COVID Vaccine !

[SpokeyDokey]

Feeling great this morning and again not even a sore arm.

Probably because I am well 'ard although not as well 'ard as @Drago of course.

Seriously though, I wonder if my immune system is a tad lazy. Is that possible?

 

[Milkfloat]

Prevalence in Bolton is twice that of the second worst!
You can see the marginal benefit (see SPI-M-O precis in my post above) of using doses in specific areas of high prevalence (with a more transmissible variant) as first doses for all adults accepting the opportunity cost of slightly slower (by a few days) second doses in areas (regions even) of the UK where prevalence is very low. There's clear merit in turning round vaccine hesitancy in those areas/communities too and getting first jab uptake into the high 90s. Look at the number in Bolton hospital who had been offered a vaccine and refused it (some may have for medical reasons, of course).

Send the relevant hubs some diverted supplies (at the expense of other regions whose second doses can stay at 11-12 weeks and who can pause the first jabs for 37+ year olds) and allow the local vaccine programme managers some freedom to achieve clear objectives (see below).
Surge vaccination (high prevalence areas) priorities:
1) First jabs for the previously vaccine hesitant (with the almost explicit threat of a local reversion to greater restrictions as the 'stick')
2) Second jabs for all those over 55 (will be an 8 week gap at least) - note the enhancement of a second jab at 8 weeks is less than one after a gap at 12 weeks (but the next 4 weeks matter in high prevalence areas)
3) First jabs for anyone over 18
Vaccinating the third category is not in line with the direct saving of lives/from serious illness (the JCVI mantra) but, 14 days down the line, all adults will have first jab level of protection; thus the susceptible population will have shrunk and community spread of this highly transmissible virus variant will be curtailed. Indirectly this will save lives and importantly keep cases UK-wide lower than they would be if we (just) plough on down the ages. This is a better outcome for the UK population as a whole and for the vast majority in particular. This hopefully temporary diversion of effort is, I acknowledge, not without operational challenge.

I wonder if there is a SAGE/SPI-M-O versus JCVI battle going on? Politicians will be the arbiters, thank goodness: we've seen how these scientists love to argue (arguing is a good thing btw, though not so much when the enemy is firing at you).

With this methodology surely you are just risking chasing the variant around the country? By the time you have diverted supplies, ramped up delivery into arms and then waited for the vaccine to work then you are too late. The peak in cases will be well over and moved on elsewhere, perhaps the areas that supplies got diverted from. I agree with getting first and second jabs in arms for high risk people, but not by diverting resources from elsewhere.

 

[Ajax Bay]

I appreciate that's the argument against @Milkfloat , but the diversion of supply would be delaying second jabs, where the potential recipients have reasonable (?70%) protection already and the risk of infection is very low because prevalence is low in that area/region.
I don't think giving first doses in very high prevalence towns will, taking a one month view, be too late. Sure the jabs will take 14 days (ish) to give a decent level of protection, but then you'd almost get local 'flock' immunity to strangle community transmission.
"The peak in cases will be well over and moved on elsewhere" you suggest. I do hope the peak is soon 'well over'. If it moves "elsewhere" that elsewhere is likely not Scotland, Wales or SW England (for example).
It would be good to see modelling (@midlife to inform the O and D your OODA loop) which aims to show the range of outcomes with different temporary vaccination strategies. Up till now the emphasis has been on directly saving lives, and JCVI explained their rationale in their 30 Dec directive. But the current risk is not serious disease and in extremis death because all over 43s (less the vaccine hesitant) have good protection, and the lower age groups have a very low IFR. The risk to the community is ramped up prevalence which will then result in leakage and infection of the 10% (say) of the fully vaccinated over 65s whom the vaccine doesn't protect.
Any surge vaccination effort is subordinate to surge testing, effective tracing, intrinsically motivated isolation (after first symptom or a positive test) and community 'enforced' limitations on movement in and out of the community.
As an example (and an aside, and verging off topic) I fear that there'll be fans from Bolton going down to Old Trafford. Out in the open air is low risk, but there'll be public transport used and beers drunk, indoors before and after.

 

[roubaixtuesday]

I appreciate that's the argument against @Milkfloat , but the diversion of supply is delaying second jabs, where the potential recipients have reasonable (?70%) protection already and the risk of infection is very low because prevalence is low in that area/region.
I don't think giving first doses in very high prevalence towns will, taking a one month view, be too late. Sure the jabs will take 14 days (ish) to give a decent level of protection, but then you'd almost get local 'flock' immunity to strangle community transmission.
"The peak in cases will be well over and moved on elsewhere" you suggest. I do hope the peak is soon 'well over'. If it moves "elsewhere" that elsewhere is likely not Scotland, Wales or SW England (for example).
It would be good to see modelling which aims to show the range of outcomes with different temporary vaccination strategies. Up till now the emphasis has been on directly saving lives, and JCVI explained their rationale in ther 30 Dec directive. But the current risk is not serious disease and in extremis death because all over 43s (less the vaccine hesitant) have good protection, and the lower age groups have a very low IFR. The risk to the community is ramped up prevalence which will then result in leakage and infection of the 10% (say) of the fully vaccinated over 65s whom the vaccine doesn't protect.
Any surge vaccination effort is subordinate to surge testing, effective tracing, intrinsically motivated isolation (after first symptom or a positive test) and community 'enforced' limitations on movement in and out of the community.
As an example (and an aside, and verging off topic) I fear that there'll be fans from Bolton going down to Old Trafford. Out in the open air is low risk, but there'll be public transport used and beers drunk, indoors before and after.

If you look at the PHE data above (assuming I've interpreted it right)

https://www.cyclechat.net/threads/covid-vaccine.267960/page-255#post-6411422

Then very roughly across the vaccines 1st dose protects against infection by ~60% *and* if infected, against onward transmission by a further ~50%

That means a single dose reduces transmission by 80%!

A second dose, even if 100% effective, can only add a max further 20%

So we get 4x more transmission benefit by prioritising first doses. Given a spike in infections is the worry, it seems unanswerable to me that we should be prioritising first doses now. Delay 2nd doses more if necessary. Obviously this is the opposite of what is happening, so I've probably missed something obvious!

 

[Ajax Bay]

I suspect that in the areas of outbreak, there are lots of 'clinical discussions and appraisals' going on and local medical professionals are taking a pragmatic approach (eg underlying conditions, one of the carers of an over 70?). It was noticable (to me) in this morning's radio interviews that probing questions on 'are you giving under 35s a first jab, then', were stylishly answered with a forward defensive square bat. I hope people, within the supplies of vaccine available, are taking a nuanced 'French' approach to de rulz as opposed to a Germanic stance.

 

[Ajax Bay]

A useful plot of daily vaccine delivery (peaks are Wed/Thu, troughs are w/es (big one Easter)):

Data from: https://coronavirus.data.gov.uk/details/vaccinations
We can see the increased proportion of daily doses given as second ones, from about 1 Apr onwards.
The 11 week gap between doses is the distance from the end of the green region to the right edge of the data on the plot.
If weekly dose rates remain the same, we return to giving mostly first doses in about 5 weeks ~ about 21 Jun.

 

[dodgy]

Booked in for 2nd jab next Wednesday, 10 weeks and 1 day after the first.

 

[Ajax Bay]

Mongolia coming up on the rails for the 'win'!

 

[classic33]

Why when the gap between injections in the UK, is 9 - 12 weeks, has America decided that 28 days is the better option. Should the Oxford/AstraZeneca vaccine be licensed for use in amerw.

 

[vickster]

Why when the gap between injections in the UK, is 9 - 12 weeks, has America decided that 28 days is the better option. Should the Oxford/AstraZeneca vaccine be licensed for use in amerw.

What does the FDA licence stipulate?

 

[classic33]

What does the FDA licence stipulate?

Not approved for use yet. If it is approved, they'll be using 28 days between injections.
Less than half the approved time over here, between jabs.

 

[vickster]

Not approved for use yet. If it is approved, they'll be using 28 days between injections.
Less than half the approved time over here, between jabs.

I don’t follow...you said jabs are being given 28 days apart?

 

[classic33]

I don’t follow...you said jabs are being given 28 days apart?

Should it be approved for use, the jabs will be given 28 days apart.
Contrast that with the 12 weeks here.

 

[vickster]

Different vaccination strategy ?
Lots of countries are spacing differently

 

[Ajax Bay]

Why when the gap between injections in the UK, is 9 - 12 weeks, has America decided that 28 days is the better option should the Oxford/AstraZeneca vaccine be licensed for use in [the USA].

The RCT trial of the Oxford-AZ vaccine used a 4 week gap so there was no trial evidence that a longer gap would offer good protection.
Lancet article: Single-dose Oxford–AstraZeneca COVID-19 vaccine followed by a 12-week booster
"to achieve the greatest health benefit rapidly, the UK Government decided on a policy of administering as many first doses as possible and delaying the second dose of the ChAdOx1 nCoV-19 vaccine until 12 weeks after the first dose. Although this policy was criticised, the latest results reported by Voysey and colleagues provide a necessary evidence-based justification for the decision.1"
The USA FDA prefer to stick to the 4 week gap. They have vaccinated the vulnerable half of USA's population so the benefit of a delayed second dose to give as many people as possible a first jab doesn't apply. Their call. But somewhere I've seen science/evidence suggesting the protection enhancement from the second dose is greater with the longer gap. Many other countries have moved to an extended gap (ie >4 weeks).
Also this (early Jan):
"Andrew Pollard, the head of the Oxford Vaccine Group and chief investigator into the trial of [the Oxford-AZ] vaccine, said that extending the gap between vaccines made biological sense. “Generally, a longer gap between vaccine doses leads to a better immune response, with the second dose causing a better boost. (With HPV vaccine for girls, for example, the gap is a year and gives better responses than a one month gap.) From the Oxford vaccine trials, there is 70% protection after the first dose up to the second dose, and the immune response was about three times greater after the second dose when the second dose was delayed, comparing second dose after four weeks versus second dose after 2-3 months,"