Covid vaccine
So, there’s good news about the Pfizer vaccine. Some context:
- What we have now is just a press release. However, the analysis and criteria were specified in advance, and we actually have that document, so it’s less fuzzy than it might be
- Data are still coming in, so the estimate of vaccine efficacy will change over time to some extent. In particular, we wouldn’t have heard anything if the estimated efficacy wasn’t at least 63%, so the current estimate is likely a bit too high. The current estimate is so far above the threshold of 63% that this bias shouldn’t be huge
- The trial focuses on preventing symptomatic infection. We haven’t heard anything about the impact on serious disease or on asymptomatic disease. The impact on serious disease is, oddly, less important, since the vaccine is good enough for herd immunity. However, if the vaccine (a bit implausibly) had no effect on serious disease and just made symptomatic infections asymptomatic, it wouldn’t be that much use. Pfizer are collecting this information; it just wasn’t in the press release.
- The next important step isn’t peer-reviewed publication, it’s the FDA external advisory committee meeting. These are public and involve scientists and doctors external to the FDA who get to ask Pfizer questions and have them answered. If the advisory committee is strongly in favour of emergency authorisation, I would expect Medsafe to reach the same conclusion.
- Duration of effect matters. We cannot possibly know for another year whether protection lasts for a year (which would be plenty). Very short duration of protection would still have some use for making travel safer and for ring-fencing small outbreaks, but it wouldn’t have much impact on the pandemic
- New Zealand is in line for enough vaccine for 750,000 people, and Megan Woods says it could arrive early next year. That’s not enough to have any noticeable impact on population spread, but it is enough to reduce transmission to border staff and healthcare workers. It might even allow some increase in the safe admission to NZ of temporary workers or students — the government needs to decide how to allocate the vaccine. Expanding on this: a vaccine could be used to reduce the probability of an outbreak, to increase travel and help the economy, or to reduce the harm of an outbreak (eg vaccinating elderly people). These are all worthwhile and the detailed choice is a policy question.
- Mass vaccination won’t happen for a while. Even if other candidate vaccines are effective (increasing the number of suppliers), mass vaccination in NZ is probably at least a year away
- If the current estimate holds up, the vaccine is effective enough that we might get reasonable herd immunity by vaccinating only people who actually want to be vaccinated, which would make life simpler.
- The Covid vaccines seem to have a higher rate of mild adverse effects than most vaccines we’re used to. It’s important not to deny these, and it would be useful if there were careful monitoring of adverse event rates in the first wave of NZ vaccine recipients by, eg, the NZ Pharmacovigilance Centre