The Vaccine Discussion Thread

[brentm77]

So, we have early indications of how businesses may bring vaccination into the fold. Best Buy to give additional paid time off to the vaccinated employees:

https://www.cnbc.com/2021/02/23/best-buy-gives-pandemic-related-bonuses-amid-company-layoffs.html
Right now, it looks like a carrot. Let's see if or when it changes into a stick.

It seems to be the way nearly all businesses are going. As you may know, EEOC guidelines allow companies to require vaccinations, so long as they provide an exemption for religious and disability accommodations. I think the general idea though, is that companies will get more compliance by offering incentives versus requiring it. I recall some studies that confirm this idea. In addition, requiring vaccination opens liability issues for the employer if there is an adverse reaction or it is not administered safely.

Utah has a short-sighted bill with the legislature that will prohibit an employer from requiring it. I think it is short-sighted because there may be a future pandemic where it will be more important that employers require vaccination to keep operations running in essential businesses. What happens if we get hit with something even deadlier and/or even more contagious? This virus is somewhat weak compared to what we could be hit with.

 

[brentm77]

AZ missing from the new orders - is what the concern is. I very much agree it's good news for the South Africans (and the world) that vaccines are going to get into the arms.

I think it's fair to help others for two key reasons:

1. The US and UK cases are dropping very fast because they were just so bad. There are diminishing returns, however, as Israel's experience is showing. If we ignore the spread in another part of the world, new variants will be out before long. And you will be back to vaccinating your own population.

2. Our trade has economic benefits - and closed borders don't help anyone. Shutting out others will also move them to produce domestically - and would have the long-term effects on global competition. China and Russia are playing this long game. Mexico, for example, is already Russia's vaccine customer.

How far down the risk spectrum you go domestically is predicated on the options. If a treatment was also at hand, I would be more comfortable sharing the vaccines early. If the vaccine production was inside our border (= control), I would be more comfortable sharing. If the domestic spread was under control, I would be more comfortable. Or,, say, if the domestic economy already recovered, etc.

Great points. I do think it makes sense to start looking at a plan for where it makes sense to start sharing. Unfortunately, it may be a difficult case to make to a large portion of the country. There will be an emotional gut reaction against it if it is not clearly articulated how it will benefit Americans in the long run. It would be good to start laying the groundwork for that option now.

 

[Grabnar]

J&J vaccine gets emergency approval:

https://twitter.com/x/status/1364576885926076416

Not quite; it "meets requirements" for emergency approval, there will be a full discussion with the FDA licensing council on starting Fri through this weekend. Approval should be expected sometime soon, though.

 

[sullivan.kscott]

It seems to be the way nearly all businesses are going. As you may know, EEOC guidelines allow companies to require vaccinations, so long as they provide an exemption for religious and disability accommodations. I think the general idea though, is that companies will get more compliance by offering incentives versus requiring it. I recall some studies that confirm this idea. In addition, requiring vaccination opens liability issues for the employer if there is an adverse reaction or it is not administered safely.

Utah has a short-sighted bill with the legislature that will prohibit an employer from requiring it. I think it is short-sighted because there may be a future pandemic where it will be more important that employers require vaccination to keep operations running in essential businesses. What happens if we get hit with something even deadlier and/or even more contagious? This virus is somewhat weak compared to what we could be hit with.

Montana has a similar bill in the works. Also makes vaccine "passports" illegal, though TSA could have a beef with that as it pertains to AmTrack and the airports. I agree it's short sighted and if enough people get vaccinated the passport thing is a moot point, anyway.
The real problem with Montana's bill as it is currently proposed is that it prevents healthcare providers from verifying vaccination/immunity status.

 

[sullivan.kscott]

Great points. I do think it makes sense to start looking at a plan for where it makes sense to start sharing. Unfortunately, it may be a difficult case to make to a large portion of the country. There will be an emotional gut reaction against it if it is not clearly articulated how it will benefit Americans in the long run. It would be good to start laying the groundwork for that option now.

Some timelines I've seen floating out there show that by late April, early May, enough doses will have been delivered to the US to hit 80% of the adult US population. Not administered, but manufactured and released to states. Those numbers include the presumed approval of J&J.

If we get to that point in the next 10 weeks, I think the time will be ripe to fully illustrate to the American people that the best path forward will then be to start international outreach efforts.

 

[Intr3pid]

Moderna is updating its vaccine for the South African variant:
https://www.cnbc.com/2021/02/24/moderna-covid-vaccine-booster-shots-south-africa-variant-trials.html
Some highlights:
- They have created the modified vaccine (candidate) but it has to be clinically studied next.
- They will evaluate it both as a booster (for those already vaccinated) as well as a standalone double shot (for those yet to be). Plus, they want to look at the combination too - that is, the first shot from the original vaccine plus the booster shot.
- A lower dose test is also in the works - which, I presume, is meant to extract more shots out of their current capacity
- Not clear yet how long these studies will take, but a few months are a good guess

 

[brentm77]

Moderna is updating its vaccine for the South African variant:
https://www.cnbc.com/2021/02/24/moderna-covid-vaccine-booster-shots-south-africa-variant-trials.html
Some highlights:
- They have created the modified vaccine (candidate) but it has to be clinically studied next.
- They will evaluate it both as a booster (for those already vaccinated) as well as a standalone double shot (for those yet to be). Plus, they want to look at the combination too - that is, the first shot from the original vaccine plus the booster shot.
- A lower dose test is also in the works - which, I presume, is meant to extract more shots out of their current capacity
- Not clear yet how long these studies will take, but a few months are a good guess

Moderna is trying to fit 15 doses in each bottle. This is just by filling them more.

If the lower dose study you mentioned proves effective, the vaccine supply will increase substantially above the current estimated future doses. That, along with 50% more in each vial, should help supply and distribution.

Pfizer is going to begin testing of its booster shot too:

Pfizer to begin testing booster shot targeting variants
Pfizer-BioNTech will begin testing a booster shot to combat COVID-19 variants, the companies announced Thursday. The announcement came one day after new research published in the New England Journal of Medicine suggests that two doses of the Pfizer-BioNTech vaccine cut symptomatic COVID-19 cases across all age groups by 94%.

Now the two-company collaboration has asked 144 volunteers who participated in the earliest phase of its clinical vaccine trials last year to volunteer again to receive the booster, a third shot of the same vaccine designed to see whether it will help them fight off new, more infectious variants that have been circulating in recent months. It’s not yet clear whether a new vaccine or booster will be needed to address the known variants. But companies want to be prepared if studies show a new vaccine is needed.

“While we have not seen any evidence that the circulating variants result in a loss of protection provided by our vaccine, we are taking multiple steps to act decisively and be ready in case a strain becomes resistant to the protection afforded by the vaccine," said Albert Bourla, Pfizer's chairman and CEO said in a prepared statement.

 

[Cheburashka]

Utah has a short-sighted bill with the legislature that will prohibit an employer from requiring it. I think it is short-sighted because there may be a future pandemic where it will be more important that employers require vaccination to keep operations running in essential businesses. What happens if we get hit with something even deadlier and/or even more contagious? This virus is somewhat weak compared to what we could be hit with.

If that happened, they would just pass another bill that overrides this bill.

 

[brentm77]

If that happened, they would just pass another bill that overrides this bill.

It's not nearly that simple. We have a part-time legislature that would need to be called into session if it wasn't at the right time of year - which can be time consuming and problamatic. It would also be fraught with politics, as many would be in denial about the threat and/or the need for a vaccine. There is a strong anti-vaxer movement in Utah that wouldn't help. I am of the opinion that it is better to pass laws that are well defined, limited in scope, and address readily seeable futures instead of hoping we can patch it later. As the proposed law conflicts with employer's obligations under federal law, as well as federal guidance, I don't want it to pass. It also happens to be much broader than just the vaccine, interfering with common existing employment practices.

 

[Intr3pid]

Reinfections are one of the next areas of interest. If reaching herd immunity is predicated on both vaccinations and prior infections, we have to investigate those infections carefully.

At the moment, CDC is studying the high-risk groups for reinfections, and the results in the nursing homes look concerning.

https://www.cnbc.com/2021/02/25/cdc...were-reinfected-with-worse-case-of-covid.html
One noteworthy corollary of "nursing home residents may be particularly at risk given their congregate living" is the implications for the cruise ship staff. Most of them live in close quarters on board for long periods of time and would be more susceptible to reinfections. Vaccination has to be a must.

 

[Cheburashka]

It's not nearly that simple. We have a part-time legislature that would need to be called into session if it wasn't at the right time of year - which can be time consuming and problamatic. It would also be fraught with politics, as many would be in denial about the threat and/or the need for a vaccine...As the proposed law conflicts with employer's obligations under federal law, as well as federal guidance, I don't want it to pass...

Meh. If that theoretical pandemic were as severe as you described, politics would be driven by fear, just like after 9/11. A special session would be called and such a bill would pass easily.

You might not like the currently proposed bill for its potential impact on the world we live in, but that's a separate issue from what would happen if an Ebola-like plague descended on our country.

 

[brentm77]

Reinfections are one of the next areas of interest. If reaching herd immunity is predicated on both vaccinations and prior infections, we have to investigate those infections carefully.

At the moment, CDC is studying the high-risk groups for reinfections, and the results in the nursing homes look concerning.

https://www.cnbc.com/2021/02/25/cdc...were-reinfected-with-worse-case-of-covid.html
One noteworthy corollary of "nursing home residents may be particularly at risk given their congregate living" is the implications for the cruise ship staff. Most of them live in close quarters on board for long periods of time and would be more susceptible to reinfections. Vaccination has to be a must.

Could also be a function of age of patients. I was surprised that wasn't mentioned in the article - but haven't read the study. It is well known that older patients have immune systems that don't respond as well to the flu, for example.

Why those most at risk of COVID-19 are least likely to respond to a vaccine

Luckily, vaccine results have been good among older individuals so far, but they may have issues with maintaining it long term do to impaired T-cell function.

Update: Skimmed the study it this is what it said about age and the immune system: "The patients with recurrent illness ranged in age from 67 to 99 years; a decline in immune system function with aging is well-documented, but little scientific evidence is available to date regarding whether or how an aging immune system might affect response to initial SARS-CoV-2 infection, likelihood of reinfection upon new exposure, and illness severity associated with reinfection."

It seems reasonably to me, based on what we know with aging populations and other viruses, that these results may be different in a younger population, even in close quarters.

 

[Intr3pid]

Could also be a function of age of patients. I was surprised that wasn't mentioned in the article - but haven't read the study. It is well known that older patients have immune systems that don't respond as well to the flu, for example.

Why those most at risk of COVID-19 are least likely to respond to a vaccine

Luckily, vaccine results have been good among older individuals so far, but they may have issues with maintaining it long term do to impaired T-cell function.

Update: Skimmed the study it this is what it said about age and the immune system: "The patients with recurrent illness ranged in age from 67 to 99 years; a decline in immune system function with aging is well-documented, but little scientific evidence is available to date regarding whether or how an aging immune system might affect response to initial SARS-CoV-2 infection, likelihood of reinfection upon new exposure, and illness severity associated with reinfection."

It seems reasonably to me, based on what we know with aging populations and other viruses, that these results may be different in a younger population, even in close quarters.

Yes, the virus affects the aged more than it does the younger population. It infects them faster, it kills them more frequently, and it leaves them in hospitals or under care for longer. It's very logical that they will be re-infected more easily too.

The difference we can expect for the young - based on the data around the initial infections - is that they will be re-infected less often and/or with less severity. Getting sick is - all else equal - a sliding scale of incidence and severity based on the strength of your immune system.

 

[ruadisneyfan2]

That's great news. I was reading a headline from one year ago, today, that said the vaccine was "years away." One expert I heard on a podcast was predicting 3-4 years last summer. It still amazes me how quickly it was developed and produced, but even more, how effective it is.

It was not developed as quickly as people think. What happened quickly was funding and removal of beauracratic roadblocks that might hamper progress. Yes, none had yet been FDA approved but this idea was not first created last March.

Here is an article from 2012 discussing mRNA vaccines. Developing mRNA-vaccine technologies (nih.gov)
Warp Speed basically said, "Hey! You guys in the upper level, back row seats, come down here and get up on the stage. You belong in the spotlight! What can we do to help your progress?" "Just say the word and we'll get it for you."

 

[brentm77]

It was not developed as quickly as people think. What happened quickly was funding and removal of beauracratic roadblocks that might hamper progress. Yes, none had yet been FDA approved but this idea was not first created last March.

Here is an article from 2012 discussing mRNA vaccines. Developing mRNA-vaccine technologies (nih.gov)
Warp Speed basically said, "Hey! You guys in the upper level, back row seats, come down here and get up on the stage. You belong in the spotlight! What can we do to help your progress?" "Just say the word and we'll get it for you."

That's actually a great point. The knowledge was there long before the pandemic. I read somewhere that it was only a matter of days to actually develop the vaccine for this particular virus, once they had the info for it.

 

[tvguy]

Got an e-mail from my Health Organization this morning. They are suspending the making of appointments for first vaccines due to a lack of vaccine. If they don't have enough vaccine for the first tier of recipients, it is going to take a LONG LONG time to get to the rest of us.

 

[ruadisneyfan2]

That's actually a great point. The knowledge was there long before the pandemic. I read somewhere that it was only a matter of days to actually develop the vaccine for this particular virus, once they had the info for it.

Yes, once the product is complete, they can change out the amino acid du jour as needed. I would LOVE to be cured of my allergies with a one time injection with a custom-made cocktail of all my allergens.

mRNA vaccination as a safe approach for specific protection from type I allergy - PubMed (nih.gov)

I recall reading somewhere they were also looking at mRNA vaccines as a possible cure for cancer since many cancers grow and grow undetected by the body's immune system. Friggin brilliant!!

 

[ruadisneyfan2]

Got an e-mail from my Health Organization this morning. They are suspending the making of appointments for first vaccines due to a lack of vaccine. If they don't have enough vaccine for the first tier of recipients, it is going to take a LONG LONG time to get to the rest of us.

That is not happening in NJ. It is possible that in your state they overestimated the number of possible appointments to create and then realized they can't fulfill them so they cancelled some. Here, they are not creating appts unless they know they have vaccine. It's a real bugger to get an appt. We are expected to get J&J next week so that should help.

 

[ruadisneyfan2]

That is not happening in NJ. It is possible that in your state they overestimated the number of possible appointments to create and then realized they can't fulfill them so they cancelled some. Here, they are not creating appts unless they know they have vaccine. It's a real bugger to get an appt. We are expected to get J&J next week so that should help.

I take that back. We did have appt cancellations but it was weather-related. Winter storms closed some vaccine sites and also weather nationwide caused shipment delays. Hopefully with spring around the corner, severe winter storms will be behind us now.

 

[tvguy]

That is not happening in NJ. It is possible that in your state they overestimated the number of possible appointments to create and then realized they can't fulfill them so they cancelled some. Here, they are not creating appts unless they know they have vaccine. It's a real bugger to get an appt. We are expected to get J&J next week so that should help.

IMHO the issue is they put more people in the first tier than they knew they could get vaccine for. Another Medical group here ignored the 65 plus rule, and imposed a 75 plus rule because even that smaller group was more people than they could get vaccine for.
Here is the e-mail.
"

We understand it’s been an incredibly long and difficult year for everyone. The pandemic has changed all our lives in immeasurable ways, and we share your hope that COVID-19 vaccines can help bring us back to some sense of normalcy.​

​ Limited Vaccine Supply​ At this time, the vaccine supply we’re receiving from the state is extremely limited and unpredictable. The lack of vaccine has forced us to relocate, reschedule or indefinitely postpone some appointments and stop booking new ones for the time being. We know this is incredibly disappointing, and we share your frustration. We appreciate your patience and flexibility as we continue doing everything we can to keep our commitment to our communities despite the supply challenges. With enough vaccine supply, we could be vaccinating more than 25,000 patients each day across our network. We’ve built up our vaccination clinic capacity and opened nine large-scale sites in Modesto, Pleasanton, Roseville, Sacramento, San Francisco, San Mateo, Santa Clara, Santa Cruz and Santa Rosa. Our teams stand ready to vaccinate. Please know we’re doing everything we can to get additional vaccine supply as quickly as possible and remain hopeful the state will allocate more doses to us very soon based on our urgent requests.​ Appointments for Eligible Patients​ Following the state’s tiered system, we’ve been vaccinating 1A and began vaccinating 1B with those age 65 and older, which is about 745,000 patients in the communities we serve. Because we’re not currently able to schedule new appointments, we’re not opening to other groups at this time, although we’re still preparing and hope to do so soon. If you’re currently eligible and don’t find a vaccination appointment right away, we ask for your patience as we wait for additional supply from the state. Please check our website frequently for the latest updates. Vaccinations won’t be scheduled through your provider’s office, so please don’t call your doctor about COVID-19 vaccination appointments or scheduling exceptions – including for those ages 16-64 with qualifying health conditions who are eligible for vaccination in California beginning March 15. ​ Vaccination Elsewhere​ We understand you may be offered vaccination options outside of Sutter. As a Sutter patient, you don’t need to be vaccinated by Sutter, and you’re welcome to get vaccinated elsewhere. For help finding other vaccination sites near you, California has compiled a list of local COVID-19 resource websites."​ Keeping You Informed​ We’ll continue to keep you updated on the vaccine rollout. For the latest updates, please check your My Health Online account, email and our website at sutterhealth.org/covid-vaccine. We sincerely thank you for your understanding and patience.​