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It's my understanding that efficacy cannot be directly compared like this, as it's a function of what variants were around during the trial, amongst other things. I believe Vice produced a good video on this recently.

Importantly, don't all vaccines currently authorised have 100% protection against death from COVID-19?

Edit: it was Vox, not Vice, and the video is here: https://www.youtube.com/watch?v=K3odScka55A

> Why is everyone worried about blood clots, and not that the J&J vaccine has a crap-tastic efficiency of 66.3%?

See "Why you can't compare Covid-19 vaccines":

https://www.youtube.com/watch?v=K3odScka55A

You're welcome.

I’m seeing a lot of similar concerns in the comments so I just want to post this video from Vox. They did a great job explaining this issue.

Effectiveness doesn’t really mean much between approved vaccines in the US. Please watch this video: https://youtu.be/K3odScka55A

From what we know so far, any of the approved vaccines are excellent and no one knows for sure if one is better than the other. The only logical thing to do is get what is offered to you as soon as possible.

That being said, this is excellent news that Pfizer is protective against the SA Variant. Not trying to minimize that news, just point out that it still is better to just get whatever approved vaccine you can.

⬐ fossuser

I'm not sure I really buy that video - don't control groups account for differences in the general population at the time it was done?

This Pfizer data, plus the results in Israel suggest that the mRNA vaccines really are just objectively better.

They all prevent death and hospitalizations though so get the one you can get, but it seems likely the mRNA shots are better.

The main thing I'm wondering is if the people that got covid post J&J had really mild disease (like a tiny cold or something) or "mild" disease like absolutely miserable but just didn't have to go to ICU. Is that information known?

Basically the video confuses some of what the control group actually does and then says "well they all prevent death anyway" - no shit. The question is if one is better than the other and the answer seems like yes. The main counter would be the presence of variants, but the Israeli population faced variants and the mRNA efficacy rate held. This new Pfizer data suggests mRNA is just better.

⬐ timr

> The main thing I'm wondering is if the people that got covid post J&J had really mild disease (like a tiny cold or something) or "mild" disease like absolutely miserable but just didn't have to go to ICU. Is that information known?

Of course. It's right there in the FDA report, starting on page 51:

https://www.fda.gov/media/146219/download

7.1.1.5.3 Case Definition for Mild COVID-19

• A SARS-CoV-2 positive RT-PCR or molecular test result from any available respiratory tract sample (eg, nasal swab sample, sputum sample, throat swab sample, saliva sample) or other sample;

AND at any time during the course of observation:

• One of the following symptoms: fever (≥38.0°C or ≥100.4°F), sore throat, malaise (loss of appetite, generally unwell, fatigue, physical weakness), headache, muscle pain (myalgia), gastrointestinal symptoms, cough, chest congestion, runny nose, wheezing, skin rash, eye irritation or discharge, chills, new or changing olfactory or taste disorders, red or bruised looking feet or toes, or shaking chills or rigors.

You will find equivalently precise definitions of moderate and severe disease, as well. And if you care to look, you can find the same thing for all of the other FDA-approved vaccines. They're similar, but not identical. In general, "mild disease" is what most reasonable people would consider to be mild disease, but there are minor differences in terms of which specific symptoms/thresholds are used. For this vaccine specifically, you can see that having two or more of the above symptoms will bump you into the "moderate disease" category. So they're pretty strict.

> The question is if one is better than the other and the answer seems like yes.

Given that you clearly haven't read the data, I don't know how you can possibly make such a speculation.

I don't mean to pick on you specifically, but this entire affair has been defined by people who are way too willing to speculate after reading a few news articles.

⬐ fossuser

Thanks - that makes me feel better about how they define mild, and thanks for the direct reference. Earlier in the pandemic mild was being used to mean only not hospitalized.

> “I don't know how you can possibly make such a speculation.”

I don’t mean to come across as overconfident, is my understanding of efficacy wrong? Or the purpose of control groups? I’m happy to be wrong or corrected.

The speculation comes from the efficacy numbers and the results in Israel - is there a reason to dismiss those?

Edit: Reading the Pfizer results from here (https://www.fda.gov/media/144245/download) it seems like fewer moderate/severe cases of covid in the vaccinated population when compared to J&J (taking into account both of their placebo groups)? I’m not sure if I’m reading these correctly, but the docs don’t seem to contradict my impression that the mRNA vaccines are better.

⬐ starik36

I am not sure that it's a good explanation. Just the opposite.

J&J's excuse for 66% effectiveness is that they were tested when there was more Covid going around? That's exactly when the vaccine is supposed to protect you. Not when there isn't an opportunity to catch the disease.

And if we then take this claim on its face, then Pfizer and Moderna vaccine stated effectiveness is pointless, since it wasn't tested during the worst times.

Finally, the claim that no one in the study group that did catch the virus ended up in the hospital is also based on self-selective bias. I am assuming people in the study were younger people who needed the money and not older folks who are at a higher risk. I am not saying that it's not true - just that the biases need to be taken into account in any study.

⬐ quantgenius

There are 2 reasons for JNJ’s lower top line numbers.

1) There were more of the variants going around, not more of the original strain going around when JNJ was tested and all the vaccines are less effective against the variants. PFE and MRNA were tested when only the original strain was going around. All the vaccines were designed to combat the original strain.

2) JNJ doesn’t protect as well against mild Covid. But the symptoms from this mild Covid are comparable to the side effects from the second dose of PFE/MRNA which affect 30-40% of people and based on anecdata from people I know nearly everyone.

⬐ mapme

A mild reaction to the vaccine is way different than actually having a viral infection. Potential long term persistent symptoms can occur with viral diseases and particularly COVID. Not sure that comparison makes sense.

Additionally JNJ has side effects as well.

⬐ bluGill

1 is false - this article's 91% includes data from before, during, and after the J&J trial. So it covers times when the variants were more active as well.

⬐ quantgenius

My original comment referred to the 95% effectiveness in PFE top line numbers from when we got the clinical trial readout rather than the 91% in the article. I was responding to the parent comment.

Further, the JNJ clinical trial data was from a population where the Brazilian variant, the most serious of the variants, was likely more widespread than this PFE data which seems to focus more on the relatively less dangerous South African variant.

⬐ lol768

> I am assuming people in the study were younger people who needed the money and not older folks who are at a higher risk.

I'm a participant in one of the J&J Ensemble trials. There is no payment associated with my participation.

⬐ rafram

No payment? You're getting ripped off! In my area, it's $150 per appointment.

⬐ starik36

Thanks. Good to know. Might I find out why you signed up?

⬐ bluGill

I would have signed up myself for free - a 50% chance to get a promising vaccine now instead of waiting? They weren't doing studies in my area, so I had to wait until after the study for a vaccine to be offered to me.

⬐ lol768

I'm pretty young and fairly healthy, so a licensed vaccine was a long way off (and still is) for me personally. The 50% chance of possible protection from Covid-19 was something of a selfish motivator, but more generally it seemed like a good thing to do to try and help society return to some sort of normality (I work in a sector which has been hit quite badly) - of course, there was probably no shortage of volunteers so my space likely would've been filled without my participation.

It also seemed like a kinda fun thing to do, though - I find medical sciences pretty interesting and had read through and familiarised myself with the phase 1 & phase 2 trial results for Ad26.COV2.S. I thought it'd be an interesting experience and the risks seemed acceptable to me.

The only downsides so far have been the distance I have to travel to get to the clinical research facility and the fact that I don't really like the sight of blood. I've had so many blood tests (in this study and outside) that I'm fine with the process, but I prefer not to watch.

⬐ Jeud

A recent "real-world" study done in the US between mid-December to mid-March found that people vaccinated with either Pfizer or Moderna's vaccine show 90% protection against SARS-CoV-2 . Here you can read more about it. https://www.statnews.com/2021/03/29/real-world-study-by-cdc-...

⬐ cma

> That's exactly when the vaccine is supposed to protect you. Not when there isn't an opportunity to catch the disease.

Are they saying the other vaccines were tested when you had lower chance of multiple exposures, and they were tested when there was higher chance, and it isn't controlled for in coming up with that number?

⬐ starik36

Correct. That’s what the video states.

⬐ tzs

> I am assuming people in the study were younger people who needed the money and not older folks who are at a higher risk.

That may be true in the earlier phases, when you are just trying to show that the vaccine isn't too harmful and works in at least some cases.

It's not true for the large phase 3 trials. For those you try for a study group that matches the demographics of the people who will be getting the vaccine in the wild.

For the J&J phase 3 trial, 34% of the participants were over 60. 41% had comorbidities associated with an increased risk for progression to severe COVID. Race was 74% white, 13% black, 6% Asian, and 1% Native American. Ethnicity was 15% Hispanic.

Pfizer was 45% age 56-85, Moderna was 16% over 65. Race for both was about 80% white, 10% black, 4-5% Asian, 1% Native. Ethnicity was 26% Hispanic for Pfizer, 20% for Moderna. I don't know what percent had comorbidities.

⬐ MuffinFlavored

Genuinely asking: What happens if you are vaccinated but then exposed to a variant of COVID your vaccine doesn't support? Is it the same as having no vaccine at all?

> The only logical thing to do is get what is offered to you as soon as possible.

Is there any reason to be skeptical of the vaccine? Long term effects, etc. I don't normally get a flu shot or go to the doctor or anything like that. I'm pretty nervous. I used to date an anti-vaxxer who swore some kind of shot gave her brother autism... Obviously that's material to get downvoted and laughed at here on HackerNews but... just thought I'd bring my "atypical" perspective to the table.

⬐ xen2xen1

All evidence points to the your symptoms being much lower if you have the vaccine even if it's a different mutation. If the vaccine really did nothing for a certain mutation it would be front page news all over the world.

⬐ blub

Of course citizen. All of them are excellent and equal, but some are more excellent and equal than the others.

⬐ treme

This is same thing that happened with CDC and "masks aren't needed". A white lie with good intent but nevertheless just false info.

I'm sure if we polled all the bio-phd's with option between the vaccines, they will all choose mRNA based ones because they have higher protection %'s, and significantly lower side effect risks.

Most countries don't have the luxury of giving their citizens the choice, so they resort to making up a lie to calm people from "bank run" on mRNA vaccines.

https://old.reddit.com/r/COVID19/comments/mh7wtw/astrazeneca...

"It was mentioned by Emer Cooke during the press conference.

"For the AZ vaccine based on spontaneous reporting in the EEA it's 4.8 cases per million, for the Biontech vaccine, based on the same criteria it was 0.2 cases per million and for the Moderna vaccine, based on the same criteria, 0 cases per million"

So ~25 fold compared to the BioNTech/Pfizer vaccine. 0.2 cases per million is in line with the expected number of cases in the general population. The Moderna vaccine probably hasn't been used enough in the EEA for such rare events to occur.

It's also worth keeping in mind that these numbers are based on older data. It is based on 62 reported cases (of which 44 are in the EEA). Germany alone has reported 31 cases and they aren't all included here. So expect these numbers for the AZ vaccine to go up a bit when they announce their updated recommendations at the plenary meeting next week."

⬐ krona

You're mixing statistics from different testing protocols. Apples and oranges.

Effectiveness doesn’t really mean much between these vaccines. Please watch this video: https://youtu.be/K3odScka55A

From what we know so far, any of the approved vaccines are excellent and no one knows for sure if one is better than the other. The only logical thing to do is get what is offered to you as soon as possible.

⬐ umeshunni

That video is bullshit (and Vox is a publication that in Feb 2020 was pushing the "just a flu" narrative).

The effectiveness is measured as 1-(Nnotinfected / (Ninfected + Nnotinfected)).

The video claims that when the study was done during the surge or in "other countries", the effectiveness might be different because Ninfected is higher, which makes no sense at all, since the probability of the vaccine protecting you shouldn't change based on how the virus is spreading in the general population. For a set of 100 placebo and 100 vaccinated, even if all 100 are infected, the vaccinated segment should be as protected as possible. 95% efficacy means only 5 in the vaccinated are infected. 66% efficacy means 50 in the vaccinated are infected.

⬐ tzs

That's not what they are claiming. They are claiming that the chance that a vaccinated person will get the disease is higher if that person is subject to more exposure events. What they say about trials during surges then follows from that.

For the part about other countries, what they are saying is that there were more infectious strains circulating in those countries during the trial, so you can't compare to trials done before those strains were circulating.

⬐ ardit33

bro, you are missing out the news and the point of this whole post, pfizer is 90% effective against all current strans overral, even the nasty ones

Unless you are claiming that right now there are less strains around, compared to october-novemeber (when the J&J data was compiled)

This news just solidifies the argument that the mRna vaccines are much better. Suggesting otherwise is just either ignorance, or willful lie (let other take it, so i have more for me)

> I like to think of it as I am ~1/10th as likely to get the disease as I would be if i had not been vaccinated.

> Is this what they mean in this?

Yes, that's what they mean. And even for the vaccines that are ~60-70% effective, all of them have so far been 100% effective in preventing hospitalization and death. It's not binary, the vaccines don't make you completely immune to this virus but greatly reduce the impact it has.

I thought this video explained it well: https://www.youtube.com/watch?v=K3odScka55A

⬐ makomk

As I understand it, it turns out that none of the vaccines are 100% effective in preventing hospitalization and death, it's just really hard to measure this accurately in the kind of studies used for vaccine approval because there aren't enough people in them, especially people at high risk. The actual figure from the various large-scale rollouts is closer to 80% I think?

⬐ alistairSH

Yeah, the language I've seen is usually something like "...there were 0 deaths in the test group..." Which most people will read as "100% effective in preventing deaths" but technically there's no specific claim at preventing deaths - the "0 deaths" is effectively an anecdote.

⬐ Spivak

I would assume that even a claim about being 100% effective has some asterisks like “has a strong enough immune system” where “strong enough” means “unless you’ve already been diagnosed with having a weak immune system you’re fine.”

⬐ thamer

It's quite possible that some people will eventually contract COVID-19 and die from it, even several weeks after getting their last immunization shot (supposedly at a point when they're fully protected). It just didn't happen in any of the trials.

If anyone wants to look at the raw phase 3 numbers:

Pfizer numbers: 43,448 participants received injections (21,720 the vaccine and 21,728 the placebo); 8 cases of COVID-19 in the vaccinated group and 162 in the placebo group, 9 were severe (8 of those in the placebo group).

Pfizer study: https://www.nejm.org/doi/full/10.1056/NEJMoa2034577?query=fe...

Moderna numbers: 30,420 participants, evenly split with 15,210 in each group, over 96% got both injections. There were 185 symptomatic cases in the placebo group and 11 in the vaccinated group. 30 participants had severe cases including one causing death: all were in the placebo group.

Moderna study: https://www.nejm.org/doi/full/10.1056/nejmoa2035389

⬐ mapme

Israel has much more robust data than the trials for pfizer (monster study group size of 600k per group). They have seen hospitalizations and death in fully immunized individuals. There’s more papers out there but here’s one.

https://www.nejm.org/doi/full/10.1056/NEJMoa2101765

This short video[1] explains it quite well imo. They also make the interesting point that efficacy rates are not comparable because the studies were done at different times/locations with different spread of the virus in the population.

[1]https://youtu.be/K3odScka55A

⬐ amichal

Reading the more technically detailed comments I think really reinforces throwaway894345's point. I understood what "91%" means (much better than non-techies in my circle) but assumed a lot incorrectly about the controls and the actual "end point" they are measuring. It seems lots of folks are saying the different studies use different sets of symptoms etc and not routine testing at intervals to identify those who have the disease.

I suspect most of the public doesn't even know what 91% means. Combine that with being bad at evaluating risk in general. It mostly represents a 10x improvement in cases per capita per time, but I think telling folks that their risk went from 1 in 10,000 to 1 in 100,000 (or whatever) probably doesn't mean a lot. Folks just want "safe" or "not-safe" :(

You can't compare the 91% vs 76% numbers because the 91% test was performed in the late summer last year between virus waves and in a location with an less-contagious form of the virus.

Whereas the JJ virus was tested during the fall 2nd-wave in South Africa when there was a lot of cases and more cases of a higher infection strain.

The only fair comparison would be if all of the testing was done at the same time in the same geographic location.

source: https://www.youtube.com/watch?v=K3odScka55A&feature=youtu.be

⬐ bluGill

No, the 91% from Pfizer is just announced and covers roughtly 6 months, including up until at least the middle of march, at which time the variants were circulating. Notably this covers the entire time of the J&J trials.

Of course they used somewhat different geographical regions so you can't compare them, but still the 91% does include variants.

⬐ boc

There was a new, recent study that showed that the mRNA vaccines were still 90% effective among healthcare workers during the big surge in December/January period when the variants were certainly present.[1] This doesn't mean the J&J vaccine is bad by any means, but it does show how incredible the new mRNA vaccines have performed.

[1] https://www.statnews.com/2021/03/29/real-world-study-by-cdc-...

⬐ ehsankia

From that same study:

> The study suggested that even the first dose of vaccine was 80% effective at preventing infection

Which is within the error bar of J&J's one dose result in the US (75%). We will have to see the results of the 2-dose J&J trial coming out soon, but I expect that to be around 90% too.

It's also worth noting that some places in the world (UK, Canada), have been using 1-dose pfizer regimen to get the most out of their short supply, with possible 2nd shot 3-4 months down the line. Similarly, we could see a delayed J&J booster being given to increase immunity to matching 90%.

I saw this video, which illustrates what you pretty much stated:

https://www.youtube.com/watch?v=K3odScka55A

I actually wish I got the JnJ vaccine (I got the first dose of the Pfizer vaccine last week).

⬐ pardner

Best general explanation I've seen so far, thanks for posting the link.

Unfortunately, it still completely sidesteps any discussion of the relative risk of a vaccinated person (who is protected from a severe infection themselves) still a) getting infected and b) causing a severe case in someone else who is not yet vaccinated.

So while "efficacy" may not be relevant on one dimension (MY chances of severe infection) it still seems important in another dimension (the chances of ME nonetheless getting infected then giving a severe case to someone else).

Good explanation on efficacy of vaccines.

https://www.youtube.com/watch?v=K3odScka55A