UKC

According to the New York times,  Israel has vaccinated 10% of its population since 20th December.  We need to get going.

Well, that's the power of money!

Eh? Us that some weird antisemitism?

Yes, you’d think with the daily death totals being so high the vaccination programme would be ready to roll the moment a new vaccine was authorised for use. Waiting days to begin seems bizarre for want of a better word.

Israel ranks 25th in terms of wealth per capita, below say, Malta and Denmark.

Africa seems to be still waiting for vaccs ... https://www.africanews.com/2020/12/31/africa-battles-covid-19-second-wave-a...

The key factor with Israel is a high proportion of the population do military service, they are probably much easier to mobilise when required, will naturally adopt some regiment regime, even those not issuing the vaccination will be more accustomed to doing what they are told, the first time they are told. Given their relations with their neighbours they are likely very self reliant anyway, none of this eu communal vaccine shared out, where for example sweden got just 10,000 doses in the first delivery for 10m people, it doesn't even cover the estimated 23,000 over 95 yr olds.  

According the NYT, the factors were early ordering of the vaccine, a highly digitized health service (whatever that means), and Netynahu needing a "win" to recover popularity.  The military wasn't mentioned. 

I do find it bizarre how the "the army" is always mentioned when there is a need for something to happen that isn't otherwise happening.  They are good at doing army stuff, and small extensions of this such as building things quickly but why people think that will make them good at giving injections, or organising massive distribution programmes is beyond me.  The are also quite small 80,000 or so in total. so the difference they will make nationally will be similarly small.  

Because health services globally are already maxed out. So you need an additional organised disciplined group, young enough to graft, with an established supply chain, vehicles, temporary buildings and power supplies, the means to accommodate and feed themselves anywhere...  sticking a needle in somebody is the easy bit. 

Whilst amazon might have a supply chain what percent of amazon workers could drop everything if told they have to work the next 2 months in different parts of the country? What percent of the average delivery company are already qualified medics? 

I agree, but I think it is a legacy from times when, not only were the armed forces so much larger and a good source of labour, but they also had a completely parallel structures of things like hospitals, doctors, wireless sets, supermarkets, distribution networks, transport and even a post office. Calling on 'the army' allowed everyone else to benefit from this huge pool of often under utilised resources. 

But now not only are numbers a fraction of what they were, even in the 70's , but there is a much greater integration of military and civilian life. The parallel surplus has been reduced which makes sense (until they're needed). Now if you want to mobilise a national, efficient, scalable distribution service, then Tesco home delivery is probably a better bet - it's larger with more resources than the Royal Logistic Corps.

None of which the army has at any worthwhile scale!  An difference they make is marginal once you get beyond acute disaster management.  The picture of an RAF transport plane (a significant part of the what the RAF have) dwarfed by  one commercial plane (a rounding error is what is available) during the PPE disruption captured the situation well.

Quite.  Tesco alone recruited more staff than 50%  of the entire army in April alone to respond to the pandemic.  

The problem would be when vaccine stocks run low they'd be substituting for  anything else beginning with V and injecting folk with vimto etc.. 

I don't think they'll be needing to send individual transport aircraft or helicopters to each care home, I'd imagine there are easier ways. 

...and in other news India will have 100 million doses of Oxford vaccine available by the end of this week which is a bit galling given the stuff was developed here but we can only get hold of a limited quantity at the moment.

https://www.itv.com/news/2021-01-01/india-approves-oxford-university-and-as...

This.

I get that the vaccine has only limited availability at first, but to seemingly lack a plan and waste hours and even days before starting is a criminally negligent act.

A month ago we could have been gearing up by specific training on injecting being given to medical students, vets,  dentists and others who could be trained to be competent to deliver the vaccine. The number of doctors required to supervise and deal with small numbers of contra reactions would be small.

We can build Nightingales in weeks so we could easily do the same and create centres for vaccination. 

Leave it to GPS? Really, I don't believe that anyone with any understanding of what these facilities can accommodate would ever think that's a plan. I live 3 doors from our surgery.  Its waiting room seats 5, which is lucky as there are only 6 car parking spaces.

Alternatively hospitals deliver them? Are these different hospitals to the ones which will be on the brink due to covid for months to come?

In the meantime let's divert the publics attention onto schools so they don't notice the lack of a half coherent vaccination plan.  Clever.

its particularly upsetting because India doesn't actually have a covid problem anymore, i presume they have hit herd immunity already,  their current 7 day average is 261 deaths a day, and they have a population 21 times the size of the UK.  Also their rate of infection is dropping so fast that with or without a vaccine it seems covid will be all but extinct their in just a few months from now.  Those 100 million doses would be so much more useful in Europe.

How concerned were you and Europe when it looked like India was heading for a catastrophe? 

Is that true? Or can people not afford to go to hospitals and is public health not sufficient to track how people die?

I don't know enough about their experience with it but it strikes me that lack of access to health care could mean that they don't really know what people die of in the way we do here?

Some very valid points there.

When we have an election we utilise many public buildings and mange to enable millions of people to vote in a day.

Judging by the few seconds it took for me to receive my flu jab it should be possible to use a similar plan to rapidly vaccinate many people.

Admittedly it won’t be as easy as I suggest but I don’t understand why we aren’t Oxford vaccinating right now

They did. My sister (a nurse with 40 years' experience) has done the five hour online course. Most of which seemed to be about being able to explain to patients how it worked (and that it didn't contain Bill gates' nanochips, I guess...)

I’m very unclear what the production status of the AstraZeneca/Oxford vaccine in the U.K. actually is right now.  There’s the concerning FT article from early December on manufacturing delays, and I’ve not found anything concrete since.

I’d been expecting a much more coherent announcement over plans to immediately start vaccinating >1m people per week immediately after the MHRA approval.  I’d been expecting this because the alternative is not good so this is the only sensible way to go.

That would be funny if the UK government wasn't already saying that if they run out of Pfizer vaccine they'll just substitute Astra Zeneca for the second dose.

I wonder if they put some Tory Lord that used to be a Tesco executive in charge of vaccine distribution.

why not actually look at the data and have a think about the greater good, rather than just smear me as uncaring because i dared to suggest that we might need something more than a developing country.   187 people died in India yesterday, 964 people died the day before yesterday in the UK.

Quite.

Imagine if we were to have 100 million doses available next week.

At work we get a flu jab every year. A nurse comes in and over the course of a day about 100 people get injected. In other words one person can vaccinate about 100 people a day.  A thousand vaccinators could vaccinate 100000 a day and ten thousand vaccinators could vaccinate a million people a day. 

By April we could have pretty much the whole UK fully protected with two shots.

I really want to know what the problem is.

You and your Bill Gates, very naughty!

Good to hear they have done something but bearing in mind things are going seriously tits up right now why is that plan so anonymous? Ditto vaccine supply numbers? How many, by when? 

Not only is the plan not shared, but there doesn't feel like there is any real urgency. We can throw about big meaningless numbers.....2 million a week being a classic....but by when, is that 2 doses ie a complete vaccination or just 2 million shots? Meanwhile 25% of health staff have covid or are isolating and *we* are happy to continue to put un vaccinated health staff in harms way to save our own arses. Pathetic. 

.....I need to go and wash the car in the rain to calm down.

Yes it's true.  sure the indian government will record a much lower % of infections and deaths than the U.K does but the important thing is the trend, India has had a continual decline in infections and deaths for four months now.  There is no reason to think that they were counting deaths before but have now given up.

I can't really see how you can find people getting access to vaccines as being upsetting. But anyway there is a worldwide plan to make sure that developed countries don't get preferential access to vaccines just because they have the money. And I image whats happening here is that India has the manufacturing infrastructure to rapidly take advantage of the research and development committed here. We gave up manufacturing anything some time ago.

Do you think it is the right decision to send all these doses to India?

I find it upsetting because there is a limited supply and people getting access to the vaccine who dont really need it may stop someone getting access to the vaccine who does really need it.

If rich countries should not be allowed to take all the vaccine just because they have funds than a poor country should not be able to have more vaccines just because they have the manufacturing facilities, it should be distributed based on need.

Well yes,  you pay a company that delivers packages to deliver your packages instead of p*ssing about with the military so as to get pictures of people in uniform on the TV.

Are you sure they're being sent to India? Rather than actually being produced in India?

Dont misunderstand me; I'm far from convinced that 'the plan' is mature or well thought out. Having completed the training, my sister is getting repeated, changing information about her start dates...

As wintertree points out, information about the status of UK production is very thin, to non-existent.

They are being produced in India to the Oxford recipe in the biggest vaccine manufacturing plant in the world. It's in the report I linked to.

They'll have produced 1 billion by the end of the year. That can only be considered a good thing. 

Israel's a country the size of Wales. Population just under 9 million. 10% of that's the population of Liverpool. Plus it's quite high tech and organised. All this probably helps.

That's exactly as I suspected.

I couldn't read the ITV report, as there is no cookie opt out; have we ditched that EU legislation already...?

If their government ordered and paid for them, then yes absolutely.

I wonder if they put some Tory Lord that used to be a Tesco executive in charge of vaccine distribution.

Parliamentary Under Secretary of State (Minister for COVID Vaccine Deployment) - Nadhim Zahawi

Parliamentary Under Secretary of State (Minister for COVID Vaccine Deployment) - GOV.UK (www.gov.uk) 

If you uk can't get their quarantine and distancing in order, why should India care? It'll just get its own act together and slowly become one of the new super economies of world. The west hasn't cared about India very much for the last how many centuries?

Liverpool's part of Israel? Or are there 900,000 Israelis living by the Mersey?

Nursing Times magazine said military greatly helped with logistics, extra help in hospitals. Nightingale hospital construction?

How does it help? If it can  be done.in Israel size chunks, divide the UK in to similar sizes and go from there. 

A few week ago I was shot down for predicting the government would screw this up. I can't help childishly wanting to tell then 50 dislikers "I told you so"

https://ourworldindata.org/grapher/covid-vaccination-doses-per-capita?tab=c...

Germany's COVID vaccine procurement labeled a 'gross failure' https://p.dw.com/p/3nS9q

I think you're going to have to keep wanting. As much fun as it is to shit on ourselves for screwing everything up and keep naysaying and wishing for the worst, it turns out we're doing relatively ok. 

Let's see where we are in a month or two.

That's the spirit

I don't much benefit in assuming against all the evidence so far the government will suddenly be competent.  There seems to be no effective plans for ensuring vaccines are available in sufficient quantities, that there are people to administer them, or that there is much urgency to rectify these problems.  We are relatively far ahead just now because they were approved in the UK ahead of the countries.

Not trying to defend the government (though I will defend the NHS, they're doing an amazing job), but what would be satisfactory? What would make you say "yeah, ok, that's not a bad job?" I suspect the answer is nothing would. There's no magic vaccine fairy that the government has just chosen not to call.

Saying how many will be vaccinated week by week and then delivering on that.

It really needs to be a million or several million per week to get the job done in a few months for the sake of our sanity and the economy. If there's not enough vaccine for that they could at least tell us how much is expected week by week.

It's their record for delivering that depresses me...

That's exactly what they are doing.  They have decided to call the magic vaccine fairy rather than sticking to qualified protocols and lockdowns.   It is a roll of the dice, very possibly, perhaps even probably,  they will get lucky and it will work, potentially the untested protocol will not be effective and they will have chucked away tens of millions of doses of vaccine and less likely but still possibly there will be some unconsidered side effect or we will find the virus mutating to resist both vaccines because large numbers of people get insufficient doses of both.

I actually think they have that bit correct, given the doubts over vaccine availability. The Pfizer trials were undertaken with the second dose out to 42 days so going for up to 12 weeks seems a small risk  for a potential large gain, against a certainty if many deaths. Of course if they.could actually organise effective distribution, that would be preferable. 

On the contrary. A clear, articulated plan ( not just words) to deliver the vaccine,  with some obvious in urgency would make me say "OK".

I do share some of your pessimism, but a part of me still thinks and hopes it might not entirely go to shit. (Edit: the vaccination programme, specifically) At the very least, it might go even worse everywhere else. 

Let's see where we are in a month or two.

A major problem throughout has been the tendency of the politicians here to over promise and then under deliver.  A few optimistic slogans are no help......indeed, they just reinforce the impression that the politicians haven't really got a grasp of what to do and the U turns become inevitable.

Considering the eu has only got 10,000 doses out on the ground so far for each country, the UK is doing OK relatively speaking. Next delivery of another not particularly impressive amount around the eu is later this month.

The U.K. is ranked  3rd at that moment. 1st is Israel , 2nd is Bahrain. 
 

nobody else is anywhere these 3 countries. 

We went through that higher. We have done Let's see in a month or so.

12 x 7 = 84.

So how do you evaluate that it is a small risk if you have zero data beyond 42 days (never mind sufficient data for statistically confidence).

Pfizer have officially stated that there's no data to support it.  This is like if Boeing said their plane wasn't qualified to operate in a particular way, the aviation regulator approved it anyway and the whole fleet of planes in the UK started to do it next week.

No it's not. It's safe. Efficacy studies are ongoing. We know antibodies are present after one dose. Give it a rest. 

And there is also the alternative of knowing many people will die if we stick to 3 weeks. Boeing weren't facing  lots of planes crashing as a default.

Umm.......

Yes, also this point...But... Unfortunately... we've possibly not started with the best example.....🙄

Can we all agree to switch to Airbus, maybe, if we're going to stick with the airline analogy?

Idle question, how is that 10% derived?

10% of everyone living in Israel, 10% of Israeli citizens, 10% of people who are in groups suggested to get vaccinated?

(Sorry hadn't seen the initial article and am always mildly suspicious of nice round numbers)

You give it a rest.

Safe is about more than immediate consequences for the patient that takes it.  It is also about how long the vaccine remains effective against a mutating virus and having millions of people take an ineffective dose may influence that.   And safety for the patient of taking two different vaccines isn't qualified at all.

If safety testing was all that was needed they could have approved these vaccines months ago.  Up to a couple of weeks ago we were getting told all about the MHRA process and how careful they were.  Pointless if you aren't going to follow the protocol that was qualified.

Probably why it isn't proposed (with the rarest exceptions)

Yep,  “a very exceptional basis, when the alternative is to leave someone with an incomplete course.” 

and not in Wales?

"An official in Wales said that first and second vaccine doses there would be matched."

a bit intrigued what this means

"if the patient is considered unlikely to attend again"

Perhaps this is being reserved for wanted criminals, so Tom might be correct??

Give it time.  They are backpedaling because of the outcry but they clearly thought about it and when it comes down to it they may well do it.  If you are going to hand out single doses of the Pfizer vaccine as fast as possible without reserving the second dose and you have bought much more of the Astra Zeneca vaccine than the Pfizer one then you are going to be in that position.

The BMJ's take on it:
https://www.bbc.co.uk/news/uk-55519042

Apparently informed support here(implying 3 weeks actually more risky but chosen to speed trials).

https://twitter.com/sandyddouglas/status/1344949258483621888?s=19

Israel spends less per capita on healthcare, and certainly doesn't employ as many in its healthcare system. Guessing whatever they have is just much more efficient than our sacred cow. 

What is the difference between taking a tablet and having a jab? Don't both eventually get into the blood stream and disperse throughout the body? Obviously self administration is easier with a tablet than with a jab, so it could be rolled out a lot quicker.

When I've travelled I've had typhoid injections, but malaria tablets etc.

I can see that it would be much easier for a mistake to be made with self administration of tablets like over or under dosing, and keeping records etc.

There are obviously reasons for a jab rather than a tablet. I suspect that the mechanics of how each work is different,  but can someone who knows explain please?

Absorption, Distribution, Metabolism, Elimination.

you need to get your active ingredient to the right part of the body. Some drugs will be absorbed well from the gut and distributed effectively through the body - good choice for oral administration. Others won’t get absorbed, or when the blood goes from the gut goes to the liver will get metabolised or excreted before they are spread around the rest of the body so they cannot reach their targets - good choices for injectable, or some transmembrane route that bypasses the liver. 

lots of pharmacology is getting an effective agent to the site in the body you want. A great Petri dish molecule might never work clinically because of issues around this.

there are oral and nasal vaccines - your anti-malarial drugs however are not vaccines.

Thanks for that

Well we could do it in Israel style chunks. It would be better to concentrate infrastructure ,medical expertise etc  in a concentrated area. However, I can just hear the row if say- everyone in London got vaccinated first, and Granny in Grimsby or a nurse in St Helens was in the back of the queue.

Seems to me that if they change strategy and use all the Pfizer that comes in in the next few months for first jabs they're going to need the same again for second jabs and the total amount of Pfizer they purchase will increase.   So we should be seeing announcements about buying more Pfizer and less Astra Zeneca.

It's quite incredible to me that NO ONE in this thread has so much as mentioned the Palestinians, and the fact that the Israelis are withholding the vaccine from them and prioritising the settlers. As I said in a tweet, I have no words. (And I have no intention of 'arguing' about it, because there is no argument.) 

https://www.theguardian.com/world/2021/jan/03/palestinians-excluded-from-is...

I didnt know that. However it's hardly only Israel vaccinating their own nationals ahead of others. The UK (or India) for example are too. I think expecting anything else is unrealistic. 

"their own nationals"

Your irony (or perhaps lack of it?) is awesome.

I don't follow you. 

My point in this thread isn't another Palestine/Israel one but that it is possible to vaccinate very quickly with competent government. However, since you brought the issue up,  I think it would be hypocritical for anyone in the UK to complain about other countries vaccinating their populations ahead of others.

https://www.theguardian.com/world/2021/jan/03/palestinians-excluded-from-is...

Aye, had to criticise this I suppose, or the prisoners held in Israeli jails, even if you have to travel to occupied land to make sure it happens.

Edit: Sorry Gordon didn't see you'd posted this before I posted it.

Our local vaccination centre is in a council theatre.

Appointment only by some kind of invite system.

Its half way down a cliff  You must park at the top, walk down a couple of flights of outside stairs (no lift for the elderly).  get your injection - Then leave by the lower entrance, and walk back via the access road  to where you left your car, zimmer frame, mobility scooter or whatever.  

I've no idea how many collapsed or fell into the sea on the way down or back.   But in one day they only managed 450 injections in an 8 hour day 5 days a week. On of the reception desks I saw had two nurses sat down a desk and a chair for the person being injected.  the 'patient came in, spent a few minutes talking with one of the nurses.  Eventually a vaccine was produced the old lady injected, the other nurse put a plaster on and helped the lady pull her shirt and jumper back.  Off the lady went and the two cleaned the whole of the desk, chairs and so on.   I don't know how many people were doing the actual injections.  

This centre has to serve  well  over 39,000 people.  Its going to be months and months at this rate.

Bring in the military.  Please.  I don't mind standing up in a queue with my shirt rolled up  walk past a desk with a guy and a pile of vaccines, quick injection in your arm,  move along and then go home.  

It could be done much, much much quicker if they got in more and more people who are already used to giving injections.  It is not rocket science!

Lets get rid of some of the bureaucracy 

According to a bit in todays Sunday Times there are 360,000 people in this country who do not currently have any vaccination centre to get called to.    Local authorities and the NHS have had nearly a year to plan for mass vaccinations.  What is going wrong?

It is not rocket science. Its data science. If you get that wrong you screw up the whole vaccination programme.You cannot have people wily nilly been given the vaccination to keep track of it.

At the moment they have a  limited supply of vaccines, what on earth do you expect ..mass role out.

Give it a few weeks.

There is nothing wrong other than you needing to manage a reasonable expectation.

Well come on! Look who's in charge.

Israel has a compulsory insurance system that's run on a not for profit basis. This provides for basic care. Individuals  can top up by paying more if they wish. When this is factored in they pay more per capita than in the uk.

Neil, I wasn't exactly suggesting we avoid cutting corners in terms of record keeping.

Yes, my 'reasonable expections are somewhat dampened by the gradual covid hole we;re in, and by my own personal experiences of how big organisations like the NHS sometimes move like behemoths.  I seem to recal when I was at school we were innoculated/.vacinated at school in the 1950's 
 

The NHS is not the only organisation which can/could deliver or be part of,  the vaccination programme and they are not the only employers of people capable of both record keeping and giving injections safely either.

But as you say, early days - I just hope they move quickly.  

It seems that the biggest obstacle to rapid vaccination is form filling.

https://www.itv.com/news/2021-01-05/how-to-speed-up-covid-vaccinations

If so, it is utter bollocks.

With no free health system and lots of the population living in abject poverty, I suspect most cases just aren't being reported.

Add to that that it's hot all year round, and the virus doesn't like heat.

Are you actually opposed to using vaccines to exit this?

Do you actually enjoy lockdowns and the destruction of the economy?  They are a necessary evil, but now there is another option that should be chosen.

Giving an injection into a muscle isn't rocket science.  I agree with you and the writer in the reference. 

I'm not sure whether the NHS is going to rely only on it's own employees (nurses), but it is a simple  task to train others to give vaccinations.  
 

You are taking what I said out of context.

I was not arguing against using vaccines, I was arguing that the vaccines should be used according to the qualified protocols.     What they are doing is rolling the dice and taking unquantified risks.  It will probably work but if it doesn't the consequences could be pretty bad.

If the unqualified protocols are not effective then we will have chucked away our vaccine supply.   If they not only do not work but also give the virus more opportunity to mutate in a way which renders the vaccines ineffective then everyone on the planet will be in really deep sh*t.

Than why were they reporting 80,000 cases and 1000 deaths a day  throughout july aug and September and h

that makes no sense, why would they have reported thousands of deaths a day in july august and september but now report  just 200 a day?

well that makes it all the more unlikely that it would disappear during the winter.