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How well the vaccines actually work
On the Robert Koch Institute's communication on vaccine efficacy.
Germany is vaccinating its population against a virus that doesn’t exist anymore.
The vaccines that are being used were developed to tackle the so-called ‘wild-type’ (with emphasis on the word wild) that was first located just down the road from the world’s leading research laboratory on bat-based coronaviruses.
That virus has disappeared, though. It was first replaced by the Alpha variant, which was then pushed from its perch by the more infectious Delta variant. According to the latest weekly report by the Robert Koch Institute (RKI), “in Germany, as well as in other European countries, practically all infections are caused by the Delta variant.” [my emphasis]
So, if Germans are looking for reliable information on the efficacy of vaccines, one would expect that the RKI would give them information for efficacy against the strain of the virus which almost all Germans are currently being infected with.
Instead, the RKI’s Q&A on “Wie wirksam sind die COVID-19-Impfstoffe?” (How effective are the Covid-19 vaccines), has the following information:
“Based on current knowledge, the COVID-19 mRNA vaccines Comirnaty (BioNTech/Pfizer) and Spikevax (Moderna) and the vector vaccine Vaxzevria (AstraZeneca) offer high efficacy of approximately 90% against severe COVID-19 disease (e.g., hospital treatment) and efficacy of approximately 75% against symptomatic SARS-CoV-2 infection with Delta.”
The answer does not give the reader the necessary context to understand that the only number important to their lives in November 2021 is the 75% efficacy for Delta.
It goes on:
“What does this mean? The probability of becoming severely ill with COVID-19 is about 90% lower in those fully vaccinated against COVID-19 than in those not vaccinated. For example, imagine that in an area with many active COVID-19 cases, there are about 20 cases per 1,000 people. If part of the population in this area were then vaccinated, 20 out of 1000 unvaccinated people would therefore become sick with COVID-19, but only about 2 out of 1,000 vaccinated people.”
This information hasn’t been true since around July at the latest, when the Delta variant became the dominant strain in Germany.
The difference is significant. An efficacy of 75% means that in their example five people would fall ill instead of two. Rather than ten times the overall number of cases needed to reach the same number of deaths as in pre-vaccine times, only four times the number are required.
In fact, at the moment, we have around three times the number of recorded cases in Germany as we had last November (a current 7-day incidence of 416 compared to 140 on this day a year ago.) In other words, even with a 100% vaccination rate, we wouldn’t be that far behind the mortality rate from last year.
Search a little deeper though and that 90% number seems even less relevant. In this week’s report, the RKI breaks down vaccine efficacy by age. An effectiveness of 90% is recorded among the age group 12-19; in the age group 18-59 the vaccines are 68% effective, while in the 60+ age group they are just 65% effective.
As a reminder, over 95% of all deaths in Germany occur in the 60+ age group. If the current vaccines are only 65% percent effective for this demographic, surely this is the number the RKI should be putting front and centre of its public information?
I don’t know why the RKI is not presenting people with the information they need. Perhaps they are scared that a weaker headline number on vaccine efficacy will put some people off. Perhaps they only get around to updating their website every few months…
Either way, it’s a dereliction of duty.
A 70 year old who wants to be able to assess how risky it is to meet people indoors needs to know how well the vaccine works for them. That person isn’t likely to scour the RKI’s PDF-based weekly reports until they find the information they need. Giving them the headline number of 90% efficacy is deceptive.
More than half of all Germans aged over 60 in hospital with Covid at the moment have been vaccinated. Would some of these people have been more careful about whom they meet if public health authorities had done a better job of informing them?
If the public messaging hadn’t been reduced to two banal catchphrases - “get vaccinated and protect yourselves and others” and “vaccines are the only way out of the pandemic” - would people be able to make more educated decisions about their own lives?
Perhaps there is something to the accusation often levelled at the RKI, which is an agency within the Health Ministry, that it is not politically independent enough.
By the way, if you are wondering why Germany is still using an out-of-date vaccine, an interesting article in Die Welt today went into detail on the issue.
BionTech and Moderna are both in the process of testing updates that should be more effective against the Delta variant, but they currently face legal hurdles in proving that the changes do not pose additional risks. Basically, they have to obey laws which are designed for diseases that don’t pull on new disguises every few months.
Ultimately, what is needed is a legal basis similar to that for the flu vaccine, which is updated every year to cope with the highly mutable influenza virus without the need for authorization from the European Medicines Agency every year.
For the flu, the World Health Organization (WHO) identifies variants that are likely to dominate the coming season and the necessary vaccines are prepared in time for the autumn, when they are shot into the arms of those who need them.
This system doesn’t always work, some flu vaccines are duds meaning that, like in 2018, tens of thousands of people die. In the winters when that is the case responsible public health policy should be about informing people of weaknesses with the vaccine rather than on wasting energy shaming “lazy Germans” who can’t be bothered to get their jabs.