Not all vaccines are equally useful
How many millions of Russian residents will receive a "weak" vaccine and who is to blame for this?
Alexander Berezin, Naked Science
Although the press writes a lot about extremely rare "side effects" from vaccines, practice shows that you have to be afraid of something completely different. The most terrible enemy of the vaccinated remains... coronavirus. Even after Pfizer or Moderna vaccines, people sometimes die from it – and there are already hundreds of similar cases. Of course, there are orders of magnitude more of them among the unvaccinated, but this does not make it easier for the deceased and their family members. Even worse, two of the three Russian vaccines seem to protect against covid much weaker than Pfizer and Moderna. This is quite strange considering that the third Russian drug in this regard is not inferior to Western analogues. Why do the Russian authorities finance millions of copies of a weak vaccine, having at their disposal a completely full-fledged one?
It won't be like before
Today, about half a million people have died from the coronavirus epidemic in Russia (contrary to the statements of the authorities about 110 thousand). Many of us still live with the expectation that this nightmare will end soon. That vaccines will bring the world back to a pre-crisis time, tens of thousands of excess deaths every month will be a thing of the past, free trips without masks will resume, the economy and tourism will work as of old, and so on. Let's put it bluntly: this is practically impossible.
Firstly, if you are a resident of Russia, then you live in a country where at least 40% categorically do not want to be vaccinated. And these are not those who have read the relevant press about how the spine "shrinks" from the "Satellite" (in fact, from a placebo). The audience of such media in Russia is limited to 20% of the population. But there are much more unwilling to be vaccinated. These people do not want to be vaccinated, not because they are oppositionists, but because, in principle, they do not understand how viruses and vaccines work. They heard somewhere out of the corner of their ear that the risk of dying from Covid-19 is low (only 1%), and out of the corner of the other ear that there are fatal thrombosis after some vaccine.
But they are not aware that the probability of dying from thrombosis even abroad (where the vaccines that cause them are used) is several thousand times less than from Covid-19. And that there are no vaccines causing such thrombosis in Russia at all. They are not aware that every tenth person who has been ill experiences the effects of infection for at least three months – and this also applies to those who have been ill seemingly in a mild form. They do not know that after covid, not only taste and sense of smell, but also potency can disappear.
In terms of vaccination success, Russia is at the bottom: even frankly impoverished India has vaccinated a slightly larger part of its population than our country. Countries such as Mongolia or Brazil are completely unattainable above us. The graph clearly demonstrates that the main shortage during vaccination is not so much the vaccine itself, as the presence of citizens who are sensitive to reality, and not to conspiracy theories. And with this we did not work out / ©OurWorldInData.
And they are not aware of the above because they are often people for whom everything that is arranged is too difficult to understand is the malicious and malicious manipulations of Bill Gates / the world behind the scenes / pharmaceutical giants. They don't want to know what the real situation is. Because their position, in which they are smart, and everyone around them is submissive puppets of evil forces, allows them to feel better against the background of others who are deprived of access to hidden knowledge about the vaccine conspiracies of the world behind the scenes. Therefore, any arguments for them are generally of little use. Many will never be persuaded. You just have to put up with it.
Of course, if we had the USSR, it could simply and quickly force these 40% of the population to get vaccinated. But we don't have the USSR (and in many other ways it's even not bad, that's just not in the situation with vaccination). And our current authorities are extremely far from the Soviet ones in terms of rigidity, and they have a corresponding difference in their opportunities for coercion.
This means that the coronavirus epidemic in Russia will never end at all. After all, 40% of the "unwilling" will remain a reservoir where the virus will constantly multiply, gradually mutate and continuously keep the remaining 60% of the population under threat of infection. It will not work to destroy it in the same way as smallpox was destroyed at the time. The reasoning of the authorities about vaccinating the majority of the population should be attributed to a simple poor understanding of their people (which, however, is not news for Russia). Therefore, we need to calm down – and learn to live with the coronavirus.
And how to live with it? It seems that for non-conspiracy theorists in Russia, the recipe for "how to live with coronavirus" is extremely simple: get vaccinated. And what does it matter to you after that, what is going on in the minds of those 40% who do not want to be vaccinated?
Alas, this is an illusion: such people will still influence your life – and in some cases death. Recently, the Centers for Infectious Diseases Control of the United States published statistics on the number of those who died from coronavirus, having become infected 14 days after the second Pfizer or Moderna vaccination. These days are important here: by this point, both vaccines already give the vaccinated the maximum possible antibodies. Despite this, there are still deaths among them.
Out of 123 million vaccinated Americans – many times more than in Russia, we note – 290 managed to die from covid. This is not because vaccines don't work or don't work the way they do in clinical trials. They are just working, hundreds of thousands of people simply do not participate in research, so no one has been able to stumble upon cases of covid death after vaccination before mass vaccination.
Why do such deaths occur at all? People in modern society, unlike societies of the past, can often live even with suppressed immunity, because they are treated with modern medicines, they are cared for. But when people with suppressed immunity are vaccinated, their immune response may be too weak.
One person for almost half a million vaccinated – it seems to be small, it seems that the chances of such an outcome are negligible. In the end, among the unvaccinated, five thousand people per half a million will die from covid sooner or later (the mortality rate for covid is around 1%).
However, it is worth remembering that vaccination in the States began not so long ago. Therefore, among the vaccinated, not everyone managed to contact the carriers of the virus and get infected. In the coming months, they will do this: then the number of deaths from coronavirus among vaccinated people will increase significantly. It cannot be excluded that for the United States it will reach one person per hundred thousand. Yes, it is still a thousand times less likely to covid death among the unvaccinated. But still quite real. And on the scale of a state like the United States, more than one thousand people may be vaccinated, but they may die.
However, that we are all about the States. And what is the risk of dying from covid if you are vaccinated by a "Satellite"? Unfortunately, this is an unsolvable riddle for Russia: the Ministry of Health does not consider it necessary to inform citizens about such trifles as the chances of life and death. The Russian Direct Investment Fund, represented by its press secretary, has not found time to respond to the relevant letters and calls from Naked Science.
Fortunately, we have the export of Sputnik abroad, and there are completely different Ministries of Health, for example, the Argentine one. Unlike the Russian one, it regularly publishes detailed reports on what happens to the vaccinated vaccines used in the country. AstraZeneca, its Indian counterpart Covishield (only 0.78 million vaccinated) and the Chinese Siporhagm (1.30 million) are among the "Sputnik-V" (3.41 million injections, according to the latest report).
Unfortunately, even the Argentine report cannot answer the question "how many will die from covid after Sputnik". That's because so far the Argentines have not been able to count a single death for 3.41 million vaccinations. In general, such a case is indicated only for vaccinated Covishield.
This is a good sign. Most likely, the probability of dying from coronavirus among those vaccinated with Sputnik is at least no higher than for those vaccinated with Pfizer or Moderna. It is very likely – judging by the Argentine data – that the risk is noticeably lower. Although, to find out for sure, it is better to wait for additional reports from the Argentine Ministry of Health – fortunately there are no hopes for the Russian one in this regard.
Conclusion: if you want the endless (because of those who do not want to be vaccinated) covid epidemic in Russia not to affect you, it is enough to inject yourself with a "Satellite". After that, it's worth checking the antibodies: if they are tragically low anyway, it's better to continue wearing a mask and avoid crowded places, so as not to become one of those who will die even after vaccination. It is worth emphasizing: in the USA, vaccinated, but those who died from covid were also among middle-aged people, not only among the elderly. That is, you should not think "I am young, vaccination will definitely cause an immune response in me, so I am not afraid of a covid death after vaccination." Not a fact: in modern society, even a relatively young person may not have the best immune system.
Another important point: if you are ill, do not think "I have antibodies, so the vaccination is not needed." According to research, the level of antibodies after Pfizer, Moderna or Sputnik is on average higher than in those who have been ill. This is not surprising: the "live" coronavirus somehow bypasses the protection of the immune system, but its S-protein, which the body receives after these three vaccines, does not know how.
But even with high levels of antibodies after Pfizer and Moderna, the chances of death from coronavirus are still quite noticeable (probably up to one in 100 thousand). This means that they are even higher for those who have been ill. Vaccination in such a situation can significantly increase the chances of survival.
What's wrong with the other two Russian vaccines
Unfortunately, with the other two coronavirus vaccines registered in Russia, everything is much worse.
Let's start with KoviVak (the development of the Chumakov Center). In addition to Russia, the whole–virion vaccine was brought to mass production only by China - however, there are three of them at once, with minor differences among themselves. The real experience of vaccination of millions of Chileans, according to their Ministry of Health, has shown that it reduces the risk of death by only 86%. This is much lower than the Pfizer and Moderna indicators, which, as we noted, reduce the probability of death from coronavirus significantly more than 99%. And much worse than that of Sputnik, for which such deaths have not yet been shown at all.
There are no scientific papers on the effectiveness of the protection of the "KOVIVAK" yet and will not be in the near future (the third phase of testing is just beginning). But it must be clearly understood that from a scientific point of view it is extremely doubtful that the Chinese have a whole–virion vaccine that protects against covid death weakly, and the Russians - strongly. Both use a dead coronavirus, so it's naive to expect a fundamentally different level of protection.
There remains the "EpiVacCorona" (the development of the Vector center at Rospotrebnadzor). This is the world's first peptide vaccine against coronavirus – that is, one that "trains" our immunity not on the S-protein of the coronavirus, but on some of its small fragments (peptides). Previously, no one brought peptide vaccines to mass use, and Vector plays the role of a pioneer here. The Russian authorities have already allocated funds for 2.17 million doses of EpiVacCorona and plan to purchase an additional 4.7 million doses this year alone. In total, 6.87 million people will receive this vaccine.
But how much does it work? To find out the effectiveness of the vaccine, you need to see at least the preliminary results of the third phase of its clinical trials. Although the representative of Vector said that such results could be available in February 2021, in fact they have not been announced now, at the end of May. And soon the reader will understand the possible reasons.
A few days ago, a preprint of another work was posted for public access – a general overview of the situation with vaccinated "Epivaccorona" outside of clinical trials. The preprint reports data on covid mortality only among 807 employees of Rospotrebnadzor and its subordinate institutions. During several months of observation (between December 2020 and May 2021), 37 people among them fell ill with covid of unspecified severity. Two of them died from covid.
We tend to assume that the real number of coronavirus cases was higher, because the death of two of the 37 cases looks too strange. Usually one out of a hundred sick people dies from covid, and not one out of 18-19. But even despite the likely underestimation of the total number of cases, 37 who caught the coronavirus among only 807 vaccinated are still a lot. For comparison: during the clinical trials of Sputnik, out of 19,866 vaccinated with it, only 78 people (0.39%) fell ill, and all in mild form. And among the 807 vaccinated with Epivaccorona, 37 (4.58%) fell ill, and this is a difference of more than an order of magnitude.
However, this is not the most important thing, the most important thing is covid mortality after vaccination.
Recall: in the United States, 290 out of 123 million vaccinated people died from covid during a similar time. One in 424 thousand. And after the "EpiVacCorona" – one for 404 people. Not 424 thousand, but just 404. Without thousands. Coronavirus mortality of 0.25% in a few months is a mortality of the same order as in general among the population of Moscow during this period.
In other words, "EpiVacCorona" according to this preprint either does not protect those vaccinated with it at all, or does it very poorly. Therefore, we do not see preliminary results on its protective effectiveness either in the press or in scientific journals. It is simply impossible to compare it with Sputnik, whose deaths after the end of the period of immunity formation are still generally unknown (at least for Argentina, since data for Russia are not available). It is impossible to compare EpiVacCorona with Pfizer or Moderna, which provide very real protection.
To vaccinate living people with an "Epivaccorona" means to create a false illusion of security for them and nothing more. In addition, such actions spur anti-vaccination sentiments. Every message about the death of a sick person after a full vaccination cycle and the end of the period of immunity formation in the age of the Internet is instantly spread across social networks. And it serves for the struggle of anti-vaccinators with peace and common sense that does not subside for a minute, not for a second.
The fact that the state plans to spend several billion rubles to purchase 6.87 million doses of such a weak vaccine is very bad. Among these millions, many thousands of people will simply die. And if you're not lucky, then tens of thousands. And this future catastrophe is sponsored by the same state that has developed a very effective "Satellite".
Why does "EpiVacCorona" not work? Most likely, it's the difficulties of creating peptide vaccines. The fact is that the antibodies of our body do not bind to all the components of the S-protein of the coronavirus (it is this protein that is in its shell). They are associated with its specific fragments located in the outermost part of the shell. In order for antibodies to peptides from the "EPIVAC" to bind precisely to the external parts of the S-protein, peptides in the vaccine must be selected with jewelry care. The slightest mistake – and the peptide vaccine will create antibodies to those protein fragments that are in the thickness of the viral envelope. And then these antibodies will be ineffective against the coronavirus, they will not be able to attach to it.
A logical question arises: how did it happen? Why was Russia able to create a vaccine no worse than the world's best samples (or even better), but along the way it cannot reject an obviously weak one?
Crisis of expertise: you can't control what you can't understand
There is a misconception among the population of our country and a number of other countries that the world is really controlled by someone. Within the framework of such a paradigm, people choose politicians, and those, listening to the opinions of people, on the one hand, and experts, on the other, make certain decisions.
In reality, this ideal scheme often does not work. People do not know how this or that politician will actually govern until he has shown himself in reality – but this is still the least of the troubles. The main reason for the severity is that politicians have no idea which of the supposed experts actually understands their business and who does not.
In fact, how do you choose a scientist/expert you trust? And this is absolutely necessary – because scientists very often have completely polar opinions on the same question.
In theory, you can take one of the scientists, skim through the list of his publications, try to figure out who he is and what he is, and compare it with the scientist who defends the opposite point of view. In practice, a politician normally has neither the relevant knowledge nor the time for such operations. His assistant, too.
The methods used in the animal world remain – formal signs of authority and significance. For example, gorillas knock on their chests, and by this knock other gorillas accurately estimate the size – and potential strength – of the knocker. So the bigger male shows others that he is more authoritative than them.
There are similar mechanisms in the world of science and expertise. Some scientists have a doctorate degree, while others have only a candidate. One has "professorial crusts", and the other does not. Someone served as a full-time epidemiologist, and someone did not serve.
This system, however, has the same drawbacks as in the animal world: cheaters. To impress predators, some animals disguise themselves by coloring under more dangerous species. In order to impress those who are not scientists, many people working in positions of scientists pay increased attention to obtaining degrees, publishing in the most prestigious scientific journals or advancing through the ranks. As a result, society perceives such people as more authoritative scientists and experts than those who have fewer degrees, titles and other options for knocking on the chest.
Unfortunately, some of these most "settled down" scientists are not necessarily well versed in the field where society considers them experts. Take, for example, Vasily Vlasov, vice-president of the Society of Evidence-Based Medicine, epidemiologist, professor, author of university textbooks, and so on, and so on. The list of regalia and titles is impressive – at first glance, everything is fine with the sound of the chest knocking. But the problem is that he periodically gave interviews about vaccines. A few quotes:
"[The developers of Sputnik] are lying when they say that they got a vaccine for the Middle East respiratory syndrome caused by the MERS-CoV coronavirus ... [their other vaccine] did not reach field trials – moreover, those tests that were conducted in Russia were falsified… Perhaps no one will ever be able to create an effective vaccine against SARS-CoV-2…This is a big adventure on a global scale."
These words were said on September 14, 2020, by this time it is already quite known about the Sputnik vaccine and the level of its antibody response (there was already the first publication in the Lancet).
A month later, on October 15, 2020, Vlasov said in an interview even more incredible:
"Most likely, there will be no effective vaccine [for coronavirus] ...wearing gloves is pointless, and the question of wearing masks remains controversial." And he was not joking: in the photo from the place of uttering these words, he is giving a lecture to students, some of whom are wearing a mask – and Vlasov is without it.
Yes, you saw everything correctly: the epidemiologist gave a lecture in a public place in a butterfly, but without a mask. In the midst of an epidemic that killed tens of thousands of Muscovites / © ITMO.
If it seems to you that on October 15, 2020, only those who are not at all interested in the topic did not know that Sputnik has efficiency, then it does not seem to you. It's not just the oral statements of the developers of this vaccine – the levels of antibodies to the S-protein from the publication in the Lancet indicated the same thing since the beginning of September 2020.
But Vlasov had a much better opinion about the EpiVacCorona vaccine, which has not shown serious effectiveness at the moment, than about Sputnik and its developers: "There is very little information about the second vaccine, but I can assume that its creation and clinical research can go a more or less decent way."
By the way, Vlasov has not changed his position much today. If he changed his mind with the "Epivaccorona", then he is still writing a scientifically dubious criticism of the article on the third phase of the "Satellite" in the Lancet. In the answers to him, Logunov and co-authors show that he is wrong, and Vlasov in his Facebook claims that Logunov responds to Vlasov's claims: "Well, yes, it is." In other words, Professor Vlasov is shockingly resistant to information signals from the surrounding reality – and will most likely be so for the rest of his life. Probably, even when Sputnik is registered in the EU.
Screenshot from the "Facebook" of V. Vlasov / ©Facebook.
Now put yourself in the politician's shoes. Someone comes to you who is fine with a knock on the chest - he is a professor, an epidemiologist and a major face in the Society of Evidence–based Medicine. What happens if you believe him? It is obvious that after his words, if you do not decide that the "Satellite" was made by liars, you will still want to insure yourself with an "Epivaccorona" – especially since Vlasov evaluates it much more decently. Perhaps, you will think, it is worth financing both Sputnik and the vaccination of millions with Epivaccorona – maybe at least some of this will work.
The question may arise: maybe Vlasov, who goes without a mask unvaccinated among innocent people, is an exception? Maybe the rest of our professors and epidemiologists do not cause such acute cognitive dissonance?
Alas, but no – the problems are not only in Vlasov. Take Nikolai Filatov: Professor, Doctor of Medical Sciences, Corresponding Member of the Russian Academy of Sciences since 2016, Deputy Director for Science of the Mechnikov Research Institute of Vaccines and Serums, Head of the Department of Epidemiology of Sechenov University. From 1993 to 2012 – Chief sanitary doctor of Moscow. Honored Doctor of the Russian Federation. Three hundred scientific papers, including monographs and textbooks for universities. What did he think about the epidemic and about coronavirus vaccines?
"We all look somewhere, compare ourselves with individual countries and the rest of the world as a whole. We don't need to compare ourselves with the rest of the world. We are an order of magnitude higher than everyone else. They have a mortality rate of 6.9 percent of the number of infected, and we have 0.9 percent."
Maybe this is Filatov's single inadequate statement? Doubtful. Here is what he proposed at a meeting with the President of Russia in the spring of 2020:
"I expressed my point of view at this meeting – we need to release the children and open recreation areas."
It's still not so scary about children: they rarely get seriously ill. But the opening of recreation areas during a pandemic is, as you might guess, not the most epidemiologically reasonable solution. Fortunately, then, as Filatov says: "I failed to convince the members of the staff and the president of the correctness of my point of view at this meeting." And this is not so bad, considering that he also doubted the meaningfulness of vaccination against coronavirus.
But we must understand that there are a lot of Filatov, and a drop sharpens a stone, not like the brain of a politician. We know the results perfectly well: in Russia, anti-weed measures were lifted earlier and as a result came out much weaker than in Germany. Accordingly, the number of coronavirus victims per one hundred thousand people in our country is much, much higher than that of the Germans. Let 's continue with a quote from the same Filatov:
"Coronavirus infection will fall during this period [in the summer of 2020], and the entire period of its entry will end... more and more people with antibodies protected from this infection will appear among us. In the fall [of 2020], no one will remember this as the topic of the day… People will stop dying from this, because a weakly virulent pathogen is not able to trigger the mechanism of an inadequate immune response."
On February 4, 2021, Nikolai Filatov died of coronavirus, illustrating with a personal example whether he was right or wrong in his predictions.
But his case is still alive today: not only he and V. Vlasov have an impressive list of titles and regalia, but they do not understand well how the epidemic is developing, and which vaccine is better.
There are many other people giving fewer interviews, but more often advising the president and the government. And their judgments are often not much better than Vlasov's: "About the second vaccine ["EpiVacCorona"] ... I can assume that its creation and clinical research can go down a more or less decent path."
But what about the clinical effectiveness, the likelihood of getting sick, you ask? For example, it is difficult for the president to distinguish Vlasov and Filatov from people who are quite adequate – doctors of sciences, three hundred publications, and so on. But can he look at the figures of the effectiveness of the vaccine?
Alas, no. You can't control what you don't understand.
Take the example above: preprint of an article about 807 employees of Rospotrebnadzor, among whom two vaccinated died. We saw this as a disaster, and the people who gave information about this preprint in the media presented it quite differently:
"Among the employees of Rospotrebnadzor and its subordinate institutions, which were monitored, after vaccination with EpiVacCorona, 95.8% did not get sick after contact with coronavirus."
How do you read these words if you are a politician? That's right: you will perceive them as the same percentages of protection (91.4-97.6%) that the developers of Sputnik claim. You will think that these percentages reflect how much the vaccine has reduced your likelihood of getting sick.
Countries of the world by the number of those who consider it important to vaccinate children. It is easy to see that even before the coronavirus epidemic, Russia was in one of the worst places in the world in terms of vaccine literacy. It is impossible to solve this problem, because the moment of obtaining a high-quality school education by the majority of citizens has already been irrevocably missed. In such a situation, it is important to give as few reasons as possible to say "vaccines are ineffective." Alas, the state's proposal to inject "Epivaccorona" pours water precisely on the mill of anti-vaccinators / ©OurWorldInData.
Moreover, there is nothing in these words "for the press" that two out of 807 died of coronavirus, despite vaccinations.
Of course, if you have spent your time trying to understand the term "protection after vaccination", then you know that 95% protection is not when 95% of those vaccinated have not fallen ill. This is when there are 95% fewer cases among those vaccinated over a period of time X than among the unvaccinated (who received a placebo). And since there is no placebo group at all in the preprint for these 807 "vaccinated" sufferers, then 95.8% of the preprint is a simple fraud for the authorities and no more. An attempt to create "protection" figures in the absence of serious protection.
But you know this only if you have been delving into the topic for a long time and persistently. A politician cannot delve long and hard into all the topics that he formally manages. Because he has too many such topics. Life is not enough to understand everything.
All he can do is look at doctors of various sciences and frantically try to figure out which one of them (and they all have different opinions!) more adequate. It is inevitable that sooner or later a politician makes a mistake.
Yes, we can say, in the same way they are wrong not only with us. We can recall the serious mistake of French President Macron, who did not want to help Russia in deploying the production of Sputnik (despite the failure of efforts to develop its own vaccine and Moscow's offer to share the technology of Sputnik). You can also recall how the politicians of the West and Russia could not repeat the quarantine success of China. All this shows that it is not only local political leaders who make mistakes in such a situation. Only the fact that politicians make mistakes everywhere will not comfort the relatives of those who will die from their inability to separate true experts from false ones here in Russia.
If we honestly look at the prospects of the situation with the "Epivaccorona", we will understand that they are disappointing. Almost seven million residents of Russia will receive a vaccine this year, which, if it protects against covid death, is very weak. Many thousands of these people will die. Although their last breath is still many months away, there is a high probability that they will not be saved, because in modern society there is an extremely serious crisis of expertise.
There's just no one up there to stand up and say, "The King is naked." Because in the world of complex technologies, a politician simply cannot distinguish a naked vaccine king from one that is dressed in the latest fashion.
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