outbreak! (ebola, sars, coronavirus, etc)

Really odd phrasing on BBC news "this Oxford vaccine is up to 70% effective or more than 90% effective if you adjust the dosage."

Well um maybe we could you know... adjust the fucking dosage?!

I'm not sure how the BBC should report it, but it's not that simple. It's a strange result and I'm not surprised their stock is down on the news.

I'm not looking forward to the part where we have to read and listen to people screaming about "oppression" when their workplaces/schools/whatever won't let them come back without a vaccination.

Obv not an expert but I don't see how the AZ dosing thing is all that fishy?

It is the job of an immune system to react to a pathogen, and begin to develop antibodies. It gets better at it with subsequent exposure.

The strength of said antibody-production response varies over time. Hence "booster" shots that are distinct from an initial dose.

I don't see why a particular vaccine might not work like this:

1. (gets initial dose of vaccine)
2. OH SHIT A LITTLE BIT OF VIRUS / BETTER DEVISE A DEFENSE
3. (devises defense, begins producing antibodies)
4. HERE ARE SOME ANTIBODIES M.F.ER!
5. (gets subsequent dose of vaccine)
6. FUCK! BETTER STEP UP PRODUCTION AND MAKE MORE!
7. (immunity increases)

As opposed to the one-dose model that ends at step 4.

Am I missing something? The initial half-dose primes the immune system to get the factory going. The second dose causes the factory to increase production in response to greater need.

xp

this is a valid concern, but otoh I worry that businesses will use lack of access to vaccines as an excuse to thin their workforces

there wasn't a one dose trial. see https://arstechnica.com/science/2020/11/astrazenecas-covid-19-vaccine-shows-success-heres-how-it-stacks-up-to-others/.

it was:

- full dose, full dose (62% effective in a sample of ~2k people)
- half dose, full dose (90% effective in a sample of ~8k people)

sure, you can come up with plausible sounding (to non-experts like us) explanations why someone who receives a 1.5 doses should do better than someone who receives 2 doses. but it's weird. and those sample sizes are pretty small.

sorry, those numbers are backwards. it was

- full dose, full dose (62% effective in a sample of ~8k people)
- half dose, full dose (90% effective in a sample of ~2k people)

2k is really very small to claim anything (especially without detailed results. this is just a press release.)

this is a valid concern, but otoh I worry that businesses will use lack of access to vaccines as an excuse to thin their workforces

Very, very good point as well.

Pharma companies are notorious for overselling the effectiveness of their products.

I would guess that that difference in effects between those two trial arms cannot actually be convincingly asserted based on the study design and the multiway comparison with placebo, but yeah it doesn't stop it from appearing in the press release

Not an expert at reading clinical trial results btw but the basis on which these comparisons are to be made is never just number > other number

yup.

"overall efficiency is likely about 70% but we don't know what the dose should be"

sure, you can come up with plausible sounding (to non-experts like us) explanations why someone who receives a 1.5 doses should do better than someone who receives 2 doses. but it's weird.

On what basis, as an admitted non-expert, do you make this claim of weirdness?

the weirdness is that, absent the statistical details, one shouldn't conclude that there's a true difference in effects between the two dosing arms.

All of the 2741 in the half/full dose regimen were from the UK trial, whereas the 8895 in the full/full dose regimen aggregated participants from the Brazilian and UK trials. So perhaps there were some cultural, climatic or viral strain contributions to the differing results.

that would be my guess, I think the samples are big enough where a giant swing like that has to be significant in some way

It basically seems like they didn’t run the trial very well

The half-dose thing was a serendipitous mistake

https://www.theguardian.com/uk-news/2020/nov/23/oxford-covid-vaccine-hit-90-success-rate-thanks-to-dosing-error

that is not giving me huge confidence in the testing process

lmao

not like this is important of anything

ffs what else did they fuck up

we were having a pint and a chaser and Hughie discovered a chaser and a pint got you pissed faster

buy our shares

So we left out all this bread and

Good thing there were two other vaccines that announced levels of success without that kind of fuck up.

I’m personally excited that there seem to be 3 different effective vaccines!

one for each arm, um, wait

TMI (too many innoculations)

it takes a lot to make a vax

hopefully this means they'll compete on price and not somehow cartelishly collude to fix prices

bwahahahahaha

When demand outstrips supply as much as it will in the case of these vaccines, price gouging will be an available option without recourse to a cartel. Congress could impose price controls, but if they do I will eat something improbable. The major restraint on pharma would be public outrage.

The Biden Vaccine Riot, playing the Trocadero this Saturday night at 7

Interesting article today in NY Times about how the scientific evidence is piling up that the 614G strain was more transmissible than the original strain which would help to explain why it grown from being 1% of cases in January to 99% today. There doesn't seem to have been any research yet on whether it may be less deadly than the original strain and though the article doesn't go there, its interesting to speculate given how the 2nd wave seems to be less lethal.

Per dose in the U.S., Pfizer $20, Moderna $15, AstraZeneca under $4. All three say free for early recipients.

https://observer.com/2020/11/covid19-vaccine-price-pfizer-moderna-astrazeneca-oxford/

xp: IMO more available testing (increasing the denominator) and better treatment protocols (early corticosteroids & anticlotting agents, proning and other efforts to delay intubation as long as possible) are enough to account for the drop in case fatality rates from the ~6% seen in March-May to the ~1.7% seen since.

Jackson CEO Carlos Migoya confirms Pfizer expects to first produce 40M Covid-19 vaccine doses. At 2 doses/person, that's 20M initial immunizations. Miami-Dade expects to get 1M of those doses for 500K people, first to go to health workers, first responders and at-risk people.

— Jesse Scheckner 🗞️ (@JesseScheckner) November 24, 2020

shouldn't the distribution be based on the guiding hand of the free market?

Fwiw Astra Zeneca claims to be selling the vaccine at cost. Not sure if that’s uk only. And not sure if r&d is included in the cost or it’s just manufacturing. But in any case I assume that’s why it’s the cheapest. (That and they saved money by not hiring someone who knows how to run a clinical trial.)

Having your company be behind one of humanities great achievements will probably be worth it.

yeah was gonna say how long's it been since one of these companies got good press

AstraZeneca/Oxford's chimp adenovirus can be produced in cell culture, and that's a fairly mature technology used for flu vaccines and the like. The Pfizer and Modern mRNA vaccines are produced by cell-free mRNA synthesis. The capital and ingredient costs can be a lot higher.

mRNA synthesis: an enzymatic reaction involving linearization of pDNA and mixing with enzymes and nucleotides to allow mRNA linearization, transcription, and mRNA capping.
mRNA purification: removal of enzymes, remaining nucleotides, pDNA and defective mRNA.
mRNA concentration and final, sterile filtration.

https://www.statnews.com/2020/11/23/astrazeneca-covid-19-vaccine-is-70-effective-on-average-early-data-show/

If a final analysis, conducted after the inclusion of additional data, concludes the vaccine’s actual efficacy is around 70%, that could be a problem.

“If it’s 70%, then we’ve got a dilemma,” said Fauci. “Because what are you going to do with the 70% when you’ve got two vaccines that are 95%? Who are you going to give a vaccine like that to?”

The problem was also flagged in an analysis by Geoffrey Porges of the investment bank Leerink. “We believe that this product will never be licensed in the US,” Porges wrote.

Fauci cautioned that full datasets — which the Oxford researchers said they intend to publish in a scientific journal — need to be pored over before conclusions can be drawn.

“We’ve got to look at the analyses, the real granular data. It’s always tough when you’re looking at a press release to figure out what’s going on,” Fauci said.

Other experts were more enthusiastic about the findings, suggesting the vaccine could be an important tool in low- and middle-income countries, where substantial production of the vaccine is expected to take place.

I'd still rather be in the UK where everyone who wants it gets a 70% vaccine in what i assume will be reasonably well-organized fashion, vs the shitshow we'll get in the US next year

https://newrepublic.com/article/157704/coronavirus-vaccine-united-states-health-care

The U.S. simply does not have anything resembling the infrastructure necessary to ensure that everyone gets anything, including food or water or shelter, let alone something that requires access to a health care worker. To the extent that we have ever aspired to this sort of capability, those traditions have long eroded, worn down by our debased politics. We do not have a National Health Service–style system, which was able to produce a (poorly handled but nevertheless extant) list of patients who were at high risk for the coronavirus. My mother in Britain, who has received immunotherapy for lung cancer for the past two years, was on this list. She received a text from the government telling her to stay inside for 12 weeks, plus a phone call and two letters, which also advised her of government resources for food and help for the extremely vulnerable and suggested that she spend time with the windows open or sitting on her doorstep. 

America does not really have a health care “system” at all; it has a chaotic array of overlapping systems of private and public health financing, clinics, hospitals, and doctors. This lack of a single system will pose a challenge for administering a vaccine to the entire population. It’s not as simple as adding one more to the list of vaccines that children receive or distributing vaccinations at schools: People of all ages will need one. Can you name a physical institution that every American interacts with and has easy access to and that is prepared to distribute something universal like this? The Social Security office? The DMV? McDonald’s? (Starbucks and McDonald’s bathrooms are often the only place homeless people can go to freshen up, so it’s not like we’re not used to substituting chain restaurants for a society.) The closest thing might be the post office, currently in danger of being left to rot and die because of the virus. It may be that setting up post offices with government-employed pharmacists to distribute the vaccine would be our best bet, given the lack of universal access to medical settings.

libraries?

> I'd still rather be in the UK where everyone who wants it gets a 70% vaccine in what i assume will be reasonably well-organized fashion

ha ha

“If it’s 70%, then we’ve got a dilemma,” said Fauci. “Because what are you going to do with the 70% when you’ve got two vaccines that are 95%? Who are you going to give a vaccine like that to?”

I would suppose the only answer to that would depend entirely on availability. Obviously, the 95% vaccine should be prioritized for high risk populations, but there will be a long line of successively lower priority people who might benefit from a 70% vaccine if it were available to them much sooner. I'm sure the health professionals will figure it out.

i walked into that one, and government services in the UK have room for improvement (lived there for 30 years). but this is one of those things like public transport in london/new york: there's lots of room for improvement but it sure beats the alternative. not sure if people in the UK realize how simply absent and/or maliciously badly run government services are in a lot of the rest of the world.

I'm sure the health professionals will figure it out.

this seems like a job for public health administration in a government. would be cool if the US had one rather than relying on thousands of city/county/state-level services to figure it out, and for-profit entities to do the right thing.

"I'm sure the health professionals will figure it out." -- the march 2020 federal plan for protective clothing and masks

well I trust my local health department more than I would trust a national one, if it existed