The Cost-effectiveness of Vaccinating Pregnant or Lactating Women against SARS-CoV-2 - Part 2

The JCVI evidence

According to the Conversation piece and JCVI document, the decision to no longer offer COVID vaccines to pregnant women is based on a recent cost-effectiveness  preprint:

The authors are affiliated with the Universities of Warwick, Liverpool, Oxford, and the UK Health Security Agency. Oddly, the JCVI text also refers to a “DHSC model,” which is not referenced.

Although the authors looked at the efficiency of Covid vaccines in all adult age groups (split into 16 five-year bands from 15 to 90 years and over), let’s focus on the issue of pregnant women.

That’s a bit difficult, folks, because they are mentioned only once in the evaluation, in Method 2 (the authors used five different economic methods to build their models).

A closer look at the five methods reveals that they are all based on assumptions or “bespoke health economic parameters”.

However, the two old geezers must confess that they are unclear about the different assumptions on which the methods and, hence, the models are based. 

The “bespoke” variables are even less clear. The sentence at the end of the study (page 22) makes it absolutely clear we can all bug off if we want to see the data: “The raw study data are protected and are not available due to data privacy laws”. So this is a rerun of Dr Jenny Harries's secret squirrel refusal to release death data to Parliament based on the number of vaccine doses, citing "commercial confidentiality."

If assumptions are made, these should be listed in the paper under each method. Do you agree?

The detail that surprises us is that the “cases”, “hospitalisations”, “ICU admissions”, and “deaths” are all critical outcomes attributed to SARS-CoV-2, but they are not clearly defined.

For example, what is meant by case, hospitalisation and which of the 14 definitions of deaths used in the UK are the authors using? Or is it all of them?

https://open.substack.com/pub/trusttheevidence/p/the-uk-covid-official-narrative?r=1lcx51&utm_campaign=post&utm_medium=web

We think that the answers and the rationale for the whole exercise are actually explained very well and very honestly in the abstract:

Here’s our translation: There is no point in conducting an economic evaluation of decisions already made (we purchased over 400 million doses and needed to roll them out). In this instance, a financial model wouldn’t have changed anything; it was a political decision- nothing to do with evidence. When decisions were made and the contracts were signed, the vaccines didn’t even exist. Yes, we agree. Hancock rules, OK.

However, now that the stocks of pre-paid vaccines are running low and the country is bankrupt to the point of freezing pensioners to death, we have to start rationing - a politically incorrect term that sends chills down a politician's spine. Let’s not go there. 

Well, that’s OK, too; as we explained in the first post of this short series, resources are finite.

So what?

We will reserve judgment on the paper, the methods, the models and so on until we are clearer on the assumptions used in the five methods. However, this is the conclusion the JCVI drew from the models:

When we were in medical school, we were taught that pregnancy is not a deadly disease; it is a physiological state in a woman's lifespan —that is, if doctors can stop interfering. 

We were also taught that drugs should only ever be prescribed in pregnancy if the evidence shows that the expected benefit (to the mother) is greater than the potential risk (to the foetus). A risk-benefit assessment should also be taken out on an individual patient basis, and the consenting clinician should ensure the most up-to-date evidence is used to ensure the safe and effective use of medicines and vaccines. 

So we agree with the JCVI, which thinks it’s not a state of heightened risk for either mum or baby. 

But where are the data for pregnant women in the economic evaluation? Apparently, 007 has them.

Please review the five models the authors propose, and you can help us understand the assumptions. Meanwhile, we hope they will be listed and defined on the journey from preprint to published paper. If not, this study will be one more piece of garbage infesting the airwaves.

Now that we are done with this (for now), we will examine why the Conversation piece's authors did not like the JCVI’s conclusions.

Two old geezers wrote this post with no secret squirrels in their gardens who prefer sunlight to darkness.