Looking ahead on vaccines - Printable Version

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Looking ahead on vaccines - Hurlburt88 - 05-03-2021

behind a paywall but hopefully a good number can read it

I am becoming increasingly interested in next vaccine steps (boosters, variants, etc.) as well as overcoming vaccine hesitancy.   So this article caught my attention also (not paywalled)

RE: Looking ahead on vaccines - M_T - 05-05-2021

Clearly, one of the next vaccine steps is to get as much of the world's population vaccinated with a good vaccine. If, say, the Chinese vaccine really has the poor effectiveness reported in South America, then the continued level of COVID in that region (SA) will push the government to find more effective vaccines.

IMO, the world is fortunate that China didn't (or, at least, hasn't yet) get the infection levels that the US had. Instead of 150M cases (1.95% of the world population), we might have several times that many (with the resultant variants). The fact that India didn't get too bad a hit until recently was fortunate, but they now have about 12% of all the cumulative cases. That has the potential to create new variants.

I suspect that the mRNA vaccines will be quickly adopted to any new variant, if needed. So, we may have EUA vaccines about 6 months after the variant surfaces. Now that the manufacturing & distribution processes are in place, new vaccine "boosters" may get to all the population in the US within 3 months after EUA.

Vaccine hesitancy is another issue. Is it a mostly US fad? I am not sure, but I can imagine it might be. I imagine that most countries will simply require vaccination of their population. The US may be an outlier here, considering vaccine to be a personal choice rather than a public health necessity.

Ah... here's another viewpoint. I would paraphrase this article as saying that the perception of the significance of vaccine hesitancy as an issue is a result of desired eradication of a disease plus the media's highlighting those that stand in the way of that goal. (In the US, we add to that the manipulation of public opinion as a tool of the various parties striving to solidify their support and weaken their opponent.)

If you're interested, here's a 2017 report on polio vaccine hesitancy in Nigeria. (Click on "Open Manuscript" near the top to see the full report.)

Here's a 253 page WHO report from 2014: Strategies for Addressing Vaccine Hesitancy -- A Systematic Review

RE: Looking ahead on vaccines - ChrisGreene - 05-05-2021

"I suspect that the mRNA vaccines will be quickly adopted to any new variant, if needed. So, we may have EUA vaccines about 6 months after the variant surfaces. "

Didn't someone in the CDC say that boosters for the variant won't require a full review, sort of like the flu? That would imply that once the vaccine is approved, boosters would be approved with a much quicker process.

RE: Looking ahead on vaccines - Hurlburt88 - 05-06-2021

regarding vaccine hesitancy, my understanding is that Europe has a pretty good level of hesitancy, unfortunately

RE: Looking ahead on vaccines - akiddoc - 05-07-2021

Europe is another hot bed of vaccine resistance.

Watching the vaccination rates in SEC country is depressing.

64% of California adults are at least partially vaccinated. It's going to be tough to get the next 11%.

New Hampshire at 75% and still having a lot of Covid.

RE: Looking ahead on vaccines - M_T - 05-07-2021

20% of California's population is under 16. So with current policies, 80% of the population was the limit.
CDC indicates 50.4% of CA's population has at least one dose. (61.2% of NH's population has had one dose.)

LA Times shows (tiny) Alpine Co. to have 71.4% with 1 dose, 5 counties > 60% (Marin, SF, SD, San Mateo, SCC), and the other general Bay Area counties to be in the upper 50s. San Bernardino is only at 35%.

I see predictions that Pfizer will get an EUA for 12-16yo next week. Yeah! That will raise the upper limit to about 87%.

I wish it were the case that the vaccinations were the reason that California has a low case rate now, but I think it is just the fickleness of COVID.

RE: Looking ahead on vaccines - M_T - 05-07-2021

The LA Times COVID pages show vaccinations by zip-code. Looking at the zip codes in some of the more vaccinated counties is still disappointing.
94022 is much of Los Altos & LAH. Pop 19,378. First dose: 13,955=72%. If 20% are too young, that leaves nearly 1550 that haven't gotten a shot. Why? I suppose that number might represent children listed as residents but off at school or in the military.
94024 is mostly Los Altos & LAH as well. Pop. 23.961. First dose: 15,644=65%. Around 3500 eligible but not yet gotten the first shot.
(Cumulative cases in Los Altos & LAH is about 2.5% of the population.)
94031 is Palo Alto. Pop. 17,191. First dose: 11,500=67%. Around 2,250 eligible but not vaccinated.
94305 includes Stanford. Pop 15,730. First dose: 7,792=50%.

One of the least vaccinated regions in the Bay Area is between Alameda and San Leandro.
94601 Pop. 52,299. 1st dose: 23,397=45%
94621 Pop. 35,261. 1st dose: 12,034=34%
94695 Pop. 43,112. 1st dose: 19,557=45%
94603 Pop. 34,593. 1st dose: 12,359=36%

On the other end, the 3 zip codes around Compton (pop. 139K) average only 30% first-dose vaccination.
(Cumulative cases in Compton represent about 17% of the population.)
This is in the middle of a large L.A. region of zip codes all less than 50% vaccination.

I'm less concerned about the rural areas where vaccination rates are low. It is the urban areas that are liable to light up quickly. Perhaps part of the issue is that people who had COVID are not getting vaccinated. (Perhaps because they think they are already "immune" or perhaps they never would get vaccinated anyway.)

While the vaccination rate is about 30% in Compton, the data shows Compton had about 17% cumulative cases of COVID (1700 per 10K). Ignoring the issue of children contributing to the case rate, that suggests maybe a 47% "immunity" rate for that area. That's a lot more encouraging than 30%. In my opinion, it likely better represents the vulnerability status of Compton.

The CDC recommends those that had COVID should get vaccinated, but people may hesitate to get the shot if they had the disease.
When looking at measuring the chance of COVID outbreaks in the future, it may be worth looking at a "resistance" map which combines vaccination rate and cumulative infection rate. I don't like the term "immunity" as it sounds 100% effective and permanent. "COVID-resistance" may be a better term.

You could even get a little fancier and multiply case rate and vaccination rate by an effectiveness factor that decreases over time.
The best numbers I've seen for effectiveness against getting COVID:
90% effectiveness of both doses of mRNA vaccines (CDC study of health care workers)
80% effectiveness of one dose of mRNA vaccines (CDC study of health care workers)
67% effectiveness of Janssen vaccine (clinical trial results)
80% effectiveness of having had COVID (from a Dutch? study)
The effectiveness will decrease over time but those numbers should be good for 6 months after the vaccine or illness.
(And, of course, you may adjust them if the effectiveness of the vaccines differs for the prevailing variant as the infections evolve in the area.)

For instance, if in 10,000 people,
2,000 have 2 mRNA doses, they constitute (100-90% = 10%) vulnerable: 200
1,000 have 1 mRNA dose, they constitute (100-80%= 20%) vulnerable: 200
2,000 have Janssen, they constitute (100-67% = 33%) vulnerable: 600
1,500 have had COVID (if we presume none got vaccinated), they constitute (20%) vulnerable: 300
3,500 have no infection or shot, they are 100% vulnerable: 3500
Total vulnerable: 4,800 = 48%
If each of the 10,000 were exposed today to the virus, then about 48% would get sick.

I think a map per zip code or community showing either the simple sum of vaccination rate plus infection rate
or this vulnerability measure, would help clarify how vulnerable communities are to COVID outbreaks.

You could go one step further and calculate a weekly transmission rate. If you figure a community has 4800 vulnerable per 10K, and gets 48 cases per 100K in a week (4.8 per 10K), then the "transmission rate" is 4.8/4800 = 0.1%. This would be a measure that is the result of two factors
(1) how many people are infectious and are exposing others
(2) how effective the community is against spreading the disease (by vaccine, hygiene, or restrictions on activities) by those walking around while infectious.

Using the 0.1% "transmission rate", in the next week, the estimate for the 10,000 people,
2,000 * 0.1% * 10% = 0.2 with 2 mRNA will get COVID
1,000 * 0.1% * 20% = 0.2 with 1 mRNA will get COVID
2,000 * 0.1% * 33% = 0.6 with Janssen will get COVID
1,500 * 0.1% * 20% = 0.3 with previous COVID will get COVID
3,500 * 0.1% * 100% = 3.5 with no vaccine or previous COVID will get COVID
Total 4.8 will get COVID

This is related to R (where 1 infection will cause R infections). Both are inversely proportional to the 2nd factor. R is usually used to describe the (positive or negative) exponential growth of an epidemic, and is usually thought of as primarily a parameter of the infectiousness of the virus.

This transmission rate is more clearly focused on how many are vulnerable and how many have the disease now, and so can be used to measure the risk to an individual, or the effectiveness of ALL the controls (including vaccination) in one community versus another.

RE: Looking ahead on vaccines - 82Card - 05-07-2021

Looking at the vaccination rates is tricky. You have to be aware of what the denominator being used. Sometimes the same entity will use different denominator on the same page. For example, Contra Costa County reports 71.5% of eligible population has at least one shot. Lower down on the page, they report that 75% of the town I live in is vaccinated. But about a fifth of the town is under 16. That means that more than 93% of the eligible population has at least started vaccination.

Not sure how one town in the county gets to 92% of the population. They must be counting people that don't live in the town or weren't counted as living in the town by the census. People from other counties may have put down a fake address. That kind of thing isn't really necessary anymore. The county will now vaccinate anyone over 16 that shows up, no appointment or county residence necessary.

RE: Looking ahead on vaccines - M_T - 05-08-2021

CoCoCo  has 57.0% of its population with at least one shot, 45.9% fully vaccinated.  1+ is 70.0% of the 16+ population.

The state's demographic data indicates 660,893 (1+) or 531,821 (full) vaccinations for  944,600 (16+) or 1,159,500 (all ages).
The CDC reports 526,274 = 45.6% fully vaccinated out of 1,153,526.

The state data source indicates
Quote:These data do not include doses administered by the following federal agencies who received vaccine allocated directly from CDC: Indian Health Service, Veterans Health Administration, Department of Defense, and the Federal Bureau of Prisons.

For some ZTCAs, vaccination coverage may exceed 100%. This may be a result of many people from outside the county coming to that ZTCA to get their vaccine and providers reporting the county of administration as the county of residence, and/or the DOF estimates of the population in that ZTCA are too low. Please note that population numbers provided by DOF are projections and so may not be accurate, especially given unprecedented shifts in population as a result of the pandemic.

For all of us that were trying to get vaccinations as soon as possible, I suspect many got shots where they worked (esp. health care workers and other workers at health care facilities). A similar effect may apply to people who were patients in hospitals or rehab facilities. They may have been told to enter the zip code of where they worked rather than their home address.

Or perhaps they lied because there weren't doses (or they didn't qualify) in their resident county.  I know that some of the pharmacies were saying that they were only allowed to vaccinate those from the same county as the pharmacy.

Zip code % of population in CoCoCo with at least one dose (only the high % zips)
94516 117% (yes, > 100%)
94528 222% (yes)
94530 72%
94563 73%
94569 74%
94595 80%
94582 70%
94583 71%
94596 73%

At a particular zip for a military base in SoCal, there were only 52 first doses recorded for 12,000 residents (since CA doesn't get the DoD dosing info.)

For CoCoCo, the state's data indicate that through May 7: (1+ means 1 or 2 doses)
Age 0-17: Full: 8,402  1+: 15,981  UnVax: 230,197    UnVax 16+: 15,297
Age 18-49: Full: 217,437  1+: 296,182  UnVax: 165,902
Age 50-64: Full: 152,541  1+: 179,828  UnVax: 54,180
Age 65+:  Full: 153,441  1+: 168,902  UnVax: 48,328
Totals of above:  Full: 531,821  1+: 660,893  UnVax: 498,607  UnVax 16+: 283,707
where the unvaccinated numbers are based on population estimates.

You can get the numbers of how many in an  age group (or by race/ethnicity) for each day since vaccinations began.

Vaccination was opened to everyone 65+ on January 14.  Through Jan. 13,  only 5820 (2.7%) of the 217,230 age 65+ already had one dose.  (CoCoCo only)
Vaccination was opened to everyone 50+ on April 1.  Through March 31, 127,533 (54.5%) of the 234,008 age 50-64 already had one dose.  (CoCoCo only)
Vaccination was opened to everyone 16+ on April 15.  Through April 14, 238,010 (51.5%) of the 462,084 age 18-49 already had at least one shot. (8,317 (26.6%) of 31,278 16-17yo had at least one shot)  (CoCoCo only)

RE: Looking ahead on vaccines - Hurlburt88 - 05-23-2021

light reading on boosters that I stumbled across today
nothing particularly "new", IMO