How do we know the vaccines are actually working?

I have been gamely trying to understand just how we know that the COVID-19 vaccines are actually working. I read reports and articles assuring me that that is the case, but how do we actually know?

Surprisingly, it's not easy to ascertain. Perhaps the best overall article I have found about how efficacious and effective the new vaccines are is this one, produced for the UK Parliament. The first thing to note, then, is the difference between vaccine efficacy and effectiveness.

Vaccine efficacy is what is measured during randomized controlled clinical tests, before a vaccine is licensed and released, which compare the rates of infection between vaccinated people and those receiving a placebo. This I understand, and this is where figures like 94% for the Pfizer/BioNTech vaccine come from. It is a kind of theoretical measure, based as it is on mainly healthy younger volunteers and only over a relatively short timespan.

Vaccine effectiveness, on the other hand, is a more real-world measure, evaluated during post-license observational studies of the whole population of vaccinated people of all different ages, health profiles, etc, over an extended period. This may be quite different from the theoretical efficacy rate, and this really is the one that counts. But it is notoriously hard to pin down. How do you measure it in practice? Is it just the proportion of vaccinated people who catch the virus compared to the proportion of those unvaccinated people who test positive?

The only published study I have seen so far comes from Israel, and concludes that the Pfizer/BioNTech vaccine is around 50% effective in preventing transmission, and just 33% effective for adults over 65 years of age. Scientists seem pleased with this, but it is light years away from the 94% theoretical efficacy. Britain, which also started vaccinating quite early, says it will not be able to produce any useful effectiveness figures until late February at the earliest, although an early analysis suggests that just the first dose of the Pfizer vaccine reduces the risk of infection by around 70% (57% on those over 80). A Scottish study has shown an 81% reduction is hospitalizations among vaccinated seniors over 80. These are, however, not very exhaustive or conclusive results. 

So, what are the (mainly non-scientific, political) claims that "the vaccines are working" based on? Just the fact that new cases have been falling in recent weeks? (I had hoped this was due to public health measures and the lockdowns we are all putting up with.) The recent fall in hospitalizations and deaths? (Is that not because we are getting better at treating the infections that do occur?) 

What is the so-called "real world" data that many of the more cavalier scientists are touting? Merely comparing the hospitalization rates of those who have had the vaccine with a completely different group of unvaccinated people, who may have different health, age and socioeconomic profiles. This is hardly controlled, double-blind testing.

Then, of course, there is the whole issue of whether the vaccines are "sterilizing vaccines" (ones that actually prevent infections and transmission completely) or "disease modifying vaccines" (that just reduce the severity of the disease when it is contracted). There is the issue of the duration of the immune response. There is the whole issue of what we are looking for in a vaccine: a cessation of transmission and carriage of the virus, or just a reduction in the numbers of hospitalizations, or of deaths? The whole field is rife with gradations and definitions and assumptions and what have you.

Everyone claims to be "following the science" and "basing decisions on the data", and yet we have widely different policies arising, e.g. some countries and provinces are happy to give AstraZeneca to seniors, while some are not; some are waiting the manufacturer-prescribed three or four weeks (or up to six weeks) between doses, while some are waiting three months, even four months, in between. All still claim to be "following the science". At this point, "the science" becomes a very murky and imprecise concept indeed.

The bottom line, though, is that any functional vaccines are better than none, and I'm certainly not going to turn any down. Some people will, though, and there have already been differences in what some countries are willing to accept in a vaccine (e.g. South Africa has rejected the AstraZeneca vaccine because it has not been shown to be effective enough against the South African variant, and France and Germany are not using it on over 65s because of a lack of testing on that age group, despite some evidence from the UK that it is effective on seniors). It's a real scientific minefield. 

Public health officials are starting to unravel in battle against variants

Like in a bad Hollywood movie, the variants are coming! Nay, they're here already, they're everywhere!

First there was the British variant, then the South African variant, and the Brazilian variant. Then the original British variant had to be renamed as the Kentish variant (in Britain at least), because there was now  a Liverpool variant and a Bristol variant as well. In the US, there was a nasty California variant and a mid West variant.

And now, following that bad Hollywood script, there is a new variant of concern first identified in New York City, a particularly nasty one that can apparently protect itself against antibodies and vaccines. And people are getting well and truly fed up with the whole variant thing. One New York public health advisor referred to it as "pathogen porn", and cautioned researchers to "please review high impact studies w/govt health depts before marketing it to [the] media".

Ouch, tetchy! Maybe it makes for a good soundbite, but those researchers are pedalling as fast as they can, and it is, after all, their job to alert public health authorities to anything that might conceivably help them, and in as timely a manner as possible. The New York variant now makes up over 12% of positive tests in New York and surrounding areas (as of mid-February), so it is not insignificant, and people need to know about it. 

I get it that public health officials are tired and approaching the end of their tether after a year of battling against this virus. But, hey, don't shoot the messenger. That's not going to help anybody.

A typeface that helps you remember what you type

Researchers at RMIT University in Melbourne, Australia, have developed a typeface that they say is "scientifically proven" to help you remember what you type. 

Or, more specifically, what you read. Sans Forgetica (ho, ho, ho!) is a reasonably notrmal sans-serif typeface with some chunks strategically snipped out of the letters. This makes it harder to read than most typefaces (but not TOO hard to read) which, psychologists say, means that you have to work harder at reading it, thus helping you retain the content better.

Of course, writing by hand also works...

P.S. I have used the word "typeface" here advisedly, because I believe it is more correct than "font" (even though "font" is the word used by RMIT and most font download sites).  According to Wikipedia (and who am I to argue?), Caslon is a typeface, while 8-point Caslon Italic is a font, i.e. a font is a specific size, weight and stylistic variant of a font family or typeface.

Media's disingenuous portrayal of Canada's "pandemic early warning system"

There has been much rending of garments and tearing of hair in the media over the demise of Canada's Global Public Health Intelligence Network (GPHIN), which was effectively abandoned in May 2019. An easy scapegoat for Canada's experience of COVID-19 makes just too good a story, but I think its real significance has probably been much overstated.

In fact, it seems like the  network, often described, rather grandly, as our "pandemic early warning system", was established in 2009, but was already starting to be run down and reassigned as early as 2013. In 2009, for example, the network issued 877 alerts (a ridiculous number, and way too many for any government official to keep track of and assess). This had already fallen to 198 by 2013, and just 21 alerts were issued in 2018.

So, this was not a case of the Liberal government making a single bad decision in 2019; it was a fait accompli long before that. And anyway, it turns out that GPHIN itself had, to a large extent, control over its own budget and its priorities, and it was not really, as it is usually portrayed, a dramatic decision of a faceless bureaucrat (or even a Prime Minister) to "pull the plug" on an organization that was at the top of its game, and which could have somehow saved Canada from the COVID pandemic and saved thousands of lives.

There seems to be little evidence that the network ever saved ANY lives, even through outbreaks of SARS, H1N1, Zika and Ebola. In the case of COVID-19, governments around the world were well aware of it in January 2020, but very few considered it to require any action until March. Even then, the virus was not well understood, and most countries were not  giving good, effective advice until much later. GPHIN would not have changed this. If GPHIN had issued an alert in, say, December, would anything have transpired any differently? I don't think so.

In fact, you can probably say the same thing about the UN's investigation of China's early communication about the virus. If China had told the world in December rather than January that there was this unexplained virus it was concerned about in Wuhan, what would actually have changed in the world's reaction to it? (Setting aside the fact that very few people outside of China believe a word that China says these days anyway...) This is also, to a large extent, a more-or-less pointless search for a scapegoat, not so much by the UN, but by many member countries.

And GPHIN? Meh.

Investigations into long-term care homes still ongoing ... or not

In the first wave of the COVID-19 outbreak, long-term care homes and  retirement homes were disproportionately hit, particularly in terms of deaths. We all saw those harrowing reports about old people languishing in their own feces as support staff were overwhelmed and sickened. Various investigations and inquests were promised, and many were begun, as doctors warned of an impending second wave of the virus.

Well, the second wave came, and LTC and retirement homes again bore the brunt of infections and deaths. Figures are hard to come by, but there seem to have been been more outbreaks and deaths in senior's homes than during the first wave.

Now, the healthcare professionals are talking about a third wave (before the second is even finished), and we are still no further forward on improving staffing and regulations in long-term care homes. We know how this is going to play out (and, with the spread of various variants of concern, this one may be even worse, vaccinations notwithstanding).

So, it comes as a double slap in the face that an investigation into the Herron group of nursing homes in Quebec has been suspended. A probe into the Residences Herron in Dorval, Quebec, was due to start next week, but now it has been delayed until September(!) It was argued that, if investigators did not agree to a delay, the company would just launch a legal challenge that could delay it even longer. What a ridiculous situation!

It seems like the investigations have no teeth and take forever. Meanwhile, more seniors are likely to die senseless and preventable deaths. Crazy!

Blame for Canada's vaccine rollout problems largely partisan in nature

It's interesting how Canadians are perceiving our undeniably stuttering vaccine rollout, and where the blame is being laid. Because, make no mistake, pretty much everyone wants to blame someone, even though, personally, I don't think it's been that disastrous (sure, more and faster would be nice, but this is a marathon not a sprint, and most of the problems have not been of our own making anyway and will be made up).

A Léger poll for the Institute for Canadian Studies shows that, overall, 39% blame the Liberal government's procurement practices, 33% blame the pharmaceutical manufacturers, 12% blame the USA and Europe, 12% blame a lack of infrastructure, and 4% blame "other" ( which I'm guessing might include Health Canada for not approving new vaccines quickly enough).

But the breakdown of respondents by political affiliation is telling. Among Conservative voters, 55% blame government procurement, 19% pharmaceutical manufacturers, 12% the US and Europe, 11% the lack of infrastructure, and 2% other. Compare this with Liberal voters: 21% blame government procurement, 49% pharmaceutical manufacturers, 15% the US and Europe, 11% the lack of infrastructure, and 3% other. Voters for other parties typically, and perhaps predictably, land somewhere between these two extremes, with he NDP and the Bloc Québécois both leaning more towards blaming the Liberals than the vaccine manufacturers for the non-delivery of promises doses, even though this has been largely out of their hands.

So, it seems to me that this poll is, more than anything else, a poll on how partisan the different political parties are, with the Conservatives finding themselves way out in front in terms of partisanship. It's interesting that the Green Party, whose members I trust to be more thoughtful and objective than most others, are allied much more closely with the Liberals on this, with 36% blaming pharmaceutical manufacturers and just 27% blaming the Liberals' procurement. And the Greens are not doing this out of a desire to protect their chosen party's reputation - they are as critical of the Liberals as any party - so this is probably closer to where the blame should actually lie.

Chinese treatment of Uyghurs: genocide or not genocide?

It has been rather heavy weather listening to Justin Trudeau prevaricate about whether or not the Chinese treatment of their Uyghur (Uighur, Uigur) minority in Xinjiang state amounts to genocide. Granted, the use of the word is not to be taken lightly, as Trudeau points out, but still...

There is no shortage of media reports about what is happening in Xinjiang: mass incarceration in concentration camps ("re-education centres", as China would have it), forced enslavement, torture, mass rapes, disappearances, murders, forced sterilizations and abortions. The list goes on. It certainly looks, and probably smells, like genocide.

This is not just a nice matter of semantics: to be branded as a country guilty of gencide is about as bad as it gets in international relations terms. The UN''s Genocide Convention defines genocide as "acts committed with an intent to destroy, in whole or in part, a national, ethnical, racial or religious group", including killing or causing serious bodily or mental harm to members of the group, deliberately inflicting conditions aimed at destroying the group, imposing measures intended to prevent births within the group, and forcibly transferring children from one group to another.

A Liberal-dominated House of Commons sub-committee concluded back in October 2020, that all of this did indeed constitute genocide as it is understood under the UN Genocide Convention. Former Liberal justice minister and the government's special advisor on Holocaust remembrance and anti-semitism has confirmed more recently that what is happening in Xinjiang meets the test of genocide in his respected opinion.

Most countries have issued statements condemning China's treatment of the Uyghurs (not to mention Tibet, Inner Mongolia and Hong Kong). The exceptions include a group (including Nepal, Pakistan, Sri Lanka, Cambodia, Myanmar, and the Philippines) that is financially beholden to China, and of course Russia, which merely says the direct opposite of anything the West says as a matter of principle, and a group of ex-Soviet states (Belarus, Turkmenistan, Tajikistan) that just parrots whatever Russia says. But only the USA has gone so far as to publicly label it as genocide, both under President Trump and President Biden. 

Canada - like so many other countries that have expressed their outrage at the conditions in Xinjiang, but have fallen short of actually calling it genocide - has yet to do so officially. Now, though, a Conservative motion on the issue will come to a non-binding vote next week. The Conservative, NDP and Green opposition parties have all come out unequivocally in declaring the Chinese practices to amount to genocide, so the vote is sure to succeed. 

Prime Minister Trudeau, though, Is being much more careful in his statements on the matter: "When it comes to the application of the very specific word 'genocide', we simply need to ensure that all the i's are dotted and the t's are crossed in the processes before a determination like that is made... It's a word that is extremely loaded". Many people think that Trudeau is being way too careful with his words, but it's not quite as simple as that.

But it's one thing to make these kinds of declarations as an opposition party and quite another to be the party in power that will be saddled with the responsibility for official decisions made. It is the governing Liberal Party that will have to deal with China, not the Conservatives, safe in opposition. How the government follows up any vote would be an equally fine line, balancing symbolic gains with strategic costs.

And make no mistake, there will be repercussions from China for such a vote. You only have to look at the arrest of Michael Kovrig and Michael Spavor on trumped-up charges 802 days ago in retaliation for Canada's arrest of Huawei executive Meng Wanzhou. China would be quite capable of executing the two Michaels in retaliation for such an international embarrassment as a vote of genocide, or of kidnapping other Canadian citizens. Such an eventuality would be on the heads of the government, and specifically on Justin Trudeau. The economic fallout would also certainly be heavy, although that would be more easily justified.

So, yes, I can say that it is genocide. The opposition parties can say it is genocide. Even the USA can say it is genocide. But can Canada?

UPDATE

The vote on whether or not China is committing genocide in Xinjiang resulted in a resounding "yea", to the tune of 266-0. So, no-one voted against the motion, but a lot of MPs abstained (there are 388 MPs in parliament in total), including Prime Minister Justin Trudeau and the whole of the Liberal cabinet. However, some 70 Liberal MPs did vote for the motion, in a free vote, and arguably this sets an important, and possibly dangerous, precedent, and sends a reasonably unequivocal message to China. This marks the first time a legislative body has declared the Chinese treatment of its Uyghur population to constitute genocide, and so in some respects it goes further than the USA, which has just limited itself to comments and opinions of some major administration figures. UPDATE: Since then, the Dutch parliament has also passed a very similar non-binding motion.

The Canadian vote is non-binding (i.e. just for show), and does not commit Canada to any concrete actions, although the extent of the majority suggests that SOMETHING should be done. Canada's membership of the UN Convention on Genocide means that they cannot just deal with a genocidal country on a business-as-usual basis. A last-minute amendment to the motion calling for the 2022 Winter Olympics to be moved from China was also passed, albeit with a smaller majority. But it remains to be seen what Canada will feel obliged to do in concrete terms. And, of course, what China does in response...

India tries to outdo China and Russia in vaccine diplomacy

Some interesting geopolitical moved are playing out in the area usually referred to as "vaccine diplomacy".

The main players are China and Russia - no surprise there - but also India, which is increasingly active. Both China and Russia are playing economic and political games quite unabashedly, as is their wont, exporting vaccine doses even at the expense of their own populations, while accusing Western countries of hoarding doses for their own populations. This plays very well with developing nations. Crates of Sinopharm vaccines have been arriving in countries like Zimbabwe and Equatorial Guinea marked with stickers blazing "China Aid. For shared Future." Quantities of Russia's Sputnik V vaccine has been shipped to countries like Guinea, Algeria, Tunisia and Togo.

Even Europe has been tempted. Serbia, for example, has snapped up vaccines offered by both Russia and China, rather than wait for the EU to get its act together, as has Hungary. Even worse, Serbia has been offering some of its doses to ethnic Serb populations in Bosnia-Herzegovina and Kosovo, adding a whole ugly ethnic element to vaccine diplomacy.

India, which has a huge vaccine production capacity (indeed, the largest in the world), has, in some ways, gone even further than China and Russia. It is offering vaccines FOR FREE to neighbours ("friendly countries") like Nepal and Sri Lanka, which it worries have increasingly fallen under Chinese sway in recent years, accumulating large amounts of goodwill and soft power in the process. It has also exported large quantities to relatively wealthy countries like Brazil, South Africa and UAE on commercial terms, as well as several poorer countries in Africa, Latin America, the Caribbean and Asia, despite having vaccinated only 1% of its own huge population. Even Canada is trying to import vaccines from India. 

Both Russia's Sputnik V and, to a lesser extent, China's Sinopharm and Sinovac  vaccines are considered to be both "safe and effective" (even by "Western standards"), so you can well see that if poorer countries are faced with a choice of no vaccines (or maybe vaccines through the UN-sponsored COVAX program at some unspecified time in the future) or vaccines naow from China or Russia, they might choose the latter.