A lot of discussion about this here. The bottom line seems to be that the scary headlines are running ahead of the available evidence, and we may as well wait to panic until some actual data has been released, which will be tomorrow; but even then, there are a tiny number of people involved in this study, so it will be hard to conclude anything definite.
South Africa is suspending vaccination using the AZ/Oxford vaccine.
South Africa suspends Oxford-AstraZeneca vaccine rollout after researchers report ‘minimal’ protection against coronavirus variant
By William Booth and Carolyn Y. Johnson
The general opinion seems to be that although the AZ vaccine has limited ability to stop people getting mild versions of the disease for the SA variant, it still should prevent severe cases, hospitalisations and death.
To be honest, had you offered even that limited functionality from vaccine in March last year the world would have bitten your hand off.
Work is already underway to tweak it anyway (as with the other jabs) a version of it that works with the new variant will be available later in the year.
Seems a certainty now that there is no way of eradicating this virus in the short to medium term if ever.
However if, as seems to be the case, we can vaccinate easily against the risk of severe cases and death then we have relegated this disease to something no worse than then yearly flu. That’s not a bad place to be.
Presumably, there will also be fewer variations if there are fewer cases. It doesn’t seem to be as inherently prone to drift as the flu. It’s just that the more infections, the more variations.
Do you have a link for this?
We will probably never be able to fully eradicate this virus because not only of its contagiousness but ability to transfer back and forth between human and non-primate mammal hosts. That being said, a comprehensive vaccination campaign could suppress it enough that along with disease surveillance it could be reduced the the point that test and trace efforts could keep it below the epidemic threshold. There are still some worrisome aspect about this virus including the wide degree of tissue tropism, some indications that it can infect T-lymphocytes and apparent chronic reinfections in a small number of people, and all of the other symptoms and interactions that are not well-understood about this virus, so protection from severe morbidity and mortality, while desirable from a medical services standpoint, is ultimately not enough. This is not just a seasonal flu or cold in terms of its effects as many of the “long haul” conditions demonstrate.
The mutation (antigenic drift) rate of SARS-CoV-2 is higher than initially estimated but still looks to be about a quarter of that of Influenza A, and so far there is no indication that it has undergone antigenic shift since it started infecting humans, but the ability to host in multiple domestic and farmed mammal species suggests that this is certainly possible and could result in the kind of periodic radical variability that causes InfA to exceed the epidemic threshold every fifteen years or so. Given just how infectious this virus is it certainly bears continued surveillance and genomic sequencing of all positive tests because like InfA it has the potential to evolve into a dramatically more virulent pathogen. Fortunately, the rapid vaccine development has shown that the ability exists to produce a targeted vaccine quickly, and the bigger challenges are actually ramping up production and all of the logistics with distributing and getting people inoculated, all of which are pretty conventional problems that can be solved with expertise and political will.
Stranger
So far, this “small scale study” has only been related by press release and there isn’t even a pre-print paper with summary data to evaluate, so it is difficult to say what the real efficacy, and since it was done with a population in their thirties who are statistically unlikely to get a severe presentation of COVID-19 the impact upon severe morbidity and mortality overall is not quantifiable. But thus far all other vaccines have demonstrated dramatic reductions in severe morbidity and mortality even though their measures of efficacy against more mild presentations are difficult to compare due to a lack of standard in testing (e.g. rtPCR testing of the entire population versus just symptomatic cases).
For South Africa to suspend the large scale vaccination campaign and only roll out a limited trial really doesn’t make much sense because even limited efficacy is still substantially better at none in terms of reducing the severe cases requiring hospitalization. We can fully expect that updated booster shots will be required for long term protection akin to seasonal influenza shots (which often have poorer efficacy at preventing symptomatic infection than what is being reported for even the least efficacious SARS-CoV-2 vaccines) so it really makes little sense to put off vaccination now in order to await a ‘better’ vaccine later. This is a literal example of “perfect being the enemy of good.”
There are certain vaccines, like that for dengue fever, where “mixing and matching” different vaccines can result in adverse effects but that is because of immune reactions to different serotypes of that virus (and can also occur through natural infection with different strains), but thus far there is no indication of adverse reactions due to infection with multiple variants of SARS-CoV-2, and because of how tightly targeted vaccines are on the S-protein it is probably unlikely that even a radical shift will result in some adverse cross-reactivity between vaccines, or a previous vaccine and a new variant. In short, if you have vaccines, there is no good reason not to vaccinate as many people as possible.
Stranger
This was what I understood from a BBC interview with one of the Scientists attached to the Oxford/AZ vaccine and was backed up as likely by other independent opinions. Nothing is certain though.
I took their suspension of the AZ vaccine to suggest that they may be wanting to switch to another vaccine that is more effective against the prevalent variant there.
Pfizer and Novavax have been reported to be effective against the SA variant. Pfizer apparently 60%. The number I’ve seen for AZ is 10%. So it would make sense to try to shift to a more effective vaccine rather than spending millions of dollars on one that you have reason to think is much less effective.
Novavax info:
10% figure:
Stranger
Yes, there’s a lack of information and clarity of information, but if the information you have suggests that what you are doing will have much lower efficacy than switching, it could make sense to switch.
I hope the public health decisions South Africa is making are data driven as much as possible, and that they are weighing all of the relevant factors. I presume part of why they need to halt the AZ is to shift funding to getting a different vaccine. If they are already on the hook and have plenty of AZ vaccine, and no way to recoup the cost, then sure, they should keep going. Likewise, if they have no prospects of getting a more effective vaccine in the near future, they should keep going with what they have, as the best they can do, in the hopes that it will at least mitigate severe illness incidence. But it doesn’t make much sense to me to just keep doing what they’re doing because the study was only small and preliminary.
Huge decisions need to be made on the basis of incomplete data. Like, back in March, decisions about requiring masks were made without clear data to back them up. The best officials can do is get as much info as they can and then try to err on the side of safety, taking as much as possible into account. So, I think it’d understandable why they would halt the AZ vaccine, if they needed to to pursue other options.
South Africa has already paid for and received 1 million doses of the AstraZeneca vaccine (sufficient for half a million innoculations) and does not currently have a supply of another vaccine to deploy. According to the following Washington Post article, they have an order to 20 million doses of the Pfizer vaccine (enough to immunize 10 million people) on order but with no delivery date.
In the study that has been reported (for which there is, again, not even a pre-print paper to review) there is no data on its effect on severe morbidity and mortality, and the study population is small enough and of an age range that would be poorly suited to assessing efficacy of protection against severe disease.
Given the information available, the only sensible reason to suspend the vaccination campaign would be a safety concern which does not seem to be present. This would appear to be one in a continuing series of mismanagements by the South African government in response to the pandemic; not that South Africa is alone in that regard.
There will hopefully be due consideration given to lessons learned after this pandemic is under control, for there were and continue to be certainly many mistakes made with only a few countries approaching anything like an effective response. If this were a really virulent pathogen like smallpox or a really aggressive Influenza A strain, we would be in serious trouble.
Stranger
Except, as I’m sure you know, there is absolutely zero reason to believe we’d have seen the same responses in that case. A saying comes to mind. Something about if my grandmother had…
Well, your experts are downgrading the alarm. Shocking.
The fact that something changed after an alarm was raised does not mean it was wrong to raise the alarm, and it does not equate to an expert being dismayed at the alarm being raised in the first place.
Also, that article does not really say what you are suggesting. The article makes clear that a hard lockdown has been in place for over a month, and the experts are still issuing warnings. Previous to the variant showing up, Denmark’s numbers were going down. They imposed a very strict lockdown at the end of December, and now the numbers have stopped decreasing but are staying steady. And the B.1.1.7 variant is still the minority – 27% – of cases.
They kept up the same restrictions that were happening when they made their “alarming” announcement. The only change they made was reopening early school grades. I think it’s fair to say the article I posted about an earlier version of this was on point.
I’ll also note that experts were probably dismayed more noticeably over the account I spoke of because it dealt with a research paper in preprint. I don’t think a Danish press conference gets the same scrutiny.
The strict lockdown was kept in place, and schools were closed, I believe.
This is from the original article I posted, and quoted, back in the exchange you quoted to restart this:
My bold.
Once again, best case scenarios of the models are beaten by reality.