POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)

‘It’s Like Buying Bruce Springsteen Tickets’

Dr. Fauci encouraged Americans not to compare shots’ efficacy numbers side-by-side because each shot was examined in three different trial settings.”…”Because of the difference in the trials, making direct comparisons is a bit like comparing apples and oranges.”

for links to POSTS 1-137 in chronological order, highlight and click on

“In an interview with “Meet the Press” Sunday, Dr. Anthony Fauci said all three coronavirus vaccines, including Moderna, Pfizer and now Johnson & Johnson, are “highly efficacious.”

“All three of them are really quite good, and people should take the one that’s most available to them,” Fauci said. “If you go to a place and you have J&J, and that’s the one that’s available now, I would take it. I personally would do the same thing. I think people need to get vaccinated as quickly and as expeditiously as possible.”…

Fauci encouraged Americans not to compare shots’ efficacy numbers side-by-side because each shot was examined in three different trial settings.

“[The vaccines] were not compared head-to-head. “They were compared under different circumstances,” Fauci said. “[The J&J shot is] not the weaker vaccine, they are all three really good vaccines.”” (A)

“Trial data can’t tell us everything about how effective vaccines are: we need to wait to see the real world impact

The delivery of Covid-19 vaccines continues apace in Britain and around the world, and soon we will have a lot of data on their initial effectiveness. Vaccines are vital tools that will help to rescue us from the pandemic, and most people accept them as part of everyday life. But many people have differing opinions about how they should best be used, and there is concern that vaccines won’t be as effective against new variants. Indeed, one study (which has not yet been peer reviewed) suggests that the Oxford/AstraZeneca vaccine provides only minimal protection against illness caused by the South African strain of Covid-19, meaning people may need a third jab later in the year to protect them from other variants. In any case, we need to understand what vaccines are, how we measure how well they work, and what they can and cannot do.

1. Vaccines and the diseases they prevent are all different…

2. Vaccines don’t guarantee complete protection…

3. You can’t compare the numbers from different trials…

4. You can’t compare the results of randomised trials with the results of ‘real-world’ studies…

5. Most (but not all) vaccines reduce transmission, to create ‘herd immunity’…

The bottom line here is that we need to see the bigger picture to understand how vaccines really work. Thinking about Covid-19 vaccines at the level of individuals, particular occupations, localities or even whole countries obscures how immunisation affects entire populations.

When your vaccine supplies are limited, accurately targeting the doses you have towards those most likely to get seriously sick doesn’t just benefit them, it benefits everyone. By bringing down the number of dangerously ill people as fast as possible, we can relieve the pressure on hospitals, which is a threat to us all. The efficacy percentages we are now reading about from the reported trials of the different vaccines are not by themselves good predictors of the impact these vaccines will have as they become more and more widely used. That will depend much more on how soon and how well they work in the real world, in the high-risk people receiving them, and on how quickly and comprehensively we deliver the doses we have.

But the most important question is how well the vaccines reduce transmission. If they can do that reasonably well, and we should be optimistic that they will, then getting people across the world immunised in sufficient numbers to achieve herd immunity really does become a pathway back to normality.” (B)

“For a number of reasons, it’s not possible to make a precise comparison between these vaccines. One vaccine may have a higher point estimate than another, but their confidence intervals may overlap. That effectively makes their results indistinguishable.

Making matters more complicated, the vaccines were tested on different groups of people at different stages in the pandemic. In addition, their efficacy was measured in different ways. Johnson & Johnson’s efficacy was measured 28 days after a single dose, for example, while Moderna’s was measured 14 days after a second dose.

What’s clear is that all three vaccines authorized in the United States — made by Johnson & Johnson, Moderna, and Pfizer and BioNTech — greatly reduce the risk of getting Covid-19.

What’s more, all the vaccines look as if they have a high efficacy against more serious outcomes like hospitalization and death. For example, no one who got Johnson & Johnson’s vaccine had to go to the hospital for a Covid-19 infection 28 days or more after getting an injection. Sixteen people who got the placebo did. That translates to 100 percent efficacy, with a confidence interval of 74.3 percent to 100 percent.

A clinical trial is just the start of the research on any vaccine. Once it goes into widespread use, researchers follow its performance. Instead of efficacy, these scientists now measure effectiveness: how much the vaccine reduces the risk of a disease out in the real world, in millions of people rather than thousands. Early studies on the effectiveness of coronavirus vaccines are confirming that they provide strong protection.

In the months to come, researchers will keep an eye on this data to see if they become less effective — either because the immunity from the vaccine wanes or because a new variant arises. In either case, new vaccines will be created, and manufacturers will provide new measures of their efficacy.” (C)    

“Some of these vaccines (like Johnson & Johnson’s) were tested in areas where more contagious variants have taken hold, such as South Africa, whereas Moderna’s and Pfizer’s vaccines were tested before the variants identified in the U.K. and South Africa struck and began spreading like wildfire.

The biggest takeaway is that while the vaccines differ in how well they prevent symptomatic disease, so far nobody who has taken any of these vaccines have died or been hospitalized due to COVID-19. Preventing severe disease is something all the shots do well, so even imperfect vaccines will prove invaluable in our quest to end the pandemic…

Which vaccine should you get?

Experts say it doesn’t really matter (and you likely won’t have a choice in most cases). Any vaccine you get should do a pretty great job at protecting you against severe illness, along with hospitalization and death.

From an individual standpoint, a slight dip in efficacy might not make a big difference, but from a population standpoint, it can translate to a lot more people who remain susceptible to getting sick and spreading it to others, Ogbuagu said.

All of these vaccines working together will help us achieve herd immunity. We really need 65% to 85% of the population to have protection against the virus, Ogbuagu said. And that end goal becomes a lot more realistic when we’ve got a mix of highly efficacious vaccines.” (D)

“The Pfizer and Moderna vaccines have shown astonishing — and essentially equivalent — degrees of efficacy, at least in the early stages after vaccination.

The Pfizer vaccine showed efficacy of 95% at preventing symptomatic Covid infection after two doses. The vaccine appeared to be more or less equally protective across age groups and racial and ethnic groups.

The Moderna vaccine was 94.1% effective at preventing symptomatic Covid-19 after the second dose. The vaccine’s efficacy appeared to be slightly lower in people 65 and older, but during a presentation to the Food and Drug Administration’s advisory committee in December, the company explained that the numbers could have been influenced by the fact there were few cases in that age group in the trial. The vaccine appeared to be equally effective across different ethnic and racial groups.

But comparing the efficacy of those vaccines to the efficacy of Johnson & Johnson’s is challenging because of differences in the designs of the Phase 3 clinical tests — essentially the trials were testing for different outcomes. Pfizer’s and Moderna’s trials both tested for any symptomatic Covid infection. Pfizer started counting cases from seven days after receipt of the second dose of vaccine, while Moderna waited until day 14 to start counting cases.

J&J, by contrast, sought to determine whether one dose of its vaccine protected against moderate to severe Covid illness — defined as a combination of a positive test and at least one symptom such as shortness of breath, beginning from 14 or 28 days after the single shot. (The company collected data for both.)

Because of the difference in the trials, making direct comparisons is a bit like comparing apples and oranges. Additionally, Pfizer and Moderna’s vaccines were tested before the emergence of troubling new variants in Britain, South Africa, and Brazil. It’s not entirely clear how well they will work against these mutated viruses.” (E)

“If you kind of do a comparison for influenza vaccines, which we do annually, influenza’s efficacy can range anywhere from 40% to 60% – and that’s a good year,” Monica Hendrickson, public health administrator for the Peoria County Health Department said Wednesday. “So again, something that’s high public health was, you know, we were hoping for something above 40%. To get to 95%, even 65%, that’s a homerun.”

Hendrickson noted that the vaccines each hold a high effectiveness against death and severe illness for coronavirus.

“So, really, you’re looking at a distinction that from a clinical standpoint, or from, you know, an epidemiological standpoint is very minor compared to what we really are hoping for, which is decreases in death and decreases in severe illness, where they all match up between the three vaccines,” Hendrickson said. “Most important thing though is that when these vaccines come on the market, if you have an option to any of these, get one of them.”

Hendrickson’s message echoes one made by Dr. Marina Del Rios, emergency medicine specialist at the University of Illinois-Chicago, during NBC 5’s “Vaccinated State” panel last week.

“Part of my messaging in the community has been that the vaccines on the market are equally efficacious and equally safe,” Del Rios said. “The best vaccine you can get is the one that you can get a hold of first, and getting vaccinated earlier, sooner rather than later, protects us from getting sick ourselves and also our community, which has been so terribly devastated by this virus.”

Dr. Arnold Monto of the University of Michigan, who chaired an FDA advisory panel that unanimously voted that the Johnson & Johnson vaccine’s benefits outweigh its risks, said the evidence shows no reason to favor one vaccine over another.

“What people I think are mostly interested in is, is it going to keep me from getting really sick?” Collins said. “Will it keep me from dying from this terrible disease? The good news is all of these say yes to that.”” (F)

A VERY INFORMATIVE SUMMARY CHART! Here’s how the top 3 coronavirus vaccines compare when it comes to efficacy, cost, and more..(G)

Even with inoculation rates accelerating and new vaccines entering the market, finding a shot remains out of reach for many, nearly three months into the country’s vaccination campaign. Websites crash. Appointments are scarce. Severe weather like last month’s winter storms can wreak havoc on shipments. Many Americans have been left feeling like they are on their own.

“There are people who feel desperate, and this is what they end up doing,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “It’s ridiculous. It’s wholly unnecessary. There should be a way to do this that does not require us going down this path.”

The leftover shots exist because the Moderna and Pfizer-BioNTech vaccines have a limited life span once they are thawed and mixed. When no-shows or miscalculations leave pharmacies and clinics with extras, they have mere hours to use the vaccines or risk having to throw them away.

And so, tens of thousands of people have banded together on social media groups under one mantra: Better in an arm than in the trash. They trade tips about which Walmarts have extra doses. They report on whether besieged pharmacies are even answering the phone. They speculate about whether a looming blizzard might keep enough people home to free up a slot.” (H)

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