Anvisa (Brazil's drug regulator) has just announced it has denied the request to import Sputnik V vaccine because of absence of data & issues with the development of the vaccine, including vax quality. g1.globo.com/bemestar/vacin… Meeting still streaming ..1/n
...Unanswered questions about the vaccine include basic biological data about its actions in the body, data on adverse events (including questions about thromboembolic events) ...2/n
...I think with all the focus on Lancet paper for phase 3, people forget how little study there had been of this vax: eg only 38 people in phase 1/2 trial version with lots of problems. (absolutelymaybe.plos.org/2020/09/11/pha…) Assessing a vaccine isn't only about the phase 3 trial results...3/n
...They pointed to issues with reporting of adverse events in the phase 3 trial (I wrote about this here: absolutelymaybe.plos.org/2021/03/16/com…). Remember: deficiencies in a trial/study program are not the same as deficiencies in a vax, but they affect how certain we can be about the vax...4/n
..*So* wishing I understood Portuguese properly right now! Big thanx to @gutoaqui who's translating these slides as I post them.
Here pointing to uncertainties around vax efficacy because of biases that could arise from the way they ascertained & determined cases of Covid-19..5/n
... This is depressing. Basically, the developers have failed to provide enough data to back up their claims of efficacy & have left a string of open questions about te vaccine's development. ...6/n
...Questions about quality control of manufacturing. (I'm now at the point I'm glad I don't understand enough Portuguese - this is too depressing) ...7/n
...Distilling some of the fundamental issues lacking here: assurance of potency of the formulation (if I understand that correctly) & basic issues about how replication for the adenoviral vectors in both shots...8/n
...The catalog of what's missing to explain the action of these vaccines continues: here basics about spike protein & replication of the Ad26 component (the 1st dose of Sputnik V). (I'm only including some of the slides, not all of them) ...9/n
...Onto trying to establish the credentials of the manufacturing sites: couldn't, if I'm understanding this correctly.
I've seen enough. This seems very thorough work again from Anvisa. For those who want to see more, a reminder it's here 10/10
PS: The adenovirus in Covid vax is not supposed to replicate (it's supposed to be just a carrier). Specific critical detail on Anvisa's Sputnik V evaluation I missed: replicating adenovirus was identified in every lot of the vax inspected coronavirus.atarde.com.br/diretoria-da-a… HT @swiftshoes
Important PPS: the Ad26 vax lots (first Sputnik V shot) not yet analyzed - this is what was identified in every lot of the Ad5 vax (2nd shot) HT @Dereklowe
Woke up to see this BBC graphic & claim doing the rounds. It's a great example of how data can come with a variety of biases & why perspectives on Covid vaccines is dramatically skewed in entire countries because of national/media bias. Here's why...1/n
..First the claim about AZ being the cheapest: it's on the cheaper end, but it's not the cheapest.
There are 2 aspects to this: the costs of a dose & the costs of vaccinating. Eg vaccinating with a single dose is far cheaper; needing super-freezers is far more expensive...2/n
...Out of vaxes on the BBC list, cheapest per person are Covaxin & CanSino (single dose).
J&J not far off AZ in real costs: manufactured in richer countries so doses more expensive, but it's one of several non-profit vaccines & it's a single dose ...3/n
Sinovac's CoronaVac in Chile: for Feb-Mar, during major outbreak. Data from National Health Fund, comparisons adjusted for age, gender, region, income, nationality. Fully vaccinated after 14 days was effective; 1 dose wasn't ...1/n minsal.cl/wp-content/upl… (TY for all the alerts!)
...Data doesn't report dosing interval. Covers about 10.5 million aged 16+. 34% of the group was fully vaccinated, but only the CoronaVac data reported here. Comparisons are for people with positive PCR tests: no info on how good that coverage is...2/n
...5.1m had 2 doses, 7.6m, 1; 90% are CoronaVac, reported here. Partially vaxed = 14 days after 1 dose; fully = 14 days after 2.
Sinovac's CoronaVac, in healthcare workers in Uni of São Paulo hospital vs the city: considerable uncertainty, but suggests ca 50% effective despite high level of variants of concern 2 wks after dose 2, rising to around 70% some weeks later...1/n medrxiv.org/content/10.110… Preprint
.For the healthcare workers, "cases" = Covid-19, symptomatic & confirmed. Around 22,000 healthcare workers were vaccinated. If they had symptoms, they left work & got tested... 2/n
...The data are compared with the officially published rates of Covid-19 in the city (presumably not necessarily all symptomatic). Early testing was inadequate as the rate of confirmed cases didn't track with deaths. Later on though the estimates for the city more reliable...3/n
Some things to keep in mind when you see people dumping on "low efficacy" of "Chinese Covid vaccines", particularly based on that single medium-sized trial in Brazil of doses only 2 weeks apart...1/n
...There's the obvious ones: the results of this trial aren't the whole picture - not of the trials that are underway, nor of the way the vaccine is being used (doses more than 2 wks apart)...2/n
...The efficacy against fearsome outcomes was good in this trial - a vaccine that could prevent over 80% of the worst outcomes & reduce the severity in a major way is incredibly needed in a world bereft of enough options...3/n
Preprint on Brazilian trial by @butantanoficial of Sinovac's CoronaVac, 2 weeks apart. Data for 9,823 people who had 2 doses, 12,396 after 1 dose.The P1 ("Brazilian") variant of concern was not circulating in the areas the trial ran...1/n papers.ssrn.com/sol3/papers.cf… HT @josegallucci
...14-day interval seems too close, & immunity may increase over time: they recommend 28 days. Their primary efficacy, unlike other vax trials, includes people who had previous SARS-CoV-2 infection. But this table provides the comparable number: 50.5% (CI 34-63)..2/n
...Their primary efficacy analysis was based on 85 vs 168 people with symptomatic Covid-19. Unfortunately, they don't provide detailed data on symptoms so can't try to see whether this was milder disease than other trials... 3/n
The FDA has said it investigated the blood clot/low platelets cases after J&J vaccine & found no causal association with the vaccine: they're continuing to investigate. abc.net.au/news/2021-04-1… Given the way the EMA's statement of formal investigation is being reported,...1/4
..I went back to EMA press conference to check my tweets. Peter Arlett from EMA said: (at ~40 mins) Since the trial "There have been 3 cases with the J&J vaccine of blood clots associated with low platelets which have some similarities to these cases...2/4
...that we’ve been describing today for AstraZeneca vaccine. However the numbers are extremely small compared to the 4.5 million patients vaccinees that have received the J&J vaccine worldwide.” (~51 mins) "…if you look at those reports of blood clots with thrombocytopenia...3/4