"The number of new cases of #covid19 reported to WHO has now declined for 6 weeks, and deaths have declined for 5 weeks”, says @DrTedros at @WHO presser. "However, we still see a mixed picture around the world.” Deaths went up in Africa, Americas and Western Pacific last week.
@DrTedros@WHO “Increasingly, we see a two-track pandemic: many countries still face an extremely dangerous situation, while some of those with the highest vaccination rates are starting to talk about ending restrictions”, says @DrTedros.
@DrTedros@WHO "With the increased global transmission of variants of concern including the Delta variant, lifting restrictions too quickly could be disastrous for those who are not vaccinated”, says @drtedros.
@biorxivpreprint What we already knew:
There is very little genomic data on 1918 flu. Basically two full genomes from the US (one from a woman buried in permafrost in Alaska, one from a soldier who died in Camp Upton, NY) and a few dozen short fragments.
Getting vaccinated this week was a “bittersweet moment”, for him, says @DrTedros at @WHO press conference. “On the one hand, vaccination is a triumph of science, and global solidarity", he says. On the other hand, global vaccine inequity is continuing.
@DrTedros@WHO “My thoughts were very much with the health workers around the world who have been fighting this pandemic for more than a year”, says @DrTedros.
"The fact that so many are still not protected is a sad reflection on the gross distortion in access to vaccines across the globe."
@DrTedros@WHO "I understand why some countries want to vaccinate their children and adolescents”, says @drtedros. "But right now, I urge them to reconsider and to instead donate vaccines to COVAX.”
The most comprehensive review of how the world responded to #covid19 and how to prevent the next pandemic was published today.
It will likely be the basis of discussions in coming months and years and so I read it for you.
Who wrote the report?
This is the Independent Panel for Pandemic Preparedness and Response (IPPPR), established last year in response to a resolution of the World Health Assembly.
It consists of 13 members led by @HelenClarkNZ and @MaEllenSirleaf.
@HelenClarkNZ@MaEllenSirleaf (To be completely transparent:
I was actually interviewed by this panel in February but only about the communication aspects of the pandemic. I have no other involvement with this report or the panel.)
"Globally, we are now seeing a plateauing in the number of #COVID19 cases and deaths, with declines in most regions”, says @DrTedros at @WHO presser. "But it’s an unacceptably high plateau, with more than 5.4 million reported #covid19 cases and almost 90.000 deaths last week."
@DrTedros@WHO “We've been here before”, says @drtedros. “Over the past year, many countries have experienced a declining trend in cases and deaths, relaxing public health and social measures too quickly, and individuals have laid down their guard, only for those hard won gains to be lost."
@DrTedros@WHO "We are still in a perilous situation”, says @DrTedros.
"The spread of variants, increased social mixing, the relaxation of public health and social measures and inequitable vaccination, are all driving transmission."
@GretchenVogel1@Sciencenorwayno I have made the point again and again that his is about context.
In this case on top of low infection rates (see page 9):
- mRNA vaccines are becoming available faster in Norway
- 2nd dose of mRNA now to be given after 12 weeks, so more people will get first dose faster.
@GretchenVogel1@Sciencenorwayno If the context changes, decision may too:
Recommendation is "based on the level of knowledge we have at present… Changes in infection rates, new virus mutants, unforeseen problems with vaccine deliveries and new information about side effects could lead to other conclusions"
“I know that this is not a politically easy thing to do. So I very much appreciate the leadership of the United States", says @DrTedros at @WHO presser on #covid19 about US support for #TRIPSwaiver “We urge other countries to follow their example.”
@DrTedros@WHO "We are in an unprecedented crisis that requires unprecedented action”, says @drtedros.
“The World Trade Organization provisions for IP waivers were designed precisely for a situation like this.
If we don't use them now, then when?"
@DrTedros@WHO This is important news:
"This afternoon, WHO gave emergency use listing to Sinopharm Beijing's #COVID19 vaccine, making it the sixth vaccine to receive WHO validation for safety, efficacy and quality."
UK’s Joint Committee on Vaccination and Immunisation is now advising healthy adults younger than 40 “to receive an alternative to the Oxford/AstraZeneca vaccine – where available and only if this does not cause substantial delays in being vaccinated”.
This is based on the fact that “the chances of a younger person becoming seriously ill with #COVID19 get smaller as infection rates increasingly come under control in the UK”. @GretchenVogel1 and explored these trade-offs in risk and benefit here:
@GretchenVogel1 UK's regulator, the MHRA:
"The balance of benefits and risks is very favourable for older people but is more finely balanced for younger people and we advise that this evolving evidence should be taken into account when considering the use of the vaccine” gov.uk/government/new…
So where are we on the rare clotting disorder linked to AZ and J&J shots? What do we know? How do risks and benefits compare? What does it mean long-term and around the world? @GretchenVogel1 and I tried to answer some questions, thread to come in a bit.
This is complex and I‘m tired of people pretending it‘s all obvious.
So a few general points about the decisions that have to be made here:
- local, but with global implications
- based on imperfect data in an evolving pandemic
- about individual decisions as well as population-level effects (and these two things can point in opposite directions)
In the US the Advisory Committee on Immunization Practices (ACIP) is meeting at the moment to discuss data on the rare clotting disorders seen after immunization with J&J’s #covid19 vaccine and to make recommendations on future use of the vaccine.
I’ll tweet along a bit.
Outcomes from the rare clotting disorders are likely to improve from "recognition among physicians also recognition in the public that if you develop a severe headache, severe abdominal pain that you really need to see your doctor", says @mstreif1.
@mstreif1 As of 21 April, 15 confirmed cases of the rare clotting disorder (here called TTS, Thrombosis with Thrombocytopenia Syndrome) after about 8 million vaccinations with J&J’s #covid19 vaccine, says @CDCgov's Tom Shimabukuro
“We have now heard of 8 cases of these very rare side effects as part of the rollout in the US, where the vaccine has been given to over 7 million vaccinees”, says EMA head Emer Cooke at press briefing on the safety review of J&J's #covid19 vaccine.
“This is a very rare effect but it also makes it very important for doctors and patients to be aware of the signs so that they can spot any concerns and seek specialist help as soon as possible”, says Cooke. "Early intervention by specialists can change the outcome."
"The scientific assessment that PRAC has concluded on today will allow vaccination programs in member states to take decisions on how to roll out this vaccine based on their national situation” (infections, hospitalizations, ICU admissions, vaccine availability), says Cooke.
Getting a bit annoyed at everyone using numbers from yesterday’s Oxford pre-print to compare how often CVST occurs after mRNA vaccines and AstraZeneca vaccine.
We cannot directly compare these numbers because they came about in completely different ways.
The authors say so themselves IN the preprint:
"we cannot directly compare the risks of CVT associated with ChAdOx1 nCoV-19 with any of the other vaccines, or with COVID-19, since we are using data collected by the EMA monitoring system, not from the electronic health records..."
And yes, @UniofOxford press release does exactly that anyway:
"Compared to the AZ-Oxford vaccine, the risk of a CVT from COVID-19 is about 8 times greater."
This is one reason (of many) why we need science journalists and not just press releases.
There is an interesting new preprint out that will probably generate a lot of coverage at least in the UK. Essentially it argues that the risk of CVST is much higher from #covid19 than from vaccines.
Quick thread on this:
Here is an image from the paper that is likely to feature heavily in debates around this.
As you can see the risk of CVST here seems to be 8-10 times higher in people with CVST than in people who received mRNA vaccines or AstraZeneca.
BUT: A lot of caveats here.
First of all:
The paper really only makes a like-with-like comparison with mRNA vaccines (as authors pointed out in presser this morning too: “I think our data say actually nothing about the AZ vaccine.”).
That’s why the data on AstraZeneca is greyed out in that graph.
Most fascinating bit of ACIP meeting so far is a detail on the 25-year old male in J&J trial, who developed CVST with hemorrhage after 8 days.
J&J representative says it was retrospectively determined that he was negative for anti-PF4 antibodies before vaccination, positive after
Case reports are fascinating.
Here are some details on the case from previous tweet.
(Short sentence on anti-PF4 antibodies is a bit misleading here: he was negative at baseline, positive post-vaccination according to the presentation)
As I have said before these decisions depend a lot on context. In this case:
- infections are low
- other vaccines available and
- oldest people largely vaccinated (so future vaccinees would be younger)
Different places will come to different conclusions and that’s reasonable.
"In the midst of an epidemic, it has been a difficult decision to continue our vaccination programme without an effective and readily available vaccine against COVID-19. However, we have other vaccines at our disposal, and the epidemic is currently under control.”
“While these events are very rare, we’re recommending a pause in the use of the J&J #COVID19 vaccine in order to prepare the healthcare system to recognize and treat patients appropriately and to report severe events they may be seeing in people”, says @CDCgov’s Anne Schuchat.
@CDCgov Q how long the pause may be
“The timeframe will depend obviously on what we learn in the next few days. However, we expect it to be a matter of days for this pause”, says @DrWoodcockFDA.
@CDCgov@DrWoodcockFDA "The issue here with these types of blood clots, is that if one administers the standard treatments that we as doctors have learned to give for blood clots, one can actually cause tremendous harm or the outcome can be fatal”, says Peter Marks.
I just don’t get it, @NateSilver538. I admire your work on polling and you clearly appreciate the complexity there.
You can argue about the FDA decision for sure, but pretending it is blindingly obvious that they are wrong, simply isn’t true or fair to this situation.
As so often in this pandemic, I agree with @angie_rasmussen here.
I don’t think vaccinated individuals need to lose sleep over this, but I certainly want people at the agency tasked with ensuring the safety of vaccines to lose a little sleep over this.
US FDA is recommending a pause in the use of the J&J #covid19 vaccine while they investigate 6 reported cases of the kind of rare clotting disorder seen after AZ vaccine too.
Should not come as a huge surprise to those of you who have been following the reporting on this.
As @GretchenVogel1 and I wrote last week, EMA is already investigating this safety signal.
Given that this vaccine (like AZ one) too uses an adenovirus to deliver the genetic instructions for #SARSCoV2 spike protein, there were worries about this.
@GretchenVogel1 There will be a press conference at 10am ET that may have more information.
But for now, think of this as a cautious approach to a safety signal, similar to what, for instance, PEI in Germany did when reports of AZ side effects emerged almost exactly a month ago.
Gerade etwas verdutzt festgestellt, dass wir @pandemiapodcast jetzt schon seit mehr als einem Jahr machen. Am 13.4.2020 kam unsere zweite Folge raus, in der wir über Ebola in Liberia sprechen.
Was war eure Lieblingsfolge? Was würdet ihr gern noch hören?
Und an dieser Stelle etwas verspätet ein riesiges Dankeschön an alle, die uns im ersten Jahr unterstützt haben! @pandemiapodcast ist ein Herzensprojekt, aber die Finanzierung ist nach wie vor schwierig und wir hätten es nicht bis hierhin geschafft ohne großartige Unterstützung:
“We have now seen seven consecutive weeks of increasing cases and four weeks of increasing deaths”, says @DrTedros at @WHO presser on #covid19. “Last week was the fourth highest number of cases in a single week so far."
@DrTedros@WHO "This is despite the fact that more than 780 million doses of vaccine have now been administered globally”, says @DrTedros.
"Make no mistake, vaccines are a vital and powerful tool, but they are not the only tool."
@DrTedros@WHO “Confusion, complacency and inconsistency in public health measures, and their application are driving transmission and costing lives”, says @DrTedros.
"It takes a consistent, coordinated and comprehensive approach."