Absolute risk reduction of ~0.75% (over the time period of the study, which is difficult to tell).
Number-needed-to-Treat (NNT): 134 vaccinations to prevent 1 symptomatic case over the study duration.
Keep in mind, this is over some time period. Annualized, these numbers would almost certainly increase. We don’t know how many days/weeks/months it took to reach 162 / 8 cases respectively (something between ~5-6 months and ~5 days)
How much longer? There is significant benefit to rolling out massive amounts of vaccine immediately. I know that any scientist worth their salt will almost always claim that more study is warranted. But we're playing against a clock measured in human lives right now
And if this vaccine doesn't work or has nasty side effects, or even ends up killing people, most people will be very reluctant to take it, or any of the next better vaccines, and that would cause even more deaths.
It's a hard problem, and even though the clock is ticking, we also need to get it right the first time.
Sure, but the sample of confirmed positives is so small that it might not include some important subgroups. If only 1 at risk person in the placebo tested positive, and 0 in the vaccinated group did we haven't learned much.
The relevant piece for most people to know is that based on data from a short time period, people were 20x less likely to get symptomatic COVID if they get the vaccine. The exact number will probably change a bit as more time goes by and more data comes in, but 20x is the ballpark.
Things we still don't know:
- Does the vaccine also stop you from contracting the virus asymptomatically and spreading it? People enrolled in the trial were only told to get tested if they showed symptoms.
- How long does the immunity from the vaccine last? We won't know this for some time.
I presume how long immunity lasts is based on how well and quickly the virus can mutate itself? Do we have any research on other Coronaviruses that might hint at how long immunity will last?
A new study of 185 COVID patients found that 90% of the subjects were still seropositive for neutralizing antibodies at the 6 to 8 month time points. B-cells specific to the Spike and to the nucleocapsid coronavirus proteins actually increased over a five-month period. Memory T cells appeared to have half-lives of at least five or six months in these patients, and helper T cells were completely stable over the entire period studied.
The study enrolled more, but slowly increased the number of vaccinated since the start (which was initially, I'd expect, 0) -- the second dose was still not received by all enrolled as of November 13:
"The Phase 3 clinical trial of BNT162b2 began on July 27 and has enrolled 43,661 participants to date, 41,135 of whom have received a second dose of the vaccine candidate as of November 13, 2020."
So there is no single date one can reasonably use 41,135 or ~20,567 for the efficacy calculations. As the observations continue (expected up to 2 years) there could be much more useful data there.
I also guess the people who haven't received both doses but got sick before are separately counted.
The only useful numbers at the moment we have are 8 and 162 (and 1 and 9 for the severe cases). And that we can assume that from all thousands vaccinated these 170 in total got sick by chance, and that the thousands were carefully enough selected to represent bigger population, and using that we can expect that the efficacy won't too dramatically change as more data come in, the same way as the polls can use smaller samples to conclude something about bigger population, if the sampling is careful enough. But some changes are expected.
It appears it's still too early to know if those who are vaccinated could protect those who aren't, or if the vaccine protects only those who received it (1) -- but anyway we know that still not all of those who will be vaccinated will be protected from having a severe case: there was up to now one severe case in the vaccinated group, versus 9 severe cases in the placebo group, 11%.
"In an ideal world, a vaccine would prevent infection entirely and, it follows, also prevent disease and severe disease. But this may be hard to achieve for a respiratory virus vaccine. Animal challenge data suggest that vaccinated animals may still be infected even if they don't experience symptoms. A vaccine that is able to reduce the severity of disease, even if it cannot prevent infection entirely, would obviously still have enormous public health value. Therefore, this is what trials target as their primary aim."
Is NNT a good number to use when evaluating effectiveness of vaccines during a pandemic? It'll change substantially over time as the virus waxes and wanes and from location to location. So it won't be comparable across different vaccines. Moreover, the fact that cases create more cases means that preventing 1 case could prevent other future ones.
I would agree, it probably not a good metric. Just providing some standard numbers for treatments.
Keep in mind the definition of a case here is having symptoms, so we don’t know if the vaccine prevents lightly symptomatic or asymptomatic cases, which may or may not result in transmission.
I've seen this NNT argument a few places now, and no it doesn't make any sense because most of us will be living in a society for years and years to come so if we resume normal life at some point and it's out there we all will be exposed at some point.
Its current prevalence is irrelevant because if we live how we want to live it will be everywhere (assuming no vaccine).
Key words here are "over the study duration" and "over the time period of the study". The study started in late July, so it's been about 4 months. The data that they examine probably lags a bit too and in the intervening period, cases have gone up significantly.
Over the course of a longer period of time and with cases on the rise as they are now, I'd expect the risk reduction to be much higher.
Edit: Also, these numbers are somewhat skewed by the fact that not all 40k people got the vaccine/placebo at once, but over a period of time.
Is it cases or symptomatic cases? I presume they were testing their sample regularly. Preventing symptoms would be a great outcome anyway, but it’s not the same as preventing cases.
Actually, they are not. They only advise participants to get tested if they show symptoms. So it's possible that a bunch of people on the vaccine are getting asymptomatic cases.
My wife is in a different vaccine trial. For her they do a test monthly. They also do a blood draw where I would guess they are checking for antibodies, but I don't know. In addition, she reports in every single day with an app for symptom reporting.
umm this seems non-ideal. I assume people want to be vaccinated against the damages covid causes, neurological, cardiovascular, etc, not just against the symptoms of covid.
b) It's likely that it is protecting against those. But hard to specifically prove that it's protecting against each and every symptom. I think the hope is that if you don't develop lung issues, you are unlikely to develop long term damage.
I was just responding to the GP regarding when candidates are tested. Sure they're symptoms. That'd be relevant if they were following the non-placebo group to test for long-term organ damages or other "symptoms" too. The easier way would be to consistently test all candidates for asymptomatic covid which isn't the case here.
Maybe I'm misunderstanding the data here. It seems like we've only directly proven that the vaccine has been effective at reducing the normal symptoms (coughs, fevers) to the point where candidates don't seem to be prompted enough to go get tested anymore. It doesn't directly prove those candidates didn't get covid.
I don't know how you expect these companies to prove their vaccine protects against asymptomatic long-term damage when nobody can prove asymptomatic long-term damage exists in the first place. It's like asking a home security company to prove their system keeps leprechauns out of the house.
COVID is symptomatic, it's a disease. This vaccine is not preventing getting infected, just reduces getting.the disease significantly. I'm more optimistic about Moderna, as this vaccine doesn't prevent me from infecting my parents.
Still, I'll use this vaccine if I can't get Moderna in time. The safety profile looks great.
> This vaccine is not preventing getting infected, just reduces getting.the disease significantly. I'm more optimistic about Moderna, as this vaccine doesn't prevent me from infecting my parents.
What does that mean? Don't both vaccines work exactly the same? Both are mRNA vaccines.
Not really sure why this is downvoted. SARS-CoV-2 is the virus, COVID-19 is the combination of virus and symptoms.
I can't say anything about these vaccines, but there is such a thing as a non-sterilizing immunity, that would prevent you from developing COVID-19 but still be infected and able to spread SARS-CoV-2.
I guess you're saying - that's a lot of vaccines needed to prevent a very small number of cases - right?
But presumably incidence is low because of safety restrictions (lockdowns, masks etc.) which are untenable long-term. Whereas if we can vaccinate O(everyone), we can, maybe, stop the restrictions?
They are going to charge the US ~$40. So $800,000 to prevent 150 cases. That's incredibly cheap, and doesn't factor in an increase of social activities.
if it's targeted at the elderly/at risk (at first?), the reduction in hospitalisation should be higher; and I'd think that would pay back pretty quickly.
In short, we still don't know which measures would have to be kept even when a lot of people are vaccinated. It will be much better known in some time, but it's still not known at this moment. It depends on sterile immunizing properties of the vaccine, which are still unknown.
Edit: re the Moderna protocol mentioned in
sanxiyn's comment below: even if they will measure sterilizing immunity (as one of their "Secondary" objectives), as far as I know, they still haven't published something on that topic (1) From them we still have only data on the level comparable to those from Pfizer/BioNTech:
90 cases in placebo, 5 in vaccinated, 11 severe cases, all in placebo group. Where "cases" could simply be defined "those who were recognized of having Covid-19" (as the illness). (Also see my other comment here for more general references about the primary objectives of all Phase 3 trials).
Here's what Moderna only writes about their secondary objectives in the only release: "Key secondary endpoints include prevention of severe COVID-19 disease and prevention of infection by SARS-CoV-2. The trial will continue to accrue additional data relevant to safety and efficacy even after an EUA is submitted." Meaning, eventually, we should be able to know more.
I didn't know that Pfizer doesn't even have that kind analysis written in their protocol, thanks. I'd hope they can add that in some later phase.
Why should we care about the absolute risk reduction rather than the 20x relative risk reduction (i.e. "95% effectivity")? The idea of these fixed-term RCTs is that the numbers generalize to larger periods of time, right?
What the poster means is that going from 0.79% to 0.04% means that 0.75% were prevented from getting it due to the vaccine. You go from 79 per 10000 to 4 per 10000, meaning you saved 75 per 10000.
But preventing 0.75% of the population from getting it out of the 0.79% who got it implies 94.9% (0.0075/0.0079) of those who _would_ have gotten it were prevented from getting it. That's the relative ratio.
I agree with the poster that the relative number seems more interesting. There are lots of things going on right now (masks, social distancing, etc.) to prevent people from getting COVID. The fact that only 0.79% of the placebo group got it implies a lot about _other_ mitigation factors, and puts a limiting force on how many can be saved by the vaccine (a number less than or equal to 0.79%). Like OP, I wonder if there's any case where the -0.75% number is interesting in and of itself. In fact, if we weren't social distancing, presumably the prevalence of COVID would be much higher and thus the absolute ratio of people prevented from getting COVID would be higher too.
The 95% effectiveness number should (theoretically) be the same no matter what other measures you're taking. It would reduce 0.79% of population from getting it to 0.04% getting it, and would reduce 10% of the population from getting it to 0.5% of the population getting it. I'm totally ignoring that lots of people getting the vaccine will lead to less people getting sick and less people spreading it (herd immunity), but you get the point.
With absolute numbers of 162 and 8, 94.9% would have an error range of somewhere around 10%, right? So the actual percent would be somewhere in the range of 85-97%?
(No actual math done here, I'm ballparking it based on looking at error ranges with sample size 100 at work; my main point is that I don't think the ~20k enrolled in each group affects this particular error range, so even though "94.9%" is stated precisely the actual data isn't nearly so precise)
Sure, but we also have to consider the r0. For both the placebo and the non-placebo patients, they were generally operating in an environment where essentially ~90% of others effectively had the placebo (no immunity). As the number of people with the vaccine goes up, the number of transmission vectors goes down, further decreasing the spread. So even on the low end of the error bar, the impact here would be huge.
"""There are lots of things going on right now (masks, social distancing, etc.) to prevent people from getting COVID"""
I hope this doesn't come across as snarky, but this seems like it could have a larger impact in the US than elsewhere, since we've (collectively) been doing such an abysmal job of doing masks + distancing.
I'm curious, is there any information on the confidence interval for this 95% number?
Intuitively, I would expect the confidence to be pretty low - after all, if tomorrow 2 more people in the vaccine group happen to get sick, the relative risk reduction will go from 20x to 15x.
No, you bring up a great question. This kind of vaccine trial is not designed to provide that information, unfortunately. The goal of this study is to show that the vaccine is at least 30% effective (defined by Vaccine Efficacy (VE) in the Pfizer protocol), with a soft goal of hitting a VE of 50%. We don't know anything about what the total population of _possible_ infections in either arm would be.
That said, if we assume that there are in total 170 cases (which is true at this point in time but will change), and that there are 162 cases in the control group and 8 cases in the vaccine group, we can construct a posterior of the VE. Here's an older posterior (done with data from the press releases in the first IA a few days ago) http://blog.fellstat.com/?p=468 that graphs this posterior. There is some uncertainty, but as you can see results are still promising. That said we just don't know how case counts will change, and while it will be fascinating to watch the results change over time, these sorts of tests are just about getting enough data to mark a vaccine as effective, not about trying to extrapolate any larger effect.
I hope this isn't a silly question - do we know that the placebo group represented half of the total enrolled? The Pfizer press release is very short on details.
Given exponential growth of the virus, and the very large changes to society made to avoid virus population growth I think the NNT isn’t an effective measurement tool. Clearly the value of the vaccine depends heavily on where/when you are.
Additionally, if the virus has an R greater than 1, preventing one person from being infected has a larger impact on total infected population.
That's the point. Pfizer's trial does not evaluate reduction of R or "preventing one person from being infected". It would have been better if it did, but it does not. NNT is a natural way to measure the result of this trial since the result is about prevention of disease, NOT prevention of infection.
The Moderna trial had a control group infection rate of 0.6% vs. Pfizer's 0.79%. It doesn't really change the story, but if we are going to split hairs over effectiveness ratings, I wonder how sensitive are they to random variance in the control group outcomes, assuming both drugs are exactly the same (they're not), and both tested populations are exactly the same (they're not).
This is a vaccine against a communicable disease. The NNT is almost certainly much lower, since preventing the 154 cases among vaccinated patients would almost certainly prevent cases among their contacts.
We actually at the moment still don't know if having some people vaccinated would "prevent cases among their contacts." The published results don't show that at all. What's published is only if the vaccines prevent the occurrence of the illness (as in "did somebody have symptoms"). Also: "Animal challenge data suggest that vaccinated animals may still be infected even if they don't experience symptoms." For more details (including the whole article from which is that citation) see my other comments here.
Unfortunately there is some pessimism about whether a coronavirus vaccine is likely to provide "sterilizing immunity" which would prevent spread, as opposed to just reducing the severity of the disease. https://www.statnews.com/2020/05/22/the-world-needs-covid-19...
Would this mean we are having a bunch of asymptomatic reinfections resulting in retransmission? Surely we would have seen a lot of examples of this already with test and trace?
I'm a complete layman here, but I would expect that the "prevent spread" is not binary, it's a spwetrum [0,1].
Thus, even if it does not completely prevent spread, if just a part, or even a smallish part, is prevented, that also helps others.
(Same thing in mask discussion. Lots of people dismiss masks because they may not completely prevent an infection; that is stupid, because masks still decrease the probability of infection (and more importantly, spreading to others).
The "absolute risk reduction" and NNT numbers seem pretty useless, since they are in a context where people are trying their best to avoid getting infected with isolation, masks, distancing, etc.
Once the vaccine rolls out, people will return to previous habits and without the vaccine a large percentage of the population would be infected, so these numbers look completely different (i.e. absolute risk reduction of at least 45% from 50% to 0-5%, and NNT of something like 3-to-1 to 10-to-1).
Participants will continue to be monitored for the next 2 years. This just marks the point at which Pfizer can claim their vaccine to be more than 30% effective.
They will unfortunately vaccinate the placebo arm as soon as they get the EUA. At this point the study would be mostly unblinded, so far as I can tell, there will also be a much smaller, if any control group.
“If our potential vaccine receives an EUA, we would propose amending the study protocol to create a process so that interested, eligible participants who received the placebo could ‘cross-over’ to the vaccine arm of the study,”
Note that it is 170 cases as defined in the study protocol. Which is not positive in a PCR test like you see in the media, it is positive in PCR while showing symptoms.
I just read that Pfizer reports its vaccine as 95% effective, even though pharmaceutical originally reported its vaccine as 90% effective. This new number matches Moderna's reported effectiveness reported yesterday. I don't know enough about how the reporting process works. To me, it appears that Pfizer will report whatever number sounds good, not the true number. I'm glad several states, like New York, want to review the clinical trial data independently of the FDA
EDIT: I am getting serious downvotes for this comment! Whoops! I do not mean to suggest people should not take the vaccine, only that the optics of news presses look bad. I say this as someone who takes the Flu vaccine every year and elected for the HPV vaccine a few years ago
How much more data did they get? For a trial that's been going on for months, it seems nonintuitive that 2 more days of data would move the needle so much
Well with case counts in the US doubling roughly every two weeks, you would expect to see the number of cases among trial participants there doubling over that period.
I added that sentence to make it clear that I am not an expert. I am highlighting how this appears to me. I was hoping that someone with experience working in clinical trials would chime in
You can follow Dr Eric Topol or Dr Florian Krammer on twitter as they for sure will be able to explain the data in layman terms. Great people to follow. There are others as well.
Yet by publicly speculating about unethical behavior that you have no basis for, you give wrong and potentially harmful ideas to people who are not experts. If you want to get an expert opinion, you should ask "Why did the effectiveness rise from 90% to 95%?".
For much the same reasons as you don't want people adding additional baseless speculation to passing observations of you that you may be a pedophile in passing conversation.
If that was indeed your intent, it definitely didn't sound like that in your post, which came across as unwarranted conspiracy theory BS.
You could have gotten your point across better without insinuating negative intent, i.e. "As someone unfamiliar with the reporting process, can someone more familiar with the process explain how Pfizer's effectiveness number went from 90% just recently to 95% today? Thanks in advance."
If you're looking to be educated, instead of drawing unfounded conclusions, you might instead ask a question, like "I'm confused what these numbers represent. Could someone more versed in clinical trials explain them?"
This comes across much differently than "this seems like these numbers -- which I confess I do not understand -- seem manufactured by the drug companies to look good."
> I just read that Pfizer reports its vaccine as 95% effective, even though pharmaceutical originally reported its vaccine as 90% effective
I think, "originally" is not the right term. "Pfizer’s Early Data Shows Vaccine Is More Than 90% Effective".
Now more data is in, and it is indeed more than 90% effective, more like 95%.
They already have sold the vaccine, and it won't be sold over the counter. I don't see any gain in telling to have 93%, 95% or 98% efficacy, if you don't have it.
Clinical trials like this are subject to an enormous number of regulatory and statistical controls, particularly if they're in the public spotlight as much as this one is. It's unlikely the true effectiveness of the vaccine will be very different from what they're reporting here.
- The percentage of people in control that had confirmed COVID-19 cases was ~0.79%
- The percentage of people in treatment that had confirmed COVID-19 cases was ~0.04%
- This represents a risk ratio of 0.04/0.79 = ~0.05.
A risk ratio of 1.0 means that there was no reduction in risk, i.e. the treatment had no effect. A risk ratio less than 1.0 means that the treatment reduced the risk (or was correlated with this), and above 1.0 means that the treatment increased the risk (or was correlated with this).
Since the risk ratio of treatment was 0.05, there was a 0.95 reduction in risk, which is where the 95% number comes from.
Didn't they initially announce effectiveness as people infected in the trial arm over people infected in the control arm? Changing the metric to the better one feels a bit marketingy.
Getting downvoted on HN is normal in the last few years. There are much more readers who don't think as critically as the early readership, so you have to be extra careful with your wording if you don't want to be downvoted. Or just learn to not care about it :)
Thinking critically, in this case, would have been trying to understand where this 95% number came from at the very least, before making suggestion of unethical behavior.
I see, so it was the last sentence, not the fact that he pointed out that the number changed. Thanks for the explanation! Still, I believe that he was constructive just as you.
There are two differences between the 90% reported originally and the 95% now. The first value was a lower bound, it was formulated a bit mushy as far as I remember, but it almost certainly wasn't the same type of value as the one reported now. And the trial is now finished, the first value was from an interim analysis with fewer data points. So there is nothing unusual here at all.
Pfizer's Phase 3 study was meant to have three readouts of data, which would happen when they hit a pre-specified number of cases. The first readout was to have been at 32 cases in design, but after discussion with the FDA, Pfizer changed the first readout to 62 cases. By the time the discussion concluded, the study had already hit the second readout of 94. The final study analysis is concluded at 164.
The 90% efficacy is reported based on the second readout data, which was all the data they had at the time. The 95% efficacy is reported based on the final readout data, which was only more recently available.
Note that the media has not done a great job of indicating that the initial Pfizer (and Moderna, for that matter) results were based on interim analysis.
The Pfizer press release reported a week (or so) ago said the vaccine was "over 90% effective" in the preliminary data. They did not explicitly say the vaccine was 90.000% effective.
I don't really trust any kind of data coming from companies (or government for that matter). I will wait few years and see for myself if there are no side effects.
I am surprised so many people are suddenly in full "believe the science" mode, especially when big pharma companies weren't exactly the most ethical players on the market in the past.
I'm not - the government's messaging throughout the whole pandemic has been "get back to work, peon". There is absolutely no reason to believe that the two vaccines aren't more of the same. You need to work with accurate priors.
I'm not sure how the government's messaging during the pandemic affects a private company, with global shareholders, claiming efficacy of a product whose results will be plain to see for all of those shareholders. You cannot lie about your products in an open market and be successful.
Sure, we should be skeptical of the government line on the pandemic, but why should we be skeptical of a product that comes from a company whose product must work for them to make money?
I think instead of letting our previous biases in one arena influence our current decision making in another, we should look at the evidence, make an independent decision, and then loop back on that when the evidence changes. Government bad != private company creates product that doesn't work
There is no reason to believe in long-term safety, neither is there reason to believe in long-term efficacy, the vaccine is too new for that to have any good data, meanwhile the manufacturers are indemnified to the hilt. Not that there's anything wrong with vaccine indemnification, when the product is proven safe and improves public health, as the vaccines on the markets all are, but this one was rushed through at unprecedented speed.
And what's with the trust in the market to fix things? The 737-MAX crashes did not affect Boeing share price or Boeing management in any meaningful way, neither are safety problems with the new covid vaccines going to affect Pfizer or Moderna.
What are you going to do for a "few years"? The potential long-term side effects from covid far outweigh the potential side-effects of a well-tested vaccine.
> I am surprised so many people are suddenly in full "believe the science" mode
Two reasons:
1. We want our lives back. Covid sucks and people are getting tired of the precautions. Many of us are still being careful to protect others, but "covid fatigue" is very real. A vaccine promises tangible light at the end of this tunnel.
2. While many of the efficacy trials are shorter than normal, there's no reason to believe that these vaccines are dangerous. mRNA ones, in particular, basically can't give patients the virus itself, unlike many other kinds of vaccines.
For a healthy young adult, what are the potential long term side effects of covid? For most healthy young adults it is a mild flu in terms of symptoms. I know there is a minor risk of having a worse case, but the odds of that for young adults with healthy BMIs is low.
I'll take the vaccine when it is available but I understand that others are looking at the risk/reward and being distrustful of a vaccine. Particularly when the vaccines have been rushed and have unknown long term effects
There's some decent evidence of long-term (permanently?) lowered VO2Max in a large proportion of cases in younger people, along with lower quality evidence of prevalence of scarier post-infective consequences. I don't really want even a minor case of COVID-19.
Yes, the vaccines may be riskier than we're accustomed to. GBS is a 1 per million side effect in most vaccines, with some proportion of these people having permanent side effects. I wouldn't be surprised if we find that these vaccines are more like 1 in 25k. But that's better than the odds even young people face from COVID-19.
I know some healthy young people who have a much harder time exercising months after getting the virus, but I concede that those cases are fairly rare—although much more common than any issues from vaccines in trial.
Thinking about it from a societal perspective, I'm willing to take a small risk from getting the vaccine to avoid inadvertently getting and spreading the virus to more vulnerable people like my grandparents.
> For a healthy young adult, what are the potential long term side effects of covid?
From an overall risk/reward perspective, I would include the risk of subsequently infecting your parents, grandparents or other vulnerable/high-risk family/friends with severe disease as a 'potential long term side effect' of covid in a young/low-risk individual.
I'm thinking of not rushing out to get vaccinated right away.
(1) My company switched to work from home two or three years ago, I've just recently subscribed to Walmart+ so I've got free grocery delivery for a year, I've gotten into the habit of making my own meals which is healthier and cheaper than how I ate pre-COVID so I'm going to stick with that even after COVID is gone, and my socializing was almost all online before COVID.
It is no problem for me to keep mostly quarantined for another year.
(2) The few times in the next year I will have to interact closely with other people will probably be with people who have taken it (e.g., doctors and dentists).
(3) While it is true that mRNA vaccines cannot give you the thing they are vaccinating against, it is still possible they will have other side effects. As far as I know there is no way to determine the long term risk of a medicine other than just waiting to see.
(4) I live in a county that has not been hit hard.
(5) It looks like there are at least two vaccines that are going to get quick approval, and I believe there are more deeply into their phase 3 tests.
Putting this all together, it seems I personally have a pretty low chance of getting COVID, and if I do get it a pretty low chance of spreading it while I'm still asymptotic, so can afford to wait and see if any of the vaccines have longer term issues or if one of them is clearly better than the others.
How far out are you drawing the line? You mention another year so it's gonna suck more in an ironic sense for you if side effects come out 2, 5, 20 years from now.
I'll be the first in the queue personally. Lets get back outside, even I'm bored of these walls now.
> I'll be the first in the queue personally. Lets get back outside, even I'm bored of these walls now.
Excellent! That is exactly what I want. The more people who take it because they are either at high risk, or because avoiding exposure seriously harms their lifestyle, the more data there will be for me when I decide to take it.
As far as side effects go, the kind of things that take years to show up are usually things that you'd only see in a medicine that you have to take regularly.
The latest research suggests that we probably get long term COVID immunity. Those few cases of people getting it twice were probably people who got a small viral load the first time and didn't develop strong immunity.
All the COVID vaccines look like they will be take once (or take twice over a short period) and that's it, so we almost certainly won't see anything like people developing cancer from it 5 years later. Those things take times to build up, like say we had with Actos and bladder cancer, with each time you take it adding to the risk.
If there are long term bad effects from the COVID vaccines, the underlying damage will happen within a couple weeks or so of taking them, and then should start being detectable in the health statistics of people who took it versus people who did not within a year.
Thus, at the latest we should know about any long term effects by the time my Walmart+ subscription is up for renewal, which is perfect timing.
It seems like tzs is some kind of basement dweller who would prefer to never leave the house even in the absence of a pandemic, in which case holding off on the vaccine does seem like the optimal move.
I personally like to read primary sources and I trust Pfizer and other Pharmaceutical companies to not lie in their research findings. I believe in my own ability to read and draw my own conclusions and I trust Pfizer’s own fear of a lawsuit.
Should have clarified, the reason why I am asking is because my understanding is that under usual circumstances it is the government that pays out for vaccine damages. Does the same apply in the case of an EUA?
[1] https://www.theatlantic.com/health/archive/2019/05/vaccine-s...
You don't have to "believe" in science. Believing in something means trusting something is true, in absence of evidence. That's at the base of all religions and the opposite of science.
I just trust the scientific process. Yes, the conclusions currently drawn from the evidence can be wrong. I'm not disappointed if it is. If scientists gain new insights, it just means the proces is working.
In this context, I think they mean, believe that the published data is true. You don't have to believe in science itself, but you do have to trust scientists when they report data (you can check the conclusions yourself, but you can't check if the data was accurately reported, if the published protocol was followed etc).
That said, I believe the legal repercussions of lying about these studies will be too high to stomach, so I do trust the companies to be truthful here. That doesn't mean that it is irrational to choose not to trust them.
You don't have to trust a specific company to trust the scientific process. If they lie, we will find out. They don't have a lasting monopoly on that data.
Yes, we will find out eventually, but if you want the vaccine today, you need to trust them today.
Again though, the fact that it is inevitable that we will eventually find out is why I personally believe the data today - I trust the company to not sacrifice long-term credibility for short-term gains.
There is a difference between science and "corporate science". "Corporate science" once said tobacco was healthy for you - doctor recommended cigarettes.
Also science can be corruptible as well. It was once scientific fact that non-whites were inferior to whites. The "father of gynecology" experimented on black women because it was scientific knowledge that black women don't feel pain.
It was once "science" to cure sick people with leeches. It was once science to give "misbehaving" women hysterectomies or lobotomies. One of the most famous ones being rosemary kennedy.
> If scientists gain new insights, it just means the proces is working.
I guess the victims of mengele and U-731 appreciate your confidence in the "process".
For someone so critical of religion, you have an almost blind and zealous and unquestioning faith in the "scientific process".
When money, corporations and politics are involved, you should be skeptical. Even if it is "science". And pfizer and these companies aren't in the business of science, they are in the business of making money.
Yes. Companies can lie. But your point is buried in the false assumptions about me.
"Trusting something" !== "An almost blind and zealous and unquestioning faith"
Trusting the scientific process doesn't mean you shouldn't be skeptical. It means the opposite. If a company lies, we will find out eventually. You can look at the evidence. There will be independent data eventually. You don't need "faith".
Why you needed to involve Mengele to make an argument is beyond me. Invoking Godwin's law will never help you win a discussion.
My general rule is that I will not take any vaccine which has active patents. If doctors are recommending it way past the patents have expired, it is very likely that it fares well in terms of risk/reward.
There are already 2 known virus mutations: G614 and D514. In Italy new research suggests even a 3rd mutation might go around. And Denmark also had a mutation.
Do those vaccines work on all mutations or are they like the common flu vaccines that must be adapted every year?
Yes, at this time, all virus variants have the same spike structure where the vaccines and commonly produced antibody responses to vaccine/infection target.
Oddly enough, the G614 mutation is moderately more vulnerable to neutralization.
Once enough people are no longer susceptible/vaccinated, there may be considerably more selective pressure for the virus to mutate in ways that antibodies to past variants don't work. Whether we'll get variants that are virulent and bypass immunity is TBD. The spike protein is functional; changes to it that bypass immunity likely reduce function.
Is it correct that once enough people get vaccinated, even if we don't eradicate the virus, it will have to mutate into something milder in order to still effectively spread?
It is not a given that it will be milder, just estimated to be more likely once everything is taken into account.
As an example of why, the comment you are responding to mentioned the spike being functional (it is used by the virus for cell entry) and it is also targeted by our antibodies. So, for the virus to evade antibodies, it would have to change the spike enough so that antibodies don't detect it anymore. But, by changing it would likely lose some of its current efficacy.
There's some nuance to this. The current most common strain is theoretically the most genetically fit strain. Wide use of vaccines targeting conserved regions of the spike protein almost certainly would result in less genetically fit virus progeny becoming more common by simple selection. But, there's no predicting the virulence of the the less genetically fit strains that will pop up. ie) very deadly viruses aren't necessarily very genetically fit. The short of it is, the resultant strains will probably be less transmissible (the "R" number will decrease), but it's hard to predict their virulence/serverity.
I think consensus is we don't know for sure, but there's reason to be hopeful. SARS-CoV-2 probably won't evolve as fast as the flu, which undergoes a "sexual-like" evolution process called "re-assortment." On the other hand, CoV-2 has "re-combination," which gives similar results, and it does have zoonotic hosts.
Note there is some correlation between virulence and severity. For something with a longer incubation time, increased viral load tends to mean both increased virulence and transmissibility. This relationship is far from universal, though.
All mutations share the same spike protein, which the vaccine targets, and as far as we know the virus cannot reproduce without that exact same spike protein. Having the virus mutate in a totally different but still successful spike protein should be very very unlikely.
AFAIK the spike protein is used by the virus to gain entry into cells, it's not strictly related to reproduction. In theory the virus could mutate to gain entry into the cells via a different mechanism.
That is very strange claim. D614G is a mutation in the spike protein, and also there is a document ed case of very rapid mutation of the spike in an immuncompromised patient.
> Bottom line: the coronavirus can’t undergo the wholesale changes that we see with the influenza viruses. And the mutations we’re seeing so far appear to still be under the umbrella of the antibody protection we’ll be raising with vaccination, which argues that it’s difficult to escape it.
I talked with a Spanish scientist that has developed a vaccine for covid and other vaccines for other illnesses before that.
He said something like that most of the work in testing is for the "carrier" or something like that(in Spanish). Once your vaccine works with that you could modify the vaccine very fast with little consequences.
Hew also told me that you can share "carriers" for different illnesses and he had tried to convince politicians for decades trying to create "generic carriers" in order to be prepared for something like this.
Does this new generation of mRNA vaccines even have carriers in the conventional sense?
But when you can change payloads of a pre-validated generic carrier at will you are roughly on the same level of biotechnological advancedness as the mRNA companies anyways, both are lightyears ahead of ancient techniques like breeding weaker viruses in animals or neutering them somehow before injection. A lot of vaccine skepticism seems to be based on the performance of those old ways, it would probably be quite wise to avoid a vaccine that was come up by old trial&error methods in less than a decade.
I thought that these vaccines were targeting the spike protein which seems to be unique to these viruses. Hopefully that would make them easier to vaccinate against.
I'm confused, who actually made the vaccine? I read that BionTech created it and Pfizer is handling logistics, approval, and distribution in the US. But I keep seeing it as "Pfizer's vaccine"?
I share your understanding of which companies did what.
You're probably reading U.S. media sources.
Wouldn't surprise me at all if BionTech have similar partnerships with large pharma companies in other countries, where the media there similarly claim it for their national champion.
It is known as the Pfizer/BioNTech vaccine in europe as well; Pfizer did not just handle logistics but the trials as well, which are a huge part of the effort.
It sounds like BioNTech did all the development work on the vaccine, but Pfizer funded the actual creation of the vaccine and runs the trials/logistics/finances/business stuff (considering how temperature-sensitive this is, logistics have to be fairly painful). Both should probably be credited (as they are in this article).
Yes, likely. I also would not make sense for a small company to build distribution and marketing channels (marketing might not be necessary in this case).
Also, big name. Nobody knows BionTech but the name Pfizer signals trust. In most cases the small company is actually getting bought by big pharma.
I work on a medical consumer device. Would be madness to market this ourself. A big company has the resources for distribution and marketing.
A delightful moral dilemma: There is concern that the vaccine stops you from developing Covid symptoms but not from becoming asymptomatic. If it turns out that the vaccines do not prevent you from being asymptomatic (you can still spread Covid), what is your obligation to wear a mask have continued lockdowns to protect people who refuse to get the vaccine?
You still need to wear a mask, but once vaccination rates are high enough the pandemic will roughly end and people as a whole can stop wearing them.
Also remember that by vaccinating the highest risk patients first we can make big impacts in the death toll without necessarily stopping the spread of cases.
I believe GP's hypothetical assumes that everyone has an opportunity to get vaccinated, and all those who remain susceptible to the virus refused to get vaccinated for selfish reasons.
If society continues to coddle anti-vaxers, it reinforces a positive incentive for selfish behavior, which in turn creates a negative drag on overall well-being. At a certain point, society shouldn't allow the selfish acts of small group of individuals undermine the well-being of society at large.
Obviously, there would need to be ample warning and a concerted effort to educate everyone on consequences. Once these requirements are met in this hypothetical, I believe the moral thing to do is to stop wearing masks and stop social distancing.
That said, this is an idealized hypothetical. In reality, there will be many people who can't get vaccinated for reasons that are not selfish. In this case, there is still a moral dilemma, but I'm unsure on how I'd approach it. Surely, asking 200 million people to wear masks for another year to save 1 life isn't worth it. The question is where to draw the line.
I have heard the prediction that some people will stop wearing masks with the [false] claim they have "had the vaccine." Not necessarily a "moral dilemma" but a kind of moral hazard perhaps, much as these sound the same. Part of that same prediction was: don't underestimate the frustration and fatigue, when people hear that after getting vaccinated they still have to wear a mask and social distance (if an "effective" vaccine does not create sterilizing immunity).
Do we know if any of the cases on the treatment side of the study led to hospitalizations? (I.e. were the cases as mild as the average control group case, or did we have a selection effect where the cases that did turn up in the treatment group were more severe?)
"Of the 10 cases of severe Covid-19, nine were in the placebo group, an important finding which suggests the vaccine prevents not only mild cases, but the type of serious disease that leads patients to die or be hospitalized." https://www.statnews.com/2020/11/18/pfizer-biontech-covid19-...
So the distribution amongst vaccinated group cases seems to be roughly the same as on the control group. In my armchair viroligy ponderings I have come to the conclusion that this is the best possible outcome because both directions of possible distribution shifts could be bad news: if all detected vaccinated cases would be hard cases it would indicate that the vaccine has much lower efficacy than stated with those that require the hardest to be saved by a vaccine, whereas an overrepresentation of weak cases would suggest that much more weak cases get through, that the vaccine would not prevent infection very much but only keep an infection from becoming a heavy case (weak cases are very likely to remain undetected in both the vaccinated group and in the control group). A downshift in severity would be just fine for the vaccinated, but with a virus like SARS-COV-2 that is very good at asymptomatic spread it would not contribute much to herd immunity, increasing risk for the non-vaccinated (because the lucky ones would drop all precautions.
Ignoring statistical significance for the purposes of this discussion, the observed rate suggests that the vaccine is 90% effective at preventing severe infections as well, not just mild infections.
In a worse world it could have been the case that e.g. the vaccine was 90% effective at preventing infections but still had the same number of severe infections because it did nothing to help the most vulnerable patients.
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[ 3.0 ms ] story [ 229 ms ] thread~20,567 in each arm
162/20,567 cases in the placebo arm (~0.79%)
8/20,567 cases in the vaccine arm (~0.04%)
Absolute risk reduction of ~0.75% (over the time period of the study, which is difficult to tell).
Number-needed-to-Treat (NNT): 134 vaccinations to prevent 1 symptomatic case over the study duration.
Keep in mind, this is over some time period. Annualized, these numbers would almost certainly increase. We don’t know how many days/weeks/months it took to reach 162 / 8 cases respectively (something between ~5-6 months and ~5 days)
It's a hard problem, and even though the clock is ticking, we also need to get it right the first time.
Things we still don't know:
- Does the vaccine also stop you from contracting the virus asymptomatically and spreading it? People enrolled in the trial were only told to get tested if they showed symptoms.
- How long does the immunity from the vaccine last? We won't know this for some time.
https://www.biorxiv.org/content/10.1101/2020.11.15.383323v1
"The Phase 3 clinical trial of BNT162b2 began on July 27 and has enrolled 43,661 participants to date, 41,135 of whom have received a second dose of the vaccine candidate as of November 13, 2020."
So there is no single date one can reasonably use 41,135 or ~20,567 for the efficacy calculations. As the observations continue (expected up to 2 years) there could be much more useful data there.
I also guess the people who haven't received both doses but got sick before are separately counted.
The only useful numbers at the moment we have are 8 and 162 (and 1 and 9 for the severe cases). And that we can assume that from all thousands vaccinated these 170 in total got sick by chance, and that the thousands were carefully enough selected to represent bigger population, and using that we can expect that the efficacy won't too dramatically change as more data come in, the same way as the polls can use smaller samples to conclude something about bigger population, if the sampling is careful enough. But some changes are expected.
It appears it's still too early to know if those who are vaccinated could protect those who aren't, or if the vaccine protects only those who received it (1) -- but anyway we know that still not all of those who will be vaccinated will be protected from having a severe case: there was up to now one severe case in the vaccinated group, versus 9 severe cases in the placebo group, 11%.
---------
1) https://www.medscape.com/viewarticle/941030
"In an ideal world, a vaccine would prevent infection entirely and, it follows, also prevent disease and severe disease. But this may be hard to achieve for a respiratory virus vaccine. Animal challenge data suggest that vaccinated animals may still be infected even if they don't experience symptoms. A vaccine that is able to reduce the severity of disease, even if it cannot prevent infection entirely, would obviously still have enormous public health value. Therefore, this is what trials target as their primary aim."
Keep in mind the definition of a case here is having symptoms, so we don’t know if the vaccine prevents lightly symptomatic or asymptomatic cases, which may or may not result in transmission.
Its current prevalence is irrelevant because if we live how we want to live it will be everywhere (assuming no vaccine).
Over the course of a longer period of time and with cases on the rise as they are now, I'd expect the risk reduction to be much higher.
Edit: Also, these numbers are somewhat skewed by the fact that not all 40k people got the vaccine/placebo at once, but over a period of time.
That’s not good though... really could but a kink in establishing herd immunity until everyone is actually vaccinated.
b) It's likely that it is protecting against those. But hard to specifically prove that it's protecting against each and every symptom. I think the hope is that if you don't develop lung issues, you are unlikely to develop long term damage.
Maybe I'm misunderstanding the data here. It seems like we've only directly proven that the vaccine has been effective at reducing the normal symptoms (coughs, fevers) to the point where candidates don't seem to be prompted enough to go get tested anymore. It doesn't directly prove those candidates didn't get covid.
Still, I'll use this vaccine if I can't get Moderna in time. The safety profile looks great.
What does that mean? Don't both vaccines work exactly the same? Both are mRNA vaccines.
I can't say anything about these vaccines, but there is such a thing as a non-sterilizing immunity, that would prevent you from developing COVID-19 but still be infected and able to spread SARS-CoV-2.
What does this mean?
As I understand it, all vaccines ever do is provide you with a prepared immune system for when you do get infected.
But presumably incidence is low because of safety restrictions (lockdowns, masks etc.) which are untenable long-term. Whereas if we can vaccinate O(everyone), we can, maybe, stop the restrictions?
https://news.ycombinator.com/item?id=25111284
In short, we still don't know which measures would have to be kept even when a lot of people are vaccinated. It will be much better known in some time, but it's still not known at this moment. It depends on sterile immunizing properties of the vaccine, which are still unknown.
Edit: re the Moderna protocol mentioned in sanxiyn's comment below: even if they will measure sterilizing immunity (as one of their "Secondary" objectives), as far as I know, they still haven't published something on that topic (1) From them we still have only data on the level comparable to those from Pfizer/BioNTech:
90 cases in placebo, 5 in vaccinated, 11 severe cases, all in placebo group. Where "cases" could simply be defined "those who were recognized of having Covid-19" (as the illness). (Also see my other comment here for more general references about the primary objectives of all Phase 3 trials).
Here's what Moderna only writes about their secondary objectives in the only release: "Key secondary endpoints include prevention of severe COVID-19 disease and prevention of infection by SARS-CoV-2. The trial will continue to accrue additional data relevant to safety and efficacy even after an EUA is submitted." Meaning, eventually, we should be able to know more.
I didn't know that Pfizer doesn't even have that kind analysis written in their protocol, thanks. I'd hope they can add that in some later phase.
1) https://investors.modernatx.com/news-releases/news-release-d...
https://www.modernatx.com/sites/default/files/mRNA-1273-P301...
But preventing 0.75% of the population from getting it out of the 0.79% who got it implies 94.9% (0.0075/0.0079) of those who _would_ have gotten it were prevented from getting it. That's the relative ratio.
I agree with the poster that the relative number seems more interesting. There are lots of things going on right now (masks, social distancing, etc.) to prevent people from getting COVID. The fact that only 0.79% of the placebo group got it implies a lot about _other_ mitigation factors, and puts a limiting force on how many can be saved by the vaccine (a number less than or equal to 0.79%). Like OP, I wonder if there's any case where the -0.75% number is interesting in and of itself. In fact, if we weren't social distancing, presumably the prevalence of COVID would be much higher and thus the absolute ratio of people prevented from getting COVID would be higher too.
The 95% effectiveness number should (theoretically) be the same no matter what other measures you're taking. It would reduce 0.79% of population from getting it to 0.04% getting it, and would reduce 10% of the population from getting it to 0.5% of the population getting it. I'm totally ignoring that lots of people getting the vaccine will lead to less people getting sick and less people spreading it (herd immunity), but you get the point.
(No actual math done here, I'm ballparking it based on looking at error ranges with sample size 100 at work; my main point is that I don't think the ~20k enrolled in each group affects this particular error range, so even though "94.9%" is stated precisely the actual data isn't nearly so precise)
I hope this doesn't come across as snarky, but this seems like it could have a larger impact in the US than elsewhere, since we've (collectively) been doing such an abysmal job of doing masks + distancing.
Intuitively, I would expect the confidence to be pretty low - after all, if tomorrow 2 more people in the vaccine group happen to get sick, the relative risk reduction will go from 20x to 15x.
Is there anything wrong with this reasoning?
That said, if we assume that there are in total 170 cases (which is true at this point in time but will change), and that there are 162 cases in the control group and 8 cases in the vaccine group, we can construct a posterior of the VE. Here's an older posterior (done with data from the press releases in the first IA a few days ago) http://blog.fellstat.com/?p=468 that graphs this posterior. There is some uncertainty, but as you can see results are still promising. That said we just don't know how case counts will change, and while it will be fascinating to watch the results change over time, these sorts of tests are just about getting enough data to mark a vaccine as effective, not about trying to extrapolate any larger effect.
Additionally, if the virus has an R greater than 1, preventing one person from being infected has a larger impact on total infected population.
Thus, even if it does not completely prevent spread, if just a part, or even a smallish part, is prevented, that also helps others.
(Same thing in mask discussion. Lots of people dismiss masks because they may not completely prevent an infection; that is stupid, because masks still decrease the probability of infection (and more importantly, spreading to others).
Once the vaccine rolls out, people will return to previous habits and without the vaccine a large percentage of the population would be infected, so these numbers look completely different (i.e. absolute risk reduction of at least 45% from 50% to 0-5%, and NNT of something like 3-to-1 to 10-to-1).
SCNR
It's about eliminating excessive fear. And fear kills economic activity.
“If our potential vaccine receives an EUA, we would propose amending the study protocol to create a process so that interested, eligible participants who received the placebo could ‘cross-over’ to the vaccine arm of the study,”
EDIT: I am getting serious downvotes for this comment! Whoops! I do not mean to suggest people should not take the vaccine, only that the optics of news presses look bad. I say this as someone who takes the Flu vaccine every year and elected for the HPV vaccine a few years ago
For much the same reasons as you don't want people adding additional baseless speculation to passing observations of you that you may be a pedophile in passing conversation.
You could have gotten your point across better without insinuating negative intent, i.e. "As someone unfamiliar with the reporting process, can someone more familiar with the process explain how Pfizer's effectiveness number went from 90% just recently to 95% today? Thanks in advance."
This comes across much differently than "this seems like these numbers -- which I confess I do not understand -- seem manufactured by the drug companies to look good."
Not a crime, but strictly speaking, thats how theories are formed. You test them or otherwise find evidence that contradicts them.
I think, "originally" is not the right term. "Pfizer’s Early Data Shows Vaccine Is More Than 90% Effective".
Now more data is in, and it is indeed more than 90% effective, more like 95%.
They already have sold the vaccine, and it won't be sold over the counter. I don't see any gain in telling to have 93%, 95% or 98% efficacy, if you don't have it.
From this comment, which summarized the statistics of the phase 3 trial: https://news.ycombinator.com/item?id=25136588
- The percentage of people in control that had confirmed COVID-19 cases was ~0.79%
- The percentage of people in treatment that had confirmed COVID-19 cases was ~0.04%
- This represents a risk ratio of 0.04/0.79 = ~0.05.
A risk ratio of 1.0 means that there was no reduction in risk, i.e. the treatment had no effect. A risk ratio less than 1.0 means that the treatment reduced the risk (or was correlated with this), and above 1.0 means that the treatment increased the risk (or was correlated with this).
Since the risk ratio of treatment was 0.05, there was a 0.95 reduction in risk, which is where the 95% number comes from.
Thinking critically, in this case, would have been trying to understand where this 95% number came from at the very least, before making suggestion of unethical behavior.
The 90% efficacy is reported based on the second readout data, which was all the data they had at the time. The 95% efficacy is reported based on the final readout data, which was only more recently available.
Note that the media has not done a great job of indicating that the initial Pfizer (and Moderna, for that matter) results were based on interim analysis.
I am surprised so many people are suddenly in full "believe the science" mode, especially when big pharma companies weren't exactly the most ethical players on the market in the past.
Sure, we should be skeptical of the government line on the pandemic, but why should we be skeptical of a product that comes from a company whose product must work for them to make money?
I think instead of letting our previous biases in one arena influence our current decision making in another, we should look at the evidence, make an independent decision, and then loop back on that when the evidence changes. Government bad != private company creates product that doesn't work
And what's with the trust in the market to fix things? The 737-MAX crashes did not affect Boeing share price or Boeing management in any meaningful way, neither are safety problems with the new covid vaccines going to affect Pfizer or Moderna.
> I am surprised so many people are suddenly in full "believe the science" mode
Two reasons:
1. We want our lives back. Covid sucks and people are getting tired of the precautions. Many of us are still being careful to protect others, but "covid fatigue" is very real. A vaccine promises tangible light at the end of this tunnel.
2. While many of the efficacy trials are shorter than normal, there's no reason to believe that these vaccines are dangerous. mRNA ones, in particular, basically can't give patients the virus itself, unlike many other kinds of vaccines.
Yes, the vaccines may be riskier than we're accustomed to. GBS is a 1 per million side effect in most vaccines, with some proportion of these people having permanent side effects. I wouldn't be surprised if we find that these vaccines are more like 1 in 25k. But that's better than the odds even young people face from COVID-19.
Thinking about it from a societal perspective, I'm willing to take a small risk from getting the vaccine to avoid inadvertently getting and spreading the virus to more vulnerable people like my grandparents.
Testicular covid, there are credible reports of male infertility in recovered patients.
From an overall risk/reward perspective, I would include the risk of subsequently infecting your parents, grandparents or other vulnerable/high-risk family/friends with severe disease as a 'potential long term side effect' of covid in a young/low-risk individual.
(1) My company switched to work from home two or three years ago, I've just recently subscribed to Walmart+ so I've got free grocery delivery for a year, I've gotten into the habit of making my own meals which is healthier and cheaper than how I ate pre-COVID so I'm going to stick with that even after COVID is gone, and my socializing was almost all online before COVID.
It is no problem for me to keep mostly quarantined for another year.
(2) The few times in the next year I will have to interact closely with other people will probably be with people who have taken it (e.g., doctors and dentists).
(3) While it is true that mRNA vaccines cannot give you the thing they are vaccinating against, it is still possible they will have other side effects. As far as I know there is no way to determine the long term risk of a medicine other than just waiting to see.
(4) I live in a county that has not been hit hard.
(5) It looks like there are at least two vaccines that are going to get quick approval, and I believe there are more deeply into their phase 3 tests.
Putting this all together, it seems I personally have a pretty low chance of getting COVID, and if I do get it a pretty low chance of spreading it while I'm still asymptotic, so can afford to wait and see if any of the vaccines have longer term issues or if one of them is clearly better than the others.
I'll be the first in the queue personally. Lets get back outside, even I'm bored of these walls now.
Excellent! That is exactly what I want. The more people who take it because they are either at high risk, or because avoiding exposure seriously harms their lifestyle, the more data there will be for me when I decide to take it.
As far as side effects go, the kind of things that take years to show up are usually things that you'd only see in a medicine that you have to take regularly.
The latest research suggests that we probably get long term COVID immunity. Those few cases of people getting it twice were probably people who got a small viral load the first time and didn't develop strong immunity.
All the COVID vaccines look like they will be take once (or take twice over a short period) and that's it, so we almost certainly won't see anything like people developing cancer from it 5 years later. Those things take times to build up, like say we had with Actos and bladder cancer, with each time you take it adding to the risk.
If there are long term bad effects from the COVID vaccines, the underlying damage will happen within a couple weeks or so of taking them, and then should start being detectable in the health statistics of people who took it versus people who did not within a year.
Thus, at the latest we should know about any long term effects by the time my Walmart+ subscription is up for renewal, which is perfect timing.
Good points regarding the build up, thanks for the response
I just trust the scientific process. Yes, the conclusions currently drawn from the evidence can be wrong. I'm not disappointed if it is. If scientists gain new insights, it just means the proces is working.
That said, I believe the legal repercussions of lying about these studies will be too high to stomach, so I do trust the companies to be truthful here. That doesn't mean that it is irrational to choose not to trust them.
Again though, the fact that it is inevitable that we will eventually find out is why I personally believe the data today - I trust the company to not sacrifice long-term credibility for short-term gains.
Also science can be corruptible as well. It was once scientific fact that non-whites were inferior to whites. The "father of gynecology" experimented on black women because it was scientific knowledge that black women don't feel pain.
https://www.independent.co.uk/news/world/americas/james-mari...
It was once "science" to cure sick people with leeches. It was once science to give "misbehaving" women hysterectomies or lobotomies. One of the most famous ones being rosemary kennedy.
> If scientists gain new insights, it just means the proces is working.
I guess the victims of mengele and U-731 appreciate your confidence in the "process".
For someone so critical of religion, you have an almost blind and zealous and unquestioning faith in the "scientific process".
When money, corporations and politics are involved, you should be skeptical. Even if it is "science". And pfizer and these companies aren't in the business of science, they are in the business of making money.
"Trusting something" !== "An almost blind and zealous and unquestioning faith"
Trusting the scientific process doesn't mean you shouldn't be skeptical. It means the opposite. If a company lies, we will find out eventually. You can look at the evidence. There will be independent data eventually. You don't need "faith".
Why you needed to involve Mengele to make an argument is beyond me. Invoking Godwin's law will never help you win a discussion.
If we're wrong we can be disappointed about it later
https://www.statnews.com/2020/11/17/pfizer-may-be-within-day...
Do those vaccines work on all mutations or are they like the common flu vaccines that must be adapted every year?
Oddly enough, the G614 mutation is moderately more vulnerable to neutralization.
Once enough people are no longer susceptible/vaccinated, there may be considerably more selective pressure for the virus to mutate in ways that antibodies to past variants don't work. Whether we'll get variants that are virulent and bypass immunity is TBD. The spike protein is functional; changes to it that bypass immunity likely reduce function.
As an example of why, the comment you are responding to mentioned the spike being functional (it is used by the virus for cell entry) and it is also targeted by our antibodies. So, for the virus to evade antibodies, it would have to change the spike enough so that antibodies don't detect it anymore. But, by changing it would likely lose some of its current efficacy.
I think consensus is we don't know for sure, but there's reason to be hopeful. SARS-CoV-2 probably won't evolve as fast as the flu, which undergoes a "sexual-like" evolution process called "re-assortment." On the other hand, CoV-2 has "re-combination," which gives similar results, and it does have zoonotic hosts.
Note there is some correlation between virulence and severity. For something with a longer incubation time, increased viral load tends to mean both increased virulence and transmissibility. This relationship is far from universal, though.
Why? Has it had a ton of time to evolve?
https://www.medrxiv.org/content/10.1101/2020.07.22.20159905v...
They just finished the first study on the regular virus yesterday!
To quote his summary:
> Bottom line: the coronavirus can’t undergo the wholesale changes that we see with the influenza viruses. And the mutations we’re seeing so far appear to still be under the umbrella of the antibody protection we’ll be raising with vaccination, which argues that it’s difficult to escape it.
He said something like that most of the work in testing is for the "carrier" or something like that(in Spanish). Once your vaccine works with that you could modify the vaccine very fast with little consequences.
Hew also told me that you can share "carriers" for different illnesses and he had tried to convince politicians for decades trying to create "generic carriers" in order to be prepared for something like this.
But when you can change payloads of a pre-validated generic carrier at will you are roughly on the same level of biotechnological advancedness as the mRNA companies anyways, both are lightyears ahead of ancient techniques like breeding weaker viruses in animals or neutering them somehow before injection. A lot of vaccine skepticism seems to be based on the performance of those old ways, it would probably be quite wise to avoid a vaccine that was come up by old trial&error methods in less than a decade.
You're probably reading U.S. media sources.
Wouldn't surprise me at all if BionTech have similar partnerships with large pharma companies in other countries, where the media there similarly claim it for their national champion.
> BionTech created it and Pfizer is handling logistics, approval, and distribution
AIUI, Pfizer is also handling US and some EU manufacturing.
I work on a medical consumer device. Would be madness to market this ourself. A big company has the resources for distribution and marketing.
Also remember that by vaccinating the highest risk patients first we can make big impacts in the death toll without necessarily stopping the spread of cases.
If society continues to coddle anti-vaxers, it reinforces a positive incentive for selfish behavior, which in turn creates a negative drag on overall well-being. At a certain point, society shouldn't allow the selfish acts of small group of individuals undermine the well-being of society at large.
Obviously, there would need to be ample warning and a concerted effort to educate everyone on consequences. Once these requirements are met in this hypothetical, I believe the moral thing to do is to stop wearing masks and stop social distancing.
That said, this is an idealized hypothetical. In reality, there will be many people who can't get vaccinated for reasons that are not selfish. In this case, there is still a moral dilemma, but I'm unsure on how I'd approach it. Surely, asking 200 million people to wear masks for another year to save 1 life isn't worth it. The question is where to draw the line.
https://news.ycombinator.com/newsguidelines.html
i don't see how that rate implies anything about the severity of the infection
In a worse world it could have been the case that e.g. the vaccine was 90% effective at preventing infections but still had the same number of severe infections because it did nothing to help the most vulnerable patients.