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The Vaccine Thread


JennyD

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I listened to a press conference given by my state's health department on vaccination this afternoon and someone asked specifically about efficacy and J&J vs. other vaccines.   She made the point that J&J was tested against more of the ongoing variants and the earlier vaccines were not.   So they may not be as far apart as they look.  She also made the point that J&J is testing a 2 dose regimen as well, so those recipients may get better efficacy with a booster in the not distant future (and we all may getting boosters over time with variants, etc).  It's also an important option for certain demographics and locations as a one dose option.  She also said the J&J study had NO hospitalizations or deaths in their vaccine group at 28 days post vax.   She said she is much more optimistic about this vaccine than it is getting credit for right now.  

Some of their data is in their press release.

https://www.jnj.com/johnson-johnson-announces-single-shot-janssen-covid-19-vaccine-candidate-met-primary-endpoints-in-interim-analysis-of-its-phase-3-ensemble-trial

"The vaccine candidate was 85 percent effective in preventing severe disease across all regions studied,[i] 28 days after vaccination in all adults 18 years and older. Efficacy against severe disease increased over time with no cases in vaccinated participants reported after day 49.

The Janssen COVID-19 vaccine candidate demonstrated complete protection against COVID-related hospitalization and death, 28 days post-vaccination."

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29 minutes ago, wathe said:

 I think it's more likely that of those who got covid post vax, those who were vaccinated with J&J vaccine were 85% less likely to experience severe disease than those who were not vaccinated.  The absolute numbers and the methodology details will be really important to interpret the data properly.

I would assume that what it means is that when you compare the vaccinated and the unvaccinated populations, the ratio between people with severe disease in the groups was 15 to 100. So, there were almost 7 times as many people with severe disease in the unvaxxed group. 

At least, that's what those efficacy numbers have meant in general. That's what the 95% efficacy of the Pfizer/Moderna vaccine means, right? That the ratio of people with COVID symptoms in the groups is 5:100. 

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16 minutes ago, Not_a_Number said:

I would assume that what it means is that when you compare the vaccinated and the unvaccinated populations, the ratio between people with severe disease in the groups was 15 to 100. So, there were almost 7 times as many people with severe disease in the unvaxxed group. 

At least, that's what those efficacy numbers have meant in general. That's what the 95% efficacy of the Pfizer/Moderna vaccine means, right? That the ratio of people with COVID symptoms in the groups is 5:100. 

I think so. 

 

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7 minutes ago, Not_a_Number said:

I would assume that what it means is that when you compare the vaccinated and the unvaccinated populations, the ratio between people with severe disease in the groups was 15 to 100. So, there were almost 7 times as many people with severe disease in the unvaxxed group. 

At least, that's what those efficacy numbers have meant in general. That's what the 95% efficacy of the Pfizer/Moderna vaccine means, right? That the ratio of people with COVID symptoms in the groups is 5:100. 

Yeah, I'm sure you're right about that, I'm in the middle of making bread and I just totally miscalculated the hydration percentage, so I think the math part of my brain is not functioning this morning, lol. 

But even in those terms, the rate of covid symptoms would be 5:100 for Pfizer / Moderna versus some unknown number greater than 34:100 for J&J because their 66% efficacy does not count mild cases even if they test positive. So it could be 50:100 for testing positive, for all we know.

Is the 76% that Oxford/AZ just published for testing negative after the first dose 24:100 compared to the control group? 

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13 minutes ago, wathe said:

The primary endpoint for the Pfizer trial was number of cases of covid with onset at least 7 days after second dose.  There were 8 cases in the treatment group, and 162 cases in the placebo group.  8/162=0.043, or approx 5%.  Relative risk  5%, or relative risk reduction 95%.

The numbers would have been calculated to account for the slight difference in size in the placebo and treatment groups, but they were pretty darn close.

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So based on the numbers published so far, it seems like:

Pfizer = 92% efficacy 14 days after Dose 1, counting all symptomatic cases

Oxford/AZ = 76% efficacy 21 days after Dose 1, counting all positive tests

J&J = 66% efficacy 28 days after the only dose, counting only moderate to severe cases

If the other vaccine manufacturers decided to market their vaccine as a "1-dose" deal, they would all out-perform J&J. The 1-dose claim is J&J's only marketing advantage, but AZ also doesn't need special storage conditions, it's cheaper, and it's more effective, more quickly, after a single dose than J&J is. 

I also find it somewhat suspicious that J&J is the only manufacturer that excludes mild cases from their stats. All the others count any symptomatic cases, and the newest AZ figures count any positive test, not just symptomatic cases. That suggests to me that their efficacy rate would look even worse if we were really comparing apples to apples. 

I guess my concern is that the convenience of a supposedly "1-dose" vaccine will be considered "good enough for poor people," since at least they won't die, while those who are better off and have access to better health care will get the much more effective vaccines that seem more likely to prevent disease (and presumably spread). But poor people are the ones who can least afford to get sick — less likely to be able to miss work, less likely to have insurance, less likely to afford medical bills, less likely to have access to good care, more likely to live in multi-generational households that increase spread, etc. 

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7 hours ago, wathe said:

My local public health unit is quoting very reassuring numbers regarding efficacy after just the first dose of the Pfizer vaccine:

Up to 92% fourteen days after the first dose.

Based on data from England and Quebec.

They go on to argue that the 52% efficacy quoted in the original NEJM paper is too low, because they counted all cases of covid post first dose of vaccine starting immediately - so cases acquired within hours or days of vaccination were counted, even though it is not reasonable to expect that vaccine would provide protection so quickly.  Also, some of those early cases may have been acquired pre-vaccination, but not detected until post vaccination.

So that's some good news.

Wow, that is remarkable.

The preliminary data from Israel has found efficacy of around 50% two weeks after the first dose of the Pfizer vaccine, but much higher (92%) after the second dose.  

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51 minutes ago, Dmmetler said:

At current numbers of Pfizer and Moderna vaccines being given, it will take several YEARS to vaccinate everyone in my county. If I can get the J&J vaccine at 66%, say, 6 months before I could get the Pfizer or Moderna one, I'm taking it! 

Pfizer and Moderna are way ahead of J&J for production, though. We will have 200 million doses by March, then another 100 million of Pfizer by May and another 100 million of Moderna by June at the latest. OTOH, J&J have said they are running up to 2 months behind schedule, can only supply "single digit millions" by the end of February, and hope to have an unspecified "much large number" available by April. So that's enough Pfizer & Moderna to vaccinate 77% of the adult population of the US by June — which is a higher percentage than those who say they will take the vaccine. 

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2 hours ago, JennyD said:

Wow, that is remarkable.

The preliminary data from Israel has found efficacy of around 50% two weeks after the first dose of the Pfizer vaccine, but much higher (92%) after the second dose.  

You know, both England and Canada are dealing with supply issues, and have reasons for why they need to be able to justify a longer dosing interval.  Isreal doesn't (I don't think.)  I think it's reasonable to conclude that there is a certain amount of bias and possibly some spin.  It will be interesting to see how it all turns out over the long term.

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Pew has a nice roundup of different states' success thus far in deploying the vaccine.  The headline is that the states doing the best -- Alaska and West Virginia -- did not hop onto the CVS/Walgreen bandwagon, judging at the outset (before vaccine was even approved) that the chains' reach to their disbursed rural populations and that other distribution channels would be necessary. Alaska already had an extensive public community health network, and West Virginia apparently already had a network of independent pharmacies already paired to residential senior and nursing homes, so they built off those.  West Virginia also enlisted their National Guard from the outset (this was also in the NYT article Frances linked upthread).  Alaska also -- due to its particular challenges -- received a months' worth of vaccine deliveries, as opposed to a week's worth at a time as all the other states did; and Native American communities got their own allotments; and Alaska already had "snow-ready medical teams it could charge with vaccine distribution."

Another theme that cam out is that states that delegated allotments down to county- and town-levels have had more difficulty than those that managed more centrally (South Dakota: via just three regional health networks covering the state; Vermont: the state's alliance of hospital and health centers) have managed to do better.

Another perhaps counterintuitive finding is that states that simply opened up vaccination sites, no appointments necessary so long as folks are in the eligible category to receive it, unclogged the signup hiccups, such that other states are now looking to do polio-style events:

Quote

Now some populous states are taking a page from the successful states’ books and changing course, setting up more centralized systems, calling up the National Guard to help with distribution and revamping signup websites. Massachusetts Gov. Charlie Baker, a Republican, unveiled several steps last month to speed up the rollout, including plans to open a mass vaccination site at Fenway Park, home of the Boston Red Sox, at the beginning of this month.

Another success factor cited was states' decision to enlist their respective National Guards for deployment logistics

Quote

The third factor was an early reliance on the National Guard to set up clinics. Since reports of early successes emerged, more states have asked National Guard troops to set up field hospital-like vaccination centers or to help with distribution.

 

A problem that has emerged among states relying on hospital networks as vaccination sites is hospitals viewing vaccine allotments as "theirs," rather than as community resource:

Quote

Some hospitals in larger states, meanwhile, seemed to consider their vaccine allocations hospital property, and if they couldn’t find enough people who fit the criteria for early vaccinations, gave shots that would otherwise spoil to younger, nonmedical workers.

“I think more states added the National Guard to their planning and to their response once they saw that the vaccines they were sending to hospitals weren’t going like hotcakes,” Hannan said. “They had to think differently.”

and another problem has been that some administrating groups have "held back" vaccine to ensure second doses would be available, rather than depending on later deliveries. (CT was doing this until a few weeks ago.)

 

You can see how your state is doing on various deployment metrics on Bloomberg's tracker here (you can flip the map between measurements per capita, and % of vaccine doses that have been delivered).  At the rate of 1.3M doses a day of a 2-dose vaccine, it will take about a year to get to where we need to go... so deployment has to step up SUBSTANTIALLY.  J&J's single-dose would help a lot even if it is less optimal.

And you can check whether/how extensively your state is availing of the national CVS/Walgreen program by putting your state into the dropdown box here.  It's a funny mix of states that appear to have opted out  for at least the first phase -- some big, some small, some concentrated, some rural, some blue, some red.

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12 minutes ago, vonfirmath said:

This is what I'm afraid of slowing down the rollout. People will reject the newer vaccines for the "better" versions.

There is a significant difference. Why would I take chances with my health to get a vaccine that’s only 60% effective? If I were healthy and young, maybe, but my responsibility also lies to me as well. Unless they did 2 dose J&J and it had efficacy similar to Moderna, I will wait an extra 2-3 months. 
And my kid with severe allergies will wait for Novavax. I am not willing to take chances. 
 

Of course people will want what they perceive is better for them. 

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1 hour ago, kand said:

I felt the same initially (though I thought it likely my only choice would end up being JJ or AZ, but was bummed about that). I still would much prefer Moderna or Pfizer if I could get one, but at this point I will take one of the others if I can get it sooner. The data so far is showing no one in any of the vaccine groups hospitalized or dying. I’d rather get a shot sooner to keep me from hospitalization or death than wait a few more months and risk getting infected with no protection.

I’d dearly love to see us squash this virus by Fall and it seems the only chance of that is by getting as many people as possible vaccinated. Not to mention that the more it spreads in the meantime, the more chance there is of a mutation that evades the vaccines we have. 

I understand this.

But Given the commitments from Pfizer and Moderna on number of dosages, and potential Novavax in the pipeline, I think we can hold out for better than what J&J is offering. I will be sitting home until then. If I were working, maybe I would think differently. 

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How are you guys finding out which vaccine you will be getting ahead of time? Or will you go to get it and ask which one it is, and if it isn't the brand you want just leave?    I have my preferences as well but didn't know how to go about finding out which one is being given.

It must be said again,  I can't wait until my family and I can get vaccinated. 

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2 hours ago, Roadrunner said:

I would rather take one with 90%+ efficacy. 
 

For my highly allergic son, we will wait for Novavax.
 

I heard on the news this morning that the J and J vaccine was tested with the new strains of Covid?  The others were not?  

I would rather have one with higher efficacy, but from what this doctor was saying it not apples to apples.

 

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5 minutes ago, mommyoffive said:

I heard on the news this morning that the J and J vaccine was tested with the new strains of Covid?  The others were not?  

I would rather have one with higher efficacy, but from what this doctor was saying it not apples to apples.

 

I believe Moderna and Pfizer have said their vaccines perform nearly well against the UK variant, and somewhat less well with the SA variant, but J&J only showed 56% efficacy against the SA variant, and I doubt very much that Moderna and Pfizer will be even lower than that.

Edited by Corraleno
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4 minutes ago, mommyoffive said:

I heard on the news this morning that the J and J vaccine was tested with the new strains of Covid?  The others were not?  

I would rather have one with higher efficacy, but from what this doctor was saying it not apples to apples.

 

I am also hoping if they turn it into a two shot vaccine, they can increase efficacy. We shall see. 
 

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3 minutes ago, mommyoffive said:

I heard on the news this morning that the J and J vaccine was tested with the new strains of Covid?  The others were not?  

I would rather have one with higher efficacy, but from what this doctor was saying it not apples to apples.

 

I agree.  I've seen this from multiple scientists that they suspect the vaccines aren't as far apart as the numbers may seem based on the newer variants. It's nice Pfizer and Moderna "think" their vaccines will hold but we really don't know that or have data on it.  Moderna said it's looking at boosters already, so to me they see the writing on the wall.  Not to mention, J&J 2 dose is in study.  You may be able to turn around and get a booster for that within a few months anyway if that proves more affective.  I think we're just going to wait and see on the science and how it holds over time.  I'd prefer an mRna vax for a few reasons actually for myself but will probably take first available if the science holds.   I am wondering if J&J might end up a good choice for healthy younger people who especially aren't likely to follow through on a 2nd dose.  I do hope if it is approved they might make some general recommendations.  

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J&J's efficacy in the US alone, where the new variants were not widespread, was only 72%, so still significantly lower than Moderna & Pfizer. And keep in mind that J&J, unlike every other vaccine candidate, excluded "mild" cases from their stats, so if we were really comparing "apples to apples," based on symptomatic cases, the discrepancy between J&J and other vaccines would likely be even more stark.

Even Novavax was 95% against the original strain, and I think 86% against the UK strain. If J&J's 2-dose trial shows efficacy rates comparable to the other three, then I'd consider it, otherwise I'd rather wait an extra month or so for a better option. And unless Pfizer and/or Moderna run into significant production issues, they are on track to supply far more vaccines in the next 3-4 months than J&J anyway, so I imagine that anyone who is not in an area where storage conditions are a problem is more likely to be offered one of the mRNA vaccines anyway.

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Hey, I hope you're right and that 90+% holds for all variants.  It'll be easier to get other vaccines and people up to that level of immunity, J&J would probably  be more likely to get better efficacy with 2.  The US is doing an awful job monitoring for variants though, I have heard scientists that do think J&J went through a different period of testing than the earlier vaccines that are currently in circulation.  I think we just wait and see and keep watching the science.  

 

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19 hours ago, Ditto said:

How are you guys finding out which vaccine you will be getting ahead of time? Or will you go to get it and ask which one it is, and if it isn't the brand you want just leave?    I have my preferences as well but didn't know how to go about finding out which one is being given.

It must be said again,  I can't wait until my family and I can get vaccinated. 

My dad and brother knew they were getting Pfizer because at that point in deployment, that was what the local hospital hub was getting. They were, however, part of the early vaccine rollout, before Moderna and OxfordAstrazeneca had many doses in the distribution system.

At this point, asking the expected provider appears to be the best option, with the proviso that the vaccine they get may change and they may not be in a position to respond quickly due to being busy. I'd prefer OxfordAstrazeneca as it has no ingredients in common with this winter's flu vaccine (to which I had a hospitalisation-grade, although not overnight-grade or life-threatening, negative reaction), but the way the various vaccines have been performing, I'd happily take any of the ones my doctor gives me. Even J&J (which is not yet approved in the UK, but at 66% is high enough that it could be very soon) is 6 percentage points more effective than the flu vaccine, which may explain why vaccine hesitancy is fairly low where I live.

(I'd definitely want to know which vaccine I'd get if I am asked to go to a mass vaccination venue, simply because I don't want to publically collapse and accidentally put off an onlooker from getting their dose. If I'm to go to a doctor's practice to get it, I probably wouldn't bother asking in advance).

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I dreamed that I received my first vaccination.  It was such a nice dream. I  was so happy.

I'm lucky enough to be usually healthy, so I haven't received my invitation letter in real life. It shouldn't be too long until healthy over-fifties are asked in though.

Mass vaccination could blunt epidemic in U.K. in weeks. https://nyti.ms/3aJTfNo

Screenshot_20210207-090907_NYTimes.jpg

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Dr. Fauci Says Don't Do This After Your First COVID Shot (msn.com)

Fauci does not recommend delaying your second dose.

On Meet the Press on Jan. 31, Michael Osterholm, MD, an epidemiologist working with the White House COVID response team, suggested that prioritizing more first doses was the best way forward. However, Fauci said this week on the program that he didn't believe the science was clear enough to advise that course of action.

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1 minute ago, mommyoffive said:

Dr. Fauci Says Don't Do This After Your First COVID Shot (msn.com)

Fauci does not recommend delaying your second dose.

On Meet the Press on Jan. 31, Michael Osterholm, MD, an epidemiologist working with the White House COVID response team, suggested that prioritizing more first doses was the best way forward. However, Fauci said this week on the program that he didn't believe the science was clear enough to advise that course of action.

Osterholm and Fauci seem to be taking different positions on several things. osterholm was also the one saying he did not double mask and did not see the science being clear it would be useful.

 

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7 minutes ago, mommyoffive said:

Dr. Fauci Says Don't Do This After Your First COVID Shot (msn.com)

Fauci does not recommend delaying your second dose.

On Meet the Press on Jan. 31, Michael Osterholm, MD, an epidemiologist working with the White House COVID response team, suggested that prioritizing more first doses was the best way forward. However, Fauci said this week on the program that he didn't believe the science was clear enough to advise that course of action.

The data just don't exist yet to prove who will be right in the end.

Fauci is probably right that sticking to the fixed schedule is what's best for each individual, and that the evidence that the fixed schedule has high efficacy for each individual is very solid.

But Osterholm is also right, because modeling predicts that, during these times limited vaccine supply and high covid prevalence, partially vaccinating twice as many people will save more lives overall (especially over age 65).  And if the recent re-interpretation of the evidence suggesting that efficacy after a single dose is much higher than previously thought (89-92% vs 52%), then partial vaccination is probably the best choice from a public health perspective.  My jurisdiction moved from fixed to flexed based on this reasoning.

Take a (well reasoned, high probabiility of success, but not a sure thing) chance to save more lives, or stick with the known facts to save fewer lives.  That's the choice, I think.

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41 minutes ago, wathe said:

The data just don't exist yet to prove who will be right in the end.

Fauci is probably right that sticking to the fixed schedule is what's best for each individual, and that the evidence that the fixed schedule has high efficacy for each individual is very solid.

But Osterholm is also right, because modeling predicts that, during these times limited vaccine supply and high covid prevalence, partially vaccinating twice as many people will save more lives overall (especially over age 65).  And if the recent re-interpretation of the evidence suggesting that efficacy after a single dose is much higher than previously thought (89-92% vs 52%), then partial vaccination is probably the best choice from a public health perspective.  My jurisdiction moved from fixed to flexed based on this reasoning.

Take a (well reasoned, high probabiility of success, but not a sure thing) chance to save more lives, or stick with the known facts to save fewer lives.  That's the choice, I think.

Yes this seems to be exactly what the issue is! 
As far as double masking goes, I heard Dr Osterholm talking about that, and his point was that it might not be helpful if the filtration part of the mask is so thick that it increases leaks around the edge when you breath, so you would be breathing in a greater % of unfiltered air. Also may cause you to breath out more virus containing leaked air.

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Are most people actually given an option not to delay their second dose? My MIL received her first dose last week but they wouldn’t schedule her for the second for at least four weeks. She wasn’t given an option for two weeks and was told it would probably be closer to six.  

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45 minutes ago, Joker2 said:

Are most people actually given an option not to delay their second dose? My MIL received her first dose last week but they wouldn’t schedule her for the second for at least four weeks. She wasn’t given an option for two weeks and was told it would probably be closer to six.  

Two weeks isn't the recommended schedule. I believe it is three for Pfizer or four for Moderna.

 

Did she get the Moderna shot?

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21 days for Pfizer and 28 days for Moderna.  My jurisdiction is flexing up to 42 days.  They are also prioritizing longterm care residents for timely second shots, at the expense of HCW, who are getting flex scheduling (which, in terms of most lives saved, is sensible)

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https://www.nytimes.com/2021/02/08/health/immune-thrombocytopenia-covid-vaccine-blood.html#click=https://t.co/hrVVQYSvJe
 

A few people have developed a blood disorder after receiving the vaccine.  It doesn’t seem to be at higher than background rates.  Experts in the blood disorder do thing there’s a possible link as it has occurred after other vaccines as well. 
 

edited to add its worth reading the whole article rather than my summary - it is a very rare thing.

Edited by Ausmumof3
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3 hours ago, maize said:

Two weeks isn't the recommended schedule. I believe it is three for Pfizer or four for Moderna.

 

Did she get the Moderna shot?

Thanks! I don’t know why I thought it was two weeks between. 🤷‍♀️ She did get Moderna so is scheduled to come back in 4 weeks but they did tell her it is likely to change (hopefully with the news about trying to send directly to pharmacies that won’t happen).

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Good thread discussing new paper about immune response after immunization in people who were previously infected  Also reassuring about the South African/B1351 variant.

Article here about Israeli rollout. Apparently the pace of vaccination has suddenly dropped off as far fewer people want to get vaccinated.  The former head of the FDA has been saying for a while that we should expect the same phenomenon here, and much sooner than most people expect.  I can't even wrap my mind around this, but the vaccine drive in Israel really slowed down in a big way after they got through the older groups.  I think the UK is still vaccinating quickly but they are at about 18% for at at least one dose; Israel is 39% and US is a little below 10%.

 

 

Edited by JennyD
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