(2021-02-05) ZviM Covid 02/04: Safe And Effective Vaccines Aplenty

Zvi Mowshowitz: Covid-19 2/4: Safe and Effective Vaccines Aplenty. The vaccine data is in. It’s pretty great. We now have six known safe and effective Covid-19 vaccines. The problem is that due to our unwillingness to properly fund the process of scaling up, we are stalling out at about 1.3 million doses per day for a population of 330+ million people each of whom needs two doses.

The other vaccine approvals are not in. It’s pretty terrible.

By all metrics, every day we are a percent or two safer than the day before, with politicians hard at work to bring the control systems back online. The problem is that in the medium term, the English strain is coming fast and our current pace of vaccinations isn’t going to make much impact.

It’s easy to mistake improvement for being at a good level, and we’re not at a good level

The average is up to 1.34 million doses per day versus 1.21 million doses per day last week, but the increase is in second doses many of which were held back in various places (despite instructions not to do this, I’m confident this was frequently ignored). Even worse, the averages have stalled out over the past few days.

It looks increasingly like the South African strain reduces, but does not eliminate, efficacy of vaccines and of previous infection

There were a lot of reinfections in the South African study

The obvious thing that Crotty is missing here, which I keep having to point out because everyone constantly ignores it, is that people do not get infected with Covid-19 at random. People get infected proportional to the amount of risk they take. The people who previously got Covid-19 both were previously taking more risk as a group, because that’s how they got infected, and also were likely taking even more risk now, because they had multiple reasons to think themselves relatively safe.

English Strain (B117)

More evidence that it’s more virulent, although the overall virulence on display here is not high

Even worse, it looks like it’s acquiring the mutation from the South African strain

There’s a big push by everyone, and I am no exception to this, to boil down the effectiveness of a vaccine to one number. It increasingly looks like it does not work that way. The vaccines are better thought of as being protective at each stage of the disease.

That means that you are personally very very protected from the worst outcomes and vaccinated people are going to be at minimal risk themselves, but their chance of being infected won’t improve as much. What about infecting others? That will be somewhere in the middle

This does update me against acting as if fully vaccinated people don’t pose risk to not-yet-vaccinated others, so precautions in those situations look more sane, as does the case for continuing mask wearing and social distancing in general until things are suppressed. If all parties involved are vaccinated, that’s another story.

Moderna is therefore asking the FDA permission to put more doses in the vials, which somehow they need to do, and also the answer wasn’t ‘yes of course do that I know technically you had to ask but this really, really isn’t a question.’ The contrast with Pfizer’s ‘I know you’re using that sixth dose so we don’t have to give you as much vaccine’ is rather stark.

The AstraZeneca Vaccine: At least Europe has approved the vaccine

Delaying the second dose appears to actively make the second dose more effective. Which is common for vaccines.

In the meantime, the single dose alone is 76% effective, presumably against symptomatic infection (WaPo) and was found to be 67% effective against further transmission

AstraZeneca has not applied for emergency use authorization, because it has been told not to do so. If told to apply, they would doubtless quickly apply. Or you could of course approve it without an application. The regulatory norms were made for man, not man for the regulatory norms.

The good news is that the factory is running despite our failure to act. We are sitting on tens of millions of doses of a proven safe and effective vaccine. They’re sitting around in Baltimore waiting for approval.

How long it takes us to approve this vaccine is a major test of the Joe Biden administration.

A test they have clearly already failed, and continue to fail. We must make it clear how unacceptable this is.

The Johnson & Johnson Vaccine

As always, every headline writer has a choice to make.

Option one is to point out that the Johnson & Johnson vaccine is inferior to the Pfizer and Moderna vaccines

Or, you could go with something like this Bloomberg headline instead: "J&J Single-Dose Vaccine is 100% effective at Preventing Deaths, Hospital Stays"

Not only no deaths but also no hospitalizations in the treatment group is pretty great

I’d pay a substantial amount to get Pfizer or Moderna instead of J&J if I could get either one today, but given the choice between waiting and taking what’s available, I will happily accept the J&J vaccine now rather than hold out for Pfizer or Moderna.

Unless Johnson & Johnson is committing outright fraud, the data shows the Johnson & Johnson vaccine is safe and effective, and every day that we do not approve it will cost lives for no reason whatsoever. How long it takes us to approve this vaccine is a major test of the Biden administration.

The Novavax Vaccine

Novavax was found to be 89.3% effective for preventing symptomatic Covid-19, which as we’ve learned presumably means less than that against asymptomatic Covid, but far more effective against hospitalization and death

Alas, there is a major problem, which is that the study wasn’t conducted in the United States.

Therefore, they are ‘in talks’ with the FDA about asking for emergency use authorization, but it has yet to announce that it will even seek approval before its ‘Prevent-19’ American study is complete

last year the FDA graciously said that outside data could be submitted, but you need to talk to the FDA first on a case by case basis.

The lack of reciprocity in approvals between the US and UK/EU or other first world nations is senseless and costs lives and money and stifles innovation, but at least I understand it. You don’t want to trust your regulatory decisions to another country. Easy thing to get. But it’s worth periodically pointing out that this thing where we don’t have data reciprocity is completely insane.

Then, of course, we mandate where the vaccines are made. Even more vaccine nationalism.

Unless Novavax is committing outright fraud, the data shows the Novavax vaccine is safe and effective, and every day that we do not approve it will cost lives for no reason whatsoever. How long it takes us to approve this vaccine is a major test of the Biden administration.

When we see an article called “Biden’s Latest Move Just Handed The Vaccine Market To These Two Companies” it should be about how they won’t approve anyone else’s vaccine, not about how Biden wisely is buying enough doses from those two companies alone to vaccinate everyone if necessary. We should do that several times over to be safe.

The Russian Vaccine

Beep. Beep. Sputnik works too. Data source here.

Don’t get me wrong. There are some details that are indeed rather suspicious, and some process decisions that are highly suspicious.

The Amazing Race

Vaccine Allocation By Politics And Power

When you allocate by politics and power, you also allocate technological contracts and logistics the same way. Some places were so foolish they decided to use the CDC’s software to schedule appointments, that it paid $44 million to create. That turned out about as great as you’d expect.

This is all business as usual. I’m not exactly surprised or outraged, but I want to make it clear that this is business as usual so maybe don’t give these people our business:

They let counties set their own additional requirements, on top of anything from the states.

There’s also the issue that counties in New York aren’t allowed to vaccinate seniors or anyone not on their particular priority list, even if those people are eligible. That’s a different department.

Covid Tracking Project Calls It Quits

At core, they say this is a government job, and now that the government will actually do it, they can stop. I wish I shared their confidence.

Your Periodic Reminders (You Should Know This Already)

(excellent section)

Physicists tried to model everything that happened on campus, the distances between students, and dangers of each activity. They made an insanely complicated model, which they thought had room for error. The problem is that once your model tries to model something, if you miss any components or mess up any components, now you get the wrong answer. One ludicrously wrong input – in this case assuming everyone would follow the rules, despite everyone being college students – and your results are meaningless. That’s why I try to stick to much simpler models that allow us to take into account the factors that we can’t model directly, by using inputs that incorporate those factors. It’s the only way. Even if they hadn’t made this particular dumb mistake, they doubtless had lots of other mistakes, and lots of other places where they had to guess because we banned experiments and don’t know the answer.

Those taking mass transit need to wear masks. The CDC has now caught on and announced a mandate, and only about a year late and after the President signed an explicit executive order.

We Can Still Agree: Andrew Cuomo Is The Worst

Cuomo is reopening indoor dining, despite conditions being worse than when he banned indoor dining, and there being a higher payoff to staying safe now than before due to vaccination progress, and despite the new variant coming soon that’s easier to transmit. To justify this, he’s distorting data in a way that would shock even psychiatric researchers.

In Other News

Far right anti-vaccine protesters blocked access to the mass vaccination site at Dodger Stadium, forcing it to shut down for a day. Somehow we did not simply physically remove them.

Curative is providing massive amounts of testing, and wants to test asymptomatic people because it’s called testing. The FDA is pushing back and warning against this, because there is a ‘risk of false negatives’ which is concentrated on weeks-old infections... The good news is, as the article notes, lots of asymptomatic people are getting these tests anyway, despite the FDA’s best efforts to get us all killed.