12 FEBRUARY 2021 - International SOS

INTERNATIONAL SOS WEEKLY SCIENTIFIC UPDATE
Focussing on immunity and vaccine development
Produced by Dr Doug Quarry

12 FEBRUARY 2021

1. Israel: Hospitalizations reduced by vaccination

This graph tweeted by Eran Segal** shows that the drop in cases & hospitalizations of 60+ age group
in cities with early vaccination is stronger than in late-vaccinated cities.

Note that the effect is independent of the thirdrd lockdown which began country-wide on 8 January.

International SOS Comment:
Israel continues to lead the world in terms of
percentage of population vaccinated.
The effect of the Israeli vaccination program
is expected to be able to be extrapolated to
other communities as their vaccination rate
increases.

2. Israel: Cases in 60+ group down nearly 50% since start of vaccination program

OurWorldinData now has several detailed graphs looking at the extent and impact of the Israeli
vaccination program.

Read the instructions for this graph carefully.

Tweet from Eric Topol***

If we look to Israel, with nearly all B.1.1.7 strain, and ask if an mRNA vaccine is working, the answer
is “really well.”

3. US to accelerate vaccination program

Tweet from Andy Slavitt****

“Good news. President Biden just announced the US has accelerated timeframe to have enough
vaccines to supply 300 million Americans by the end of July.

“This is an acceleration over what I announced just 2 weeks ago.”

4. Differing efficacy of vaccines according to outcome

Last week we provided a
“back of the napkin”
sketch from Prof Natalie
Dean***** of how different
vaccines can have a
range of efficacies.

The efficacies measured
can be the effect on:

•   Severe symptoms
•   Moderate symptoms
•   Mild symptoms
•   Asymptomatic

The Economist has this
week formalized these
diagrams showing two
main vaccine types:

1. Vaccine that prevents
   disease but not
   infection
2. Vaccine that prevents
   disease and infection

International SOS
Comment:

This is sound structure
with which to consider the
different types of vaccines
AND especially their effect
on variant strains of
SARS-CoV-2.

5. B.1.1.7 appears not to cause more severe illness in childen

There have been recent concerns and media reports that B.1.1.7 has more effects in children and
young adults than the ancestral strain. This notion has been challenged by a recent Lancet
article which includes this statement in the summary:

“Importantly, we have found no evidence of more severe disease having occurred in children and
young people during the second wave, suggesting that infection with the B.1.1.7 variant does not
result in an appreciably different clinical course to the original strain.

6. Spain's recovering COVID-19 patients must wait six months for vaccine

Reuters reports that:” Spain’s Health Ministry said on Wednesday that people under the age of 55
without major health complications, who have previously contracted coronavirus, will have to wait six
months from their diagnosis before receiving a vaccine.

“The provisional measure, which appears to be unique in Europe, will apply to the vaccines developed
by Pfizer and BioNTech, Moderna, and Oxford University and AstraZeneca currently being distributed
in Spain.

“Justifying the decision to prioritise those without a history of COVID-19, the ministry said reinfection
within six months was ‘exceptional’.

“A major British study published last week found 99% of participants who previously tested positive
retained antibodies for three months, while 88% still had them after six months.”

7. Israel Plans “Green Pass” to Leisure for COVID-Immune on 23 February

“Israel plans to open up some hotels, gyms and other leisure facilities in two weeks to those
documented as being immune to COVID-19…” reports Reuters.

“Israel has said it would issue an official app allowing users to link up to their Health Ministry files and
show if they have been vaccinated against or recovered from COVID-19, with presumed immunity, in
order to gain entry to leisure facilities.

“Those who have not been vaccinated and have not had COVID-19 would be able to get a COVID-19
test and, if the result is negative, display it on the app for up to 72 hours of similar access.”

8. Use AstraZeneca's vaccine even in countries with South African variant: WHO
   Panel

The World Health Organisation “Strategic Advisory Group of Experts on Immunization (SAGE)” at its
extraordinary meeting on 8 February 2021, said that the AstraZeneca COVID-19 vaccine is safe and
effective and should be deployed widely, including in countries where the South African variant of the
coronavirus may reduce its efficacy.

The vaccine should be given in two doses with an interval of eight to 12 weeks and should also be
used in people aged 65 and older.

Even in countries such as South Africa, where questions have been raised about the AstraZeneca
vaccine's efficacy against a newly-emerged variant of the SARS-CoV-2 coronavirus, "there is no
reason not to recommend its use," SAGE's chair, Alejandro Cravioto, said.

"We have made a recommendation that even if there is a reduction in the possibility of this vaccine
having a full impact in its protection capacity, especially against severe disease, there is no reason
not to recommend its use even in countries that have circulation of the variant," he said.

9. Fauci: Vaccines for kids as young as first graders could be authorized by
   September

“’Children as young as first graders may be able to get the coronavirus vaccine by the time school
starts in September, presuming trials are successful in those age groups, Dr. Anthony Fauci, Director
of the National Institute of Allergy and Infectious Diseases’, said in an interview with ProPublica.”

10. CDC: Fully vaccinated people don't need to quarantine if exposed to COVID

People who have been fully vaccinated against COVID-19 do not need to quarantine if they are
exposed to the coronavirus, the Centers for Disease Control and Prevention (CDC) said Wednesday
in updated guidance on its website.

In the updated guidance, the CDC said such quarantining is not necessary for fully vaccinated people
within three months of having received their last doses if they did not develop any symptoms. "Fully
vaccinated" means that at least two weeks have passed since a person has received the second dose
of a two-dose vaccine or one dose of a single-dose vaccine.

Other recommendations remain in place for fully vaccinated people; they include wearing masks,
social distancing and avoiding crowds and poorly ventilated spaces.

11. Denmark says it has U.K. coronavirus variant under control, for now

The Washington Post reports: “After more than six weeks of a rigid national lockdown, Denmark says
it has curbed the spread of the coronavirus variant first identified in Britain.

“Danish health authorities - who are trying to sequence all positive coronavirus tests, giving them a
detailed view most countries do not have - worried earlier that established methods of control might
not work against the more contagious variant.

“But new data suggests that at least at the beginning of the month, infection levels in Denmark were
constant - not shrinking but not growing exponentially, as they had been in earlier weeks.

“That’s hopeful news with implications far beyond Denmark, as the variant has been quickly spreading
around the world. The Centers for Disease Control and Prevention estimates it will be dominant in the
United States by next month.”

12. Experts say it will be six years before the world is vaccinated against COVID-19

A briefing at the Australian National Press Club, reported by the Sydney Morning Herald, has been
told
“…it will take six years to vaccinate enough of the world’s population to reduce the threat of COVID-
19, but public health experts say vaccines are no silver bullet and hygiene measures and masks will
be part of life for years to come.

“Infectious diseases expert, Associate Professor Sanjaya Senanayake, said the SARS-CoV-2 virus
could eventually become another seasonal cold or flu-like virus, but there were some major obstacles
to that, including the global vaccine rollout.

“’Only about 70 nations have started to vaccinate their populations, and at the current rate of
vaccination, it is estimated we won’t reach global coverage of 75 per cent with vaccines for about six
years - not one or two years, but six years,’ he said.

“’In addition, Oxfam has said that by the end of this year, there will be 70 poorer nations where only
one in 10 people have been vaccinated.’”

13. Israeli study suggests that Pfizer/BioNTech vaccine reduces viral load

The study uses quite complex sampling and mathematical logic but it is well explained by the
Guardian here.

14. Wealthy German high-tech hub doubles as anti-vaxxer base

Reuters reports that: “Christoph Hueck illustrates the challenge Germany faces in rolling out a mass
vaccination campaign to tackle the coronavirus pandemic. A scientist living in a wealthy, high-tech
region, he does not plan to have any of the shots on offer.

"’I will not get vaccinated,’ Hueck, a molecular geneticist who authored a string of immunology papers
before changing careers, told Reuters with a smile.

“Now 59, he trains teachers for the Waldorf kindergartens inspired by esoteric thinker Rudolf Steiner,
which began in Stuttgart. He has also addressed several anti-lockdown and anti-vaccination protests,
although he does not reject vaccines altogether.

"’I am convinced that should I get infected anywhere, I will weather the illness,’ he said of COVID-19.
‘I am not vaccinated against other diseases either, except when I travel to the tropics where it's
mandatory.’

“Almost a third of Germans (31%) said in a December poll that they would not take a coronavirus
vaccine, a number that rises to almost half in neighbouring France.”

**Eran Segal: Scientist at the Weizmann Institute. Microbiome, Genetics, Nutrition, Machine learning

***Eric Topol: Professor of Molecular Medicine at The Scripps Research Institute. Editor-in-chief of
Medscape and theheart.org

**** Andy Slavitt: White House Senior Advisor, COVID Response

****Natalie Dean: Assistant Professor of Biostatistics at the University of Florida specializing in
emerging infectious diseases and vaccine study design.

9 FEBRUARY 2021

1. Pfizer expects to halve COVID-19 vaccine production time

USA Today reports that Pfizer expects to cut the time taken to produce a batch of COVID-19 vaccine
from 110 days to an average of 60 as it makes the process more efficient.

“Pfizer's COVID-19 vaccine is made at three Pfizer plants: starting in Chesterfield, Missouri, moving to
Andover, Massachusetts, and finishing in Kalamazoo, Michigan.

2. UK says COVID-19 booster and annual vaccinations very probable

Reuters reports: “A COVID-19 booster in the autumn and then annual vaccinations are very probable,
Britain’s Vaccine Deployment Minister said on Sunday…

“Britain has already given over 12 million first doses of COVID-19 vaccines and is on track to meet a
target to vaccinate everyone in the most vulnerable groups by mid-February.

“Among coronavirus variants currently most concerning for scientists and public health experts are the
so-called British, South African and Brazilian variants, which appear to spread more swiftly than
others.”

3. US gave 2.1 million COVID-19 vaccinations on 7 February

Data from Bloomberg

4. Reduced viral loads 12 days following Pfizer-BioNTech COVID-19 vaccine

A non-peer reviewed paper from Maccabi Healthcare Services, Tel-Aviv, Israel, has found: ”…that the
viral load is reduced four-fold for infections occurring 12-28 days after the first dose of the Pfizer
BNT162b2 mRNA vaccine.

“These reduced viral loads hint to lower infectiousness, further contributing to vaccine impact on virus
spread.”

5. UK to test mixed COVID-19 vaccine dosing strategy

CIDRAP reports that: “…the UK government said it has provided $9.6 million to back a study that will
look at the effects of mixing vaccine types for the two doses, such as AstraZeneca-Oxford first,
followed by Pfizer-BioNTech.

“’The goal is to have data to support a more flexible immunization program,’ said Jonathan Van-Tam,
MBBS, the United Kingdom's Deputy Chief Medical Officer.

“He also said the study could shed light on whether combining vaccine types could enhance or
prolong immune response. ‘Unless this is evaluated in a clinical trial, we just won't know.’

“The trial of a mixed-vaccine strategy comes as governments look for ways to protect as many people
as possible as quickly as possible with vaccines, amid short supply and the threat of more contagious
and lethal coronavirus variants.”

CIDRAP:
   • Center for Infectious Disease Research and Policy, Minneapolis, Minnesota

6. Summarising the categories of efficacy of the major vaccines

As we have previously said, each vaccine has a different efficacy for different endpoints. The most
important efficacy endpoints are:

1. Prevents hospitalization / death
2. Prevents severe disease
3. Prevents mild disease

Monica Ghandi has constructed an elegant summary table with Columns 6 and 7 being the most
important.

                                                                         6             7

•   Column 6 shows all vaccines fully protect from hospitalization/death
•   Column 7 shows four vaccines fully protect against severe disease, one provides 85% protection
    and data is not shown for one.

Note: this table does not contain the reduced efficacy against milder disease of the AstraZeneca
vaccine against the B.1.351 variant. See below…

Monica Ghandi MD, MPH
   • An infectious diseases and HIV doctor at University California, San Francisco.

7. Astra vaccine is less effective against South African variant

AstraZeneca’s COVID-19 vaccine does not appear to offer protection against mild and moderate
disease caused by the 501Y.V2 variant (B.1.351) which accounts for around 90% of cases in South
Africa, the Financial Times reported, citing a study which has not been published.

None of the participants in the study died or was hospitalized, however the study had a relatively
small sample size of around 2,000 individuals.

Consequently, the rollout of the Oxford AstraZeneca COVID-19 vaccine in South Africa has been
suspended. The other licensed vaccines, including Pfizer and Johnson & Johnson, will be given while
the Oxford-AstraZeneca vaccine is reviewed, reports the British Medical Journal

8. Amended Oxford-AstraZeneca COVID-19 vaccine coming

Oxford researchers expect to have a modified vaccine to cope with the B.1.351 variant later in the
year.

“’We have a version with the South African spike sequence in the works,’ Sarah Gilbert, lead
researcher for the Oxford team, told the BBC on 7 February.”

9. Russian vaccine team in talks with China on combination trial

Bloomberg reports that following the recent publication of the high efficacy (91.6%) of Sputnik V
vaccine, Russian developers are in talks with China’s CanSino (vaccine efficacy not released yet) to
test if a combined regimen of their shots can better protect against new virus strain

Currently a trial is being designed which would replace Sputnik’s second shot with CanSino’s.

Researchers are looking at whether combining different developers’ vaccines in a two-shot regimen
produces results that are as good as, or better than, using the same product as a booster. That
flexibility could help to relieve pressure on individual vaccine makers if they run into manufacturing
difficulties.

10. More US COVID-19 vaccination statistics

As of 7 February:

•   31.7 million had received 1st dose (9.6%)
•   8.8 million had received both doses (2.7%)
•   Total of >40.5 million vaccine doses have now been given
•   There are still 32% doses distributed but yet to be given

Data from Tweet by Eric Topol

Eric Topol
    • A professor of Molecular Medicine at The Scripps Research Institute, and a senior consultant
       at the Division of Cardiovascular Diseases at Scripps Clinic in La Jolla, California. He is
       editor-in-chief of Medscape and theheart.org.

11. Looking ahead to a possible vaccine glut in the US in April

Scott Gottlieb and Mark McClellan discussed, in the Wall Street Journal, the possibility of a vaccine
glut in the US, especially if demand is weaker than expected

“…by the end of March, the monthly vaccine supply may reach 100 million doses. To keep pace, the
vaccination rate would have to double and then some. This will require an all-of-the-above approach
to administering vaccines, tapping substantial capacity in pharmacies, primary-care practices and
other trusted health-care providers.

“…with improved delivery, at some point, perhaps in April, supply will start exceeding demand. The
challenge won’t be how to ration a scarce resource, but how to reach patients reluctant to get
vaccinated.

“Based on the latest Kaiser Family Foundation tracking surveys, more than half of Americans say they
don’t want to get vaccinated. Some may simply want to wait; others may be set against getting it.

Scott Gottlieb
   • The 23rd Commissioner of the Food and Drug Administration from 2017 until April 2019

Mark McClellan
   • Director of the Robert J Margolis Center for Health Policy and the Margolis Professor of
       Business, Medicine and Health Policy at Duke University.

12. Two different COVID-19 pandemics

               DENMARK
                                            Dr Eric Ding has provided a table using Danish data to
                                            show how the number of new cases of the “old variants” is
                                            dropping while the more contagious B.1.1.7 strain looks
                                            as though it will dominate.

                                            Eric Ding
                                                • Senior Fellow at the Federation of American
                                            Scientists, Washington DC

13. Excellent interview of Dr Fauci on JAMA Network

Dr Howard Bauchner discusses topics including:

•   Mutation and the need for global vaccination
•   Will COVID-19 vaccination become annual?
•   Sputnik V and the Chinese vaccines, including would/could they be licensed in the US?
•   Apparent lack of progress on treatments

Recommended viewing

Dr Howard Bauchner
    • Vice chairman of Pediatrics at the Boston University School of Medicine, is the Editor-in-Chief
       of the Journal of the American Medical Association (JAMA) since July 1, 2011

Dr Anthony Fauci
    • Physician-scientist and immunologist serving as the director of the National Institute of Allergy
       and Infectious Diseases since 1984 and chief medical advisor to President Joe Biden since
       2021.

14. France, Poland, Sweden rule out AstraZeneca vaccination for the elderly

Euronews reports that France, Poland and Sweden issued recommendations on 2 February not to
use the COVID-19 vaccine developed by AstraZeneca for the elderly. They join Germany and Italy,
which issued such recommendations last week.

Authorities in France and Sweden say the vaccine should be prioritised for people under the age of
65, both citing insufficient clinical trial data for older people.

Sweden's public health agency said it expects such data "to come later in the spring from an ongoing
and large US clinical trial in Phase 3."

"It will include sufficient number of older participants to be able to draw more certain conclusions
regarding the protective effect," it added.

FOR INTERNATIONAL SOS MEMBERS (First login at http://www.internationalsos.com)
   • To view a digest of articles on COVID Immunity and Vaccine development: CLICK HERE
   • To view a digest of articles on COVID Testing: CLICK HERE
© 2020 AEA International Holdings Pte. Ltd. All rights reserved