One thing that struck me tonight is that the UK roll-out of vaccine is much more in line with public health and practicality than US rollout which is much more 'academic'. For those in academia, you know what I mean but we pay attention to every single detail of the trials-
In fact, an academic ID doctor worth their salt better know which HIV trial of the new injectable HIV medications allowed in a K103N mutation or not. However, when it comes to achieving herd immunity, we do not need 100% of the population to have 100% protection- we need as many
people as possible to get vaccinated as soon as possible with any of these vaccines, all of which encode for the entire spike protein and are very immunogenic. So, the UK authorized AZ/U of Oxford vaccine, Moderna, & Pfizer because the more you authorize the more supply you have.
UK putting 1st shots in as many as possible now with a plan for 2nd shots 12 wks later because later is okay (for instance, in childhood vaccinations, we don't want 2nd dose too soon but if child misses visit, fine to be late; AZ trial showed longer duration more immunogenic)
And if someone got a 1st shot and somehow wasn't recorded what kind, the 2nd shot can be another kind (I know, I know, not the trial design but no one cares at this point which HepB shot you get at 6 months if you forgot what you gave at 0 months). This is practical.
Practical will get us to herd immunity faster. So, would advise authorization of J&J vaccine ASAP as 1 shot is practical and having more companies provide vaccine will get more U.S. population immunized sooner; approve AZ/Oxford asap and that will make 4 vaccines. Academic
thinking and strict adherence to trial design may not be the most practical approach in a public health emergency when the tools are now available (vaccines) and time is of the essence.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Monica Gandhi MD, MPH

Monica Gandhi MD, MPH Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @MonicaGandhi9

1 Feb
okay let's put it specifically from NYT since everyone thinks I am Pollyanna: "In official language of research science, vaccine is typically considered effective only if it prevents people from coming down with any degree of illness..."
nytimes.com/2021/02/01/bri…
"With a disease that’s always or usually horrible, like ebola or rabies, that definition is also the most meaningful one.
But it’s not the most meaningful definition for most coronavirus infections. Whether you realize it or not, you have almost certainly had a coronavirus. "
"Coronaviruses have been circulating for decades if not centuries, and they’re often mild. The common cold can be a coronavirus. The world isn’t going to eliminate coronaviruses — or this particular one, known as SARS-CoV-2 — anytime soon. Yet we don’t need to eliminate it for"
Read 5 tweets
1 Feb
Efficacy refers to how a drug/vaccine does in a clinical trial; effectiveness refers to how it does in the "real world". Nice preprint on the effectiveness on the Pfizer vaccine which has arrangement with Israel to get data weekly as it rolls out
medrxiv.org/content/10.110…
503,875 individuals (mean age 59·7 years); 351,897 had 13-24 days of follow-up. Cumulative incidence of infection was 0·57% days 1-12 and 0·27% days 13-24. Relative risk reduction 51.4% after 1st dose with more expected after 2nd. Real world looks as good as trial, exciting!
By the way, for my academic friends, this is clearly being reviewed at Lancet with the decimal point in the middle and the "evidence before this study" part at the beginning!
Read 6 tweets
30 Jan
And then wanted to explain why you should be beaming ear-to-ear about vaccine data. Why would an infection trigger all of this testing, masking, life halting? Because severe illness/hospitalizations/deaths occur. All vaccines to date prevented hospitalizations/deaths completely.
Severe illness prevented completely in Moderna/Pfizer/AztraZeneca trials; 85% across regions (even in South Africa - South Africa variant there) in J&J trials and immune response from 1 dose may keep on giving (remember, outcomes evaluated 14-28 days out due to expediency)
But as I wrote yesterday, immunogenicity from 1 dose of J&J likely extends beyond 14-28 days - keeps on going so likely more protection over time - see graphs in this paper. Two-dose trial still going. Finally, S. Africa variant is one with less protection
nejm.org/doi/full/10.10…
Read 6 tweets
30 Jan
Know very tempting to feel nervous about variants. Please don't: 1) RNA viruses do mutate and those more fit spread more readily; 2) SARS-CoV-2 has much lower mutational rate than influenza A - we are seeing more because transmission high, want to tamp down (& now sequencing);
3) Vaccines do not generate just antibody response, but T cell responses (measured in all 3 trials published) and B cell responses). So if neutralizing antibodies slightly lower in vaccinated blood to a variant (and not yet lower in clinically significant way), remember T cells.
4) So far, all of these vaccines involve genetic material that code for the spike protein/RBD- mRNA in mRNA vaccines and double-stranded DNA in adenovector vaccines. Sequences of genetic material can be "tweaked" to respond to variants as needed; 5) As tweeted before, efficacy
Read 4 tweets
29 Jan
Wonderful news about the Johnson&Johnson vaccine! Let me explain (and also let me tell you I was just on an interview with Dr. Paul Offit, who believes - like me- that control is nigh). J&J vaccine press release here:
jnj.com/johnson-johnso…
J&J vaccine is a modified cold virus adenovirus (this vector doesn't replicate or cause illness in humans) with double stranded DNA coding the spike protein of SARS-CoV-2 inside. Nice explanation of NYT of how it works. The adenovirus "vector" (carrier)
nytimes.com/interactive/20…
gets the DNA inside host cell nucleus where it is "transcribed" into mRNA and then you make the spike protein of the virus % raise immune response against it. Initial phase I/II data from NEJM showed high immunogenicity of 1st dose that went up over time.
nejm.org/doi/10.1056/NE…
Read 10 tweets
29 Jan
At risk of upsetting people, I need to address why I think teachers should feel very safe going to in-person learning after vaccination. Let's start with why COVID-19 was a bad virus and how vaccines defang this virus and then let me address transmission one more time. As said
many times, Moderna and Pfizer phase 3 trials were meant to assess the risk of COVID-19 infection with symptoms as they were designed for expediency. So, 1st outcome was 1) do you have any symptoms suggestive of COVID-19, we will swab and see if you have COVID-19? 2nd outcome was
did you get severe disease from COVID-19?. In terms of 1st outcome to look at, 95% of COVID-19 cases with symptoms occurred in people who got placebo, not vaccine. Vaccine massively reduced chance of getting COVID-19 with symptoms. In 2nd outcome, all of the severe COVID-19
Read 16 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!