covid-19

[RandBlade]

I spent a lot of time and effort trying—in vain—to find any data on these models you say exist. If you have access to reports modeling the different alternatives, feel free to share.

You should, at the very least, require them to make public their data, models, assumptions and reasoning, so that it can be subjected to scientific scrutiny.

Its online. With explanations, reasoning and tons of references and citations.
https://assets.publishing.service.go...ter_14a_v6.pdf

I believe you should use each vial to vaccinate 100 people. This is, after all, an emergency.

Have you got a method of making that work? Following the JCVI advice is possible, 100 doses per vial is not.

However comparably getting 6 doses per vial, when Pfizer only said 5, was possible. So it was done. Same logic. Should the 6th doses be thrown in the bin since it wasn't part of Pfizer's original plan?

And 6. It's not just a question of short-term safety for individuals but also a question of medium-to-long-term safety of the strategy from an epidemic control perspective. Depending on parameters such as the ones I have mentioned in earlier posts, the strategy you're currently using can result in a higher or lower overall attack-rate. That's why the decision should be based on thorough modeling and detailed analyses that can be subjected to scientific scrutiny by external experts.

Which is what has been done and the data is online - and more reports going online regularly. The JCVI are external experts like the Professor quoted above and their research is put online so anyone in the world can scrutinise it further every couple of weeks.

Except that that is a silly way to look at it. The challenges of producing and handling 5 million doses are different from doing the same with 50 million doses.

Only by scale. If you've invested to scale it isn't. Have you invested to scale?

We're talking about a deficit of nearly 50 million doses for the EU order, so I suspect this note about a bad batch at the Welsh facility is not even a little relevant.

And there was a 30 million deficit for the UK's order too. Very similar. Its the sort of problem that all companies have faced - in the UK and USA before the EU. We got ours three months later than planned, which wasn't an issue since we'd ordered three months earlier and the vaccine wasn't authorised when originally planned (September).

You only put your order in just before ours was originally planned to be completed.

It's not even a little relevant for the present discussion. If you believe otherwise, feel free to construct an argument showing how it is relevant.

I have done, read it again.

If your data appears to show a relationship that is nonsensical, that should prompt you to be more cautious in your interpretation. There are many spurious correlations. What I want to know is, why have the US and the UK chosen to spend so much per capita on vaccine-related matters when it is absolutely clear that greater spending is leading to more deaths per capita? It's unconscionable. They should be spending that extra money on bringing back old-school piracy, as we have compelling data showing that pirates can prevent global warming.

There is no evidence to support the notion that the delay in authorization was caused by an expected delay in shipments; if anything, the converse is more likely to be true—an expected delay in authorization may have caused AZN in particular to prioritize other orders, while hoping to be able to "catch up" once the authorization was given.

Except that's bullshit. The orders are coming from different plants. As part of the authorisation the plants producing the vaccine are part of the actual submission to get authorisation and the EU submission and the UK one are different plants. Its not like its all coming from the same plant but has been sent to the UK instead of the EU as some sort of twisted conspiracy - the EU plants were approved months later when the contracts were signed months later and have hit similar problems to what the plants started earlier for the UK faced and already had to overcome too.

Yes, your demands are lower in absolute terms than the EU's, which makes them far more manageable. For example, AZN expected to be able to give you 4 million doses using excess capacity at their continental facilities; it's much easier to make up for a shortfall that is small in absolute terms than to make up for a shortfall that is 10 times as large in absolute terms. If I need £5 I can probably get 5 people to give me £1 each. If I need £50, it will be considerably more difficult for me to get 5 people to give me £10 each—I might have to ask 50 people, which presents a greater and completely different challenge than asking 5 people, esp. if I'm working under time constraints.

Except that's not the case. The UK's plants, which were approved three months before the EU ones, faced a slow start but are now operating as planned. The EU plants, with a needless three month delay caused by the EU not signing contracts until three months later, are not doing so.

The UK isn't "asking for" excess supply from the EU. There is no "excess EU supply" if there was this wouldn't be an issue. The UK is getting supply as the plants its paid for, months sooner, are actually working. The plants the EU dragged their heels on during a pandemic are not.

6 P's in operation: Piss Poor Preparation leads to Piss Poor Performance.

You seem to have difficulties keeping track of what you're discussing. If you're wondering about supply, many countries are using their supply very slowly, opting to prioritize people in eg. care homes. The distribution of doses to each member state is a matter between that member state and the company in question, and the distribution within each member state is, of course, a national or regional matter for each state and/or region. Unfortunately, we have no good way to track percentage of distributed doses that have been administered. If you're wondering about administered doses, which is what the chart you tweeted actually shows, that reflects national issues, and most nations have not been constrained by supply; their rollouts have been slow for a variety of reasons, eg. because they're focusing on fully vaccinating care home residents rather than racing to partially vaccinate the entire population, or due to administrative and IT issues. All of these member-state-specific issues are for member states to address—with policies and with spending as required and as they see fit; those things will not be accounted for in any comparison that only looks at the EU's institutional expenditures. I understand that your severe simplism requires black-and-white answers devoid of nuance, but reality won't oblige.

They're using supply slowly because they're capped in supply. No member state has been capable of matching the UK's progress, or anything close to it, because no member state has the UK's supply.

You're losing track of your own arguments. How do you expect the EU or Pfizer to stockpile something that doesn't exist? If the stock doesn't exist, the stock doesn't exist; it's a complicated procedure to generate it and all companies are struggling with that. The UK's acceleration so far is easily explained by its decision to prioritize broad coverage over fully vaccinating people, and by its earlier deployment of the AZN vaccine.

No. The Pfizer stock did begin when the UK used it, it existed. If the EU had paid for the same proportion of doses as the UK had - at the same delivery schedule as the UK had - then the weeks the UK was using the Pfizer stock and the EU wasn't then the EU's stockpile would have been building. It wasn't because the EU was tardy at ordering the Pfizer one too.

This is a dubious argument. It's not simply that they expect a "stronger" response—it's that they hope, with some justification, for a response that is qualitatively better, eg. wrt affinity to the targeted protein. However, it fails to take into account risk of exposure & illness during the interval between doses, which is 1. higher in eg. the UK and Israel now than when the phase 3 trials were conducted, and 2. changing over time. The reasoning they're using wrt this specific question is appropriate when discussing pre-pandemic vaccination or vaccination for illnesses that are unlikely to result in a pandemic of this kind—situations when risk of infection between doses is virtually zero.

I'm glad you acknowledge its with some justification.

Absolutely there is a risk of exposure between the interval doses, nobody denies that. However the risk of exposure to the unvaccinated are greater too. So all the more reason to ensure all the vulnerable are protected as fast as possible. It is a sprint to save lives.

The risk of exposure is real for both the vaccinated and unvaccinated so its not a question as to whether to give someone two vaccines with no opportunity cost, if it was then give the 2 vaccines. The question is whether to give the 2 vaccines to the same people or different people and since the majority of protection comes from dose 1 then giving the majority of protection to double the people > giving full protection to half the people.

Priority groups can be changed as needed; it is a matter of public health policy, not a strict scientific matter. The utility of partially vaccinating at-risk groups is something that should be argued on the basis of data and modeling subjected to outside scrutiny, not simply through an unsystematic discussion of principles.

Which it is.

How would you change the priority groups if you were not to take the JCVI's advice to get all done by middle of February for the first dose, then start doing the second doses for all of them within 12 weeks of the first?

For ease of reference the priority groups are

1: Residents in a care home for older adults and their carers.
2a: All those over 80
2b: All frontline health and social care workers
3: All those over 75
4a: All those over 70
4b: The clinically extremely vulnerable individuals.

All of them are categorised as clinically extremely vulnerable, the latter category means specifically though eg younger adults suffering from cancer undergoing chemeotherapy etc.

If you're going to reject the JCVI advice, sacrifice half of those in order to give the booster shot to half of them rather than one shot to all of them, then which half would you choose to sacrifice and why?