Tag: vaccines

Booster — the final report

Another update of my Covid booster saga. After the only walk-in vaccination centre in Oxford decided to stop accepting walk-ins I looked about for other options. I was now eligible for a booster, but couldn’t sign up for an appointment, because only NHS-delivered vaccines count. I considered getting an appointment for a nominal first vaccine, but worried that that might just get me into trouble. I heard that the NHS had suddenly decided to start registering vaccinations performed abroad, and that would allow me to get a booster. (The website even suggested that you may be given a booster vaccine at the appointment, but you may not, and the appointment is really only to register your information.) But, bizarrely, the registration has to be done in person, and the nearest place is Reading, 25 miles away. So I could take the train, possibly get infected on the way, in order to get a booster.

Instead, I saw that there was a pharmacy offering drop-in vaccinations in Aylesbury, about 17 miles from Oxford, and connected by a reasonable route for cycling. And they were open Sunday. The weather was good, so I set out a bit after 8 on my bicycle, arriving around 9:45, shortly after they opened at 9:30.

“Do you have an appointment?”
“No. I’m here for a walk-in.”
Funny look.
“This is listed on the NHS website as a walk-in site.”
“It was, until yesterday, when we ran out of vaccine.”
“I just cycled two hours from Oxford.”
“If you want you can wait in that queue over there and try your luck.”
There were about a dozen people waiting already. I ended up being the last walk-in they let in, and I got the booster.

A student of mine waited 6 hours in the rain yesterday for a booster. I remember a German colleague commenting many years ago that he liked American university libraries because the librarians consider it their job to serve the readers with books. Unlike German librarians who consider it their job to protect the books from the readers.

The NHS — meaning, the larger dysfunctional system of the NHS and its many private subcontractors — seems to have a similar attitude toward vaccines. Better that ten should go unvaccinated than that one ineligible person should be vaccinated.

No booster [update 10-12-2021]

The UK government is apparently desperately eager to get the whole population fully protected with three doses of Covid vaccine, to try and head off the mounting omicron wave. In a particularly awkward mixed pharmaceutical metaphor they promised to put the programme “on steroids”. But not so eager that they’re willing to resort to extreme measures like… just letting people get vaccinated.

The NHS website says people will be contacted for appointments six months after their second dose. But the government announced more than a week ago, following new advice from the Joint Committee on Vaccinations and Immunisations (JCVI), that “the booster will now be given no sooner than 3 months after the primary course.”

Having been initially vaccinated in Germany I can’t get on the list for an appointment anyway, so I decided to cycle down to Kassam Stadium, south of Oxford, the only nearby vaccination centre offering walk-in service. The fellow managing the queue was friendly and helpful, but told me that the current regulation — until they get new rules from the government — is actually a completely arbitrary seeming five months gap for people over 50 years of age (which I haven’t seen reported anywhere) — and six months for people over 40. (And no boosters for younger people.

So, no booster yet for me…

Update (8/12/2021): The NHS has now opened up boosters to people who had their second dose more than 3 months ago. Except, the bad people who had their first doses in foreign lands — including, if I understand correctly, Scotland — are still excluded.

[update 10-12-2021]: Yesterday mid-afternoon the official NHS website for vaccination information reported that anyone over 40 could get a booster at a walk-in site 3 months after their second dose. So I cycled down to Kassam Stadium again this morning. And again I was turned away. This time they agreed that I was eligible according to the NHS rules, but they have their own rules at this centre, and they’re not changing until Monday.

Not that it matters, because they also — my partner found this out when she went in the afternoon — decided spontaneously as of 2pm today to stop accepting walk-ins at all.

Delta may not mean change

Germany is in a confusing place with its pandemic developments. Covid cases have been falling as rapidly here as they have been rising in the UK: More than 50% reduction in the past week, dropping the new cases to 6.6 per 100,000 averaged over the week, under 1000 cases per day for the first time since the middle of last summer. At the same time, the Delta variant is rapidly taking over. Last week the Robert Koch Institute reported 8%, this week it’s 15%. Virologist Christian Drosten, speaking on the NDW Coronavirus podcast this week (before the new Delta numbers were available) spoke of the 80% level in England that, he said, marked the watershed between falling and rising case numbers.

I think this is the wrong back-of-the-envelope calculation, because it depends on the overall expansion rate of the virus, and the difference between Delta and Alpha, which is likely particularly large in the UK because of the large number of people who have received just one AstraZeneca dose, which seems to be particularly ineffective against Delta. There’s another simple calculation that we can do specifically for the German situation: In the past week there have been about 810 cases per day, of which 15.1% Delta, so, about 122 Delta cases per day. The previous week there were about 1557 cases per day, of which 7.9% Delta, so also about 123 Delta cases. That suggests that under current conditions (including weather, population immunity, and social distancing) Delta is not expanding. This may mean that current conditions are adequate to keep Delta in check, while Alpha and other variants are falling by more than 50% per week.

This suggests a very optimistic picture: that total case numbers will continue to fall. Within a few weeks Delta will be completely dominant, but the number of cases may not be much more than around 100 per day. And that ignores the increasing immunity: The infections reported this week occurred in the previous week, and the immunity is based on the vaccinations two weeks before that. With about 1% of the population being vaccinated every day, we should have — relative to the approximately 70% non-immune population* 20 days ago — already have about 15% reduced transmission by the first week in July. And at current vaccination rates we can expect, by the end of July that will be 30% reduced, providing some headroom for further relaxation of restrictions without an explosion of Delta cases.

That does raise the question, though, of why the general Covid transmission rate in Germany seems to be lower than in the UK. I don’t see any obvious difference in the level of social-distancing restrictions. Is it just the difference between single-dose AZ versus Biontech? If so, we should see a rapid turnaround in the UK soon.

* I’m very roughly counting each dose as 50% immunity.

How to vaccinate all the Germans in two easy steps

One might despair at how hopelessly behind Europe in general, and Germany in particular, is with its vaccination campaign. According to the data below from the Robert Koch Institute, they recovered last week from the collapse of the week before due to the brief rejection of the AstraZeneca vaccine, and resumed their very modest acceleration, but that seems to have stopped, and they’re now back to the rate of the previous week of about 1.5 million vaccines per week, a rate that would get them through the entire adult population in around… 2 years.

RKI Vaccine statistics 1/4/2021

But not to worry! says Der Spiegel. They quote an expert — Sebastien Dullien, scientific director of the Institute for Macroeconomics and Economic Research (Institut für Makroökonomie und Konjunkturforschung (IMK) der Hans-Böckler-Stiftung), for which I’ll have to take their word that he’s somehow an expert on vaccines and public health, because his job (and his Wikipedia page) make it seem that he’s an expert on finance and economics — who claims that the vaccination of the entire German adult population will be complete before the middle of the summer. “Es ist realistisch, alle impfbereiten erwachsenen Deutschen bis Ende Juli durchgeimpft zu haben.” [It is realistic, that we can have all willing adult Germans vaccinated by the end of July.) Sounds good! He goes on to say “Dafür müssen nur zwei Bedingungen erfüllt werden.” [This depends on just two conditions being fulfilled.] Okay, two conditions. I hope the conditions are fulfilled… What are they?

Der Impfstoff muss kommen, und er muss verimpft werden.
[We have to get the vaccine, and then we have to vaccinate people with it.]

It’s this kind of reduction of complex problems into manageable sub-problems that only the truly great minds can deliver. This goes on my list of “How-to-do-it” solutions to complex problems. (Previous entries here, here, and here.)

Actually, this is amazingly close to the Monty Python original, where the kiddie show How to Do It explained “how to rid the world of all known diseases”. Their method was more elaborate, though, involving five steps:

First of all, become a doctor, and discover a marvelous cure for something. And then, when the medical profession starts to take notice of you, you can jolly well tell them what to do and make sure they get everything right, so there will never be any diseases ever again.

Absence of caution: The European vaccine suspension fiasco

Multiple European countries have now suspended use of the Oxford/AstraZeneca vaccine, because of scattered reports of rare clotting disorders following vaccination. In all the talk of “precautionary” approaches the urgency of the situation seems to be suddenly ignored. Every vaccine triggers serious side effects in some small number of individuals, occasionally fatal, and we recognise that in special systems for compensating the victims. It seems worth considering, when looking at the possibility of several-in-a-million complications, how many lives may be lost because of delayed vaccinations.

I start with the case fatality rate (CFR) from this metaanalysis, and multiply them by the current overall weekly case rate, which is 1.78 cases/thousand population in the EU (according to data from the ECDC). This ignores the differences between countries, and differences between age groups in infection rate, and certainly underestimates the infection rate for obvious reasons of selective testing.

Age group0-3435-4445-5455-6465-7475-8485+
CFR (per thousand)0.040.682.37.52585283
Expected fatalities per week per million population0.071.24.11345151504
Number of days delay to match VFR120070206.41.80.60.2

Let’s assume now that all of the blood clotting problems that have occurred in the EEA — 30 in total, according to this report — among the 5 million receiving the AZ vaccine were actually caused by the vaccine, and suppose (incorrectly) that all of those people had died.* That would produce a vaccine fatality rate (VFR) of 6 per million. We can double that to account for possible additional unreported cases, or other kinds of complications that have not yet been recognised. We can then calculate how many days of delay would cause as many extra deaths as the vaccine itself might cause.

The result is fairly clear: even the most extreme concerns raised about the AZ vaccine could not justify even a one-week delay in vaccination, at least among the population 55 years old and over. (I am also ignoring here the compounding effect of onward transmission prevented by vaccination, which makes the delay even more costly.) As is so often the case, “abundance of caution” turns out to be the opposite of cautious.

* I’m using only European data here, to account for the contention that there may be a specific problem with European production of the vaccine. The UK has used much more of the AZ vaccine, with even fewer problems.

The poisoned roots of German anti-vax sentiment

I’ve long thought it odd that Germany, where the politics is generally fairly rational, and science education in particular is generally quite good, has such broad acceptance of homeopathy and a variety of other forms of quackery, and a special word — Schulmedizin — “academic medicine” — to express a dismissive attitude toward what elsewhere would be called just “medicine”, or perhaps “evidence-based medicine”. I was recently looking into the history of this, and found that attacks on Schulmedizin — or “verjudete Schulmedizin” (jewified academic medicine) — were as much a part of the Nazi state science policy as “German mathematics” and “Arian physics”.

Medicine in the Third Reich remained a weird mixture of modern virology and pseudo-scientific “racial hygiene”. The celebrated physician Erwin Liek wrote

Es ist mein Glaube, dass das deutsche Volk berufen ist, nach und nach eine ganz neue, rein deutsche Heilkunst zu entwickeln.
(It is my belief, that the German people has a calling, gradually to develop a pure German art of healing.)

Liek was appealing for a synthesis of Schulmedizin with traditional German treatment. As with Arian physics*, and the Nazi state was careful not to push the healthy German understanding so far as to undermine important technology and industry. But the appeal to average people’s intuitive discomfort with modern science was a powerful propaganda tool that they couldn’t resist using, as in this 1933 cartoon “The vaccination” from Der Stürmer that shows an innocent blond arian mother uncomfortably watching her baby being vaccinated by a fiendish Jewish doctor. The caption reads “This puts me in a strange mood/Poison and Jews never do good.”

1933 Cartoon from Der Stürmer: Blond German mother looking concerned as a beastly Jewish doctor vaccinates her baby. Caption: "This puts me in a strange mood/Poison and Jews are seldom good."
1933 Der Stürmer cartoon “The vaccination”.

Today’s anti-vaxers fulminating against Schulmedizin and the Giftspritze (poison shot) are not necessarily being consciously anti-Semitic, but the vocabulary and the paranoid conspiracy thinking are surely not unconnected.

* Heisenberg was famously proud of having protected “Jewish physics” from being banned at his university, considering himself a hero for continuing to teach relativity theory, even while not objecting to the expulsion of the Jewish physicists, and agreeing not to attach their names to their work. Once when I was browsing in the science section of a Berlin bookstore in the early 1990s a man started chatting with me, telling me that he had worked for decades as a radio engineer in the GDR, and then going on to a long monologue apropos of nothing about how wonderful Heisenberg was, and how he had courageously defended German science during the Third Reich.

NHS wants you! (to spread the varicella virus)

I’ve long wondered why children in Britain generally don’t get the chickenpox vaccine. In an article describing a move by drugstores to offer the vaccine for a substantial fee, the BBC quotes the NHS:

The NHS said a chickenpox vaccine is not offered as part of routine immunisations as it would leave unvaccinated children more susceptible to contracting the virus as an adult.

There could also be a significant increase in shingles cases as being exposed to infected children boosts immunity to this.

This is like the cracked-mirror reflection of the usual herd-immunity argument for why, even if you don’t want vaccines for yourself or your children, you have a civic obligation to make yourself immune to avoid transmitting the virus to others. Here they say that children have a duty to suffer with an unpleasant disease, so that they can serve as walking virus reservoirs that will more efficiently infect other children, and boost the immunity of adults.

I suppose there’s a cost-benefit analysis somewhere that shows this is the cheapest approach. And I’d bet that the cost of children’s discomfort is set at zero.

Building confidence in public health

The NHS informs concerned parents about vaccines:

The 4-in-1 pre-school booster is very safe. Before it was granted a licence, the safety, quality and effectiveness of the pre-school vaccine, like all vaccines, was thoroughly tested. It does not contain thiosermal (mercury).

A lot of parents are (probably unnecessarily) worried about thiomersal in vaccines. The reassurance from NHS would probably be more persuasive if they knew how to spell it. (Thiomersal is, confusingly, called “thimerosal” in the US, but not “thiosermal”.)

What does an anti-vaccine activist want?

With the swelling of interest in the anti-vaccine movement, inspired by the recent California measles outbreak, I’ve seen a number of opinions published similar to this one from Ian Steadman in the New Statesman

Then there’s also this to think about: if somebody’s distrust of scientific and/or political authority is so great, for whatever reason – maybe they’ve been scared by sensationalist stories in the media, or maybe they sincerely believe the government has no moral right to dictate health choices to citizens – that they’re willing to significantly increase their child’s risk of catching a (possibly fatal) illness, then calling them names and telling them scientists and politicians disagree with them is probably futile. Arguing that “the science is settled” with someone whose stance is predicated on the belief that the standards of proof used by scientists are flawed is definitely futile.

The article is excellent, but I don’t entirely agree with this sentiment. Living in Berkeley and Oxford, I have encountered some vaccine refuseniks, and it’s not clear to me that they have anything as definable as a belief about “the standards of proof used by scientists”. Rather, I think that they have a desperate need to feel special, protected not by mass vaccination — and definitely not by anything as infra dig as “herd immunity” — but by their special virtue, which may be Christian purity or organic health-food purity. Continue reading “What does an anti-vaccine activist want?”

Benjamin Franklin’s advice on vaccination

I’ve never seen Franklin brought into the discussion of parents’ refusal to vaccinate their children. This passage from his autobiography made a deep impression on me:

In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.

More comments on Andrew Wakefield and the MMR-autism hoax here.

I once was at a parents’ meeting in Oxford where a homeopath had been invited to speak. I was genuinely nonplussed that she was raving against vaccines. Aren’t vaccines the one great success of the homeopathic world-view? Giving a tiny dose of the disease-causing agent to cure (or prevent) the disease. Her answer was incomprehensible to me, but seemed to suggest that the very fact that there was a measurable physiologic effect showed that they weren’t any good (from a homeopathic perspective). And the fact that pharmaceutical firms made the vaccines was all you needed to know about their chthonic nature.

I fled the meeting in revulsion when the homeopath started prating about homeopathic cures for tetanus.