AstraZeneca (Latest Trials)

[tjh290633]

Since AZ would not have made a profit on those sales then they don't lose anything and it means more to go round for the RoW.

John

There is a big difference between not making a profit and covering your overheads. Charities would refer to having a surplus, because they are non-profit-making. That share of the overheads could make a significant difference to the bottom line of AZN as a whole.

TJH

[absolutezero]

USA has now paused Johnson vaccine due to blood clots. 6 women had rare and serious blood clots from 6.8million jabs.

What's that noise?
Oh. It's Macron and Merkel bad mouthing the J&J vaccine.

Oh. No. My mistake. They don't seem to have much to say about it.
Funny, that...

[murraypaul]

But when there are other jabs available, jabs which also seem to offer better efficacy against Covid as well, there comes a point when you're just got to accept, this time the Americans and the Germans did it better. Perhaps it was just bad luck for Oxford / AZ, good fortune for the Americans and Germans. But if you put petty squabbling and nationalism to one side, and look at the evidence...

Surely the balance is between how many people would have died from presumed vaccine induced clots, vs how many would have died if they had not been vaccinated?

UK clotting rate is being quoted at 4 per million, and deaths at 1 per million?
UK Covid deaths are at 127K, or around 1800 per million?

The evidence at the moment is UK cases at around 3k/day, Germany around 17k/day and the US around 64k/day?
The US are still seeing 1k covid deaths per day, the UK, with maybe 20% of the population, are seeing about 35.
Besides, the US has enough domestic supply of Pfizer and Moderna to do without AZ (or J&J), Europe doesn't.
Using the AZ vaccine has allowed the UK to give a first dose to ~59% of the population. Germany is at ~22%.

I have my first jab coming up soon, and have no qualms about it being AZ.

It might take a while for some people to accept it, but the EU caution over the safety of the AZ vaccine looks to be perfectly reasonable and evidence based to me, and nothing at all to do with politics.

But the UK's "just get on with it" approach may have saved more lives.
Certainly the statistics suggest so.

Looking at charts like this (slightly out of date, because the UK is now no longer in the top 16 European countries by case rate), I'm certainly happier living here:

[Lootman]

But when there are other jabs available, jabs which also seem to offer better efficacy against Covid as well, there comes a point when you're just got to accept, this time the Americans and the Germans did it better. Perhaps it was just bad luck for Oxford / AZ, good fortune for the Americans and Germans. But if you put petty squabbling and nationalism to one side, and look at the evidence...

Surely the balance is between how many people would have died from presumed vaccine induced clots, vs how many would have died if they had not been vaccinated?

The problem with that reasoning is clear. If your life is saved by being vaccinated you would have no idea that is the case. You can never know that you would otherwise have died.

But if you drop dead from a vaccination then you very definitely do know what killed you. Or at least your surviving family know, and will sue accordingly.

[murraypaul]

The problem with that reasoning is clear. If your life is saved by being vaccinated you would have no idea that is the case. You can never know that you would otherwise have died.

But if you drop dead from a vaccination then you very definitely do know what killed you. Or at least your surviving family know, and will sue accordingly.

To put it bluntly, not really seeing the problem, from a societal point of view.
Fewer people have died. That is really the only metric that matters, if you are the government trying to manage the pandemic.

From a company point of view, unless there is evidence that AZ knew of a problem and covered it up, or 'massaged' trial data, not seeing what liability they have.

To put it in perspective, it appears that the vaccine may slightly less than double the chances of a rare condition occurring:

Over 20 million doses of the AZ vaccine have been given in the UK so far. According to the MHRA, the risk of a serious blood clot as a result of the jab is approximately one in 250,000 people vaccinated, or four in a million. It’s also worth noting that Covid-19 itself carries a significant risk of blood clots; according to a study in the journal Thorax, the prevalence of pulmonary embolism and deep vein thrombosis in people with the virus was 7.8% and 11.2%, respectively.

What’s more, around 10,000 people usually develop blood clots in the EU in any given month, while an estimated 3,000 blood clot cases occur monthly in the UK. The general population’s risk of cerebral venous sinus thrombosis (CVST) – one of the blood clot types observed in Vaxzevria recipients – is around five in a million; slightly higher than the risk associated with the vaccine.

I think this could be a situation where both 'sides' were right.
Germany and other countries can show the clotting risk and say that they were right be cautious.
The UK can show the vaccination numbers and lower case and death rates, and say they were right not to be.

[Lootman]

The problem with that reasoning is clear. If your life is saved by being vaccinated you would have no idea that is the case. You can never know that you would otherwise have died.

But if you drop dead from a vaccination then you very definitely do know what killed you. Or at least your surviving family know, and will sue accordingly.

To put it bluntly, not really seeing the problem, from a societal point of view. Fewer people have died. That is really the only metric that matters, if you are the government trying to manage the pandemic.

It is more a problem of perception and politics. If you replace 10 people who were saved but do not know it, with 5 people who died from taking the vaccine and do know it, then in theory that is a net gain of 5 lives. But in practice it is a public relations disaster.

That is why various governments have paused the AZN vaccine, and now the JNJ vaccine. The primary goal of a vaccine is that it should do no harm, not do less harm than a purely theoretical alternative.

Moreover there are no known problems with using the Pfizer and Moderna vaccines. I was adamant that I wanted one of those two and not the AZN one, because the latter has had issues dating way back to its iffy trials.

[murraypaul]

It is more a problem of perception and politics. If you replace 10 people who were saved but do not know it, with 5 people who died from taking the vaccine and do know it, then in theory that is a net gain of 5 lives. But in practice it is a public relations disaster.

Yes, that would be.
But when you have replaced 1000 people with 1 person, and when everyone can see how the vaccination effort in the UK compares with the rest of Europe, not so much.
If there had been enough Pfizer/Moderna to go around, then sure, why take the possible risk with AZ.
But there wasn't. The decision was vaccinate with AZ or don't vaccinate most people.
(Even the countries in Europe most cautious about the AZ vaccine were still fighting to get more doses of it.)
I guess there is a simple way of measuring it: Do people still go and get vaccinated with the AZ vaccine? If they do, there clearly they can see that balance.

That is why various governments have paused the AZN vaccine, and now the JNJ vaccine. The primary goal of a vaccine is that it should do no harm, not do less harm than a purely theoretical alternative.

It is known that regular seasonal flu jab has a chance of causing Guillain-Barré syndrome that is somewhere in the region of 1-2 cases per million.
Everyone is still vaccinating people for the flu, because the vaccine does less harm than the flu does, especially because the flu is also known to cause GBS.

Similarly, covid is known to cause clotting issues, at a higher rate than the vaccine is.

It’s also worth noting that Covid-19 itself carries a significant risk of blood clots; according to a study in the journal Thorax, the prevalence of pulmonary embolism and deep vein thrombosis in people with the virus was 7.8% and 11.2%, respectively.

Moreover there are no known problems with using the Pfizer and Moderna vaccines. I was adamant that I wanted one of those two and not the AZN one, because the latter has had issues dating way back to its iffy trials.

Good for you if you had the luxury of being picky, most people don't.

[thebarns]

Lootman, interesting that you were adamant it was Pfizer or Moderna for you.

And I am pretty sure I would have been the same as you if in the USA and the choice was available.

In the U.K., there is no choice or option - you are given what is there on the day and in the last few weeks, that has largely been AstraZeneca for the first dose. Of course, there are a number of reports of people turning up for their appointment, finding out it is AstraZeneca, refusing to have it and walking out.

I also get the argument that it quite probably saves by some distance more lives than it will cause deaths - I know USA is a more litigious society, but I think it will be pretty hard to sue for clotting deaths in the U.K., unless something in the data was being hidden that subsequently comes out.

I think the U.K. will press on with the Astra vaccine as it has no real option if it wants to complete the second doses and also vaccinate in good time most of the 30-50 cohort.

Interesting to see the updated clotting data in the next few weeks to see if it develops further.

[Arborbridge]

I've just had it confirmed: it was a first jab.

Arb.

He was also a smoker with high blood pressure and high BMI.

So he has never been too worried about his health, and can take this affliction in his stride?

But what actual evidence is there that the jab caused the blood clot? I say this as somebody who has never smoked, and is not really obese, yet suffered an unprovoked DVT in my left leg a few years ago. Unprovoked meaning there was no identifiable cause. Just, perhaps, as in this case.

But what actual evidence is there that the jab caused the blood clot?
Well, none, as you will know. I guess you could swipe away every individual case in the same way.

[Bouleversee]

I accept what you say, murraypaul, but if some extra study now could establish who is among the small number of people who are particularly at risk and by testing before and monitoring after the jab (from what I have read, most of the vaccines are producing a small number of the cerebral blood clotting cases) their risk of serious consequences could be reduced or removed, that would encourage those who are hesitating about taking any vaccine to go ahead. It could be simply a case of vaccine overload in some cases. There is still much to learn and the drug manufacturers don't want to be responsible for even a small number of deaths..

[Arborbridge]

USA has now paused Johnson vaccine due to blood clots. 6 women had rare and serious blood clots from 6.8million jabs.

What's that noise?
Oh. It's Macron and Merkel bad mouthing the J&J vaccine.

Oh. No. My mistake. They don't seem to have much to say about it.
Funny, that...

You made a similar remark earlier which was effectively countered at the time by a couple of people. We'll just have to go through a groundhog day each time..

Perhaps they've learnt the lesson? If you want to get your population jabbed, then the PR has to be entirely positive otherwise you end up with a nation of refusniks. Striking too cautious a tone was praised by many because they felt governments were taking their welfare seriously whilst the Brits were throwing caution to the wind, but it's difficult to switch modes later when the data suggests that losing a few to clotting is the better outcome.

Arb.

[Arborbridge]

Since AZ would not have made a profit on those sales then they don't lose anything and it means more to go round for the RoW.

John

There is a big difference between not making a profit and covering your overheads. Charities would refer to having a surplus, because they are non-profit-making. That share of the overheads could make a significant difference to the bottom line of AZN as a whole.

TJH

Indeed, but I think even without the US sales AZN will have their work cut out keeping up with demand. THey will be producing enough to make a serious contribution to overheads, one hopes.
I think the reputational damage of any delayed approval in the US is longer term, to their sales effort in the developed world - when it comes to the next phase of selling "at profit" when the pandemic is over. That's when AZN will be at a disadvantage and will not be able to clean up in the richer nations who will be paying higher prices.

[onthemove]

Surely the balance is between how many people would have died from presumed vaccine induced clots, vs how many would have died if they had not been vaccinated?

Note, I did say...

"In the very near term, where there isn't the manufacturing capability to get enough Pfizer doses, you can probably still use the 'lesser harm vs covid' argument"

My point is that in the longer term, it isn't a binary choice between OAZ or Covid.

It might be the case that right now, while manufacturing (across all vaccines) is being ramped up, that we have current OAZ production capacity which can fill the gaps that Pfizer (etc) aren't able to meet in the short term.

But for future doses, why wouldn't you invest more heavily in the safer, more effective vaccine (based on the emerging evidence so far).

Like I said... if OAZ were the only vaccine in town, absolutely it would be a winner. The deaths from covid vs the risk from the vaccine, would be no contest.

But it isn't the only vaccine in town, so (going forwards a few months) it is not a binary choice.

I notice today that Boris is trying to say that the vaccine won't be the end of it (ffs!)... but if you take that stance, then why wouldn't you invest in the safer vaccine with the better efficacy?

The existing 19 deaths (in the UK alone) are unfortunate and unavoidable risk... we only know about the risk because of the deaths. Even if approval had been deferred, that risk wouldn't have been discovered until just as many people had had the vaccine and died.

But going forwards, when you know that a safer vaccine exists, that also happens to be more effective against covid to boot, it's a different picture.

If continuing to use OAZ could cause a further 19 deaths, but switching to Pfizer wouldn't (and would be more effective against covid as well), how can you justify not switching?

Look at it this way... it makes national headline news if a terrorist goes on a rampage and kills 19 random people.

But knowingly continuing to give the population a vaccine that could result in just as many (further) deaths, when there's an alternative available which, on the best evidence so far, isn't believed likely to cause that number of deaths... isn't that morally the equivalent to just randomly shooting 19 people people?

Obviously, if the clots really are treatable, and the treatment generally results in full recovery, and therefore the risk is now mitigated then perhaps not such an issue.

The article I referenced earlier seemed to suggest that once diagnosed, it was most important how you *don't* treat these specific clots, but it left unsaid whether there was a definite (alternative) treatment that works as long as you know to use it.

Since writing my earlier post, I've come across this later, and fairly interesting article (definitely worth a read) which does suggest that an alternative treatment is known for these specific clots, if properly diagnosed... and seems to suggests it's practically the opposite to how you'd treat a regular blood clot; in other words, it kind of implies that some of the deaths may have occurred because the (unwittingly) wrong treatment exacerbated the problem.

https://www.theguardian.com/society/202 ... n-hospital

It meant they had a diagnostic test – and that the medical world needed to know about it immediately. “The reason that they had to know – everybody – is because it was a massive switch in how you would treat patients. It wasn’t just diagnosing it. The normal lines of therapy had to almost be reversed,” she said.

Blood thinners are needed but not heparin. Platelet transfusions aggravate the clots, so they are out. There is an urgent need to damp down the immune system, so it does not produce the PF4 antibodies. Intravenous immunoglobulin, in short supply, has been authorised by the NHS for all these cases. With appropriate treatment and earlier diagnosis as people have become aware of the symptoms, lives are being saved."

Though it doesn't indicate how successful the treatment is.

But clearly if the appropriate diagnostics are available in most hospitals, along with the necessary treatment, *and* if it is mostly effective, to the extent it would have been possible to avoid most of the reported 19 deaths had it been known sooner, then it could justifiably buy the OAZ vaccine a longer term reprieve.

But the regulators, etc, will need to consider the availability and likely success (or otherwise) of those treatments, when deciding whether to grant the OAZ vaccine longer term approval.

[murraypaul]

My point is that in the longer term, it isn't a binary choice between OAZ or Covid.

How long is longer term?
We still need to vaccinate people right now. And right now we have AZ.

But it isn't the only vaccine in town, so (going forwards a few months) it is not a binary choice.

Going forward a few months, we will hopefully have vaccinated everyone already.

I notice today that Boris is trying to say that the vaccine won't be the end of it (ffs!)... but if you take that stance, then why wouldn't you invest in the safer vaccine with the better efficacy?

Going forward, I would hope we would.
If there were enough supply of Pfizer and Moderna right now, I hope we would.
But there aren't.

If continuing to use OAZ could cause a further 19 deaths, but switching to Pfizer wouldn't (and would be more effective against covid as well), how can you justify not switching?

Because we cannot source enough Pfizer vaccines to replace the AZ ones.

But knowingly continuing to give the population a vaccine that could result in just as many (further) deaths, when there's an alternative available which, on the best evidence so far, isn't believed likely to cause that number of deaths... isn't that morally the equivalent to just randomly shooting 19 people people?

Key words: "when there's an alternative available"
There isn't, not for the number of shots we need.

If we had enough P/M vaccines to vaccinate the entire population of the UK, I would agree and say dump the unused AZ ones.
(Ignoring the increased logistical issues with the other vaccines)
But we don't. So do we use the AZ ones, or leave people unvaccinated for longer?

If I went for my jab and they offered me a menu, would I choose AZ? No.
But when I go for my jab and they say the only vaccine available is AZ, will I take it? Yes.

[onthemove]

But what actual evidence is there that the jab caused the blood clot?[/i]
Well, none, as you will know. I guess you could swipe away every individual case in the same way.

I don't know about the specific case you're talking about, but generally the connection between then vaccine and specific type of clots of concern is looking pretty convincing (unfortunately)...

https://www.theguardian.com/society/202 ... n-hospital

"
How UK doctor linked rare blood-clotting to AstraZeneca Covid jab
...
Prof Marcel Levi, at the time chief executive of UCLH and also a haematologist, was there. “I said ‘it’s really weird’. It looks like HIT, but obviously these patients didn’t get heparin. And then Marie thought, ‘well, let’s test for it’,” said Levi.

Scully cannot now remember why she thought it was a good idea to test for the PF4 antibody triggered by heparin. “Oh, I’d love to tell you why. I don’t know why I did it. Looking back, it makes no sense,” she said. But by then they had tried everything else.
...
"To her amazement, both tests came back positive. By then, she knew of another case in Birmingham being managed by a colleague, Dr Will Lester, who also ran a PF4 test. That also was positive.

... most of the cases in the UK and Europe have been in people who were fit and well and not on medications that could cause clotting. “The only thing they’ve had [in common] is the AZ vaccine.”"

[onthemove]

My point is that in the longer term, it isn't a binary choice between OAZ or Covid.

How long is longer term?
We still need to vaccinate people right now. And right now we have AZ.

But it isn't the only vaccine in town, so (going forwards a few months) it is not a binary choice.

Going forward a few months, we will hopefully have vaccinated everyone already.

I notice today that Boris is trying to say that the vaccine won't be the end of it (ffs!)... but if you take that stance, then why wouldn't you invest in the safer vaccine with the better efficacy?

Going forward, I would hope we would.
If there were enough supply of Pfizer and Moderna right now, I hope we would.
But there aren't.

If continuing to use OAZ could cause a further 19 deaths, but switching to Pfizer wouldn't (and would be more effective against covid as well), how can you justify not switching?

Because we cannot source enough Pfizer vaccines to replace the AZ ones.

But knowingly continuing to give the population a vaccine that could result in just as many (further) deaths, when there's an alternative available which, on the best evidence so far, isn't believed likely to cause that number of deaths... isn't that morally the equivalent to just randomly shooting 19 people people?

Key words: "when there's an alternative available"
There isn't, not for the number of shots we need.

If we had enough P/M vaccines to vaccinate the entire population of the UK, I would agree and say dump the unused AZ ones.
(Ignoring the increased logistical issues with the other vaccines)
But we don't. So do we use the AZ ones, or leave people unvaccinated for longer?

If I went for my jab and they offered me a menu, would I choose AZ? No.
But when I go for my jab and they say the only vaccine available is AZ, will I take it? Yes.

Like I say, I already stated that in the short term, the OAZ vaccine is filling a gap and the risk of the vaccine vs the risk of covid probably justifies it. I even said that if I were offered the OAZ in a few weeks, I'd probably take it.

So I'm not really sure what you seem to be arguing with me for.

We generally seem to be putting forward the same point.

[UncleEbenezer]

Any data coming from India? They may not be doing as well as us in percentage terms, but in sheer numbers they've rolled out a huge amount of vaccines, among which AZ is a major player.

[servodude]

Any data coming from India? They may not be doing as well as us in percentage terms, but in sheer numbers they've rolled out a huge amount of vaccines, among which AZ is a major player.

They're looking in to it https://www.reuters.com/article/us-health-coronavirus-india-vaccines-idUSKBN2BW052
- to be fair though they've got their hands full at the moment and appear to have bred a funky version https://www.abc.net.au/news/2021-04-13/how-double-mutant-coronavirus-complicated-indias-outbreak/100059714


- sd

[gryffron]

Dr Fauci told us on radio 4 that the AZ vaccine may never be used in the US.
To be fair, they have also halted use of the J and J vaccine.

So the US has blocked use of all the cheap vaccines, and continues to use the most expensive. Nice little earner. Wonder how much the regulators were paid for that.

The graph of relative national rates is interesting. With our nearest neighbour France, showing the highest rates. Presumably we will be red listing travel from countries with much lower rates whilst continuing to allow truckies to travel freely from France

Gryff

[absolutezero]

USA has now paused Johnson vaccine due to blood clots. 6 women had rare and serious blood clots from 6.8million jabs.

What's that noise?
Oh. It's Macron and Merkel bad mouthing the J&J vaccine.

Oh. No. My mistake. They don't seem to have much to say about it.
Funny, that...

Perhaps they've learnt the lesson?

Or perhaps there isn't a lesson to be learned and it *IS* all purely political.
But you don't seem to be very open to that possibility, do you?

You never know. Maybe money from the 'for profit' vaccines has managed to find a way into EU politicians' pockets.
That would go a long way to explaining why the EU crooks don't like the AZN jab if it's only £3 a jab... Not much nest feathering can come from that.