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We’ll need more than one vaccine to beat the pandemic – Ars Technica

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Close-up photograph of a gloved hand holding a tiny bottle of clear liquid.
Enlarge / A medical worker holds a bottle of a candidate COVID-19 vaccine developed by Oxford University that is being tested in a trial in Soweto, South Africa.

On Monday, a press release from the transnational pharmaceutical company Pfizer dropped a rare spark of hope into the ongoing misery of the COVID-19 pandemic. Yes, new infections have hit an all-time high in the United States, and, yes, cities and states around the world are walking back their reopenings. But Pfizer says it has results from a massive clinical trial showing that its vaccine against the disease works, and works well. The release touted “a vaccine efficacy rate above 90 percent,” and it announced the company’s intention to seek from the US Food and Drug Administration an authorization to start giving people shots. The company’s ready to make 50 million doses this year and 1.3 billion doses in 2021.

That’s an ember of hope, but it’s sitting under a bucket of cold water, ready to pour. The Pfizer vaccine is finicky—hard to make, transport, and deliver. Because of desperate need, it’s in short supply even before it becomes available—1.3 billion doses is several billion short of what the world needs. The press release wasn’t peer-reviewed science, and it lacked critical details about how the vaccine works and on whom. Even the simple fact of this vaccine’s existence, some analysts have argued, might jeopardize the testing and success of potentially better vaccines down the line, a case of the imperfect being the enemy of the good.

Before the ember dies out completely, here’s a theory: no. The Pfizer vaccine’s imperfections make it a perfect prime mover, because if it works as well as the company says, it’ll help people now and require research into more, better, different vaccines for later. All the things nobody knows about the Pfizer vaccine mean that the door is wide open. “Whether its effects are durable, whether it’s effective in the elderly, whether it has safety issues, the cold chain issues, the ability to have access,” says Wayne Koff, president and CEO of the nonprofit Human Vaccines Project, “all that points to the need for a number of vaccines.”

Working with a smaller company called BioNTech, Pfizer moved off the starting block fast, and without the money from the US Operation Warp Speed program that funded other drug companies’ trials. This vaccine (like another candidate made by the company Moderna) is actually a tailored bit of genetic material called messenger RNA; give it to people, and the mRNA acts like biological software, teaching cells to manufacture the “spike” protein on the outer coat of the virus that causes COVID-19. Those people’s immune systems then learn to recognize and attack the spike, which gives them the ability to fight the virus. It’s a cool idea, and as my colleague Megan Molteni has written, it could change the future of vaccinology and infectious disease.

Cold case

But this is the first mRNA vaccine, and it turns out to be a precious little snowflake. Pfizer’s vaccine has to be stored and shipped at ultracold temperatures, less than 80 degrees below zero—it’ll keep for a few days at higher but still very cold conditions. And it needs vials made of a special glass that’s able to tolerate the freezing temperatures. (This is neat, actually—the key is that the glass is low in boron, exactly the opposite of famously temperature-change-tolerant Pyrex glass, which is a mix of boron and silicon dioxide. The glassmaker Corning has a $204 million contract with the government to make it and cut a deal in May to provide it to Pfizer. Whether Corning can make enough is the tricky part.)

All that shipping and freezing requires a level of technical sophistication that, for now at least, mostly exists in hospitals and labs—posing significant logistical challenges in rural areas and in the developing world. These are the “cold chain” problems that Koff mentioned, the problem of refrigerated shipping. (A critical Ebola vaccine needs the same deep freeze, and engineers stepped up to create specialized coolers to transport it across western Africa—but that was a pandemic that affected tens of thousands of people, not billions, and the people who made the coolers have since gotten out of the cold-chain innovation game.)

“Minus 70 is almost a nonstarter”

Those logistical challenges and an overall shortage of the vaccine are going to limit even further who gets the vaccine first. A spokesperson for Pfizer says the company has built its own network of distribution centers, freezers, and specialized shipping containers. And, meanwhile, Phase I of any vaccination plan will probably involve giving it to health care workers and first responders—the kind of people who’ll have easier access to the places that actually have the drug, and are perhaps more likely to come back for the second shot the Pfizer vaccine requires.

“We understand that Pfizer has a network of locations that it worked with to conduct its clinical trials throughout the United States,” says Anna Legried Dopp, senior director for clinical guidelines and quality improvement at the American Society of Health-System Pharmacists. Dopp says she understands there to be upwards of 100 of these locations. “They’ll leverage the ultracold freezers that were given to them for purposes of the clinical trial,” she says.

This is good; the freezers will be able to change temperatures to accommodate other, future, vaccine candidates that need cold, but not as cold, conditions (like, apparently, Moderna’s).

OK. So at least one set of weaknesses might also be a strength. So might some others. “We’ll probably figure out how to solve, in the short term, the cold chain, just because the estimates of the economic costs I’ve seen in the US are in the trillions of dollars. Longer term, in the US and globally, something that has to be at minus 70 is almost a nonstarter,” says Sam Scarpino, a mathematical epidemiologist at Northeastern University who studies disease spread. “We’ll continue to find out more and more about the vaccine as it scales up from Phase III to being injected in 100 million people, and then a billion people—whether it turns out that there are other things we need out of a vaccine, and if other stuff remains in the pipeline.”

Science by press release

What Scarpino means is, the Pfizer vaccine might be good enough to start healing the world but not good enough to finish the job. Pfizer has promised a peer-reviewed, detailed accounting of results, but for now it’s just a press release, and it leaves a lot out. (Getting science by press release is never ideal.) Pfizer and the FDA withstood extraordinary political pressure to forgo faster-moving data releases that wouldn’t encompass potential side effects, yet the press release didn’t say anything about whether the vaccine shows different levels of protection in different demographic groups (most saliently children, adults, and the elderly) or has longer-term safety issues.

How could it? The vaccine is too new, and studying vaccine efficacy in subgroups is notoriously difficult. But policymakers are going to need that data, because they’re going to have to decide how to deploy limited supplies. If they know one vaccine is better for older people, that helps tell them where to send it—and vaccines will certainly have different skill sets.

For one thing, they’ll have different levels of protection overall. The Pfizer study covered 43,538 people, 38,955 of whom got the two doses required. And the company reported only 94 cases of COVID-19. (Presumably many more of the infected were in the placebo group that didn’t get the actual vaccine; the release didn’t give the exact numbers.) But it’s probably not the case that nine times as many non-vaccinated people got the disease as vaccinated people; those numbers vary based on how many people were in each group. And that math is supposed to include a statistical range of possibility called a confidence interval. It’s sort of the possible answers the same data could account for. The smaller the confidence interval, the more sure that researchers are about a number.

People are going to want those, because they’ll make it easier to compare vaccines. Moderna spokespeople have issued a statement saying they’re about to release their initial data too. What if they say their efficacy is higher than 90 percent? Without a confidence interval, it’ll seem like Moderna’s drug is better than Pfizer’s. But if the confidence intervals of the drugs overlap, people will know that they’re actually closer to each other in terms of effectiveness.

“If Moderna comes out and it’s a 93 percent, let’s say, now we have to unwind the messaging on this. Are these numbers the same? Are they different?” says Peter Bach, director of the Center for Health Policy and Outcomes and the Drug Pricing Lab at Memorial Sloan Kettering Cancer Center. “Sure, it’s a big effect. It’s unmistakable. But because the actual numbers are pretty small, they’re just very unstable.” Confidence intervals will make the public health messaging easier later, when other vaccines come out—especially since nobody’s actually comparing these vaccines head-to-head.

Trial and errors

Comparisons will only happen after the fact, almost inferentially. “It’s very hard to do head-to-head comparisons, in part because nobody’s interested. The companies, unless they see a commercial advantage, aren’t going to do it,” says Arnold Monto, an epidemiologist at the University of Michigan School of Public Health who chairs the FDA’s Vaccines and Related Biological Products Committee. “This information is going to come from observational studies after vaccines are being used.”

At an October meeting of the FDA vaccines committee that Monto chairs, he worried that a too-early reveal of data from any of the companies might induce participants in the study to bail out. When volunteers consent to be part of a trial, they often get the right to leave the study and find out whether they received the vaccine or the placebo. As soon as one seems to work, everyone in every study might, potentially, want to just go get that—torpedoing all the other work in progress. Monto now says he’s a little less worried about that. “It may all be moot, because the trials are large in size,” Monto says. “If people do drop out, it may not really matter in terms of the long-term study of both efficacy and safety.”

In fact, having a working vaccine could, in some interpretations, mean that ethically other companies can’t keep testing their own candidates—exposing people to COVID-19 when, nominally, an actual vaccine exists. That doesn’t seem to be happening either. The other trials are still ongoing. Vaccine makers know how to compare different vaccines against the same disease in “noninferiority” studies. They already do that for influenza shots. COVID-19 vaccines might have entirely different “correlates of protection,” the thing that’s actually conferring immunity. Some might induce more neutralizing antibodies, the immune system’s general infantry, while others might induce more T cells, a more specifically targeted fighter.

“Almost a miracle”

People need vaccines to do different things—to work better on old people or on kids, or to stave off different sets of symptoms. Pfizer’s end points, the things they were actually studying, were bad side effects (which they didn’t see) and a lack of mild symptoms or disease. That seems good, but it’s not the whole story.

“How does that correlate with emergence of symptoms severe enough that they require medical attention? Hospitalization? Mortality? Long-haul symptoms?” asks Llew Keltner, a drug development expert and CEO of Epistat, a health care strategy consultancy. “If we’re preventing hospitalization, preventing death, and preventing long-haul disease at 9 to 1? Oh my God, it’s almost a miracle.” Nobody knows if that’s what the Pfizer vaccine does.

For that matter, a vaccine that has lower efficacy but only requires one dose might be better. Getting two shots is no fun, and it requires an informational infrastructure to track who has gotten what and when. A single shot makes everything easier, even if it works slightly less well. “Maybe we give up a little bit in efficacy,” Bach says, “but true efficacy in the real world with Pfizer and Moderna is hampered, because it’s very hard to get people to return.”

So that’s yet another reason the Pfizer vaccine will encourage rather than block development of competitors. The market, so to speak, isn’t uniform. Two key pieces of information about any vaccine simply aren’t available yet—how long its protection lasts, and whether it prevents not only illness but actual transmission of the disease from person to person.

“I am not concerned about long-term protection initially, because we’ve got a pandemic to deal with. But I think, down the road, duration of protection is going to be very important, given the fact that the virus is not going to go away,” Monto says. “I’ve been around a number of rollouts of vaccines, and the question is always, is this lifelong protection? And we never know the answer until time passes. It’s going to be very difficult to find out, and it’s going to be different for different vaccines.”

We don’t know “longer-term health consequences”

If a vaccine can’t prevent transmission, that may likewise open a door to other candidates. A vaccine that’s 90 percent effective at preventing sickness, in conjunction with all the familiar public health “non-pharmaceutical interventions”—masks, distancing, testing, and contact tracing—might be enough to bring the US back to a new normal by late summer. But it wouldn’t be enough to allow US citizens to travel anywhere that doesn’t have the vaccine. In those places, a vaccinated person exposed to the disease and able to transmit it is just an asymptomatic superspreader.

“In terms of understanding the epidemiological consequences of the vaccine, we don’t know. The longer-term health consequences, we don’t know,” Scarpino says. “The degree to which this actually blocks transmission is going to dictate the kinds of non-pharmaceutical interventions we’ll have to layer with it.”

Even if Pfizer gets some kind of authorization to start giving people shots, as seems likely, the world will still need other COVID-19 vaccines, too. “That was the goal, to not put all our eggs in one basket. In many ways, that’s a good problem to be talking about—how the market will absorb many vaccine candidates. That’s not new to health care,” Dopp says. “Right now, there’s not enough information that would give any sort of picture to that. Right now, people are just wanting to vaccinate with an effective vaccine.” That ember of hope burns on, even with cold water raining down upon it.

This story originally appeared on wired.com.

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Oil prices rise on Middle East tensions; crude stock build caps gains – CNBC

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Oil pump under the blue sky with beam pumping unit in the oil field.
Zheng Zaishuru | iStock | Getty Images

Oil prices edged higher on Thursday, supported by tensions in the Middle East, but failed to regain most of the previous day’s losses after a surprise build in crude stockpiles in the United States, the world’s top oil consumer.

Brent crude oil futures rose by 14 cents, or 0.2%, to $70.52 a barrel by 0132 GMT, while U.S. West Texas Intermediate (WTI) crude futures increased by 18 cents, or 0.3%, to $68.33 a barrel. Both benchmarks fell by more than $2 a barrel on Wednesday.

Israeli aircraft struck what its military said were rocket launch sites in south Lebanon early on Thursday in response to earlier projectile fire towards Israel from Lebanese territory.

Two rockets launched from Lebanon on Wednesday struck Israel, which initially responded with artillery fire amid heightened regional tensions over an alleged Iranian attack on an oil tanker in the Gulf last week.

The exchange came after an attack last Thursday that Israel blamed on Iran on a tanker off the coast of Oman. Two crew members, a Briton and a Romanian, were killed. Iran denied any involvement.

The U.S. State Department said on Wednesday it believed Iranians hijacked the Panama-flagged Asphalt Princess tanker in the Gulf of Oman but was not in a position to confirm.

Helping check gains, a rise in locally transmitted Covid-19 cases in China, the world’s second largest oil consumer, that has prompted restrictions in some cities and cancellation of flights is threatening demand, analysts said.

Prices also fell steeply in the previous session after the U.S. Energy Information Administration (EIA) said crude stockpiles rose by an unexpected 3.6 million barrels last week.

Still, some analysts pointed to a bigger-than-forecast 5.3 million barrel fall in fuel stockpiles.

“The fall in U.S. gasoline stockpiles to the lowest level since November 2020 suggests that fuel demand conditions in the U.S. are still quite resilient,” analysts from Commonwealth Bank of Australia said in a note on Thursday.

The bank expects Brent oil prices to rise to $85 a barrel by the fourth quarter as oil demand outpaces supply growth. 

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Ontario removes one COVID-19 case from Ottawa total Wednesday – CTV Edmonton

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OTTAWA —
Ottawa Public Health says five more people have tested positive for COVID-19 but the health unit removed 12 cases from its pandemic total after it was found those individuals did not live in Ottawa.

Cases are sometimes removed from totals for a particular health unit when investigations reveal the individual or individuals who tested positive live in another health region.

“On Aug. 3, 2021, some cases were removed from the OPH dashboard because it was determined that the individuals did not live within the city of Ottawa,” Ottawa Public Health said in a statement. “As such, OPH’s cumulative case count has decreased since the previous report.”

A previous version of this article reported an increase of three new cases and the removal of 10, based on changes in daily figures for total cases by age category. Ottawa Public Health later told CTV News Ottawa the correct figures in terms of daily new cases and cases removed via data correction was five new cases and 12 cases removed. The overall change to the pandemic total remains the same.

The correction brings the total number of confirmed COVID-19 cases in Ottawa down to 27,821, seven fewer than what was reported Tuesday. Eight of the cases removed from Ottawa’s total were considered resolved. The number of confirmed active cases in Ottawa rose by one.

Hospitals and ICUs in Ottawa remain free of COVID-19 patients and there are zero active COVID-19 outbreaks in the city.

Across the province, Public Health Ontario said 139 more people have tested positive for COVID-19 and 11 more Ontarians have died, while noting that seven deaths are from 2020 and were added following a data cleanup. Another 155 cases are now considered resolved.

Two new cases were reported in the Hastings Prince Edward Public Health region on Wednesday. No other eastern Ontario public health unit reported new COVID-19 infections.

OTTAWA’S KEY COVID-19 STATISTICS

Ottawa is now in Step 3 of Ontario’s Roadmap to Reopen plan.

Ottawa Public Health data:

  • COVID-19 cases per 100,000 (July 27 to Aug. 2): 3.8 (down from 4.0)
  • Positivity rate in Ottawa (July 28 to Aug.3): 0.5 per cent (unchanged from July 23-29)
  • Reproduction number (seven day average): 0.95 (down from 1.16)

Reproduction values greater than 1 indicate the virus is spreading and each case infects more than one contact. If it is less than 1, it means spread is slowing.

COVID-19 VACCINES IN OTTAWA

Ottawa Public Health updates vaccine numbers on Mondays, Wednesdays and Fridays. 

As of Monday:

  • Ottawa residents with 1 dose (12+): 768,618 (+1,266)
  • Ottawa residents with 2 doses (12+): 668,736(+6,771)
  • Share of population 12 and older with at least one dose: 83 per cent
  • Share of population 12 and older fully vaccinated: 72 per cent
  • Total doses received in Ottawa*: 1,333,790

**Total doses received does not include doses shipped to pharmacies and primary care clinics, but statistics on Ottawa residents with one or two doses includes anyone with an Ottawa postal code who was vaccinated anywhere in Ontario. 

ACTIVE CASES OF COVID-19 IN OTTAWA

There are 43 active cases of COVID-19 in Ottawa on Wednesday, up from 42 on Tuesday.

Ottawa Public Health removed eight resolved cases from its pandemic total on Wednesday. The total number of resolved cases of coronavirus in Ottawa is 27,185. The eight cases were removed upon investigations revealing these individuals did not live in Ottawa.

The number of active cases is the number of total laboratory-confirmed cases of COVID-19 minus the numbers of resolved cases and deaths. A case is considered resolved 14 days after known symptom onset or positive test result.

HOSPITALIZATIONS IN OTTAWA

Ottawa Public Health is reporting zero COVID-19 patients in local hospitals and zero in intensive care.

Local ICUs have been COVID-19 free for more than a month.

These data are based on figures from Ottawa Public Health’s COVID-19 dashboard, which refer to residents of Ottawa and do not include patient transfers from other regions.

COVID-19 CASES IN OTTAWA BY AGE CATEGORY

  • 0-9 years old: Three new cases (2,307 total cases)
  • 10-19 years-old: Zero new cases (3,586 total cases)
  • 20-29 years-old: Three cases removed from total (6,243 total cases)
  • 30-39 years-old: Three cases removed from total (4,251 total cases)
  • 40-49 years-old: One case removed from total (3,662 total cases)
  • 50-59 years-old: Two cases removed from total (3,332 total cases)
  • 60-69-years-old: One case removed from total (1,964 total cases)
  • 70-79 years-old: Zero new cases (1,097 total cases)
  • 80-89 years-old: Zero new cases (856 total cases)
  • 90+ years old: Zero new cases (520 total cases)
  • Unknown: Zero new cases (3 cases total)  

VARIANTS OF CONCERN

Ottawa Public Health data*:

  • Total Alpha (B.1.1.7) cases: 6,834 (-1)
  • Total Beta (B.1.351) cases: 406
  • Total Gamma (P.1) cases: 35 
  • Total Delta (B.1.617.2) cases: 52 (+1)
  • Percent of new cases with variant/mutation in last 30 days: 40 per cent
  • Total variants of concern/mutation cases: 9,154 (+1)
  • Deaths linked to variants/mutations: 101

*OPH notes that that VOC and mutation trends must be treated with caution due to the varying time required to complete VOC testing and/or genomic analysis following the initial positive test for SARS-CoV-2. Test results may be completed in batches and data corrections or updates can result in changes to case counts that may differ from past reports.

COVID-19 TESTING IN OTTAWA

Ottawa Public Health says 525 Ottawa residents were tested for COVID-19 on Tuesday. The daily positivity rate was 0.95 per cent.

The weekly average positivity rate for Ottawa residents for the week of July 28 to Aug. 3 is 0.5 per cent.

CASES OF COVID-19 AROUND THE REGION

  • Eastern Ontario Health Unit: Zero new cases
  • Hastings Prince Edward Public Health: Two new cases
  • Kingston, Frontenac, Lennox & Addington Public Health: Zero new cases
  • Leeds, Grenville & Lanark District Health Unit: Zero new cases
  • Renfrew County and District Health Unit: Zero new cases

Correction:

A previous version of this article reported an increase of three new cases and the removal of 10, based on changes in daily figures for total cases by age category. Ottawa Public Health later told CTV News Ottawa the correct figures in terms of daily new cases and cases removed via data correction was five new cases and 12 cases removed. The overall change to the pandemic total remains the same.

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Feds say 82000-plus doses of AstraZeneca vaccine to be sent to Trinidad and Tobago – CP24 Toronto's Breaking News

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OTTAWA – The federal government has announced it will send more than 82,000 doses of the Oxford AstraZeneca COVID-19 vaccine to Trinidad and Tobago.

International Development Minister Karina Gould said in a release Wednesday that Trinidad and Tobago was selected to receive the excess doses that had already arrived in Canada based on need and the country’s capacity to deploy them immediately.

Gould said the doses will be delivered in the coming days and the Government of Trinidad and Tobago will manage the administration of the vaccines in accordance with manufacturing guidelines and public health best practices.

Last month, the federal government said it would donate nearly 18 million doses of the Oxford-AstraZeneca vaccine to poorer countries.

At the time, Procurement Minister Anita Anand said after talking to the provinces, the federal government determined these vaccine doses were excess supply, as demand for the AstraZeneca vaccine had been met.

She said Canada would donate 17.7 million doses that were supposed to flow into Canada from the United States through an advance purchase agreement with AstraZeneca and that they would be made available to lower-income countries through the global vaccine-sharing alliance COVAX.

In her statement Wednesday, Gould said vaccinating the world against COVID-19 continues to be the best strategy to end the pandemic.

“By redirecting excess doses we do not need here in Canada, we are supporting global efforts to fight this virus, and ensuring vaccines get to those in need,” she said. “Canadians know that no one is safe until everyone is safe.”

At the G7 meeting in June, Prime Minister Justin Trudeau pledged that Canada would give back at least 13 million doses it was set to receive through a contract with COVAX, on top of millions of dollars already set aside for the global vaccine effort.

Global Affairs Canada said Trinidad and Tobago is a key partner for Canada, with more than 100,000 Canadians with connections to the country, and many thousands of Trinbagonians with connections to Canada.

This report by The Canadian Press was first published Aug. 4, 2021

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