Possible vaccines/treatment(s) for Coronavirus

[Wilf]

That's... interesting. My quick search suggests that GPs or vaccination centres will simply give out whichever vaccine they have at that point. However, there's a good chance it will be the above, because of storage issues (is that correct?). I don't want to encourage vaccine hesitancy, even on this thread, but you are allowed to have a quite rational moment of 'hesitancy' over this. For example, I'm 60 and will be getting the jab mid March perhaps. Couple of underlying conditions but none of them are on the 'list', though I'm not allowed in work due to an occupational health assessment. Don't want to make this about me and, unless anything much worse emerges about astrazeneca I'll have it. For me, it's literally antisocial not to have the vaccine, unless of course you have specific health reasons.

Anyway, what I'm fumbling towards, is the issue of whether we can have a rational discussion about risk, without it generating conspira-shite and threatening the whole vaccination programme. In turn, the government's appalling messaging on the pandemic is an issue with regard to trust and being treated as adults.

 

[teuchter]

Supposedly this is from Germany's analysis of the results for the AZ vaccine.

It shows that in the over 65 group, 1 in 341 vaccine recipients got Covid-19, and 1 in 319 placebo recipients got it.

I can certainly see why you might look at that and decide there's no evidence of efficacy for that age group.

Presumably the approval in the UK relies on the trials indicating that it's safe for the over-65s, and just hoping that the efficacy shown in younger age groups can be extrapolated to the over 65s, where the sample was too small to show an effect either way?

 

[Supine]

Supposedly this is from Germany's analysis of the results for the AZ vaccine.

It shows that in the over 65 group, 1 in 341 vaccine recipients got Covid-19, and 1 in 319 placebo recipients got it.

I can certainly see why you might look at that and decide there's no evidence of efficacy for that age group.

Presumably the approval in the UK relies on the trials indicating that it's safe for the over-65s, and just hoping that the efficacy shown in younger age groups can be extrapolated to the over 65s, where the sample was too small to show an effect either way?




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its also based on the over 65's showing a good immune response to the vaccine i believe.

i'd imagine a lot of >65's were hiding at home last year so less likely to catch covid / help the trial determine efficacy.

 

[2hats]

Supposedly this is from Germany's analysis of the results for the AZ vaccine.

It shows that in the over 65 group, 1 in 341 vaccine recipients got Covid-19, and 1 in 319 placebo recipients got it.

I can certainly see why you might look at that and decide there's no evidence of efficacy for that age group.

Presumably the approval in the UK relies on the trials indicating that it's safe for the over-65s, and just hoping that the efficacy shown in younger age groups can be extrapolated to the over 65s, where the sample was too small to show an effect either way?

The efficacy data from AZD1222 clinical trials for 65+ is not very substantive right now. To be fair to AstraZeneca they have always been quite clear that there is a paucity of data in those age groups. What the trial data do show though is an immune response (in sera) to the vaccine in 65+, but not quite as strong as in younger cohorts (to be expected). That's part of the basis for the JCVI/MHRA recommendations/approval. Precisely how that translates to efficacy is not straightforward and only further extensive trials will clarify.

Note that those German trial results for the 65+ cohort have huge confidence intervals, the sample in each group is small, and only one infection per group (vaccine recipients and control) implies there wasn't much exposure, so it doesn't really shed much light on those matters.

e2a: More results for AZD1222 from a US phase III trial of >30K participants are expected within the next couple of months.

 

[elbows]

Well by starting outr vaccination programme at a time when viral prevalence has been very high, we'll probably soon have lots of real world data to analyse. Or perhaps not, if rates of infection fall very dramatically in a way that is sustained all the way down to low levels. I recall that they had some similar issues with the first wave diminishing in a manner that made it harder for them to get the desired numbers in some clinical trials.

 

[magneze]

I think I know the answer but has any country nationalised vaccine production so it's no longer controlled by pharmaceutical companies?

 

[platinumsage]

Novavax phase III trial success including against Kent and South African variants:

Is being manufactured in Teeside

 

[Supine]

Novavax phase III trial success including against Kent and South African variants:

Is being manufactured in Teeside

90% effective but only 49% against the B.1.351 variant. That included people with HiV so could partly explain the lower results. The vaccine is being reformulated for this mutation. Its looking likely that a booster every year or two will be required.

 

[2hats]

90% effective but only 49% against the B.1.351 variant. That included people with HiV so could partly explain the lower results. The vaccine is being reformulated for this mutation. Its looking likely that a booster every year or two will be required.

NVX-CoV2373 96% efficacy wrt B.1.117, 86% wrt B.1.1.7, 60% wrt B.1.351 all HIV-, 49% wrt B.1.351 with HIV+ members included. Large CIs for the B.1.351 results. No severe episodes of COVID-19 amongst the vaccinated.

 

[William of Walworth]

90% effective but only 49% against the B.1.351 variant. That included people with HiV so could partly explain the lower results. The vaccine is being reformulated for this mutation. Its looking likely that a booster every year or two will be required.

The figures you mention from that tweet are (?) 'phase 2b' trials.

But do you know whether tweaks to the vaccine are allowed/likely to happen ahead of or during full-on phase 3 trials??

 

[2hats]

NVX-CoV2373 96% efficacy wrt B.1.117, 86% wrt B.1.1.7, 60% wrt B.1.351 all HIV-, 49% wrt B.1.351 with HIV+ members included. Large CIs for the B.1.351 results. No severe episodes of COVID-19 amongst the vaccinated.

One other observation buried in the trial data: previous infection with earlier SARS-CoV-2 variants did not prevent reinfection with B.1.351. Novavax is already working on a bivalent vaccine to target both earlier variants and B.1.351.

 

[cupid_stunt]

The one shot Johnson & Johnson vaccine is looking promising.

A fifth vaccine, made by the US company Johnson & Johnson, has shown efficacy against the coronavirus and could transform prospects for protecting both the UK and the rest of the world, because it needs only a single dose.

The vaccine, made by the US giant’s subsidiary Janssen, based in the Netherlands, was trialled in the UK – and the British government has bought 30m doses. The EU has ordered 400m doses.

The company said it had 72% efficacy in preventing Covid in the US but a lower rate of 66% was observed globally in the large trial conducted across three continents and against multiple variants.

Johnson & Johnson one-dose Covid vaccine shown to work

UK has bought 30m doses of product that could transform world’s immunisation programmes

www.theguardian.com

 

[2hats]

EMA approval for AZD1222 for use in anyone 18+ based on ~60% efficacy seen in trials on 18-55 year olds.
"However, protection is expected, given that an immune response is seen in this age group [>55] and based on experience with other vaccines".
EMA recommends COVID-19 Vaccine AstraZeneca for authorisation in the EU - European Medicines Agency

 

[Monkeygrinder's Organ]

The one shot Johnson & Johnson vaccine is looking promising.

Johnson & Johnson one-dose Covid vaccine shown to work

UK has bought 30m doses of product that could transform world’s immunisation programmes

www.theguardian.com

Is it 'one dose' because there's something fundamentally different about it to the others, or just that they've decided to run one dose tests? Seems they're testing now whether two doses is better.

 

[prunus]

Is it 'one dose' because there's something fundamentally different about it to the others, or just that they've decided to run one dose tests? Seems they're testing now whether two doses is better.

The latter, basically. It's largely the same tech as the AZ one (don't know if J&J use an adjuvant as well maybe?)

 

[DaveCinzano]

The one shot Johnson & Johnson vaccine is looking promising

Might help take-up if there was a discreet rebranding, mind

 

[Wilf]

Might help take-up is there was a discreet rebranding, mind

Boris Johnson... one shot you say...

 

[Indeliblelink]

 

[2hats]

mRNA vaccinations in children.

U.S. likely to start COVID-19 vaccination in children by late spring or early summer - Fauci

The United States will likely start vaccinating children by late spring or early summer, top U.S. infectious disease expert Anthony Fauci said on Friday, as studies are underway to test the safety and effectiveness of Pfizer Inc and Moderna Inc's COVID-19 vaccines in children...

www.reuters.com

 

[Sunray]

I think there is real promise for the frighteningly expensive polyclonal antibody cocktail from Regeneron. The one that saved Trump.

It's being trialled in the UK. The Germans just bought a lot of doses for £1775 per dose.

Hard to believe it's not working at least modestly well if they spent that much cash on it.

 

[weltweit]

Sunray that is a stunning price. Amazed that anyone is placing any orders for that!

 

[Supine]

Sunray that is a stunning price. Amazed that anyone is placing any orders for that!

Compare it to the cost of having someone in an ICU for a day and it's remarkably cost effective

 

[weltweit]

Compare it to the cost of having someone in an ICU for a day and it's remarkably cost effective

True enough, but compared to the at cost price Astra Zeneca of £3.00 per dose?

 

[prunus]

True enough, but compared to the at cost price Astra Zeneca of £3.00 per dose?

Different things - one’s a vaccine the other a treatment. And you’d probably have to vaccinate more than 400 people to prevent one going into intensive care, so the cost comparison isn’t far away anyway.

 

[weltweit]

Different things - one’s a vaccine the other a treatment.

Oh aha, didn't realise.

And you’d probably have to vaccinate more than 400 people to prevent one going into intensive care, so the cost comparison isn’t far away anyway.

 

[2hats]

First major 'real world' vaccine performance study in. Here a retrospective cohort phase IV study of 2.6 million recipients of BNT162b2 in Israel. After the first jab, by 24 days, a relative risk reduction of 51% overall is seen, slightly lower (44%) in older (60+) cohorts (based on PCR confirmed infections), though that "might be an underestimation".
"Together our findings and the 95% efficacy shown in the phase III trial, suggest that the BNT162b2 vaccine should be administered in two doses to achieve maximum protection and impact in terms of disease burden reduction".
DOI: 10.1101/2021.01.27.21250612.

 

[Sunray]

First major 'real world' vaccine performance study in. Here a retrospective cohort phase IV study of 2.6 million recipients of BNT162b2 in Israel. After the first jab, by 24 days, a relative risk reduction of 51% overall is seen, slightly lower (44%) in older (60+) cohorts (based on PCR confirmed infections), though that "might be an underestimation".
"Together our findings and the 95% efficacy shown in the phase III trial, suggest that the BNT162b2 vaccine should be administered in two doses to achieve maximum protection and impact in terms of disease burden reduction".
DOI: 10.1101/2021.01.27.21250612.

I think this is the same as the Phase III trials. The current idea is to stop people going into hospital when vaccine supply is limited.

Then hope a second dose will be a booster when we get more vaccines.. I see the logic to this, we will see if this pays off in the coming month or two.

 

[2hats]

The latter, basically. It's largely the same tech as the AZ one (don't know if J&J use an adjuvant as well maybe?)

They tested adjuvants in earlier trials but I can't find one in the most recent phase III formulation.

 

[2hats]

Is it 'one dose' because there's something fundamentally different about it to the others, or just that they've decided to run one dose tests? Seems they're testing now whether two doses is better.

One reason for only developing and trialling single dose is to (try to) speed up delivery to market (short <1 month dosing windows were trialled for similar reasons - get results sooner).

But it also partly addresses a weakness of viral vector vaccines - which AZD1222 will likely suffer from (for example) - one of a limited window of utility arising from the immune response to the viral vector itself which can reduce the effectiveness of a second dose (or subsequent booster shots), homologous boosting, as your immune system attacks the vaccine undermining delivery of the immunogen payload (in part, if not all).

This can be addressed by using a different viral vector for each subsequent dose but the choice of viral vectors is limited. The Russian Sputnik V viral vector vaccine uses two different human adenoviruses for precisely this reason and this is quite possibly why the AZD1222 accidental half/full dose regime appeared to be more efficacious than full/full - the first half dose didn't prime the immune system to attempt to undermine the second to the same degree that the first full dose did. Indeed, there is work underway looking into using AZD1222 with Sputnik V to see if this heterologous boosting might make for a good two dose combination.

This is another big win for RNA and protein subunit platforms - there is no virus based vector 'vehicle' as such. So there are no viral vector antigens for the immune system to respond to, so no immunity to the vaccines themselves can be acquired and consequently there is no response to interfere with subsequent doses/boosters.

 

[Cloo]

It seems to me like, when it comes to reopening society, a lot hangs on whether, or the degree to which, vaccines inhibit infectiousness. I hope/presume someone, somewhere is monitoring this in vaccinated people? Would it be a case of 'backwards tracing' and presumably you'd have to test a selection of vaccinated people regularly?