I think it's mostly because NHS organisations are already well organised for distribution of vaccines to staff. They're large organisations with thousands of employees.
Care homes are all mostly small, with a handful of employees.
In Denmark where I live, a large proportion of infected people are age 20-29, and I wonder if it would make sense to vaccinate them first when you get to "rest of the population". Even though they have a smaller risk of getting seriously ill, that could be an effective way to lower transmission.
That is:
1. Immunize the age group that is dominating in the hospitalization statistics, then
2. Immunize the age group is accounting for the majority of transmission, then
3. Immunize the rest.
Because A.) Approx 1 20yo in a million will have life threatening complications. Plus B.) there are a lot more of them than their (are people who have non-negligible chance of dying + people around those with non-negligible chance of dying).
The lockdown is justified by certain measurable factors, such as hospitalization rates, the risk of death, and the risk of major complications, and as we vaccinate the population, these factors will decrease. They will decrease quickly at first and then very slowly taper off to zero. (Remember there will be idiots who avoid the vaccine altogether.) It makes sense to ask when Covid crosses the line from a risk that justifies lockdown to a risk that does not.
We don't know yet whether the vaccine stops people from being asymptomic spreaders. We do know that it is effective at stopping people from getting ill.
So we don't know how beneficial your 2 above would be.
So I should only get the vaccine if I fear for being sick, similarly to the flu, right? I do not want the vaccine. I have been exposed to many COVID-19 positive people and I am fine, thus, I do not want a rushed vaccine.
I don't know why you've been downvoted, because this is really important to point out. The vaccine does not, as far as we know, prevent you from spreading COVID; it simply tries to prevent you from having any symptoms. So while it will be effective at keeping people out of hospitals, it may not actually do anything to stop the spread of the virus.
From a sheer infection control standpoint it makes a sense to vaccinate hypermobile social superspreader nodes first. Anyone who comes into contact with lots of people is going to be responsible for more onward infection chains than a reclusive grandma. The butterflies among the young are probably key drivers of spread. Take them out of the susceptibility picture and everyone benefits.
If you want to keep the amount of dead people to a minimum, then it makes sense to first vaccinate those who are most likely to die.
HN-ians like to model stuff, and i get that. To do it properly we need to know how many "young"(active ppl) there are, how many old with lung problems, the rates of propagation in and between those, and probably other stuff. But the goal is to keep the deaths down, and my opinion is that by far the smartest way is to first vaccinate the vulnerable people and those who deal with them directly (nurses, etc.). There's also a lot of points about practicality. For example; If i get infected not much happens (i'd just have to isolate myself, even with heavier symptoms). But if my mother gets those severe symptoms she would need to go to the hospital, if she would live at all.
Even if the math says it's better to vaccinate the young ones first, i'd still argue that it's overall safer to vaccinate the vulnerable ones first.
Smartphone mobility and social graph data that’s already being collected and analyzed. Rather than just using existing tech to target ads and build surveillance capitalism profiles, it could be used in the public interest. On an opt in basis naturally; but as frictionlessly as possible via cookie tracker popups and updates to FAANG terms of service perhaps.
Stranger things have happened in 2020 than that! It’s a win-win. Superspreader nodes either get their vaccine or they become aware of how much they’re already tracked may begin to consider the nuances and implications.
There is a considerable Moral Hazard element to this, but it would make sense to vaccinate the most irresponsible people first, since they're the ones spreading it most.
How do you know whether someone is being 'irresponsible' before they catch the virus? Do you follow them around, taking photographs? Imagine the social stigma, for starters. Do you live in the real world, or a computer game?
It's not realy moral hazard, it's about what is the goal.
If the goal is to slow down the pandemic, then the "irresponsible spreaders" should be vaccinated first.
On the other side, if the goal is to punish "irresponsible spreaders", then they should be vaccinated last. But that also means that pandemics would not be slowed down, and the ones taking that decision will be responsible for further spreading.
There are far, far too many of them compared to the number of vaccination treatments currently available. It wouldn't make a dent. Better to treat the much smaller number of people in high risk groups.
I have a suspicion that once the vaccine rolls out and is working then everybody will throw caution to the wind. It’s going to be interesting to watch this unfold.
Fully expect the same. Basically, if you are less than 65 years old and not working in one of the early access professions, forget all concerns about vaccine safety. Buckle up to face the virus natively in that third wave that will sweep through unmitigated once the high mortality groups are vaccinated.
There may be places you won't be allowed to go and things you won't be allowed to do (like work, maybe) unless you show proof of having been vaccinated.
There's a good chance that situation will create a black market both for vaccines (real and fake) and forged proof of vaccination.
You are painting a scenario that could theoretically become an issue if vaccination somehow got stuck at some point close to or far beyond the 50% mark for some reason. E.g. to deliberately exclude some part of the population, or in some "the vaccine is actually a carrier for something else" movie plot. But if the limits of vaccination are just the confines of ramp-up and particularly if priority is given to the elderly, it's just a phantom fear. Not allowed to go to work unless you are older than 75? Right...
At first glance forgery seems like a very real threat considering how hard it is to tell vaccine from sodium chloride (entire testing procedures are based on this), but the same difficulty is also working against a black market: why pay if the seller can't give event the slightest indication that it's not a fake and the fake has no intrinsic value at all? You'd have to fake the distribution structures and not the product and an elaborate fake structure isn't something that suddenly pops up from some dark market investment, it could only evolve from simpler black market schemes. But those won't happen, at least not in time (except maybe in places with a truly corrupt regular distribution system, where it would start with "redistributed" real vaccine and then slowly shift over to fakes)
There may be places you won't be allowed to go and things you won't be allowed to do (like work, maybe) unless you show proof of having been vaccinated.
The UK government has ruled out having a vacination passport (for good reason in my opinion).
As I recall, the UK government very loudly and repeatedly refused to rule out a second national lockdown, despite calls to do so. Now, Boris Johnson said that he really didn't want to carry out a national lockdown and that it was a last resort, but that's not the same thing at all. Didn't stop the press calling it a u-turn anyway of course.
The Flip-flop / U turn complaint has always irked me. People don’t know the future, people change their minds. I would be disappointed if government were given new information and didn’t change their mind if it was now clear they should do so.
I am not saying that the government can't change their minds, new things pop up, future is hard. I am just saying that relying on "they promised us to not do that" is dumb. They will do anything once circumstances change.
This isn't a fair comparison, or reasoned in good faith.
The UK government changed their mind about a second lockdown given new evidence. The virus got much worse and they responded. What new evidence is there that the UK government is going to start vaccination passports? Has something changed?
That's the wrong question. The right one is "may something change in the future?" And an answer on this: "maybe, we don't know, nobody knows the future".
That being said, extrapolation of the exponential curve a month forward is one of relatively simple ways to predict the future. And yet, it was _completely_ unexpected for the UK government. Think about that.
that has already been ruled out in the UK and by many other nations and it is also not something that the WHO advocates so I dont see that getting leverage ever. Except in authorotarian regiemes where it would not be about the vaccine anyway.
There are people far smarter than I am developing plans for this, but I'm assuming the thinking is "it's better to vaccinate the person who could die from Covid than to vaccinate the person who could potentially give it to them".
I have no doubt there are some pretty interesting models being developed to determine the best course of action.
This only would makes sense if there would be evidence that the vaccines are so-called _sterile_ vaccines. Which means vaccinated people cannot transmit the virus to others. But, absolutely no covid-19 vaccine can be considered as sterile, because there is just no data for it. So, it is, for now, just a self-protection vaccine.
Older Adults' is a shortened term for certain divisions e.g. Older Adults' Mental Health in UK medical circles. it's a bit of a catapostrophe, but I suspect it was copied, pasted, then added to without due attention
Would the vaccine work on those groups? My understanding is that you need baseline immuno-response to develop the resistance with help of vaccine.
Isn't one point of vaccination of population to protect exactly that population who can't receive the vaccination?
I'm going through the transplant pipeline right now, and I've been told to expect that it should still work, but probably at a lower effectiveness than someone not on a post-transplant drug regimen. I'm really hoping the timing works out so I can get it pre-transplant though.
I'm Canadian, so I imagine it's a completely separate system (for example, I don't know what a "trust" is). I go to my local hospital which has a pretty large nephrology department.
At first I missed NHS staff on the list; it's tucked in the second bullet point as part of "health and social care workers". A footnote attached to it says:
> The final decision on the prioritisation for health and social care workers will be dependent on vaccine characteristics and the epidemiology at the start of any programme.
So in the UK we have a really good set of expert bodies that put forward reccomendations on these things, the JCVI being the vaccines body. They are every bit as good as the current government are terrible.
The FDA already recommended (it's not binding) that front-line healthcare workers and seniors in long-term care are the first wave of 20M people (40M doses).
20% points seems to be the drop as the rapid approval process became a victim hyper-partisanship in the US. The push for a rapid approval has been viewed, by the left, as a political ploy by the right instead of a well-planned & scientifically supported approval process. Early polls about taking a vaccine showed much higher support for it before it was politicized. [0]
Support dropped by 20%. Surprisingly, it dropped by about the same amount for both the political right & left, although support on the left started at a higher level. This may indicate that even people on the right were influenced by the perception of a too-rapid approval process.
Having worked in the pharmaceutical industry, if I ever said my FDA approved drug was "safe and effective" I'd have the FDA dropping the hammer on me.
The FDA does not prove a drug is safe. No drug is 100% safe. The FDA determines whether the risks of the treatment are outweighed by the benefit.
I have no doubt that additional safety signals will pop up from Covid vaccines as the treated population expands by 100x. Most likely they will not be severe and the risk will still outweight the benefit.
But to say "we've tested the vaccine on a 15,000 people so we know it's safe to vaccinate 1B+ people" is not something the FDA would agree with.
Nothing is 100% safe. The word "safe" is used by almost everyone to mean a feeling they get. Something is safe to them if it feels safe. Flying is "safe" if you don't fear flying. It is not if one is afraid of getting on an airplane. Is driving a car "safe"? It is if you don't feel scared when driving in a car. Any other use of the word would need to have some statistical evaluation of the situation. Saying the risks of the treatment are outweighed by the benefit is a great rational way of saying drug is safe enough to use, but most people don't use the word safe in that way.
To me a chainsaw is a safe tool to use. Dangerous, but safe. To others it is not. Is a chainsaw a "safe" tool?
It might be a matter of "do as I say, not as I do". If you look up prior FDA violations, you'll see the FDA get pretty ticked about not clearly laying out the safety risks of a medication - as such, using language such as "our drug is safe" would go directly against that.
The FDA is incredibly strict when it comes to advertising. I remember reading about one violation where the ad had a tagline for an ADHD medication "So you can concentrate on the important things" and showed a picture of a child studying. The FDA said "the image implies that your medication will improve the ability of a child to study and you have submitted no data to the FDA to support this claim".
Oh boy, these people completely have missed the approved, and then later withdrawn medications. There have been quite a fuckton of them, or late black box warnings.
A seatbelt might strangle you in one in a million crashes, but colloquially, we can all agree that seatbelts are safe.
No drug is safe, but in this case, not taking a drug is not safe. If it's safe enough to vaccinate 15,000 people, when 300 of them are expected to die without vaccination, it's incredibly unlikely that side effects discovered on 1 billion people will not make the vaccine the safe choice.
Conversely, I am finding the reaction to anti-vaccine sentiment from some politicians to be pretty creepy. Already there is talk of compulsory vaccination or "vaccine passports". Labour (the UK opposition party) were even calling for spreading "misinformation" online to be illegal.
I find this ridiculous considering the massive challenge we have ahead of us just to get the vaccine to the millions of people who desperately want it.
Sure, if we get to the point where everyone who wants the vaccine has had it, and there are still people dying from COVID, then we can discuss illiberal measures to increase vaccine take-up. (I'd still be opposed to them).
Getting worked up about this stuff when not a single person (outside of the trial groups) has been vaccinated yet just demonstrates our politicians' (on all sides) tendency towards authoritarianism.
I'm not sure I agree. The maths says that we need about 70% of the population to take the vaccine in order for it to no longer be a threat. We also have polling that says about 53% will refuse to take the vaccine. So we're already at the point where something else must be done such as adding incentives, a passport system or better advertising etc. OR continued lockdown measures and enforcement of mask wearing. It's not a theoretical problem we're already there.
> The maths says that we need about 70% of the population to take the vaccine in order for it to no longer be a threat
...to no longer be a threat to an unvaccinated person.
This isn't like the childhood vaccines, where we need herd immunity to protect the children who are too young to be vaccinated.
Provided that everyone who wants the vaccine can get it, I don't see the problem with letting everyone else make their own decision.
The current priority list of people is nowhere near 70% of the population anyway. Most people under 50 won't have the opportunity to be vaccinated for months. So this absolutely is a theoretical problem, at least for now.
Given that Covid is such a mild disease for most young people, I predict that by the time the elderly and vulnerable have been vaccinated, this will be a non-issue anyway.
Yeah, the only reason I'm holding to the guidelines is for elderly and immunocompromised. I don't care about catching covid and nor anybody I know not in one of those categories.
This whole thing becomes moot once the vulnerable are vaccinated, no need for creepy immunity passports.
I used to agree but a few of my 20-29 year old friends have had much worse experiences than expected. One had some neurological side effects, which is rare but happens, that affected his eye movement and made it impossible for him to read or work comfortably.
It wasn't healing and it turned out he had an undetected issue processing folic acid I believe, which has an effect on how your body heals from neurological damage. He's recovering now after 3 months but has to take folic acid and other supplements 5 times a day.
Other friends have had persistent diminished lung capacity for months on end; these are folks who had no co-morbidities and in their 20s.
Yea I'm not totally concerned about catching it but if I do, I increase my likelihood of hurting others. That's been the logic of most of my peers (early 30s, late twenties).
However, through my partner I am friends with many classical singers. They are absolutely worried about damaging their instrument.
>This isn't like the childhood vaccines, where we need herd immunity to protect the children who are too young to be vaccinated.
It's not only too young children who might not be legitimately unvaccinated...some people who are immunocompromised or otherwise medically unable to take certain vaccines must also rely on herd immunity for protection.
> ...I don't see the problem with letting everyone else make their own decision.
Pandemics have, since time immemorial, been an exception to the "I can do what I want" rule.
Much like allowing parents to fall into conspiracy theory traps and refuse to allow their children to be vaccinated against measles, resulting in that disease suddenly becoming a threat again, if we're going to get back to normalcy we can't let half the population ignore the vaccine.
But, since we are going to let half the population ignore the vaccine, prepare for a long, drawn-out period of time during which the disease will flare up, lockdowns will be imposed, more people will needlessly die, and conspiracy theories will continue to make a mockery of civilization.
It's still unknown whether vaccines convey sterilizing immunity. Even if they don't, there will be no political will to institute lockdowns if the people who are getting sick could have been vaccinated. If unvaccinated people getting Covid-19 creates undue strain on the healthcare system, the calls will be for mandatory vaccination, not for lockdowns.
Restricting social interaction and business is a crushing approach to solving the problem, with severe consequences to health and economics. It's brute force, like securing a computer using an air gap. The only reason lockdowns have been used in 2020 is because we have no other options available, but a free and readily-available vaccine changes the calculus.
While the healthcare is centralised, the data is not, and often poorly federated between a multitude of organisations. Scotland has unified this much more and is far better placed to monitor for efficacy and side effects.
I'm pretty sure the "column limit" claim was a false online theory that just stuck around because we're in such a post-truth era that even the definition of post-truth is itself post-truth... The reputable news coverage all said it was the number of rows that was the problem.
I suspect the bulk of the population will receive the 'Oxford' vaccine. It's still going through the approval process but the UK has ordered more of it. I believe the Pfizer vaccine is targeted to front line workers and the clinical vulnerable.
Yeah, there was a ton of news on that vaccine last week.
After a bit of push-back the laboratory acknowledged that this 90% efficacy was comparing a much younger vaccinated population than the one that got placebo.
That has put some doubts on the entire procedure (with countries forcing them to publish details), but it doesn't look like a real problem right now. Anyway that one high efficacy result is very likely flawed.
Anyway, what I get is that the important part is this: "Nobody getting the actual vaccine developed severe-Covid or needed hospital treatment."
We don't need the super-high efficacy numbers (>90%) that the other vaccines are reporting for this to stop the virus. Typical flu vaccines are ~ 50%, I think the Oxford vaccine's results show that they've achieved this.
The efficacy does not need to be super-high, provided enough people decide to actually go get vaccinated, and the percentage of skeptical people seems to be quite high.
Plus, any given vaccinated individual would have to rely less on others being vaccinated as well.
But I am grateful that vaccines got developed and tested so quickly anyway.
Yes I think they only need to hit 50% for approval. Conservatively they were getting 62% as I recall and the 'experimental endpoint' dose got them to 90%.
The Oxford vaccine is far cheaper (15x) and easier to store so long term it has a lot of competitive advantages.
There's certainly been issues with how parts of the trial was run. However, it's not insurmountable. It's possible to untangle some of the past data and the trials aren't over yet and these aren't the last trials so we will have better data soon and it could all check out.
This vaccine is appealing in particular because it's a lot cheaper to make and a lot more straightforward to distribute and even with questions over how the trials were run it's still looking like the good results will probably hold up mostly.
My understanding is that that trial condition (half->full) was administered accidentally (thus not pre-registered) and nobody expected it to work better, and the sample size is small and on the wrong age groups.
The half dose was an 'experimental endpoint'. Always planned but not seen as critical. FDA rules now stipulate you can only register on primary endpoints declared before the trial starts. I suspect AZ have argued that the accelerated nature of the process should take this into account.
I don't think that gives an accurate picture of what happened. Even AstraZeneca themselves are calling the half-dosage a mistake. Their US trial of that vaccine does not currently contain a half-dose arm [1], though it likely will be amended to do so. As best I can read it, the dosage amount was planned but it was intended to represent the "full" dosage and not to be a half-dosage, but was updated when they noticed unusually mild physical symptoms in people receiving the vaccine. [2] I haven't seen anything to support the idea that a half-dosage was an intended endpoint, whether secondary or otherwise. Do you have a source for that?
No, the results are not valid, or at least not in a useful way. The group who have received the wrong dose isn't a random sample from the treatment group, so we don't know whether it's more effective or not. It could even be less so.
I don't know what the regulator will do about this situation; it's clear that the vaccine is effective in at least one of the dosing regimes administered, but being entirely certain as to which is better is probably impossible to determine from the data available.
My understanding is that the results are still useful and can be include in the statistical analysis. This is what I heard form the BBC's Newscast podcast
Professor Jennifer Rogers (clinical trial statistician):
> "There was some planned dosing differences anyway but this one happened by accident. Now that doesn't mean these results are completely invalid - doesn't mean that at all. You can make changes to your protocol and you can make changes to what you're gonna analyse all the way up until you actually see your data.... If you haven't seen what the data looks like, you are allowed to make changes to your protocols and it is quite common, it does happen that people make changes as to what they're going to analyse.
> "So this change was carried out with discussion with the regulators so it was all fine..."
Now I tried to find the same information reported online and I found this from the same Professor:
> It is perfectly acceptable to make changes to the protocol prior to database lock, so the protocol could have been updated to include this additional analysis (the point of closing a database is to ensure a trial can remain blind, meaning researchers can’t carry out ad-hoc analysis or potentially selectively report results before proper analysis takes place). However, according to version 14 of the protocol, dated 9 November 2020, the primary analysis was set to be the efficacy of two doses of vaccine (across both half and full dose), with secondary analyses being the efficacy of at least one full dose and efficacy of two full doses of vaccine. Efficacy of half dose with a full dose booster was not considered as a secondary analysis in the protocol and so could be an ad-hoc analysis post database lock.
So I'm not actually sure whether AstraZeneca announced the change to their analysis before or after they started looking at their results. If they announced they were going to include the half-doses before database lock then they can use them as valid results.
Ignoring the 90% that is was based on a population below 55, a 70% efficacy is still a success for the Oxford vaccine, as it can be stored in a regular fridge. This makes distribution outside health settings much easier. I would happily take the Oxford vaccine if it was offered to me.
I'm sure the UK is in the top twenty countries in the world for logistics infrastructure. It's easy to read news stories about your country messing things up, and quietly not read foreign-language media about poorer countries messing things up a lot more by comparison, and get a biased perspective.
We had excellent Public Health test and trace departments who had a wealth of experience of tracing people for sexual health purposes. But we still chose to give the contract to Dido Harding despite her poor record at NHS Improvement.
And I saw what happened to NHS Logistics, which was one bit of the NHS that wasn't losing money. It was running well. It was privatised to DHL in 2006 for purely ideological reasons, and then for several years was terrible. Ten years later, after Lord Carter's report into efficiency and productivity, we set up a new org called NHS Supply Chain and in effect re-nationalised it by giving the responsibility to a company which is owned by the Secretary of State for the Department for Health and Social Care. I don't think anyone has really learned any lessons from that.
From a high level overview and global perspective, what the OP is saying, or meant, is that comparatively speaking UK is much better than possibly 80% of developed countries. Not to say NHS is without flaws, far from it. But if you step outside and look around the world many are surprised how awful public health services and logistics can be.
So to put it another way, It is not that NHS is good, it is just the others are worse. Although this conclusion or opinion also makes me rather sad.
What you're missing is that amongst a certain class of Brit, and across much of the West, relentless and savage cultural self-criticism has become the norm, and a currency used for in-group signalling. Even when people in the UK should be celebrating, as literally the first country in the world to develop an approved C19 vaccine in record breaking time, and enjoy the privilege of a free health system that can roll it out within _weeks_ they still find a way to twist it. Asking them to truly recognise the fact that there indeed exists big differences between the UK and much of the world in this respect will fall on deaf ears - it doesn't serve their purpose - which to be clear, isn't truth-telling or (heaven forbid expressing pride in their national achievements) it's a habit of personal advancement at the expense of others and dissolving their own culture in an acid bath of manifold criticism. It's only where this sort of criticism is expressed in forums with international readers, many in far less fortunate positions, does it begin to reveal itself for the pathology that it is.
Much of what you say is true, but doesn't negate the point of the comment you are assuming the motivation of.
The UK national infrastructure does have a history of dubious at best procurement, outsourcing and "consultancy" decisions in supplying it's services - those public services often then coming under extreme criticism from the same quarters as your attack - who are often the same private sector blowhards who cause many of the problems in the first place.
Far more public sector hating and damage comes from there than from the virtue signallers you (rightly) criticise.
Completely agree. Same thing happens in the US - to hear some Americans speak they have become a dictatorship with a tyrant in charge, and the whole system is broken. Meanwhile they continue to have free and fair elections, first amendment rights, the ability to take their government to court etc. In my country (in west africa) just voting against the dictator in charge can get you banned from getting any employment, send you to jail to be tortured etc. And marching on the streets in peaceful protest has actually had people sent to death row awaiting execution. I guess it’s a matter of perspective :)
Seriously. I encourage anyone who thinks the US or any other Western country is a dictatorship to move to a developing nation and give it a try. I have.
Once you've interacted with a corrupt bureaucracy or wondered whether the medicine you bought is counterfeit or realized the only thing stopping the cops from shaking you down is luck, you get a new found appreciation for stability, reliability and fairness (yes not always) of developed countries.
I'm not from the UK but assuming the grandparent is right, you're saying they should be thankful that their country isn't as corrupt as other countries even though there's blatant corruption in something as important as the COVID response?
That's like beating your children but comforting them that they atleast have food on the table and clothes on their back.
A better analogy would be living in a nice comfortable house, which is much better than nearly all other houses - but then someone spots a problem with the chimney and starts comparing it to other houses’ chimneys, some of which have better chimneys, some of which have better chimneys but a worse overall house, and some of which are fantasy chimneys that could theoretically exist if only we all spent a bit more time thinking about chimneys. And in amongst all this chimney woe, the fundamental qualities of the house and the fundamental privilege of having such a house go forgotten.
Not quite. A substantial number of people in the UK live in poverty - between 20 and 25% [0].
This has been made worse by terrible political decisions, such as Brexit [0]. Specifically, austerity and political decisions (not limited to corruption) is linked to 130,000 preventable deaths [1]. Those same "budget cuts" for austerity exist while money is sent to "consultants" to "help fix things".
Not everyone in the UK has it well. The government, quite frankly, is fairly shit. And corrupt.
Thanks for the great example. The poverty chimney needs to be considered in conjunction with the security doors and the air quality windows and the human rights carpets and the unemployment basement and the healthcare bathroom and so on... before deciding on the house’s value.
A certain amount of self-criticism and cynicism is healthy and stops society from becoming complacent and sliding backwards. The more developed a country is, the higher the need for it is to maintain its status. As the US has shown in recent years, complacency erodes democracy, national status and personal quality of life.
To take the example of the NHS - it is constantly under attack by budget cuts, fragmentation and privatisation. Would it still be something to be proud of in a few decades if everyone stopped holding leaders to account?
I think you are arguing that some people are not genuine. If the price of progress is hearing people you don't care for virtue signalling, that's fine by me. I'd much rather have too much, and risk some of it not being genuine or warranted, than too little.
And I would argue that the people who genuinely want better demonstrate more national pride and a better understanding of their own culture than those sitting back and patting themselves on the back.
> Even when people in the UK should be celebrating, as literally the first country in the world to develop an approved C19 vaccine in record breaking time
The UK has one of the first (Oxford/AstraZenica), but this news about the first approved is not a vaccine developed in the UK. But I'm still happy to celebrate the Turkish couple's German company that's owned by Pfizer, as I will be when Oxford hopefully release more good news on top of their initial press release.
And our culture is far from perfect in the UK. Criticising a country's problems doesn't prevent also celebrating its positives.
Well, a country is a shared endeavour isn't it? We collaborate together by following our national laws, paying our taxes, follow our customs and traditions and engage in cultural renewal and repair when required. In this way, everyone in the country is responsible for fostering a peaceful and prosperous environment that can prove to be fertile infrastructure for advancements and breakthroughs. Why not take some small measure of pride in this? It's a generational effort.
Isn't it essentially the same human instinct that drives the desire to increase representation in media for underrepresented groups of people? We relate to people who are "like us" in some dimension. Sure, it doesn't make sense in a sterile intellectual sort of way, but why does that matter? It's still real.
> Patriotism is the belief that your country is the best by virtue of you having been born in it
I can't find the original quote but I 100% agree with you that it is pretty odd to take pride in something you have an extremely tangential relationship with
I've got to say that you yourself seem to fall victim to the very thing that you're criticizing (namely, polarizing over a national pride thing) as the vaccine is neither developed nor produced in UK. In fact, given the demand, it's not clear supply of the vaccine will allow for NHS' projections.
NHS Logistics didn't run well. As is consistently true of government run organisations it was run so badly that most of the NHS didn't even try to use its services. At the time of the privatisation the NHS sourced around half a million products but only acquired 50,000 of them via NHS Logistics. The entire purpose of privatising it was to try and make it work better and thus to encourage the NHS to buy more centrally to get bulk discounts, something that wasn't going to happen for as long as doing so required them to work with a small, sclerotic socialised bureaucracy.
Why would anyone think that an organisation which had no economies of scale, nor any demonstrated expertise in logistics in a competitive environment, be better at delivering things than DHL, a world famous delivery and logistics company that the NHS frequently chose to use anyway in preference to its own operation? That's ideology.
How much did NHS Logistics workers care about the health of the citizens who paid their salaries? Not at all: even though many of them were going to keep their jobs anyway they reacted to privatisation by going on strike and picketing trucks to stop them delivering supplies to hospitals. That's ideology. Fortunately it didn't kill anyone, but only because hospitals were already mostly bypassing the striking workers already due to aforementioned poor performance.
The NHS had its limits thrown into sharp focus this year. Mass testing is a bad idea, but putting that to one side for a moment, Germany and indeed most other places were able to ramp up test volumes far faster than the UK did, because Germany used private labs from the start when the NHS insisted on only using NHS labs, despite being given direct commands to scale up testing as fast as possible. That's ideology.
Finally, the supply chain hasn't been effectively renationalised. The contract changed from DHL to Unipart:
Supply Chain Coordination Ltd is what the name suggests: a relatively small coordinating body that manages contracts for various services, including contracts for logistics provisioning.
The brutal reality about the NHS is that not a single country in the world has copied this model. If it was good we'd see other countries adopt it but they don't. They don't adopt it because it's not good: this model is a relic of a time when the British public had just won a world war and as such had been exposed to years of war propaganda that made the government look artificially competent. In countries where that didn't happen the idea you'd want a single, centralised government agency to run every aspect of something as vital as healthcare was seen as insane: after all, if you go down that route why not have the government supply all food too? All entertainment? Why not run a fully USSR-style economy? Well because we know it doesn't work, that's why. There's nothing magical about the NHS that renders all those experiences irrelevant.
Your last paragraph caught my interest. Can you point me at countries that are widely accepted to have done a better job?
My own experience of the NHS (as a non-Brit who lived in the UK for more than a decade) is that it is inefficient at the small things (sitting in a waiting room for an hour - but being shamed if I show up 10 minutes late for my appointment) but brutally effective at big important things (treatment for life threatening diseases - worked well, but the biscuits were rubbish). I know this isn't data, but I also know that British people love to carp about the NHS, and having lived with health services in two other industrialised countries, I quite liked it.
The problem with British people's opinions of the NHS is that they routinely conflate the NHS with healthcare. (BTW, I am British myself). You're doing the same thing here.
The NHS is not healthcare. The NHS is not doctors or nurses or life saving operations. The NHS is not hospitals. All first world countries have these things, but none have an NHS except Britain.
The NHS is a bureaucracy that manages resource allocation. That's it. That's all it boils down to.
When you saw life saving operations working as hoped, that isn't happening because of the NHS. You'd see the same in France, Germany, Sweden, the USA, Japan or many other places. We don't judge the skill of a bureaucracy or institution based on the skill of individual employees, we judge it based on factors like:
1. How much overhead does it impose?
2. How competent is it at organising its operations?
3. How agile is it, how able is it to react to new circumstances and continually improve itself?
4. How many people can access its services, who might want to use them?
5. If it fails at any of those criteria, how easy is it to switch to a competitor?
The NHS varies from average to poor when evaluated by these criteria, with the exception of (4) where it gets the best possible score because it even happily treats people who flew in to the UK specifically for free treatment! But if we exclude that edge case then it becomes pretty average again, because universal access is solved in other societies using insurance schemes of various kinds (sometimes mandatory and subsidised). The exception is the USA where for cultural reasons a lot of people don't like being forced to buy health insurance.
Although its overhead is reasonable when evaluated in pure GDP terms, this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable.
The biggest problem with government run industries is not that they can't carry out their mission at all. Soviet factories successfully made steel and rockets, after all. Their problem is lack of agility and lack of quality. Agility: see the NHS testing ramp-up problems discussed in sibling threads. Quality: see how slowly the NHS ramped treatment back up after the April shutdown. Other countries did much better in that regard, because private hospitals desperately want to treat people in ways that the NHS just doesn't. How could it be otherwise: if private hospitals don't treat people then they run out of money and go bust, like any other business. If the NHS doesn't treat people, its staff basically get a paid holiday with no negative consequences. Of course that affects people's behaviour.
I said average to poor, that's true except for (5) where the impact is catastrophic. Its tax funded status means the private health sector is seriously throttled in the UK. So only the rich can work around NHS failures, and even then not always (private hospitals don't do the full range of treatments in the UK).
The principle of "free at the point of use" is the critical factor in the NHS; while other countries manage to achieve that with different organisational structures. (4) is critical. Any whiff of ineligibility by payment is completely unacceptable, and rightly so, or we'd end up with the US disaster. From a political point of view, we have to defend the existing system because otherwise the US one will be forced on us. Nobody in UK politics will give us the Swiss system.
> tax funded status means the private health sector is seriously throttled in the UK
This doesn't make sense? Bupa exists?
Private health insurance is quite cheap in the UK compared to America because anything complicated or expensive can and will be dumped back on the public sector.
> this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable.
Nobody in UK politics will give us the Swiss system
How do you know? Nobody talks about alternatives to the NHS in the UK, even though it's an obvious topic that should be talked about all the time (the UK's a highly visible exception to the consensus of other rich countries and that would normally provoke debate). You don't actually know what the alternatives to the NHS are because any attempt to be honest about the system's problems are immediately met with a horde of leftists yelling things like "Tory propaganda", and insisting that anyone who criticises the NHS inexplicably hates nurses/babies/life saving operations, etc. They successfully shut down political debate every time.
It's entirely plausible that if there was a serious, honest and rational debate in the UK about healthcare then the country would move towards a European system. Why not? The UK aligns with European neighbours far more often than it does with the USA and that will likely continue even after Brexit.
Re: Bupa. Aren't you agreeing with me here, then? The private healthcare sector in the UK is anaemic compared to other countries because it's so hard to compete against "free". They end up trying to offer slightly better quality around the edges. They can offer complicated or expensive operations too, but people are already being forced to pay the government for them regardless of their own personal evaluation of quality or need, so hardly any market exists. Bupa is a minnow compared to its equivalents in the rest of the world, and how many competitors to Bupa can you name? The British healthcare market exists forgotten in the shadows because the NHS drowns it.
[Unpleasant facts] Unsourced Tory propaganda.
This is what I mean. It's not propaganda, it's actual reality that Labour and leftists live in denial of. Literally the first result for [nhs maintenance backlogs] is this:
"In 2018/19, the total cost of tackling the backlog of maintenance issues in NHS trusts rose by 8.4 per cent to £6.5 billion. And of this over half, £3.4 billion, was for issues that present a high or significant risk to patients and staff (see Figure 1). Now, if these numbers don’t quicken the pulse, a little more context is needed. High-risk issues are identified where repairing or replacing NHS facilities or equipment ‘must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution’"
Or you can read about it direct from Parliament (see section 2):
Note that this backlog is just to restore physical objects to an "acceptable state" (quoting the Parliament document here). It's not to actually make the NHS better than it used to be, just the cost to stop it being so degraded it's actually dangerous: "One director of an NHS trust told me that broken gutters in his hospital lead to water seeping through the walls when it rains heavily. This happens so frequently that nurses now give ‘water updates’ in their shift handovers, so incoming team members know when they will have to start unplugging electrical equipment".
That was the backlog before an epidemic of bad data and advice from government run bureaucracies destroyed the economy that has to pay for it. The government no longer has any financial strength left to tackle this issue, and risks triggering serious inflation by trying to print its way out.
There are many other places you can read about this. The NHS is decaying away because its managers are terminally incapable of making the difficult decisions management requires. Given a choice between paying down their maintenance backlog or giving nurses a pay rise, they do the latter every single time even when commanded by ministers not to. Sometimes they even fail to spend the money they were given and end up with a "surplus", just through managerial incompetence.
That's not "Tory propaganda". It's reality, and exactly how the Soviet union looked at the end of its days.
> Any whiff of ineligibility by payment is completely unacceptable, and rightly so, or we'd end up with the US disaster
Lots of European systems require e.g. payment for GP appointments and aren't anything like the US system. Likewise, the UK makes people pay for dentistry, spectacles.
> From a political point of view, we have to defend the existing system because otherwise the US one will be forced on us
This sounds like unsourced propaganda...
> Private health insurance is quite cheap in the UK compared to America because anything complicated or expensive can and will be dumped back on the public sector.
Most private healthcare in the UK covers complicated and expensive cancer treatments, including ones not covered by the NHS, so this doesn't hold water. (There are a few cheaper, less common insurance plans that don't cover cancer and are designed to complement the NHS coverage, AFAIK)
You're going to have to provide sources for this lot. When we're talking about corruption we're talking about things like the no-bid contract to Platform-14 for PPE. Or the "Seaborne Freight" incident.
Tiny firms and shell companies are "an organisation which had no economies of scale, nor any demonstrated expertise in logistics in a competitive environment". DHL at least has a track record of large scale delivery.
> NHS insisted on only using NHS labs, despite being given direct commands to scale up testing as fast as possible
"Part of the reason the UK has had difficulty in meeting the 100,000 tests daily goal was because of its focus on centralised testing centres. In contrast to the robust and wide-reaching testing programmes in Germany and South Korea, the UK government initially decided to centralise all of its laboratory testing in a few large hubs"
And yes of course there's corruption and incompetence in government - in procurement as well as everything else. The fact that governments routinely fail to even write proper contracts to buy things should give pause for thought when considering how well they'd handle running the entire operation.
So, not an NHS decision but a political decision by the relevant cabinet minister? That changes the answer. It's important to distinguish between decisions made by "the NHS" (to the extent that this isn't just individual trusts, or NICE, or whatever) and political decisions made by the government which are ideological.
Mandatory health insurance. Look at the Swiss type system or really more or less any modern healthcare system. Pro-NHS Brits love to compare it exclusively to the USA, but most countries do far better than both.
That's not an alternative, health insurance is mandatory anyway by virtue of us being made of flesh – the alternative is going bankrupt due to having no leverage after getting treatment for anything.
No it isn't. Healthcare isn't infinitely expensive, the world is full of people who can pay cash for healthcare (or take an insurance policy with a very high excess which approximates the same thing).
"Full of people" is an idiom, it means there are lots of them. It doesn't mean all of them. There are lots of cheap medical interventions and lots of people who earn more than $33k a year.
It's a fairly stereotypical British trait to be self deprecating. If we were singlehandedly saving the world from a rogue asteroid the general sentiment would probably be "let's hope we don't mess this up".
Government is a continuum, and I don’t remember a time that it wasn’t riven with cronyism. A book came out in 2005 called The Essential Guide to Quangos and I’m willing to bet it wasn’t Blair’s government that invented them (and it certainly didn’t put a stop to them).
No government has ever or will be completely uncorrupt or efficient. Thatcher bent various rules for her shady son. Labour arranged all those dodgy PPI deals. Humans will be human. But in my 54 years on this planet and living in the UK I don't remember a government being anything like this corrupt or inefficient. Everyone politician with a brain, spine or conscience was fired and replaced by Brexit 'loyalists'. And here we are. One of the worst responses to the pandemic in the world and I don't know if I will even be able to get fresh veg in January. So much for British exceptionalism.
I live in Japan and the response by the government here was and is in sharp contrast to that in the UK (a super soft lockdown that ended before the summer is one example), yet it has been akin to comedy show from the beginning, before it hit the UK.
Still, there has not been the same hit from the disease, which only underlines that the differences in effect that are seen worldwide are about differences in population and geography - being overweight, having a very low friction of movement (e.g. excellent transport links, many borders), and not being low in vitamin D etc - far more than they are about government response.
I'm not saying the UK government has done well but it's striking to me that, from a distance, the criticisms of the UK and US I see coming from my friends are very similar, very parochial, and seem driven by media headlines rather than anything objectively sound.
In short, I'd give it another few years before you judge them more harshly than the government that brought us the Iraq war, for one.
The quango is the worst of all worlds, so it's not surprising that the concept was invented by governments.
I haven't seen the word used outside the UK so a definition might be useful: a quango, or quasi non-governmental organisation is the platypus of the British government world. As the name implies it's neither a part of the government nor the private sector. Instead, quangos are paid for by taxpayers but are completely unaccountable to them, as they can't be directly controlled by ministers or the civil service.
The theory behind this is that governments are crap at things because elected politicians interfere with the expert work of technocrats. So by setting up artificial blockades to political interference, power is transferred to technocrats and things should work better.
In practice what happens is that the government ends up hiring people who aren't very good at what they claim to be expert in, and who get corrupted by whatever unaccountable powers have been delegated to them. But they aren't easily fixable because they're "independent".
The Electoral Commission is a good example of a completely broken quango. Its only goal in life is to organise elections and referendums in ways that everyone agrees is completely fair and trustworthy. It is a staggering failure: the board of directors is full of people who publicly state very strong political opinions. It engaged in a legal vendetta against people who campaigned for Brexit. It has constantly prosecuted pro-Leave campaigners and got its ass kicked in court, where judges have repeatedly dismissed cases on the grounds that they have no evidence and/or are engaged in malicious legal behaviour. They've referred cases to the police that were then dropped for lack of evidence. Senior staff have posted on Facebook that they cried when the Tories won the election. Nobody who has followed these sagas can possibly believe these people are neutral, independent or even possess basic competence, but as they're a "quango" there isn't much of a framework to fix it beyond changing the law to totally abolish them.
Opinion, not necessarily fact, but my understanding of the "piss up in a brewery" outlook comes from Parliament, not the government. The structure of Parliament is that the opposition has to challenge everything the government in power says and does in order to keep them in check, even when the opposition has exactly the same views on the policy being discussed; this leads to arguing for the sake of arguing even when common sense would say "this is entirely agreeable to practically everyone".
I'm not saying that the government shouldn't be kept in check, but the fact that the UK government appears to move with all the speed of a striking slug appears to be the fault of the system they are required to follow, not the government itself.
While I appreciate your point I think the current UK government have done more than average to "shake up" the civil service. Others might describe these changes in less charitable terms.
> It's a fairly stereotypical British trait to be self deprecating. If we were singlehandedly saving the world from a rogue asteroid the general sentiment would probably be "let's hope we don't mess this up".
was this always so? i've noticed this while living in London and, coming from a literal 3rd world country, I do not understand it. i'm trying to find when this started... i don't it started anytime in the recent past. seems to have been going on for a while.
It's an interesting question. I'm sure you could probably do a study and find that on average British people are no more self-deprecating than the average; and yet it does appear as one of those commonly accepted parts of the British psyche.
I've noticed a shift in the last decade or so from self deprecating to self loathing. People seem loath to admit that we are one of the richest, most privileged, most developed countries in the world.
I do not believe that it is a stereotypical British trait to be self deprecating.
Being self deprecating is very common in a large number of countries, among all those who are reasonably intelligent or educated, to be able to notice how many bad things exist around them.
As others have already mentioned, this is caused by the fact that people can see directly the many bad things that exist in their neighborhood, but they have very little information about how things are bad elsewhere, and they hope that at least in other distant places the same mistakes are not being made.
they're pushing for more cycling, more climate measures, more taxes on IT giants etc
and these are Conservatives, the opposite of left-leaning.
on the other hand, their Covid response was the same as Spain, Italy, France etc i.e. pretty bad. but they also approved the vaccine really quick, and we're getting that next week.
so overall, a meh, like most other countries where I lived.
as a point of reference, from the countries I lived in, I consider Singapore and Tokyo to be a notch above the rest of the world when it comes to governance.
but most government of the countries i've lived in were the same as the UKs: they only react, they're politicians, they're detached from the real world etc etc
To me the Conservative party feels fairly centrist at the moment, or at least they certainly aren't as right-leaning as our Big Media seems to portray them. Just a personal thought.
It’s a very English trait to think of itself as a self-deprecating, gentle and peace-loving nation while also being inordinately proud of the Empire and its conquests.
Even success story South Korea has been doing a lot worse than you'd think from the BBC coverage. For example, they ran this article about Europe struggling with Covid that made it sound like South Korea's test and trace is working so well, they can even reopen pubs and nightclubs: https://www.bbc.co.uk/news/world-54482905 In reality, pub closures and social distancing measures had only been lifted the day before the article, every time they've lifted them before cases have gone up and they've had to reimpose them, and this time was no exception. You wouldn't know that from the BBC coverage, at all. If the UK was doing the same thing, there'd be endless headlines about U-turns, arbitrary and unpredictable measures that change for no reason, the cost to businesses of both the closures and the uncertainty - but because it's happening in South Korea readers are given the false impression that it isn't happening at all.
A huge part of the perception that the UK is failing at dealing with Covid-19 due to awarding contracts to cronies comes from exactly this comparison with a South Korean success story that is a complete and utter media illusion. (They're also testing at something like a twentieth the rate of the UK - not enough to offer free testing to everyone with potential symptoms like we do, let alone do regular testing of all medical staff or any of the other things our press says our government is incompetent for not achieving - but you wouldn't know that from the UK media coverage either. Judging from their media reporting on the number of people awaiting results, they're probably not even doing any better at returning the results to people fast either.)
Sometimes they even just outright lie. When the UK hit 100,000 Covid tests in a day, the BBC ran a completely false claim that Germany reached that level of testing a month before the UK when in reality they didn't until several months after us. The BBC kept that claim in an article that was prominently featured on their news front page for a month after they were aware it was false meaning a substantial proportion of the entire UK population probably saw it. I still see it popping up everywhere. (They also claimed that meeting the 100,000 a day goal was faked by counting tests when they were sent out rather than when they were completed. In reality, it was met either way, and one of the minsters involved even pointed this out in a BBC interview - but people who followed the BBC coverage wouldn't know about it.)
Sure, but the political party currently in government (and the particular people from that party in government) have shown great inclination to put "Favour for an old friend" above "This makes sense to not kill thousands of people" in their priorities.
The UK has universal healthcare so the infrastructure and public understanding are in place to actually do the vaccination programme per se. I have every confidence that the NHS medics will do their part efficiently as they do every year for the Flu shot I get, but getting frozen vaccine delivered to local NHS clinics is a logistics problem and an opportunity for somebody's wife's best friend's ex-boyfriend to be given a £100M contract even though he has no relevant experience and is obviously the wrong choice.
Six months later, with headlines about vaccine shipments defrosting abandoned in carparks miles from their intended destination and tens of thousands more dead the government will announce it had a brain wave, the Army (always the people drafted in when policy has failed) will now deliver vaccines. Don't worry about the money which has meanwhile mysteriously increased to £250M due to "performance payments" which somehow didn't involve performance but did involve payments - that's water under the bridge, can't be helped ...
Remember when we were going to do a snap Brexit, no transition, just drop dead one day suddenly? Basically the same group of fools paid people with no relevant experience and no ships to provide last minute ferry services. How do you provide ferry services with no ships? You don't, you just pocket the cash.
OP appears to have got lost on the way to /r/unitedkingdom where similar comments are generated by angry bots all day, every day.
Some perspective would be nice.
When you tell your buyers to go grab every last bit of PPE they can and cut them a blank cheque to do it of course you're not going to get the best price, especially when every other country in the world is doing the same things.
Do you focus on the 10s of millions of pieces delivered successfully? Absolutely not, get the tinfoil and red yarn out, we'll dig up something questionable. I've seen some other countries equipping medical staff in bin liners and gaffer tape, on reflection we have it pretty good.
I mean, even their own watchdogs say that there were problems:
>In the months following the emergence of the COVID-19 pandemic in March 2020 in the UK, government awarded around £18 billion of contracts using emergency procurement regulations to buy goods, services and works to support its response to the pandemic. Government was having to work at pace, with no experience of using emergency procurement on such a scale before and was developing its approach at the same time as procuring large quantities of goods and services quickly, frequently from suppliers it had not previously worked with, in a highly competitive international market. This procurement activity secured unprecedented volumes of essential supplies necessary to protect front-line workers. Our separate report on the supply of PPE looks in detail at the extent to which demand for that equipment was met and the value-for-money achieved.
While government had the necessary legal framework in place to award contracts directly, it had to balance the need to procure large volumes of goods and services quickly, with the increased commercial and propriety risks associated with emergency procurement. We looked in detail at a sample of contracts selected on a risk basis. Although we found sufficient documentation for a number of procurements in our sample, we also found specific examples where there is insufficient documentation on key decisions, or how risks such as perceived or actual conflicts of interest have been identified or managed. In addition, a number of contracts were awarded retrospectively, or have not been published in a timely manner. This has diminished public transparency, and the lack of adequate documentation means we cannot give assurance that government has adequately mitigated the increased risks arising from emergency procurement or applied appropriate commercial practices in all cases. While we recognise that these were exceptional circumstances, there are standards that the public sector will always need to apply if it is to maintain public trust.
And remember everyone, when reading reports like this one should replace any soft seeming rebukes with phrases such as "these muppets had no idea what they were doing" and "this looks incredibly corrupt, but if we say that this report will never be released".
The infrastructure, absolutely. A serious road, rail and air network, lots of companies with lots of experience and all the right gear and so on.
Where we fuck up is in the competency of the people in charge of awarding contracts.
Be it Grayling giving millions of pounds to a ferry company with no ferries owned or leased, or indeed any experience at all with ferries (and, wonderfully, with a T&Cs on their website copy-pasted from a pizza delivery site). As a wonderful finale, the government was sued by EuroTunnel because they awarded the contract without going through the proper process (which, of course, would have meant that the drawbacks of a pizza delivery business offering ferries might have been identified); we gave millions to a Ferry company incapable of delivering anything, and then millions to an actual transport company in compensation for breaking the rules on tendering.
Or be it KFC awarding their chicken distribution (despite warnings from people who knew) to a company with no experience in or facilities for cold food distribution, leading to KFC going literally out of business for a couple of weeks because they had no chicken in the stores.
We Brits have a competent infrastructure and the ability for the people in charge to award contracts to entirely the wrong parts of it.
I know it's guaranteed internet points to deride the current government, and the ferry thing is/was despicable, but I think it's highly unlikely they're going to put KFC in charge of logistical operations for the vaccine rollout.
Large PPE contracts were given to companies with no experience in making nor providing PPE, while companies with some experience were ignored. (Sometimes these contracts were awarded to personal contacts of ministers -- one was given to a bloke in the pub who happened to have the minister's contacts in WhatsApp.
The point being made is that you have to give out the contracts to vetted companies who can actually deliver on it. Just because there's a cheapest option that, on paper, seems to tick all the boxes, doesn't mean said option is actually any good.
Well thanks for chipping in [0]. Got anymore glib, smug responses to things that nobody said?
[0] I don't actually mean "thanks". That's childish and passive-aggressive of me, and I shouldn't do it. What I really mean is to suggest that I think you've added nothing to this and that you're addressing a point that nobody made, for reasons only you know. I would guess that it's some kind of hyperbole, and that what you kind of mean is "oh, for something as important as this, someone will do a proper job" which is at least a meaningful statement (if perhaps something of a triumph of hope over experience), but if I have to pick apart your snark to get the actual meaning, I'm doing your job for you. Can you not just write clearly, and state what you mean?
Both of the massive fuckups I listed were highly unlikely, but they still happened.
Yeesh, it was a light hearted joke about KFC because of the mildly amusing tangential link you made between the logistical problems of a fast-food retailer and a nationwide once-in-a-lifetime government backed vaccine rollout.
No, I didn't actually interpret your comment as a claim that KFC will be in charge of the rollout. There's no need to be aggressive.
Yes the British MOD has a record of being very good at logistics [1]
"One country that has achieved an unparalleled level of efficiency and responsiveness in its logistics and sustainment activities is the United Kingdom (UK). The British Ministry of Defense (MOD) has wholeheartedly embraced outsourcing many of these functions to the private sector."
Also of interest:
"One of the primary reasons why the MOD is willing and able to enter into long-term PBL-based service and support contracts with private companies, not just British firms but global providers, is because of its attitude towards the private sector. The MOD views the private sector as a positive contributor to their mission. It works hard to establish a collaborative relationship. MOD officials are demanding and insist on adherence to contracting requirements. But they treat the private companies as partners, not adversaries."
I had the good fortune of first-hand experience of working with the MoD for a small slice of the mobile testing unit logistics, and would absolutely echo the sentiments expressed in that blurb.
The whole article is a fascinating read, especially when I noticed that it was written in 2016 :-O
The MOD has been heavily involved in logistics from the start; they were the ones delivering the PPE to the NHS stockpiles (my understanding is that the biggest hospital in the region acts as storage and a distribution centre for the smaller, more rural hospitals that don't have storage space). They weren't involved with taking PPE from those local distribution centres to the actual hospitals, however, that was up to the NHS to do what they had always done, and for some areas this was the bottleneck where shipments slowed or were even lost.
To be fair there has been some shocking failures directly related to cronyism, largely the huge failure of track and trace and dire situation around PPR procurement. All of these were closed bids (no one else could submit an offer) and all were won by relatives or those close to an elected official in government (mostly the health secretary). Legal action is just been granted for this to go to court and gain transparency into the £billions of hidden contracts.
The issue is not that things are being given to private companies that are mates with a Tory. The issue is that too many of these things are turning out to be given to private companies that are mates with a Tory where no basis exists for believing they can deliver, when other, qualified companies exist. Or, as in Serco's case, with no penalty clauses in place if they don't.
Again, for clarity: using the private sector isn't a problem. Corruption is. Failing to get results is.
I'm all up for chucking money at a big problem and sorting out the mess later, but this is a depressingly predictable mess, and chucking money at the problem bought us a demonstrably worse outcome than we should have had.
I know you are /s but just in case you didn't realise - the spreadsheet part was only on the export of the data from the tracking system (when it was sent to Gov).
Indeed logistics will matter as the vaccine needs to be transported at around -80°C. So let’s hope nothing happens which might cause delays in shipping from Belgium to the U.K. after 31st December.
Look at the way people communicate here, how little empathy they show, the complete sense of humour, how anal they can be about not about the big picture that the other person is arguing for but, say, choice of words, someone's formulation of a sentence, use of the oxford comma, whatever really.
Then tell me if this site is not the largest community for autistic software developers, diagnosed or not.
Look at the way people communicate here, how little empathy they show, the complete sense of humour, how anal they can be about not about the big picture that the other person is arguing for but, say, choice of words, someone's formulation of a sentence, use of the oxford comma, whatever really.
Some people’s insecurities make them allergic to (admittedly tenuous) attempts at humor in face of absurdities and so they downvote as if they’re on Reddit.
The United Kingdom is made up of the island of Great Britain and a part of the island of Ireland (Northern Ireland). It also includes many other smaller islands
You're probably thinking of Great Britain by itself, which is the island containing the main parts of the countries of Scotland, England, and Wales.
While you're right that it is called that (by many), some people object to it:
> In Ireland, the term "British Isles" is controversial, and there are objections to its usage. The Government of Ireland does not officially recognise the term, and its embassy in London discourages its use. Britain and Ireland is used as an alternative description, and Atlantic Archipelago has also seen limited use in academia.
I'm Irish and I've always found the controversy a bit ridiculous; it's a classic example of Irish people's distaste for all things English being taken to a nonsensical extreme. You never hear Brits complaining about the Irish Sea being called such.
I don't know, given the Isle of Man is in the middle of it, maybe it should be The Manx Sea? If we don't want anyone to own it, maybe call it The Sea of Sodor?
A similar controversy exists in the Arab world about what to call the Persian Gulf, where the names "Arabian Gulf" or simply "The Gulf" are preferred. [1]
Amusingly (but perhaps not surprisingly), British imperialism briefly waded into this dispute as well:
> Following British attempts to control the seaway in the late 1830s, the Times Journal, published in London in 1840, referred to the Persian Gulf as the "Britain Sea", but this name was never used in any other context.
I guess that's reasonable, though it appears the name goes back to the 1st century, so the UK is named after the Isles, rather than the other way around?
Great Britain may have been named after one of the isles, but the controversy arises because the UK spans (part of, but not all of) the two main isles.
> Has anyone proposed a viable alternative?
I don't know what would count as "viable" if you reject "Britain and Ireland" and "Atlantic Archipelago".
> Great Britain may have been named after one of the isles
Great Britain is the largest island of the isles. The UK's full name is The United Kingdom of Great Britain and Northern Ireland; ie there's no political entity of Great Britain (and never has been).
No, I don’t think you can fairly say a country is an archipelago unless it’s solely composed of islands all of which are entirely the territory of that state.
The hippocratic oath doesn't pertain to a doctors effect on an entire society, but to her patient. Utilitarian medical ethics do not apply in any sane society.
Worth noting that COVID-19 probably triggers GBS in some people (like many infections). So maybe the vaccine triggers GBS in rare cases, but the disease appears to also sometimes cause long term problems (neurological and otherwise).
1976 was potentially problematic because there was a massive immunization program because of fears of a pandemic, but H1N1 was not actually spreading.
2020 is obviously a different story. The pandemic is here.
As someone who had GBS and was put into a coma at 16. I'm very uneasy about the vaccine, but I also don't want COVID.
I'm likely going to end up taking the vaccine as soon as it's available and hoping GBS doesn't happen again, just so I can go back to my life ASAP. Depends on how the risk of GBS with the vaccine compares with the risk of GBS from COVID.
I do not want the vaccine, but it might be mandatory here in Eastern Europe. My family member was tested positive, and I lived with him, we were under quarantine. No symptoms, ever! I do not want to the vaccine, damn it.
I don't want to have to be sober to drive my car on public roadways, and yet, here I am, acknowledging that I have some basic responsibility for the safety of people around me.
This approach is incredibly selfish. Would you pursue it if you were held responsible for consequences of that behaviour, as drunk drivers are?
That's a poor analogy. Remaining sober doesn't have potential negative side effects unless you're already addicted to alcohol/benzos.
The fact is that the COVID vaccines, as with any medicine, will have side effects, and some of those side effects may be life-altering. There are valid concerns about the vaccines and these effects that cannot simply be brushed off as anti-vax nonsense.
> This is false when it comes to the COVID-19 vaccines under development. They do not—and are not meant to—prevent people from contracting and spreading the virus. They only reduce the symptoms. This does not help herd immunity (other than perhaps allowing the virus to spread faster, I guess).
Some other HN-er said this. If this is true, then it should be my decision. Since I have been through it without symptoms, I am supposedly immune for 6 months, but even after that, I do not really care. I care about it personally as much as I care about the flu. I have not vaccinated myself against the flu in years. Let it be my decision, please. I am not an anti-vaxxer, but when it comes to the COVID-19 vaccine, I am a bit wary. I do not mind tested vaccines that have been around for decades and have been extensively researched and are pretty known to be safe.
This is a bad argument. The two aren't comparable. Drinking a lot of alcohol and getting into a car is a choice. The intent doesn't even matter in most countries since it's a "Strict liability" crime.
The government forcing you to take an injection is literally not your choice. Not to mention, we know drunk driving impairs people and increases risk. There are tons of studies that show that (they also show sleep deprivation is worse than alcohol for driving, but that's not illegal ... probably because it's not measurable, or it's hard to gauge intent).
This vaccine has been rushed through the process with zero long-term Longitudinal studies. A drug company can yell 95% effective all they want, but the fact is, this is a HUGE unknown. The vast majority of normal scientists in other fields cannot do this research themselves and there aren't even any published papers yet we can look at.
This is a bad argument. You want some more bad arguments? Look at the Buck SCOTUS decision which lead to forced serialization, or the SCOUTS decision that lead to Japanese internment camps. You know what those two decisions were dependent on? Jacobson. The vaccine case.
> Drinking a lot of alcohol and getting into a car is a choice.
Not taking a vaccine and interacting with other people is also a choice.
> they also show sleep deprivation is worse than alcohol for driving, but that's not illegal
Drowsy driving is difficult to prove, but generally held to be within the coverage of reckless driving laws. Some jurisdictions have expressly included coverage of it, as well, at least in the context of establishing the necessary illegality in vehicular homicide statutes (NJ and Arkansas.)
Taking a rushed vaccine with God knows what long-term effects is not going to be a choice. Have fun with it. You are playing Russian roulette that I do not wish to play. In majority of the cases COVID-19 is not lethal at all, there should be no mandatory vaccines, especially not when we have no knowledge of its long-term effects and so on and so on. If you want you can take the Chinese or Russian vaccine. I do not want to. Anecdotal: my grandmother (over 70) has been in contact with 4 COVID-19 positive people. She developed no symptoms. I think this is way too overblown. She has been in contact with many old people, too. No symptoms.
> Apr 2, 2020: Asymptomatic transmission refers to transmission of the virus from a person, who does not develop symptoms. There are few reports of laboratory-confirmed cases who are truly asymptomatic, and to date, there has been no documented asymptomatic transmission.
If you have news on it, say so instead of down-voting. I want to know how likely it is for asymptomatic people to spread the virus. I swear, I will keep checking the responses because I am curious how likely it is that people will catch it from me, excluding the fact that I do not leave the house for weeks (I work remotely).
> You are playing Russian roulette that I do not wish to play. In majority of the cases COVID-19 is not lethal at all
You accuse them of playing Russian roulette while you justify not taking the vaccine with "the majority of COVID cases aren't lethal"?
> I think this is way too overblown.
1.5 million people have died.
> I want to know how likely it is for asymptomatic people to spread the virus. I swear, I will keep checking the responses because I am curious how likely it is that people will catch it from me
If you're trying to determine the risk of someone catching it from you (and assuming that you'd immediately self-isolate when you start experiencing symptoms) you should be looking at pre-symptomatic transmission rather than just asymptomatic transmission.
But did they die FROM or WITH covid? That's the million dollar question. Here's CDC data that says 94% of Covid-19 deaths involved one or more comorbid conditions... i.e. these are not healthy people struck down in their prime... https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Co...
Point is, just a raw number doesn't actually make a great argument.
Even worse, it's a number without context. The most recent annual death stat I could find was for 2017 which saw about 54,750,000 deaths. So '1.5m dying from covid' is less than 3% of this year's deaths.
In my opinion, and the opinion of many others, those numbers seem a fair argument for the "overblown" POV.
I am certain many reported cases here are false, or "with COVID-19" cases as the other guy has said. I know, because a family member works at the hospital and we know what is going on there. They make up lies about the cause of death for funds they get after COVID-19 patients. This is our reality, sad but it is what it is.
I'd love it if people questioning vaccine safety had actual numbers, instead of empty platitudes like '>50% of people who get COVID don't die'. (And if they made an apples to apples comparison with the numbers of not vaccinating. They never do, though, because the numbers don't help their argument.)
Most people who play one round of Russian Roulette don't die, either.
Look, I know for a fact that I was positive before. I was asymptomatic. I have an autoimmune disease. I do not want the vaccine for myself. Does the vaccine actually stop the spreading of COVID-19? Because according to other posts, we do not know that it does, all we know is that people would take it for their own safety, but do not know if it actually stops transmission, in which case we are just talking about whether or not I decide to risk my own health. I would risk it, considering I have been asymptomatic positive before, and I do not know what this vaccine would do to me given that I have an autoimmune disease. The vaccine seems much riskier to me, than COVID-19. That, plus I barely leave the house.
Are you meant to reply to me? It seems quite odd. What numbers do you want from me? I think it is quite useful to know that 1) I have an autoimmune disease, 2) the vaccine has unknown side-effects especially for me, 3) I have been through COVID-19 without any issues, and 4) we do not know if it actually stops transmission. To get the vaccine is risky for me, regardless of your imaginary numbers.
Show me evidence it stops transmission, and show me evidence it is safe for people with autoimmune diseases. If they come back good, I might take that particular vaccine. If not, then get off my back. If it does not stop transmission, it should be my choice, and you are just giving me a selfish opinion. I am NOT going to risk my health, period. Risk yours if you wish.
> Not to mention, we know drunk driving impairs people and increases risk.
How is that different from not vaccinating against a dangerous, contagious disease. It increases risk, and it kills people around you.
> This vaccine has been rushed through the process with zero long-term Longitudinal studies.
There are zero long-term longitudinal studies for the dangers of COVID, too (Or of odds and dangers of losing immunity years after an infection.) Do you get to just assume that there aren't any, without extending the same latitude for vaccination?
Look at the comments in this subthread. Look at the arguments made against vaccination. They aren't data-driven. Not a single number is listed in them. No number of studies are going to convince people whose argument for not getting vaccinated is 'I don't think it's a big deal, and I don't want to, and I will only talk about personal responsibility, because I don't care about my impact on anyone else.'
I would be shocked if any state made vaccination mandatory today (and I'd probably also be surprised if any of those SCOTUS decisions would be upheld/made today although, given the circumstances around Korematsu, who knows).
But might universities and workplaces make it a requirement once a vaccine becomes readily available? That wouldn't surprise me in the slightest. And that may force some tough decisions on skeptics who would have liked to see more time. (Which doesn't include myself.)
The vast majority of people under 50 who catch CoV2 recovery completely with minimal symptoms. There is a trade-off and people need to be able to evaluate those risk and make those decision individually.
If there's an effective vaccine, those who do not want to risk infection from COVID can make the choice to take the vaccine. Those who feel that the risk that they will become infected is one that they are willing to take can do that. Nobody is put into danger that they do not choose to accept.
Taking the choice not to take the vaccine is not taking a choice about personal risk.
It's like driving drunk. It's personal risk AND risk to every other person around you.
When you do not vaccinate, and then go out and about, you are inflicting risk on immuno-compromised persons, for whom the vaccine doesn't work well.
Unless we lock anti-vaxxers in their homes, or unless we hold them criminally liable for infecting someone else, it's not a question of their personal risk.
Do you know that there are quite a few people who can't get vaccinations? Most of them also can't afford to self isolate.
Choosing to not get a vaccination primarily endangers you personally, but definitely also raises the danger level to those who have no choice in the matter.
What is a 'vast majority', please post actual figures.
> and make those decision individually
if you can somehow ensure people who get sick can't spread it, sure it's down to the individual, but it's a society-level problem. That's what "infectious" means.
The worst year of the Polio epidemic in the United States was 1952 where 3145 people died and about 21,000 had some level of lasting (but not necessarily permanent) health impact.
I personally don't think the state should mandate vaccinations by the way, even though such a mandate would almost definitely be a net good to society.
That's his point. A decade ago, the comments on this site were 99% relevent, solid technical feedback and analysis. The top post being layperson speculation with a joke response topping it bears a much stronger resemblance to reddit than to hn's origin.
You are being down-voted, but our politicians are saying exactly this. Well, either you vaccinate yourself, or you have to remain at home. How they are going to enforce it? No clue. Perhaps proof of being vaccinated before entering Government buildings, or the workplace.
> Boris Johnson says he strongly urges everyone to be vaccinated (jabs rolling out next week) but says it is 'no part or ambition of this country to make vaccines mandatory - that's not how we do things.'
In a recent article about the Moderna vaccine, it was mentioned that the actual development only took 2 days.... and it was done in January!
Given how short of a time it took to actually develop this thing, could we have drastically sped up this process by maybe being a bit more risky with the trials? At this point ~1.5 million people have died from the virus.
I've really struggled with this knowledge that we've had a vaccine which it turns out is 95% effective for practically the entire course of the pandemic at at this point... and our conservative "moral" process was to let 1.5 million people die while we vet it.
There are 321 vaccine candidates under development as of September with about 30 in clinical trials. Throughout the year there were probably many, many hundreds or thousands more discarded at early stages of development and evaluation. How would you have selected this particular candidate over all the other possibilities that got dropped?
I understand your point, I really wan't try to make some kind of moral criticism of the process. I realize it was developed for a reason. My question was more about the point that especially with this new mRNA process, we're going to be able to develop these things blazingly fast. But the process for approvals is still glacier slow (and this was already the SPED UP timeline).
My question was more where is there room to speed this stuff up?
Efficacy (the main thrust of Phase 3 trials) could be sped up and made more thorough by deliberately exposing participants. I think one could argue that deliberate exposure and waiting around for enough people to be "naturally" exposed are pretty equivalent in terms of end results, but that's not a winning argument so far. Might be harder to recruit when you know you're definitely getting exposed vs. no change in risk from the no-action option.
But that does presume your methods of exposure are equivalent to what's happening in the real world, both in terms of method and dose. And those are both open questions here and could have bearing on efficacy.
To be fair, a lot more than 1.5 million people could have died if there were delayed adverse affects of the vaccine and we'd already done a mass rollout. I think it's probably good that we put it through a proper trial process.
Also, we'd still have had to wait for production ramp up which I believe has been done in parallel to the testing, so it may not have saved that much tie.
Whether or not it would have been a good idea to loosen the approval process aside, accelerating it would likely not have had much of any effect on saving those lives. The bottleneck is production capacity. As I understand it Moderna and Pfizer/Biontech have both been building production capacity and creating vaccines as fast as possible, but have only now created enough to vaccinate a few tens of millions of people combined. If they had been approved in the summer, when they went to Phase III trials, they might have, perhaps, been able to turn out a few thousands vials a day which is not really enough to meaningfully impact the spread or death rates even if you were able to highly target high-risk groups.
We also have a fairly old, fat, and alcoholic population so if this doesn't work we're probably not getting out of this lightly (even relative to where we are now)
Ok, apart from that, the ideal guinea-pigs would have been the House of Commons and The House of Lords. The former are ultimately replaceable by the electoral process, and the latter are equivalent to a Care Home, albeit taxpayer-funded and all the residents wear ermine-collared red gowns.
To your point 3, Belgium may well have great logistics but the UK government has knowingly undermined and compromised UK logistics (the whole industry is crying out) as part of their Brexit process.
Maybe there are extraordinary arrangements being made for the vaccine, but it won't be because of a good prevailing open-market logistics situation.
Your comment has nothing to do with the logistics of rolling out a mass vaccination programme, but how exactly have the UK government’s Brexit negotiations “undermined and compromised UK logistics”?
Negotiations are ongoing to secure a trade deal with the EU once the transition period is over. The UK are also securing trade deals with other countries, including Canada and Japan.
Both sides recognise failure to reach a deal, or to extend the transition period, would be damaging for both sides.
Which is precisely why both sides are negotiating a deal to ensure that doesn’t happen...
Which I now realise I misread as "Developed in a country" (i.e. Belgium, where it's manufactured). An entirely different, erroneous, reading of the sentence.
Therefore my comment addressed the nature of cross-channel shipping which authorities I respect have repeatedly warned about.
It's too late to edit to add that clarification about the misreading. But that's what was missed.
If the army steps in to provide logistics at a time of national crisis, that's great. But it's not what I would expect this government to do based on the recent historical evidence: We've been in a national crisis for a while and the government has routinely preferred to neglect public-sector expertise and go private in a vast array of public procurement. Much of it has been highly questionable judgment (ministers awarding contracts to friends with penalty clauses).
This could be the fastes approval in the whole drugs' history considering that
The assessment of a marketing authorisation application for a new medicine takes up to 210 ‘active’ days. This active evaluation time is the time spent by EMA experts to evaluate the evidence provided by the applicant in support of a marketing authorisation application.
This time is interrupted by one or two ‘clock-stops’ during which the applicant prepares the answers to any questions raised by the CHMP. The maximum duration of a clock-stop depend on how long the applicant thinks it will take to respond, but must be agreed by the CHMP. The first clock-stop usually lasts 3 to 6 months and the second one 1 to 3 months.
Overall, the assessment of a new medicine usually lasts around a year.
> This could be the fastes approval in the whole drugs' history considering that
Without a doubt. The closest competitors would be imatinib (3 years) and several other chemotherapy drugs (~5 years) meant to treat malignant tumors. The vast majority of the drugs approved this quickly, with the exception of the HepC treatment, treated diseases with a life expectancy of less than the time it took to approve the drugs so long term side effects was less of a concern.
Would those drugs be in use by the majority of the patients that need them before that though, as they'd be in the studies etc? Whereas this vaccine needs to be given to a large percentage of the population. How are flu vaccines regulated? They change yearly, correct?
Do drug approvals even have much history? My impression was that the concept of drugs needing to be approved has been around for less than 100 years, but I guess it will vary from country to country.
The US meeting date is based on an arbitrary scheduling rule saying meetings like this must take place 15 days after request, or something to that effect.
The FDA itself closely inspects data throughout the phase 3 trials so this review should just consist of looking at the details to see if something was missed, (ideally) not some brand new information come to light.
Wow, thanks for the info. I didn't know it was arbitrary scheduling. Seems like given the circumstances you'd hope they would just setup a meeting tomorrow.
AFAIK both the FDA and the MHRA have been getting data regularly from the various vaccine developers. They didn't have to wait for a final dump of data just to see any of it.
Given that they could halt the rollout of the vaccine at any point, it makes sense to approve ASAP to get all bureaucratic burdens out of the way, and concurrently analyze the situation. Not saying that this is the case though.
For example, the EU is going to review the Pfizer vaccine on December 29, and they have requested further information.
Yes, it's likely. Regulators are not as independent from the industry as you think. They've been getting closer and closer over the decades. It's call corruption and it's growing.
Having a reasonable fear of corruption within the regulation process is not dangerous. How is it dangerous to address real concerns that a number of people at the CDC/WHO are deeply connected to Gavi/Gates and industrial interests?
Medical isn't constrained to science. Healthcare professionals are allowed to use tradition, authority, and Art in combination with science.
It's mind boggling to Engineers to hear this, but Medicine is older than the scientific method and physicians used Regulatory capture to prevent competition.
Science doesn't have all the answers. My partner recently got into a heated debate with a pharmaceutical company she was working for because they wanted something added to their standards of care document for a rare genetic disorder they developed a therapy for.
She couldn't find a study to backup the claims that the medical team wanted to make in the document, but the lead doctor said that if this wasn't included, the patients would suffer and ultimately die.
So she said "you need to prove this in a study so it can be included, otherwise you put the company at risk". To which the doctor said "We could do that, but it would take 3-4 years, and in the mean time, the patients we're caring for would go back home, the doctors would be missing the one key piece of advice, and then they'll all suffer and die".
I'm sure many, including myself, have experienced this issue very personally and tragically. Both parties were correct in your example. In my case I was the patient advocate and would argue very strongly on the side of the doctor. Your partners case has merit as well, however, as malpractice insurance and lawsuits are impacting healthcare costs and risk management decisions considerably.
But not a lot. That's what's fascinating. At least in the US, over 95% of fatalities are people over 55. We're at 200k ~ 300k deaths for the year in the US (and I think there is reason to believe this is an overestimate, not an underestimate). That's lower than heart disease and cancer (500~600k yearly). I doubt we'll even approach those numbers by March.
Science is slow because it needs to be right. We're no longer in a time 185 years ago when Jenner could just stab people with puss he pulled off of a Horsepox infected cow. Remember that 500 years ago, the Chinese were blowing smallbox puss into people's noses (infections in the nose were typically not bad and people recovered faster) and isolated them. Many of them survived fine, but some died.
Do you want to return to that world where we just experiment on humans without regards to what that means?
This vaccine should be a choice. I'm under 40 and not in a high risk group. I'm fine with people volunteering to take this vaccine. Maybe I'll take it in 5 years. But I don't want to see this become mandatory for going to work or being able to enter a music venue.
You can quote the Jacobson decision all you want, but that SCOTUS decision only said Jacobson had to pay the $5 fine, he never was forced to take the vaccine. Furthermore Jacobson lead to the Buck decision (forced sterilization) and the SCOTUS decision that led to the WW2 Japanese internment camps. It's bad law that's bread a poisoned well of bad law.
> At least in the US, over 95% of fatalities are people over 55
I'll never understand people who say this, thinking it somehow proves their point or something. My parents are nearly 60, and easily have 20 more years of time with me and their grandkids. Why are we okay with that?
Then why not protect them specifically? Give money to isolate them if they don't live in their own homes. Provide grocery delivery services. Let them make the choice. There are some old people who are 70 and say "I want to live my life" and so let them go out and do whatever and assume the risk themselves.
We can provide support specifically to those at risk, while also respecting the liberty and freedom of everyone else. Someone with an autoimmune disease or who is 65 can choose not to go to a pub and simply not interact with the rest of the world using technology. At the same time, the pub owner should be allowed to make a damn living.
I don't think it is fear mongering. While the health institutes have access to the data, I don't. I don't think anyone on hacker news can make many intelligent statements about side effects, yet, though the press releases claim that they are similar to what is typical of other vaccines.
We are a scientifically literate society, and increasingly so. We do not simply summon blind faith in institutions to interpret the world in which we live; we share with each other and seek truth.
I do not trust governments, not only (and not primarily) because they have violated trust, but because trust in governments to be arbiters of scientific truth is not a healthy or sustainable practice in a civilized society.
Pretty much all governments have a history of maliciousness and/or incompetence. Well I think it unlikely they would allow it. It is certainly in the realm of possible scenarios.
I don't actually want the raw data as I am not an epidemiologist, but I do want to see peer-reviewed papers as the grandparent to my original comment was waiting for before making a judgment. The point is that there are very few people in the world who can currently say anything intelligent about the subject of side effects in this vaccine. From my basic knowledge of vaccines and the approval process, I suspect any side effects will be heavily out-weighed by the benefits, but right now, I have no way of making an educated assessment. To be clear, I'm not really worried about it. My point was simply that I saw only intellectual curiosity in the grandparent to my original comment where the parent saw fear mongering.
> the press releases claim that they are similar to what is typical of other vaccines.
They are much, much, worse but typically subside in a day and at most two. The side effects are bad enough that there is worry people won't show up for the second dose.
Why do you believe this out of curiosity? Every single "long term covid" symptom study I've read are case studies. The UK one from the publication in Charlottesville covered 60 distinct people and they were all either high risk workers or over 55.
We don't know what "permanent damage" is actually happening. I remember having pneumonia in the 90s and it took my lungs over 3 months to recover, and that's from a normal known infection.
I think there is a strong case to be made, that a lot of these "long covid" cases might be a combination of normal pneumonia recovery, nocebo effect and fear/hysteria over this disease.
For me personally the unknowns of such a new virus mean that the existence of the case studies would be enough to be concerned. And the strongest case is made by the fact that this virus' closest relative known to infect humans has caused lasting damage to people with cases that lead to hospitalization:
"Evidence from people infected with other coronaviruses suggests that the damage will linger for some. A study published in February recorded long-term lung harm from SARS, which is caused by SARS-CoV-1. Between 2003 and 2018, Peixun Zhang at Peking University People’s Hospital in Beijing and his colleagues tracked the health of 71 people who had been hospitalized with SARS. Even after 15 years, 4.6% still had visible lesions on their lungs, and 38% had reduced diffusion capacity, meaning that their lungs were poor at transferring oxygen into the blood and removing carbon dioxide from it."
We know this much and SARS is poorly studied because it faded away so we generally lost interest in it. This virus is both similar and different enough to be very, very wide spread so even minor negative effects over the total population that gets moderate to mild cases will have the potential to have very large impacts on worldwide health.
As time goes on we are going to better document the consequences of mild and moderate cases and understand these things better, caution seems advisable until we do.
It's important to remember that SARS was a lot more deadly that COVID-19. I am not at all surprised such a high percentage of people suffered long term lung damage given how virulent it was. Case fatality was somewhere around 10%.
I'm curious if there was widespread serology testing to get to that number with the original SARS. That's in the ballpark of what the early SARS-COV-2 research (15%) showed until we realized there were asymptomatics and people who don't go to the hospital (because they aren't severe) and that numbers drawn from the hospitalized were not representative. If that number was just pulled from hospitalizations because we shut SARS down before we studied it as closely, it makes me wonder if the mortality rates are similar.
There was not widespread serology testing but subsequent analysis has the WHO pegging the fatality rate at about 3% (as opposed to the 10% from the time of the outbreak itself).
We didn't really shut SARS down so much as it seemed to have shut itself down, conventional epidemic control measures were enough to contain it and it was not quite easily transmissible enough to sustain itself in the wider population without being allowed to gain a real foothold undetected first.
That last point would be why you would not expect (and I would think it is impossible) to find that at the end of the day COVID-19 will be anywhere near as deadly as SARS. We have strong evidence that it takes truly extraordinary measures to suppress this new virus at a rate that will in fact eliminate it from a population when compared to SARS. SARS simply didn't spread that widely because if it did that would directly contradict the relative ease of its containment.
Sounds like they're saying Coronaviruses aren't a new thing, just that new types pop up. The CDC lists human Coronaviruses were first found in the mid-1960s [0]
Ok, how is that relevant?
Coronaviruses collectively have been known for a long time, this was also true when the SARS outbreak occurred, is true during MERS.
Likewise influenza was well known before the 1917 pandemic, or H1N1.. and?
I am not a doctor but normal pneumonia recovery doesn't cause myocarditis, memory loss, abnormal liver function, kidney damage or gastrointestinal damage.
It seems very likely at this point that COVID is a disease of the blood vessels, which has the potential to do some really nasty damage to your organs. The numbers are hard to estimate but I've seen experts say that they think about 5 times the number of people who die will have enough problems to be considered having a long term disability. With estimates of case fatality being about .5% - 1.5% that would mean about 5% of the people who get it will have enough long term damage to be disabled.
theres a huge hysteria market for this virus. it seemed like at one point and article was coming out weekly saying long term effects were worse and worse and worse. i don’t believe it
What do you know about the long-term side-effects of "the" vaccine, and how? Could you elaborate? You must know about it to be able to determine the risk between the two.
CDC has a page [1] with the notable historical vaccine adverse events. I think it's an informative page to read, but just in case you don't have time, here's my summary:
- most adverse events were due to manufacturing issues (e.g. contamination with some live virus). In this respect, I don't think the Covid vaccines are likely to be any more or less risky than other vaccines, such as the annual flu vaccine
- two vaccines had an association with the Guillain-Barré Syndrome (GBS). Even nowadays, if you take the annual flu vaccine they advise caution if you've had GBS before.
- one Rotavirus vaccine was quickly discontinued after they saw it can cause a serious condition called intussusception
- finally, a case that you'll hear lots of people talking about, a possible link between a flu vaccine adjuvant (AS03) and narcolepsy. The CDC page directs you to the actual study [2]. My summary is that this link was observed only in Sweden and Taiwan, but in no other countries. The Pfizer and Moderna vaccines do not have adjuvants (but Novavax and others will have).
Well, fwiw, the inventor of the mRNA vaccine idea, Ingmar Hoerr, thinks side effects are very unlikely, since the mRNA molecules dissolve after a few days. He has been working on this for 20 years, with no serious side effects ever observed.
A lot of these side-effects affect >50% of people (phase 3 dosage is 100ug), including fatigue, chills, headache, muscle pain, nausea, and pain.
100% of the 100ug treatment group had at least one symptom, 80% of those classified as moderate. The vaccine is going to make you feel sick for a little while.
the parent is concerned regarding the appearance of ADE (Antibody-dependent enhancement) during the creation of the SARS vaccine.
While we cannot totally disregard ADE, I assume we should have seen it by now (and the Oxford trial was stopped exactly because they thought they might have observed something like it). Whether it appears again on a population scale level, nobody knows.
Not a doctor, just a member of a risk group. The continued spread of Covid poses a rather high risk to me, both because of mortality and because of potential long-lasting aftereffects ("Long Covid"). Even if the vaccine turns out to have longterm side effects, I find it very unlikely that those will be more significant than Long Covid. Therefore the risk tradeoff makes any vaccine a complete no-brainer to me.
What about people in the risk group(s) for vaccine side-effects? E.g., people with autoimmune issues. Does their safety matter less than yours? (Assuming you're advocating for vaccinating others; if you're just advocating for vaccinating yourself and yourself only, then carry on.)
I'm also in the autoimmune-disorder bucket. From what I understand, Covid also triggers plenty autoimmune issues, so the risk assessment does not change in a significant way.
At this point, the autoimmune dangers of vaccines are well understood but the autoimmune dangers of COVID-19 aren't. Doesn't that mean it's safer to avoid the vaccine, until that situation changes? In fact it's exactly the opposite of what many people here are saying, considering only themselves and not others, but using their own logic!
I dunno. I have an autoimmune disease. I was COVID-19 positive without any symptoms. It has been some time now. Everything is fine. With regarding to the vaccine: I do not want to risk it, when I know that I went through COVID-19 without symptoms and may just do it again and again after 6 months? They say I have 6 months of immunity.
> A possible concern could be that some mRNA-based vaccine platforms 54,166 induce potent type I interferon responses, which have been associated not only with inflammation but also potentially with autoimmunity 167,168 . Thus, identification of individuals at an increased risk of autoimmune reactions before mRNA vaccination may allow reasonable precautions to be taken. Another potential safety issue could derive from the presence of extracellular RNA during mRNA vaccination. Extracellular naked RNA has been shown to increase the permeability of tightly packed endothelial cells and may thus contribute to oedema 169. Another study showed that extracellular RNA promoted blood coagulation and pathological thrombus formation 170. Safety will therefore need continued evaluation as different mRNA modalities and delivery systems are utilized for the first time in humans and are tested in larger patient populations.
I'm curious for an actual expert to answer, but when I've heard this question presented they would point out that the risk of long-term side effects from a vaccine must be compared relative to the unknown, long-term side effects of a covid infection and continuing to live in a society that's locked down.
The only potential long-term risk I wonder about is antibody dependent enhancement [1] for future variants of the virus. But, that has nothing to do with whether the vaccine uses mRNA or an attenuated virus. Those involved in making a vaccine are very much aware of this issue and design vaccines to avoid it.
I'd also be interested to know whether mRNA vaccine, in hijacking the body's own cells then training the immune system to attack them, carries extra risk for those with autoimmune disorders i.e. people whose immune systems already have an unfortunate tendency to attack themselves.
I'm sure this has all been thought about by relevant experts but I'd like to see the published research.
From what I understand, people unlucky enough to have certain conditions haven't been included in the studies, and therefore won't be taking the vaccine. That includes pregnant women, and (I think?) people with autoimmune disorders.
I’m not aware of any vaccine that had long term side effects that were not also apparent in the short term.
E.g. I believe it was the swine flu vaccine that caused narcolepsy in a small percentage of people receiving it. But that was apparent immediately.
To my knowledge no one has identified any slow acting consequences of a vaccine that would not have been obvious from the first rollout of a vaccine.
So this question is mostly academic. Unless you’re someone in the UK slated to get the first dose, you probably won’t even have an opportunity to get the vaccine before the effects in early groups become known. And for those in high risk early groups, the risk of covid surely outweighs the risk of vaccine.
Nothing has shown up in trials so far so I’m not expecting side effects beyond the known effect of short term flu like symptoms for a couple days.
What do you mean by short term? That swine flu vaccine is my main concern. It wasn't clear in trials, and it took a couple of years before anyone took the problem seriously as far as I can tell -- by that point a significant chunk of the world could have a COVID vaccine.
I mean the effects would have been immediate, rather than say “develops cancer in 20 years”. Though I guess the narcolepsy took about a month to develop. I suspect there will be much more monitoring and speed with these vaccines than with the swine flu vaccine.
The mechanism for the narcolepsy was a protein present in the virus itself. So actually getting the flu would have been much worse for those with the genes that made them susceptible.
It doesn’t sound like mRNA vaccines would have this vulnerability. Though I do take your point that it’s possible something like the swine flu narcolepsy event would only be found after the fact. However that would be a pretty small consequence since in this case the flu also would have caused worse narcolepsy.
Even if we just vaccinated those at greatest risk the death rate would plummet to an acceptable level, and for those people the benefits far outweigh any potential risks.
Vaccines are also very young. We've had them for 185 years, and there were probably a lot of side effects from people getting stabbed with Horse Pox, but a lot of them probably just died and we didn't collect data back then they way we do today.
No the 2009 one. Caused narcolepsy in a small number of people. Notably the mechanism was the same one as in the flu itself, so actually getting the flu would have caused worse narcolepsy.
Of covid or the vaccine? Vaccine side effects are, generally speaking, either immediate, or are a problem with the immunological response that they elicit. I would say that these scenarios have not been fully evaluated, but the risk of other kinds of side effects is very very low.
I am personally quite terrified of the possible unknown long term side effects of COVID-19 and largely confident that the vaccines are going to be safe.
If you offered me a vaccine tomorrow vs a 100% certain mild case of COVID-19 that would guarantee me immunity for a year so I could get the vaccine in 12 months when there was /even more/ confidence about the safety of the vaccine I would take the vaccine.
Yeah I think that basically sums it up. The dangers of long term COVID far, far outweigh the potential risks of the vaccine. It seems many people have a fundamental distrust of vaccines and many also still don't understand how dangerous COVID seems to be for people who have relatively little risk of dying from the disease.
I haven't been able to come up with a theory as to why public health departments and the media haven't been making the long term effects a key part of their messaging.
Is the long covid phenomenon any more pronounced with this virus than any other coronavirus (last I read[0], the answer seems to be 'no')? Since there are four others circulating, will this vaccine even have a significant effect on these post-viral symptoms?
That article is really something, the first thing that jumps out:
"Second, covid is not some magical entity, it’s a coronavirus, and it behaves like other coronaviruses, and other respiratory viruses more generally. It would be strange for covid to cause symptoms that other respiratory viruses don’t. And since I’ve never heard of “long rhinovirus” or “long influenza”, I’m inherently doubtful of claims that there’s such a thing as “long covid”."
This is just getting caught up in silly semantics, people are experiencing longer term health effects, they are calling it "long covid" for lack of a better name not because it is an affirmative diagnosis.
"On MedRxiv, there is a pre-print awaiting peer review of a prospective cohort study that followed 4,182 people with positive PCR tests... if we assume that this study was reasonably accurate, then one in 50 people who get covid still have symptoms at the twelve week point..."
This is supposed to be an argument that inclines me to think that whatever "Long Covid" is I am not supposed to be worried about it? If 1 in 50 people that get a positive test are still feeling after effects of having what the author believes "behaves just like other coronaviruses" then I think we should be very concerned! Even if truly long term effects only develop in 1 in 500 COVID-19 cases.. that's a lot of people who are going to be sick for a really long time! It would be 400 Americans a day right now. Yikes! That's bad!
I'll take my chances with a vaccine!
(And I know the standard response to this is.. "well, those people are mostly old or sick with something else so you can't really count it that way" but a certain, maybe large, proportion of those people would probably never get a serious respiratory virus in the near or medium term in the absence of COVID-19. It is a really large number of extra sick people, and all at once.)
Also the 4 other coronaviruses circulating thing is silly, obviously the long term effects of the common cold viruses are not going to be comparable if the short term effects are clearly not comparable, it is reductionism of the worst kind.
Hmmm. I've read your comment twice now, and it seems like you have glossed over the entire observation and assertion that Rushworth (and Gupta, and Henneghan, and Kulldorff, and other reputable experts) are making with what amounts to a side note in your comment:
> Also the 4 other coronaviruses circulating thing is silly, obviously the long term effects of the common cold viruses are not going to be comparable if the short term effects are clearly not comparable, it is reductionism of the worst kind.
What you are saying is "obvious" is not at all obvious, and is not the assessment of the experts who have looked at the data and weighed in.
In terms of obviousness: why do you think that the long term effects are unlikely to be comparable (if not strikingly similar), since the long term (adverse) effects of each of these four (and also several of the influenza A) viruses seem to be clinically identical, despite each having distinguishable acute characteristics?
> This is just getting caught up in silly semantics, people are experiencing longer term health effects, they are calling it "long covid" for lack of a better name not because it is an affirmative diagnosis.
I agree that the terminology becomes tricky. But I think the question is better stated as: is "long COVID19" any different from other "long covid" (ie, the rare but well known post-viral syndrome that is observed with all coronaviruses).
> Even if truly long term effects only develop in 1 in 500 COVID-19 cases.. that's a lot of people who are going to be sick for a really long time! It would be 400 Americans a day right now.
...but a relatively small cohort in the bigger picture of post-viral syndrome, if indeed it occurs with approximately equal frequency with the other coronaviruses (and some influenza A viruses).
I think we need to be careful about measuring potential adverse outcomes against one another, and try our best to use numbers that reflect the likely lived experience of people (to wit, nearly everyone contracts the "garden variety" coronaviruses a few times in their life).
If the current slate of vaccines don't prevent this effect, then I'm having trouble putting any math together that suggests that it will generally reduce population-level instances of "long covid" (again, defined broadly as long effects from any covid, not just COVID19).
Inspired by your citation I went out and had a look on the Internets.. a direct quote from Sunetra Gupta in May: "the epidemic has largely come and is on its way out in [the UK]."
How is this a credible person to listen to? It boggles the mind, she is an epidemiologist! After making a professional error on that scale I would crawl in a hole and not come out for a year!
I guess I glossed over the claim that the author offered completely unsupported, yes. This is the fundamental problem here, you need to be completely absorbed into this information universe to just accept statements like "all coronaviruses are the same as this one" as fact. Rushworth is not an expert on viruses, Kulldorff is not an expert on viruses, Gupta is not an expert on viruses.. there is a difference between epidemiology and virology. If you want to make virology claims based on citing authorities, cite virologists.
Asserting that all coronaviruses are similar and must have very similar effects in the short and long term seems like a very bad assumption to make, before the original SARS outbreak the scientific consensus was that coronaviruses were not capable of causing sevre illness in humans - despite their long history of being known killers of animals! Asserting we absolutely know things about this virus based on things that we didn't think the whole category of viruses was capable of doing less than 20 years ago without citations is bad!
So asserting that the long term effects of this virus are likely to be similar to the long term effects of other coronaviruses is not credible given the available evidence, and saying that it is likely to be similar to influenza (an unrelated virus that is very different) is even less credible. (And if the hospitals were this overloaded with flu patients every year we'd be worried about the long term effects on the survivors, but they are not!)
"I think we need to be careful about measuring potential adverse outcomes against one another, and try our best to use numbers that reflect the likely lived experience of people (to wit, nearly everyone contracts the "garden variety" coronaviruses a few times in their life)."
I don't know what this is supposed to mean, but if is contingent on believing that "garden variety" coronaviruses are similar in their effect to SARS-COV2.. I mean we can see just by looking at the ICU tallies in nearly every jurisdiction in the world that this is not the case so I don't know what conclusions you expect anyone to draw.
At the end of the day that is what this always comes down to with these COVID-19 debates it seems, the jurisdictions that haven't taken the virus seriously have been absolutely devastated by it, there is no secret knowledge to uncover. One should draw from that the inference that assuming that there is some secret formula of logic that will arrive at the conclusion that we already know the long terms effects of this virus seems less than credible. It might turn out to be correct! But that still won't vindicate the flawed logic of drawing the conclusion now.
If having one's virus research repeatedly published in the world's top journals, and securing a patent for a novel influenza vaccine, does not make one an expert, I think maybe we're casting too narrow a net. Not only in Sunetra Gupta an expert on viruses in my book, but one of the world's best.
> Asserting that all coronaviruses are similar and must have very similar effects in the short and long term seems like a very bad assumption to make
But I didn't do that. This brings us back to my original question: is there evidence that "long COVID19" is different than other long covids? If I'm understanding you correctly, you seem wont to presume that the answer is "yes", simply because the acute affects are different. But, as I pointed out, viruses with a wide-range of acute effects all produce clinically similar "post-viral syndrome". To my knowledge, there is no convincing evidence that SARS-CoV-2 is an outlier in this specific respect. Or am I wrong?
You misunderstand the nature of Gupta's expertise and how it might relate to the issue at hand. She has also demonstrated her lack of qualifications in this matter with her public statements even in the areas where she would be legitimately qualified.
You're just goalpost moving here, the argument in the article you are citing clearly says the viruses are similar and presumes that their effects are similar on that basis. If YOU don't accept that then you don't accept your own cited authority, you're wasting your own time here on that basis.
I'm concerned about that, but I'm far more concerned about covid-19, so I would be pretty happy to take a vaccine. Covid is known to have risk of death, side-effects, and unknown future medical conditions, so it seems unlikely that a vaccine would be much worse than that.
It's really a problem everywhere, UK & US are just leading the charge. E.g. Germany has over half the population overweight, and a solid 1 in 4 are obese. While that doesn't match the US, it's not exactly something to brag about.
I can't be bothered to grab numbers, but in the US, and perhaps elsewhere, I'd wager that the number of people a) over 55, or b) obese, or c) otherwise high risk make up more than half the population, or very much near it.
However, if they do not screw something up in production (which I regard a larger potential source of error than the vaccine itself) there won't be long term side-effects for most people. There were some side effects from swine-flu in Sweden around 2010 that were certainly major and those affected 1/12.000 people. I would guess that is an upper bound for side effect, but as I said, guessing probabilities of an unknown with sample size one is hard.
BioNtech has been developing mRNA vaccines for cancer patients for some time, so I would not expect any really large long term (in the range of 2-4 years) side-effects for fractions of the population larger than 20% based on that alone.
That's a question for someone who's heavily schooled on mRNA vaccines and/or a practitioner involved in the trials for this particular vaccine.
Not that I have a problem with your asking the question, I just don't think an opinion poll on a tech board is going to yield an accurate prediction of what to expect.
> I just don't think an opinion poll on a tech board is going to yield an accurate prediction of what to expect.
Part of your answer, which I'm paraphrasing to "I don't know, talk to the experts", is already a good answer. But I was hoping that there was an expert lurking around that might be able to explain the risks or link to some evidence.
If you hold a strawpoll of everyone around, then you may get an expert. But you will also primarily get non-experts, which is the problem and what headmelted is pointing out. If expert opinions are desired, why not ask for that? The non-expert opinions are already abundant, vocal, and ready to spread misinformation. shusson was not soliciting only expert opinions or even primarily expert opinions, whether that was intentional or not.
> I just don't think an opinion poll on a tech board is going to yield an accurate prediction of what to expect.
I'm pretty sure they were hoping to be answered by someone heavily schooled in mRNA vaccines and/or a practitioner involved in the trials for this particular vaccine. On this particular "tech board", there's a reasonable chance of getting a response from those kinds of experts.
From covid? Pretty high, pretty sure I read 5-10% of people in infected. For these vaccines 0.0000001%. So I'm saying not zero but you're more likely to die on the way to get the vaccine (car/bus/stroll) than any long term side effects.
Hopefully the risk for long term side-effects will be lower than last time with the 2009 swine flue pandemic when my government used pandemrix. Hopefully any similar signs of long term side-effects will be discovered before low-risk groups start to receive the vaccine.
Personally since I belong to a low-risk group, there will be quite some time before the line reaches me where I need to make a decision, in which more data will be available from high-risk groups. It will also take time for my country currently pressured health care system to allocate resources for vaccinations without causing even more problems. My current estimate is many months from now.
Outside of long term side-effects I am concerned about how long the protection last. It is difficult to calculate risk without knowing that data point.
For me, from a strictly individual perspective, the health risks from a vaccine is almost certainly less than the long term (and short term) risks of COVID-19 infection.
Is the long covid phenomenon any more pronounced with this virus than any other coronavirus (last I read[0], the answer seems to be 'no')? Since there are four others circulating, will this vaccine even have a significant effect on these post-viral symptoms?
As I see it, the political side is pushing for a solution for the now, damn the consequences in 5-10 years. This is really just BAU in politics.
I wouldn't be surprised if the leaders of the vaccine firms weren't using their own vaccines on themselves and their families for a couple more years, until they have sufficient data.
I have read enough research papers about the replication crises in many fields to know how much these long term studies are needed to properly assess a risk-benefit analysis for vaccination. I will, personally, stay the fuck away for the next couple years. My life didn't change much anyway, I've been working from home for years now. Less social life, but I can weather that.
As a note, we got COVID with the wife, I was without symptoms while she lost taste for a couple days and was tired for a week. That was all.
How did they approve it that fast? Is the approval process so different and so much more efficient than the one in the EU or USA? Was it extremely rushed to make sure to get doses before they have to compete with other countries for limited supply? I'm pretty curious now. Let's hope for the best, i.e. a good vaccine, a good process and no trust problems, the latter because at least it feels rushed.
It hasn't been approved esp faster than anywhere else - it's just the first out the gate. The regulators have had the data for a while now, you'll see steady approvals over the next couple weeks.
The only danger sign I would foresee that would indicate a rush is if some regulator declines to approve emergency use - but given the data that seems highly unlikely.
To be clear, the complete dataset and approval application was not delivered to the EMA by Pfizer until Monday. You can't expect a regulatory approval in two days - it takes longer to even read the complete application.
I have zero insight into what was shared when, but I'm assuming if Pfizer completed their primary analysis in time for the Nov 20th FDA submission, they could have shared that with the EMA at that point. So somewhat of a rolling review (submit data to regulator as it becomes available).
But yes, you are correct, the EMA has specific requirements for it's submission and if they haven't received it until Monday, it's going to take a while to review it, even on an expedited basis.
I would assume the EMA has different forms, and wants the data in a different format. Pfizer as a US company presumably has more experience with FDA formats as well, and more FDA experienced people on staff (this is one of the advantages of the revolving door between industry and regulators - there are disadvantages as well).
I'm not sure why the UK got things sooner unless it is because they accepted data sooner there was time to figure out how to submit it while not even knowing if they would submit to the FDA.
My understanding is that they've been carrying out a rolling evaluation that has been going on for the duration of the trials, which has helped accelerate the normal process.
Having said that, I believe the EMA (EU) also carried out a rolling evaluation, so I'm not sure what the differences are there.
From what I remember from the news yesterday the EMA will be done with the evaluation (if they don't find anything that causes concern) by the end of the month, so they aren't that far off
You are correct. The meeting for the "decision" (rather, it is a recommendation on which the European Commission acts upon) is scheduled to be December 28th at the latest.
Yeah, and given the political pressure they're likely to do it earlier (I believe they meet every 2 weeks, and they received the application documents with the complete data set on monday). Dec 28 is their "no later than" internal deadline. The EC has already said they'd hold an emergency meeting to formally approve immediately after.
I'd rather they take a reasonable amount of time to evaluate. It's just the reality of things. A lot of those people would have lived if they had stuck with the plan to distance and wear masks but here we are.
So easy to use an ill-defined group of disobedients as the scapegoat. Back in the real world the effect of the masks recommended to the public is marginal at best.
Delaying vaccines is not ‘just the reality of things’. It’s a political decision with grave consequences. One country makes one choice, another makes another choice. The reality of things is that choice decides wether people live or die. There is no way to shift the blame away from that.
I bet everyone there wants to get the vaccines out of the door as fast as possible. That does not mean that people are willing to cut corners where they should not.
Sure, that's why I am convinced that they are working as fast as possible. (I'm fully aware by now that you seem perfectly fine with corner cutting, so no need to reiterate that again).
The EU didn't get the data to make a decision until just a couple days ago. The FDA and UK had a head start so of course they can make an informed decision sooner.
Maybe the EU should say "We haven't seen the data, but it is good enough for the UK so good enough for us.". However what if the data shows it is good enough for anyone from north-west Europe, but not anywhere else in the world - then the approval would just needless divert the vaccine from where it would work (the UK) and give people it won't work on anyway a sore arm. This is an extreme, unlikely situation, but it is the type of thing they EU needs to know about.
If people don't trust that the vaccine is safe, they will not take it, which will basically throw away a year of vaccine development and lower trust in vaccines in general and prolong the pandemic.
Doing the theatrics and vaccinating people are not mutually exclusive. There’s plenty of people who want to get vaccinated now, so they can go first while the people who don’t can wait for this ‘necessary research’ to be done.
If you are actually familiar with their processes, you could critique them and tell us where they could be improved. It doesn’t sound like you are, though.
So enlighten us! As far as I can tell it’s a bunch of scientists reading the report. There’s a reasonable procedure involving asking questions, responses, waiting, but it takes over a year. So it’s been shortened.
The report is about 15000 people who got the vaccine and didn’t get seriously ill. There’s nothing to judge on that you can seriously do in 20 days, in that time frame you can only look at the basics and these are clear: 15000 people got the vaccine, didn’t get seriously ill and mostly became immune.
>There is absolutely 0% chance at the end the vaccine will not be approved.
That's not true, I think it's foolish to 100% trust a company to not make any rushed mistakes, lie, or hide some facts, when there are massive amounts of money involved.
It’s not like they suddenly dumped a stack of papers on the regulators’ doorsteps. 99% of all the data they are going to get has been available for a long time and everything they are going to be able to check in their 20 days has been available for a long time.
How are they going to check if the manufacturer fudged the report? Run the experiment themselves again in 20 days?
Edit: by the way in the UK they were prepared properly and the vaccine is approved today. Or would you say they are acting irresponsibly?
It would have been impossible to predict the problems with thalidomine by looking at the equivalent report as what is available now for these vaccines.
So looking at it for 20 days isn’t going to help with that. It’s just going to cost 100000 lives.
Even if they approve today and the best case happens were are still looking at the same 100000 lives lost. Maybe a handful would be prevented, but no matter what supply ensures that they cannot vaccinate enough people to make a significant dent in that number.
No because if you start later you’ll be done later. The vulnerable population is a really small part so the first batch is already big enough to cover that.
The UK has put a lot of effort into speeding up the roll-out of these vaccinations in general. Enough that it basically leaked the fact some kind of Covid vaccine was coming a few weeks in advance because so many people were involved in the pre-planning and the timescale was so aggressive.
You make it sound like a bad thing. It was never a secret the vaccines were coming and as each day of delay means 5000 people dying I think putting a lot of effort into speeding up the rollout is pretty well worth it.
Unlikely to be the latter, because they've already prepurchased millions of doses. Unlikely to be the former either. The UK regulatory system is highly-regarded, and until January the EU medicines regulator was based in London. It may just be that they're particularly efficient.
It had actually been identified that our pandemic preparedness was overly focused on influenza. Still, I have no idea whether we'd have fared better in a flu pandemic - maybe the assumption was that we'd be able to get a vaccine quicker in that case?
In any case, it's still somewhat unclear why the UK has done so badly with Covid. There are some obvious things the government should have done better - and unless Brexit turns out to be a "titanic success", I can't see how Boris Johnson will remain PM until the next election. But even compared to countries that have implemented weaker measures, slower than we have, or have had their healthcare systems overwhelmed, or struggled with testing - we've suffered much worse. And the reason why is, at this point, unknown.
One argument is we have a less healthy population, either due to lifestyle factors or due to having relatively mild previous flu seasons. Another is our dense, poor housing and service economy. Another is travel and weather. Will be interesting to see what falls out over the analyses over the next few years, and if anything is done to act on the problems (I doubt..).
The factor that these preparedness plans can't account for who is in charge at the time the disaster hits. We might have technically had the best plans, best scientists, best civil service, best procedures - and then the person in charge refused to listen to them. Like Trump and the CDC. Maybe people will vote for competence over bluster next time around? (I doubt..)
I suspect it's because a large portion of society didn't take it seriously rather than preparedness. There are a lot of protections against government forcing the populace to do things that they don't want to do unlike in some much more authoritarian countries.
They generally are ahead of the USA in most areas of medicine on average, whereas the USA probably has peak research and medical capabilities IF you have the money to pay for it like when Trump had the disease.
Approval is like code review. They go over the work and make sure it is sound. Just giving an OK without doing the approval work would be called "rubber-stamping".
It is of vital importance that the majority of people feel safe taking the vaccine, because you need herd immunity. If people have doubts that it has been correctly vetted they will be reluctant to get vaccinated which makes the whole investment in the vaccines pointless.
Especially when you have so many antiscience/luddites/antivaxxers in the USA. We will probably need at least 70% of the population to get the vaccine if it's really 95% successful before we can start going back to normal. That's going to be a hard thing to do before the end of 2021.
It'll be interesting to see what happens if there is a significant amount of antivax attitude towards the COVID vaccines. I wonder if we'll see a lot of employers mandating it.
Safety tests were already completed and approved by regulators months ago. The Phase 3 trials are efficacy trials to show that the vaccine gives immunity. Certainly we learned more about the safety of the vaccines from Phase 3 data, but we already knew that adverse immediate reactions would be very rare.
What's ridiculous about this situation is that the regulatory authorities are not willing to weigh against the benefit which would come from an early emergency-use authorization (which could have happened as early as August). It's like CPU branch prediction: approve the vaccine for early distribution as fast as it can be made--which would only have been a few hundred million doses globally so far--while the phase 3 studies are going on. The early distribution would be watched as observational studies, of course. If it fails Phase 3, stop distribution and move on to the next vaccine.
If the vaccine works, this strategy would have directly saved tens or hundreds of thousands of lives, and potentially millions from getting sick and whatever long-term complications come from COVID-19. Indirectly, early vaccination of essential workers would work to decrease R0 and therefore cause fewer people to get sick through normal means.
If the vaccine doesn't work, there isn't much money wasted since the manufacturing is already being done pre-approval anyway.
In the worst case if the vaccine primes and adverse immune reaction, that is bad and an argument against early approval. However you have to weigh the added risk (that early vaccinated people have a higher CFR) vs the probability of that happening, which is low.
High likelihood of highly beneficial outcome if it works. Lower possibility of a relatively moderate bad outcome to a smaller population if it doesn't. Certainty of many added deaths if you wait. I don't have the data the regulators have that is necessary to quantify this and make the call.
But for dumb political reasons, this option is off the table. Only Russia and China went ahead with early vaccination; all the other national agencies decided not to even think about early distribution. It was not even an option on the table.
>Only Russia and China went ahead with early vaccination
I don't know about China, but mass vaccination have not started in Russia yet. It will begin only from the next week starting with medical personnel and teachers. Effectively the Russian vaccine has only finished phase 3 trials (based on 40k volunteers) relatively recently.
The 1970s swing flu vaccine was ineffective but harmless for millions and left a few thousand with permanent neurological symptoms.
This disease has over a 98% survival rate, and even higher if you're under 40. Many of the "long COVID" studies I've read have been in high risk or elderly people, they were limited case studies and I think a case can be made that most "long COVID" could be nocebo or mass hysteria at this point (or the fact that it could just take the body months to heal from a bad infection).
We've never approved a drug, much less a vaccine, at this speed before. Unless you go back to the days of Jenner where he just stabbed people with Horsepox and there was no real regulation or long term data collection.
As far as I've understood it, the whole COVID-19 vaccine research has been going at a breakneck speed. First vaccine batches were made back in February.
Yea, and honestly, huge money grab for big pharma. Over 100 companies started working on vaccines. They got huge amounts of money, knowing they didn't even have to be successful.
Who cares in the broader scheme of things? The toll it's taken on the economy is in the trillions, 10 billion to speed it up is literally almost nothing compared to that.
I mean once you have the data it shouldn't be exactly rocket science to check if the trial was done well. Given how clear the data is as far as one has heard until now the decision should be a no-brainer. You already had the trial protocol since several months, so that could've been checked in advance.
I'm actually rather wondering what's taking the EU so long.
It is not a trivial process, and these are ferrociously complex. Safety, Quality and Efficacy - each are hard to check. From how people are categorised in trials, how missing data rules are implemented, to how it is manufactured and the stability data. It doesn't take a year for no good reason. Yes this has been sped up massively, but steps have been abbreviated - let's not kid ourselves.
If interested, the FDA release all documentation - search for Drugs@FDA and find a recent medicine, and see just how much review it gets. You'll be surprised!
I believe a big part of speeding up was parrallelization(spelling?) of the phases rather then the usual running them in series. Also I would imagine that the teams working on these had all the resources they needed, minimal internal delays and no expense spared on budget. I can see how those things combined, coupled with 10 months of “crunch time” work from the teams involved could see a 10x improvement in vaccine production.
Some things can be done in parallel, yes, but a large chunk of the speed comes from literally skipping some animal testing and ALL long-term longitudinal studies.
I read that the approval process might take until end of December and that first vaccinations for people at risk and system-relevant groups was expected for beginning of January.
Source (german):
"Bund und Länder stellen sich darauf ein, dass "bei bestmöglichem Verlauf" noch im Dezember mit ersten Impfstoff-Lieferungen gerechnet werden kann. Gesundheitsminister Jens Spahn sagte heute im Deutschlandfunk, dass Anfang Januar die Ersten aus den Risikogruppen und auch schon Pflegebeschäftigte geimpft sein könnten.", https://www.tagesschau.de/inland/faq-corona-impfstoff-105.ht... , 1. Dezember 2020, 11:00 Uhr
Generally approval of this is fast-tracked everywhere, but the UK being first is a political marketing stunt in my opinion.
The UK government is in dire need to demonstrate positive aspects of leaving the EU, and being able to independently greenlight this vaccine first is one particularly well suited for PR. The Brits love their NHS system and healthcare in general, so hitting it home on that turf resonates with them.
Ceasing this opportunity is especially important because all the other aspects of Brexit are just about to hurt the Brits big time next year, with the EU transitional period running out at the end of this year, with effectively no trade deal whatsoever in place to replace it, and Trump having been thrown out of office and most of the British prime ministers' hopes for an advantageous and quick trade deal with the US being dumped together with him.
Well there's a lot of pressure on the government Boris Johnson is facing a lot of pressure from his MP's in particular the red wall (former labour held constituencies in then north)
Money Quote: "...because of Brexit we’ve been able to make a decision to do this based on the UK regulator, a world-class regulator, and not go at the pace of the Europeans, who are moving a little bit more slowly."
Interesting. However, this does not undermine my original claim - actually I think it even increases its viability. The undisputable fact that several UK officials specifically praise Brexit as the enabler for this quick approval process, even though it actually was not necessary at all (which they possibly even knew in the first place), increases the likelihood that there was at least some political motivation behind the quick approval move. Whether the statements of the politicians are true or not does not matter with regard to the PR value of them; the only thing that matters is what the general public knows, and not knowing that the UK could have made a national approval even if still part of the EU is probably widespread.
I'm really glad that this brings hope into a dark season.
People are already rewriting Christmas carols: "wipe the halls with sanitizer, falalalala lalalala 'Til we get the cure from Pfizer falalalala lalalala"
Not sure why the posts asking for vaccine risks are getting downvoted. Pandemrix, the vaccine for swine flu, caused a notable amount of narcolepsy cases in recipients here in FIN (notable here meaning the amount of yearly cases spiked by 3-4x) and as with anything that's taken quick to market there has to be some risk of overlooking some tail events somewhere.
It's not an anti-vaccine attitude, just healthy skepticism considering how much pressure there is to get this out and into distribution.
You have to compare the risks to the risks of the disease and the likelyhood of contracting that disease. And for COVID-19 the risks are very high. It doesn't make much sense to me to trade the very high known risks of COVID-19 against the relatively low risk of rare side effects in a vaccine. These vaccines have been tested in ~40,000 people each, so we do know quite a bit about their safety.
The fatality rate of COVID-19 and the rate of serious complications is high enough that it easily dwarfs the chance of any potential rare side effects of the vaccines.
> These vaccines have been tested in ~40,000 people each, so we do know quite a bit about their safety.
We know quite a bit about their short term safety. It's impossible to know for sure if there is any long term side effect. But that is probably a risk we have to take to get past the immediate threat of covid-19.
so because other unrelated vaccines that have existed for a long time and known to have no long term side effects, we should assume that this brand new vaccine has no long term side effects?
Do you have an actual source for that? People keep repeating it over and over but I've seen no evidence that COVID-19 carries particularly high risk compared to other infectious diseases.
If this is indeed the point of contention - balancing the risk of adverse outcomes from a rushed vaccine vs those from a virus, I think it's inaccurate to say that the risks from this virus, understood generally across the population, are "very high". The likelihood of contracting it is of course very high, but the risk of adverse effects are only high for a relatively small stratum of the population.
It makes sense to reserve "very high" for pathogens like HIV or Ebola, not SARS-CoV-2. For a very large majority of the population, SARS-CoV-2 has approximately equal risk to the four seasonally circulating coronaviruses, so even a small risk from an overlooked data point might be significant.
We need to reach herd immunity one way or another, so I'm not sure the discussion of individual risk is the right one. With no data being available for patients to examine ourselves, it's hard to even know how to make these decisions.
>In our paper, we show that the risk appears to be limited to only one vaccine (Pandemrix®). During the first year after vaccination, the relative risk of narcolepsy was increased 5 to 14-fold in children and adolescents and 2 to 7-fold in adults. The vaccine attributable risk in children and adolescents was around 1 per 18,400 vaccine doses. Studies from Finland and Sweden also appear to demonstrate an extended risk of narcolepsy into the second year following vaccination, but such conclusions should be interpreted with a word of caution due to possible biases.
I'd love to see a source for that. Just a couple of weeks ago there was an interview with a girl with narcolepsy on SVT (Swedish public broadcasting). This was regarding people being a bit wary of the new vaccines. I can't imagine them running a piece like that if it had been debunked.
Because the entire subject is so politicised and polarised that even daring to ask a question that might go against the current might get you labeled as a right wing science denier racist (based on the country, different labels might apply).
Edit: it's funny that the comment above gets downvoted just for asking a question. Great world we live in. We didn't learn anything from the past. Blaming and shaming gay people in the AIDS epidemic, some previous hastily released vaccines that caused the anti vaccine current to gain momentum (just look in the nordics at the current willingness to get a COVID vaccine, something like 1 in 4 maybe)
Yes, and this is a serious problem. It seems to be one camp or the other, blind fear or blind approval, with little room for thought.
I honestly hate anti-vaxxers with incredible intensity now. Before they were an annoyance, now they have destroyed all intelligent discourse on this current topic.
For logical concerns, another example is an earlier, mouse brain derived Japanese encephalitis vaccine. Pulled, due to suspected prions causing brain swelling, and death. It should be noted that these effects were not seen until years after a peron received vaccination.
It does not matter that current vaccine $x does not "work that way", instead, it is well known that some vaccines will be troublesome.
This is not anti-vaxxer, I have all standard vaccinations, for they are tested, years of use behind them, safer than the alterative.
Yet it is so hard to find accurate info, everything is filled with crazy, emotionally based screaming and decision making, it's infuriating.
To expand a bit on that comment, 46% said that they would take the vaccine while 26% said that they wouldn't. The numbers in August were 36% and 37% respectively.
Same in Sweden. Currently, 26% stated[1] that they do not want to be vaccinated. The issues with the swine flu vaccine are still fresh in our collective memory.
The swine flu that vaccine protected against also causes narcolepsy, in exactly the same genetically susceptible population, except more frequently and severely.
In other words those who got narcolepsy were nonetheless better off with the vaccine than if they had caught the flu.
The UK has a vaccine rollout plan that involves starting with health workers and over 80s. Due to supply issues, only those with the highest risk of death from COVID will get this vaccine.
UK health care workers were one of the main groups affected by Pandemrix-related narcolepsy. It was a bit of a scandal over here, though perhaps not the most well-known one.
The "issue" I've heard with simply referencing fatality rates is that the fatality rate does not equally apply to all age groups/risk factors.
So anyone under 30 has a dramatically lower chance of dying due to covid, and therefore would likely have a higher risk of a serious side effect when compared to the risks of contracting covid.
It's an interesting dilemma, for the good of public health you have to have certain populations actually increase their own personal risk, at the benefit of the majority overall.
I think that's how it's going to go down in most countries. No need to waste precious vaccines on us who can work remotely and can limit our outings to the local grocery store and the park.
Healthy skepticism belong in peer-reviews, in revisions of medical journals. Skepticism in the public space fosters anti-vaccine sentiments, adds to the already growing anti-vax movements and puts in risk the vulnerable in our society as they require shielding and for the rest of us to do our part.
That exact sentiment is the reason for this problem even existing. Peer review and medical journals are by no means exempt from usual human corruptions, and there is absolutely no rational way to say that certain concerns should only be allowed there, and that we should not be able to even discuss them outside of those closed circles.
> Peer review and medical journals are by no means exempt from usual human corruptions
Individual instances can be found, and errors do happen. However the idea that the biggest pharma companies, integrated by incredibly talented and hardworking people, and every safety institution (The american FDA, the EU security council etc) are all so compromised as to miss real problems and purposefully endanger the population is in my humble opinion absurd.
What is the societal advantage on letting a baker share his uninformed opinion on epidemiology? Why let software engineers discuss the safety standards of the medical field? A ton of the situations and problems are heavily skewed to high technical knowledge of narrow field.
I have no idea about how many volunteers are a good number to run a vaccine experiment, I have no idea what a good control group vaccine looks like or why use HepB and not measles. Me sharing my opinions on this topic only pollutes the conversation when I do not have the background knowledge to form an opinion on it.
If you look for information on this topics it would be much better for society if my blog is not there and there is information from actual doctors and epidemiologists talking about it.
You don't seem to fully grasp the importance of free speech is and what it has done for the western society. What you are advocating is supressing speech, however clever little reasons you might have tried to find for it. None of the problems you described come even close to the clusterfuck of hurt we are going to experience in the society (and that other societies did and still do) if we are going to start supressing speech.
First of all, there is nowhere the concept of free speech, there are ALWAYS limits. Europe has more limits than America but both have limits.
Second, as any right free speech comes with certain responsibilities. My point is education people in using their right appropriately.
Lets get all Spiderman, great power comes great responsability. The right to free speech comes with the responsability to know when to shut up. Letting professionals speak and have the floor during events that concern their domain knowledge is a basic pre-requisite for the good ideas to flourish.
I think anti-vaxx and other fringe groups are more driven by distrust in society, and by denying discussion to be had in the first place will further build anti-societal silos.
It's a difficult problem, because inevitably there will be harm initially if you allow free discussion. But over time the harm will be less in comparison to complete shutdown of any public conversation about the vaccines.
If the anti-vaxxers don't want the COVID vaccine, so be it. Let them pay with their health. That'll be the best course of action for beating down the quacks who will oppose any vaccinations.
There are several problems with that, and they can be seen online already.
1) It is much easier to spread misinformation than to collect facts and spread real data
2) Mistrust is insidious and spreads, allowing anti-vaxers then goes into other forms of anti institutional ideologies.
3) Herd immunity. If some kid has leukimia and cannot get vaccinated, he survives thanks to everyone else being vaccinated. Some 30 year old reactionary being an anti-vaxxer and getting covid and surviving it would be ok if he was not a vector of infection to the most vulnerable in society.
So in my opinion teaching people basic scientific literacy (so they can check primary sources like published research), and fostering scientific respect and trust would do us wonders as a society. We put a man on the moon, and reduced child mortality by 90% by trusting science, why allow people who think the theory of gravity is "just a theory" spread their thoughts.
> 3) Herd immunity. If some kid has leukimia and cannot get vaccinated, he survives thanks to everyone else being vaccinated. Some 30 year old reactionary being an anti-vaxxer and getting covid and surviving it would be ok if he was not a vector of infection to the most vulnerable in society.
You can develop resistance naturally. I was exposed to COVID-19, therefore I have antibodies and I am immune, supposedly for 6 months.
> You can develop resistance naturally. When your body is exposed to a virus or bacteria, it makes antibodies to fight off the infection. When you recover, your body keeps these antibodies. Your body will defend against another infection. This is what stopped the Zika virus outbreak in Brazil. Two years after the outbreak began, 63% of the population had had exposure to the virus. Researchers think the community reached the right level for herd immunity.
sorry, but anti-vaxxers are empowered by doubtful and propagandistic press releases...when you have solid, scientific and independently peer-reviewed data the only thing that anti-vaxxers can do is be silent and accept them.
That is just not how anti-vaxers work, if you ever talked to one. There is a multitude of problems they can say they found even with an RCT with 100k participants. You are assuming you are talking to a person with years of experience with science and critical thinking. That's not a typical antivaxer.
And if you do talk to a person like that, no press release is a problem for them, they see right through it.
There are two challenges I haven't seen talked about a lot.
1. I expect that there will be a lot of people who think that once they get the shot, they can immediately stop wearing masks and practicing social distancing.
The rollout to the general public will need to be combined with extensive efforts to make sure people know that it takes time for a vaccine to actually provide protection.
In the case of this one, it is about a week after the second shot, which is three weeks after the first shot, so you should keep up all your pre-vaccination measures for a month after getting the first shot.
2. In a fair number of people, the first shot is accompanied by strong symptoms similar to a severe flu, which lasts for about a day. (I haven't read anything about whether or not this can also happen with the second shot).
The people who get that strong reaction might be reluctant to get their second shot.
The education efforts accompanying the rollout to the general public should make sure people know that there is a decent chance of such a reaction, but they will get over it in a day, and it will be worth it for the protection from COVID.
I do not see an easy answer. We could wait until we have 600 million doses on hand, to limit the crossover time when part of the population is vaccinated and part is not. But people will be dying every day in the meantime. But if we start rolling the vaccine out, there will be a significant number of people who will stop wearing a mask as soon as they get the first shot. And probably a bunch of people who will stop because they figure this means the pandemic is basically over.
What I don't think is realistic at all is expecting the population as a whole to continue to wear masks until everyone is vaccinated, and then just everyone goes back to normal at once. Like it or not, this just isn't how it will play with most regular people. People are itching to be done with 2020 and the pandemic, they just gave up their Thanksgiving, they're about to give up their Christmas gatherings, it won't take much to push people over the edge into throwing up their hands and saying "all done!"
In the UK, I think they're likely to recommend masks and social distancing for everyone until a large proportion of the population are vaccinated. And that will take a long time.
Why a Covid vaccine doesn't mean the end of face masks yet
3. Vaccinated people can still be carriers of the virus and infect others who aren't vaccinated yet. As you point out in #1, vaccinated people still need to practice social distancing and wear masks.
Is there a high chance for it? I’d really like to know.
Moderna was testing for SARS-COV-2 protection efficiency, while Pfitzer was testing for COVID protection efficiency, but they have similar targets as far as I know.
I’d love to know an experts’ answer because the difference between the two is huge, I would hate myself to kill my parents by catching SARS-COV-2 after getting vaccinated.
The answer is that we don't know. But it is not unlikely.
You can still get the flu even if you had a flu shot for example. Some of that may be due to the flu shot being the wrong strain but some of it is definitely due to infection post vaccination. The main reason that they recommend a flu shot is that you usually have a milder course of illness.
Covid will probably be the same way. You could have mild symptoms or be asymptomatic despite being vaccinated and infect someone else.
There has never been a flu shot with 95% efficiency. Actually Moderna announced in September that they are getting into the flu vaccine business. It will be great to see mRNA based flu vaccine coming hopefully soon.
If you read the clinical trial press they state that nobody who received the vaccine had a severe covid 19 disease. That means some had symptoms and a mild course of disease.
We do not know that if you get covid, despite vaccination, that you are not infectious.
I had COVID-19 early in the year, and so did my Wife (not sure about my Daughter, harder to tell with kids).
I would really like to know whether I should get the vaccine or not? All the info that's out there says that immunity to C19 is temporary, so a vaccine after having gone through it doesn't seem redundant.
Does anyone know if there's been any research on effects of the vaccine on the people who got C19 and recovered? I'm especially worried about possibility of a cytokine storm possibility as a reaction to vaccine.
I find it hard to believe they haven't covered this with their phrase 3 trials, where the intent is to ensure that there is no risk at broad scale (in addition to effectiveness), and they pause the trial if anyone dies for unknown reason (etc) -- I definitely remember the trials pausing briefly while they investigated[1], and then continuing once resolved.
I also saw a study a few weeks ago where they found people with antibodies 6-8 months later[2][3]. Suggesting longer term immunity.
> All the info that's out there says that immunity to C19 is temporary
This isn't quite true. What is true is that there is no information out there to conclusively support long term retention of antibodies, in large part because we've only got 6 months of data.
As to the latter point, I wonder about the trial design. If they didn't give all participants a Covid antibody test before starting, it is very likely that several participants were previously infected. Smaller sample size though.
There's always some criteria for the test group. An example might be:
Age 20-65, BMI below 2, with no long term medical conditions
You find enough people that fit that group and then randomly divide them into two groups, one of which is the test group and one the control. It is possible but unlikely that the criteria includes "has not previously had Covid 19". Assuming the criteria didn't include that, then some of the participants and some of the control group will have previously had Covid, and so we now have some evidence as to whether a cytokine storm occurs.
From what I have seen the data says immunity is at least six months, and potentially years as with the original SARS.
For me it is easier, I had it only a month ago, so I am good at least till the summer.
COVID-19 reinfection is negligible. Only 26 cases worldwide are reported - sad for them but they are extreme abnormal cases. Immunity seems to work with this virus as well.
"People who have gotten sick with COVID-19 may still benefit from getting vaccinated. Due to the severe health risks associated with COVID-19 and the fact that re-infection with COVID-19 is possible, people may be advised to get a COVID-19 vaccine even if they have been sick with COVID-19 before."
Presumably one could get re-infected after vaccination, too, isn't that how vaccines work? I.e. they try to simulate as close as possible a real prior infection.
It's more than likely that unless you are in an at risk group, or work in healthcare etc you won't be getting the vaccine until many more people have it first.
I would also wager (but this is a weaker probability) that the majority of healthy young people on HN won't be getting a vaccine at all.
I suggest you donate blood via the Red Cross [1] and get a free Covid antibody test. The presence of those antibodies should be a good indicator of whether you are still immune and that will help you decide whether or not you need the vaccine. You can do this every month or two and run your own experiment to determine the length of post-infection immunity.
I remembered seeing an article a few days ago where Dr Fauci was saying people who have had coronavirus should still get vaccinated. I've also heard elsewhere the immune response from the vaccine is much higher than the body's natural response from getting it.
Having had Covid-19 should confer at least as much immunity as a vaccine does. It's possible that a vaccine could act as a "booster" to extend immunity, but I don't think there's any data on that.
Your fears about "cytokine storm possibility as a reaction to vaccine" are unfounded. These vaccines have been tested on tens of thousands of trial participants.
> Having had Covid-19 should confer at least as much immunity as a vaccine does.
[If I'm understanding what you're saying correctly] Not necessarily. There are vaccines, such as those for HPV and Tetanus that provide better immunity than the natural immunity provided by having and surviving the illness [1].
I don't recall reading any research on the immunity provided between a vaccine and the illness on COVID-19, so I don't know whether this could be such a case.
Do we have any more data on what the wider effectiveness of these vaccines is likely to be?
Duration of immunity? I've heard a minimum of 3-4 months reported, possibly longer, but do we know more now?
Am I right that we don't yet know if they reduce transmission or simply prevent the disease?
If the duration of immunity turns out to only be a few months, I wonder how this is going to play out. Will we periodically vaccinate 25-60% of the population, indefinitely? (I've seen varying estimates on what kind of coverage is needed to keep the pandemic in check.)
Short of eradication, if immunity is not permanent, what options do we have apart from a perpetual vaccination program or just accepting an increased rate of mortality going forward?
> Duration of immunity? I've heard a minimum of 3-4 months reported, possibly longer, but do we know more now?
The only way to know for sure is to wait and see. But patients vaccinated for SARS in ~2004 still show immune responses now and people who received the various SARS-COV-2 trial vaccines in April of this year still show immunity. There's also studies showing many people who recovered from COVID on their own have demonstrated 9 months (and counting) of immunity. The truth is that the immune system is super complex and there isn't a single simple blood test they can do to tell if a person will resist a virus or not, so a lot of the conflicting numbers you will have seen depend on what exactly was tested and the media reporting has been pretty poor at contextualizing those study results.
So there's reason to hope vaccine-derived immunity could be long lasting (say 1-10+ years), but we'll just have to see. But talk of 3-4 months of immunity seems to be media hype.
> Am I right that we don't yet know if they reduce transmission or simply prevent the disease?
Correct, we don't know yet. Pfizer unfortunately only tested people with symptoms for COVID in their trial, so we have no idea if it reduced asymptomatic cases or reduced transmission. Oxford did test thousands of people weekly in the UK to find asymptomatic cases and they have said they have "evidence" their vaccine reduces transmission, but they haven't published their peer-reviewed Phase 3 results yet so we don't know by how much. The scientific consensus seems to be that all the vaccines will probably reduce transmission by some amount, but by how much is unknown. But it stands to reason that the quicker someone clears the virus from their body, the less time they will be shedding infectious levels of virus.
> Short of eradication, if immunity is not permanent, what options do we have apart from a perpetual vaccination program or just accepting an increased rate of mortality going forward?
Luckily, this probably won't be the case. In any case, viruses tend to mutate and become less virulent over time since killing your host is a bad way to transmit yourself. So the general guess is that the virus will eventually mutate to be less lethal, similar to the how the 1918 flu virus still circulates but doesn't cause that level of mortality anymore.
>Will we periodically vaccinate 25-60% of the population, indefinitely?
Considering the common side effects from this vaccine (most people get severe flu-like symptoms for about a day after each shot), it's pretty unlikely people would be willing to be re-vaccinated every few months.
Amazing that people will be getting vaccinated against coronavirus before the year is out.
Is there any evidence of whether these vaccines prevent transmission of the virus yet? Or so far do we just know that they protect the person who is vaccinated?
It is planned that it requires 6 weeks to acquire immunity with 2 shots (4 weeks apart) of this vaccine. Realistic outcome if enough people get vaccinated should be that spring/summer wave of covid is suppressed or at least death rate and amount of severe cases will be much lower.
Vaccines that prevent disease symptoms but don't completely prevent infection are definitely a thing (they're said to confer "non-sterilizing immunity," vs. "sterilizing immunity" which prevents both infection and disease). The inactivated polio vaccine (the injectable one that's used in the US) is an example of such a vaccine. The oral polio vaccine, which is the main one used in the developing world, interestingly does confer sterilizing immunity, but with the tradeoff that sometimes it also causes polio.
At least in the US, the explicit target endpoint for FDA approval was just prevention of disease, not prevention of infection, and the phase III trials for both the Moderna and Pfizer/BioNTech trials were only designed to assess this criterion: they only tested symptomatic people, so it's entirely possible (though not that likely given animal model observations, etc.), that infections were just as common in the treatment groups as control groups, but they just never developed symptoms and so were never tested. More research will be needed to ascertain which kind of immunity is being conferred.
The researchers joke that "animals lie", in the sense that animals can have different reactions compared to humans, in spite of the researchers trying as much as possible to get something useful in the experiments. Having said that, I still believe your claim of what can be concluded to be unlikely based on "animal model observation" is false, from what is known up to now. Specifically:
"In an ideal world, a vaccine would prevent infection entirely and, it follows, also prevent disease and severe disease. But this may be hard to achieve for a respiratory virus vaccine. Animal challenge data suggest that vaccinated animals may still be infected even if they don't experience symptoms. A vaccine that is able to reduce the severity of disease, even if it cannot prevent infection entirely, would obviously still have enormous public health value. Therefore, this is what trials target as their primary aim."
I suggest everybody to read carefully the whole article, as it is written by an indisputable expert, and what is presented in the article isn't based only on the animal models but on much broader knowledge. Nobody at this moment should expect that the vaccines guarantee that somebody who is vaccinated won't be able to infect somebody who hasn't received a vaccine. That, for example, means that even if the health workers do get a vaccine they will still have to wear protective equipment.
Might this also have a silver lining? If the virus is still able to spread, does that mean that it is less likely to face selection pressure to mutate around the vaccines?
Contrary to what is often believed, regarding mutations, coronaviruses behave completely differently than flu viruses.
The mutation rate among coronaviruses is so slow that it's much more probable that whenever we see some new significant change among them it is due to the recombination, not due to the mutation. Coronaviruses have a specific mechanism of "error correction" in them which lowers the mutation rate, compared to most RNA viruses.
The "selection pressures" are also less likely in this case then most would estimate. We as humans are much more "pressured" by this virus in its current form than the virus by anything we'd do. The viruses themselves don't even "need" to come "around" anything, and there are enough unknown viruses in the world which aren't less potential threat than this one which understandably got the spotlight.
It's surely good to be aware of all the processes involved but the probabilities of different events and outcomes should also direct our responses.
The question is whether the vaccine against covid prevents people from getting infected with the virus or whether the vaccine protects against the effects of the Covid disease. This is not the same.
What I remember but cannot currently find a source for, is that there are three levels of protection that vaccines can provide. First is to protect patients from developing the sickness (but not from being infected!), second is to even prevent them from spreading it and best outcome is to prevent them getting infected at all. Only the second and third level prevent spread.
I'm surprised so many people are excited about this. I have many concerns with the Pfizer vaccine
* 99.96% of the placebo group did not have a serious case of covid
* 99.25% of the placebo group did not get covid
* No one in the trial was deliberately inoculated - participants just lived their lives as normal.
* Only symptomatic participants were tested - this seems unbelievable to me - we have no idea what the actual incidence rate is because not everyone was tested
* Vaccines might just mask symptoms - since not everyone is getting tested, vaccine makers just have to make sure there are no symptoms. No symptoms equals no test.
* No trials done with two placebos - we need trials where both groups are in a placebo group. One gets a shot that gives a mild side effect and the other gives no side effect
* No trials done with unrelated immune boosters - we need to see how well this vaccine performs against other immune boosters. This could be a drugs or even supplements (vitamin D & C and exercise).
* Two shots were given in a trial lasting just 4 months - 4 months is an incredibly short amount of time to know whether it will be effective long term. It also gives Pfizer two chances to boost immune
* Long term health consequences of vaccine - we only have 4 months of data, which is way too short of time to see any longer term consequences
* There is a huge incentive to provide something that masks symptoms - billions of dollars are at stake. Big pharma is one of the very last companies I would trust with a novel vaccine
* No coronavirus vaccine in history - many coronaviruses currently circulate, but no vaccine has even been produced for them. It seems quite coincidental that humans finally put the pieces together for our current novel strand
Generally it isn't on the individual to try to weigh something like that up. Here in the UK, at least, the Vaccine will be offered to people in order, so if you are offered it, there would be no reason to defer—others who need it more should have been offered it before you and you accepting won't deny them anything.
This is why countries and public health departments are discussing and agreeing on who gets a vaccination first - people in care homes, front-line health workers, or perhaps even young, healthy people because they heavily drive the spread. I don't think there's a situation anywhere where it's a free-for-all.
Personally, I will take the vaccine as soon as it's made available to me. Even if my risk is perhaps low (which may or may not be true), taking the vaccine reduces the chance that I would spread COVID to someone else. It's a collective effort to reduce the spread, not an individual or selfish one.
it would prevent infection and transmission as much as any other vaccine would. you're just priming your immune system to handle something its not actually seen before. you can still get the virus, it will still affect you, but your immune system will recognize and deal with it much much faster. thinking logically, if you are given the virus, your body will still make copies for a short amount of time and you would still be able to give it to someone else. getting the vaccine makes the window of opportunity much smaller and dramatically lowers the risk that you will die from it.
Yes we basically need everyone to get it who is willing to get it because we want to eradicate as much of the virus in the population as possible.
Also as a society we need to encourage everyone to get the vaccine and do whatever possible to suppress anti-vaccine hysteria, you know the conspiracy theories are already going to go crazy over this I'm sure.
There is significant evidence that it prevents you getting the disease. That's the 95% efficacy everyone is talking about. Whether or not it fully prevents spreading has not been tested yet, but early signs sound positive.
The BioNTech/Pfizer press release mentions a reduction in confirmed cases (8 vs. 162), not in severity. There is no good reason why such an effective vaccine should not reduce the risk of spreading the disease. However, even a large phase 3 trial doesn't have enough statistics to answer this question.
Assuming you're somewhere between 20 and 30, your risk of dying when contracting COVID-19 is somewhere around 0.01%, so 1 in 10,000. I'm not including the chance for severe side effects, hospitalization here (I don't know a good data source for those that is age-specific).
That's a lot lower than the risk for older people, but it's still a somewhat high absolute risk.
Personally, I'd get vaccinated. The risk even for young people is still there, and it's not that low.
The source for these numbers is the following paper, specifically figure 2a:
Even a doctor can't answer that without having access to your medical documents.
So get advise from your doctor. Perhaps it depends on your "health issues". And, don't look for an answer from the internet anytime soon.
I assume it depends on your condition. If you are lucky, they have tested it on people with similar conditions and there is data for it. Otherwise, they may still be able to measure the risk. If your doctor suggests that there is a risk because of your condition, then you have to calculate the risk of not taking it as well. How much risk is there for you with the vaccine? How long can you keep yourself safe from COVID19. That depends on your interactions with other people, your job, and people around you etc.
if you're a young person with no health issues you probably won't be on the list for getting the vaccine first (it's at risk groups and healthcare workers first)
Also importantly and slightly paradoxically, if you are a young person who would eagerly volunteer to get a vaccine, it's likely that you are diligently compliant with all the other necessary rules like hand washing, masks, social distancing, and so the need for a vaccine would be even lower!
Identifying those who would most benefit is hard. Those who would most benefit is not the same group as those who would jump at the chance of a vaccine.
Yes, if you don't the virus you can't infect someone else. Vaccines are the quickest way to herd immunity, which is the safest layer of protection against the virus.
Yes, some young people with health issues can’t get vaccines of various kinds and they rely on herd immunity. One of the really sad things about the anti-vaccine movement is the people who are now at risk for things that they can’t get vaccinated against through normal fault of their own because herd immunity is reduced.
This isn't true. In my country we've had 25-35 deaths in people under 45 from Covid-19. So the death rate is very very small, but its not zero.
Including deaths of people under 25. These people may have had existing co-morbidities of course, but not all of them might have known they had those co-morbidities.
In Germany it is mostly referred to as the BioNTech vaccine. I think it's more about international publications being more likely to use the name they recognize or think their audience will recognize.
Most everyone is going to know Pfizer and Oxford respectively. Internationally Mainz isn't exactly a famous city, nor is AstraZeneca a well-known pharmaceutical company.
> Internationally Mainz isn't exactly a famous city
It might not be famous but it played a key role in the development of the Renaissance, Reformation, Age of Enlightenment, and Scientific Revolution, as well as laying the material basis for the modern knowledge-based economy and the spread of learning to the masses.
AstraZeneca is as well known as Pfizer, they are big pharma after all, the subset of people who know about Pfizer and not AstraZeneca is going to be quite small.
Another risk factor that I doubt anyone is considering -- if the vaccine is rolled out and ends up not being effective (if vaccinated populations still die from covid at more or less same rate once the vaccinated population becomes sufficiently large) -- then this could lead to a real, long term, and very unfortunate surge in anti-vaxxers ability to persuade people not to take good vaccines that are proven to be effective ...
At the end of the day, a Smallpox pandemic in 10-20 years might end up killing more people than a premature covid vaccine saves ... No idea how you could quantify this risk though -- but seems unfortunate that medical science has no way to realistically factor in this kind of third order effect into their risk modeling ...
I wouldn't worry about it. There's still plenty of positive evidence for vaccines from the last 100 years. A mistake with a covid vaccine wouldn't change that.
You have to take the social context into account too.
There seems to be a surge in anti-anti-vaxxer sentiment (any skepticism being met with strong resistance). If the vaccine were to fail after that much hype I believe it'd be a concern for worry. (Not that I think it's likely to "fail" in obvious way, just defending OP)
I'm not convinced that anti-vaxxers are on the increase - they've always been there, but usually only that subset with young kids (and hence faced with childhood vaccinations) had anything to specifically complain about. Now they've all got something to complain about, all at the same time. I don't see the point of considering the 'risk' of increasing anti-vaxx sentiment. We're in a pandemic, we just need to crack on with it. The anti-vaxxers aren't going to change their minds either way.
>I'm not convinced that anti-vaxxers are on the increase
I didn't mean they were on the increase, I was saying the people against them have been more outspoken because of the pendemic, to the detriment of people that are skeptic (but not anti-vaxxer). The issue isn't about the anti-vaxxers, it'd be more about radicalizing more center people.
>The anti-vaxxers aren't going to change their minds either way.
But this is false for anyone not super anti vaxxer
>Why worry about it? We've got bigger fish to fry right now.
It's important to weigh all the effects of our policies as a nation. If we can accomplish 99% of the result without some side effects it's better than trying for 100% with possible future problems. I think it's fair to see how policies will affect the population/its divide (i.e. it's not a small enough fish to disregard).
I'm not really proposing a solution, I'm just in agreement that we should consider multiple factors when we do deploy the vaccine.
I think just deploying the vaccine and encouraging people to take it would work fine imo. It's a strategy that is not controversial and would fix 99% of the problem.
In one way paying for giving the vaccine makes sense, on the other I'm not sure it's needed or that it'd be seen in a favoritable light (there's already a lot of controversy about how the pandemic was handled economically).
EDIT: to backup why I don't think it's needed; I haven't found the study from the article you linked, but according to https://www.nature.com/articles/s41577-020-00451-5 about 70% of people need to be immune. I don't think that's a hard number to get (but I may be wrong), but assuming there is some immunity when you get the virus (which seems supported), you don't need to vaccinate 70%, you need 70% either vacicnated or having already gotten the virus (which is 10% of the population as of now). I understand it's not insanely supported take, but that's why from curosry look I don't think it's needed. Not a firm belief though.
Where I live all the hospitals are shut down with the lights off and all my neighbors that were nurses got laid off moved away who's going to administer these if there's no one in the hospital
The question is what will be the rate of vaccinations rather than who begins first (though, the sooner the better really). Less risky groups won't be so eager to get vaccinated ASAP, so there will slower adoption after the initial wave of vaccinations. In a few months we ll be assessing what needs to be done to reach herd immunity levels.
This is not Pfizer’s Vaccine. It’s Biontechs vaccine. Biontech is a German company. Pfizer “helps” to distribute it. Trump was not fair to not mention that it’s a German vaccine and tried to claim this success as an American-only success.
My go-to resource for educated COVID-19 coverage has been This Week in Virology[1], which usually has between 4 and 6 virologists reporting and analyzing COVID-19-related news every week.
I've kind of OD'ed on COVID-19 news myself, so haven't listened to them for a while and don't know if they've commented on this vaccine yet, but they probably will, and for a thorough, educated, hype-free analysis, there's no better place I can think of to go to than TWiV.
Wikipedia [1] has an overview of mRNA vaccines, including a summary of some potential side-effects/risks. For more technical details, this review of mRNA vaccines [2] appears to be a decent place to start.
With regards to mRNA, mRNA is a fragile molecule that is quickly broken down inside the body after injection, so there's unlikely to be much long term risk with mRNA itself.
An immediate "but if it breaks down fast, how can it do anything?" thought springs to mind.
I know what you mean is "not dormant and doing something for months/years", but at the same time, if it can initiate a modification of immune response, it can do "other things".
I believe we must take the utmost of care at this juncture, and make sure assurances are not construed as in a poor light.
For me the most convincing argument regarding safety is that mRNA vaccines essentially do the same thing that the virus does, just extremely limited in scope (producing just one protein instead of a bunch of them, and not reinfecting more cells).
So, even if producing the proteins turns out to be somewhat harmful long term, it cannot possibly be as harmful as the whole virus.
Assuming that covid infection is inevtable without a vaccine, we really have a choice between getting a little bit of mRNA injected into our cells, and a ton of mRNA injected.
That's an interesting perspective. I've actually had the virus. I'm interested to see what the differential outcome of having the virus and having the vaccination is.
The extent to which a molecule is active in your body is only slightly correlated with toxicity. There is zero reason why a fragile molecule can't cause damage before it breaks down.
This is how ended up with thalidomide. They tested it in pregnant lab rats, but the window for birth defects is incredibly short in rats. So everything checked out.
In drug development you can't assume anything without data to back it up.
This particular vaccine is literally just a bit of RNA in a blob of fat. The fat sticks to cell membranes, and the RNA pokes through. There's nothing more to it (this is also why it's possible to scale up production so quickly)
I don't know much about this subject but i found https://www.nature.com/articles/nrd.2017.243 to be quite interesting. Its from 2018, before all the covid stuff hit, so i think it gives a much more detached overview. However it might not be precisely about the current crop of vaccines.
Isn't there usually at least a 1:100 or 1:1000 safety buffer between vaccination and control to make a vaccine safe? At least for other vaccines that's a common threshold.
The relative risk between potentially getting the disease even though the population is already highly herd immunized (compare e.g. measles) and the risk of the vaccine is still 1:1000. This means despite measles already being such a rare disease it is still a clear benefit to get vaccinated.
With a disease such as Covid it might be 100000x safer to get vaccinated than not.
All national vaccination programs must calculate and assess such relative risk and find so much advantage in favor of vaccination.
> It is a new type called an mRNA vaccine...An mRNA vaccine has never been approved for use in humans before, although people have received them in clinical trials.
Wait... This doesn't scare anybody?
Why has this not been approved before?
Would an mRNA vaccine be approved under less pressing circumstances...?
There is a first time for everything. mRNA is a developing technology, BioNTech was researching it for fighting cancer. When the Covid crisis struck, a lot of companies were focusing their efforts on a vaccine. In contrast to what many claim, vaccines are not making companies rich, so research in this field is rather slow. The pressing circumstances, as you phrased it, caused several companies in applying mRNA technology for the SARS-Cov-2 vaccination. Otherwise they might not have pushed in that direction quickly.
The requirements for approval are the same ones as for any other vaccine, they have to run through the same procedures and tests.
Not particularly, the UK has just concluded their approval of this vaccine and the EU and US are also reviewing it, so if there is something wrong they will most likely find it. There are enough different vaccines in development that there isn't much incentive to ignore faults if they show up.
>Why has this not been approved before?
I think it is new technology, which arrival has been accelerated by the enormous investments in vaccine technology over the past year.
>Would an mRNA vaccine be approved under less pressing circumstances...?
Can't really comment on this because I don't know much about it, but I would guess that they would have never reached the approval state without the pandemic and the huge need for parallel development of vaccines. I think that at all times there are a bunch of technological developments that are on the cusp of being ready for broad adoption that are just waiting for some boost in funding that propels them to maturity. Progress happens very quick when the whole world has a need for the development of something.
Not really. mRNA starts to degrade within minutes of injection, and lasts maybe at most a few days in your body. It cant turn back into DNA, so once its gone, it can no longer have any effect on you.
> Why has this not been approved before?
Its a relatively new technology that took a lot of work and money to make a stable, effective vaccine with. Its also relatively expensive to manufacture.
> Would an mRNA vaccine be approved under less pressing circumstances...?
Yes, though these almost certainly were approved faster than other vaccines would be because of the pressing nature of things.
So its effect on the immune system lasts even after it's gone. So if it were to cause any problems (in the immune system, for example), those could also persist after the mRNA is gone. So how exactly is this line of reasoning reassuring?
> So its effect on the immune system lasts even after it's gone.
The general principle is the same as for most vaccines: make the body generate its own antibodies (and/or T cells) for the virus in question. So in that sense of course its effect is long term, just like when you get sick with some virus and your body develops antibodies for it - the virus itself is gone, but the effect on the immune system is long-lasting.
From an FT article:
> Conventional vaccines administer an inactivated virus, or proteins from that virus, into the body to trigger an immune response, which can prevent subsequent infection.
> In contrast, mRNA technology — originally developed as a cancer therapy — injects genetic instructions into the body that tell cells to make viral proteins that prime the immune system. Although mRNA vaccines had been under development for several years for viruses including influenza, cytomegalovirus, HIV, rabies and Zika, the arrival of Covid-19 turbocharged the process.
Everything you're exposed to in your environment impacts the immune system. That's one of the mistakes anti-vax people make about childhood vaccination. They're like "Oh no, my baby can't handle six different vaccines in one shot, that must be too many at once surely" but actually it's a baby and babies eat dirt - its immune system is already seeing all sorts of new nonsense that isn't supposed to be there every day and problems are very rare, vaccination isn't any more of a problem.
So yes, but no. And it's reassuring compared to say DNA tweaking which would permanently change the instructions in some cell lines in your body, or more extremely germ line DNA tweaking which would alter your cells and those of any subsequent offspring you have.
> Not really. mRNA starts to degrade within minutes of injection, and lasts maybe at most a few days in your body.
According to the data I've seen on kinetics (these vaccines have been in development since 20 years ago, so there's plenty of basic and animal test data) there's production of the antigen at the site of injection for approximately ten days. There's some systemic production in the liver for 2-4 days, but that's it.
The mRNA can last this long (normally, as you correctly say, it would get broken up in minutes) due to the lipid nanoparticles it is bound to, which are the "secret sauce" of this vaccine.
I wouldn't focus too much on that--at least for yourself. You won't necessarily get an mRNA vaccine. The first two vaccines are mRNA based, but there are a bunch of others right behind it that aren't. The Oxford vaccine isn't and cheaper to produce. Since the Pfizer vaccine has all of the logistical issues with temperature storage (it not only has to be transported at -20 degrees F, it has to come to room temp before injecting) it will probably only get used at designated sites for people with higher priority. I heard someone say most non first-world countries likely won't bother with the Pfizer vaccine at all.
I believe Pfizer and Moderna are mRNA based vaccines. The Oxford and Russia's Sputnik V are adenovirus vector vaccine.
I guess something's gotta be first and in the absence of any prevailing pandemic there's not as much incentive to develop vaccines as opposed to say cancer treatments.
Seems like the mRNA technique is pretty new and simply hasn't been used for anything else before.
The approval processes are still the same, just without the years-long idle cycles that usually slow things down. The end result will be good as any other vaccine you might get.
This is an insane experiment on humanity. First, Big Pharma tried to sell us Remdesivir, an expensive drug that does not work and is potentially dangerous. Now, they're trying to sell us a rushed vaccine that has only been tested for a short time on a few tens of thousands people, and they have made deals so they're not liable for side-effects. All of this for a virus that has something like 0.05% mortality rate.
The mortality rate is much higher than that, in the US it's 1.9% based off the individuals identified. And that does not capture the significant amount of people with severe, long standing side effects. Many people have had months of decreased lung capacity and cardiovascular problems post covid recovery.
Beyond all that, these drugs are being rolled out to the most at risk group, those that have a mortality rate higher than any risk rate that was not captured by a smaller sample size of the test. Unless you're elderly or a medical worker, you won't have the option to take the vaccine until millions of other do. I'm getting pretty sick of you people whining about nonsense.
This isn't "fast" we just have low expectations of our government. The FDA in the US is taking 3 weeks to reviews, about 5-10% of the entire time to develop this is just to schedule this (3rd to last) meeting. All while over a thousand people die per day (so during this waiting period something like 10x the lives of 9/11).
We just spent 9 months trying to lift the ban on this vaccine. We have the technology to beat pandemics, we only lack the regulatory structure.
Vaccines are typically so safe and effective that for high risk populations taking a completely untested vaccine would be expected to (a) be effective and (b) safer than covid. So approving this was maybe the easiest call in medical history, and from first principles could have taken 1 day to approve for high risk groups.
We need a regulatory framework for fast approval anyway, if we ever want to have personalized medicine. With mRNA vaccines now in play, we can beat so many things if the regulatory environment lets us.
1) BioNTech/Pfizer haven't "just" tested for safety (I'm implying that's what you meant with your "trying to lift the ban" hyperbole), they have also used the clinical trials to single out one particular candidate out of at least four initial candidates for best expected efficacy. And they have used the trials to evaluate the best dosage. Medical trials are about much more than just the safety aspect.
2) It's easy to say "we could simply have broadly distributed this vaccine back in March" now in hindsight. However, in March, there were serious doubts about whether it would even work, considering the entire technology hadn't ever yielded a fully approved commercial vaccine.
3) I don't want to highlight this once more, but COVID-19 wouldn't be so deadly if the US hadn't fucked up its response in every possible way, and some that were thought to be impossible. A good part of those "over a thousand people dying per day" are self-inflicted and have nothing to do with any vaccine tests or vaccine approval timelines.
There have been many hundreds, possibly thousands of candidate vaccines in development through the year. It's not as if this one vaccine has been sitting by itself on a shelf with regulators umming and aahing about whether to try it or not. Hundreds of labs have been working on a myriad of different approaches, the vast majority of which have been cast aside. As of September there were still over 300 in development and right now there are almost 30 in clinical trials.
While vaccines that have made it through the regulatory process have for the most part been extremely safe, without that process we have no idea if the vaccine is going to cause more problems than it solves.
Some elderly friends have asked why Britain is opting to use a brand new RNA/nanotechnololgy style vaccine (which has never been approved before) and is only ~94% effective, when there is a traditional inactivated vaccine that is 100% effective? I presume Pfizer simply have better lobying, but given the choice, I would rather go with old-fashioned sinovac https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
No one was deliberately inoculated with the virus and only symptomatic people were tested. 99.96% of the placebo group did not have a severe case of covid. There is no way to determine effectiveness from this trial.
Pfizer submitted an emergency use authorization request to the US FDA on Nov. 20. Why was it not approved within a day or two? Is it merely a matter of reading the submitted paperwork and scheduling a committee meeting? There better be a damn good reason, because people are dying out here. I understand that trials take time, but we already have trial results now, so what's the hold up?
There's thousands and thousands of pages of trial data, and if there's a significant screw-up, it would destroy public trust in all vaccines for decades.
It's been almost two weeks. That's more than enough time to read thousands of pages if they are literally the most important thousands of pages in the world right now.
What makes you so confident? If someone gave you the source code to a major software project, even with a large team of highly qualified engineers working as fast as they could, how long would it take to read over the entire thing and be absolutely sure that there were no serious mistakes?
Well for starters, it would be stupid to pipeline the process so that nobody could start reviewing the code until after it was done. Secondly, I don't believe it's a valid analogy because the process of reviewing clinical trial evidence is not similar to the process of reviewing executable code. Thirdly, there is no amount of review that guarantees a lack of mistakes, so it's simply a question of risk tolerance which you have to balance against the harm of delay.
> Well for starters, it would be stupid to pipeline the process so that nobody could start reviewing the code until after it was done.
I imagine the expedited process also means summaries and overviews that would normally be presented were skipped--detailed documentation if we're continuing the source code metaphor.
If a team from the UK had already done it, I would just go ahead and accept their analysis. The US should give emergency approval now, based on the UK approval.
I’d prefer to see multiple agencies independently evaluating this.
Swiss cheese model. Each agency is going to have holes, and many previously unknown ones could be exposed given the unusual time and societal pressures they’re working under.
If the UK approves something and everyone goes “eh, good enough” that’s significantly riskier than if we wait the extra week or two and get consensus from the UK, EU, US, etc. The chances of large holes showing up in the processes of all of those agencies that align to miss something is much less.
We’re talking about things we’re going to be injecting into literally hundreds of millions of people very quickly. The risks of a fuckup here are pretty severe and it’s quite likely a severe mistake would cause more harm than delaying another week or two.
And if it turns out the UK approval process, like so much else of its bureaucracy because of years of austerity cuts, has been under-staffed, under-funded and simply bowed to political pressure?
I wouldn't be so quick to trust anything British right now. We're in a bit of a state.
The only reason we're not the laughing stock of the world right now is because the Americans managed to fuck up even more than us.
Pfizer only submitted the data package on Nov 20th, with a review on Dec 10th. That's 20 days to review what is likely hundreds of pages of data, if not thousands. It will be reviewed by hundreds of people, all with different expertise, who will need to talk to each other, dig into the data, re-run analyses, etc. You certainly don't want to just take the drug manufacturers word that everything checks out.
Plus, how the FDA approves it (including the speed) will create an impression on people's minds of how safe the vaccine is. Fast is good. "Too fast" is bad.
Pfizer had FDA Fast Track approval in July which means they could start reviewing it early as the trial progressed. In a sensible process all those hundreds of people should have reviewed and discussed nearly everything but the final numbers prior to Nov. 20 and been ready to plug in the numbers as soon as they came out.
1. Heavily impacted by Covid-19.
2. Centralised health care system makes it easier to compare results and efficiency. E.g. it's UK which figured out that dexamethasone is efficient against Covid https://www.who.int/news/item/16-06-2020-who-welcomes-prelim...
3. Developed country with great logistics.