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So far 17 million people in the UK have received the Astra Zeneca vaccine.  35 cases of blood clots, 15 of pulmonary embolism and 22 of deep vein thrombosis have been reported across the UK and EU. In a normal year more than this number of cases of blood clots are seen say experts. These occur naturally in the population, including elderly population. Astra Zeneca's chief medical officer, Ann Taylor, says the number of blood clots in the 17 million people who have received the vaccine across Europe is actually lower than would be expected in the general population. The EU countries of Germany, France, Netherlands and Italy have temporarily stopped using it after 3 healthcare workers in Norway had blood clots. In Germany 7 out of 1.6 million had a rare condition of cerebral sinus thrombosis. Both EU and medical regulators say that there is no evidence that these blood clots are caused by the vaccine. The number of clots are similar to what was seen in the population before the coronavirus. Also this report in The Times says taken together there is no difference between the number of clots in the population that received the Pfizer vaccine or the Astra Zeneca vaccine.  The Daily Telegraph reports that one in 1000 people have blood clots every year, so that for 17 million people in vaccinated population with the Astra Zeneca vaccine there would be 17000 cases of blood clots over 12 months. During the clinical trials Astra Zeneca reported there were fewer people with blood clots who had been vaccinated than in the people who were not vaccinated. ...

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How is it that Britain's regulatory agency approved the Pfizer vaccine before the U.S. FDA agency? This report in the NYT says FDA looks at the raw data. Britain's Medicine and Healthcare Products Regulatory Agency looks at the information provided by the company. It still does the testing batch by batch and has access to the data and looks at thousands of pages of data. What about the European Union? The European Union Medicines Agency meets on December 29. It takes days after it meets to get input of 27 countries so that vaccination cannot start till January. The U.S. president summoned the FDA to the White House to find out how soon the FDA could act. Both Britain and the U.S. are feeling the impact of the second wave of coronavirus.

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Jonathan Rockoff interviews Pfizer CEO, Ian Read. Read says Pfizer will make up for the loss of patent protection on Lipitor sales of $10.7 billion. He plans to cut Pfizer's $8.1 billion research budget to $6.5 billion. Pfizer sold one unit that makes drugs in capsule form for $2.4 billion. He looks to growth in Lyrica for fibromyalgia, and Prevnar for pneumococcal vaccine. And sees growth in China and emerging markets. Even with government ordered price reductions in China, increase in volume sales make up for the price reductions. Asked about the closing of the Pfizer labs in Sandwich, England, Read says the competitors were ahead of Pfizer in areas of research at Sandwich such as allergy, respiratory and urology. Pfizer will move scientists from Groton, Connecticut, to Cambridge, Mass, to bring scientists together in hubs of innovation such as La Jolla, Boston, and Cambridge, England. In the old days Groton served as a location because it was near a river, fermentation was needed and water access had to be provided. Read says Pfizer will focus on the core- neuroscience, cardiovascular medicine, oncology, inflammation, immunology and vaccines, specialized units for pain, sensory disorders and biosimiliars- and make sure this is producing results....

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European Union countries reopen for travel this summer. A new travel pass or digital Covid certificate is approved to promote freedom of travel as more people get vaccinated. About a third of people are vaccinated for first shot in France and about 40% in Germany, which means in coming weeks they will have the second shot and enough antibodies to make a return to normal life possible. The EU has negotiated this time with Pfizer for 1.8 billion doses and is building enough vaccine supplies. For the first time governments are stepping up with plans and resources allocated - in India the government now has plans to create supplies of 2 billion doses by the end of the year. This means there is new hope if the vaccination is accompanied by efforts to build booster shot supplies this time planning ahead. Managing the risk of those who are vaccine skeptical remains a problem to be tackled. Masks and other essential precautions also need to be followed in crowded spaces as this was neglected where there was a second or third wave. Public education for this is essential to better manage the pandemic. ...

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Israel remains a laboratory for the rest of the world in tackling coronavirus. During the beginning of 2021 Israel was the first country to push ahead with Pfizer vaccines for the over 18 population in a country of 10 million people. As winter approaches Israel has given a third booster shot to 50% of the population and is able to conduct normal life with a green pass system and the use of masks indoors. Each time a major surge has been prevented. The green pass in Israel is now for people who have had a third shot or booster shot. By thinking one step ahead, making decisions rapidly, and coordinating action early between the government and other organizations to vaccinate everyone, Israel provides lessons for the rest of the world. Not that there are no unvaccinated -about 700,000 people do not believe in vaccination and are unvaccinated. They are a vocal group but only about 8% of the population, and the vast majority of Israelis are in favor of vaccination and the green pass system. ...

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Melina Grundmann is the author of this video about Turkish life in Germany. What is it like for three generations of Turkish immigrants, 3.8 million Turkish people today after the first arrivals under a guest workers program in the 1960's. The guest workers program brought Turkish workers to Germany at a time of high unemployment in Germany and shortages of workers in German factories. One such factory was the Ford factory in Cologne which soon became a center for Turkish immigrants. It is useful to look at Turkish immigrants in Cologne and other German cities as one of the two researchers who researched and developed the Pfizer mRNA vaccine is a woman scientist whose father was a guest worker at the Ford factory in Cologne. Turkish people face an identity crisis as they work to fit into German society. Yet their contributions have made Germany prosperous. Some say even less boring as Turkish people are passionate and Turkish food is accepted in Germany. ...

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The Moderna vaccine can be more easily shipped and handled than the Pfizer vaccine making it easier to use at smaller hospitals and in rural areas. Moderna would add 20 million doses in December to that of Pfizer's 25 million doses for the U.S. Moderna vaccine is developed in Cambridge Massachusetts Labs and is manufactured in the U.S. and Switzerland.  Moderna vaccine can be stored in freezers does not require ultra low temperatures as Pfizer vaccine. Once thawed it can be stay refrigerated for 30 days compared to 5 days for Pfizer vaccine. Moderna ships in containers of 100 vaccine doses or larger, Pfizer minimum container size is for 975 doses. Both Pfizer and Moderna vaccines are in th 94-95% effectiveness range. Moderna can be injected as is, Pfizer's requires to be diluted in a separate solution. On Dec. 11 the U.S. ito double its purchase of Moderna vaccine to 200 million doses by end of June, Pfizer 's is still at 100 million doses. Moderna may get its approval from FDA in U.S. by Dec. 18. Both Moderna and Pfizer would require a second dose in 3 weeks, both use the same MrnA technology. J&J is developing a vaccine that requires only one dose. J&J finishes its trials in January and expects approval in February.  ...

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Dr. Ezekiel Emmanuel of the University of Pennsylvania gives this early warning on the risks of the sudden U turn in China's zero covid policy to complete reopening. He says the switch from zero covid to population wide immunity via viral spread is coming on too suddenly without preparation. He says China made three mistakes. First, the economic cost of zero covid that dropped growth and created high youth unemployment of over 20%. Second, not procuring Pfizer and Moderna mRNA vaccines with newer technologies. Third, moving to abruptly end the zero covid policy 180 degrees in a sudden move that lacks preparation. Precipitiously ending the zero covid policy for 800 million people means rapid spread says Dr. Emmanuel. He says the key variable the R statistic that measures how many people get infected from one covid patient on average, has moved from 2 to 3 during the early stages of the pandemic to 10 with the omicron variant. Chinese officials report the R to be at 16 in China today, says Dr. Emmanuel. ...

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The Ministry of Commerce in China conducts anti-monopoly reviews and sets rules for which divestments need to occur in merger arrangements. In the Pfizer merger with Wyeth, the Ministry required Pfizer to sell a Chinese swine vaccine business to Harbin Pharmaceutical Group.. The concern- Pfizer could control 50% of the swine vaccine business in China with some 500 million pigs. Five other merger and acquisition transactions have come under review. Coca-Cola's $2.4 billon acquisition for a Chinese juice maker is stalled. Novartis and Eli Lilly showed interest but the Ministry of Commerce preferred to steer things to a Chinese player. In future it is expected that rules will favor up and comig local companies over large foreign companies.

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Speaking for the Biden administration Anthony Blinken says that "on the current trajectory, if we don't do more, if the entire world doesn't do more, the entire world won't be vaccinated until 2024." What is needed he said is to "speed this up, and get that done, I think, in a much shorter time." Experts say the immediate impact of the Biden decision to give waivers on transfer of patents technologies is to get drug companies to cooperate with each other and for them to voluntarily join in the manufacture of vaccines globally. This would be done through global manufacturing alliances in major pharmaceutical manufacturing nations such as France, India and other countries that can quickly ramp up manufacturing if they have access to the technologies involved and the knowhow itself. The Biden decision is then the first of many decisions that would lead to voluntary action by pharmaceutical companies cooperating say Novartis and Sanofi in France and Switzerland with a Pfizer or Moderna in increasing manufacturing capacity or a Serum Institute or Reddy Labs in India working with Pfizer and Moderna or Novavax. These companies already have the basic structures to ramp up. This would take months yet the process has to start immediately. Today many companies such as Glaxo Smith Kline in UK and US are in a position to get involved in manufacturing but need access to the technologies and knowhow. Leadership by the US plays a huge part in making that happen.  ...

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Israel's vaccination drive shows the effectiveness of vaccination in controlling the pandemic. It also shows the vaccination using Pfizer vaccines achieving the trial results of 94% effectiveness in actual results with the Israeli population. Israeli experts in Tel Aviv and other places say vaccination is the best way to control the pandemic and encourage countries to move quickly with vaccination drives.

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Merck's decision to organize R&D using four innovation hubs in Boston, San Francisco, London and Shanghai. Merck currently lacks a large R&D presence in London and it has commercial operations in Shanghai. Experts say innovation centers enable drug companies to take advantage of academic research at an early stage. Pfizer and other companies are also pursuing a similiar strategy. The new head of R&D at Merck, Dr, Perlmutter plans to shrink staff and focus on promising areas such as immunoterapies for treating cancer and vaccines. Perlmutter comes from Amgen and is bringing people who he worked with at Amgen. The focus is also shifting to tapping the new science behind dieseases.

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Thre drug companies are placing bets on the vaccine business. Johnson and Johnson paid 302 million euros for 18% of Dutch biotech company Crucell NV, to jointly develop vaccines. Abbott Labs says it will acquire a unit of Belgian conglomerate Solvay SA for 4.5 billion euros in adeal that includes a vaccine business. And Merck obtained the marketing rights for a seasonal flu vaccine from Australia's CSL Ltd. This follows Pfizer's Wyeth acquisition. Low prices, high costs and fear of lawsuits made most drug makers to exit the business in the 1980's and 1990's. Now vaccine sales are growing faster than other prescription drugs and are largely protected from generic competition. And government agencies here in the USA and around the world are reliable buyers of vaccines as they seek to stockpile medicines that could be needed in aflu outbreak. Merck never exit the vaccine business and now makes 8 of 10 vaccines recommended for adults. Flu and other vaccines are especially attractive for entering drug markets in Brazil and China and developing countries. Governments lke the idea of lowcost prevention at $10 adose, and with this new relationships are developed in these countries. And even at price of $10 or $20 a dose they provide asteady stream of revenue.Vaccines are estimated to generate $21.5 billion in revenues by 2012 according to Sanofi-Aventis SA, which is a leading vaccine maker....

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Israel vaccination drive has now reached 2 million people for the first dose and 400,000 for the second dose. What do early results show? As the effectiveness is only 52% after the first dose, according to Pfizer for its vaccine, vaccination drive is only one part of the solution. The number of cases in Israel are high at 10,000 a day. There is concern about the ultra-Orthodox community following the protocols and rules for prevention. Ben Gurion International Airport may be restricted to only essential flights. A mutation variant of the coronavirus, a UK detected variant, is seen as making up about 30% of the cases and could make up the bulk of cases in the future. Lessons being learned are that Pfizer vaccine is effective at about 52% for the first dose. Only after the second dose are enough antibodies triggered to resist the virus effectively. This can be as much as 6 to 12 times the increase in antibodies for second dose, compared to what happens after the first dose says the Sheba Medical Centre at Tel Hashomer, Israel.   ...

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Johnson & Johnson begins a 60,000 person clinical trial on 3 continents in the final stage of testing. It could learn vital results in early next year which if positive would lead to government authorization for emergency use soon after. J&J will test whether a single dose of vaccine will work. It is also doing work separately with the UK government for a separate phase three study to test whether a 2 dose vaccine will work.

Other companies in final stage of testing are Moderna and Pfizer with studies results expected in October and Astra Zeneca working with Oxford expecting results by the end of 2020.

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In a factory the size of 5 football fields located in Gurnee, Illinois, Abbott Labs makes its BinaxNow Covid-19 home tests. Abbott turned out 1 billion tests in 2021 and at one point had 80% of the market. Along with Pfizer vaccine, BinaxNow Home covid-19 tests are a dominant product during the pandemic. Abbott generated a fifth of its $43 billion in revenue from these home tests. Abbott faced several hurdles along the way. It gained when the US government authorized it to make the test. Yet after vaccination took off by mid 2021 the demand for tests declined and Abbott nearly idled its giant factory in Gurnee. Delta and Omicron variants led to a sudden reversal and surge in demand. Abbott developed its test based on an existing design it used in the US for flu tests, by a company it inherited by acquisition called Binax. To do that test one sends a swab up the nose, add that sample and a liquid mixture to a rectangular paper card, and close the card shut. The liquid then travels up the paper strip, revealing one or two pink lines, one for negative, two for positive. This is done in 15 minutes and the simple design described as a lollipop shape, put Abbott far ahead of competitors. The US FDA authorized Becton Dickinson and Quidel to make the tests before it authorized Abbott, but these rival companies had a poor and complex design. The Trump administration gave Abbott a $760 million contract to buy 150 million tests for distribution to health departments, long termcare facilities, nursing homes, and schools. And by October 2020 Abbott was already making 50 million tests a month. When it comes to distribution Abbott tapped into its pharmacy connections for baby products such as Similac baby formula. This gave it an advantage over Quidel and others who also lacked the manufacturing knowhow for large scale ramp up. The BinaxNow in pharmacies was sold at $24 for a box of two tests, while government paid $5 for one test. Abbott says it makes $ 7 per single consumer test. Yet there was one problem waiting to hit Abbott in 2021- demand dried up as the vaccination campaign took off. In fact the plant manager, Mr. Rodriguez, planned to move to another job inside Abbott as production declined. Then came the Delta variant and he was asked to ramp up production again. With Omicron demand soared. The Biden administration committed $3 billion to help boost test production and asked Kroger and Walmart to sell over the counter tests at cost for 3 months. Abbott had to lure workers from Amazon at $25 an hour for the Gurnee plant expansion. What was learned by the government and Abbott from this experience? The US government now looks for ideas in meeting demand volatility, supply challenges and production needs,. Sustaining production capacity is important for future virus flareups- a new government-industry partnership is required for maintaining test making infrastructure. With government help Abbott plans now to keep the facility at Gurnee operating indefinitely. ...