COVID-19: Vaccine and testing procedures Megathread Part 3 - Read OP

stephenjmcd

stephenjmcd wrote: »

Hopefully NIAC take a very practical viewpoint here, I'd be ok with something along the lines of the UK saying over 30s and a preference to use something else for under 30s but to still have AZ available for u30 if needs be.

Putting a limit of say 50 or 60 could seriously slow down the rollout in my view. I couldn't see how the June targets would be met & significant delay.

https://www.irishtimes.com/news/ireland/irish-news/ministers-fear-new-astrazeneca-restrictions-will-slow-vaccine-rollout-1.4534654?mode=amp

The UK simply don't have the scope to go for a similar age cut off to other countries. They have already vaccinated the over 50s and they are very much reliant on AZ as the workhorse vaccine there. The fact that they have applied any restriction at all is significant.

Like other European countries, we have more flexibility here due to the make up of our supply. I think younger cohorts waiting a few extra weeks to be given a safer vaccine is fine. By that point the elderly and vulnerable will be covered.

stephenjmcd

Flying Fox wrote: »

The UK simply don't have the scope to go for a similar age cut off to other countries. They have already vaccinated the over 50s and they are very much reliant on AZ as the workhorse vaccine there. The fact that they have applied any restriction at all is significant.

Like other European countries, we have more flexibility here due to the make up of our supply. I think younger cohorts waiting a few extra weeks to be given a safer vaccine is fine. By that point the elderly and vulnerable will be covered.

AZ is roughly 20% of supply in Q2, whatever about their delivery schedule and the schedule of others its a large number and would have an impact whatever way you look at it. The higher the cut off (if there is one - not going to second guess NIAC) the more severe the impact & it would impact rollout to the vulnerable, the lower the cut off the less impact. It's a very very rare side effect, lots to weigh up for NIAC.

Pfizer is the workhorse here but it needs all the others to chip in & AZ is a big part of that.

As for the rest of the post I think we've exchanged views on this in the AZ thread a good bit so not going to bring it back up, we'll agree to disagree on a bit of it.

Miike

I wonder if NIAC will take the route of 2nd vaccine from a second manufacturer or start a new schedule (ie; get 2 doses of Pfizer for people who have 1 dose of AZ gotten). I don't think there a question they will limit it based on age at this point. I'd be fairly satisfied to motor on with my AZ schedule though.

The decision to use AZ as the dominant HCW vaccine in certain parts of the country is going to haunt this government in my opinion.

sd1999

Miike wrote: »

I wonder if NIAC will take the route of 2nd vaccine from a second manufacturer or start a new schedule (ie; get 2 doses of Pfizer for people who have 1 dose of AZ gotten). I don't think there a question they will limit it based on age at this point. I'd be fairly satisfied to motor on with my AZ schedule though.

The decision to use AZ as the dominant HCW vaccine in certain parts of the country is going to haunt this government in my opinion.

Given the three month gap between AZ doses, there might be enough of other vaccines by then to complete a new course with a different vaccine? Maybe those with one AZ dose who are too young to get a second one could get J&J?

Stark

J&J and AZ are essentially the same vaccine in the way that Pfizer and Moderna are essentially the same. I imagine any advice that applies to AZ will also end up applying to J&J which is more worrying than just AZ being restricted. (We're due something like 400,000 J&J in June by which time it'll be mostly young people that we have left to vaccinate).

funnydoggy

https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/vaccination-programme-dashboard-as-of-10-april-2021.pdf

Saturday the 10th of April

+12,287 total doses
+9,178 dose 1
+3,109 dose 2


I really hope that this picks up a lot. Kinda concerning, but I do know we are ramping up so I just need to sit down and wait. Also, I know it's a weekend day so naturally lower.

Miike

sd1999 wrote: »

Given the three month gap between AZ doses, there might be enough of other vaccines by then to complete a new course with a different vaccine? Maybe those with one AZ dose who are too young to get a second one could get J&J?

I can't see this flying with a lot of AZ recipients and might actually increase hesitancy. Totally my opinion though but with how the optics look for a lot of people at the minute: I already got AZ and it's been restricted because of clotting so the offer to fix that is a another vaccine currently under review for clotting?

I know one thing for certain I'd rather continue with the AZ vaccine if the replacement is going to be the J&J one, considering with a new vaccine you introduce a whole new set of possible side effect profiles and we have exactly zero data on how this mixing of vaccines works out.

stephenjmcd

sd1999 wrote: »

Given the three month gap between AZ doses, there might be enough of other vaccines by then to complete a new course with a different vaccine? Maybe those with one AZ dose who are too young to get a second one could get J&J?

Of course France went down this route but I wouldn't see us following. There's no firm data on this course of action and it's not something either WHO or EMA are in a position to recommend. It's a risk to be honest.

Would need more trial data.

At the end of the day with AZ we're looking at a very very rare side effect, for the majority we should continue with the use of AZ is my opinion.

MerlinSouthDub

funnydoggy wrote: »

https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/vaccination-programme-dashboard-as-of-10-april-2021.pdf

Saturday the 10th of April

+12,287 total doses
+9,178 dose 1
+3,109 dose 2


I really hope that this picks up a lot. Kinda concerning, but I do know we are ramping up so I just need to sit down and wait. Also, I know it's a weekend day so naturally lower.

120,000 for the last 7 days, which I think was the target. They've talked about 180,000+ this week. Hopefully, the AZ stuff doesn't disrupt that.

funnydoggy

MerlinSouthDub wrote: »

120,000 for the last 7 days, which I think was the target. They've talked about 180,000+ this week. Hopefully, the AZ stuff doesn't disrupt that.

Fingers crossed. I'm normally very optimistic about it so I'll just stay hopeful

Van.Bosch

MerlinSouthDub wrote: »

120,000 for the last 7 days, which I think was the target. They've talked about 180,000+ this week. Hopefully, the AZ stuff doesn't disrupt that.

We did slightly less this week than last which isn’t great. A week of 180,000 will be good though and boost confidence we can handle the “ramp up”

Miike

stephenjmcd wrote: »

Of course France went down this route but I wouldn't see us following. There's no firm data on this course of action and it's not something either WHO or EMA are in a position to recommend. It's a risk to be honest.

Would need more trial data.

At the end of the day with AZ we're looking at a very very rare side effect, for the majority we should continue with the use of AZ is my opinion.

The research proposal from France was only submitted last week. We're a long while out before we have good trial data for their course of action and in the absence of that data as you say the EMA or WHO are not in a position to make that recommendation and quite frankly neither are the NIAC.

I'll take my chances with AZ and evidence based practice please and thank you :pac:

seamus

Deleted User wrote: »

Why? And in what sense?
Firstly why wouldn't we expect to follow the Israelis? Apart from anything else they're even more densely populated so a lower threshold would make sense for us if anything.
And what's this "foot to the floor" mean? Make every keep their lives on hold for even longer?

Sorry, jumping back a bit. We wouldn't follow the Israelis because they're purely using Pfizer. We have a mix with different efficacies, so we can't assume that infection spread will hit the floor at 56% vaccinated.

"Foot to the floor" means we don't ease up on our vaccination programme like Israel have done.

stephenjmcd

The examiner article below for anyone thats interested regarding J&J & choice of vaccine or lack of.

https://twitter.com/irishexaminer/status/1381512436906389504?s=20

Lucas Hood

Would I right in assuming that you can now go to any walk in test center within your county now the 5km limit is gone.?

seamus

We'll probably be a bit like the UK though. People find out through various means, what vaccine is in use in which MVCs and book themselves into the MVC which is using the vaccine they want.

It's probably address-based, but people give relatives' addresses to get around it.

landofthetree

https://twitter.com/BallouxFrancois/status/1381327338533699587

is_that_so

Lucas Hood wrote: »

Would I right in assuming that you can now go to any walk in test center within your county now the 5km limit is gone.?

Think that will remain, in terms of managing numbers it makes sense and it is focusing on local transmissions. That said, they probably couldn't stop you rolling up to one.

salmocab

Lucas Hood wrote: »

Would I right in assuming that you can now go to any walk in test center within your county now the 5km limit is gone.?

They are for targeted localities so I doubt you’d be entitled to a test

josip

stephenjmcd wrote: »

AZ is roughly 20% of supply in Q2, whatever about their delivery schedule and the schedule of others its a large number and would have an impact whatever way you look at it. The higher the cut off (if there is one - not going to second guess NIAC) the more severe the impact & it would impact rollout to the vulnerable, the lower the cut off the less impact. It's a very very rare side effect, lots to weigh up for NIAC.

Pfizer is the workhorse here but it needs all the others to chip in & AZ is a big part of that.

As for the rest of the post I think we've exchanged views on this in the AZ thread a good bit so not going to bring it back up, we'll agree to disagree on a bit of it.

If an over 45 only for AZ was chosen, then there would be c.10% reduction in Q2 first doses.
They would be more than covered by the July supply from the other manufacturers.
Plus they would be fully vaccinated sooner than if they had gotten AZ.

landofthetree

landofthetree wrote: »

https://twitter.com/BallouxFrancois/status/1381327338533699587

https://twitter.com/BallouxFrancois/status/1381327343994642433

https://twitter.com/BallouxFrancois/status/1381327340429524995

https://twitter.com/BallouxFrancois/status/1381327345810804737



https://twitter.com/BallouxFrancois/status/1381327349849948168

Posting much of the remaining information from that thread as some alarmists may incorrectly interpret the initial tweet

josip

This doesn't come as a surprise based on the reported efficacy and anecdotally from what I'm hearing from countries where Sinopharm is doing the majority of vaccinations.

https://www.theguardian.com/world/2021/apr/11/china-considers-mixing-covid-vaccines-to-give-greater-protection

Hopefully they can work out a booster that will increase the efficacy.

Russman

josip wrote: »

If an over 45 only for AZ was chosen, then there would be c.10% reduction in Q2 first doses.
They would be more than covered by the July supply from the other manufacturers.
Plus they would be fully vaccinated sooner than if they had gotten AZ.

That wouldn't be too bad considering. But would there be a reduction at all in the absolute number of first doses ? I haven't really gone through it in detail, but would it not just be a rebalancing of who gets jabbed and when ? If the cut off was over 45 or 50 or whatever, is there enough people in those cohorts for us to use our full AZ allocation on ?
Not arguing with you at all, just hypothetically playing it out really.

Tricky one for NIAC. I know the numbers and the odds don't extrapolate out directly, but if its a 1 in 200k chance of these events, and AZ are doing 800k-1m of our population, we could be seeing 5 cases. If the Norwegian rates came to pass we could be looking at 40-50 cases.

josip

Russman wrote: »

That wouldn't be too bad considering. But would there be a reduction at all in the absolute number of first doses ? I haven't really gone through it in detail, but would it not just be a rebalancing of who gets jabbed and when ? If the cut off was over 45 or 50 or whatever, is there enough people in those cohorts for us to use our full AZ allocation on ?
Not arguing with you at all, just hypothetically playing it out really.

I'd been thinking about that too and the downside I can see is that you'd have to delay vaccinating some of the older, more at risk, AZ-eligible cohort until May, June when AZ doses for those months were delivered.
How much of a downside that would be, versus delaying some of the younger cohort to July would be for NIAC to calculate.

A reporter from The Examiner was just on RTE Radio saying that from speaking to his medical sources, there's no major concern about how any change in NIAC advice would affect the rollout. It's primarily a scheduling issue, and while it would have some impact, it's not as big a deal as is being made out. This is because Astrazeneca makes up only a fifth of our supply this quarter.

titan18

It might not even be an issue. If you go over 50s atm lets say, all you do until probably end of May is disrupt AZ to people under 50 in groups 4 and 7. By the end of May, there might be more information on who exactly is prone to the clotting issue.

sd1999

Flying Fox wrote: »

A reporter from The Examiner was just on RTE Radio saying that from speaking to his medical sources, there's no major concern about how any change in NIAC advice would affect the rollout. It's primarily a scheduling issue, and while it would have some impact, it's not as big a deal as is being made out. This is because Astrazeneca makes up only a fifth of our supply this quarter.

AZ was always planned for the 65-69s too so they've got as long it'll take to give them their first doses to iron things out.

eoinbn

sd1999 wrote: »

AZ was always planned for the 65-69s too so they've got as long it'll take to give them their first doses to iron things out.

Once there is a restriction then that doubt could cascade to other groups. I can see a lot of people in the 50's/60's age groups turning AZ down. Hopefully I am wrong.

Gile_na_gile

Perhaps the MDs can chime in, but it seems the rare clotting issue is more related to the adenovirus platform than the AZ vaccine specifically, since we are seeing similar results from the Janssen vaccine. Given their importance and similar efficacy (J&J seems better against variants), it would indicate it was best to plough on as the UK have done. Let other cohorts start and register their interest if the stock is building up and prioritise vaccination by any means rather than wondering what to do with AZ. The clotting risk is probably common to all groups anyway, since existing data favours the fact that many vaccinated people were female HCWs or social care workers.

Anyone concerned about efficacy might get an mRNA top-up later in the year anyway, probably including protection against new VOCs, but would be good to have some data already on vaccine mixing.

sd1999

eoinbn wrote: »

Once there is a restriction then that doubt could cascade to other groups. I can see a lot of people in the 50's/60's age groups turning AZ down. Hopefully I am wrong.

If that’s their choice they just end up at the back of the queue. There’s no evidence to suggest it’s not safe for them. There’s only so much that can be done.