"92% EFFICACY"

I was having an argument with someone about how we report our COVID cases, hospitalizations, ICU admissions, and deaths. My issue wasn’t to do with any of the legitimate concerns others have raised around the lack of transparency in this province, having overly restrictive definitions for what counts as a case, our habit of ignoring known cases, or the formal strategy of simply not testing. All of that seems real and well-acknowledged.

Instead, I was noting how I found it curious that we disaggregate the numbers of cases, hospitalizations, and deaths into three distinct groups: fully vaccinated, partially vaccinated, and unvaccinated. My interlocutor saw no issue with that. I explained that it was only by this method that authorities were able to claim, as they seem to so enjoy, that we now find ourselves in a “pandemic of the unvaccinated.”

I was assured that my assertion was absurd. In response I argued that I was paying attention when just a few months back the universal declarations and celebrations about vaccine efficacy came through. I recounted for them “92% effective two weeks after dose one.” I was told this reference was silly and that no serious person did or would make such a stupid claim, that this wasn’t how the biology works. “You need two doses,” they said.

I told my friend how I’d recorded references to these figures in this 90% range (and after just one dose) and that it had been all over the place for months. I assured them I hadn’t imagined it. As only happens online, they told me I was crazy and must be consuming some wacky sources of information. I assured them again that this wasn’t a one-off wild claim from the marketing folks at Big Pharma or holders of their stocks but arrived from global, federal, provincial, and other health authorities in official reporting. And, further, that this official reporting was informing policy and our pandemic response. I told them that this was a main talking point for our government as they sought to defy vaccine developer recommendations and the testing upon which approvals were based to stretch the time between vaccine doses.

They persisted, arguing that I was just terribly confused, and demanded to see these sources if I was so darned certain. I told them they could just Google it or just pick any of their preferred sources and see what those have to say. This was read as being evasive and they doubled-down, suggesting that this couldn't possibly be so and that I was full of it. So I posted for them four screenshots I'd captured at the time all of this was going down. As is the custom on social media, despite the content of the images the fact that I shared images and not links was only seen as further evasion. So I then offered links to official publications from the WHO, UK HSA, US FDA, the government of Canada’s National Advisory Committee on Immunization, the BC CDC, as well as a news report about findings published in the New England Journal of Medicine.

Here are those sources and my summary of them:

• The World Health Organization’s Strategic Advisory Group of Experts on Immunization issued recommendations for the use of the Moderna (mRNA-1273) vaccine. This recommendation is summarized for public consumption on their website. On their “What you need to know” page, under the heading “How efficacious is the vaccine?” they tell us “The Moderna vaccine has been shown to have an efficacy of approximately 94.1 per cent in protecting against COVID-19, starting 14 days after the first dose.” And they have a nearly identical page for the Pfizer vaccine which reads, “The Pfizer BioNTech vaccine against COVID-19 has an efficacy of 95% against symptomatic SARS-CoV-2 infection.”

• The UK Health Security Agency also published COVID-19 vaccine guidance for health care professionals but with slightly different numbers. Of the Moderna mRNA vaccine trials, they report:

The cumulative case numbers in the phase 3 study showed a clear divergence between the vaccine and placebo groups from about 14 days after the first dose. Re-analysis of the phase 3 data from 15 days after the first dose to the time of the second dose, suggested that efficacy of a single dose was 92.1% (95% CI 68.8%-99.1%)

• Similarly, the US FDA published a briefing document from their Vaccines and Related Biological Products Advisory Committee Meeting on December 17, 2020. There they report the same figures as the UK HSA and offer this table:

• Following that, in February of 2021, Reuters published a piece titled “Researchers urge delaying Pfizer vaccine's second dose as first highly effective.” The reporting shares the work of two Canadian-based researchers, Skowronski and DeSerres, who published findings demonstrating the vaccine had a 92.6% efficacy after just one dose.

• Here in Canada, a publication from the federal government, by the National Advisory Committee on Immunization, came out on this topic in April of 2021. Titled “Extended dose intervals for COVID-19 vaccines to optimize early vaccine roll-out and population protection in Canada in the context of limited vaccine supply”, it explains:

Data from the two clinical trials for mRNA vaccines (Pfizer-BioNTech and Moderna) provide evidence that indicates that efficacy against symptomatic disease begins as early as 12 to 14 days after the first dose. Excluding the first 14 days before vaccines are expected to offer protection, both vaccines showed an efficacy of 92%...

• Locally, a similar justification for extending the interval between doses was offered in an official public statement by the BC Centre of Disease Control and arrived in June of 2021. It tells us that:

Both mRNA vaccines approved for use in Canada have high (>94%) efficacy against COVID-19 disease after the second dose; both vaccines are also highly efficacious after the first dose, at least in the short term (see Table below). For either mRNA vaccine, the second dose provides relatively little additional short-term benefit.

So, at least I had demonstrated that I wasn’t dreaming this up. The person I was communicating with conceded that this was, perhaps, what was reported. “But what does any of that matter with regard to case or death reports?”, they wanted to know. “Well,” I explained, “we’re being told the overwhelming majority of cases, hospitalizations, and deaths are among the 'unvaccinated'; but that’s only occasionally so, and then just barely, and only if you ignore the single dose ‘partially vaccinated’ cohort.” I walked them through once again how the argument was made for stretching out the gap between doses on the grounds that the first dose provides virtually all the benefit, after the two weeks needed to get things going, and that the second dose adds little in terms of additional efficacy. I argued that, for all intents and purposes and contrary to daily statements by our health officials, in terms of protection folks with a single dose are ‘fully vaccinated.’ I suggested that excluding someone with a possible 92.6% or maybe 95% protection from their accounting and only accepting those with 96% protection (all entirely assumed and untested of course) seemed, if only to me, wonderfully outlandish.

I then brought up recent declarations by folks in public health and government and showed how their whole narrative about the “pandemic of the unvaccinated” collapses if ‘partially vaccinated’ folks are brought into the picture. I showed that 30% or, as in some weeks or months, as many as 80% of those being inflicted likely have substantial vaccine-induced protection. I also showed how, importantly, even while provincial reports and news articles offer case, hospitalization, and ICU numbers by vaccination status, they almost never provide the same breakdown for deaths. Of course, that’s because the vast majority are elders who’ve been fully vaccinated and, though doubtless helped by vaccine, are still dead from the virus. All of this is real and substantial and suggests to me that with 100% vaccination and continued high vaccine efficacy we would still have a serious COVID burden – even without more pernicious variants.

That said, none of this gets into the abundance of data suggesting their faith in and assertions about the power of our current vaccines against COVID-19 are unfounded. For instance, the European Journal of Epidemiology just published an investigation into the correlation between vaccination and cases across 68 nations as well as 2,947 counties within the United States. And not only does this analysis appear to me to involve good data and a very large sample size but it looks to be well executed. It seems to be the best information we have so far. Subramanian and Kumar's research finds "no discernible relationship between percentage of population fully vaccinated and new COVID-19 cases..." Similarly, in July the US CDC shared their findings of very significant increases in hospitalizations (from 0.01% to 9%) and deaths (from 0% to 15.1%) among the fully vaccinated all across the United States. The above tells me that vaccination cannot be our primary strategy and that we need to take masking far more seriously while also making working and learning from home or in small cohorts far easier for people. (All of which can be done without mandates.)