Reasons for Optimism

After an interruption of almost two months because of a Cyberattack on the Health Service Executive’s computer system, daily updates of Ireland’s vaccination statistics have at last resumed, including via the Covid-19 app (which has been moribund since 11th May).

You might think it strange but I find the restoration of daily updates reassuring. I suppose it’s because I work in a quantitative discipline but I like having things expressed in figures, though I am of course aware of their uncertainties and other problems involved in interpreting them.

The latest figures above show that about 70% of the adult population has received at least one dose while about 50% have had two doses; the latter are regarded as “fully” vaccinated as are the smaller number who have received the one-shot Janssen vaccine produced by Johnson & Johnson. Although the Government missed by some margin its target of giving one dose to 82% of the adult population by the end of June, I find myself much more optimistic than in past few weeks about how things are going.

Two developments in particular have helped.

First the Government is set to purchase about a million doses of Pfizer/BioNTech from Romania. That would be enough to fully vaccinated about 10% of the population. These doses have become available because take-up in Romania is very poor and the shots would go to waste if not disposed of elsewhere. What’s bad news for Romania is, however, good news for Ireland.

The second change is that the Government has decided to allow the AstraZeneca and Janssen vaccines to be used on adults in the age range 18-34 and that vaccinations of this group are now being carried out by pharmacists. Previously these vaccines were only to be given to persons aged 50 and over. Indications are that there is some reluctance among the younger cohort, which is hardly surprising since it was only a few weeks ago that they were being told these vaccines were too risky, but I suspect this change will go a long way towards fully vaccinating the adult population, which may be possible by the end of August.

I regard the immunization of students next year’s intake to third level education institutions as a necessary condition for opening up campuses to something like “normal” teaching. Just a couple of months ago I didn’t think this would be possible, but now it might be. It’s still possible that there will be disruptions in supply but it’s looking reasonably good at the moment based on the arithmetic of how many doses are available.

The fly in the ointment is of course the so-called Delta Variant, which has already gained a foothold in Ireland and is set to cause case numbers to rise substantially. We will soon see whether this causes an increase in hospitalizations and deaths. The most vulnerable should be protected so the probability of a case turning into serious illness or death should be much lower, but we don’t know by how much. Unfortunately the statistics of Covid-19 are still not being reported publicly. Some people seem to think this means they’re not happening. It doesn’t. It just means the system for reporting them is not working. I expect the forthcoming announcement of the backlog will cause some alarm.

The Irish Government recently decided to pause the gradual reopening of the economy to allow vaccinations to proceed further. There is still a race between the Delta variant and the vaccination programme. The number of people vaccinated increases approximately linearly with time, while the number of Covid-19 cases grows exponentially in the growth phase of the pandemic. I think the pause was sensible.

Across the Irish Sea there is a different situation. The English Government has decided to abandon all attempts to control the spread of Covid-19 at precisely the point when the pandemic is in another exponential phase. The number of cases is now likely to increase dramatically. The number of resulting deaths may be fewer than in previous waves but won’t be zero. Perhaps more importantly, allowing a huge pool of virus to develop increases the chance of yet another variant evolving, perhaps one that can evade the defences afforded by vaccination even more effectively than the Delta variant. I shudder to think of the consequences if that does happen. Perhaps it already has.

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On Vaccination in Ireland

Following from my weekend post about issues with Covid19 vaccination, which seems to have ruffled a few feathers, I thought I’d just mention a couple of recent developments.

The first is that on Tuesday (yesterday) the Irish Government decided to change the way it vaccinates the rest of the population. The previous plan was rather complicated with a number of groups to be vaccinated in order of priority:

That plan has now been scrapped and after the current groups 1-3 are completed it will revert to a simpler scheme with priority determined only by age. As an oldie I will benefit from this, moving up several steps in the pecking order as a consequence of the decision.

Frontline workers such as teachers and Gardaí are dismayed by this decision. On the news just now various folk were trying to argue that the change is for health policy reasons, stating that the prime factor in risk for Covid-19 is age. Actually, it isn’t. The prime factor is exposure to the virus.

What I mean is that the probability of dying from Covid-19 if you haven’t been infected is zero: 100% of those suffering death or serious illness from Covid-19 have been in contact with the virus. Someone who is 60 years old but able to work effectively at home at far lower risk of exposure than a 35 year old schoolteacher.

The real reason for the change is that Ireland does not possess a system that can be used identify groups by occupation in an efficient way. Doing it by age is far simpler and would lead to a much more rapid rise in the fraction of the population immunized. Sometimes decisions have to be made for such practical reasons, but I do wish certain people were more honest.

The slow rollout of the vaccine in Ireland should have provided the Government to work out how to implement their original strategy. Obviously they decided that they couldn’t.

Anyway, for myself, I am pleased that it now looks quite likely that I’ll get at least one jab by May. Assuming the vaccine supply holds up, of course.

I thought I’d end with a thought following on from my earlier post. Some people will ask whether I would have the AstraZeneca vaccine given my views about the company’s behaviour and the lower efficacy of the vaccine as compared to others available.

I think there are two motivations for getting vaccinated. One is self-preservation. I want to protect myself as much as possible. If I had the choice of vaccine for this reason I would pick Moderna or Pfizer-BioNtech but would accept AZ if that was the only one available. As things stand, over 75% of doses administered in Ireland have been Pfizer-BioNtech,

The other motivation is to help reduce the transmission of the disease. For that even a low efficacy vaccine would play a part. If the only shot available offered just 50% protection I would still take it, as if everyone did so the population dynamics would still be significantly slowed.

It’s a similar thing with face masks, actually. Their role is only partly to protect the wearer. The other part is to protect everyone else.

So on both grounds, yes I would take the AZ vaccine if that was the only one on offer, but if I had the choice I would pick a better one. I feel the same way about the Johnson & Johnson vaccine, which will start to become available in Ireland very soon.

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SARS-Cov-2 Vaccine strategy: One Jab or Two?

I’ve been thinking quite a lot about the issue of the Coronavirus vaccination programmes currently underway and have had some interesting and informative exchanges on Twitter about it. This morning’s news that AstraZeneca has finally applied to the European Commission for permission to market its vaccine within the European Union reminded me of those discussions so I thought I’d post a question here. I genuinely don’t know the answer, incidentally, so there’s no agenda here!

As you probably know all SARS-COV-2 vaccines (Moderna, Pfizer/Biontech and AstraZeneca) require two doses, administered about three weeks apart, for maximum efficacy. It’s worth saying before going on that the scientists involved deserve high praise for developing these highly effective vaccines at a speed that has exceeded all expectations.

At the moment however supplies of these vaccines are fairly limited and it’s early days for immunization programmes so there are serious logistical problems to be solved before we get anywhere near full vaccination. I grabbed this from Twitter yesterday showing the state of play in various countries:

Note, incidentally, that Denmark is doing particularly well within the EU but France, Netherlands, Luxembourg and Belgium have started very slowly. Ireland is about mid-table.

At the top of the league is Israel, though  they are not offering vaccination to the Palestinian people whose lands they occupy. Israel has just reported that after 12 days the Pfizer/BioNTech vaccine has about 50% efficacy after one dose based on results from its own programme. That number is roughly consistent with initial estimates of from trials this vaccine but the statistics aren’t great and there is a considerable margin of error on these figures.

Now the question I am asking myself is that given the limited supply is it better at this stage to give as many people as possible one dose of the vaccine, or follow the manufacturers’ original plan and give two doses to half as many people? There are reports that the UK has been deferring the second dose beyond the recommended interval, where there is no data on its efficacy. Perhaps I’m being excessively cynical but it seems to me that the UK Government’s approach is more driven by public relations than by public health considerations.

I understand that there are difficult issues here, not least the ethical one of having people sign up for a specific two-dose vaccination only to find that’s not what they get. Another issue is the speed with which doses are being made available relative to the size of the population. Yet another issue is who you prioritize.

Above all, though, there is the question of what you mean by “better”. One criterion would be to save as many lives as possible. Another might be to slow the rate of infections as much as possible. Another might be to allow the economy to open up as early as possible. These are all different and would lead to different decisions, particularly with regard to who should get the vaccine. Saving lives obviously means protecting the vulnerable and the people who care for them (e.g. health workers). Economic considerations would however lead you to prioritize those on whom the economy depends most directly, which would include workers who can’t easily work from home (many of whom are in low-paid manual jobs).

The following poll is therefore going to be very unscientific, but I’m interested to find out what people think. In  order to keep it simple, lets suppose you have a batch of two million doses of a vaccine (say the Pfizer one) and the next batch is due in three months.

You have to decide between the following two options:

1.  Give 1,000,000 people one dose now and another dose in three weeks’ time
2.  Give 2,000,000 people one dose now and hope that it is effective for three months (or that additional supplies appear more quickly than anticipated).

Vote now!

A similar poll I did on Twitter a while ago can be found here: there are some quite interesting comments in the ensuing thread.

Comments are of course welcome through the Comments Box!

P.S. I’m quite low down the pecking order in Ireland so it’s unlikely I’ll get vaccinated before the summer.

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