviously the rare clotting problems which were completely unexpected but they do now know what causes it so can look for a solution. Regardless, without the emergence of the mRNA vaccines, we’d have seen AZ used much more widely and it would have saved a lot more lives than it already has. It is one of the absurdities, for example, that vaccination rates in South Africa were low earlier in the year due in part to the AZ vaccine’s lack of efficacy against infection against Beta, that the Delta wave was so damaging there – the chance of pretty good protection had been spurned in return for none.
For the lack of widely-available data, I think much of the data has been there – the PHE Vaccine surveillance reports contained estimates of effectiveness against different variants – but it hasn’t been widely discussed. I can sort of understand why they didn’t separate out the calculated efficacy against Delta between the two vaccine types in these reports, because what would be the point? The efficacy against hospitalisation and death between the two was similar and those most at risk had already received the vaccines. It was actually only when the waning of efficacy of both vaccine types was noticed that we saw some charts comparing efficacy and even then the uncertainty indicated that the efficacy of the AZ vaccine might have been longer lasting as it was within the error bars (though probably not).
As long as this pandemic is running (and it looks like we’ve got at least another year of this ahead), receiving any vaccine is a good thing, even if efficacy against infection is low for newer variants. It is hopefully likely that it will still provide good protection against the most serious infection and death, even against Omicron. Of course, if other more expensive and more effective vaccines are available, you may want to have one of those.
I received a Moderna booster at the weekend after two AZ jabs earlier in the year. I’m pretty relaxed about eventually becoming infected as is pretty much certain as I have two young children with no protection or mitigations in school and nursery and a wife who is a secondary school teacher in classes full of unvaccinated or partially-vaccinated teenagers with no mitigations! More concern about my children and parents who help with childcare and are of an age where they are at risk. They spent enough time last year keeping away from the children and don’t want to continue with that.
Just to follow up this post, the COV-Boost data now published shows that the AZ vaccine followed by an mRNA booster appears to show the broadest immune response (in terms of antibodies and T-cells). In fact, better than an mRNA booster after earlier mRNA vaccine in some regards.
I expect that this almost certainly explains the decision to stop using the AZ vaccine in the UK (especially as they aren’t using it for under-40s due to the clotting issues). The COV-boost also explains why they dropped the Valneva vaccine as well, because the use as a booster wasn’t at all effective. The ham-fisted way in which Javid dealt with this is a different matter, of course.
Excellent, I’m so pleased you recognised that we ‘Jag’ people here in Scotland.
“unless you’re in Scotland when it is jagged six times”
Thank you for the respect you give to Scotland x