Vaccine Megathread No 2 - Read OP before posting

SJFly · 13-06-2021 11:16PM

It's really interesting to watch the incidence rates collapse around Europe while ours remain stagnant. The vaccine hesitancy in many countries has meant they have gone down through the age groups quickly. Is this working out in their favour? I know there was talk months ago about prioritising the 18-30 year olds, which was later abandoned, but it may be the case that our numbers won't settle until at least some of this age group are vaccinated. I don't know the right answer but I think the government need to keep looking at how to maximise the effectiveness of the rollout at a population level.

SJFly · 13-06-2021 11:17PM

PhoenixParker wrote: »

I think they did a bit of targeted vaccination in Limerick.

OK. That's good to hear.

lucernarian · 13-06-2021 11:44PM

SJFly wrote: »

It's really interesting to watch the incidence rates collapse around Europe while ours remain stagnant. The vaccine hesitancy in many countries has meant they have gone down through the age groups quickly. Is this working out in their favour? I know there was talk months ago about prioritising the 18-30 year olds, which was later abandoned, but it may be the case that our numbers won't settle until at least some of this age group are vaccinated. I don't know the right answer but I think the government need to keep looking at how to maximise the effectiveness of the rollout at a population level.

That's a good point. My hunch would be that emphasising the age-based rollout instead of allowing for a modicum of "all ages can apply if they really want it", at least after all 40+ year olds were offered one, might be more suitable as the way the public have voluntarily followed advice and heeded the law suggests that people more desperate for the vaccine are also more at risk to others via working with lots of other people, or living in crowded settings and whatnot. Instead we will be prioritising people who may be more likely to be working from home to begin with, instead of trusting people who've made their own calculations and desperately want the vaccine. Whether it's the 20-something working with that colleague who doesn't believe in covid while living with elderly parents, or the apprentices who are too busy to be thinking of social distancing on a site but lives with 5 other lads in a cramped Dublin house rental.

Based on the available info on mortality, it's increasingly ethically dubious to prioritise based on age when we start with the 30-something group. There should be some informed consent for Janssen vaccines based on doctor consultation like Germany, at the minimum.

PhoenixParker · 13-06-2021 11:44PM

SJFly wrote: »

It's really interesting to watch the incidence rates collapse around Europe while ours remain stagnant. The vaccine hesitancy in many countries has meant they have gone down through the age groups quickly. Is this working out in their favour? I know there was talk months ago about prioritising the 18-30 year olds, which was later abandoned, but it may be the case that our numbers won't settle until at least some of this age group are vaccinated. I don't know the right answer but I think the government need to keep looking at how to maximise the effectiveness of the rollout at a population level.

There's been a fairly decent drop this week. 121/100k to 110/100k.

SJFly · 13-06-2021 11:52PM

PhoenixParker wrote: »

There's been a fairly decent drop this week. 121/100k to 110/100k.

And hopefully it will keep going in the right direction. A few weeks ago we had one of the lowest incidence rates in Europe and soon we may have one of the highest. If there is something we can do to change that (without going in to another lockdown) it should be considered.

lucernarian · 13-06-2021 11:57PM

PhoenixParker wrote: »

I think they did a bit of targeted vaccination in Limerick.

It's the first I heard about this. Back in January, in desperate times, I screamed from the rafters about prioritising Donegal and Louth, as they had hit prevalence rates exceeding 2% of the population in 14 days. My sources indicated no prioritisation for them based on feedback from nursing home HCWs in those areas. And at a point where 25 year old friends of mine working in blood testing in a large Dublin hospital got their first Pfizer dose already. Admittedly, it was still given in January. But there was such an extraordinary emergency in some areas that it raised lots of doubts, like how and when could they respond to new challenges with 10x the available doses coming in each week.

Wolf359f · 14-06-2021 12:03AM

SJFly wrote: »

It's really interesting to watch the incidence rates collapse around Europe while ours remain stagnant. The vaccine hesitancy in many countries has meant they have gone down through the age groups quickly. Is this working out in their favour? I know there was talk months ago about prioritising the 18-30 year olds, which was later abandoned, but it may be the case that our numbers won't settle until at least some of this age group are vaccinated. I don't know the right answer but I think the government need to keep looking at how to maximise the effectiveness of the rollout at a population level.

Very interesting observation. From the map view, you can see mid/eastern European rates dropping, faster than western Europe. Flip side, Eastern Europe have higher daily deaths per/mil than western Europe. That kinda ties in to what you were alluding to.

Wolf359f · 14-06-2021 12:05AM

SJFly wrote: »

And hopefully it will keep going in the right direction. A few weeks ago we had one of the lowest incidence rates in Europe and soon we may have one of the highest. If there is something we can do to change that (without going in to another lockdown) it should be considered.

Why would we soon have the highest incidence rate in Europe?

duffman13 · 14-06-2021 12:06AM

lucernarian wrote: »

It's the first I heard about this. Back in January, in desperate times, I screamed from the rafters about prioritising Donegal and Louth, as they had hit prevalence rates exceeding 2% of the population in 14 days. My sources indicated no prioritisation for them based on feedback from nursing home HCWs in those areas. And at a point where 25 year old friends of mine working in blood testing in a large Dublin hospital got their first Pfizer dose already. Admittedly, it was still given in January. But there was such an extraordinary emergency in some areas that it raised lots of doubts, like how and when could they respond to new challenges with 10x the available doses coming in each week.

Not sure on this to be honest, Louth, Monaghan, Cavan and Donegal all got good supplies quickly up until maybe March. Donegal maybe not the same extent as the others.

Louth has dropped back since mainly due to capacity issues but and another small vaccination centre has come on stream in Drogheda I believe. It may not have been said but border counties were given additional support its just at that point supply was generally low

deeperlearning · 14-06-2021 12:06AM

Which is more important - reducing the case numbers or reducing the numbers hospitalised with covid. I think most people (with the exception of ISAG) would agree with the latter.

The age-based vaccination programme has been very successful at reducing the numbers hospitalised with covid and these numbers have fallen dramatically. A very high percentage of over 50s here have at least one dose of the vaccine and our hospitalisation rates per million are currently lower than the UK and most (if not all) other countries in the EU.

SJFly · 14-06-2021 12:11AM

Wolf359f wrote: »

Why would we soon have the highest incidence rate in Europe?

If you look at the trends, that's the way it is heading. Not that we are getting worse, but everywhere else is improving so much faster.

lucernarian · 14-06-2021 12:12AM

Wolf359f wrote: »

Very interesting observation. From the map view, you can see mid/eastern European rates dropping, faster than western Europe. Flip side, Eastern Europe have higher daily deaths per/mil than western Europe. That kinda ties in to what you were alluding to.

Also a good point and shows how this is a very tricky issue both ethically and from a pure healthcare perspective. Though I'd highlight German experiences, where rapid antigen tests are widely used, the predominant rollout is/was age-based, but there is a shift to demand-led rollout, and there was comparatively early access to a proven vaccine that could be administered if a qualified doctor thought it was appropriate despite side effect risks.

It's worth heeding this as we make our way out of the pandemic while case numbers are still dropping slowly.

Wolf359f · 14-06-2021 12:16AM

lucernarian wrote: »

Also a good point and shows how this is a very tricky issue both ethically and from a pure healthcare perspective. Though I'd highlight German experiences, where rapid antigen tests are widely used, the predominant rollout is/was age-based, but there is a shift to demand-led rollout, and there was comparatively early access to a proven vaccine that could be administered if a qualified doctor thought it was appropriate despite side effect risks.

It's worth heeding this as we make our way out of the pandemic while case numbers are still dropping slowly.

I don't get that point. Demand-led in what way?
Were we wasting our time forcing elderly and vulnerable people to take the vaccine when it should have been focused on others who wanted it?

lucernarian · 14-06-2021 12:21AM

deeperlearning wrote: »

Which is more important - reducing the case numbers or reducing the numbers hospitalised with covid. I think most people (with the exception of ISAG) would agree with the latter.

The age-based vaccination programme has been very successful at reducing the numbers hospitalised with covid and these numbers have fallen dramatically. A very high percentage of over 50s here have at least one dose of the vaccine and our hospitalisation rates per million are currently lower than the UK and most (if not all) other countries in the EU.

That's not as simple a question as you put it. While vaccines are capable of protecting against all known variants, that does not give us carte blanche to allow low risk groups be unvaccinated while opening up the country (and be inherently wanting to enjoy the benefits of that). If the vaccines appear capable of eliminating endemic circulation of the vaccine, as basic microbiology would predict, that changes the focus of the risk factors a bit. New Zealand opted to get workers involved with the quarantine system vaccinated first, not nursing home residents.

lucernarian · 14-06-2021 12:23AM

Wolf359f wrote: »

I don't get that point. Demand-led in what way?
Were we wasting our time forcing elderly and vulnerable people to take the vaccine when it should have been focused on others who wanted it?

I think you need to reread my post then. Emphasis on "shift to".

Wolf359f · 14-06-2021 12:27AM

SJFly wrote: »

If you look at the trends, that's the way it is heading. Not that we are getting worse, but everywhere else is improving so much faster.

So if we exclude the UK, Spain, Portugal & Belarus, all of which are increasing.
Then it's possible when the rest get to super low cases (ie. vaccines doing their job) then yes, with a smaller population, 100 cases in Ireland looks worse than 100 cases in Germany.

To put it into context, Israel have a 7 day rate of 1.57 and New Zealand is 0.77.
So Israel is 2x as bad as New Zealand, that's so tragic /s
The difference between the 2 countries is **** all. 2x of **** all is still **** all.

Wolf359f · 14-06-2021 12:29AM

lucernarian wrote: »

I think you need to reread my post then. Emphasis on "shift to".

I'm asking what demand-led is?
Are we vaccinating people who don't want the vaccine and slowing down the vaccination of people demanding it?
Who in German is demanding the vaccine and are they going to shift to them over the elderly and more vulnerable?

joebloggs32 · 14-06-2021 12:39AM

SJFly wrote: »

If you look at the trends, that's the way it is heading. Not that we are getting worse, but everywhere else is improving so much faster.

Testing levels here are much higher than most other Eu states. That's why our case numbers are not falling the same way as in other European states.

However, our hospitalisation numbers are almost the lowest in Europe. That is the true barometer in the fight against covid. A relatively strong vaccination program allied with the careful unwinding of restrictions this last couple of months has served us well in the covid battle.

lucernarian · 14-06-2021 12:46AM

Wolf359f wrote: »

I'm asking what demand-led is?
Are we vaccinating people who don't want the vaccine and slowing down the vaccination of people demanding it?
Who in German is demanding the vaccine and are they going to shift to them over the elderly and more vulnerable?

You're asking 3 questions there, that have unrelated answers. What exactly do you want to know?

ClosedAccountFuzzy · 14-06-2021 12:51AM

I think we’ll be more likely to not have further waves and bubbles though. I could see big issues with some countries with high rates of vaccine hesitancy.

Also the trends could well be socially driven. Ireland has a younger population than many of those countries with lower increases and we’ve a very, very big tendency to socialise in a congregated way.

So you could be looking at demographics and culture and even weather as much as anything else.

Unlike the US, it’s not as easy to just compare EU counties like for like as you are looking at often quite dramatically different cultures around some of the things that matter a lot in how this spreads.

The figure to watch for is really about how many of those cases are converted to hospitalisations or bad outcomes.

At the rate we are going with vaccines we will have very very high levels of coverage fairly soon.

deeperlearning · 14-06-2021 12:54AM

lucernarian wrote: »

That's not as simple a question as you put it. While vaccines are capable of protecting against all known variants, that does not give us carte blanche to allow low risk groups be unvaccinated while opening up the country (and be inherently wanting to enjoy the benefits of that). If the vaccines appear capable of eliminating endemic circulation of the vaccine, as basic microbiology would predict, that changes the focus of the risk factors a bit. New Zealand opted to get workers involved with the quarantine system vaccinated first, not nursing home residents.

New Zealand nursing home residents were not dying.

Your suggestion that we should have allowed those in nursing homes to die and focuses our attention solely on curtailing the spread of the virus is utterly grotesque.

You are a member of ISAG, I take it?

lucernarian · 14-06-2021 12:54AM

joebloggs32 wrote: »

Testing levels here are much higher than most other Eu states. That's why our case numbers are not falling the same way as in other European states.

However, our hospitalisation numbers are almost the lowest in Europe. That is the true barometer in the fight against covid. A relatively strong vaccination program allied with the careful unwinding of restrictions this last couple of months has served us well in the covid battle.

Yeah I think I agree. I have some niggling doubts about not having the most likely superspreaders vaccinated also, but we are getting there. I don't have concerns about the current known variants, it's the future/unknown variants that pose some longer-term questions. I'd like SARS-CoV-2 eliminated before it gets a chance to re-emerge from zoonotic hosts.

lucernarian · 14-06-2021 12:56AM

deeperlearning wrote: »

New Zealand nursing home residents were not dying.

Your suggestion that we should have allowed those in nursing homes to die and focuses our attention solely on curtailing the spread of the virus is utterly grotesque.

You are a member of ISAG, I take it?

Wtf is ISAG even? What suggestion are you talking about? Are you being actually serious here?

Wolf359f · 14-06-2021 12:57AM

lucernarian wrote: »

You're asking 3 questions there, that have unrelated answers. What exactly do you want to know?

The questions are related. I could ask you what demand-led is and you can say it's the young people demanding the vaccine. Then I ask why are they not vaccinating all the older and more at risk population first? Then you say they have done and are finished. Then I ask if they had a higher uptake on vaccines on the 65+ than Ireland had? (They don't report it to the ECDC). So I ask, should we abandon the older age groups and let the younger take the vaccine ahead of them.

We have extremely high uptake in the 50+ age group, we can just offer it to the younger groups while we still have a demand.

ClosedAccountFuzzy · 14-06-2021 01:02AM

Basically you’re arguing that we should abandon the middle aged people say 30-50 and put all the focus on 18-30?

That was discussed and it’s really making a lot of assumptions about the 30 somethings having no social lives or risks. They’re also more likely to be at work, more likely to have children at school who will be unvaccinated and could bring it home etc etc

The key metric is whether cases are causing bad outcomes. Case numbers are only one measure of what’s going on. Given our pattern of immunisation, the higher risk groups are covered and we’re working our way down the mid/low risk now. What way you organise that starts to matter less and less and reverse chronological order seems as sensible as anything else.

The figures for 65+ here were close to 100%. Bear in mind though our population bulge is 35-45 year olds. The demographics in some other continental countries is much more weighted towards older cohorts.

Every strategy for allocation of doses will have pros and cons. The issue at the moment is we’ve enough doses to plough on and get through the full pop.

Spain is probably very comparable as they’ve also got huge uptake and very little vaccine hesitancy. Same in Scandinavia.

Germany, France, Austria and some eastern EU members are having bigger challenges.

lucernarian · 14-06-2021 01:08AM

Wolf359f wrote: »

The questions are related. I could ask you what demand-led is and you can say it's the young people demanding the vaccine. Then I ask why are they not vaccinating all the older and more at risk population first? Then you say they have done and are finished. Then I ask if they had a higher uptake on vaccines on the 65+ than Ireland had? (They don't report it to the ECDC). So I ask, should we abandon the older age groups and let the younger take the vaccine ahead of them.

We have extremely high uptake in the 50+ age group, we can just offer it to the younger groups while we still have a demand.

I could say that, but I haven't and I wouldn't. The rest of your post seems irrelevant after that. Not. All. Vulnerable. Groups. Are. Vaccinated. The problem is that we are purely relying on age for registration eligibility when we going to offer it up to 30-somethings who are unvaccinated soon. And in doing so, we are ignoring risk of transmission while risk of hospitalisation is not really established in the cohorts we are reaching soon. To date, under 40 year olds are highly unlikely to die from the disease, but are most likely to spread the virus (as NIAC have noted).

ClosedAccountFuzzy · 14-06-2021 01:14AM

We’ll have already reached 40 - there are people born in 1981 now getting vaccinated. So this becomes a bit of a moot point at this stage.

It’s really an argument between going though the 20s or the 30s first at this point.

A lot of those who are vulnerable and delayed at present is due to having been given AstraZeneca which had a longer interval spacing, which is now reduced a bit.

Wolf359f · 14-06-2021 01:17AM

lucernarian wrote: »

I could say that, but I haven't and I wouldn't. The rest of your post seems irrelevant after that. Not. All. Vulnerable. Groups. Are. Vaccinated. The problem is that we are purely relying on age for registration eligibility when we going to offer it up to 30-somethings who are unvaccinated soon. And in doing so, we are ignoring risk of transmission while risk of hospitalisation is not really established in the cohorts we are reaching soon. To date, under 40 year olds are highly unlikely to die from the disease, but are most likely to spread the virus (as NIAC have noted).

I'm sorry I can't understand what you're saying.
Vaccinate those most likely to spread Covid, but are least at risk, while the older people (who seemly have no social life) remain at risk. I seriously doubt 40+ people and 18+ people don't meet day to day. Or do 40+ people all socialize in the same social circle and none have kids which could spread it to the 40+ people and then in turn that 40+ person spreads it within their social circle?

Anyways, in Germany they have or may change their vaccine rollout to be in demand-led, what does that mean? The more vocal group get's it first?

ClosedAccountFuzzy · 14-06-2021 01:22AM

It mostly means that they’re having serious issues with vaccine reticence.

This is one area where I think we can probably do a lot better than Germany, France etc. I wouldn’t be getting too focused on what they’re doing as being particularly relevant here right now. It’s the same with the US too. They’re trying very hard with incentives like lotteries and so on to get past huge anti vaxxer issues.

They’re moving to demand led because they can’t get enough people to come forward or that’s where they’re about to get to.

Ireland has the opposite issue. We’ve huge demand and the system is trying to meet it. You’ve people turning up at vaccine centres who don’t even have appointments and people getting very antsy about not being able to het a vaccine NOW and checking the portal multiple times a day.

If we went demand led right now we’d swamp the system as it seems almost everyone wants a vaccine. So we we more in queue management mode than trying to drive demand.

lucernarian · 14-06-2021 01:24AM

FuzzyThinking wrote: »

Basically you’re arguing that we should abandon the middle aged people say 30-50 and put all the focus on 18-30?

That was discussed and it’s really making a lot of assumptions about the 30 somethings having no social lives or risks. They’re also more likely to be at work, more likely to have children at school who will be unvaccinated and could bring it home etc etc

The key metric is whether cases are causing bad outcomes. Case numbers are only one measure of what’s going on. Given our pattern of immunisation, the higher risk groups are covered and we’re working our way down the mid/low risk now. What way you organise that starts to matter less and less and reverse chronological order seems as sensible as anything else.

The figures for 65+ here were close to 100%. Bear in mind though our population bulge is 35-45 year olds. The demographics in some other continental countries is much more weighted towards older cohorts.

Every strategy for allocation of doses will have pros and cons. The issue at the moment is we’ve enough doses to plough on and get through the full pop.

Spain is probably very comparable as they’ve also got huge uptake and very little vaccine hesitancy. Same I’m Scandinavia.

Germany, France, Austria and some eastern EU members are having bigger challenges.

It's a bit of a simplification but at least a reasonable response. I disagree with the 30-40 cohort being more likely to be "at work", but I think the other points are very relevant. Based on the data, <40 year olds do not face a significant risk from covid when pre-existing conditions are excluded, and age profile is not easy to characterise as the older one gets, the more likely they are to have some of the risky conditions that also makes them vulnerable to begin with.

What I'm trying to say is that when we reach the point of having medically-vulnerable folks vaccinated or given some level of protection, we should look towards providing vaccines for those who want it most after that. Germany allows anyone who's recommended by a doctor to get the Janssen vaccine currently. These people may be at low-risk personally but can understand they may be likely to spread the disease to a lot of folks.

Vaccine Megathread No 2 - Read OP before posting

Comments