Alasdair Munro

Instructive thread by Alasdair explaining difference in covid vaccination policy in UK & EU vs US and the difference to flu vaccination. Refreshing to see nuance and the need for thinking in trade-offs which is a necessary element for building a sustainable and efficient public health policy.

This means an updated RCT for covid would be generalisable for future seasons

A flu RCT would not be very generalisable

Hence, a new RCT for covid vaccines in the modern immunity landscape is not an unreasonable suggestion (although personally I don’t feel is necessary)

Nothing disingenuous here

This is different to flu, where trials were conducted on a background of population immunity comparable to today

Also, there is large inter-seasonal variation in flu vaccine efficacy due to strain matching

There are much smaller, marginal differences for covid per vaccine/variant

You’ve missed the point

Not every seasonal vaccine requires an RCT (I don’t believe anyone is suggesting that currently)

The scenario for covid vaccines is unique as they were trialled on a background of ~zero population immunity

There is now substantial population immunity

They may reduce deaths to some extent, but current studies are observational and almost certainly heavily biased. That is why we don't license medicines on observational studies.

Whether the effect size in the current immunity landscape continues to justify use, and it what groups, is the question

More expensive if you spend $millions on therapies which don't significantly reduce them

I'm not personally convinced studies are needed, but I think there is absolutely room for valid disagreement

Congratulations, and, condolences 🙂

Indeed, and I think this is a space where there is room for legitimate disagreement

I do not think it is wholly unreasonable to suggest that, in the modern immunity landscape for Covid, an unbiased assessment of the relative benefits of vaccination is warranted to see if it justifies the costs

Yes, but the ratio of older people vs younger with comorbidities who received the vaccine was almost 9:1, making this overwhelmingly older people for whom no serious safety concerns exist

This is almost exclusively adults aged 65y and older, which is not the category for which safety concerns exist

The UK’s flagship health research programme promises breakthroughs, but beneath an NHS branded facade, critics are asking who really benefits from this vast database, heavily backed by industry and government.

@mgtmccartney.bsky.social and I investigate

www.bmj.com/content/390/...

I have seen data on this, and it doesn't seem to

Very unhelpfully, I cannot remember the source of the data, so this response is useless

However, it probably *shouldn't* reduce transmission much, as infants do not really mix apart from the people most likely to be their own source of infection

So long as the research is cheap, it is ethical even if it is wrong!

Then doing a TTE, then wondering whether it might be biased, so having to do an RCT anyway to validate the findings of the TTE, before celebrating that the TTE got it right, hooray!

I assume you simply hacked your old, non-windows 11 compatible laptop to force it to install windows 11?

Two Pandemics, Compared: Reflections on HIV and COVID-19 “Dr. Sax, what’s it like to have lived through two pandemics as an ID doctor?” The question came from a brand-new intern during afternoon sign-out. I took a breath — because wow, were they different. ...

"What’s it like to have lived through both HIV and COVID as an ID doctor?"

A new intern asked me that last week.

I didn’t answer it fully then -- but I did here. #IDSky blogs.jwatch.org/hiv-id-obser...

Had my first attempt today at teaching junior researchers about statistical tests with the, “everything is just a linear model” approach

Was an interesting session and am intrigued (and a bit scared) to receive the feedback…

Unfortunately the only way to discover errors in your data (or manuscript) is to gives files names like this

Pregnant woman wearing a purple vest and yellow cardigan, resting her hands on her belly. Text on the image says 'We're seeing a big increase in numbers of pregnant women getting vaccinated against whooping cough'

Our latest data shows an increase in the number of pregnant women getting vaccinated against #WhoopingCough.

Vaccination rates in England climbed from 59% in May 2024 to nearly 73% in March this year.

Find out more: www.gov.uk/government/n...

#EpiSki #MedSky

RFK Jr. says US won’t donate to global vaccine effort Kennedy ripped into Gavi, the Vaccine Alliance, in a video address at its pledging summit.

This is a travesty & a nightmare. The US was a founder of @gavi.org. It lowers global vaccine costs, has vaccinated 1B children, & averted 19M deaths. This pull out will cost 100s of thousands of children's lives a year - and RFK Jr will be personally responsible.
www.politico.com/news/2025/06...

Now acute flaccid myelitis (AFM) and EV-D68

Since the pandemic, epidemic spikes in EV-D68 with respiratory cases seems to have been decoupled from cases of AFM - but why…?!

Finally made it to IIC Oxford (stupid trains)

Managed to catch the end of John Carapetis talking about Group A Strep - and the exciting prospect of vaccines!

Why has it not happened yet? Likely to get GBS vaccines before GAS...

Fear over the MANY possible immune sequelae probably a factor

Looking forward to being in Oxford for the next few days at the Hot Topics in Infection and Immunity in Children course

Speaking about the SNAP trial with Anna Goodman on Tuesday

Might be at a loose end tomorrow evening if anyone fancies a Nando’s…

Why the Sudden Firing of ACIP Members Should Put Every Clinician on High Alert There are certain irrefutable verities when, like me, you’re an infectious diseases specialist married to a pediatrician. Here are our top two, which are deeply interrelated: Infectious deaths in chil...

The head of HHS said he’d preserve ACIP. Then he fired the entire committee.

Now a new panel -- with mostly unclear expertise in clinical trials, vaccines, and ID -- is in place. Time for high alert for changes that could seriously affect public health. #IDSky blogs.jwatch.org/hiv-id-obser...

Do you have a source for this Marc?

Exactly

Randomisation in trials makes no claims to balance anything - only to distribute them at random, causing predictable (in the sense of the philosophy of your choice) random distributions in difference

Oh dear

Poor H Elphick

Hahaha absolutely not

Rattles or rales, yes

Ruttles? Someone has never told them they’re saying it wrong

2.06 Heart Failure, Choosing a Specialty, & the Bayesian Approach with Dr. Frank Harrell We're back with more questions of the week! Our first question, from Ian Straehley, is inspired by the USMLE Step 2 CK; our second question, from Audrey Tran, is on deciding on a medical specialty. We

He was a big influence on me getting into clinical trials and methodology pre-covid through his oncology commentary on the plenary session podcast

His interview with Frank Harrel is the best hour on Bayes I've ever heard

soundcloud.com/plenarysessi...