Along with lots of caveats.
By Stephen Golub, A Promised Land, February 24, 2021
In a week when America’s Covid fatalities topped 500,000 – an official figure that might actually understate the real toll and that in any event represents more than all of our overseas wars’ combat deaths combined – it seems incongruous but useful to summarize some good vaccination news.
So here goes.
Arguably the most important data right now (and in weeks to come) comes from Israel, which is way ahead of all other countries in its vaccination rates by virtue of a deal it cut with Pfizer. That arrangement features use of the country’s sophisticated national health care system to not only efficiently administer shots but to collect and analyze “real world” data that is even more valuable than that gathered through clinical trials.
In any event, for months I’ve had four questions about Covid vaccinations’ effectiveness. Here they are, along with preliminary answers gleaned from news reports and research analyses.
1. How likely are we to fall ill even after being vaccinated?
Vaccines vastly reduce our chances of falling ill at all. Even more important, they seem to reduce hospitalizations and deaths far more, to miniscule percentages.
As explained in this analysis, none of the approximately 74,400 people who received inoculations in five clinical trials (including for the Pfizer, Moderna and about-to-be-approved-for-the-USA Johnson & Johnson vaccines) were hospitalized or died.
Multiple reports from Israel in recent weeks are similarly favorable. The most recent one determined that Pfizer’s product has been just as effective when administered on a massive scale there as it was during clinical trials. Other details emerged a week ago:
An Israeli healthcare provider said on Wednesday that Pfizer Inc’s COVID-19 vaccine was 95% effective in a trial of 602,000 people, reinforcing the drugmaker’s efficacy findings.
Israeli HMO Maccabi, which covers over a quarter of all Israelis, said in a statement that only 608 people had tested positive for COVID-19 more than a week after receiving the second of two required Pfizer doses.
The comparison was against a group of 528,000 Israelis with similar backgrounds who did not receive the vaccine, Maccabi said. Of those, 20,621 tested positive…
Most of the 608 infected vaccinees reported only mild symptoms, such as a headache or cough, Maccabi said. Some 21 required hospitalisation, seven of whom had severe symptoms, it added.
The New York Times’ Dave Leonhardt assesses this data in a comparative manner:
Here’s a useful way to think about Israel’s numbers: Only 3.5 out of every 100,000 people vaccinated there were later hospitalized with Covid symptoms. During a typical flu season in the U.S., by comparison, roughly 150 out of every 100,000 people are hospitalized with flu symptoms. [Emphasis in original.]
Now, there’s some apples-to-oranges inexactness here, including the time frames involved and his comparing vaccinated Israeli Covid patients with an American flu patient population that apparently includes unvaccinated persons. Still, the point is that our vaccinated Covid risk may be approaching a level most of us might find acceptable.
2. How probable is it that we can spread the virus to unvaccinated people after we’re vaccinated?
The data here is not as firm as for question #1. But preliminary research indicates that if you’re vaccinated you’ll run a significantly reduced risk of transmitting the virus to unvaccinated folks.
As explained in this excellent piece, initial indications from Israeli and United Kingdom research strongly suggest that at least the Pfizer vaccine (and presumably Moderna’s as well, since it’s so similar) strongly reduces our chances of being infected with the coronavirus at all. This vaccination also seems to reduce our viral loads in our noses and throats, even if infected. The upshot is reduced risk to unvaccinated people.
In other words, as per that piece:
In total, vaccination unambiguously makes people less likely to get a case of Covid-19. Then, if a vaccinated person does get a Covid-19 case, preliminary Pfizer data from Israel suggests they’ll have lower viral loads, which other research has established makes them less likely to pass on the virus. And because of the lower viral load, if they do infect another person, the infection is less likely to be serious.
Another analysis reaches similar conclusions.
3. Do the South African, U.K and other variants change the answers to #1 and #2?
A proliferation of new Covid variants that may be more transmissible or otherwise deleterious to health has triggered considerable concern about whether and how effectively vaccines will work against them. Fortunately, there’s some encouraging though admittedly tentative evidence that vaccines perform effectively against variants, perhaps in preventing illness but at least in terms of preventing hospitalization and death.
Research in Israel indicates that the Pfizer vaccine is effective against the U.K. variant.
There is also good news regarding the South African strain. The Johnson & Johnson vaccine performed well there in clinical trials. Moderna has announced the development of a modified vaccine tailored against that variant, though it remains to be tested.
It’s true that the South African government suspended use of the AstraZeneca vaccine on the basis of a small study suggesting that it does not prevent mild or moderate cases. But the World Health Organization recommends use of the vaccine against that and other variants on the grounds that it seems effective at preventing “severe illness, hospitalizations and death, including from new variants.”
In addition, Pfizer and Moderna (using its original formula) laboratory research indicates likely effectiveness against South African and other new variants. But since these are small-scale and not clinical studies (which use human volunteers), perhaps the findings should be viewed with particular caution.
Not all the variant news is good. A rapidly spreading California strain appears to be more transmissible than the “normal” variant.
But this bad news is not totally bad. Not all experts see this as being as easily transmitted as the U.K. variant. And even the doctor leading some of the research on it predicts that vaccines should be effective against it.
4. When Can We Hug Each Other Again?
Or, more specifically, when can we hug family and friends from outside our pods, if they and we are all vaccinated? The question becomes all the more salient as Pfizer and Moderna pledge to ramp up vaccine production and availability dramatically over the next five weeks.
To my mind, this is the biggie, the greatest sign of a return to some semblance of normal, of stepping out of our caves and into the sun. In one recent article, “Ashish Jha, the dean of Brown University’s School of Public Health, told [the author] that in a month or so, in the absence of a variant-driven surge, he’d probably be comfortable going to a friend’s house for a drink, mask-free and indoors, if he and his friend were both fully vaccinated.”
It’s a judgement call, tinged with some powerful emotions. Some experts are no doubt reluctant to endorse plans like Jha’s yet (even if some of them might be pondering the same actions), for fear of being or seeming irresponsible. Others, as well as non-experts like me, might be chomping at the bit, but still want to see more data come in regarding risks, transmissibility and variants.
The simple answer is that the answer isn’t simple. But the biggest good news is that we can finally ask the question.
Lots of Caveats
One huge caveat to all of the above is that we’re only starting to study and understand the vaccines’ impact on the virus within the general population, as opposed to the data from various pharmaceutical firms’ control trials. Lots can change. We’ll know far more some months from now.
Another regards the variants. The tentative good news could be swamped, should new strains arise that are more transmissible, deadly or, especially, vaccine resistant. On the other hand, modified vaccines that protect against new strains (as with the Moderna variation for the South African strain) can be developed in a period of six weeks, though getting them federally approved and then ramping up production would take additional time.
A third is that massive inequities plague the distribution of vaccines in America and abroad. These must be addressed as a matter of basic humanity and fairness, but also as a matter of protection against the growth of potentially vaccine-resistant variants.
As a final caveat, consider the source here – that is, me. I’ve done my best to summarize some complex information. But I’m just a layperson, and not an especially scientifically swift one at that.
However, I did stay at a Holiday Inn Express last night:
Stay safe and healthy, everybody.
Benicia resident Stephen Golub offers excellent perspective on his blog, A Promised Land: Politics. Policy. America as a Developing Country.
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