The @JNJNews vaccine FDA briefing documents are out, so we now can see how well this single adenovirus vector vaccine dose works fda.gov/media/146217/d… 1. It is efficacious, overall 66%, but not as high as the mRNA vaccines (even in US with D614G strain).
2. While 85% efficacy was seen for severe infections, there was some falloff in participants > 60 yrs of age
3. A look at asymptomatic infections (carrier state) suggests the efficacy for reducing that is similar to overall efficacy
4. There was a notable impact in efficacy by variants, geography of participants
5. Protection from death or hospitalizations was incomplete
6. More on deaths or hospitalizations (post hoc analysis)
All 7 covid deaths in placebo arm, but hospitalizations did occur in vaccine arm before 28 days, thereafter were all prevented
7. Overall solid evidence of safety, 1 Guillian-Barre, unresolved, a couple of facial paralysis events resolving
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There's a problem with labelling the California variant (B.1.427/B.1.429) "increasingly dangerous" when there isn't even a preprint published and we're watching dramatic descent in cases, hospitalization and deaths despite its high frequency latimes.com/science/story/…
More @nytimes on this today, without the "dangerous" stuff.
But I am not convinced there is any meaningful functional difference for this "California variant" in light of above comment (the real laboratory is what is going on in California) nytimes.com/2021/02/23/hea… by @carlzimmer
Preprints weren't enough.
Now we've got the "leaked" report + cognitive bias.
We all want to see vaccines block spread—faster end of the pandemic and need for masks
The leaked Israeli Ministry of Health report, 1st reported by @Nadav_Eyal, then by @techreview. gets much attention
The bold conclusion above is not only based on "sketchy" data, according to @Nadav_Eyal, but now being promoted as breaking news by @bloomberg
It's certainly possible that the vaccine achieves ~90% reduction in spread, but we're not there yet— even though it's the news we all want to see. Nothing like the combo of a "leaked" report and hunger for good news.
—They demonstrated how essential flattening the curve is when, during 2 surges, there was ~25% excess mortality that could have been averted
—B.1.1.7 is now 80-90% of infections. Its arrival in Israel helped their decision to go forward with very aggressive vaccination /2
—At peak of their vaccination initiative, exceeding their projection, it was equivalent to vaccinating 10 million Americans/day
—Already w/ age >60 (>90% are vaccinated), there has been 55% fewer cases, 40% fewer hospitalizations, 35% fewer deaths /3
1. Asymptomatic #SARSCoV2 carriers after vaccines, as aptly drawn by @nataliexdean (adapted @TheEconomist)
Even w/ the most highly effective vaccines (below), there'll likely be carriers, who can transmit, because shots aren't expected to achieve sterilization/mucosal immunity
2. The likelihood may increase over time after vaccination (with less circulating IgA levels, non-secretory) and with variants that have heightened transmissibility (like B.1.1.7). frontiersin.org/articles/10.33… and @VirusesImmunity
3. An intranasal vaccine would be ideal for that but they have taken a back seat to shots, even though they provide perfect complementarity. Single dose potential striking in experimental model cell.com/action/showPdf…
1. Instead of booster shots for the troublesome variants, why don't we develop bNAbs—broadly neutralizing antibodies—that are pan-coronavirus? nature.com/articles/d4158…
Dennis Burton, my @scrippsresearch colleague, and I wrote about this @nature today
2. Coronaviruses, unlike HIV and influenza are "evasion-lite." Whereas HIV constantly evolves inside hosts w/ 100,000 different strains, and influenza has marked sequence variability. The marked success of the vaccines vs the #SARSCoV2 spike protein shows how it can be outwitted
3. A schematic of bNAbs—pan-virus vaccines has been furthered by a recent @PNASNews report of an HIV neutralizing antibody this is 5,000 fold more potent pnas.org/content/118/3/…