Tuesday, April 20, 2021

mRNA's Cherry On Top: The EU Buys Another 100M Pfizer Vaccines

The EU exercised its option to buy another 100 million doses of Pfizer/BioNTech COVID-19 vaccine, bringing the total to 600 million. Combining that with the 1.8 billion dose order drafted earlier in the month, this means the EU has essentially gone all-in on mRNA. Reviewing my post on the situation back in February, this means the EU has 3.365 billion mRNA vaccine doses either delivered or deliverable. Presumably CureVac's doses are still on order as part of that sum.

The buy makes it appear that the EU has lost faith in Sanofi's protein subunit vaccine, which had trouble with efficacy in the key older group. Sanofi has since shifted gears, and on March 12 announced with partner Translate Bio, that they, too, would have an mRNA vaccine candidate, with phase 1/2 trials commencing soon (?), but these are not expected to conclude until Q3, 2021.

Saturday, April 17, 2021

COVID Vaccine Bullets

  •  The European Union is negotiating a 1.8 billion-dose order with Pfizer to be delivered in 2022 and 2023 (!!!) and will not renew contracts with AstraZeneca or Johnson & Johnson. The doses will be manufactured in the EU.
  • For all that mRNA manufacturing has generally scaled well, we finally have a story of missed shipments from Moderna, who has announced they will cut vaccine deliveries to Canada and the UK due to manufacturing problems.

    While the company didn’t specify how many doses would be cut and where, Canada’s Procurement Minister Anita Anand said Friday that its shipments will contain 650,000 doses this month instead of the expected 1.2 million. 

    Moderna also warned up to 2 million of a planned 12.3 million shots scheduled for delivery in the second quarter would be delayed until the following quarter, according to a report from Reuters. However, a company spokesperson also told the news agency that its deliveries to the European Union and Switzerland remain on track.

  • Pfizer's CEO now says there will likely be a need for COVID booster shots, possibly annually.
  • CureVac plans on releasing trial data of its mRNA vaccine in the coming weeks.
  • Moderna is putting its mRNA influenza and HIV vaccines into phase I trials this year.
    Current flu vaccines in the market have efficacy rates in the regoin [sic] of 40-60%: which Moderna believes its mRNA technology can improve on. It also says that its technology has several advantages over egg-based vaccine production: not only in terms of production advances but in accurately targetting vaccines against strains (egg-based production has the potential to cause unintended antigenic change to the vaccine virus).
    They also released phase I trial data for a respiratory syncytial virus (RSV) vaccine, and a cytomegalovirus (CMV) vaccine.

The Bogus Story About Vaccine Racism

The woke crowd has unsurprisingly turned to its favorite hobgoblin of "structural racism" (i.e. this piece in Journal of the American Medical Association) as explanatory for differing rates of COVID-19 vaccine uptake. Per recent polling by the Kaiser Family Foundation, Hispanics (61%) and blacks (55%) say they have either already gotten a COVID vaccine or plan to do so as soon as possible. The big problem the "structural racism" argument has is this reticence is more or less mirrored in historical data for influenza vaccines. Blacks (by about 15%) and Hispanics (~13%) lag white vaccination rates considerably for the most vulnerable age group (69.9% for ≥ 65 years). Otherwise there is a lag, sometimes quite noticeable, other times not so much, but the idea that COVID vaccine reticence is somehow driven by systemic racism fails to heed the historic story.

Friday, April 16, 2021

The Trouble With Labels And Facebook's Censorship

 The New York Post has a story about BLM co-founder Patrisse Khan-Cullors buying four million-dollar-plus homes in the New York area, scoping out property in the Bahamas, and last month buying a $1.4M home in Malibu. This is in addition to homes in the Atlanta and Los Angeles areas.

 BLM, of course, is a label, which means anyone can use it. There really is no unified formal organization, which has led to grifters capitalizing on the brand's goodwill. BLM Global Network Foundation, Khan-Cullors' particular instance, is one among many:

Founded by Khan-Cullors and another activist, Kailee Scales, the nonprofit Oakland, Calif.-based BLM Global Network Foundation was incorporated in 2017 and claims to have chapters throughout the US, the UK and Canada, and a mission “to eradicate White supremacy and build power to intervene in violence inflicted on Black communities.” The group does not have a federal tax exemption and donations are filtered through ActBlue Charities and Thousand Currents, two nonprofits that manage the cash.

This, of course, sounds awfully familiar; the whole point of ActBlue is to hide the operations of political scam artists. What makes this worse is Facebook censoring attempts to share the story, something mainly reported by News Corp. outlets. (Twitter has not, so far, attempted to step on this.) What good can come from this? The fact that the BLM name is being openly used by grifters is bad enough; that Big Tech covers for them is appalling.

Wednesday, April 14, 2021

The Insane, Reckless "Pause" Of The Johnson & Johnson Vaccine Will Cost Lives

 The FDA and CDC have called for a "pause" of deliveries of the Johnson & Johnson (Janssen) COVID-19 vaccine. This is absolutely insane based on relative risk alone: one woman died among the six women affected (all 18-49 years old), versus over seven million vaccinated. Meantime, the CDC's own best-guess infection fatality ratio shows twenty deaths per million infected among the 0-17 years age group. So the FDA and CDC are stopping vaccinations that could save the lives of twenty times the number of people even in the best case scenario. The most likely case, the 18-49 age bracket, sees an IFR of 500, which means you are looking at two orders of magnitude more risk of death than without vaccination. The FDA has a history of safetyism overriding sense, and this will kill people, especially as it means fewer vaccines will be available.

 In a sense, the pause may not matter, because the vaccines wouldn't be available even if these thrombotic events hadn't happened. Johnson & Johnson took over production at contract manufacturer Emergent BioSolutions following production errors there that mixed up their vaccine with AstraZeneca's, and this caused the destruction of up to "15 million doses". Accordingly, the CDC announced it expects J&J to cut supply by 80%, putting the overall annual goals of 100 million doses in the US and one billion worldwide in jeopardy.

Lastly, for anyone who wants to get into the weeds on this subject, Derek Lowe has a good explainer on the subject. This seems to be a problem shared with the AstraZeneca ChAdOx1 vaccine as well, and while I recommend the whole post, I wanted to highlight this one section in particular:

Is this blood clotting happening with the mRNA vaccines, too?

No. That seems quite clear – to the best of my knowledge, there have been no reports like this at all with either the Moderna or the Pfizer/BioNTech vaccine. That’s good news, and it tells us a lot. For one thing, this blood clotting problem is not a general feature of trying to vaccinate people against the coronavirus. It also means that it apparently has nothing to do with inducing the coronavirus Spike protein in people, since that’s what both the adenovirus vectors and the mRNA vaccines are doing, in the end.

The version of that protein brought on by the AZ/Oxford vaccine is slightly different from the others (it doesn’t have a key set of protein-stabilizing mutations), and when the clotting problems showed up in Europe some people were wondering if that had anything to do with it. But the appearance of such side effects with the J&J vaccine would seem to rule that out. Instead, what those two have in common is that they’re both adenovirus vector vaccines [emboldening mine — RLM]. Oxford used a chimpanzee adenovirus, and J&J picked a less-common human one. Which means that if this is a side effect shared by adenovirus vectors, it’s shared at a pretty basic level, isn’t it? I’m not enough of an adenovirus jock to tell you in detail about the similarities between the proteins in the ChAdOx vector versus Ad26, and at any rate it’s probably more about the antibody response to these things (and why, in a small number of people, that goes awry with the PF4 protein).

It's becoming increasingly obvious that the vectored virus vaccines are a technological dead end: harder to manufacture at scale, more likely to generate weird side effects, and less effective than mRNA vaccines. But any of them are still better than getting COVID.

Update 2021-04-15: Alex Tabarrok has a useful thread detailing post-vaccination thrombotic events in the UK. The mRNA vaccines maybe have dodged a bullet on this?

Monday, March 29, 2021

What Does Pandemic's End Look Like?

 The pandemic will go on a lot longer than people are probably comfortable with, to the extent that the disease is likely to become endemic. And it's likely to drag on a while: Moderna has committed to making 1.4 billion doses of its COVID-19 vaccine in 2022, which suggests a couple of things:

  • Moderna thinks other vaccine platforms won't actually be able to scale. This is somewhat laid out by the continuing manufacturing problems Astrazeneca has had in Belgium, Mexico, and a Dutch plant that hasn't been certified for production yet. Johnson & Johnson has similarly had manufacturing problems delaying shipments and putting commitments at risk. Likewise, the Russians are also facing similar problems scaling their Sputnik V vaccine. One might be excused for thinking this is a trend among vectored virus vaccines.
  • And/or, a variant booster will become necessary. Moderna has already committed to work on a vaccine for the the B.1.1.7 and B.1.351 variants.

For its part, Pfizer says they do not foresee strong demand for their COVID-19 vaccine in 2022, although they are similarly lining up for possible variant boosters, this mainly on the strength of many entrants to the market. Assuming Moderna is right and Pfizer is wrong, this could mean a COVID shot becomes an annual affair, like influenza. The good news, to a certain extent, appears that the virus is convergently evolving, i.e. the same mutations are showing up in different places. That is, we have a pretty good idea where the beast is headed. We also now know that the impact of the variants on T-cell reactivity is "negligible". Antibodies are nice, but they're not the whole immune system. In all, this makes it look like we're getting very close to this pandemic coming to an end.

Update 2021-03-30: Some interesting polling data:

  • First, a Washington Post poll showing "one in three" health care workers are not confident the vaccines have been adequately tested for safety and effectiveness.
    While about 2 in 10 health-care workers said they had scheduled a shot or were planning to, 3 in 10 health-care workers said they were unsure about getting vaccinated or not planning to do so. As many as 1 in 6 health workers said that if employers required them to get vaccinated, they would leave their job.
  • Next, the Wall Street Journal summarizes a U.S. Census Bureau poll showing that for the first time since polling began in December, "will not take" is now below 20% ("about 17% of adults said they would either definitely or probably not get vaccinated, down from 22% in January"). Good news.

Thursday, March 25, 2021

The Pandemic Isn't Over, But It's Getting Closer

 Coyoteblog (somewhat prematurely, I think) declares the pandemic over, at least in Arizona, this based on Arizona Department of Health hospitalization data. The obvious rejoinder to this is that we have previously seen downturns in hospitalization, but this time we have vaccinations. Arizona recently surpassed 40% of its population with one or more jabs, which the ADH boils down to 26.8% of its population vaccinated. 

Costco may have quietly come to their own conclusions on this matter:

There's reason for hope. Hopefully next month we start seeing the large vaccine increases promised back in February. Of course, this won't help if we continue to see vaccine hesitancy in younger groups — or in ethnic groups otherwise disinclined to get vaccinated. This is already being chalked up to, in part, Russian disinformation (some of which is probably due to Sputnik V vaccine marketing). But none of this makes sense against the background of historical influenza vaccination uptake.

 In the Kaiser Family Foundation's most recent poll, 51% of whites, 52% of Hispanics, but only 42% of blacks either had already been vaccinated or planned to get vaccinated as soon as possible. Yet, if you look back a ways — to this 2013 NIH study on influenza vaccination — you would see that whites lead inoculations in all age categories, with blacks trailing around 10% and Hispanics a similar percentage. As only 32.2% of whites 18-64 got inoculated in the 2010-11 season, that means about a 20-point shift in confidence and/or necessity. That's pretty impressive when you consider all the shade thrown at the vaccines as "rushed" or whatever other imagined flaws they might have.