Is the vaccine still working?

Back in November, I wrote

The Covid vaccine is safe and effective and it’s good that most eligible people are getting it. But how much protection does it give? If you look at the NZ statistics on who gets Covid, it seems to be extraordinarily effective: the chance of ending up with (diagnosed) Covid for an unvaccinated person is about 20 times higher than for a vaccinated person.

That’s probably an overestimate.

The issue was that during the Auckland Delta outbreak, unvaccinated people were probably more likely to be exposed to Covid than vaccinated people, and this was exaggerating the (real, but smaller) benefit of the vaccine.

Things have changed. The case diagnoses for vaccinated and unvaccinated people are about equal as a proportion of the population.  Partly this is because the vaccine is less effective against infection with Omicron, but now I think the social factors may well be leading to an underestimate of the vaccine benefit.  The point of the traffic-light system was to reduce virus exposure for unvaccinated people, both so they would be less likely to pass the virus on and so they’d be less likely to end up in hospital.  Reports in the news about unvaccinated people and about businesses that don’t like the system suggest that it does at least reduce the presence of unvaccinated adults in crowded indoor public settings.  You could reasonably expect, then, that unvaccinated adults are less exposed than vaccinated adults and that their equal case rate shows the vaccine is working.

In the absence of any other information it would be hard to decide how much to believe this explanation, but we do have other information. Other countries, with more cases and more data, have better estimates of the benefit of the vaccine than you can get from the published NZ data.  The vaccine does reduce infections with Omicron.  It doesn’t work as well as it did against Delta, and the benefit falls off more rapidly with time, but there is a benefit.   From the overseas data we’d expect the vaccine to working in New Zealand too, and the data we have are consistent with that expectation.

Even if we weren’t preventing cases of Omicron, there are at least two arguments for continuing to have vaccine rules. First, Delta is not actually gone — it’s still 5-7% of sequenced cases in MIQ and the community. It’s a small *fraction* of the outbreak, but the numbers haven’t gone down much. Second,  hospitalisation matters. As you may remember, we had hospitals even before Covid.  They’re important for treating everything from cancer to car crashes.  Keeping them available for non-Covid uses has always been a key motivation of the Covid strategy.

The numbers don’t decide anything; whether to change the rules is a policy question. But the inputs to policy should be the best estimates we can get of vaccine effectiveness, not the crude case counts.