Now maybe the US can finally approve the AstraZeneca vaccine and put our 20 million (!) doses on hand to good use.
Or not! But if we’re not going to use them, we should send them to another country like Canada or Mexico or Australia or the UK or EU, all of which have approved it and administered millions of doses.
Sitting on 10s of millions of vaccines during a pandemic is inexcusable.
Alas, a lot of that supposed AZ stockpile traces back to the troubled Emergent Biosolutions facility. I don't think it had FDA certification when it produced them.
Exactly zero of the J&J doses from that facility have been given to Americans. 15M J&J doses were discarded because they were contaminated with AZ ingredients. Tens of millions more are currently in quarantine awaiting other evaluations & may never be used. The facility has halted production & there are some hints it may not restart.
Some of the AZ already sent to Canada was from that plant, made under conditions that that can now only be verified imperfectly in retrospect, based on the kind of incomplete records the company has been in trouble for.
Your statement is unverifiable. We need to focus on better testing. The case and death data itself is garbage because of the use of PCR tests with a too high cycle count. Also, the risk of antibody dependent enhancement is a potential disaster.
Those discarded vaccines are assumed to be improperly constructed, in which case they are not an actual instance of the vaccine (rather, something similar but not the same, and that difference is arbitrary and variable).
That is, the vaccine name has been slapped on a box that offers no guarantees of containing that content.
It’s doing things like this that would increase trust in the system, not decrease it.
You need to be able to trust your medicine has been produced correctly, because there’s no real way to verify it as a consumer (or as a doctor, or a pharmacist, or really anywhere after the fact). As soon as that trust is lost, the whole thing falls apart.
You don’t take risks with medicine, because it’s already doing barely controlled, barely calculated shit to the body — that we only trust to do the job it says on the tin, because of the extensive and controlled tests. If those tests are no longer valid, because the medicine involved has qualities unknown (due to improper construction), anything goes.
I've been wondering about the shelf life of that "loan", and while it's reasonable to surmise it was early batches with a limited life, it doesn't look like that article is specifically describing the US shipment as near-expiration.
But: a bigger problem is that most came from the troubled Emergent Biosolutions plant, never FDA-certified, where all of its J&J production has been held back from US use:
Does the US even need the AZ vaccine? Just took a look at https://www.vaccinateca.com/ and there are lots of open slots for appointments. Got a shot yesterday with a next day appointment at a super site and they mentioned things are slowing down. We should give them to our neighbors. Or allow J&J vaccine to be available for people visiting the US.
I also got one recently in the Bay Area. There were a lot of appointments available. It was at a medium-sized site set up for 4-8x the volume. Most of the people in my small group were there for their second shot.
If you look at the national vaccination rate, it looks like it's starting to level off. J&J makes up a small portion of vaccinations in the US, so especially seeing how appointments are easy to get, the rush appears to be over.
Companies generally don’t apply for FDA authorization unless they’re confident they’ll pass. From my limited experience in the bio/med industry companies are usually in contact with the FDA and it’s a really bad look if you get a rejection.
100% agree we should send them elsewhere. It seems we’ve reached the point where we’re manufacturing enough to just about meet demand and our neighbors are struggling.
India produces their own version locally. South Africa has unapproved J&J and AstrV. Central America could use some. Brazil doesn't have a lacking issue, the big issue is they can't get people to take the second dose.
Sure, but if Canada had a pending decision on a vaccine and didn’t want to export inventory until then would anyone blame them?
And decisions to invest in R&D and production facilities has consequences. Canada is finally getting on the ball to build a vaccine factory that will be ready in 2024. Maybe.
That’s because you don’t apply until you have your whole data package. There is no “apply as step 1” it’s “you submit your application when it’s complete”.
My point is the US doesn’t have a “pending decision” on AstraZeneca, the US has the potential (uncertain for many reasons) that they might apply at some time in the future.
Of course, AZ also lost its production capacity even if it was going to be approved, since it was dependent on the troubled Emergent facility which has been taken over but J&J and dedicated exclusively tonthe J&J vaccine, and has not located new production facilities.
Both my wife and I got the J&J shot before it was cancelled. We both had a period about 12 hours afterwards where we felt like we had a mild flu for about another 12 hours, then it was over and we’ve felt fine. Very happy with this decision.
If we're doing anecdata, I too had the J&J shot right before it was cancelled. Literally no symptoms whatsoever. Very happy with the "one and done" relative to my wife who will go in next week for the second Pfizer shot, which has clobbered everyone else in our neighborhood who took it.
My anecdata, I got the J&J shot the Monday before it was cancelled. Went to sleep shivering that night. Felt better the next day, then terrible the day after that, then had an earth shattering headache like a bomb went off in my head the next day after that. Went to the ER at my wife’s insistence that they did a CT scan with the dye and all that. Said everything looks fine. I wasn’t having headaches before this but who knows maybe it’s just a coincidence. Sure seems like I’m getting a lot more headaches in the last couple weeks though.
My anecdote is that I got the JJ and kinda regret it, this blood clot thing made me realize it’s pretty untested , I feel like they should be recommending everyone get a full panel blood test a week after to add more data. After the AZ issues there should have been more scrutiny of the early clot cases
Kind of untested: sorry that's just wrong. All these shots are tested by 40,000 or more people. The problems emerging now are in the one in 100,000 or more. Do the maths on the odds.
More like 1 in 500k. The CDC reports that as of April 21 there have been a total of 15 confirmed cases of this blood clotting condition among nearly eight million doses administered. You probably won't find an issue that rare if you test 40k people.
My research indicated that the median broad-scale vaccine phase III trial is about 22,000 people [1]. I've also seen the 3,000 to 6,000 person range for smaller trials [2].
I can't seem to find it, but I remember reading that vaccine researchers hold their breaths until 1M people have had it for 8 weeks. In normal times, the J&J vaccine would probably be taken off the market or only recommended for men.
The problem is that the people who haven't been vaccinated yet tend to be younger and less likely to die from covid. Granted, it's still much more deadly than the vaccine, but with mitigations and some degree of herd immunity, those odds aren't as compelling as for 65-year-olds.
It's obviously not well tested enough to not get pulled out of use despite the pandemic, so more testing as we move forward seems appropriate. OP has a point, although the form of testing will probably be one less likely to cause people to avoid the vaccine.
Also, what are the odds of a 1 in 10k concern not being picked up as such in a 40k sample size? It would look like background noise if it was only one case in that particular group.
To be clear, I am very much pro continuing use of the vaccine, but it's not the case that every possible 1 in 40k or less concern has been discovered since we had one such group go through a controlled study. Since the odds of COVID causing serious problems are far, far higher than that, it is still a win, but we should of course learn as we go.
> It's obviously not well tested enough to not get pulled out of use despite the pandemic
Or the people making the decision are incredibly risk averse and don't mind an extra few hundred or thousand Covid deaths to save a single person with a blood clot.
>Also, what are the odds of a 1 in 10k concern not being picked up as such in a 40k sample size? It would look like background noise if it was only one case in that particular group.
It's a specific type of blood clot that is incredibly rare and occurs more often in young women. If it had a 1 in 10k rarity it would have probably been found
I never said anything like "the blood clot risk might be 1 in 10k". I said that there can be things that come up a lot more than 1 in 100k that were not found in the trials (not referring to anything specific, just unknown unknowns), and it is not appropriate to stop looking for side effects just because we have done some testing.
I’m not sure whether you’re arguing that this wouldn’t be noticed or if we cannot measure it statistically.
For the former, the side effect is blot clots with thrombocytopenia. That combo is very rare, is indicative of an autoimmune etiology, and would stand out to healthcare providers and be reported. Even if there were a few cases that were not identified or reported, it would not lead to a 2x order of magnitude difference in the reported incidence as you suggest.
If your argument is a statistical one about the study being underpowered, then show your math. Because this is definitely not a small n.
Otherwise, be careful about presuming that something in a domain unfamiliar to you is equally unclear to experts in that domain.
Its not 1 in 10k. You're overstating the risk. It's because its not 1 in 10k it was only picked up after mass vaccination began.
See? you're inflating risk and misunderstanding consequences. How many people die, if nobody is vaccinated compared to a 1 in 100,000 risk of clotting? A lot more than 1 in 100,000 die from covid.
As I said to someone else, I was referring to unknown unknowns and the need to stay vigilant, not to blood clot risks specifically. And I stated expressly that I think the vaccinations should continue. But let's not just stop learning. It's not a big ask.
The average risk of thrombosis the J&J and AstraZeneca vaccine have are between 1 in 100,000 to 1 in 250,000.
To put some perspective, estrogen-based medication like the contraceptive pill have a risk of 1 in 1,000.
Careful, You might be comparing apples and oranges...
Contraceptive pill blood clot risk is for any type of blood clot, such as deep vein thrombosis, pulmonary embolism, etc [0].
The vaccine cerebral venous sinus thrombosis blood clot risk is something like 1 in 100k+ (as you mentioned), but during J&J FDA trials of 20k people there were 50% more blood clots of other various types in the vaccinated group [1] (15 blood clots in vaccinated group versus 10 in the placebo group, which the FDA did not consider statistically significant at the time)
You may be comparing fatal-only vaccine blood clots to non-fatal contraception blood clots, and ignoring non-fatal vaccine blood clots.
I'm not saying this to throw the vaccine under the bus, just pointing out that the comparison of the odds you presented might not be fair.
> You may be comparing fatal-only vaccine blood clots to non-fatal contraception blood clots
At the time vaccination was paused, here were 6 known cases of CVST, 2 fatal, in 6.8 million vaccinated.
To come up with 1 in 250,000 like the OP, you need to consider only women (~3.5 million doses), count all cases (not just the fatalities), and assume more than half of the cases were not reported.
> I feel like they should be recommending everyone get a full panel blood test a week after to add more data.
Why? That would that be a ridiculously impractical recommendation (do we even have the capacity to run millions of full panel blood tests a week?) and completely useless for detecting the problems people are worried about. TTS[1] isn’t something subtle you need a blood test for.
I don't know if we have capacity, thats a good call out.
I just feel like more data is better, the scientist don't seem to understand the mechanism that causes this problem and why it affects a few people but not most.
Your link links the problem to low platelet count, is the vaccine affecting platelets in other people but not enough to manifest the issue? Maybe more data could help figure out why it happened to those handful of people and not others.
The J&J vaccine causes headaches and pains normally , I was down and out for a couple days, I could easily see someone with the issue thinking its normal and waiting too long to go in for help.
Another anecdote: I took the J&J vaccine and felt shitty and tired for 4 days. I generally react this way to the flu vaccine too, so I was expecting it. I didn't experience anything else unusual, and I would still take the J&J vaccine again given the choice. I'm now completely back to normal.
I had Covid in March 2020. It almost did me in. Was in ICU for a while.
Had the J&J shot three weeks ago. Did not feel a thing. My arm was slightly sore at injection site. Nothing else. I guess my body was used to it and just sort of shrugged it off.
Some of my friends who got J&J were sick for a few days, but rebounded quickly after that.
> If I have already had COVID-19 and recovered, do I still need to get vaccinated with a COVID-19 vaccine?
> Yes, you should be vaccinated regardless of whether you already had COVID-19. That’s because experts do not yet know how long you are protected from getting sick again after recovering from COVID-19. Even if you have already recovered from COVID-19, it is possible—although rare—that you could be infected with the virus that causes COVID-19 again.
Another thing is that, although it hasn't been scientifically studied yet, there are some reports that getting vaccinated has helped some COVID long haulers with their symptoms:
> That’s because experts do not yet know how long you are protected from getting sick again after recovering from COVID-19.
Since when has not knowing something been justification for intervention?
Given that people have been getting sick from COVID-19 for at least as long as vaccines have been available for testing, shouldn't experts have a reasonable understanding of whether previously infected people are as protected as recently vaccinated people, or how often (or rare) it is that people can be infected with the virus again?
If most of a population is already infected and has natural immunity, those people would certainly make the efficacy of the product seem much higher.
At some point, they'll declare the campaign a success. We'll never get to see the real data because they aren't collecting it. There's no centralized reporting or control.
In the US, there has been 32M cases reported so far, and who knows how many asymptomatic cases that were never counted. Since a large portion of cases are asymptomatic, the total case count could be multiples of the confirmed case count.
The clinical trials will never be replicated, it will just be 'oops, pandemic over, we assumed it all worked.'
In Singapore they had massive outbreaks in foreign workers dormitories one year ago. Now they have apparently seen new cases among the previously infected, suggesting that immunity starts to wear off after about a year. I'd definitely get vaccinated even if you already had it.
I'm in a similar situation - COVID-19 resulting in an ICU stay, then the vaccine (Oxford-AZ) - and I figured it couldn't hurt (read: was extremely unlikely to cause major side effects) and _may_ confer some slight benefit (similar to mixing vaccines or just renewing my immunity). Vaccine passports were also being mulled around that point, and I assumed it would make that process easier if necessary.
In the end, I did get some side effects, but nothing long term - a hard, hot to the touch, red circle of about 4" diameter formed around the injection site, and I could barely move my arm away from my body without significant pain, both for about a week.
I had COVID in March 2020 too (not as serious of a case as GP) and I'm getting my 2nd Vaccine does tomorrow so I'll answer for myself.
It's actually quite simple for me I'm traveling internationally again and the the first country on my list is a lot easier to get into if you're fully vaccinated. It seems like things will coalesce around people who are vaccinated having greater access to things, at least until enough of the world population is vaccinated that it doesn't matter.
For me, the answer is: the human immune system is weird and error prone.
Perhaps you got better because your innate immune system cleared Covid--you may not have antibodies. Perhaps your immune system keyed off something screwball on the virus--you may have antibodies that are less effective for other variants. I can go on.
Getting the vaccine means that I know I have antibodies to the spike protein in particular--which seems to be common to all the variants.
Even taking the data least charitable to my postulate, a study[1] (which there are issues with that I will not mention) using a sample of 63 million medical records found a reinfection rate of 0.48% compared to 2.2% infection rate for the previously uninfected.
This study therefore estimated protection against reinfection was 78.8%.
That's higher than the 72% efficacy offered by the J&J vaccine.
Potentially all the vaccines; the Moderna and Pfizer vaccines were tested before the emergence of variants. The J&J was more effective in the US where fewer variants were present at the time of testing than internationally where the opposite was true.
The studies have only gone on for, at most, 8 months. So for every time period studied so far, including the longest possible time periods, people retain immunity. Perhaps use this science to revise your initial belief/statement.
While I mostly agree, there have been a few rare cases of reinfection; here [0] is a metastudy that looks at several claims of reinfection, ultimately concluding that 6 cases were credible reinfections. So while the relative risk is very low, I think one could make a plausible argument that since the risk of harmful side effects is also low, getting vaccinated may be beneficial.
There is also preliminary evidence [1] to indicate that post-infection vaccination can help to resolve lingering symptoms such as fatigue, breathlessness, and insomnia.
Vaccine-based immunity allows for a greater variance in neutralizing antibodies to form relative to the spike protein, compared to natural immunity attacking less critical vectors. Get the vaccine even if you had covid
Infection is possible with all vaccines as well. Resulting viral load will be what matters: How strong their immune response is, how infectious the re-infected patient is, and how severe their symptoms are.
It's not a binary "You have COVID" vs "You don't have COVID". Not for vaccines, nor for re-infections.
An unvaccinated health care worker set off a Covid-19 outbreak at a nursing home in Kentucky where the vast majority of residents had been vaccinated, leading to dozens of infections, including 22 cases among residents and employees who were already fully vaccinated, a new study reported Wednesday.
Immunity lasts a long time in the vast, vast majority of people. People that survived SARS-CoV-1 still have strong immune response almost two decades later. You are improperly conflating lack of antibodies with lack of immunity, they are not the same thing. Antibodies are the product of active infection, not having immunity.
It is unhelpful and disingenuous to suggest that lack of antibodies imply lack of immunity or that rare edge cases are the norm. In disease, there are always edge cases.
We don't really know much about how strong or long lasting natural immunity from infection is so we aren't relying on it and can't make any assumptions. However, immunity from the vaccines is well studied and it's perfectly safe for someone with a history of covid infection to receive a vaccine.
The Trumps both received vaccines before leaving the Whitehouse even though they had prior covid infection. I know at least 4 people with prior covid infection who have received vaccines
>Data from clinical trials indicate that the currently authorized COVID-19 vaccines can be given safely to people with evidence of a prior SARS-CoV-2 infection. People should be offered vaccination regardless of history of prior symptomatic or asymptomatic SARS-CoV-2 infection. Viral testing to assess for acute SARS-CoV-2 infection or serologic testing to assess for prior infection is not recommended for the purposes of vaccine decision-making.
The unfortunate thing is the level of ignorance today mistakes a very careful effort make sure the vaccine is safe with a wanton ignoring of some danger.
Beyond talking about the fact that they determined this was safe, at some point educating people on danger in statistical terms is going to be necessary. But I'm not sure how that happens - addiction to headline-logic and single-heart-pulling-events is a huge part of the news industry.
The idea is to compare the risk of death from the AZ vaccine from blood clots (1 in a million so far) with the risks we take all the time without worrying.
For there J+J vaccine, it's also a 1 in a million risk, but just of getting the clots, not dying.
The point is to show the fallacy of comparing the risk of the vaccine with a perceived current zero risk - you are not at zero risk ever, there's a base-risk we as society and individuals have decided we are OK with, because without it we can't even get out of bed in the morning, let alone get into a car or do anything else interesting, and the risk from these vaccines is a lot lower than that.
> For there J+J vaccine, it's also a 1 in a million risk, but just of getting the clots, not dying.
Your denominator could be wrong when you factor in the attributes of the individual considering the shot. Are the blood clots appearing entirely randomly or are they happening more frequently in an identifiable sub-group of vaccine recipients? In the case of the J+J vaccine all the blood clots happened in women 18-48 years old.
It's a good point - I don't know enough about the J+J one to comment on that, this was based on the AZ vaccine.
Do you know if anyone has died from the J+J one? Because that's what I am comparing with for the AZ one, so it's actually in that sense less risky that AZ anyway.
The link above states 3 women so far have died from J&J and 7 more remain hospitalized. If you do demographic-specific division and compare that to the likelihood that same demographic would die from COVID, it seems unclear to me that young women would come out better getting the J&J vaccine. Both things are very unlikely to happen, but ultimately it's easy to get a Pfizer or Moderna appointment these days (at least in my area) so I don't see the point in trying to pressure people into getting J&J if they're concerned about that specific vaccine. Pfizer/Moderna are probably more effective anyway.
I’m here in the UK and we have limited supply of anything but he AZ vaccine which we make here, so it’s a slightly different story. We can’t choose what jab we get. You just get an appointment and get whatever you get when you arrive.
The most important comparison is the risk of getting severe covid and/or dying from it if unvaccinated.
It's tricky cause it depends on what you do (you get to do more once you are vaccinated), as well as the ever-changing rate of infection in the community where you are (which will change as more people get vaccinated among other things).
But in general, your risk of having severe complications from covid if unvaccinated is far more than your risk of complications from the vaccine.
And on the population level, we can say if say 1 million people get the vaccine, X will have blood clot complications (about 1)... if 1 million people go two months without being vaccinated, how many will get covid and have severe complications? (more than X). So if using the J&J gets a million people vaccinated two months earlier, it's a win.
Of course, ALL of this is an embaressment of riches when the USA has access to large quantities of three effective and safe vaccines, when much of the planet still has zero.
I agree that's an important part - BUT there's more to this all than the risk to ourselves as individuals.
For older people, getting the vaccine is a no brainer. The risk of covid is high, they can't see their grand kids etc, so they're lining up to get vaccinated.
For young people, the risk from Covid is low, but we need everyone to get vaccinated anyway because that's the only way to stop it spreading, infecting more vulnerable people, maybe even mutating enough to escape the vaccine.
So what this is about is asking people who might not be at that much risk from covid, to get a vaccine that they're also not that much at risk from (but might worry about with all the negative headlines), in order to save all the other people and the economy and country / world as a whole.
We have 2 other vaccines that do not present this risk. It seems pretty likely the issue affects mostly younger women, so I don't see the problem with encouraging that demographic to get a different vaccine if they have reservations about J&J. To me that seems like the more practical approach as far as safety of all involved AND actually convincing people on the fence to get vaccinated. Let's stop with the "all vaccines are the same" bullshit.
> For there J+J vaccine, it's also a 1 in a million risk, but just of getting the clots, not dying.
Are you sure about this? I thought the J&J 1 in a million number was deaths, from cerebral venous sinus thrombosis blood clots? Isn't that why they paused this vaccine?
There are many other kinds of blood clots (deep vein thrombosis, pulmonary embolism, etc). During J&J FDA trials they found a 50% increase in blood clots of any type in the vaccinated group [0], which they did not consider statistically significant at the time (20k people, 15 versus 10 blood clots in the unvacinated group). That might be an increased 1 in 4k risk of a blood clot from the vaccine, with the fatal ones being 1 in a million so far.
Medications (not necessarily vaccines) are universally risky, even a Tylenol. Doctors weight the risk of you dying or suffering from symptoms against the risks involved with taking the medication. Chemotherapy is a good example: the risks and side effects are horrific, but on the other hand it's dealing with cancer.
> Beyond talking about the fact that they determined this was safe
And so there is a miniscule risk associated with J&J - that is the truth, or the half-truth. The whole truth is that your odds of catching and dying from COVID-19 are significantly higher than an adverse reaction to the J&J vaccine.
So, even with the blot clot risk (which can be caught/treated), you should absolutely have the J&J vaccine if you have the chance to.
I think it's a direct consequence of media and government trying to remove free will from the equation and present taking the vaccine as the only choice people have. If you're going to essentially force people to do it, a statistically meaningless side-effect becomes more important as reason for people to push back (and the media to drum up false fears).
If you treat people like adults and let them consult their doctors and make their own decisions, the bar is much lower for safety (by lower I mean from impossibly high to reasonable). People willingly take much more risky medicines and treatments all the time and are fine with it. But if you try and force something in them, it's not surprising they push back on anything that isn't guaranteed to be perfect.
(So my point is, I think demand would be higher and concerns lower if you just made it available and let people make their own choice. But the whole pandemic has been more about forcing people to do things than about trying to do things that actually solve the problem)
[Edit- it's funny how any presence of giving people control over their bodies evaporates in a situation like this. And re the strawman that "nobody is forcing you" - if the consequence is severe limits on what you are allowed to do, that doesnt really hold up]
To an extent. Presently, you won't be thrown in jail if you don't get it. But you can't go to NYU. You can't go to a wedding. You can't go to a concert, or a football game, you can't fly Qantas...
This is a meaningless statement. It pretty much makes the idea of "coercion" impossible.
"The mugger didn't force you give him your money. You could have chosen to say no. You being killed is just you not being free of the consequences of your choice".
Imposing consequences on people is coercing them to make the choice you want them to. None of the consequences mentioned are natural consequences, like getting sick from the disease, but additional consequences someone decided on.
IMO the position that someone should be free from all consequences is the meaningless idea.
Someone not taking the vaccine is imposing consequences on everyone else around them and society at large, raising the risk of immune-escape variants, raising transmission risk to people that can't take it for medical reasons, raising the risk even for vaccine-protected people by defeating herd immunity (J&J gives 72% protection, so you're running a fair risk if the rest of society isn't vaccinated.)
The consequences you complain of are pretty much just pricing in those externalities to the decision.
The thrust of my argument is that imposing negative consequences (irrespective of reason) is a form of coercion. There are many things that ought to be coerced, but it is ridiculous to assert in the face of imposed consequences that people aren't being coerced or forced into taking vaccines.
People might not want to state it that strongly and the coercion isn't as strong as what criminals or the government can impose, but it's still someone or someones using their power to enforce behavior on others.
And couching that in phrases like "pricing in those externalities" doesn't change this. In fact it makes it more blatant.
By your expansive definition of coercion, everyone else would be getting "coerced" into contact with many more unvaxxed potential carriers by things like going to get groceries, getting on flights, getting tickets etc...exactly the same limitations you're claiming are coercing people into getting vaccines.
So under your expansive definition - which IMO is not the right or correct one - sure, people are getting coerced into getting vaccines. And if they aren't coerced, it's coercion against the rest of the population.
That's why your definition isn't useful and isn't used, and "coercion" is generally used for a specific set of acts.
That's a strange desire because what does it matter? If you were worried, you would have gotten vaccinated, and unless you don't believe the vaccine works, you would be protected.
It's also something that is impossible to know because you don't have the right to inspect someone's medical records.
If a large pool of people refuse the vaccine, they will eventually breed variants that make the vaccine less effective. To wipe out Covid, we need enough people vaccinated so that the disease dies out (doesn't have to be everyone), because the virus can't find enough new people to infect.
And a small fraction of people who are vaccinated won't develop a proper immune response, so they are still vulnerable. Nevertheless, once enough people are vaccinated it will die out.
It's a big shift because we have never as a society catered to the most cowardly before. Personal responsibility used to mean if you cared about something it was on you, now its shifted to forcing it on other people. This is really antithetical to western values.
I'm still waiting for the M1 Abrams I ordered to show up on my door step - I can't comprehend why anyone would object to me commuting to work in a tank.
Freedom is a process of give and take - the only way to have perfect freedom is to deny freedom from everyone else (since you're declaring your choices more important than those around you). We (I assume you mean America - where I was born and raised but since emigrated from) have never had unlimited freedom - rights and privileges have always been limited by the interests of others from traffic laws to gun ownership and even to mere communication.
I will say that the US has tried quite hard to be on the side of individual freedom over societal freedom and health whenever possible (which has led to some side effects) - that certainly can't be argued. But the US is not an anarchist state and the presence of laws - even of encoded privileges - dictates the lack of full freedom.
There's another level to consider that is a bit more rare in discussions like this though. You don't have the personal value to be held responsible for your actions - if you happen to be the person who mutates a new strain of the virus over irresponsible actions then it sucks for the rest of us since you're judgement proof. When it comes to the trillions of dollars in lost economic productivity that you should be on the hook for we can't collect even a fraction of that.
"Never" is wrong. Unless you mean never until the seatbelt mandates of the 90's. Or MADD in the 80's. Or the 70's when OSHA reared its ugly head. Or the 50's with anti-litter laws and campaigns. Or prohibition in the 20's. Or never until the FDA was founded? A hundred years is a little late to complain about this "big shift."
Acting in the collective self-interest is not new at all, unless you completely ignore history.
at least here, in California, you can not chose which one you get when making the appointment or when arriving at the vaccination site.
Also CSU and UC will require vaccinations for return to on-campus. (Though I'm not sure that they will be able to do so until vaccines are under "emergency use" authorization, not a regular one)
Here in Western Washington, I've not seen any site mixing vaccines. One Walgreens might have Moderna and another Pfizer, but any given day any particular store will only have one of them.
Most places say when you sign up which they will have for your appointment, but if they do not you can often tell by looking at the eligibility. If they are offering appointments to people age 16+, they are using Pfizer. If 18+, Moderna.
Most places here also tell you on the signup form that your second appointment will be the same time and place exactly N weeks after the first. If N = 3, they are using Pfizer. If N = 4, Moderna.
It's true that you can't choose, but lots of places are listing what vaccines they're doing on specific days. You can "choose" by booking an appointment at a location that has the one you want, or by avoiding locations that have ones you don't want.
As an example, I booked my appointment specifically at a location that only carried Pfizer.
That seems like a really weird decision because both Moderna and Pfizer are using very similar technologies and haven't had much negative press coverage.
It seems it would be harder for the government to insert a "biological backdoor" into a viral vector vaccine than something that runs any RNA code as long as it's encoded in a special lipid delivery system (according to my limited understanding). 1 in 250k chance of blood clots is nothing... at least compared to the anxiety of the government having a switch in my biology that could melt my brain at anytime.
That's one take. Mine was more about efficacy. J&J IIRC was around 60%, while mRNA vaccines are around 90%. Big brain vaccine scientists tell me that 60% is fine but all I see is 30% less efficacy. I wouldn't be able to feel confident/safe even after getting J&J.
Domestically that's the case but if you have(had) to travel abroad often for work or family reasons that won't be the case. I regularly(used to) visit and have family ties to a country that allows vaccine records in lieu of negative tests for entry. I'd say that's reasonable.
None of this has made sense for months I'm just going with the flow. We get x-ray scanned through our clothes every time we fly what's dignity? It's just another airport document as far as Im concerned.
I'm sorry, I can't really tell how your comment is related to my comment? What does verifying that you took precaution to prevent the spread of covid have to do with dignity?
My mistake. I misread your response as requiring one or the other being the same as forcing. Some people find having to show a negative test or vaccination record for international travel as invasive, and to them I'd say that the real violation of privacy happens at the TSA line.
J&J is starting a 2-dose clinical study (https://clinicaltrials.gov/ct2/show/NCT04614948), perhaps to see if it could have comparable effectiveness as the 2-dose mRNA Moderna and Pfizer protocols.
Unfortunately, the control arm for this study is a placabo instead of a single dose, which I would expect to be the standard of care.
I got confused as the same thing was reported in Oxford Astrozenica vaccine recipients. I wasn't sure if they're the same vaccine (they're not). So I read up a bit.
The same sort of clots occur in people who have been given heparin (a blood thinner). It's even called "heparin induced" in people using heparin.
People on either vaccine have been found to have an immune response to "platelet factor 4" (PF4). PF4s job is to moderate substances like heparin.
I wonder if PF4 is similar to spike protein somehow?
I wonder how long the immune response lasts?
I guess it's not super useful as it wouldn't make sense to give people a blood thickener (a coagulant?) prophylacticly. Maybe we need to consider whether this is appropriate for people on Heparin or similar medications? I'm no doctor so don't take this as discouragment, I'm just musing. I have Oxford AZ (1 dose so far) and it was fine.
I guess that the spike another function could be a trap for the immune system and antibodies - resulting in production of autoantibodies - and that's very wise choice, which parts of that trap/virus are used in vaccines.
Even the experts still don't know what could be causing these side effects, or why it would be similar between the two vaccines. However, when they want to investigate it, what they'll be looking at is that both the Astrozenica and J&J vaccines use adenovirus vaccine technology, and the Moderna and Pfizer do not, so there could be something in common there that leads to the side effects. I think people only have guesses they aren't super confident in as to what that could be at present.
This is great, but a gigantic Public Communications disaster.
I had a vax-sceptic friend send me an article from a reputable source, quoting claims from the National Health Agencies and WHO etc. about the 'blood clots' which essentially conclude that 'they are rare and treatable' ... but my friends 'interpretation' was that the vax was 'unsafe'. She literally couldn't grasp that the data in the article was supposed to make her conclude it was 'safe'. She just read 'fear'.
40% of developed world people are either 'not very literate' or 'not paying attention' or have 'reading comprehension' problems whereing they are not going to engage with the material to derive conclusions.
While the public health agencies decisions are a little cautious, they are reasonable, but the 'communications' of it via random articles with bits of 'facts' is a complete disaster from a Public Communications perspective and is causing probably measurable harm.
If there is a 'marginal risk' of 4 in 1 million of 'blood clotting' and it's entirely treatable, then this information should be made available and transparent during the official conferences, but it should not be headline news.
Whenever material information is presented regarding concerns, they have to be contextualized, and if the conclusion is effectively 'the vax is perfectly safe, this is just an administrative thing' then this has to be repeated over and over.
From the FDA: "Out of every 10,000 women taking birth control pills, 3 to 9 of them will develop a blood clot".
That is about 100x greater than clotting from AstraZeneca Vaccine, and 10's of millions of American women are taking it daily. Now that's context.
Every single story about COVID needs to start and end with the 'Net reality facts' about vaccination, which as of today is: 'It's utterly safe, basically for everyone, and it will help stop the spread and keep other safe'.
When messaging critical information for the masses it needs to be simple, clear, consistent, repetitive, words need to be chosen very carefully, and assume you're dealing with a 'Grade 8' audience in terms of net comprehension/attention/understanding.
Almost all intelligent professionals live in bubbles, we tend to have no grasp of how it is out there for a large swath of the population.
Even public health agencies web-sites are overloaded with information, literally with critical information in 'downloadable PDFs' (???), it's not good, I hope we develop a new approach but I don't think we will.
> From the FDA: "Out of every 10,000 women taking birth control pills, 3 to 9 of them will develop a blood clot".
> That is about 100x greater than clotting from AstraZeneca Vaccine, and 10's of millions of American women are taking it daily. Now that's context.
More context: the vaccine clots have been in the brain, birth control clots tend to occur in the legs (and rarely in the lungs). You can use heparin to treat the latter, but heparin could make the brain clot from the vaccine worse. I’m no medical professional, so I’ll let this article do the heavy lifting: https://www.usatoday.com/story/news/factcheck/2021/04/23/fac...
Despite that, the odds seem to favor using the J&J vaccine based on numbers. The reported clot cases and total vaccines are 6 in 6.7 million with 1 death. If those odds are extrapolated, this means approximately 1150 people would die if everyone on earth received the J&J vaccine, and 6600 would have blood clots.
All of the cases were in women of roughly child-bearing age, give them an option/priority for the mRNA vaccines, see if clots occur in other demographic groups.
> If there is a 'marginal risk' of 4 in 1 million of 'blood clotting' and it's entirely treatable
I completely agree with what you are saying, but wanted to point out that the risk of a cerebral venous sinus thrombosis blood clot risk is something like 4 in 1 million, but there are other kinds of blood clots (deep vein thrombosis, pulmonary embolism, etc).
During J&J FDA trials of 20k people there were 50% more blood clots of other various types in the vaccinated group [0] (15 blood clots in vaccinated group versus 10 in the placebo group, which the FDA did not consider statistically significant at the time).
It might not be fair to compare J&J cerebral venous sinus thrombosis blood clots only to blood clots of any type from birth control pills.
Pausing like that causes, not prevents, vaccine skepticism. In an era of declining public trust of institutions (across both political aisles, even if unequally), I argue this pause was poor politics. Science doesn't enter much into it, unfortunately.
I think either pausing or not pausing could increase or decrease vaccine confidence.
One could imagine pausing: "oh, they are being careful, great, and NOW after looking at it, they've determined it is safe." (The pausing is actually a consequence of the sped-up approval; the sped-up approval process comes with a requirement to pay extra extra scrutiny to any side effects reported) OR "See, they admit it's not safe, they paused it!"
Same with not pausing: "See they rushed the approval, and now they are ignoring side effects" OR just nobody hears about the side effects without the publicity, or figures they must not be a big deal if they didn't even bother pausig it or whatever.
Could go either way. The difference in either case is probably determined by building up trust over time, by transparency, and by having an effective communications/education/marketing plan (specifically for communications around the side effects/pause).
In the USA, of course, we have none of that. So it was probably going to decrease confidence either way. What a country!
Your confidence is unwarranted, and we don't know who you are or the significance of "every single vaccine specialist [you] know"? Just moments ago a Bloomberg summary popped into my inbox and a link from "The pause of the J&J vaccine was not without its controversy" and a link from there has this as the last sentence of the article:
In the meantime, health officials will need to convince the public to take J&J’s shot. Americans’ confidence in Covid-19 vaccines continues to rise, according to a poll from the de Beaumont Foundation, an advocacy group focused on public health. But it has taken a toll on trust in J&J’s shot, specifically, with nearly one-third of respondents saying they’d never take the single-dose vaccine.
No, implicit to the point is that what the CDC/FDA did was follow the ongoing drug safety monitoring protocols that have long been established for Emergency Use Authorization.
Why are you so wed to the idea that these protocols are in some sense correct? So many people have basically asserted infallibility for the CDC/FDA throughout this pandemic despite their consistent failures across huge swaths of the response from border lockdowns to masks and of course to this non-sensical pause.
pausing causes vaccine hesitance, but finding out that the authorities knew about potential risks like this and didn't pause the rollout to assess those risks also causes vaccine hesitance, and is also poor politics.
they did the safe thing, regardless of the politics. if you're skeptical about vaccines you should be reassured by that. and if a person is skeptical about vaccines but somehow isn't reassured by the authorities taking responsible safety precautions, they're probably not coming from a place of reason and there's not much point worrying what they think.
There have been some studies which demonstrated that experts gain credibility when they express uncertainty. Amateurs on the other hand lose credibility when they express uncertainty. I don't have a citation handy, but I thought you might find the perspective useful.
Does the citation include the recent major skepticism of Astra? There are French polls that backed major skepticism of Astra specifically after the pause.
The downvotes are puzzling. Are people capable of countering with reason, or is a downvote a proxy vote for how they wish reality to be?
They're perhaps downvoting because what was described was "studies" (not "the citation"), that were about credibility and uncertainly generally, and it's safe to assume they weren't conducted in the past 4 months and have nothing to do with covid vaccines, but you jump in with "well your study means nothing to me unless it was conducted in the past two months and already peer reviewed and published" which is not how it works.
You should be wary of concluding stupidity when the French population are skeptical towards government statements. It's a completely different culture to the one you're likely used to. The French frequently have legitimate distrust towards their authorities, and assume based on experience that the government is lying.
This would be a confounding effect when trying to determine whether it was the uncertainty that caused the distrust, or the source of the statement.
I'm familiar with French culture. What about it would you argue makes it more skeptical (as I'm reading what you wrote to mean) than the government-skeptical US population?
> Pausing like that causes, not prevents, vaccine skepticism.
Citation needed.
> In an era of declining public trust of institutions...
In such an era we need institutions to display integrity above and beyond. That means not letting unfounded vaccine skepticism affect how rollout is conducted.
> I argue this pause was poor politics.
Was this a political decision?
Example: As I understood it, choosing not to go with AZ in Denmark was not a political decision.
I just read the linked Axios article, so perhaps there is more in the CDC decision, but seems like it would make the most sense to just recommend against the J&J vaccine for anyone at higher risk of clot (e.g. all 6 of the people who had clots were women of childbearing age). With 3 good vaccines available, seems like there is plenty (or shortly will be plenty) to go around even if the J&J vaccine only goes to those at low clot risk.
I don't think the usual risk factors for clotting apply here. These cases were rare enough to stand out at just 1 per million. The clotting seems to be a specific immune response similar to some people who clot when given heparin.
FWIW, the ACIP meeting today shared that another ~7 cases were discovered. In a particular group - women between 30-39 - the numbers were more like 1 in 100k. Still very small odds, but greater than the "one in a million" widely quoted, particularly for certain age groups. Good coverage of the updated data today here: https://twitter.com/kakape/status/1385661019494699010
It's worth noting that young-to-middle-aged women are also over=represented (relative to the general public) among healthcare workers, who have been a primary target for the early rounds of vaccination.
At least where I live, none of the healthcare workers got the J&J vaccine. As you point out, they were all at the front of the line for vaccines, so they got Pfizer or Moderna before J&J was even available.
God the downvotes on this site piss me off so much. They are SO mindless.
This is what the UK is doing with AstraZeneca, for the exact same problem! Only suggesting it to people over 30! Stop downvoting the suggestion which is literally expert advice!
Just makes sense. The benefits far outweigh the risks at six cases of blood clots out of over 6.8 million doses, especially when there's a high risk of blood clots following COVID-19 hospitalization. Not to mention rates of blood clots caused by the pill are more like 1 in 3000.
Hopefully if anything the pause has shown anti-vax folks that the safety of these vaccines is being taken seriously.
I agree with you that the risk of getting Covid-19 far outweigh the risk of blood clots associated with some vaccines, however, I've read this comparison with birth control related blood clots many times and it just doesn't seem to be comparable.
> Indeed, government health officials are investigating a type of blood clot called a cerebral venous sinus thrombosis (CVST) among the J&J recipients. These clots formed in the draining veins of the brain, combined with a low platelet count, essentially causing a stroke. Hormonal birth control pills, on the other hand, raise the risk of blood clots in the leg that can break off and travel to the lung, causing a pulmonary embolism that blocks blood flow to part of the lung. The latter clots can be treated with anticoagulants, while the J&J clots cannot.
Correct! I've been pointing this out, also. I found this article [0], referencing the J&J FDA trails where they saw a 50% increase in blood clots in the vaccinated group, which was not considered statistically significant at the time (20k people, 15 blood clots in vaccinated group versus 10 in the placebo group). These were not the exceptionally dangerous cerebral venous sinus thrombosis blood clots.
I don't know if we'll get better numbers on other types of J&J blood clots from the CDC at some point, but I've noticed the same as you that people are comparing J&J cerebral blood clot deaths to birth control clots of any type and that doesn't look like a fair comparison to me, either.
There is the potential for (rare) harmful side-effects from taking many pharmaceuticals. Its all the stuff that they speak at 2x speed after the ad. People (especially the media) are understandably hyper-focused on COVID.
I am not sure it is about "anti-vax" folks so much in this case. Many are wary of getting a vaccine with < year of testing, not to mention relatively new technology (mRNA). That isn't entirely unreasonable, though I did end up getting the Moderna shot.
That's an entertining soundbite, but other health complications nonwithstanding, the risk of dying from Covid for a healthy 25-year old is approximately 1:500,000.
It's an individual decision, and although there are many factors both individual and societal, it's counterproductive to yell (or jokingly imply, as Munroe did in your link) "antivaxxer!!" whenever someone has some concern.
Many European health authorities have e.g. concluded that the risk of death from the AstraZeneca vaccine is greater than the risk of Covid infection in young people. Unless one assumes that these health authorities are wrong, this would indeed be an example where a time-limited amount of caution wasn't obviously irrational.
Was it a black swan event that one of the ~7 vaccines that passed clinical trials turned out to fail the risk/benefit ratio in some regions? No, that's probably to be expected with the probabilities involved.
We can still have confidence both in vaccines and health authorities after such an event, my point is that saying "you're stupid" in intellectual-ese is rarely the most productive response. Not everyone who has some concern is a rabid conspiracy theorist.
As ever, the thoroughly anti-vax community are going to be unconvinceable, but there is real progress to be made on the margins. There are a large number of people who are not inherently opposed to vaccination who are hesitant (for a wide variety of reasons) to take this vaccine.
I know people who have gone from "The US government has a long history of medical experimentation on people with my skin tone" to vaccination evangelists over the last few months. This isn't yet quite one of those issues where people are locked in to a narrow bimodal distribution.
It may be splitting hairs, but I wouldn't really call most vaccine skeptics "anti vaxxers". The legitimate "anti vaxx" community are legitimately uninterested in science. These people will never get vaccinated, regardless of data.
A much larger group of people is skeptical of the government and vaccines. These people might get vaccinated, and every piece of information that comes out in favor of vaccination has the possibility to sway some of them.
My post was about the first group, not the second.
It was 6 cases when the pause was announced, but it's up to 15 cases (plus one that J&J went back and found in the phase III data) now that we've had an extra week for cases to develop and reports to come in. I expect that cases will continue to happen, but hopefully patients and doctors will be more prepared to deal with it.
I think it should fall under basic common sense, not science. In reality, only a handful of people in the world understand in detail all the intricacies of the various ways our body interacts with drug substances. This group varies based on the drug in question.
The rest of us are just parroting them. Yes you can try to be informed and read-up but at the end of the day they're still a layperson.
I work in biotech (vaccines), and outside of my little niche, I'm just your average lay person, just slightly more informed.
> In reality, only a handful of people in the world understand in detail all the intricacies of the various ways our body interacts with drug substances.
That is not science, and it is not what is meant when people talk about trusting the science. Science is empiricism. The science that supports the efficacy of vaccination is the data from the trials that shows a reduction in cases. The science supporting safety is similar. This data is something anyone can understand with sufficient knowledge about probability and statistics. That level of knowledge is somewhat rare, but nowhere near as uncommon as the theoretical knowledge you are describing.
We're not really in disagreement. Let me explain a bit more. Science is a process/methodology of exploring/understanding our natural world/natural phenomenon, Yes? And as such, there is good science, there is average science, and there is junk science. They're all under the same 'Science' umbrella.
>The science that supports the efficacy of vaccination is the data from the trials that shows a reduction in cases. This data is something anyone can understand with sufficient knowledge about probability and statistics.
Yes you have a bunch of numbers, but this doesn't tell you whether the study protocol was good, nor does it tell you about the qualitative aspects like how well the study protocol was adhered to, how tight the controls were, etc. Naturally, this is not a new problem, and we have various safeguards already in place at various levels. You also need a third party like say the FDA to audit and examine what was done.
>This data is something anyone can understand with sufficient knowledge about probability and statistics.
Yes, but that is not all. People need to understand how clinical trials are conducted, and how for e.g. efficacy numbers can't simply be used to trivially compare two vaccine candidates.
Not targeting you on this, just an observation: we should be careful with the terms we use. I don't think "skeptic" or "skepticism" applies to anti-vaxxers.
Sure, if you want me to. Unless you're implying that since the AP makes use of it in this way (and/or its in their Stylebook) there can be no valid contradictory position?
They didn't permit a singular use of "they" until like 2017. Sometimes they get stuff wrong. ¯\_(ツ)_/¯
I was holding out too but the opportunity to get Pfizer part 1 came up this week and I figured "this indefinite suspension could take months might as well get this out of the way now."
Oh well. Im always wrong about these things. Either way in three more weeks I'll be done doing the "needful."
No side effects for me besides my arm sore to the touch the day after, but not painful. Similar to the day after a weightlifting workout.
I was under the impression adenovirus based vaccines are worse in the long run because the adenovirus acts as a vehicle for the proteins we're immunizing against (coivd) and that immunity can also occur against the adenovirus rendering it useless as a vehicle for proteins in the future.
Yes, there are certain strains that wouldn't work as vectors. HAd26 (used in J&J) has not shown reduced immunogenicity based on studies conducted. It was used in other vaccines previously, and that hasn't impacted its performance here. While it's not a problem now, the situation might change in the future, so you were right to ask the question. These issues of pre-existing immunity are taken seriously inside vaccine companies too.
(Note that while I work in biotech, I'm not claiming to be an expert on this topic, so don't take these as definitive claims of truth. People shouldn't be taking HN comments as a source of any kind of medical advice anyway.)
I'm the opposite. I was sort of resigned to getting the J&J but was hoping for the Pfizer. My wife got an appointment before I did and did get the J&J.
Then this clotting news happened, and I subsequently got my appointment - Pfizer. So I guess I got what I wanted.
My wife is perfectly fine though, no side effects. If given the J&J vaccine, I would have taken it too.
Speaking for myself (team J&J), single dose is definitely more convenient. Anecdotally, reactions seem to be less severe than for the mRNA vaccines. And, while it's only a minor speed bump to our gold-plated healthcare delivery system, the fact that it doesn't need an extreme cold chain means it's logistically much easier to handle.
Because of their confidence (and the FDAs confidence) in their single-dose immunogenicity data, and also the fact that they ran trials in regions (brazil, SA, US) at times when new variants were prevalent.
Damage is done... NYC saw a drop in vaccine appointments right after the original ban on J&J happen.
They could have issued a warning first, with the group ages/sex that they were seeing the clots (it was mostly women). Now they are scaring the 'indecisive' part of the population, and just making sure the pandemic will keep going.
Both the CDC and the FDA have completely dropped the ball during this pandemic. They are acting like typical bureaucrats, with the 'you don't fired if you buy IBM' type of mentality, and instead of being aggressive, they are just acting in a way so they don't get fired.
They should have done challenge trials back in April last year, and ask for military style of mobilization on productions, instead of just doing the normal/usual trails.
It would have speedup the vaccine rollout even more, and perhaps save at least 200k lives or more. (mask requirements on the Federal level, would have saved another 100-200k people).
I think a mask mandate on the federal level would have required using more emergency presidential powers than most people would have been comfortable with. A president exercising martial law or something similar that would allow increased power over the states during a presidential election might not be helpful for people's view of the procedures and result.
It's unclear that federal mandates would even have been constitutional and compliance, even in blue states in situations like people walking at comfortable distances outside are pretty spotty. There's a lot of faith in the idea that different top-level policies would have made a big difference short of truly sealing borders and having them totally shut even now.
Polling shows that pausing the J&J vaccine did not make people more hesitant to get vaccinated. https://arstechnica.com/science/2021/04/poll-shows-jj-pause-... It might have made the locations and times less convenient, or people might be waiting for a one-shot vaccine.
Vaccines take multiple years to develop normally. How much faster can you get for vaccine development? I certainly did not expect there to be more than one, or any, good options for vaccination by the beginning of this year. The trials also helped make it clear that the Pfizer–BionTech and Moderna vaccines were safe, something that will help convince people to take the vaccine in the long term.
In-depth talk with a virologist who believes that all of these vaccines currently be dangerous - and that we should perhaps stop all of them, please watch it before you assume you understand the reasoning:
I googled him to see if I could find the gist of his claims. I can't find a single thing from him, but I can find a ton of takedown pieces tearing apart this episode.
(Bret Weinstein is leaning hard into the IDW thing. DarkHorse? Really?)
The gist: Mass infection prevention and mass vaccination with leaky Covid-19 vaccines in the midst of the pandemic can only breed highly infectious variants
Source: the top of the home page of his website, which is the first result on a google search of his name (How hard did you try?)
It's worth a watch. Bret Weinstein was a year early on the lab leak hypothesis, when it was taboo to even ask the question. Only now are scientists able to discuss it somewhat openly; https://news.ycombinator.com/item?id=26750452
Or not! But if we’re not going to use them, we should send them to another country like Canada or Mexico or Australia or the UK or EU, all of which have approved it and administered millions of doses.
Sitting on 10s of millions of vaccines during a pandemic is inexcusable.