UKH

Just read on the bbc news site that TB is recommending a single dose of the RNA vaccines, he has some backing for this.  If it is the case that the Pfizer BioNtec vaccine gives over 90% protection after a single dose, what’s the rationale behind needing two doses.  I’m sure the UKC experts can help out.  On the surface, it is a way of doubling the number of people being vaccinated and lessening pressure on the supply.

This paper suggests it's 52% effective after the first dose and that rises to 95% after the second dose.

https://www.bmj.com/content/371/bmj.m4826

This article states a Doctor in America said it could be 80-90% effective after the first dose but I can't see the study / paper for it anywhere.

https://www.wbur.org/commonhealth/2020/12/18/coronavirus-vaccine-single-dos...

My initial thoughts are I'd trust the MHRA more than a random non-medical ex-politician but I'm sure he's not come up with the idea off his own back!

If you were to take those figures at face value, then 1m doses would equate to either:

520,000 immune people (of 1m vaccinated) if everyone gets one shot each,

or 475,000 immune people (of 500,000 vaccinated) if everyone gets two shots. That figure would fall to 450,000 if the vaccine is 90% effective after two shots.

So from a purely mathematical perspective you might choose to go for one shot each, if your intention is to achieve maximum immunity.

But if you're relying on people coming forward for vaccination, you're likely to get a greater uptake if you can say they're 90/95% likely to be immune than 50/50.

And if you're giving it to critical healthcare workers or other high-risk groups, I expect you'd take the increased certainty that they can go about their work safely over the ability to vaccinate more people at 50/50 odds.

Yeh - good idea and then we can invade Iraq. 

BBC news quoted someone with a medical background saying it was 91% effective after a single dose, so supporting Blair's argument. If that's true it seems like a no-brainer but I suspect the reality is there simply isn't much as evidence for effectiveness after one dose. If the real number is anywhere between 50% and 70% it's a harder balance to strike with a number of possible unknowns. Doing everyone once would then give a higher overall immunity in the short term. But if someone's second dose is delayed beyond 28 days, does their first dose start to lose its effectiveness relatively soon? Does their eventual second dose ultimately have the same effect as if they had had it on time? Etc. I suspect the MHRA will take a cautious view of all this.

Edit - plus the points Will made.

By the way, Boris said the other day we had already vaccinated over 500,000 people. If we still only have 800,000 doses in the country (?) then maybe they are already taking this approach.

Cheers.  My simple take is I’d take the MHRA, the trouble is, like it or not, Blair gets airtime.  It’s sure to come up as a question at one of the daily briefings, and one of our leading science advisors should be able to give us a view.

given his maths over lorries stacked up at Dover I'm not convinced of that

I’ve assumed the rate of vaccination is being governed by supply. The question is, when does the next batch arrive? By my reckoning Margaret, Bill Shakespeare et al need their second dose on 29th December.

The Oxford AZ vaccine should be approved and ready to administer very soon after new year. I assume that this is when things really ramp up.

Quite.

Without knowing the supply schedule and the certainty over delivery dates and quantities it's not really possible to form an opinion.

I say stick with plan A. Chopping and changing your strategy on the hoof is often a bad idea. 

Until Anthony finds those WMDs he should probably keep a low profile. As far as I'm concerned he is a major contributor to the public distrust of the political establishment in the modern day. Terrible choice if you want anyone with conspiratorial suspicions to get on board with this vaccination.

The elderly and vulnerable are by far and away the most likely to die from this, prioritise their protection ASAP and we can get back to near normality if our leaders don't needlessly keep the panic going for their own motives.

Quite why Blair gets a hearing when many actual experts get shot down immediately as quacks I do not know.

I wouldn't trust Blair, but the way it was put by an epidemiology expert on the BBC was something like:

The figures in the paper show 50% effectiveness of the vaccine between dose 1 and dose 2. This includes the 8 to 10 days it takes for the vaccine to start taking effect.

If you take the data from the same paper and measure from day 10 up to 5 days after the second dose (i.e. from the time they the first dose has become effective, until the time the second dose starts to have an effect), gives 91% effectiveness.

Second dose takes you from 91% to 95%.

Assuming he's interpreted the data correctly, that means small incremental boost from the second dose and a big advantage from giving it to someone else.

Of course if you're vulnerable, you want the second dose.

The reporter didn't seem to get it, and was questioning the validity of such an approach.

His answer was "we've done this before", and that the government should certainly be considering the options.

Perhaps a blend is the way to go... Give all the over 80s one dose, then give them all the second dose, them move down a level of priority and do the same again.

There is logic there, but I'd factor in delivery times of new batches, or new vaccines becoming available too. Plus if you delay the second jab does it become less effective. 

Hope so, but if the best plan we have is to leave it to GP surgeries sorry to say but we better be ready to be extremely patient.

I might be talking rubbish here, so am happy to be corrected. Although the Oxford vaccine might be as low as 60% effective, no one has ended up in hospital after being given it? If the one dose Pfizer has a similar effect, is keeping people out of hospital more important than preventing them getting the disease at the moment/short term? 

My guess is they'll give us all a half dose of the Oxford vaccine as fast as possible,

They have a study that says 1/2 dose followed by a full dose is 90% effective and you get some immune response from the initial 1/2 dose.   According to Tony Blair there's also data that its OK to wait a few months between doses.

So if they use 1/2 doses for the first vaccination they double the number they can vaccinate and if they don't worry about holding back enough for a second dose but just inject everything they've got they double it again. 

Then they just need to make enough for the second dose before its needed.  And they have a trial to figure out if they can use a different vaccine for the second dose.

It's all pretty flaky and rushed but the risks of not doing it increased substantially too.

Another question (from an ignoramus) might be: Can the second dose be from a different vaccine to the first (eg Oxford vaccine might be more readily available and doesn't require minus 70)? If each vaccine means the immune response is against the same spike protein then maybe?

Some vaccines don't generate an immune response though, they just give your body the data should it encounter the virus in the future (as far as I understand it). 

It was discussed by Fauci, its a credible option, the idea is we have such at risk people we should give them the almost complete protection before moving on to young healthy people for which covid really isn't a huge risk - they can still be seriously affected but much less chance.

But in terms of ICU useage its OAP's, diabetics, others with pre-existing conditions such as cardiovascular disease and then healthcare workers because of their exposure.

In reply to geode:

Which is fine.  What we don’t want to do, surely, if follow the TB strategy and find later that it doesn’t work.  That way we’ve wasted a lot of effort and time getting nowhere.  This is people’s lives were playing with, and it needs to be done right, whatever right is.

I don't think it's his strategy, it's pretty wildly discussed.

https://www.nbcnews.com/health/health-news/fda-pfizer-s-covid-19-vaccine-sa...

https://www.fda.gov/media/144245/download

Looking at the FDA document it looks like they didn't properly trial the one dose though so I'm not sure we know how long that initial protection lasts for. They just tested that for 21 days between doses and not the single dose on its own.

I didn't know Blair was  Medical expert with a knowledge of vaccines. 

"BBC news quoted someone with a medical background saying it was 91% effective after a single dose, so supporting Blair's argument. "

I've heard this stat or similar a few times and haven't seen the studies it's based on. My wife's hospital had told her similar. So it's getting repeated in medical circles.

He's not.  He is someone with a platform which allows him to put forward other people's ideas and have them reported in mainstream media.   It's not his idea or his expertise it's stuff some minion researcher in his 'institute' read somewhere else.

To be fair, raising good ideas into the public debate is a useful function.

Yes, this. The Panorama programme on the development of the Ox/AZ vaccine made the point that, although offering a lower level of protection very few of the test group were hospitalised. So whilst disease prevention might be 60%, prevention of serious disease was nearer 90% and hospital capacity would be protected. I thought that an important point not much commented on. 

Blair might have let us down on Iraq but what a refreshing change to hear a thoughtful (ex) leader talk. Such a contrast with the blustering inadequate de jour the government puts out.

Jk

Very true.  You know things are bad when the only positive thing about bungling bluffing Boris as PM is that we would be even further up the brown smelly creek if Corbyn had got in. 

I heard him on the radio spouting bollocks this morning.  It made me want to run him through a mangle.

It's not really bollox is it? It might not be the best option but it is certainly a valid opinion that was discussed by the CDC/FDA when they approved the vaccine and how it be rolled out.

He was on Newscast a while back and I was impressed.  Like a lot of ex-top people, he has access to excellent information, good advice or (less likely) his own insight, and has no political need to spout bollox

Presumably there is a reason the testing was done with two treatments. Maybe the first gives you some protection and the second improves that by 50% and a third by only 25%, so two was chosen as the optimum dose. If the recommended dose is halved so that twice as many people can have it at reduced protection I wonder if that just gives the virus a greater chance of mutating into something that is vaccine resistant, as it seems excellent at being able to adapt. Presumably this virus has a lineage at least equal to our own. Mutation has gotten it to where it is now and that isn’t going to stop. Let’s say that so far the original variant has consistently thrown 6’s to get it where it is today. It has found a niche that it can exploit and successive mutated generations will be rewarded with longevity if they are as lucky.

Something else that makes me wonder is the first new variant. How did it become so widespread, so quickly? I thought mutations were random so how could this new variant appear is so many places at almost the same time, considering the speed the original Covid spread in the lax old days?

Isn't this a variation on herd immunity? The original version involved a lot of dead people, but the economy was protected. This involves less dead people and a big, big 50% cash saving.

It sounds like there is some science behind similar schemes, but it's propelled by a lot of hot air from a think tanks or vested interests. I say go with what we know to work. When punters start suggesting they know more about vaccines, than the medics, we're on a slippery slope.

There are hundreds of documented covid mutants in circulation, our new bug isn't the first, it just seems to be markedly more competitive than most of its cousins.

There's still lots of global travel, that's how New strains spread wide and fast.

Jk

I think it's more a case of questioning whether the best approach to covid19 holds for 'covid20', the situation has changed, the optimum response may have. It's a valid question to ask and I don't know the answer but our oldest down, two dose approach was optimal for minimising harm with a less free spreading strain in a more open society than we will have early 2021. It may be that diverting doses from people at low risk of contracting covid but high risk of complications to elsewhere in a locked down society nets better results. 

Jk

I’m not convince even that is true, Corbyn might have attended COBRA once or twice before March.

That’s what people were scared of...

He would have abolished it as an undemocratic tool of the wealthy. Then he would have arranged a protest, against covid. 

I’m no fan of Corbyn, but Harold Shipman could have done a better job than Johnson.

I wonder if we created the conditions for these new strains ourselves with imperfect lockdowns.  I have no maths to back this up so could be qualitatively argued bollocks but here goes anyway

If we locked down hard enough to suppress the virus there'd be less virus about so less potential for mutations to develop.

If we lock down but not enough to suppress so there's still a lot of virus about there's a chance of mutations and the partial/ineffective lockdown has also created an environment where more infectious mutations have an advantage.

Corbyn would quite likely have got very ill if he'd been PM.  It is hard to do that job without meeting lots of people - look how many world leaders have caught it - and he is old.

Ciro gave a good explanation of this above (still based on the BBC article, but it makes clear why we are seeing a wide variety of figures reported.)

Stick to the slow and steady 2-jab strategy or roll the dice and spread it thin...?

It's the Blair Which Project

I think this first part is pretty uncontroversial. Definitely true and one of the things several people on the forum have cited as a reason they've been so frustrated by the government's consistently slow and minimal responses to rising numbers.

I'm less sure about this extension to the argument. I suspect, though without any evidence or expertise, that the evolutionary pressure to transmit more readily probably wouldn't be all that different between different levels of lockdown. There's always going to be a reproductive advantage for any strain that transmits more readily under any conditions. And in any case, it's not as if we have any option to lock down less.

Johnson of course did get very ill, basically because he thought that ignoring basic disease control measures and completely lacking all personal responsibility was Churchillian. 

Why isn't the warmongering cnut in jail? Or expelled? Preferably from Earth. 

Blair was a great PM apart from his (critical) part in the Iraq war and this is a good intervention as the public discussion is one that should be had.

It makes me sad that many people (including those too young to actually remember it) just associate him with the Iraq war and can't see other things he does in a positive light. I would still have Blair/Brown back now if it was possible, certainly in preference to any other British PM of the last 40 years.

I really recommend the recent podcast "The Fault Line" about the causes of the Iraq war, probably the best podcast I've ever listened to.

End diversion.

And compare the Britain under Blair in the late 90s through mid noughties to the one today.  Then - forward thinking, wealthy, well regarded internationally, functioning NHS, etc.  Look at the place now - third world banana republic that's either reviled or laughed at.  How the mighty has fallen.  So sad, especially as it's entirely self-induced.

Blair was like Churchill compared to this clown we have as PM now.....

Objectively this is bolx 

Blair still produces excellent stuff through his think tank on governance. His latest comments on the single vaccine are interesting and it least have some merit. 

Me too and the reality everyone overlooks is the Conservatives were all for war, it's not like a different government would have talked Bush/Cheney down, though they may have not felt the need to bring the public and doubtful MPs with them quite so disastrously.

jk

True. Although, I think most of the public were in favour anyway. I was 19 at the time and I can certainly remember lots of slightly drunken discussions in pubs in which 95% of people  were very gung-ho about it. Other groups may have been more interested in seeing the evidence but as a country we still mostly wanted to be global policemen and forces for good back then, it wasn't just the PM.

My personal impression based on what I have seen and heard is that Blair, Campbell etc were certainly not 'warmongering' nor did they have any particular ulterior motivations, but they genuinely believed (based on good outcomes from Sierra Leone and Kosovo) that war was the 'right' thing to do as long as it had international support. Unfortunately because of this, they were too willing to believe people who told them of apparent evidence supporting the need for invasion without the evidence actually being presented as hard facts. This was the point on which it all later unraveled, because that evidence turned out to be false or to not exist.

Oh I agree entirely.  However, this is what the majority of the voting electorate wanted, so there we are - the reason why we (as a society) can't "have nice things" and are international parriahs.

Sorry - I meant your statement was bolx.

apart from the laughing stock bit.

Blair played a significant part in that fall. His PFI plan burdened the UK taxpayers with over £300bn in debt for infrastructure projects with a value of £54.7bn.

That made the NHS look like it was in good health, with some shiny new buildings, but it left that entirely avoidable debt burden hanging over it, and started the privatisation process that the Tories have followed.

His win-at-all-costs election strategy, with "spin" elevated beyond anything we'd seen before outside of wartime propaganda, sowed the seeds for populist takeover of British politics that followed.

Indeed it is sad that this was all self-induced, but don't kid yourself... voting for TB was a big part of where we went wrong.

At the time, there were a great many of us out on the streets pointing out that the UK and the US had a long history of making up shit as an excuse to start wars. 

Nitpicking slightly maybe, but Blair/Brown didn't start that process.  They embraced the dodgy PFI schemes for sure, but it was John Major's government that got the ball rolling well before Blair's first term as PM.

This either shows a complete misunderstanding of what was actually being paid for, or is dishonest. Show your working out.

People also forget how he set us up for Brexit with the way he handled immigration and his wish to "rub the right's nose in diversity". And, of course, his part in the eventual future break-up of the UK through devolution. 

IMO you're right that he had a hand in strengthening the independance movement, but perhaps for different reasons.

Devolution wasn't the reason for Scotland moving towards leaving the UK, it might even have slowed it down.

But Blair is responsible for a big lurch to the right of mainstream English politics - widening the gap between Scottish and English political will - and allowing the SNP to take a left of centre political position that would fill the vaccum, rather than remaining a broad church independence party.

It took a few years for labour to really start losing their political base in Scotland, as we were tribal red voters, but there's no doubt in my mind the New Labour movement was the being of the end for labour in Scotland. And without that political vaccum to fill, it would have been very difficult for the SNP to become a credible party of government, rather than a protest party.