Monica Gandhi MD, MPH Profile picture
Apr 1, 2021 19 tweets 6 min read Read on X
Wanted to put all real-world effectiveness data for you on the vaccines together in a thread with slides so you can see where we are in the world- have come long way from our clinical trial data table with all of this real-world date. Image
Data from Israel Ministry of Health released by Pfizer press release on March 11, 2021 Image
Data from Israel and the UK Image
Data from nursing homes here in the US (CDC) Image
Health care workers in US with vaccination despite winter surges Image
CDC data from March 29 Image
And Pfizer data from this morning (April 1) on 40K participants, 6 months data, works against variants as well, 100% protection severe disease. No joke, these vaccines really work. Ok, super busy x 2 days but will tweet on weekend (vax after COVID-19?) & if huge news before Image
Good news on real-world data on Moderna vaccine at 6 months (more details later today): >90% effectiveness against all symptomatic COVID; > 95% against severe COVID. Efficacy: how works in clinical trials; effectiveness: how works in real world
reuters.com/article/us-hea…
Another study on real-world effectiveness, this time among healthcare workers in Mayo Clinic system (Florida, Minnesota, Arizona). Very large study & these studies compare groups likely taking same "risks": unvaccinated cohort 23,931; 2-dose vax 44,011
academic.oup.com/cid/advance-ar…
876 symptomatic infections in unvaccinated (37 out of 1000); 22 symptomatic infections in fully vaccinated (0.4/1000). 96.8% effectiveness for Pfizer vaccine; 98.6% effectiveness for Moderna in this real-world large study. Higher than clinical trials. Image
Another article here on real world effectiveness on vaccines, this time among those >65 in US. Examined respiratory illness admissions among adults >65 from Jan 1, 2021–Mar 26, 2021 in 24 hospitals across 14 states as vaccines first given in this group
cdc.gov/mmwr/volumes/7…
January-March 2021 still high circulating virus in U.S., most vulnerable group for severe illness (>65) &hospitalizations for COVID-19 down 94% with vaccines (Remember, Moderna had few outcomes in their clinical trial among >65 so real-world reassuring on Moderna) Image
Another stunning study on the real-world effectiveness of the vaccines detailing the vaccine roll-out in Israel even with 95.4% of strains being B.1.1.7 during later phase of roll-out (this paper details findings from Jan 24-April 3 roll-out) thelancet.com/journals/lance…
Pfizer vaccine 95% effective overall against symptomatic COVID-19; 92% effective in preventing asymptomatic infection; 98% effective against hospitalizations, 97% effective against death across all age groups even >=85 yrs. Cases still declining despite full opening March 2, 2021 Image
This high level of effectiveness seen across all age groups even those >= 85 years. Also, even though children not vaccinated (can only use vaccine >16 years old), cases in all age groups massively low even with opening of society. Fastest vax campaign on planet. Image
And though I had this study on "why not to worry about variants" thread, realized important to add here which is Qatar mass vaccination campaign from Dec 21 2020-March 31, 2021. Although virtually all circulating virus in country at end of that period was
nejm.org/doi/full/10.10…
either B.1.351 (South Africa variant) or B.1.1.7 (UK variant), the effectiveness of the vaccine (Pfizer) remained extremely high for severe outcomes at 97.4%. So must really add here that the effectiveness of the vaccines in real-world settings is Image
even higher than the efficacy of the vaccines in clinical trials so we should not longer be saying "you have a 5% chance of catching the virus" if you have had the vaccine. These studies show real-world effectiveness even higher & of course your chance of being
exposed depends on circulating cases in your community ( going down in US). Data from 4/26-out of <95 million fully vaxed in US, 6025 symptomatic breakthroughs (0.006%); 0.0006% hospitalizations for COVID; Deaths 0.0001% for COVID (1 in million); cdc.gov/vaccines/covid…

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More from @MonicaGandhi9

Aug 30, 2023
HOW LONG DOES IMMUNITY LAST? To COVID vaccines or infection? We do not really know but there have been some really nice papers lately that give us more information. Please remember immunity divided into antibodies (which can come down & not work as well against variants)
IgA is one in the nose & mouth ("mucosa") that is raised by shots (vaccines) to certain extent but rise higher after natural infection; IgG is the one that is "humoral" or in the bloodstream. Many threads on here about cellular-mediated immunity: B & T cells cover all variants
This recent preprint is really important and summarized by @florian_krammer below in depth. Main take-aways: Breakthrough infections induce IgA (we knew) but protection from vaccine long-lasting even against former variants to severe disease/mortality
Read 8 tweets
May 3, 2023
RSV VACCINE FOR OLDER ADULTS: Respiratory syncytial virus (RSV) respiratory virus (most common after flu pre-COVID). 2 subtypes, A&B (1 dominates/season). Droplet; Recurrent infections. Most severe in neonates & adults >65; FDA approves 1st RSV vax today
msn.com/en-us/news/us/…
RSV vaccine 3 trials of new RSV vaccine, all published in the @NEJM recently so just to keep them straight- here is the vaccine which just got approved May 3 by the FDA for older adults. Remember our T/B cells so protection against severe disease higher!
nejm.org/doi/full/10.10…
A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related severe respiratory illness by 94% in adults>=60 years (71% against RSV infection, likely to fall with time as antibodies fall but severe disease protection will remain)
Read 4 tweets
Mar 21, 2023
NASAL VACCINES: To explain nasal vaccines, we have to explain the immune system first.
IgA is an antibody that helps attack the pathogen and exists in mucosal surfaces (like nose/mouth)
IgG is an antibody that is in the bloodstream
bbc.com/news/world-asi…
Cellular immunity is fantastic, redundant (so even if one cell line down in immunocompromised, have other), generated by either vaccine or infection; Comprised of
T cells- so in breadth from vax - works even across spike protein with its mutations
And the 2nd type of cell produced by vaccines or infection -B cell- amazing thing about B cells is that - if see omicron or one of its subvariants in future- they make antibodies adapted to that variant or subvariant (aided by T cells); adaptive immunity
Read 15 tweets
Mar 15, 2023
PUBLIC HEALTH POLICY: Seem to be at reckoning phase of COVID response- what worked, what didn't. Which interventions will be used in future pandemic responses? Interventions asked of public need good medical evidence for them (e.g. RCTs preferably, systematic reviews) to impose
In our field, Cochrane reviews represent best way to sum up the medical evidence to date by performing meta-analyses or systemic reviews of currently-available data; here is Cochrane on masks & other interventions for respiratory viruses including COVID
cochranelibrary.com/cdsr/doi/10.10…
Many asked past 3 years how CDC developed policies on masks (& age to mask), distancing (feet), ventilation, schools-> all non-pharmaceutical interventions. Originally theory-based. Now 3 years in, have data (RCTs highest level) to form policies from both US and other countries
Read 4 tweets
Mar 6, 2023
VACCINE DISCRIMINATION: We need to stop vaccine requirements for US entry like almost every other country. Am finishing COVID chapter for our ID "bible" & vaccines prevented transmission early on with alpha, but not enough now with current variants to justify such discrimination
Moreover, shame, stigma, blame (remember COVIDiots?), coercion, discrimination not good public health tools. When used for HIV, public health & ID physicians decried them but tactics used a lot in COVID. This book tries to explore & correct that for future
barnesandnoble.com/w/endemic-moni…
Concept of #harmreduction in pandemic responses means watching carefully if vulnerable people (like students, older people, low-income populations, migrants, sex workers, prisoners, those with disabilities, refugees, minorities) harmed more by response
nature.com/articles/s4146…
Read 4 tweets
Feb 8, 2023
FEAR: Some media & public health officials concerned Americans aren't fearful of COVID now. But the vaccines & therapeutics DO WORK. If we can't celebrate biomedical advances & imbibe their effectiveness (we have better tools for COVID than flu), what is point of developing?
In HIV medicine, when therapies came out, we didn't say to people- stay fearful; make this the controlling principle of your life. The book #Endemic I wrote (coming out July 11, 2023) hails these biomedical advances & the age we are in to fight pandemics to reassure the world
This is a rather brilliant summary of the issue from @benryanwriter
Read 4 tweets

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