In my recent article in this column questioning if the COVID-19 vaccines work it transpires I was being too generous about them. I had not dug deeply enough into what the reported figures for effectiveness: 90%, 89%, 70% etc mean and thanks to an alert and knowledgeable reader, Mark Newman, I have now dug a bit deeper. The vaccine story is a lot less impressive than I first indicated. Even using the government’s own method of reporting vaccine effectiveness, recent reports in The Daily Sceptic (until recently Lockdown Sceptics Newsletter) indicate that the effectiveness of the COVID-19 vaccines is questionable and that they are much less effective than commonly believed, particularly in older people. In fact, we may deliberately have been misled from the outset.
When vaccine manufacturers report that they are effective, for example at 90%, they would like you to think that this reduces your risk of becoming infected by 90%. But this is not what it means. They are referring to what is called the relative risk ratio (RRR). This means that the effectiveness being referred to is a risk relative to others who have not received the vaccine. For example, if you take two groups with 100 people in each and the risk of the unvaccinated group becoming infected is 90 out of 100 and in the vaccinated group the risk is 10 out of 100 then the RRR is 90 minus 10 (80) divided by 90 and multiplied by 100 (to give a percentage) and that is equal to 89%. But this is not a very useful figure to quote as another example will show.
If you take another two groups with 100 people in each and the risk of the unvaccinated group becoming infected is 9 out of 100 and in the vaccinated group, the risk is 1 out of 100 then the RRR is 9 minus 1 (8) divided by 9 and multiplied by 100 (to give a percentage) then this is also equal to 89%. In both examples the apparent effectiveness is the same but in the first example the initial risk of becoming infected is 90% and in the second example the risk of becoming infected is only 10%. These figures are referred to as the absolute risk (AR). Therefore, in the first example the true benefit of taking the vaccine—the ability to prevent you from becoming infected—is 80% (90%-10%) whereas in the second example the true benefit of taking the vaccine is only 8% (9%-1%). This is called the absolute risk reduction (ARR) and, for any individual trying to decide whether to take a vaccine, this is the figure that should be considered. In other words, the benefit of any vaccine is related to the initial risk of becoming infected if you do not take it. When the risk is very low, the benefits will also be low. The RRR has its defenders as in a recent Reuters Fact Check where, in defence of its use the following was quoted: “Vaccine efficacy, expressed as the RRR means the vaccine will reduce the risk of infection by that reported percentage irrespective of the transmission setting.” But this is disingenuous. As explained above, it is not sensitive to the actual risk of infection.
What about the COVID vaccines? For the sake of illustration, the overall probability (not taking different age groups or risk groups into account) of becoming infected—based on the number who have been infected and died to date—is currently 8% and the risk of death is 0.19%. Therefore, the initial absolute risk of both is low. Moreover, it is eminently possible that the COVID-19 figures related both to infections and deaths are over-estimated. This is due to the phenomenon of false positive testing, confusion over the definitions of death ‘with’ COVID-19 as distinct from death ‘from’ COVID-19 and the procedures for death certification having been relaxed. So, what is the ARR of COVID-19 vaccines? Don’t take my word for it, this was published in The Lancet in April this year. I quote: ‘1·3% for the AstraZeneca–Oxford, 1·2% for the Moderna–NIH, 1·2% for the J&J, 0·93% for the Gamaleya, and 0·84% for the Pfizer–BioNTech vaccines.’ And remember, this is how much less likely you are to become infected it you take the vaccine than if you do not. This is not as impressive as the percentages for effectiveness usually quoted.
Using these figures, it is also possible to calculate the numbers needed to vaccinate which is the number of people who need to be vaccinated to prevent one person becoming infected. The respective figures from The Lancet article for the above vaccines are: ‘to prevent one more case of COVID-19…81 for the Moderna–NIH, 78 for the AstraZeneca–Oxford, 108 for the Gamaleya, 84 for the J&J, and 119 for the Pfizer–BioNTech vaccines.’ As with any measure of effectiveness of a vaccine, the numbers needed to vaccinate is not perfect. Like the absolute risk reduction, it depends on the initial risk of becoming infected and is also sensitive to the amount of data gathered. Therefore, it will probably change and possibly improve over time.
I hesitate to advise anyone over whether they should have a COVID-19 vaccine. It is unreasonable for everyone visiting a vaccination centre to be able to access the kind of information outlined above, or even to understand it. But there is no excuse for the UK government and the NHS not clarifying the facts about the initial level of risk to an individual and the likely benefit of the vaccine, both of which are low, and allowing them to weigh that up against the very high likelihood of unpleasant side effects and—however small—the risk of death.
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