Oxford vaccine spat could lead to divergence in Covid strategies | Vaccines and immunisation

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Millions of people in the UK who have received a first dose of the Oxford/AstraZeneca vaccine against Covid may be dismayed by the decision of German scientists not to recommend its use in the over-65s. Most of them are in that age group.

The comments from Stiko, the standing committee on vaccination that advises the German government, may well pre-empt a similar announcement by Europe’s medical regulator. Europe is expected on Friday to authorise use of the Oxford vaccine, and Emer Cooke, the head of the European Medicines Agency, this week trailed the possibility that the agency could say the vaccine should be used only for certain age groups.

So while the European commission is furiously battling to get more doses delivered to its member states, and the UK government is waving the nationalistic flag and insisting that any extra supplies will not come from British factories, the scientists and regulators in Europe seem to be throwing doubt on the usefulness of the vaccine for the people most in need of protection.

It’s an extraordinary spat, and it could lead to different nations in Europe making different decisions about who should get the Oxford vaccine once it is available. Even if the EMA says it’s fine for use in older people, governments can choose to do what they think best. One option is to give the Pfizer/BioNTech vaccine to older people and the Oxford vaccine to those who are younger.

But there are some who clearly think this dissension and the public sniping over supplies bodes ill for the massive global effort needed to bring the pandemic to an end, involving most of the world’s population getting vaccines that work.

The Oxford/AstraZeneca vaccine does work. Although the data has been messy, it is all in the public domain and experts agree that the vaccine does protect people. Efficacy is around 70%.

The German scientific body does not have an issue with the data that exists, it has an issue with the data that does not exist. Basically, too few people over the age of 65 were recruited to the trials that have reported so far. AstraZeneca has said about 10% of participants were older people.

Pascal Soriot, the chief executive of AstraZeneca, explained in a revealing interview to la Repubblica that the earlier trials were run by the academics at Oxford University who invented the vaccine. “They’re very ethical, and very academic. So they didn’t want to vaccinate older people until they had accumulated a lot of safety data in the 18 to 55 group,” he said.

“Essentially, because Oxford started vaccinating older people later, we don’t have a huge number of older people who have been vaccinated. So that’s what the debate is.”

According to the Medicines and Healthcare products Regulatory Authority (MHRA), which authorised the vaccine for use in the UK in December, there were just 10 cases of Covid in that age group in the trials to go on. Two of them had been vaccinated and eight had not.

But the German scientists appear to be scrutinising a more narrow selection of data. A table tweeted out from Germany – which was probably behind German newspaper reports of 8% efficacy that were debunked on Wednesday – suggests there were even fewer cases. It shows just two, one of which was in the vaccinated group and the other not.

However you look at it, the numbers are tiny. In making its decision, MHRA also took into account the fact that none of those given the vaccine in the trials of any age ended up in hospital with Covid or died, and that in the early trials that involved measuring antibodies formed in the blood of people who were vaccinated, older people had just as good a response as younger people. That is a good signal. People’s immune systems usually do not respond so well as they age.

On Thursday the MHRA’s chief executive, Dr June Raine, defended its decision, insisting that the “current evidence does not suggest any lack of protection against Covid-19 in people aged 65 or over. The data we have shows that the vaccine produces a strong immune response in the over-65s.” So the data was good enough for the MHRA, but not good enough for Stiko.

Soriot clearly feels there’s nothing to worry about. AstraZeneca is aiming to produce 2bn doses of vaccine this year and will be the biggest supplier to low-income countries which may not have the luxury of the arguments tossed to and fro in Europe.

“It’s possible that some countries, out of caution, will use our vaccine for the younger group,” he told the Italian paper. “But honestly, it is fine. There’s not enough vaccines for everybody. So if they want to use another vaccine for older people and our vaccine for younger people, what’s the problem? It’s not a problem.”

Hafta Ichi
Source: The Guardian
Keyword: Oxford vaccine spat could lead to divergence in Covid strategies | Vaccines and immunisation

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