In this part of the world, the first side effect of vaccines has been political. Europe’s nations are now competing to get vaccinated, and the ructions have been considerable. From the start, the UK took a vaccine friendly stance. Early on it decided that vaccination was the long-term solution, and all else was merely a grim holding pattern.
By March 2020 Kate Bingham (a scientist and venture capitalist with a long track record in pharma research and development) had begun discussions with what she and her team saw as the front runners, having done a careful calculation about which were likely to work, and time has proved them right. They identified the best candidates in each of four platform types, and engaged them all with a winning formula: we will buy in advance, at a reasonable price without much haggling, and in vast numbers, so long as you can deliver as fast as possible. As a quid pro quo will give you a fast track to conducting trials and gaining approval. We will pay for results, and use emergency legislation to cut through all the paper-work. We will check for safety and follow all the usual procedures, but will avoid any time-wasting box-ticking. In most cases we accept that our pre-booking investments may come to nothing, so we won’t ask you for our money back. If, as we hope, your candidate is successful, we have ordered more than we need so as to ensure supply for our citizens. Unused drugs we will sell, or give away to other countries, once all our citizens have been offered vaccination.
In this way they quickly and wisely spent 2.7 billion sterling. They ran all processes almost in parallel, so that vaccinations started on 8 December 2020. They also published their priority lists so that people could calculate roughly when they would be called up.
As of 1st February 2021 the UK has given a first jab to:
First dose total
Second dose total
As of today the total number is above 10 million first jabs, and daily totals vaccinated are about a third of a million.
For comparative purposes, this is about 12% of the adult population, and European countries are at about 2%. The European Union has reacted oddly, deciding to attack both the UK and AstraZeneca. In a flurry of uncoordinated blows, it threatened AstraZeneca with not being able to sell into the European market unless they stuck to their interpretation of their contract (signed at least 3 months after the UK one) which the EU read as meaning that, although they had signed late, they should be able to take some deliveries which were earlier promised by AstraZeneca to the UK. For a while the EU attempted to put forward legislation which would require any pharma company producing vaccines in Europe to apply for permission to export it to the UK, strongly suggesting they would not get it if Europe had a need for it. At this time the AstraZeneca vaccine had not yet been approved for use in the EU.
They then attacked the UK strategy of concentrating on giving the first dose to as many people as possible, saying it was unwarranted and risky. More recently both German newspapers and the French president said that the AstraZeneca vaccine was ineffective in older people, which is of course the target population. Thus, they were simultaneously demanding more than their fair share of a vaccine which, they said, did not work particularly well. As a consequence, it is now a staple of conversation in England to hear the phrase: “I voted Remain, but this European thing about our vaccines………”
As you will know, some people having been arguing for some time that the actual data show that the first jab does the heavy lifting, and afterwards it is best to have a longish delay (say up to 12 weeks, not the previously tested 3 weeks) before getting the second jab, which will not add much, but which might make immunity last longer.
Now a paper is coming out suggesting that this is precisely the best course of action. The study, which is under peer review and is expected to be published in The Lancet, concludes that leaving a 12-week gap between shots “may be the optimal for rollout of a pandemic vaccine when supplies are limited in the short term”.
The vaccine was 76 per cent effective from three weeks after the first injection and this level of protection lasted until 90 days after the first jab.
After a second dose, vaccine efficacy was 82 per cent with the three-month interval between shots that is being used in the UK.
The report also suggests that the vaccine could have a “substantial” effect on transmission of the virus, with a reduction of positive PCR tests among those vaccinated of more than 50 per cent. This suggests a pronounced reduction in the number of people who carry the disease but show no symptoms.
So, the first AstraZeneca jab gives you 76% and the second jab adds another 6%. The Steve Sailer shrug effect. It is almost as if the immune system can take a hint first time round.
A medical colleague explained why the Johnson and Johnson “Jansen” vaccine gets such good results with a single jab. “The front runners were desperate to show efficacy with this new virus, and thought that two jabs would improve their chances of getting a good result. Also, selling two vaccines is a sensible business decision, even given the not-for-profit stance AstraZeneca took. Now that it is clear that a single jab works, Johnson and Johnson, late to the party, cannot say that their two-jab version is any better than anyone else’s two-jab version, so they can now boast that theirs is the best because it only requires one jab”.
Another side effect of vaccines being available is that people question whether they should have a vaccination at all. What are the odds? Modern vaccines are rarely released unless they achieve the safety standard of no more than one severe reaction per million. The measles vaccine is at that level. People still worry about it. Let us be far more cautious, and assume that these vaccines will kill one person in every 100,000 vaccinated.
How many people would you have to vaccinate in a trial before you got a dead volunteer? Intuitively, one would need at least 100,000 subjects to have a reasonable chance of detecting a 1 in 100,000 condition, and the calculators I have looked at suggest that the number might be two or more times that, to be 95% sure of finding it. This is because rare events do no queue up to happen at a rate which we later observe and summarize. Nothing may happen for a long time, and then several events come together over a few months. Real world tests of vaccines and medicines are the harshest and truest.
If you dropped the redundant placebo arm of the trial, your chance of observing any rare serious side effect would be doubled. Given the intense focus on Covid at the moment, there is good actuarial data about deaths and hospitalization for severe case in most advanced economies. It would be more efficient to just monitor the newly vaccinated against the unvaccinated general population. It would also give you the best chance of finding rare adverse reactions. Perhaps placebo arms of Covid trials should be dropped. Another option is that new vaccines could be tested against older ones, particularly against new variants.
Israel should be able to give any warnings about untoward effects. According to The Times of Israel “a total of 652 people out of around 650,000 to have received the first dose of the Pfizer vaccine reported some discomfort after the shot.” One death is still under investigation (3 already resolved), an 88-year-old man who had serious pre-existing health problems, is currently being investigated. So, perhaps 1 death per 650,000 though better estimates will be out in five or six weeks.
The other approach is to say: at what level of mortality can I live with a 1 in 100,000 fatality risk from a vaccination? As a matter of individual choice, estimates of personal risk will vary.
Assuming that the world in 2020 had a population of 7795 millions, of whom only 2.2 million have died so far (admittedly with varying levels of lockdown, mask wearing and social distancing) then the chances of death are 287 per million, so in round figures 29 per 100,000. That is a low risk overall. However, vaccinations are currently being offered to advanced economy citizens, who have busy airports and are likely to come into contact with infected persons in their work or recreation. In those busy, exciting, cosmopolitan places the death rates can be as high as 181 per 100,000 (Belgium, as a worst case) or 136 per 100,000 as a more usual high level in the US.
Understandably, any citizen might quail at taking an immediate risk of 1 in 100,000 to protect themselves from a potential risk of 136 in 100,000. There is a gain, but to die of an individual personal choice may feel worse than being struck down by an unlikely natural hazard. Anyway, treatments are improving, so deaths will keep falling. Why take a risk, some may ask themselves?
These are the figures calculated for citizens of all ages, but it is a different story for older ones. For those between 65 and 75 year of age the risk is 2,500 in 100,000. For those between 75 and 85 years it is 6,000 per 100,000, and for those over 80 years it is 20,000 per 100,000. Individual choices will vary, but from 65 years onwards, a vaccination may look like a good bet. Naturally, people may wish to refine their bets, and if they are in reasonable health, and free of all co-morbidities (unlikely given current rates of obesity) then these rates tumble down by at least 90%. The virtuous are spared, probably.
Since the vaccinated are very likely to be half as infectious as the un-vaccinated, there is a public dimension. After an inoculation, you are less likely to be the cause of someone else becoming ill. Also, you will be reducing the chance that the virus mutates, thus requiring everyone to get vaccinated next year. The tragedy of the commons is that many prefer others to take the vaccination risk so as to live in herd safety.
Society is facing a dilemma about how to prioritize lives. Once the elderly vulnerable have been vaccinated, it is highly likely that society will open up again.
On other matters, it is Brigid’s Day, and it has been raining a lot, with some fog, very occasional sleet, some promised snow, and moments of baleful awakening, when a wan sun appears behind scudding clouds, harbinger of sunlit uplands to come.