Author: Will Humble

Novavax also announced (but did not publish) encouraging results of their Phase III Clinical Trial. Their press release (not published data) said that their clinical trial met the primary endpoints for safety and effectiveness. They said that upcoming results will show that their vaccine candidate was 89% effective in the Phase III clinical trial conducted in the UK.

“With today’s results from our UK Phase 3 and South Africa Phase 2b clinical trials, we have now reported data on our COVID-19 vaccine from Phase 1, 2 and 3 trials involving over 20,000 participants.”

“In addition, our PREVENT-19 US and Mexico clinical trial has randomized over 16,000 participants toward our enrollment goal of 30,000. NVX-CoV2373 is the first vaccine to demonstrate not only high clinical efficacy against COVID-19 but also significant clinical efficacy against both the rapidly emerging UK and South Africa variants,” (from Stanley Erck, President and CEO of Novavax.

No word on when the trial data will be published nor when they will ask the FDA for emergency use authorization. This is also an important vaccine as it too has simple storage and handling requirements and is perfect for doctor’s offices, pharmacies, mobile clinics and community health centers.

There was some drama yesterday about how much vaccine has been “wasted” at various Maricopa County mass vaccination sites.  Journalists submitted public records requests to Maricopa County Department of Public Health and the ADHS asking for data about how many doses of vaccine were unusable at the various PODs. Maricopa County produced the data, sharing that a total of 553 doses out of 153,196 administered have been discarded at county PODs between December 17, 2020 and Jan. 20, 2021.

This represents 0.3% or 3 of every 1,000 doses that have been administered through these PODs to that date. For perspective, standard wastage for all vaccines in doctors’ and pediatric offices is between 3% and 5%.

I did a few interviews on the issue of accidents and problems that can happen when administering vaccinations including this one from FOX10 saying that a 0.3% wastage rate is a testament to good performance at the PODs. By comparison, wastage rates at pediatric offices are typically between 3-5%.

The drama came when Governor Ducey tweeted the following statement:

“The COVID19 vaccine is a precious and limited resource – that any doses would be wasted is shocking and unacceptable. This has not and will not happen at any state-run sites, and local leaders must prevent it from ever happening again at any county-run site.”

The statement that no problems have come up nor mistakes made at their branded State Farm POD is, of course, preposterous. There’s no way that a mass vaccination site like State Farm has never had an issue that led to a discarded vaccine.  ADHS has not disclosed how many vaccines have been discarded at State Farm, but I can guarantee you that it is not zero. I’m hopeful ADHS will be quick to respond to press inquiries about its own data about vaccine wastage.

The fact that a small number of issues may have come up at State Farm and some vaccines discarded isn’t the issue. The problem is a when the Governor makes a false statement disparaging the performance of a key partner (performance that is, in fact, good) when the state itself is unwilling to disclose its own performance on that same metric… and then fabricates a tale that no vaccine has ever been discarded.

If there is any concern about the quality of the vaccine or any information is not readable on the label, manufacturers have advised providers to throw out the vaccine to maintain a safe operation.  That can mean things like:

1) A vial does not have a readable label or expiration date and cannot be used;

2)  There is particulate matter or “floaters” present in the vial and all 5 doses are wasted;

3) A vial is partially filled and none of the contents can be used;

4) Equipment malfunction, such as a bent needle, recapping issues, or the plunger is depressed accidentally; and

5) Draw-up issues like having a bubble in the syringe or a needle stick injury or an error mixing the dose.

These are issues that occur any time vaccines are given, particularly during large volume operations (this is not an exhaustive list of ways that vaccine doses can be unusable). Any large vaccine administration site that claims that “no doses are wasted” is not operating safely or not being honest about wasted doses.

Persons in key elected and appointed positions should be honest and transparent with the people of Arizona. We deserve at least that.  

The data are still coming in, but so far it looks like the Pfizer and Moderna vaccines are close to equally protective for the new UK strain. It’s also looking like both vaccines are less effective against the south African strain because some of the mutations on that variant code for the protein coat (that’s the queue that the immune system uses to build antibodies, B cells and T cells (see our discussion of the immune system in these previous posts Part I and Part II). 

Because there is a wide margin of safety for the protective threshold of neutralizing antibody action against the virus- the vaccine is still protective of that strain as well (although at a lower level- perhaps 70% protective against infection or so).

A new study was published this week entitled mRNA Vaccine-elicited Antibodies to SARS-CoV-2 and Circulating Variants. You can read the study yourself, but basically they found that people who have been vaccinated had high antibody titer levels of IgM, and IgG that are highly effective at neutralizing the virus. Interestingly, it found no difference in the memory B cells when comparing people that were fully vaccinated compared to people with a natural infection.

They found that the UK (B1.1.7/501Y.V1), South Africa (501Y.V2) and Brazil (B1.1.28/501.V3) have a reduced antibody neutralization potency compared to the classic strain.  However, those differences had “comparatively modest” effects on viral sensitivity.

The study does forecast, however, that:

“it is possible that these mutations and others that emerge in individuals with suboptimal or waning immunity will erode the effectiveness of natural and vaccine elicited immunity. The data suggests that SARS-CoV-2 vaccines may need to be updated and immunity monitored in order to compensate for viral evolution.”

The Company is Expected to Apply for Emergency Use Authorization This Week

Johnson & Johnson announced (but have not published) encouraging results of their Phase III Clinical Trial. Their press release (not published data) said that their clinical trial of 43,783 participants “met all primary and key secondary endpoints”. The topline safety and efficacy data are based on 43,783 participants accruing 468 symptomatic cases of COVID-19.

They say that their vaccine candidate: 

“… was 66% effective overall in preventing moderate to severe COVID-19, 28 days after vaccination. The onset of protection was observed as early as day 14. The level of protection against moderate to severe COVID-19 infection was 72% in the United States, 66% in Latin America and 57% in South Africa, 28 days post-vaccination.”

Here is the info from the full media release: Johnson & Johnson Announces Single-Shot Janssen COVID-19 Vaccine Candidate Met Primary Endpoints in Interim Analysis of its Phase 3 ENSEMBLE Trial

Note: Globally and in the U.S. this is a very important vaccine. It is simple, inexpensive, doesn’t require complicated storage and handling, and perhaps most important is a single dose vaccine. In the U.S., it will be a terrific addition to our current vaccines because it’s perfect for doctor’s offices and pharmacies. Because it’s single dose, it will be a lot less labor intensive. In developing nations, it would be a game changes for the same reasons and because it is inexpensive to make.

One of the main things that scares people that are vaccine hesitant is the fear that they might get an allergic reaction to the vaccine.  We know that allergic reactions were super-rare in the clinical trials  (each of which followed about 30,000 people). Now that the Pfizer and Moderna vaccines have been deployed – we have even more data demonstrating that allergic reactions are extremely rare.

More than 4,000,000 vaccines have been given in the community now (100x times more people than a clinical trial), greatly expanding our knowledge about the safety of the vaccines.  The CDC will be publishing reports on what has been happening in the field regarding vaccine safety from time to time.

Last Thursday CDC published in new MMWR entitled: Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine: December 21, 2020–January 10, 2021

The report found, as expected, that so far allergic reactions to the vaccines have been exceedingly rare. Between December 21, 2020 and January 10, 2021 there had been 10 allergic reactions to the vaccine among the more than 4,000,000 people that have received a dose. That’s equal to 2.5 cases per million doses.  In 9 of the 10 cases the reaction happened within 15 minutes of vaccination. No anaphylaxis-related deaths were reported.

This week saw a meaningful decline in Covid-19 cases which now clearly represents a real decrease in viral transmission. This decline is accompanied by reductions in hospital and ICU occupancy. Reductions in mortality should follow. While this reprieve is welcomed, the absolute level of SARS-CoV-2 virus transmission remains exceptionally high.

As of January 24th, new cases were being diagnosed at a rate of 557 cases per 100,000 residents per week. This rate was declining by 150 cases per 100,000 residents per week. Despite this improvement, no other state is experiencing faster transmission than Arizona according to the CDC. Because of this, Arizona has moved up 2 positions to the 6th hardest hit state since the outbreak began.

Arizona is reporting >800 Covid-19 deaths per week (>115 per day) and this count may underestimate true fatalities by half (see Woolf, Woolf, or Weinberger). Many of these deaths were preventable if the state had more aggressively adopted evidenced-based public health practices. Arizona’s weekly tally of deaths now ranks second in the nation. Overall, we rank 10th.

The Arizona Public Health Association released a report on all-cause mortality during the Covid-19 pandemic. The main finding is that all-cause mortality was 23% higher in 2020 than 2019 with the months of July and December being outliers with 64% and 61% higher mortality, respectively. This translates into approximately 15,000 excess deaths.

The Arizona Public Health Association also released a report that describes the chronological course of the Covid-19 outbreak in Arizona and chronicles the state’s response or lack thereof. 

Hospital Covid-19 occupancy is declining in the ward and ICU. However, access to care for Covid-19 and non-Covid patients remains restricted in ways that are difficult to understand owing to changes in care practices.

Hospitals continue to postpone many scheduled procedures to create additional capacity for Covid-19 patients at the expense of others with serious medical conditions.

Health professionals are being asked to work additional hours and assume duties outside their traditional scope of practice.

The test positivity rate for traditional nasopharyngeal PCR testing declined for the third straight week, dropping from a peak of 35% to 29% this past week. Nevertheless, our testing capacity is wholly inadequate to the scale of the problem and other regions.

So far, 1110 per 100,000 (1.1%) Arizona residents have received at least 2-doses of vaccine while 6044 per 100,000 (6.0%) have received at least 1-dose. Arizona vaccination roll-out places us in the bottom half of US states. To date, Arizona has administered only about one-half of its delivered doses

Here is the full weekly report, which includes all of the informative graphs.