I have had conversations with friends in Sri Lanka who ask me about the vaccines. They particularly want to know if I am going to get the vaccine and when I tell them that of course I will as soon as I become eligible, they are relieved because that country seems to be awash with all manner of false information that is scaring the hell out of people, such as that wearing masks can cause you to get sick and that the vaccine can give you HIV and even alter your DNA. This makes them apprehensive and I try my best to assure them that these stories are all false.
I was looking for a single article that would make the case that I could send to them and I found one in the February 1, 2021 daily newsletter sent out by David Leonhardt of the New York Times that I have signed up for. He reminds us that what we know about the vaccines is tremendously good news but that the scientific measure of ‘effectiveness’ that is being used to describe them may be underplaying how amazingly good they really are.
The news about the vaccines continues to be excellent — and the public discussion of it continues to be more negative than the facts warrant.
Here’s the key fact: All five vaccines with public results have eliminated Covid-19 deaths. They have also drastically reduced hospitalizations. “They’re all good trial results,” Caitlin Rivers, an epidemiologist at Johns Hopkins University, told me. “It’s great news.”
Many people are instead focusing on relatively minor differences among the vaccine results and wrongly assuming that those differences mean that some vaccines won’t prevent serious illnesses. It’s still too early to be sure, because a few of the vaccine makers have released only a small amount of data. But the available data is very encouraging — including about the vaccines’ effect on the virus’s variants.
“The vaccines are poised to deliver what people so desperately want: an end, however protracted, to this pandemic,” as Julia Marcus of Harvard Medical School recently wrote in The Atlantic.
Why is the public understanding more negative than it should be? Much of the confusion revolves around the meaning of the word “effective.”
In the official language of research science, a vaccine is typically considered effective only if it prevents people from coming down with any degree of illness. With a disease that’s always or usually horrible, like ebola or rabies, that definition is also the most meaningful one.
But it’s not the most meaningful definition for most coronavirus infections.
Whether you realize it or not, you have almost certainly had a coronavirus. Coronaviruses have been circulating for decades if not centuries, and they’re often mild. The common cold can be a coronavirus. The world isn’t going to eliminate coronaviruses — or this particular one, known as SARS-CoV-2 — anytime soon.
Yet we don’t need to eliminate it for life to return to normal. We instead need to downgrade it from a deadly pandemic to a normal virus. Once that happens, adults can go back to work, and children back to school. Grandparents can nuzzle their grandchildren, and you can meet your friends at a restaurant.
As Dr. Ashish Jha, the dean of the Brown University School of Public Health, told me this weekend: “I don’t actually care about infections. I care about hospitalizations and deaths and long-term complications.”
By those measures, all five of the vaccines — from Pfizer, Moderna, AstraZeneca, Novavax and Johnson & Johnson — look extremely good. Of the roughly 75,000 people who have received one of the five in a research trial, not a single person has died from Covid, and only a few people appear to have been hospitalized. None have remained hospitalized 28 days after receiving a shot.
To put that in perspective, it helps to think about what Covid has done so far to a representative group of 75,000 American adults: It has killed roughly 150 of them and sent several hundred more to the hospital. The vaccines reduce those numbers to zero and nearly zero, based on the research trials.
Zero isn’t even the most relevant benchmark. A typical U.S. flu season kills between five and 15 out of every 75,000 adults and hospitalizes more than 100 of them.
I assume you would agree that any vaccine that transforms Covid into something much milder than a typical flu deserves to be called effective. But that is not the scientific definition. When you read that the Johnson & Johnson vaccine was 66 percent effective or that the Novavax vaccine was 89 percent effective, those numbers are referring to the prevention of all illness. They count mild symptoms as a failure. [My italics-MS]
“In terms of the severe outcomes, which is what we really care about, the news is fantastic,” Dr. Aaron Richterman, an infectious-disease specialist at the University of Pennsylvania, said.
The biggest caveat is the possibility that future data will be less heartening. Johnson & Johnson and Novavax, for example, have issued press releases about their data, but no independent group has yet released an analysis. It will also be important to see much more data about how the vaccines interact with the variants.
But don’t confuse uncertainty with bad news. The available vaccine evidence is nearly as positive as it could conceivably be. And our overly negative interpretation of it is causing real problems.
Some people worry that schools cannot reopen even after teachers are vaccinated. Others are left with the mistaken impression that only the two vaccines with the highest official effectiveness rates — from Moderna and Pfizer — are worth getting.
In truth, so long as the data holds up, any of the five vaccines can save your life.
Last week, Dr. William Schaffner of Vanderbilt University told my colleague Denise Grady about a conversation he had with other experts. During it, they imagined that a close relative had to choose between getting the Johnson & Johnson vaccine now or waiting three weeks to get the Moderna or Pfizer vaccine. “All of us said, ‘Get the one tomorrow,’” Schaffner said. “The virus is bad. You’re risking three more weeks of exposure as opposed to getting protection tomorrow.”
I am forwarding that newsletter to everyone I know who might be confused or susceptible to the anti-vaccination propaganda.
The vaccines for CoV-2 are good -- far better than anyone had any right predicting they would be.
The only question anybody should be asking is, which virus should we go after next?
Amal Siriwardena says
There still remains the question of whether having the vaccine prevents you from spreading the disease to others even if you don’t get it yourself. Is there an answer to this?
Regarding the question of effectiveness there was some confusion about the AstraZeneca tests and the effectiveness which may be why people are biased towards Pfizer/Moderna.
But the Astra Zeneca vaccine requires only normal refrigeration (unlike Pfizer/Moderna) which makes it the most suitable for countries like Sri Lanka. It is also the only one available( but produced in India) in Sri Lanka at the moment. There have been calls that we should not depend only on one.
Marcus Ranum says
It’s really freakin’ weird -- so far something like 20 million people have taken the vaccine and, so far, none of them have died. There have been some anomalous reactions but 500,000 people have actually died of the coronavirus. Why anyone is worrying about the vaccine is so bizarre it makes me give up whatever remaining shreds of faith I had in humanity.
Mano Singham says
There is no definitive answer to your question at the moment because it is still early days.
But even after I get the vaccine, I still plan on wearing a mask and maintaining distance for two reasons: (1) Because of the concern you raise that I might still spread the virus to others, and (2) because I want to encourage mask wearing and distancing and since people will not know if I am vaccinated or not, I don’t want to set a bad example to others.
What being vaccinated will do is relieve me of the anxiety that I might get seriously ill.
consciousness razor says
That’s the trouble with them, though. A lot of people seem to think with the vaccine suddenly everything is back to normal. Open everything up again, no more worries, all is well, blah, blah, blah….
Here’s the Washington Post just yesterday, at least trying to throw a little cold water on that notion:
But those warnings ought to be headline, not that people fucking wonder what they can do.
@3: anecdotes are not data, but: one of my wifes best friends, a bridesmaid at our wedding, didn’t see her dad for most of last year, as he was shielding, hard. He had a shit year staying indoors, as many old people did. Then just a few weeks ago, he got the vaccine. Then he got covid. Then he died. Let’s not start sucking each other’s dicks quite yet. They’re good, but they’re not magic.
Who Cares says
Seeing that you literally cannot get COVID from the currently approved vaccines in the US your anecdote victim died not from the vaccine (which is what was implied by Marcus Ranum in #3) but from getting the virus. And the question is how long after the first dose did he get the virus. Answer will most likely be “not that long”, which syncs with that it takes 21 days from the first dose to get around a 50% to 60% chance of being immune and another 14 days from the booster to get the 90% -- 95% immunity chance.
And yes that means that only two weeks ago (18th Jan, 35 days from 14th Dec) the first people were truly vaccinated against COVID.
One of the things that bothers me is people being told that they have been vaccinated after only 1 jab when 2 are needed to achieve this. Additionally the British Giv’t isnow delaying the second vaccination to weeks rather than the 3 used on all the trials. Only one of these (Astra Zeneca) has done any trials at all outside of this and these were not sufficient to be statistically significant. The whole of the UK is now firmly taking part in a medicaltrial and we can only hope that it works out ok.
BMJ on this: https://blogs.bmj.com/bmj/2021/01/05/covid-19-vaccines-to-delay-or-not-to-delay-second-doses/
Marcus Ranum says
Let’s not start sucking each other’s dicks quite yet. They’re good, but they’re not magic.
Wait, you mean it’s not!?
@ 3 Marcus Ranum
Why anyone is worrying about the vaccine is so bizarre
You and I may not be exposed to them but there are entire industries out there telling people that the vaccine will kill you, make you impotent, infertile, is a New World Order plot to enslave you, NWO plot reduce the population at the behest of the 1%, inject nano-chips for some nefarious plot of Bill Gates or turn you into an alligator. This last one was as actual statement by President Bolsonaro.
President Trump’s suggestion of bleach and internal ultraviolet (infrared?) light may not have helped.
If you can persuade people to believe in Q-anon conspiracies, these are easy to believe.
These industries, in many cases, are selling all kinds of “cures” or “prophylactics” to protect you from SARS-CoV-2 . The amazing thing is that some of these grifters even believe their bullshit.
Combined with that, I understand that the Black population in the USA has some reasan not to be terribly trusting of main-stream medicine.
On a more scientific level, ASAIK, none of the vaccines currently being used have completed Stage 3 trials. All of them from the Pfizer and Moderna vaccines to the Chinese ones from Sinovac and Sinopharm or the Russian Sputnik 5 are being used under various “Emergency Ussage Orders”.
You are correct that it does not appear any of them have killed anyone nor even had seriously bad side effects but the anti-vaxers and other conspiracy theorists will seize on anything and magnify it into a catastrophe or as evidence of wide-spread conspiracy by them where “them” may be any or all of the “the government”, big pharma, the 1%, Bill Gates, possibly George Soros, Wall Street, the lizard people (no joking), and Uncle Tom Cobley. I am awaiting a claim against the Catholic Church.
Marcus Ranum says
The Lancet just had a piece that the Russian vaccine which was developed with more secrecy and fewer clinical trials also is effective and right about the same as Moderna/Pfizer. This is great news because the US and its allies won’t be able to continue to monopolize the supply! Иди в россию!
It sounds like the man changed his behaviour shortly after getting the shot, thinking that it causes immunity immediately. If he had stayed isolated for a month or so longer, he would most likely have been fine upon encountering the virus in the wild. A difficult thing to ask given the lonely year he had already had, but still. They aren’t magic, they take some time.
@ 11 Marcus Ranum
The Lancet just had a piece that the Russian vaccine which was developed with more secrecy and fewer clinical trials also is effective and right about the same as Moderna/Pfizer.
Is that the Gamaleya Institute’s Sputnik 5 vaccine?
Admittedly they were a bit late in publishing their Stage 1 & 2 results in the Lancet but secrecy seems a bit much.
A real criticism is the small n-size, n < 100, in the Stage 2 trial but the researchers seem to have argued convincingly that the vaccine was almost identical to the MERS vaccine they have been doing Stage 3 testing on in, IIRC, Saudi Arabia for roughly the last 3 or 4 years.
Currently it is reported to have 14 trials in 3 countries (https://covid19.trackvaccines.org/vaccines/). Last I heard they were in the middle of an n = 40,000 trial in Russia. I think the other countries are Mexico and Brazil but I may be mistaken so I am not too impressed with the "fewer clinical trials".
It also is reported to have been approved (EUA presumably) in 16 countries.
So far it seems to be pretty effective and can be stored at normal refrigerator (freezer?) temperatures. Back in March or April, 2020, the lead researcher was even discussing the possibility of a freeze-dried vaccine for delivery in remote areas. That may have been a pipe dream.
Hasn’t China also developed it’s own vaccine?
@ 14 springa73
Hasn’t China also developed it’s own vaccine?
Going from memory they have at least 2 in use (EUA) and another 2 or 3 at least in various Stage 1 & 1 trials. https://covid19.trackvaccines.org/vaccines/
I figure I’ll wait fo go swimming for 6 weeks. Got my first injection last Thursday
The data from Israel (currently largest ‘experiment’ in mass vaccination against Cov-2) is that the protective effect of a single dose of the Pfizer vaccine is a lot less than was expected based on the official trials. So people will keep dying of Covid if they don’t wait until at least 2 weeks after receiving the *second* dose of the vaccine before changing their isolation habits.
Rob Grigjanis says
You can’t conclude that from the Israeli data. See here.
consciousness razor says
Exactly the kind of thing I was talking about above.
The vaccines aren’t intended to make you less contagious. You can still spread it to others, even if it fully worked on you, in the sense of making your symptoms less severe.
Then what happens at least 2 weeks after your second dose? Nothing, because that’s not when other people are safe. Because you are not them, and they are not you. Does getting it yourself tell you that they all already got the vaccine too? No.
So, do not change your isolation habits then, because that would be a real asshole move.